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The variable extent of jeopardized myocardium in patients with single vessel coronary artery disease: quantification by thallium-201 single photon emission computed tomography.

To assess the extent of jeopardized myocardium in patients with single vessel coronary artery disease of variable severity and location, quantitative exercise thallium-201 single photon emission computed tomography was performed in 158 consecutive patients with angiographically proved single vessel coronary artery disease. The extent of abnormal left ventricular perfusion was quantified from computer-generated polar maps of three-dimensional myocardial radioactivity. Patients with only a moderate (51% to 69%) stenosis tended to have a small perfusion defect irrespective of the coronary artery involved. Whereas a perfusion defect measuring greater than or equal to 10% of the left ventricle was found in 78% of patients with no prior infarction and severe (greater than or equal to 70%) stenosis, this was observed in only 24% of patients with moderate stenosis. Perfusion defect size increased with increasing severity of stenosis for the entire group without infarction and for those with left anterior descending, right and circumflex coronary artery stenosis. However, the correlation between stenosis severity and perfusion defect size was at best only modest (r = 0.38, p = 0.0001). The left anterior descending artery was shown to be the most important of the three coronary arteries for providing left ventricular perfusion. Proximal stenosis of this artery produced a perfusion defect approximately twice as large as that found in patients with a proximal right or circumflex artery stenosis. However, marked heterogeneity in perfusion defect size existed among all three vessels despite comparable stenosis severity. This was most apparent for the left anterior descending coronary artery, where mid vessel stenosis commonly produced a perfusion defect similar in size to that found in proximally stenosed vessels.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Disease↗

Heterogeneous vasomotor responses of coronary conduit and resistance vessels in hypertension.

OBJECTIVES: The purpose of our study was to investigate the relation between conductance and resistance coronary vasomotor responsiveness in hypertensive patients without atherosclerosis. BACKGROUND: Although similar in morphology, conduit and resistance coronary vessels differ importantly in size, function and local environment and appear to be differentially affected in certain disease processes, such as atherosclerosis and hypertension. However, little is known about the effect of hypertension on contiguous coronary conduit and resistance vessels in humans. METHODS: Changes in coronary blood flow (a measure of resistance vessel reactivity) and coronary artery diameter (a measure of conduit vessel reactivity) were investigated in response to graded infusion of the endothelium-dependent agonist acetylcholine (ACh) in 98 patients with normal coronary arteries. RESULTS: In 31 normotensive, euglycemic patients, conduit and resistance coronary artery responses to intracoronary infusion of ACh were significantly correlated (r = 0.73, p = 1 x 10[-6]), although eight patients (26%) had constriction of conduit but dilation of resistance arteries at peak effect. In 28 hypertensive patients without left ventricular hypertrophy (LVH), conduit and resistance artery responses to ACh remained significantly correlated (r = 0.5, p = 0.006), although 12 patients (43%) had discordant findings. Finally, in 39 hypertensive patients with LVH, conduit and resistance artery responses to ACh displayed the lowest correlation (r = 0.38, p = 0.02), with 22 patients (56%) demonstrating conduit artery constriction and resistance artery dilation. CONCLUSIONS: Despite angiographically normal coronary arteries, heterogeneous vasomotor responses (dilation and constriction) were demonstrated in contiguous conduit and resistance arteries in normotensive and hypertensive patients referred for cardiac catheterization because of chest pain. In addition to more severe endothelial dysfunction among conduit and resistance arteries, a greater frequency of discordant conduit and resistance artery responses and resistance vessel constriction was found with increasing severity of hypertension. Our study suggests differing mechanisms of endothelium responsiveness to ACh among conduit and resistance coronary arteries.

Acetylcholine↗

Activation of Na+, H+ exchanger produces vasoconstriction of renal resistance vessels.

