Artery Stenosis Research Articles

Modify homotopy perturbation method using yang transform to study the effect of magnetic field with mass and heat transfer on pulsatile blood flow in tapered stenosis arteries

AbstractThe effect of a magnetic field on two‐dimensional pulsatile blood flow in tapered stenosis arteries was studied by employing the Yang transform homotopy perturbation method (YTHPM). The mathematical model which was solved by the researchers Liu and Liu, was successfully developed by adding the effect of a magnetic field for the blood flow in addition to the effect of mass and heat transfer on it. The impact of the angle of tapering, the Grashof number, the solutal Grashof number, and the magnetic field on the axial velocity, the wall shear stress, flow resistance, and the volumetric flow rate was investigated in two cases absence and presence of the magnetic field. The results prove that YTHPM is efficacious and highly accurate in finding the analytical approximate solution for pulsatile blood flow in tapered stenosis arteries under the influence of a magnetic field. The convergence of the new solutions is also discussed in the absence and presence of the magnetic field. Further, the graphs of these new solutions show the validity of, a necessity for, and utility of YTHPM, and are in line with results put forward by other studies.

Nonlinear dynamics of blood passing through an overlapped stenotic artery with copper nanoparticles

Abstract The dynamics of blood carrying microscopic copper particles through overlapping stenotic arteries is an important research area needed for scrutinizing and exploring dynamics through blood vessels. Adipose tissue deposition and other elements of atherosclerosis generate the uncommon artery disease known as arterial stenosis. It limits blood flow and raises the risk of heart disease. Using the Casson model, it is feasible to shed light on the peristaltic blood flow of copper nanoparticles over an overlapping stenotic artery. Nothing is known about the study of heat sink/source, buoyancy and Lorent force, and volume fraction because the focus is on the dynamics of blood carrying minute copper particles through an overlapping stenotic artery. When the Lorentz force is significant, the transport mentioned above was evaluated utilizing stenosis approximations to examine the stream function, wall shear stress, Nusselt number, and flow resistance distribution. In addition, temperature solutions were identified analytically, whereas a perturbation approach acquired velocity solutions. Temperature distribution and velocity are greater in stenosed arteries than in unstenosed arteries. Furthermore, extreme velocity and temperature rise as it reaches the core of the artery and falls as one approaches the wall. When the heat source parameter values increase due to an improvement in the fluid’s thermal state, the temperature distribution increases.

Impact of magnetic resonance angiography parameters on stroke prevention therapy in pediatric patients with sickle cell anemia.

Degree of cerebrovascular stenosis in pediatric patients with sickle cell anemia (SCA) informs need for chronic transfusion therapy, which has significant risks. Flow artifact, intrinsic to magnetic resonance angiography (MRA), is dependent on technical parameters and can lead to overinterpretation of stenosis. The primary objective of this study was to document any change in stroke prevention therapy that could be attributed to the implementation of a standardized MRA scanning protocol for patients with SCA. A standardized MRA scanning protocol with an echo time of less than 5ms was implemented at Montefiore Medical Center (MMC), NY in May 2016. Retrospective chart review identified 21 pediatric patients with SCA, with an MRA head both pre- and post-May 2016. Arterial stenosis on MRA, machine parameters, and treatment plans were compared pre- and post-implementation. Ten of the 21 patients met inclusion criteria. Previously seen stenosis was re-classified to a lower degree in six of the 10 patients, leading to discontinuation of transfusions in five patients. No patients required escalation of therapy to chronic transfusions. Optimizing flow artifact by decreasing echo time to less than 5ms can improve accurate interpretation of cerebrovascular disease, and ensure appropriate treatment plans are in place for stroke prevention. This is especially important for implementing "TCD With Transfusions Changing to Hydroxyurea (TWiTCH)" clinical trial results in the real-world setting.

Adenosine Receptors Profile in Fibromuscular Dysplasia.

Fibromuscular dysplasia (FMD) is a non-inflammatory vascular disease that is characterized by unexplained systemic hypertension occurring in young people, associated with arterial stenosis, aneurysm rupture, intracranial/renal infarction, and stroke. Although the gold standard for the diagnosis remains catheter-angiography, biological markers would be helpful due to the delay from first symptom to diagnosis. Adenosine is an ATP derivative, that may be implicated in FMD pathophysiology. We hypothesized that changes in adenosine blood level (ABL) and production of adenosine receptors may be associated with FMD. Using peripheral blood mononuclear cells, we evaluated A1, A2A, and A2B receptor production by Western blot, in 67 patients (17 men and 50 women, mean (range) age 55 (29-77) years and 40 controls, 10 men and 30 women, mean (range) age 56 (37-70)). ABL was evaluated by liquid chromatography, mass spectrometry. ABL was significantly higher in patients vs. controls, mean (range): 1.7 (0.7-3) µmol/L vs. controls 0.6 (0.4-0.8) µmol/L (+180%) p < 0.001. While A1R and A2AR production did not differ in patients and controls, we found an over-production of A2BR in patients: 1.70 (0.90-2.40; arbitrary units) vs. controls = 1.03 (0.70-1.40), mean + 65% (p < 0.001). A2BR production with a cut off of 1.3 arbitrary units, gives a good sensitivity and specificity for the diagnosis. Production measurement of A2BR on monocytes and ABL could help in the diagnosis, especially in atypical or with poor symptoms.

