scholarly journals Stenosis of a Reconstructed Aorta Caused a Paradoxical Diastolic Pressure Gradient after Norwood Operation

2012 ◽  
Vol 6 ◽  
pp. CMC.S9789 ◽  
Author(s):  
Satoshi Masutani ◽  
Hirofumi Saiki ◽  
Hirotaka Ishido ◽  
Hideaki Senzaki
Keyword(s):  
Pressure Gradient ◽  
Diastolic Pressure ◽  
Systolic Pressure ◽  
Aortic Pressure ◽  
Ascending Aorta ◽  
Ventricular Ejection ◽  
Norwood Operation ◽  
Descending Aorta ◽  
The Difference ◽  
Systolic Pressure Gradient

An infant with hypoplastic left heart syndrome showed paroxysmal episodes of bradycardia, hypotension, and hypoxemia upon crying after modified Norwood operation. Echocardiography showed decreased right ventricular ejection with grade III tricuspid regurgitation, a markedly enlarged aortic arch, and accelerated blood flow distal to the enlarged aorta. Aortography demonstrated an aneurysmal neo-aorta with an apple-shaped appearance. The pressure measurements revealed intriguing aortic hemodynamics: the diastolic pressure of the ascending aorta was lower than that of the descending aorta (42 mmHg vs. 52 mmHg) despite no systolic pressure gradient. Markedly reduced compliance in the ascending aorta relative to that in the descending aorta, which was suggested by the difference in time constant of aortic pressure decay, may explain this hemodynamics. Impaired coronary circulation caused by lowered diastolic pressure in ascending aorta was indicated by reduced subendocardial viability ratio, and may account for her symptom and lowered ventricular ejection. The patient's condition was indeed significantly improved by surgical correction of the aortic shape. This case highlights the importance of aortic shape and properties after Norwood operation.

Systolic pressure gradients across the aortic valve and in the ascending aorta

1965 ◽  
Vol 209 (3) ◽  
pp. 557-563 ◽  
Author(s):  
Thomas E. Driscol ◽  
Richard W. Eckstein
Keyword(s):  
Aortic Valve ◽  
Pressure Gradient ◽  
Systolic Pressure ◽  
Left Ventricular Pressure ◽  
Aortic Pressure ◽  
Left Ventricular ◽  
Ventricular Pressure ◽  
Maximum Pressure ◽  
Early Systole ◽  
Systolic Pressure Gradient

Left ventricular and aortic pressure pulses and the pressure gradient across the aortic valve were recorded in anesthetized and unanesthetized dogs. Aortic pressure recorded immediately above the valve increased 5–15 msec before it was exceeded by left ventricular pressure. The maximum systolic pressure gradient occurred in early systole and remained positive throughout the ejection period. When aortic pressure was recorded 1–3 cm distal to the valve, these pressure pulse relationships were altered so that 1) the rise in aortic pressure was delayed, 2) the early systolic maximum pressure gradient was increased, and 3) aortic pressure exceeded ventricular pressure during the latter half of systole. The changes in early systole are due to a delay in the pulse wave reaching the more distal recording site. The mean systolic pressure gradient between two sites within the ascend-ing aorta was found to be negative, i.e., opposite to the direction of forward flow. The negative pressure gradient probably accounts for the reversal of the transvalvular pressure gradient in late systole when aortic pressure was recorded distal to the valve.

THE BRACHIAL TO DIGITAL BLOOD PRESSURE GRADIENT IN NORMAL SUBJECTS AND IN PATIENTS WITH HIGH BLOOD PRESSURE

1958 ◽  
Vol 36 (9) ◽  
pp. 889-893 ◽  
Author(s):  
P. Gaskell ◽  
A. M. Krisman
Keyword(s):  
Blood Pressure ◽  
Pressure Gradient ◽  
Diastolic Pressure ◽  
Systolic Pressure ◽  
Normal Subjects ◽  
Normal Blood ◽  
Control Group ◽  
Normal Blood Pressure ◽  
Hypertensive Patients ◽  
Systolic Pressure Gradient

The brachial and digital blood pressures were estimated by auscultatory techniques in 10 patients with essential hypertension and in a group of 6 subjects with normal blood pressure who were in a state of regulated peripheral vasoconstriction and again when they were in a state of regulated vasodilatation. The brachial to digital systolic and diastolic pressure gradients in both control subjects and hypertensive patients were greater when the individuals were heated than when they were cooled. The brachial to digital diastolic pressure gradient in the hypertensive patients was not significantly different from that in the subjects with normal blood pressure. However, the systolic pressure gradient was greater in the hypertensive patients than in the control group both when the individuals were heated and when they were cooled.

scholarly journals Extra-Anatomical Bypass: A Surgical Option for Recurrent Aortic Coarctation

