Brachial Blood Research Articles

Effect of Time Ratio of Heat to Cold on Brachial Artery Blood Velocity During Contrast Baths

Contrast baths have been adopted widely in clinics. However, the time ratio of heat to cold modalities has not been well established. The purpose of this study was to explore the effect of time ratio on brachial artery mean blood velocity (aMBV) and determine the optimal duration in the second heating phase. This was a within-participant, repeated-measures, experimental study. Thirty-four young volunteers who were healthy were recruited. Each participant performed 2 kinds of contrast baths within 2 separate sessions. In the first trial with a fixed time ratio, participants immersed their left hands in a 40°C hot bath for 3 minutes and then in an 18°C cold bath for 1 minute. This procedure was repeated 3 times. In the second trial, after the initial 3-minute hot bath and 1-minute cold bath, a 10-minute 40°C hot bath immersion was adopted as the second cycle. A color Doppler ultrasound scanner was used to measure aMBV, which was used to calculate the percentage of change related to the baseline (aMBV%) and the fluctuation in the heating phases (ΔaMBV%). In the first trial, compared with the first heating phase, the ΔaMBV% was significantly lower by 57% and by 46% in the second and third heating phases, respectively. In the second trial, the ΔaMBV% beyond the 7th minute did not reach a significantly lower level. The results cannot be generalized to elderly individuals or patients with medical conditions. A longer duration in the second heating phase during contrast baths was required to produce a sufficient fluctuation in blood flow.

Lack of association between flow-mediated endothelium-dependent vasodilatation and biomarkers of endothelial dysfunction in patients with severe rheumatoid arthritis

Accelerated atherogenesis is one of the main reasons for the increased mortality observed in patients with rheumatoid arthritis (RA) [1]. Progressive impairment of macrovascular and microvascular endothelium-dependent vasodilatation is associated with increased risk of cardiovascular complications. Endothelial function can be noninvasively assessed by postocclusive reactive hyperemia, either as increase in the brachial artery blood flow, as flowmediated vasodilatation of the afferent artery (macrovascular), or as increase in skin microcirculatory flow detected by laser Doppler. Both macrovascular and microvascular studies have confirmed the presence of endothelial dysfunction in patients with long-standing RA [2, 3]. Elevated circulating levels of soluble adhesion molecules are also associated with cardiovascular risk factors and predict atherosclerosis and CV events [4, 5]. Measurement of these biomarkers of endothelial activation and dysfunction has confirmed the presence of endothelial dysfunction in patients with RA [6]. Since administration of anti-TNF-a resulted in a rapid improvement in endothelial function in patients with this chronic inflammatory disease [7], and reduction in some biomarkers of endothelial dysfunction was also observed in these patients following anti-TNF-a drugs [8], an issue of potential interest may be to establish whether a correlation between the levels of soluble biomarkers of endothelial dysfunction and the presence of impairment of endothelium-dependent vasodilatation exists in patients with RA. In this regard, Meyer et al. [9] assessed whether microvascular changes in capillary blood cell velocity had correlation with levels of soluble adhesion molecules in 30 patients with RA. However, no correlation between capillary blood cell velocity and serum levels of soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble E-selectin (sE-selectin), and soluble P-selectin (sP-selectin) was found. To further investigate into this issue, we aimed to determine whether levels of serum biomarkers of endothelial dysfunction might correlate with values of macrovascular flowmediated endothelium-dependent vasodilatation in 14 patients with severe RA refractory to conventional diseasemodifying anti-rheumatic drugs. Ethical approval and informed consent were obtained. All patients had severe disease (DAS28 in all cases greater than 3.2), refractory to conventional disease-modifying anti-rheumatic drugs including methotrexate, and were receiving periodical treatment with infliximab therapy. Evaluation of brachial M. A. Gonzalez-Gay (&) Department of Rheumatology, Hospital Universitario Marques de Valdecilla, IFIMAV, Avenida de Valdecilla s/n, 39008 Santander, Spain e-mail: miguelaggay@hotmail.com

Subclavian Steal Syndrome

Duplex sonography of extracranial arteries is one of the best tools for identifying stenoses and other diseases of the carotid, vertebral, and subclavian arteries. Abnormal Doppler waveforms in vertebral arteries could be evidence of subclavian steal syndrome. The difference of 15 to 20 mm Hg or more in systolic bilateral brachial arterial blood pressure measurements provides important clinical information in patients with subclavian steal syndrome. Complementary to duplex sonographic scanning, radiologists use computerized tomography angiography, magnetic resonance angiography, and digital subtraction angiography for preoperative planning.

