valvular insufficiency
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2021 ◽  
Vol 24 (6) ◽  
pp. E1054-E1056
Author(s):  
Mazen Shamsaldeen Faden ◽  
Nada Ahmed Noaman ◽  
Osman Osama Osman Osama ◽  
Ahmed Abdelrahman Elassal ◽  
Arwa Mohammed Al-ghamdi ◽  
...  

Ascending thoracic aortic aneurysms are rare in childhood and typically are seen in the setting of connective tissue defect syndromes. These aneurysms may lead to rupture, dissection, or valvular insufficiency, so root replacement is recommended. Here, we present a 17-month-old girl who presented with fever, cough, and pericardial effusion. Initially, we suspected this could be a COVID-19 case, so a nasopharyngeal swap was performed. An ascending aorta aneurysm involving the aortic arch was confirmed by echo, and urgent ascending aorta and arch replacement were done by utilizing the descending aorta as a new arch. The final diagnosis came with cutis laxa syndrome. In similar cases, good outcomes can be achieved with accurate diagnosis and appropriate surgical management.


2021 ◽  
Vol 102 (5) ◽  
pp. 597-605
Author(s):  
I M Ignatyev ◽  
V V Evseeva ◽  
S Yu Ahunova ◽  
E G Gradusov

Aim. To study the mechanisms of venous return and the functioning features of lower extremity venous valves in horizontal and vertical positions. Methods. The study, conducted from April 2019 to December 2020, included 100 people. The study participants were divided into 2 groups. The first group was represented by 44 patients (88 limbs) with varicose veins, whose venous system was examined by duplex ultrasound scanning during inpatient rehabilitation. The second (control) group consisted of 56 healthy individuals (92 limbs) without visible signs of venous pathology who underwent an outpatient examination of the venous system. The average age of the patients in the two groups was 49.22.4 and 51.11 years, respectively; women predominated in both groups. The qualitative and quantitative parameters of venous blood flow were studied in the study. Venous valvular insufficiency was assessed by using reflux duration and the Psatakis index. A morphometric study was conducted on 140 limbs of 48 human corpses, from which venous fragments were taken for biomechanical studies of the valves. The clinical characteristics of patients are presented by descriptive statistics, quantitative parameters are reported as the mean value (M) and standard deviation (SD). The differences were tested for significance by using the Student's t-test. Results. In the study, we introduced the concept of the valve index, the aspect ratio of the ellipse, the shape of which has a venous valve in cross-section. Duplex ultrasound scanning, as well as a morphofunctional examination of the valves, made it possible to establish that the valve index is significantly higher in the presence of signs of varicose veins, which indicates dilation and incipient varicose vein, which leads to valvular insufficiency. The elasticity index defined by us, as the indicator of change in the venous lumen size, measured by the ratio of its diameters, also significantly (p=0.034) differed in the studied groups: the elasticity index in the group of healthy people was 1.370.11, in the group of patients with varicose veins 1.560.17. The studied factors allowed us to develop a test that has an important prognostic value for the early diagnosis of varicose veins as well as the implementation of preventive health measures. Conclusion. The features of venous blood circulation and valve function studied in the study not only have prognostic value for the early diagnosis of varicose veins but are also of practical interest for developing methods of surgical correction of venous valvular insufficiency.


2020 ◽  
Vol 33 (6) ◽  
pp. 436-443
Author(s):  
Rosa Escudero-Sánchez ◽  
S. Scarleth Mendoza Lizardo ◽  
Elena Batlle López ◽  
Carolina Campelo Gutierrez ◽  
Juan Emilio Losa García ◽  
...  

Background. Infective endocarditis has a high morbidity and mortality and requires a coordinated medical-surgical management. The objective was to analyse the impact of surgery on mortality in a hospital without cardiac surgery. Material and methods. Evaluation of a prospective cohort of patients with infective endocarditis diagnosed between August 2011 and January 2016 according to modified Duke’s criteria. Results. Sixty-four patients were included, of whom seventeen patients were operated (26.6%). Mortality was 32.8% and it was associated with chronic obstructive pulmonary disease history, staphylococci coagulase-negative and the appearance of complications, as valvular insufficiency and embolisms in the central nervous system; cardiac surgery was not associated with mortality. Four patients (6,6%) were not operated despite indication of cardiac surgery. The main reason for not been intervened was the poor presurgical prognosis (44.7%). Conclusions. Mortality due to infective endocarditis in a hospital without cardiac surgery is high. The need for interhospital teams is strengthened.