Nonsplenorenal Spontaneous Portosystemic Shunts in Liver Transplant Attitude and Outcomes: A Single-Center Series

Management of nonsplenorenal spontaneous portosystemic shunts (NSRSPSS) in liver transplant (LT) is controversial. Reports on the influence of its ligation suggest improvements in morbidity and survival. Retrospective study of a single-center series. The objective was to analyze the outcomes and post-LT survival after the closure of NSRSPSS. Between January 2005 and April 2021 a total of 23 patients with NSRSPSS underwent LT. The shunt was superior mesenteric vein-vena cava in 12 (52.2%), inferior mesenteric vein-vena cava in 6 (26.1%), through the left gastric vein in 4 (17.4%), and portocava in 1 (4.3%). Seven patients presented portal vein thrombosis, with thrombectomy being performed in 5. Moreover, 21 patients had portoportal anastomosis, 1 patient required portal reconstruction at the splenomesenteric confluence, and 1 had a coronary-portal anastomosis. The NSRSPSS was closed in 22 cases (95.7%). The mean (SD) portal flow before and after the closure of NSRSPSS was 1395 (572) mL/min and 1773 (583) mL/min (104.4 [47.9] mL/min/100 g and 127.9 [4.9] mL/min/100 g, respectively). Six patients (26.1%) presented primary graft dysfunction, 13 (56.5%) acute kidney injury, and 9 (39%) ascites. Three arterial stenoses (13%), 2 biliary stenoses (8.6%), and 1 intrahepatic portal thrombosis (4.3%) occurred. Median intensive care unit and hospital stay was 5 days (range, 3-8 days) and 15 days (range, 13-21 days). After a mean follow-up of 5.18 (3.2) years, all patients except 1 are alive. The closure of the NSRSPSS during LT can optimize portal flow, with potential influence in morbidity and survival rates.

A relative study on blood-based cross ferrofluid flow over a stenosis artery

This article inspects two-dimensional magnetized hybrid blood flow behavior through cosine-shaped stenosis arteries. Iron oxide (Fe3O4) and Cobalt ferrite (CoFe2O4) nanoparticles are considered in blood flow. Also, Maxwell and Jeffrey’s models are taken individually to compare the results of flow and heat transmission. The Darcy–Forchheimer conditions, nonlinear thermal emission, Joule heating, and heat sink/source effects are applied for physical relevance. The governing equations are composed of slip and injective boundary conditions and changed into the ordinary differential equations using suitable similarities. Converted equations together with limiting conditions are solved numerically. The relative outcomes for Maxwell and Jeffrey ferrofluids are obtained and explored through tabular and pictorial representation. This study reveals that the drugs in the blood can regulate at the desired level with the help of physical effects and a suitable flow model. It is found that the hybrid Ferrous nanoparticles composed with the Maxwell flow model enhance the heat transmission rate significantly compared to the Jeffrey flow model. The natural magnetism applications of ferrous nanoparticles can be helpful in separating one tissue from another, which can help in the nanosurgery of tumors.

In vitro prediction of the lower/upper-critical biofluid flow choking index and in vivo demonstration of flow choking in the stenosis artery of the animal with air embolism

<i>In vitro</i> prediction of the lower/upper-critical biofluid flow choking index and <i>in vivo</i> demonstration of flow choking in the stenosis artery of the animal with air embolism

Numerical simulation of the fractional Maxwell fluid flow in locally narrow artery

Research on hemorheology and blood flow behavior in non-uniform vessels is of extreme significance for diagnosis and treatment of many cardiovascular diseases. The aim of this study is to reveal the hemodynamics in stenotic vessels, and provide a reference for formulating a clinical operation plan. A set of rheological data of human blood at 37° is utilized in the paper to construct the fractional Maxwell constitutive equation of blood. Consequently, the continuity and momentum equations of a fractional Maxwell fluid passing through a stenosis artery in a two-dimensional cylindrical coordinate system are established. With the help of the vorticity and stream function, the finite difference method combined with the fractional order derivative L1 algorithm is applied to acquire the numerical solutions of the velocity, wall shear stress and intravascular pressure gradient, and the validity of the algorithm is verified. Furthermore, the effects of the stenosis degree, stenosis shoulder length, various Reynolds numbers and fractional parameter α on the blood flow characteristics in stenosis are analyzed.