Iatrogenic Subclavian Steal Syndrome.

New complications are resulting from percutaneous transluminal angioplasty (PTA) and stent deployment. A 43-year-old female, admitted with weakness in the right arm, was diagnosed with right subclavian stenosis. Following PTA and a Palmaz stent deployment, her condition worsened, and symptoms spread. A corrective surgical procedure found the Palmaz stent to be almost completely compressed. The stent and plaques were carefully extracted. The etiology of compressed stent was probably due to an insufficient radial force or Hoop strength of stent. If an occlusion of the subclavian artery occurs at the segment proximal to the orifices of vertebral artery and internal mammary artery, a vertebral-subclavian steal syndrome may occur. This can be diagnosed in patients manifesting symptoms that include vertebral-basilar arterial insufficiency and a difference in brachial systolic blood pressure of at least 30 mm Hg between the two arms, with a bruit at the base of the neck or in the supraclavicular area. </hea

Noninvasive measures of vascular health are reliable in preschool-aged children

Measures of vascular health are known to be important predictors of cardiovascular disease in adulthood. The reliability of commonly used measures of vascular health has been demonstrated in school-aged children, adolescents, and adults; however, their reliability in preschool-aged children remains to be determined. Twenty 2- to 6-year-old children participated in 2 identical testing sessions on different days. Following 10 min of supine rest, carotid artery blood pressures and common carotid artery images were assessed simultaneously for 10 heart cycles, using applanation tonometry and B-mode ultrasound, respectively, while electrocardiogram (ECG) and infrared measures of arterial pressure waves at the dorsalis pedis were recorded continuously. Brachial artery blood pressures were determined using an automated oscillometric device. Carotid artery diameters and intima-media thickness (IMT) were analyzed using a semiautomated detection software program. Carotid compliance, distensibility, and stiffness index were calculated from carotid diameters and carotid blood pressures. Whole-body pulse-wave velocity (PWV) was determined from the time delay between the R spike of the ECG and the foot of the dorsalis pedis arterial pressure wave. Reliability of all measures was assessed using the coefficient of variation (CV) and the intraclass correlation coefficient (ICC). The most reliable measures were carotid artery IMT and PWV with CVs of 2.6% and 3.5% and ICCs of 0.86 and 0.76, respectively. The lower reliability of carotid compliance and distensibility (ICC≤0.63) is likely attributable to the variability of blood pressure measurements. This study confirms that vascular measurements demonstrate substantial reliability in preschool-aged children as young as 2 years.

High prevalence of peripheral arterial disease in patients with previous cerebrovascular or coronary event

Aim. The presence of peripheral arterial disease (PAD) in patients with other manifestations of cardiovascular disease identifies a population at increased risk of complications both during acute coronary events and on a long-term basis and possibly a population in whom secondary prevention of cardiovascular events should be addressed aggressively. The present study was aimed at providing a valid estimate on the prevalence of PAD in patients attending their general practitioner and having previously suffered a cardio- or cerebrovascular event. Patients and methods. 1000 patients with a previous cardiovascular event were screened and PAD was considered present when the ankle–brachial index (ABI) of systolic blood pressure was less than 0.90 using the current recommended technique. Results. 965 (659 men) patients met the inclusion criteria and had detectable systolic blood pressures on the arms and ankles. Mean age was 70±8 years, 77% were current or previous smokers, and 188 patients were diabetics. The medical history included stroke in 392, transitory ischemic attacks in 77, acute coronary syndrome in 298, and ST-elevation myocardial infarction in 253. Brachial systolic and diastolic blood pressures were 139±18 mmHg and 79±12 mmHg, respectively. Total and LDL-cholesterols were 4.5±1.0 mmol/l and 2.4±0.8 mmol/l, respectively. 625 patients were without PAD, 322 had mild to moderate PAD and 18 had severe PAD. The overall prevalence of PAD was 35.3%. Conclusion. In patients with previous coronary or cerebrovascular events, PAD occurs with a much higher prevalence than previously estimated. It is suggested that screening for PAD is justified and that it should be carried out in these patients in order to regulate the possible lifestyle and medical intervention.

