다중혈관 관상동맥 환자에서 y-문합을 이용하여 양쪽 내흉동맥만을 사용한 우회술의 조기 성적

抗原变异可使得多种致病微生物易于逃避宿主免疫应答。表达在感染红细胞表面的恶性疟原虫红细胞表面蛋白1（PfPMP1）与感染红细胞、内皮细胞、树突状细胞以及胎盘的单个或多个受体作用，在黏附及免疫逃避中起关键的作用。每个单倍体基因组var基因家族编码约60种成员，通过启动转录不同的var基因变异体为抗原变异提供了分子基础。

疟原虫var基因转换速率变化导致抗原变异[英]／Paul H, Robert P, Christodoulou Z, et al//Proc Natl Acad Sci U S A

ABCD
: Appropriate Blood pressure Control in Diabetes
ABI
: ankle–brachial index
ABPM
: ambulatory blood pressure monitoring
ACCESS
: Acute Candesartan Cilexetil Therapy in Stroke Survival
ACCOMPLISH
: Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension
ACCORD
: Action to Control Cardiovascular Risk in Diabetes
ACE
: angiotensin-converting enzyme
ACTIVE I
: Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events
ADVANCE
: Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation
AHEAD
: Action for HEAlth in Diabetes
ALLHAT
: Antihypertensive and Lipid-Lowering Treatment to Prevent Heart ATtack
ALTITUDE
: ALiskiren Trial In Type 2 Diabetes Using Cardio-renal Endpoints
ANTIPAF
: ANgioTensin II Antagonist In Paroxysmal Atrial Fibrillation
APOLLO
: A Randomized Controlled Trial of Aliskiren in the Prevention of Major Cardiovascular Events in Elderly People
ARB
: angiotensin receptor blocker
ARIC
: Atherosclerosis Risk In Communities
ARR
: aldosterone renin ratio
ASCOT
: Anglo-Scandinavian Cardiac Outcomes Trial
ASCOT-LLA
: Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm
ASTRAL
: Angioplasty and STenting for Renal Artery Lesions
A-V
: atrioventricular
BB
: beta-blocker
BMI
: body mass index
BP
: blood pressure
BSA
: body surface area
CA
: calcium antagonist
CABG
: coronary artery bypass graft
CAPPP
: CAPtopril Prevention Project
CAPRAF
: CAndesartan in the Prevention of Relapsing Atrial Fibrillation
CHD
: coronary heart disease
CHHIPS
: Controlling Hypertension and Hypertension Immediately Post-Stroke
CKD
: chronic kidney disease
CKD-EPI
: Chronic Kidney Disease—EPIdemiology collaboration
CONVINCE
: Controlled ONset Verapamil INvestigation of CV Endpoints
CT
: computed tomography
CV
: cardiovascular
CVD
: cardiovascular disease
D
: diuretic
DASH
: Dietary Approaches to Stop Hypertension
DBP
: diastolic blood pressure
DCCT
: Diabetes Control and Complications Study
DIRECT
: DIabetic REtinopathy Candesartan Trials
DM
: diabetes mellitus
DPP-4
: dipeptidyl peptidase 4
EAS
: European Atherosclerosis Society
EASD
: European Association for the Study of Diabetes
ECG
: electrocardiogram
EF
: ejection fraction
eGFR
: estimated glomerular filtration rate
ELSA
: European Lacidipine Study on Atherosclerosis
ESC
: European Society of Cardiology
ESH
: European Society of Hypertension
ESRD
: end-stage renal disease
EXPLOR
: Amlodipine–Valsartan Combination Decreases Central Systolic Blood Pressure more Effectively than the Amlodipine–Atenolol Combination
FDA
: U.S. Food and Drug Administration
FEVER
: Felodipine EVent Reduction study
GISSI-AF
: Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Atrial Fibrillation
HbA1c
: glycated haemoglobin
HBPM
: home blood pressure monitoring
HOPE
: Heart Outcomes Prevention Evaluation
HOT
: Hypertension Optimal Treatment
HRT
: hormone replacement therapy
HT
: hypertension
HYVET
: HYpertension in the Very Elderly Trial
IMT
: intima-media thickness
I-PRESERVE
: Irbesartan in Heart Failure with Preserved Systolic Function
INTERHEART
: Effect of Potentially Modifiable Risk Factors associated with Myocardial Infarction in 52 Countries
INVEST
: INternational VErapamil SR/T Trandolapril
ISH
: Isolated systolic hypertension
JNC
: Joint National Committee
JUPITER
: Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin
LAVi
: left atrial volume index
LIFE
: Losartan Intervention For Endpoint Reduction in Hypertensives
LV
: left ventricle/left ventricular
LVH
: left ventricular hypertrophy
LVM
: left ventricular mass
MDRD
: Modification of Diet in Renal Disease
MRFIT
: Multiple Risk Factor Intervention Trial
MRI
: magnetic resonance imaging
NORDIL
: The Nordic Diltiazem Intervention study
OC
: oral contraceptive
OD
: organ damage
ONTARGET
: ONgoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial
PAD
: peripheral artery disease
PATHS
: Prevention And Treatment of Hypertension Study
PCI
: percutaneous coronary intervention
PPAR
: peroxisome proliferator-activated receptor
PREVEND
: Prevention of REnal and Vascular ENdstage Disease
PROFESS
: Prevention Regimen for Effectively Avoiding Secondary Strokes
PROGRESS
: Perindopril Protection Against Recurrent Stroke Study
PWV
: pulse wave velocity
QALY
: Quality adjusted life years
RAA
: renin-angiotensin-aldosterone
RAS
: renin-angiotensin system
RCT
: randomized controlled trials
RF
: risk factor
ROADMAP
: Randomized Olmesartan And Diabetes MicroAlbuminuria Prevention
SBP
: systolic blood pressure
SCAST
: Angiotensin-Receptor Blocker Candesartan for Treatment of Acute STroke
SCOPE
: Study on COgnition and Prognosis in the Elderly
SCORE
: Systematic COronary Risk Evaluation
SHEP
: Systolic Hypertension in the Elderly Program
STOP
: Swedish Trials in Old Patients with Hypertension
STOP-2
: The second Swedish Trial in Old Patients with Hypertension
SYSTCHINA
: SYSTolic Hypertension in the Elderly: Chinese trial
SYSTEUR
: SYSTolic Hypertension in Europe
TIA
: transient ischaemic attack
TOHP
: Trials Of Hypertension Prevention
TRANSCEND
: Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease
UKPDS
: United Kingdom Prospective Diabetes Study
VADT
: Veterans' Affairs Diabetes Trial
VALUE
: Valsartan Antihypertensive Long-term Use Evaluation
WHO
: World Health Organization