Diagnostics ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 707
Author(s):  
Chien-Wei Chen ◽  
Yuan-Hsi Tseng ◽  
Min Yi Wong ◽  
Chao-Ming Wu ◽  
Bor-Shyh Lin ◽  
...  

Objectives: The distribution of venous pathology in stasis leg ulcers is unclear. The main reason for this uncertainty is the lack of objective diagnostic tools. To fill this gap, we assessed the effectiveness of triggered angiography non-contrast-enhanced (TRANCE)-magnetic resonance imaging (MRI) in determining the venous status of patients with stasis leg ulcers. Methods: This prospective observational study included the data of 23 patients with stasis leg ulcers who underwent TRANCE-MRI between April 2017 and May 2020; the data were retrospectively analyzed. TRANCE MRI utilizes differences in vascular signal intensity during the cardiac cycle for subsequent image subtraction, providing not only a venogram but also an arteriogram without the use of contrast agents or radiation. Results: TRANCE MRI revealed that the stasis leg ulcers of nine of the 23 patients could be attributed to valvular insufficiency and venous occlusion (including deep venous thrombosis [DVT], May–Thurner syndrome, and other external compression). Moreover, TRANCE MRI demonstrated no venous pathology in five patients (21.7%). We analyzed TRANCE MRI hemodynamic parameters, namely stroke volume, forward flow volume, backward flow volume, regurgitant fraction, absolute volume, mean flux, stroke distance, and mean velocity, in the external iliac vein, femoral vein, popliteal vein, and great saphenous vein (GSV) in three of the patients with valvular insufficiency and three of those with venous occlusion. We found that the mean velocity and stroke volume in the GSV was higher than that in the popliteal vein in all patients with venous valvular insufficiency. Conclusions: Stasis leg ulcers may have no underlying venous disease and could be confirmed by TRANCE-MRI. TRANCE MRI has good Interrater reliability between Duplex study in greater saphenous venous insufficiency. It also potentially surpasses existing diagnostic modalities in terms of distinguishable hemodynamic figures. Accordingly, TRANCE-MRI is a safe and useful tool for examining stasis leg ulcers and is extensively applied currently.


2020 ◽  
Vol 132 (4) ◽  
pp. 897-897 ◽  
Author(s):  
Donn Marciniak ◽  
Andrej Alfirevic ◽  
Raphaelle Chemtob ◽  
Per Wierup

2020 ◽  
Vol 27 (1) ◽  
pp. 105-125 ◽  
Author(s):  
Ivan N. Shanaev

Chronic diseases of the veins of the lower extremities include vascular pathologies within the venous system and exclude those, in which the veins suffer secondarily (chronic heart failure, iatrogenic damage, tumour occlusion). The main clinical and morphological forms of chronic diseases of the veins of the lower extremities include: varicose veins, post-thrombotic disease and phlebodysplasia. Moreover, according to publications, varicose disease accounts for the main percentage of occurrence, i.e. from about 70 to 86 %. Post-thrombotic disease occurs from 14 to 29 % of cases and develops, as a rule, during the first two years after an episode of deep vein thrombosis of the lower extremities in 20–50 % of patients. These two diseases are the main reason for the development of chronic venous insufficiency with a significant decrease in working capacity and quality of life under the age of 60. Despite the achievements of modern science, the ethiopathogenesis of these diseases is yet to be understood. Instrumental diagnostics allows a pathological retrograde blood fl ow due to the failure of the valves of the venous system of the lower extremities to be determined. However, the issue of what is primary — valvular insufficiency or venous wall deformation — remains open at the present time. This article is devoted to a review of modern theories about the mechanisms underpinning the formation of valvular insufficiency in varicose and post-thrombotic diseases. The review also addresses systemic hemodynamic disorders (heart morphology and hemodynamics) against the background of chronic diseases of the veins of lower extremities.


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