Effect of Cycling Cadence and Exercise Intensity on Brachial Artery Antegrade and Retrograde Blood Velocities

Effect of Cycling Cadence and Exercise Intensity on Brachial Artery Antegrade and Retrograde Blood Velocities

Clinical application of the anterolateral thigh flap pedicled on the transverse branch of the lateral femoral circumflex artery for reconstruction of composite defects of the elbow

Objective To reconstruct soft tissue defect of the elbow combined with brachial artery injury using anterolateral thigh flap that used the transverse branch of the lateral femoral circumflex artery as the vessel pedicle, and evaluate the clinical results. Methods Eight cases of brachial artery injury along with soft tissue defect at the elbow were treated between March 2000 and February 2008. Primary repair of the tissue defect was done by free transfer of the anterolateral thigh flap using the transverse branch of the lateral femoral circumflex artery as the vessel pedicle. The transverse branch of the lateral femoral circumflex artery was simultaneously inserted between the two ends of the injured brachial artery (3 to 7 cm defect). The areas of the skin defect ranged from 12 cm×6 cm to 20 cm×10 cm. Results Limbs and flaps of the 8 cases all survived. Postoperative follow up ranged from 10 months to 21 months. There were no obvious bulkiness and scar contracture of the tlaps. The average ROM of the elbows was 105°(95° to 125°). In all 8 cases, the pulse strength of the distal ulnar and radial arteries was the same as that of the uninjured side. Ultrasound detection of the brachial artery revealed blood flow of the injured side similar to that of at the uninjured fide. Conclusion When there exists vascular variation of the descending branch of the lateral femoral circumflex artery during dissection of the anterolateral thigh flap, the transverse branch of the hteral femoral circumflex artery can be used as the vessel pedicle of the flap. Made as a flow-through flap, this flap can be transferred to recommit soft tissue defects of the elbow combined with brachial artery defect. Key words: Wounds and injuries; Brachial artery; Surgical flans; Microsurgery

Heart protection: a key target in the management of patients with diabetes

Cardiovascular disease is responsible for 70% of all mortality among patients with type 2 diabetes and is also a major contributor to diabetes-related healthcare costs. The ADVANCE trial clearly demonstrated that a simple and easily applicable pharmacological strategy based on perindopril/indapamide fixed combination could substantially reduce total and cardiovascular mortality (-14% and -18%, respectively). The observed benefits were largely caused by a substantial decrease in systolic blood pressure (SBP), confirming the need to have ambitious therapeutic goals in such high-risk patients. This point is of importance because most of the patients included in the trial were being treated for hypertension, and baseline brachial SBP and diastolic blood pressure at inclusion were very close to normal. Previous mechanistic studies have highlighted the positive effect of perindopril/indapamide fixed combination on large artery function as well as on microvascular structure. For example, in the REASON trial, in patients treated with perindopril/indapamide, the decrease in central aortic SBP, which closely correlated with the decrease in left ventricular hypertrophy, reflected a significant improvement in large artery function and a changing pattern in both peripheral reflection coefficients and structural arteriolar network. These data are supported by those from other studies, which show increases in coronary blood flow reserve with perindopril/indapamide treatment. In conclusion, normalization of SBP, pulse pressure, arterial function and myocardial perfusion, a haemodynamic profile known to improve survival in the hypertensive populations at high cardiovascular risk, seems to be more easily achieved when a strategy based on the perindopril/indapamide combination is applied.

Heterogeneity in age related central arterial stiffening: ascending aortic stiffness is a better predictor of carotid to femoral pulse wave velocity and brachial peripheral blood pressure than carotid stiffness

Heterogeneity in age related central arterial stiffening: ascending aortic stiffness is a better predictor of carotid to femoral pulse wave velocity and brachial peripheral blood pressure than carotid stiffness

A new anatomical technique to investigate nerves by imagery

We describe a novel post mortem technique that makes it possible to visualise the nerve structure of the brachial plexus using imaging. We dissected in situ the brachial plexus of a cadaver preserved by formaldehyde. A preparation composed of a mixture of baryte powder, water and colorant, was applied to all sides of the brachial plexus and blood vessels of the region under study. A high resolution CT scan was performed. With the aid of Mimics (Materialise) software, segmentation of all the nerve and vascular structures on each of the 650 slices obtained was performed. The Mimics software then compiled all the slices to generate a 3-dimensional STL image. The image obtained was printed with a stereolythography printer, to produce a plastic model representing part of the cervico-thoracic spinal cord, the ribs, sternum, scapula, humerus, and clavicle, with the left brachial plexus and the subclavian, axillary and brachial veins and arteries. This technique has the potential for a wide range of uses: for teaching anatomy, to improve teaching of medical techniques, 3-dimensional modelisation of other nerve structures. The advantage is that the model obtained is a faithful and realistic reproduction.