To evaluate the influence of the sodium/proton exchanger (Na+,H+ exchanger) on the constriction of rat resistance vessels and on the iliac artery, the isometric vasoconstrictions of renal resistance vessels and strips from iliac artery derived from Wistar-Kyoto rats were measured using a vessel myograph. The Na+,H+ exchanger was activated by intracellular acidification using propionic acid. Cytosolic pH (pHi) and cytosolic free sodium concentration ([Na+]i) in vascular smooth muscle cells were measured using the fluorescent dye technique. The activation of the Na+,H+ exchanger increased the [Na+]i by 12.4 +/- 1.3 mmol/L (n = 8). The activation of the Na+,H+ exchanger caused a contractile response of the renal resistance vessels (increase of tension, 1.5 +/- 0.1 x 10(-3) N; n = 13) and of the rat iliac artery (increase of tension, 7.5 +/- 0.8 x 10(-3) N; n = 5). The contractile response after activation of the Na+,H+ exchanger was significantly inhibited in the absence of external sodium or in the presence of amiloride, confirming the involvement of the Na+,H+ exchanger. The contractile response after activation of the Na+,H+ exchanger was significantly reduced in the absence of external calcium, after inhibition of calcium channels by nifedipine, and in the presence of an intracellular calcium antagonist 8-(diethylamino-)-octyl-3,4,5-trimethoxybenzoate (TMB-8), indicating that the activation of the Na+,H+ exchanger consecutively caused transplasma membrane calcium influx. On the other hand, the inhibition of the Na+,Ca2+ exchanger by NiCl2 significantly increased the vasoconstriction of renal resistance vessels after activation of the Na+,H+ exchanger. The activation of the Na+,H+ exchanger produces vasoconstriction by an increased cytosolic sodium concentration, inhibition of the Na+,Ca2+ exchanger, and activation of transplasma membrane calcium influx through potential dependent calcium channels.

Acids↗

[Preoperative mortality in transposition of the great vessels].

UNLABELLED: The aim of the study was to report the incidence and causes of preoperative deaths in isolated transposition of the great vessels and to describe the clinical findings in these neonates. PATIENTS AND METHODS: In five French centers of pediatric cardiology, data of all the neonates with isolated transposition of the great vessels who died before arterial switch operations between January 1986 and June 1996 were obtained from reviewing hospital files, echocardiography records and autopsy reports. RESULTS: Among 199 neonates with transposition of the great vessels, 20 (9.9%) died before surgery. The death was related to intracranial haemorrhage in one premature neonate, severe and early hypoxemia in 13 full-term patients (group A) and later sudden collapse in six patients (group B). In group A, the symptoms occurred within 20 minutes after the birth and included cyanosis (n = 12), acute respiratory distress (n = 8), and shock (n = 4). Despite assisted ventilation (n = 13), bicarbonate infusion (n = 12), prostaglandin E1 (n = 7), inotropic drugs (n = 5) and balloon atrioseptostomy (n = 7), death occurred at the median age of five hours. The patent foramen ovale was absent or tiny in ten patients, normal in one patient and not specified in two patients. The ductus arteriosus was patent in ten patients and not specified in three patients. In group B, the neonates were initially in a good hemodynamic condition. Unexplained death occurred between two and five days after the birth: one infant with a large patent foramen ovale did not receive prostaglandin E1, four patients died a few hours after an angiographic study or a balloon atrioseptostomy was performed in a catheterization laboratory, and one child suffered from a cerebral anoxia due to a tightened cord. CONCLUSION: We conclude that the high preoperative mortality rate in isolated transposition of the great vessels is mainly due to absent or small atrial shunt. These findings suggest that only prenatal diagnosis of transposition of the great vessels with immediate balloon atrioseptostomy could avoid a fatal outcome.

Angioplasty, Balloon↗

A scanning electron microscope study of the luminal surface specializations in the blood vessels of the pecten oculi in a diurnal bird, the black kite (Milvus migrans).