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Alban Malaj ◽  
Ombretta Martinelli ◽  
Francesco Giosue' Irace ◽  
Jihad Jabbour ◽  
Bruno Gossetti ◽  
...  
Keyword(s):  
Pressure Gradient ◽  
Aortic Coarctation ◽  
Open Surgery ◽  
Median Sternotomy ◽  
Systolic Pressure ◽  
Systemic Hypertension ◽  
Aortic Reconstruction ◽  
Safe Alternative ◽  
Descending Aorta ◽  
Systolic Pressure Gradient

Background. Balloon aortoplasty with or without stenting is a less invasive alternative to open surgery for the management of recurrent isthmic coarctation. However, in patients with previous small size tube graft, an open surgical correction is mandatory and, in most cases, an anatomical aortic reconstruction is carried out.Methods. We present the case of a 48-year-old woman with recurrent aortic coarctation and systemic hypertension with systolic value around 190–200 mmHg and preoperative systolic pressure gradient 70 mmHg, submitted to an extra-anatomical bypass. Through a median sternotomy, an extra-anatomical bypass from ascending to descending aorta was performed.Results. No intra- or postoperative complications were observed. The postoperative pressure gradient was 10 mmHg and the systolic pressure ranged from 130 to 140 mmHg.Conclusion. The extra-anatomical bypass can be considered an effective and safe alternative to the anatomical aortic reconstruction in the cases with recurrent aortic coarctation unfit for endovascular treatment.

OCCURRENCE AND PREVENTION OF POSTASPHYXIAL INTRAVENTRICULAR PRESSURE GRADIENTS

1966 ◽  
Vol 44 (2) ◽  
pp. 209-215
Author(s):  
J. M. Dieudonné
Keyword(s):  
Pressure Gradient ◽  
Systolic Pressure ◽  
Ventricular Outflow Tract ◽  
Aortic Pressure ◽  
Pressure Gradients ◽  
Cardiac Stimulation ◽  
Intraventricular Pressure Gradients ◽  
Systolic Pressure Gradient ◽  
Severe Stressor ◽  
Inotropic Stimulation

Following the earlier demonstration of a systolic pressure gradient across the ventricular outflow tract after exogenous cardiac stimulation, a severe stressor, asphyxia, was produced in rats to determine whether inotropic stimulation of endogenous origin would induce comparable intraventricular systolic pressure gradients. Only during the oxygen rebound phase was a transient ventriculo–aortic pressure gradient demonstrable; it did not appear after treatment with dichloroisoproterenol and was inhibited by bilateral adrenalectomy. It is concluded that the pressure gradient coincided with a marked inotropic stimulation resulting from the release of catecholamines with adrenomedullary participation under adequate oxygenation.

THE BRACHIAL TO DIGITAL BLOOD PRESSURE GRADIENT IN NORMAL SUBJECTS AND IN PATIENTS WITH HIGH BLOOD PRESSURE

1958 ◽  
Vol 36 (1) ◽  
pp. 889-893 ◽  
Author(s):  
P. Gaskell ◽  
A. M. Krisman
Keyword(s):  
Blood Pressure ◽  
Pressure Gradient ◽  
Diastolic Pressure ◽  
Systolic Pressure ◽  
Normal Subjects ◽  
Normal Blood ◽  
Control Group ◽  
Normal Blood Pressure ◽  
Hypertensive Patients ◽  
Systolic Pressure Gradient

The brachial and digital blood pressures were estimated by auscultatory techniques in 10 patients with essential hypertension and in a group of 6 subjects with normal blood pressure who were in a state of regulated peripheral vasoconstriction and again when they were in a state of regulated vasodilatation. The brachial to digital systolic and diastolic pressure gradients in both control subjects and hypertensive patients were greater when the individuals were heated than when they were cooled. The brachial to digital diastolic pressure gradient in the hypertensive patients was not significantly different from that in the subjects with normal blood pressure. However, the systolic pressure gradient was greater in the hypertensive patients than in the control group both when the individuals were heated and when they were cooled.