Pioglitazone does not Affect Vascular or Inflammatory Responses after Endotoxemia in Humans

PPARgamma agonists have been proposed to exert more than metabolic benefits, particularly by anti-inflammatory mechanisms. We hypothesized that pioglitazone might modulate inflammatory and vascular responses to lipopolysaccharide (LPS). In a placebo-controlled parallel-group study in 18 healthy male subjects, the E. coli endotoxin model of inflammation (20 IU/kg i. v.) was employed to test the effect of 60 mg pioglitazone over nine days on inflammatory cytokines. Macrovascular function and microvascular blood flow were assessed by brachial artery ultrasound and retinal blood flow parameters, respectively. Pioglitazone increased brachial artery diameter by 5.6% but had no effect on other outcome parameters under resting conditions. LPS increased cytokine levels to peak concentrations of 91.3+/-22.5 ng/ml (IL-6), 261.4+/-60.0 ng/ml (TNFalpha), and 524.5+/-15.3 ng/ml (VCAM-1). The endotoxin caused microvascular vasodilation and increased retinal white blood cell flux, while baseline brachial artery diameter remained unchanged. Pioglitazone had no effect on inflammatory cytokine or adhesion molecule release but mitigated LPS-induced hypotension (p<0.05). Neither brachial artery function nor microvascular blood flow was altered by pioglitazone. In conclusion, acute immune reactions to LPS are not affected by pioglitazone, which exerts subtle vascular effects alone and during endotoxemia. The anti-inflammatory properties of short-term pioglitazone to endotoxins in healthy subjects are therefore limited.

Impaired Brachial Artery Endothelial Flow-Mediated Dilation and Orthostatic Stress in Hemodialysis Patients

Chronic kidney disease (CKD) is associated with an impaired endothelial function, which may contribute to cardiovascular events. Whether impairment in endothelial function is involved in the circulatory response to orthostatic stress is unknown. We assessed endothelial function via brachial artery flow-mediated dilation (BAFMD), an index of endothelial-dependent vasodilation. We measured changes in brachial artery diameter (BAD) and blood flow by Doppler ultrasound in 35 CKD patients on hemodialysis, 37 young healthy controls (HC) and 50 non-uremic matched controls (MC), in the supine position and after 60 degrees head-up tilting (HUT). In the supine position, endothelial flow-mediated BAD was significantly increased in HC (p<0.001) and MC (p<0.01) while no significant changes were detected in CKD. Mean percent blood flow changes were HC+323.5%, MC+195.1% and CKD+158.8% (HC vs. CKD p<0.001; HC vs. MC p<0.001; MC vs. CKD p=0.04). Similarly, during HUT mean BAD and blood flow increases were significantly impaired in CKD patients. In CKD patients, an impaired response in the physiologic vascular reactivity, suggesting endothelial dysfunction, was found in the supine position and after orthostasis by BAFMD. Our results are in favor of a possible adjunctive role of uremia in the abnormal brachial artery response.

Abstract 3543: Long-Term Benefits of Cardiac Rehabilitation in Patients With Incomplete Revascularization: 5-Year Follow-up.