The luminal surface of the pecten oculi of the black kite (Milvus migrans), a diurnally active bird of prey, was examined by scanning electron microscopy. In this species the blood vessels are generally of two types, the small-calibre capillaries and the large-calibre afferent and efferent vessels. The luminal surface of the efferent blood vessels possesses a few low microplicae. Conversely, the luminal surface of the afferent blood vessels is characteristically smooth except at the cell junctions and at the point of entry into the capillaries. The cells junctions are marked by low ragged ridges while the luminal surface is studded with low sparse pleiomorphic microprojections at the point of capillary emergence. The luminal surface of the blood capillaries is characterised by a labyrinth of closely disposed microplicae that projects into the lumen. These microplicae show no particular orientation with respect to either the longitudinal or transverse axis of the capillary. Instead, they are diffusely orientated. It is conjectured that such a heterogeneous design of the endothelium in the blood vessels of the pecten oculi has developed in order to augment the role of the pecten in the transport of nutrients to the avascular neural retina by an energy saving diffusion process. The process through which the design of the microfolds affects haemodynamics and their putatite role in facilitating the delivery of nutrients are discussed in the perspective of the available data.

Animals↗

Preferential involvement of larger vessels in a rat model of diabetes-induced graft vasculopathy.

Using previously described models of diabetes-induced transplant coronary artery atherosclerosis (TxCAD), we quantitatively assessed TxCAD using computer-assisted morphometric measurements. More than 95% of the evaluated vessels were intramyocardial vessels. The first and last tertile of the vessel size distribution were evaluated for the presence of TxCAD. Severe TxCAD, defined as a luminal occlusion > or =75%, was more prevalent in the larger vessels. We observed a differential involvement based on vessel size in diabetes-induced TxCAD.

Animals↗

Atheromas that cause fatal thrombosis are usually large and frequently accompanied by vessel enlargement.

Several lines of clinical evidence show that AMI frequently occurs at sites with mild to moderate degree of coronary stenosis. The degree of luminal stenosis depends on plaque deposition and degree of vessel remodeling, features poorly assessed by coronary angiography. This postmortem study tested the hypothesis that the size of coronary atheroma and the type of remodeling distinguish culprit lesion responsible for fatal AMI from equi-stenotic nonculprit lesion in the same coronary tree. The main coronary branches from 36 consecutive patients with fatal AMI were studied. The culprit lesion (Group 1) and an equi-stenotic nonculprit segment (Group 2) obtained in measurements of another coronary branch from the same patient were compared. Morphometry and plaque composition was assessed in both groups. Compared to Group 2, Group 1 had larger areas of: plaque 9.6 vs. 4.7 mm(2), vessel 12.7 vs. 7.4 mm(2) and lumen 1.7 vs. 1.2 mm(2); (P< .01). Positive remodeling was more frequent in Group 1 than Group 2: 21/30 (70%) vs. 8/26 (31%). Plaque area correlated positively with lipid core and macrophages and negatively with fibrosis and smooth muscle cells. Atherosclerotic plaques that cause fatal thrombosis are more frequently positively remodeled and tend to be larger than nonculprit plaques with the same degree of cross-sectional stenosis. We tested whether arterial remodeling and plaque size vary between segments containing a fatal thrombosed plaque versus an equi-stenotic nonculprit plaque. Culprit vessel segments had higher cross-sectional areas of intimal plaque and of vessel wall than equi-stenotic nonculprit plaques. The cross-sectional area of the vessel correlated positively with both the lipid core area and CD68(+) macrophage content, and negatively with fibrosis area and smooth muscle cell content. These results add elements explaining limitations of angiography in identifying plaques and provide new insights into the role of remodeling in plaque instability.

Antigens, CD↗

Techniques to study the pharmacodynamics of isolated large and small blood vessels.

Techniques are described for the mounting of large artery and vein ring segments on wire hooks in an organ bath chamber. Each vessel is set to normalised conditions of passive force directly determined from its circumferential length-tension relationship. This rigorous set up follows the normalisation routine established by Mulvany and Halpern for small resistance arteries mounted under isometric conditions on a wire myograph. Techniques for electrical field stimulation, and simultaneous force and membrane potential (Em), are described. An example of electrical field stimulation is given for the unravelling of the role of ATP in sympathetic co-transmission in rat mesenteric small arteries. Other techniques described include isobaric, isotonic mounting of small vessels, their morphology and receptor characterisation. Examples include human buttock skin arteries, small coronary arteries (CAs), and vasa vasorum arteries taken at coronary bypass graft operations. The underlying philosophy is that every segment of blood vessel constituting the intact resistance bed has its own pharmacology. There is no 'ideal' preparation. Whether the vessel is studied under isometric, isotonic, or isobaric conditions, the experimentalist must be wary of the influence of the methodology on the pharmacodynamics. These influences may not be the same between normal and diseased vessels.