Use of pulse pressure method for estimating total arterial compliance in vivo

1999 ◽  
Vol 276 (2) ◽  
pp. H424-H428 ◽  
Author(s):  
N. Stergiopulos ◽  
P. Segers ◽  
N. Westerhof
Keyword(s):  
Pulse Pressure ◽  
Diastolic Pressure ◽  
Arterial Compliance ◽  
Aortic Pressure ◽  
Lower Limbs ◽  
Pressure Method ◽  
Total Arterial Compliance ◽  
The Difference ◽  
Pulse Pressure Method

We determined total arterial compliance from pressure and flow in the ascending aorta of seven anesthetized dogs using the pulse pressure method (PPM) and the decay time method (DTM). Compliance was determined under control and during occlusion of the aorta at four different locations (iliac, renal, diaphragm, and proximal descending thoracic aorta). Compliance of PPM gave consistently lower values (0.893 ± 0.015) compared with the compliance of DTM (means ± SE; r = 0.989). The lower compliance estimates by the PPM can be attributed to the difference in mean pressures at which compliance is determined (mean pressure, 81.0 ± 3.6 mmHg; mean diastolic pressure, over which the DTM applies, 67.0 ± 3.6 mmHg). Total arterial compliance under control conditions was 0.169 ± 0.007 ml/mmHg. Compliance of the proximal aorta, obtained during occlusion of the proximal descending aorta, was 0.100 ± 0.007 ml/mmHg. Mean aortic pressure was 80.4 ± 3.6 mmHg during control and 102 ± 7.7 mmHg during proximal descending aortic occlusion. From these results and assuming that upper limbs and the head contribute as little as the lower limbs, we conclude that 60% of total arterial compliance resides in the proximal aorta. When we take into account the inverse relationship between pressure and compliance, the contribution of the proximal aorta to the total arterial compliance is even more significant.

Abstract P230: The Influence of Calcification of Ascending Aorta on Dicrotic Notch of Thoracic Aorta

Hypertension ◽  
2016 ◽  
Vol 68 (suppl_1) ◽  
Author(s):  
Aahad Khan ◽  
Scott Ray ◽  
Syed Haris Pir ◽  
Mustafa Noor Muhammad ◽  
Mirza Mujadil Ahmad ◽  
...  
Keyword(s):  
Thoracic Aorta ◽  
Aortic Pressure ◽  
Ascending Aorta ◽  
Arterial Calcification ◽  
Sample Population ◽  
Descending Aorta ◽  
Dicrotic Notch ◽  
One Year ◽  
Arch Of The Aorta ◽  
Contrast Ct

Background: Dicrotic Notch (DN) is known to dampen with age, with increasing arterial stiffness probably due to arterial calcification. Since arterial calcification has recently been shown to predominantly involve descending thoracic aorta, we hypothesized that calcification in different segments of thoracic aorta will have a different impact on DN. Methods: A sample of 44 patients with invasive thoracic aortic pressure tracings during cardiac catheterization was selected for this study. Non-contrast CT scans were evaluated for presence of calcification in aortic segments (ascending aorta (AA), aortic arch (arch) and descending aorta (DA)) and then quantified. DN was categorized based on aortic pressure tracings into 4 grades. Grade 1 represented normal DN; grades 2, 3 and 4 represented progressively diminishing DN, where grade 4 represented absent DN. Compliance was calculated as a change in stroke volume over aortic pulse pressure with both measurements obtained from echocardiography reports done within one year of catheterization. Results: The mean age of the sample population was 64.6 ± 10.5 years. Out of the 44 patients, 14 (32%) had a calcified AA, 25 (56%) had a calcified DA and n=28 (63%) had a calcified arch. Furthermore, 14 (32%) patients had only one segment calcified, whereas 10 (23%) had two and 11 (25%) had all three segments calcified. Abnormal DN was present in 16 (36%) patients. The odds of having an abnormal DN in the presence of calcified AA were more than 3 times (OR: 3.67; p=0.05). Compliance was higher in those with a normal DN versus those with an abnormal DN (1.64 ml/mmHg vs. 1.21 ml/mmHg) (p = 0.09). There was no significant association between calcification in the DA or arch of aorta. Conclusion: There was no association between dicrotic notch and presence of calcification in the arch of the aorta and descending aorta.

scholarly journals Balloon Angioplasty for Native Aortic Coarctation in 3- to 12-Month-Old Infants

2020 ◽  
Vol 13 (11) ◽  
Author(s):  
Juan Pablo Sandoval ◽  
Sok-Leng Kang ◽  
Kyong-Jin Lee ◽  
Lee Benson ◽  
Kentaro Asoh ◽  
...  
Keyword(s):  
Pressure Gradient ◽  
Balloon Angioplasty ◽  
Systolic Pressure ◽  
Coarctation Of The Aorta ◽  
Aortic Aneurysms ◽  
Older Children ◽  
Cross Sectional ◽  
Cross Sectional Imaging ◽  
Systolic Pressure Gradient ◽  
Lost To Follow Up