There is evidence that cardiac rehabilitation (CR) determines important benefits in patients with coronary artery disease(CAD). However, it is unclear whether CR may improve the outcome of pts with incomplete revascularization (IR) after PTCA/stenting and/or coronary artery bypass surgery (CABG). From 1/1/2002 to 30/11/2004, we prospectively studied 259 patients with CAD who underwent PTCA after a SCA or CABG in 1(10/7%, respectively), 2(20/19%) and 3 major coronary arteries (70/74%). Patients were randomized into 2 homogeneous groups on the basis of the results of cardiopulmonary exercise stress testing(CPET) performed twice one week apart: a group with a positive CPET for inducible ischemia (P, n=129), and a group with a negative CPET (N, n=130). Patients were further randomized into 2 groups. The intervention group(Group CR) received CR combining exercise training (60%peak VO2, 3 times a week for 8 weeks)+ nutrition counseling+ standard medications (65P+65N, 25% women, mean age 56±8 years), while the control group (Group C) had no CR (65P+64N, 25% women, mean age 58±8 years). On entry and at 8 weeks all patients underwent CPET, brachial artery flow-mediated dilation (BA-FMD) and blood chemistry. Group CR-N had more marked improvements in peak VO2 and FMD than CR-P (P&lt;0.001 for both). However, CPET became negative in 22% post PTCA CR-P patients and 28% post CABG CR-P (P&lt;0.001 vs initial). After 8 weeks, group CR was recommended to continue a home program of exercise training with periodic supervision at the hospital’s gym, while group C was not. At 5 years, both peak VO2 and FMD were significantly higher in CR (P&lt;0.01 vs C) with no differences between CR-P and CR-N. Cardiovascular risk profile (CVRP) was significantly improved in CR (P&lt;0.01 vs C). Cardiac events were significantly lower in CR than C : new acute coronary syndrome (P&lt;0.001); new PCI (P&lt;0.0001); new CABG(P&lt;0.001); hospital readmission: (P&lt;0.0001); cardiac death (P&lt;0.05). Multivariate analysis demonstrated that the lower rate of events in CR was not collinear with changes in CVRP. In conclusion, IHD patients with IR take advantage from CR and maintain a higher functional capacity and a better control of CVRP at 5 years. These benefits were associated with a better outcome.

Abstract 2741: Paradoxical Reduction in Pulse Wave Reflection Following Maximal Exercise in Patients with Type 2 Diabetes Mellitus: Association with Exercise Central Blood Pressure

Background: Patients with type 2 diabetes mellitus (T2DM) have increased large artery stiffness and exaggerated brachial and central systolic blood pressure (SBP) responses to exercise. Elevations in exercise central SBP may be a result of increased arterial wave reflections and this study aimed to test this hypothesis. Methods: Maximal exercise stress tests were conducted in 50 T2DM patients (55 ± 8y, 70% males) and 50 controls (56 ± 8y, 70% males) matched by age, gender, maximal exercise brachial SBP and heart rate. Brachial and central BP were measured at rest and immediately post-exercise. Augmentation index (AIx), augmented pressure (AP; markers of wave reflection) and central SBP were recorded by radial tonometry. Results: Despite no significant differences between groups in maximal exercise brachial or central SBP, AIx and AP were significantly lower in T2DM patients (Table ). Exercise central SBP was inversely and independently associated with exercise AIx in the T2DM patients (β= -0.32; p=0.05) but not controls (β= -0.10; p=0.49). The presence of T2DM was also identified as a weak but significant independent determinant of exercise AIx (β= -0.19) and central SBP (β= 0.10; p&lt;0.05 both). Conclusions: Patients with T2DM have 1) a paradoxical reduction in wave reflection at maximal exercise and 2) a significant inverse association between wave reflection and exercise central SBP that is not observed in controls. The reduced reflected pressure waves may indicate an increase in peripheral vasodilation to offset high exercise central BP. Exercise hemodynamics in T2DM patients and controls

Remodeling of cardiovascular system and function of parathyroid glands in patients with arterial hypertension

Features of structural and functional remodeling of the left ventricular and brachial artery and parathyroid hormone blood levels are studied in 95 patients with arterial hypertension. It was shown that increased parathyroid hormone blood levels correlate with increased frequency and evidence of remodeling of left ventricular and brachial artery, also significant decrease in diastolic function and endothelium-dependent vasodilatation. 21.6 % of hypertensive patients have asymptomic of parathyroid hormone hyper secretion. Pathological type of circadian blood pressure profile was observed in these patients.

Favorable Effect of Sublingual Nitrate on Carotid Flow and Pressure Augmentation index