Acetylcholine↗

Biplane X-ray angiograms, intravascular ultrasound, and 3D visualization of coronary vessels.

The technology for determination of the 3D vascular tree and quantitative characterization of the vessel lumen and vessel wall has become available. With this technology, cardiologists will no longer rely primarily on visual inspection of coronary angiograms but use sophisticated modeling techniques combining images from various modalities for the evaluation of coronary artery disease and the effects of treatment. Techniques have been developed which allow the calculation of the imaging geometry and the 3D position of the vessel centerlines of the vascular tree from biplane views without a calibration object, i.e., from the images themselves, removing the awkwardness of moving the patient to obtain 3D information. With the geometry and positional information, techniques for reconstructing the vessel lumen can now be applied that provide more accurate estimates of the area and shape of the vessel lumen. In conjunction with these developments, techniques have been developed for combining information from intravascular ultrasound images with the information obtained from angiography. The combination of these technologies will yield a more comprehensive characterization and understanding of coronary artery disease and should lead to improved and perhaps less invasive patient care.

Coronary Angiography↗

Visualization of serotonin effects on renal vessels of rats.

We studied the effects of serotonin (5-hydroxytryptamine, 5-HT) on glomerular blood flow (GBF) and on renal vessel diameters in the hydronephrotic kidney and in vascular casts of normal kidneys of rats. 5-HT (60 min after local application of 10(-8) mol.liter-1) constricted the arcuate arteries (-10 +/- 2% to -14 +/- 2%, mean +/- SEM), dilated the interlobular arteries (+13 +/- 2%) and afferent arterioles (+17 +/- 3%), and decreased GBF (-44 +/- 5%). In contrast to normal autoregulation, reduction of renal perfusion pressure after local application of 5-HT from 118 +/- 3 mm Hg by 10 and 20 mm Hg reduced GBF by 12 +/- 2% and 23 +/- 3%, respectively. The 5-HT2 antagonist, ritanserin (60 min after local application of 10(-6) mol.liter-1), dilated all preglomerular vessels and increased GBF. In the presence of ritanserin, 5-HT lost nearly all vascular effects. During infusion of 5-HT (5 micrograms.min-1 i.v. for 20 min) vascular reactions were similar to those under local application. After cyclooxygenase inhibition with indomethacin, infusion of 5-HT failed to constrict the arcuate arteries whereas vasodilation of the small preglomerular vessels remained unaffected. Analyzing vascular casts of normal kidneys we observed considerable vascular spasms and an average vasoconstriction of the interlobar arteries of 19 +/- 9% after i.v. infusion of 5-HT. We believe that 5-HT decreases GBF by 5-HT2 receptor-mediated constriction of the large renal vessels which are modulated by the prostaglandin system, whereas 5-HT dilates the small preglomerular vessels, most likely via 5-HT1-like receptors. Furthermore, our data indicate that 5-HT impairs the myogenic component of renal autoregulation in the low pressure range.

Animals↗

VEGF-D expression and lymph vessels play an important role for lymph node metastasis in papillary thyroid carcinoma.

Papillary thyroid carcinoma frequently metastasizes to regional lymph nodes, and lymph node metastasis increases the risk of local regional relapse. Recent evidence suggests that vascular endothelial growth factor-D (VEGF-D) promotes lymphangiogenesis, which in turn promotes lymphatic metastasis. Therefore, the role of VEGF-D messenger RNA transcript levels and VEGF-D immunoreactivity in lymph node metastasis in papillary thyroid carcinoma was investigated. In addition, the role of blood vascular vessel, lymph vessel, and Flt-4-positive vessel densities were studied in relation to their suspected association with lymph node metastasis, and with VEGF-D expression. VEGF-D messenger RNA transcript levels by quantitative real-time reverse transcription-polymerase chain reaction and VEGF-D immunoreactivity by immunohistochemistry in 49 papillary thyroid carcinomas were also studied. This was followed by quantitative immunohistochemical staining for CD34, podoplanin, and Flt-4. Lymph node metastasis was significantly correlated with VEGF-D messenger RNA transcript levels (P=0.027) and VEGF-D immunoreactivity (P=0.019). Increased lymph vessel density was also correlated with VEGF-D expression and lymph node metastasis. In conclusion, our findings indicate that VEGF-D expression and increased lymph vessel density may have an important role for lymph node metastasis in papillary thyroid carcinoma.