### 1.1 Principles

The 2013 guidelines on hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology …

/pdf/2013-esh-esc-guidelines-for-the-management-of-arterial-4ydvs5ifsx.pdf

2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.

The rapid technological developments of the past decade and the changes in echocardiographic practice brought about by these developments have resulted in the need for updated recommendations to the previously published guidelines for cardiac chamber quantification, which was the goal of the joint writing group assembled by the American Society of Echocardiography and the European Association of Cardiovascular Imaging. This document provides updated normal values for all four cardiac chambers, including three-dimensional echocardiography and myocardial deformation, when possible, on the basis of considerably larger numbers of normal subjects, compiled from multiple databases. In addition, this document attempts to eliminate several minor discrepancies that existed between previously published guidelines.

https://biblio.ugent.be/publication/5953422/file/5953443.pdf

Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.

Summary Structural cardiovascular disease is responsible for a significant disease load worldwide. Although currently used replacement procedures are efficacious and change the deadly evolution of many structural cardiovascular defects, the clinically used replacement materials are sub-optimal as they are prone to progressive calcific degeneration or thromboembolic complications. Therefore, the concept of cardiovascular tissue engineering has been initiated, aiming at the fabrication of autologous cell-based constructs with growth, regeneration and remodelling potential. While most attempts have focused on the in vitro fabrication of native-analogous cardiovascular constructs, more recent approaches have also focused on the fabrication of more “immature” autologous cell-seeded constructs without in vitro tissue processing – mainly aiming at full tissue development in vivo. This approach, which is also referred to as the “in situ tissue engineering” approach, has shown promising initial success in several pre-clinical as well as initial clinical investigations. Here, we review the concept of in situ cardiovascular tissue engineering and systematically compare the “in situ” technology to the “classical” in vitro tissue engineering approach.

Cardiovascular in situ tissue engineering

ObjectiveThe aim of this study was to investigate the short-term and midterm outcome of the Engager transcatheter aortic valve implantation (TAVI) system, a transapical self-expanding valve device ...

Outcome of patients treated with Engager transapical aortic valve implantation: one-year results of the feasibility study.