Background: Balloon angioplasty for native coarctation of the aorta (CoA) is successful in children and adults but in neonates results in frequent restenosis. The efficacy of balloon angioplasty for native CoA during infancy beyond the neonatal period was examined in infants aged 3 to 12 months of age. Methods: A retrospective review of 68 infants who underwent balloon angioplasty for native CoA. 95% CI are in parentheses. Results: Procedural age was (mean±SD) 6±3.4 months and weight was 7±1.8 kg. Balloon angioplasty produced a large decrease in both the noninvasive arm-to-leg blood pressure gradient (41.2±18.7 to 5.6±9.6 mm Hg) and the invasive peak systolic pressure gradient (34±12 to 11±9 mm Hg). Balloon angioplasty increased the CoA diameter from 2.7±1 mm to 4.6±1.2 mm. One patient was lost to follow-up. A catheter reintervention was required in 11.8% and surgery in 10.3%. The hazard of reintervention was highest early. Median freedom from reintervention was 89% (95% CI, 80%–96%) at 1 year, 83% (95% CI, 73%–92%) at 5 years, and 81% (95% CI, 69%–90%) at 10 years. Femoral artery thrombosis was documented in 6 (9%) infants without any long-term consequence. One patient developed a small aortic aneurysm late and has not required treatment. A robust estimate of the frequency of aortic aneurysms remains to be determined as the majority of subjects have not had cross-sectional imaging. Conclusions: Balloon angioplasty of native CoA is effective and safe in infants aged 3 to 12 months with outcomes comparable to those in older children and adults. Catheter reinterventions can avoid the need for surgery in most patients.

Isovolumetric properties of ventricles of spontaneously hypertensive rats

1981 ◽  
Vol 240 (6) ◽  
pp. H927-H933
Author(s):  
L. J. Heller
Keyword(s):  
Spontaneously Hypertensive Rats ◽  
Diastolic Pressure ◽  
Systolic Pressure ◽  
Ventricular Rate ◽  
High Frequency Stimulation ◽  
Hypertensive Rats ◽  
Spontaneously Hypertensive ◽  
Frequency Stimulation ◽  
The Difference ◽  
Wistar Kyoto

Isovolumetric pressure-producing properties of isolated Langendorf-perfused hypertrophied ventricles from adult spontaneously hypertensive rats (SHR) were compared with those of nonhypertrophied ventricles from adult Wistar-Kyoto rats (WKY). SHR ventricles were found to produce greater systolic pressure than WKY ventricles when subjected to similar stimulation and perfusion conditions. Correction for the differences in ventricular mass eliminated the difference between groups. Apparent diastolic pressure at high stimulus rates was higher in SHR than WKY, and SHR developed exaggerated aftercontractions following cessation of high-frequency stimulation. Refractory periods of hypertrophied ventricles determined by paired-pulse stimulation were not found to be different from nonhypertrophied ventricles, but hyperexcitable periods of SHR ventricles were significantly longer than WKY ventricles. In addition, the intrinsic ventricular rate of SHR preparations was significantly greater than that of WKY.

Changes in finger-aorta pressure transfer function during and after exercise

2006 ◽  
Vol 101 (4) ◽  
pp. 1207-1214 ◽  
Author(s):  
Wim J. Stok ◽  
Berend E. Westerhof ◽  
John M. Karemaker
Keyword(s):  
Blood Pressure ◽  
Transfer Functions ◽  
Diastolic Pressure ◽  
Systolic Pressure ◽  
Aortic Pressure ◽  
Finger Blood Pressure ◽  
Mean Pressure ◽  
Catheter Tip ◽  
The Individual ◽  
Finger Pressure

Noninvasive finger blood pressure has become a surrogate for central blood pressure under widely varying circumstances. We tested the validity of finger-aorta transfer functions (TF) to reconstruct aortic pressure in seven cardiac patients before, during, and after incremental bicycle exercise. The autoregressive exogenous model method was used for calculating finger-aorta TFs. Finger pressure was measured noninvasively using Finapres and aortic pressure using a catheter-tip manometer. When applying the individual TFs found during rest for reconstruction of aortic pressure during all workloads, systolic pressure was increasingly underestimated, with large variation between subjects: +4.0 to −18.1 mmHg. In most subjects, diastolic pressure was overestimated: −3.9 to +5.5 mmHg. Pulse pressure estimation varied between +4.5 and −21.9 mmHg. In all cases, wave distortion was present. Postexercise, error in reconstructed aortic systolic pressure slowly declined, and diastolic pressure was overestimated. During rest, the TF gain had a minimum between 3.65 and 4.85 Hz (Fmin). During exercise, Fmin shifted to frequencies between 4.95 and 7.15 Hz at the maximum workload, with no change in gain. Postexercise, gain in most subjects shifted to values closer to unity, whereas Fmin did not return to resting values. Within each subject, aorta-Finapres travel time was linearly related to mean pressure. During exercise, Fmin was linearly related to both delay and heart rate. We conclude that, during increasing exercise, rest TFs give an increasingly unreliable reconstruction of aortic pressure, especially at higher heart rates.

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