Adolescent↗

A quantitative analysis of lymphatic vessels in human breast cancer, based on LYVE-1 immunoreactivity.

This study was undertaken to determine the highly sensitive method for detecting tumour lymphatic vessels in all the fields of each slide (LV), lymphatic microvessel density (LMVD) and lymphatic vessel invasion (LVI) and to compare them with other prognostic parameters using immunohistochemical staining with polyclonal (PCAB) and monoclonal antibodies (MCAB) to the lymphatic vessel endothelial hyaluronan receptor-1 (LYVE-1), and the pan-endothelial marker factor VIII in a series of 67 human breast cancers. In all LYVE-1-stained sections, LV (some of which contained red blood cells) were frequently found localised in extralobular stroma, dermis, connective tissue stroma and adjacent to artery and vein, but were rare within the intralobular stroma or the tumour body (3/67 cases) or areas of widespread invasion. In contrast small blood vessels were observed in intra- and extralobular stroma in the factor VIII-stained sections. Quantitation of vessel numbers revealed that LYVE-1/PCAB detected a significantly larger number of LV than either H&E or LYVE-1/MCAB (P<0.0001). LYVE-1/PCAB detected LVI in 25/67 cases (37.3%) and their presence was significantly associated with both lymph node metastasis (chi(2)=4.698, P=0.0248) and unfavourable overall survival (OS) (P=0.0453), while not relapse- free survival (RFS) (P=0.2948). LMVD had no influence for RFS and OS (P=0.4879, P=0.1463, respectively). Our study demonstrates that immunohistochemistry with LYVE-1/PCAB is a highly sensitive method for detecting tumour LV/LVI in breast cancer and LVI is a useful prognostic indicator for lymphatic tumour dissemination.

Adult↗

Site of blood vessel damage and relevance of CD18 in a murine model of immune complex-mediated vasculitis.

How neutrophils (polymorphonuclear neutrophils, PMNs) damage vessels in leukocytoclastic vasculitis (LcV) mediated by immune complexes (ICs) is unclear. If degradative enzymes and oxygen radicals are released from PMNs while adhering to the inner side of the vessel wall, they could be washed away by the blood stream or neutralized by serum protease inhibitors. We investigated if in LcV PMNs could damage vessels from the tissue side after transmigration. We used CD18-deficient (CD18-/-) mice because the absence of CD18 excludes transmigration of PMNs. When eliciting the Arthus reaction in ears of CD18-/- mice, deposition of ICs was not sufficient to recruit PMNs or to induce IC-mediated LcV. Injection of PMNs intradermally in CD18-/- mice allowed us to investigate if bypassing diapedesis and placing PMNs exclusively on the abluminal side leads to vascular destruction. We found that injected PMNs gathered around perivascular ICs, but did not cause vessel damage. Only intravenous injection of wild-type PMNs could re-establish the Arthus reaction in CD18-/- mice. Thus, PMNs cause vessel damage during diapedesis from the luminal side, but not from the perivascular space. We suggest that in order to shield the cytotoxic products from the blood stream, ICs induce particularly tight interactions between them, PMNs and endothelial cells.

Animals↗

[Comparative study of coronary vessel diameters in intravital and postmortal angiograms (author's transl)].

In a total of 21 mongrel dogs a comparison between intravital and postmortal coronary arteriograms was made so as to establish the difference in vessel diameter. Fresh postmortal hearts injected in situ showed an average increase in coronary vessel diameter of approx. 6 per cent. Examinations of 24 hour postmortal hearts which were removed from the animals showed a vessel diameter increase of barely 20 per cent in the mean. These 20 per cent correspond fairly well with literature information about the maximal widening of coronary vessels with nitroglycerin. Nerves which are still functioning, and humoral substances which may influence the still living muscle in vessel walls are supposed to be the reason for the smaller increase in fresh postmortal in situ illustrated coronary arteries. It must be stressed, that the measured differences between intravital and postmortal coronary artery diameters can only be representative of wall sections free of arterioslcerosis.