A 29 years old male patient was found to have a systolic murmur on a routine medical examination. He was referred to a cardiologist for trans-thoracic echocardiography (TTE), which revealed a severe insufficiency of the tricuspid valve with a flail anterior leaflet due to complete rupture of a papillary muscle (Carpentier’s Type II dysfunction). The right ventricle was hypertrophic and dilated with a normal systolic function. There were no signs of pulmonary hypertension and the left ventricular ejection fraction was preserved (EF = 54%). The patient did not have any cardiovascular history such as myocardial ischemia, rheumatic fever or infective endocarditis. On the other hand, he mentioned to have had two severe car accidents 11 and 10 years ago. In detail, he suffered from two blunt, frontal chest traumas including multiple costal fractures and a clavicle fracture. Therefore, a traumatic injury of the tricuspid valve was highly suspected. In the further history, the patient denied any cardiac symptoms such as syncope, dyspnea, angina pectoris or palpitations, but reported occasional apical chest pains. The patient was referred to our tertiary center and was scheduled for surgical repair of the tricuspid valve. An intraoperative trans-esophageal echocardiography (TOE) confirmed the preoperative findings (Fig. 1a, b). The operation was performed via classical sternotomy under cardiopulmonary bypass with bicaval cannulation. After opening the right atrium, the rupture of the papillary muscle was confirmed and the anterior leaflet was massively extended. The anterior leaflet was re-fixed using six Gore-Tex sutures as artificial chordae (69 Gore-Tex 6-0 sutures) and was stabilized with a rigid annuloplasty ring (Physio 34 mm, Edwards Lifesciences, Irvine, USA). The intraoperative TOE revealed a successful repair of the valve without detectable insufficiency (Fig. 2a, b). The rest of the procedure was uneventful and the patient was referred to the ICU. After 1 day in the ICU and 5 more days in the normal ward, the patient was discharged and made a swift recovery. Three months after surgery, the patient was in good condition with no residual tricuspid regurgitation. We report a rare case of a severe tricuspid valve regurgitation following blunt chest trauma, which has remained asymptomatic and undetected for over 10 years. Posttraumatic tricuspid valve insufficiency is a rare occurrence, but due to its anterior location, it remains the most frequently reported valve injury following blunt chest trauma [1]. Major mechanisms for traumatic tricuspid valve injury include rupture of the papillary muscles, chordal disruption, free rupture of the valve leaflets or complete destruction of the valve [2]. Although there have been many advances in echocardiography, allowing a faster diagnosis and resulting in an earlier and more effective treatment, the diagnosis of traumatic tricuspid valve insufficiency is often delayed or even can be completely unrecognized,. Major reasons for this problem are the general rarity, the absence or inhomogeneity of symptoms and the presence of coexisting life-threatening injuries such as hemato-pneumothorax, which have to be treated with priority, obscuring other pathologies [3, 4]. For this reason, it is not exceptional for patients to present years after the trauma [5]. In our patient, M. Y. Emmert (&) R. Pretre S. Suendermann B. Weber S. P. Hoerstrup V. Falk Clinic for Cardiovascular Surgery, University Hospital Zurich, Raemi Street 100, 8091 Zurich, Switzerland e-mail: maximilian_emmert@web.de

/pdf/severe-traumatic-tricuspid-insufficiency-detected-10-years-2tdd8t3kcb.pdf

Severe traumatic tricuspid insufficiency detected 10 years after blunt chest trauma.

Acute type A aortic dissection is a dreaded differential diagnosis of acute chest pain. Long-term outcome mainly depends on pre-existing comorbidities and post-operative complications. We present a patient with aortic graft dehiscence and subsequent severe aortic regurgitation due to fungal graft infection 8 months after repair of acute type A aortic dissection. Redo aortic surgery had to be delayed for 28 days due to intracerebral haemorrhage caused by septic embolism and clipping of a mycotic left middle cerebral artery aneurysm. Surgery revealed a circumferentially detached graft at the site of the proximal anastomosis thereby forming a massive pseudoaneurysm. The patient underwent successful aortic root replacement using a Freestyle porcine root bioprosthesis (25 mm), followed by re-anastomosis of the coronary arteries and partial replacement of the ascending aorta with a 28 mm Dacron graft. The patient was discharged on day 67 in stable cardiac condition with persistent neurological deficits. This case highlights the challenging management of patients with aortic graft infection and neurological dysfunction after redissection of the ascending aorta who require redo cardiac surgery.

Complete graft dehiscence 8 months after repair of acute type A aortic dissection

A biomedical apparatus for pumping blood of a human or an animal patient through a secondary blood circuit (10, 11, 12) is provided, comprising a blood pump (10), an inlet duct (11) and an outlet duct (12) for guiding blood of the patient to the blood pump (10) and back to the patient. The apparatus further comprises a measuring device (14) with at least one pressure sensor (40-46) for measuring pressure values in the patient's circulatory system. A controller (13) is provided that comprises at least two different preset control algorithms for regulating the operating point of the blood pump (10) based on the measured pressure values. The controller (13) is configured to select one of these preset control algorithms for being applied in dependence on the position of the at least one pressure sensor (40-46) in the patient's circulatory system.

Volkmar Falk

Papers

Cardiovascular in situ tissue engineering

Outcome of patients treated with Engager transapical aortic valve implantation: one-year results of the feasibility study.

Severe traumatic tricuspid insufficiency detected 10 years after blunt chest trauma.

Complete graft dehiscence 8 months after repair of acute type A aortic dissection

Biomedical apparatus with a pressure-regulated blood pump