Backgrounds and Purpose: Cerebral microvascular disease (CMD) is increased in the presence of aortic stiffening. We have reported a close relation between carotid flow augmentation index (FAI) and pressure augmentation index (PAI) and have hypothesized that late systolic flow augmentation (FA) in the common carotid artery (CCA), accelerated by wave reflection, causes CMD in subjects with stiffened arteries (Stroke. 2006). To validate this hypothesis under challenge, we investigated the effects of nitroglycerin (NG) on the FA in the CCA. Methods: We recorded pressure and flow velocity waveforms simultaneously in the CCA of nine subjects with coronary heart disease aged 44–72 years before and after sublingual NG (0.3mg). Measurements were taken at baseline and every minute after NG for 8min. Results: Effects of NG reached plateau at 4min and maintained to end of the study. With a little change in brachial diastolic blood pressure (−3mmHg, p= 0.02) flow physiology assessments, for which constant crosssectional area, temperature and intravascular volume in the studied artery are pre-requisites. Methods: Four baboons were anaesthetised and femoral vascular access obtained. A Doppler sensing 0.014 in. FloWireTM and a temperature and pressure sensing 0.014 in.PressureWireTMwereplaced inasegmental lower lobe artery. Selective angiograms, vdopp and pressures were obtained at baseline and at increasing normal saline (NS) infusion rates and boluses. Intravascular temperatures were also recorded. Results: There was no change in vdopp in response to increasing NS infusion rates (25.6± 7.8, 25± 8, 24.8± 7 cm/s at 0, 5 & 15mL/min respectively (p= 0.5)), or boluses (29± 1, 28.3± 0.6, 28.3± 1.5, 28.3± 0.6 cm/s at 0, 2, 5 and 8ml respectively (p= 0.8)). There was no change in vessel diameter with NS infusions or boluses (p= 0.9 & 0.4 respectively). Similarly, there was no change in intravascular temperature (AT vs. left pulmonary artery temperature; 0.02± 0.02, 0.02± 0.02 ◦C at distal and proximal segmental pulmonary artery respectively (p= 0.1)). Conclusions: Segmental pulmonary artery vdopp and Tmn can be reliably obtained using specialised sensor guidewires. Constant vessel cross-sectional area, temperature and volume are maintained under varying haemodynamic loading, thus facilitating accurate pulmonary flow assessments using such guidewires in and heart rate (+2.9 beats/min, p= 0.002), FA [late systolic peak flow velocity – end diastolic flow velocity (Ved)] decreased from 19.4± 1.8 cm/min to 11.5± 1.7 cm/min (averaged value during 4 to 8min), FAI [FA/(peak systolic flowvelocity-Ved)] from59.9± 3.5%to39.8± 3.9%,andPAI from 30.9± 2.6% to 11.2± 4.5% (all, p< 0.0001). Correlation of FAI and PAI was maintained after NG. Conclusions: The present study confirmed the functional relation betweenpressurewave reflection and late systolic flow augmentation in the CCA. Measurement of FAI may provide a gauge of risk for cerebral microvascular disease and expose a new therapeutic strategy against stroke.

Systolic hypertension in young adults: spurious definition of a genuine condition

[1] for their criticisms about our editorial comment on spurious systolic hypertension [2]. Their remarks allow us to realize that a misunderstanding arose concerning the definition we used for the condition: 'spurious systolic hypertension is defined by a high brachial systolic blood pressure but a normal aortic systolic pressure estimated indirectly by a non-invasive technique using the SphygmoCor device'. The term 'normal' is probably unsuitable. Hulsen

The Effect of Fundal Pressure at Cesarean Section on Maternal Hemodynamics

Applying pressure on the uterine fundus to hasten passage of the fetus through the hysterotomy during cesarean delivery is generally viewed as harmless, in part because pressure usually is directed caudally for only a brief time. It is possible, however, that pressure will inadvertently be directed to the maternal spinal column and thereby compress the inferior vena cava or the aorta. The investigators monitored brachial artery blood pressure, heart rate, and cardiac output (using an esophageal Doppler probe) in 20 hemodynamically stable women having cesarean section under general anesthesia before and during the extraabdominal application of pressure on the uterine fundus. Fundal pressure was applied for an average of approximately 3 seconds. Mean systolic aortic blood flow time, cardiac output, heart rate, and arterial blood pressure all decreased significantly during the time pressure was applied compared with values recorded after uterine incision. Peak velocity and stroke distance of aortic flow remained similar to what was observed after uterine incision. Neither the mothers nor their infants appeared to be clinically compromised in any way. All infants had 1- and 5-minute Apgar scores higher than 8. Two women required red cell transfusions because of uterine bleeding. The brief extra-abdominal application of pressure on the uterine fundus during cesarean delivery reduced cardiac preload and heart rate, and therefore cardiac output, in these women, but all values remained within the normal range. Although fundal pressure did produce significant changes in maternal hemodynamics, there was no evidence of clinically significant adverse effects on either the mother or infant.

Effects of iodinated contrast media on common carotid and brachial artery blood flow and wall shear stress

Effects of iodinated contrast media on common carotid and brachial artery blood flow and wall shear stress