Animals↗

Modified trap-door thoracotomy for malignancies invading the subclavian and innominate vessels.

Thirteen patients with malignancies which had invaded the subclavian vessels and/or distal border of the innominate vessels were operated on through modified "trap-door" thoracotomy. The modification is the additional resection of the first rib from inside the thorax. Tumors consisted of thyroid cancer in 5 patients, thymic tumor in 3, Pancoast tumor in 3, and lymphoma in 2. Invaded vessels were on the left side in 9 cases, on the right in 3, and bilateral in one. Subclavian and/or innominate veins were resected in 12 cases and reconstructed in 5. The remaining case was treated with resection of the right innominate and subclavian artery and its vascular reconstruction. Compared to original trap-door thoracotomy, the modification provided a more adequate opening in the chest wall and more extensive exposure of the entire subclavian vessels, which made distal vascular control safe and easy. Postoperative complications occurred in one patient, who suffered chylothorax. In conclusion, modified trap-door thoracotomy is a viable and useful approach in the resection of malignancies which have invaded the subclavian and/or distal border of the innominate vessels.

Adult↗

[A method for recording the network topology of human retinal vessels].

Network analysis of the human retinal vessels must be based on a thorough knowledge of the topology of the network. This derives from the numerical composition of the network's individual components. Using histologic specimens, centrifugal and centripetal ordering methods were compared. It was found necessary to use an ordering system which takes both dichotomous as well as lateral branching into account, and Strahler's centripetal ordering system was found to be suitable. For various representative areas of human retinae it could be shown that the number of segments of each Strahler order forms an inverse geometric sequence which enables the Horton branching quotient RB to be calculated. It is thus possible to predict the number of vessel segments within the individual orders. Although the method ignores detailed vessel morphology, with knowledge of the vessel lengths and diameters determined in the same manner it enables the conductivity and resistance of human retinal vessels to be measured.

Blood Viscosity↗

[Possibilities for ocular vessel coagulation (author's transl)].

Present-day possibilities of influencing pathological ocular vessels using an argon laser are presented. A distinction is made here between indirect methods such as area coagulation and direct methods with which specific vessels are treated. Whereas clinical tests involving vessel coagulation with pigmented epithelium absorption have already been carried out more or less successfully, selective vessel coagulation with hemoglobin absorption is still largely at the experimental stage. Our own experiments on animals have shown, however, that with the selection of a suitable coagulation technique and the use of suitable exposure parameters, vessel occlusion can be induced with the argon laser. To achieve this, shortening of the exposure times is particularly necessary.

Aged↗

Magnetic resonance angiography of peripheral runoff vessels.

Recent improvements in magnetic resonance imaging techniques have made magnetic resonance angiography (MRA) a very useful adjunct to invasive angiography. Fifty-five limbs in 51 patients with occlusive peripheral vascular disease were studied with both MRA and contrast arteriography. The magnetic resonance and contrast arteriograms were read by radiologists and surgeons and separate interventional plans were based on each study. The MRA findings differed significantly from those of conventional arteriography in 26 limbs (48%). In every case MRA visualized all of the same vessels and hemodynamic stenoses seen on the contrast arteriogram. In 48% of the cases, however, MRA revealed additional findings. Thus the discrepancies in the two studies were always the result of the failure of the arteriogram to reveal all of the patent vessels seen on MRA. The additional information provided by MRA resulted in alteration of the interventional plan in 11 cases (22%). In nine cases (18%) target vessels suitable for use in a limb-salvage procedure were identified by MRA, although they had been missed by conventional arteriography. In all of these cases, intraoperative arteriograms confirmed the suitability of these vessels for use in technically successful bypass procedures. In two cases (4%) additional information provided by MRA identified a target runoff vessel for bypass grafting that proved to be a better alternative than the one that would have been chosen on the basis of contrast arteriography.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