A case of laparoscopic distal gastrectomy and median arcuate ligament release for a gastric cancer patient with median arcuate ligament syndrome

BackgroundThe median arcuate ligament syndrome (MALS) is a disease in which the celiac artery is compressed by the arcuate ligament and causes stenosis. If abdominal pain or an aneurysm is observed in the head of the pancreas, it is necessary to release the arcuate ligament, and recently laparoscopic surgery has been reported. However, the indication for treatment in asymptomatic cases is unknown. The treatment for asymptomatic MALS in patients with gastric cancer who are indicated for surgery is also novel.Case presentationA 70-year-old female was found with early gastric cancer in the middle body of the stomach. An enhanced CT scan showed no metastasis, but a gallstone and stenosis of the celiac artery due to the MALS were found. The patient underwent releasing median arcuate ligament after lymph node dissection. A median arcuate ligament was located on the ventral side of the left gastric artery stump, and the celiac artery was exposed when cutting it off. The operation time was 4 h and 59 min, and the bleeding was 6 ml. It took about 5 min to dissect the medial arcuate ligament. The postoperative course was satisfactory, and the patient was discharged 7 days after the operation. CT scan and 3-D CT angiography were performed about 2 months after the operation, and the findings revealed that the celiac artery's stenosis resolved.ConclusionThe patient underwent laparoscopic gastrectomy and simultaneously the median arcuate ligament release under an excellent visual field. Therefore, median arcuate ligament release may be considered if MALS is found in a gastrectomy case.

Blood Flow of Au-Nanofluid Using Sisko Model in Stenotic Artery with Porous Walls and Viscous Dissipation Effect.

Nanofluids are extremely useful to investigators due to their greater heat transfer rates, which have significant applications in multiple industries. The primary objective of this article is to look into the effect of viscous dissipation in Sisko nano liquid flow with gold nanoparticles on a porous stenosis artery. Heat transfer properties were explored. Blood was utilized as a base fluid for nanoparticles. To renovate the governing nonlinear PDEs into nonlinear ODEs, appropriate transformations were used. The bvp4c-based shooting method, via MATLAB, was used to determine the numerical results of the nonlinear ODEs. Furthermore, flow forecasts for each physical quantity were explored. To demonstrate the physical influences of flow constraints versus presumed flow fields, physical explanations were used. The findings demonstrated that the velocity contour improved as the volume fraction, curvature, power law index, and material parameter upsurged. For the Prandtl number, the volume fraction of nanoparticles, the index of the power law, and the temperature profile of the nanofluid declined. Furthermore, the drag force and transfer of the heat were also investigated as explanations for influences on blood flow. Further, the Nusselt number reduced and the drag force enhanced as the curvature parameter values increased. The modeling and numerical solutions play an impressive role in predicting the cause of atherosclerosis.

Abstract P3028: Animal In Vivo: The Proof Of Flow Choking And Bulging Of The Downstream Region Of The Stenosis Artery Due To Air Embolism

Background: Evidences are escalating on the asymptomatic cardiovascular diseases and disorders associated with air embolism due to the flow choking (biofluid/Sanal flow choking) [PMID: 32837737 &amp; PMID: 34326352]. Flow choking occurs anywhere in the circulatory system at a critical systolic to diastolic blood pressure ratio (BPR) &lt;https://doi.org/10.1161/res.129.suppl_1.P422&gt;. Flow choking leads to the shock-wave generation followed by pressure overshoots if the downstream region of the choked artery is having divergence/bifurcation regions. Methods: Animal in vivo study has been carried out on 6 th December 2021, IST: 2:00-4:00 PM (the FIRST in the World) for establishing the phenomenon of flow choking in a stenosis artery at a critical BPR due to air embolism. The high pressure air is injected into the upstream region of the stenosis using a syringe (see Fig.1(a)). Stenosis is created using a knot. Syringe infusion pump is used for altering the flow rate and upstream pressure. The multiple animal in vivo studies were carried out on 31 st December 2021 . It aims for demonstrating the phenomenon of flow choking followed by bulging and/or tearing of the downstream region of the stenosis artery of a small animal. Results: Figure 1(b) shows the animal in vivo (with the approval of the ethics committee) for the live demonstration of flow choking and bulging in a stenosis artery due to air embolism. Herein, we established the proof of the concept of flow choking due to air embolism in the stenosis-artery at a critical BPR (SBP/DBP) causing the risk of asymptomatic cardiovascular diseases and disorders. Conclusions: We concluded that at a critical BPR, the flow choking occurs in any artery. The shock wave generation due to flow choking leads to cardiovascular risk. Frequent flow choking creates memory effects (stroke history) in the downstream region due to the enhanced wall stiffness as a result of pressure-overshoot due to multiple shock waves. We further concluded that the critical BPR is a risk factor of flow choking causing asymptomatic cardiovascular disease, if the downstream region of the choked artery is having divergent shape.

Antibodies to herpes simplex virus type 1 in patients with coronary heart disease

Background and Aims : Atherosclerosis is a chronic inflammatory disease and metabolic disorder that can manifest itself as myocardial infarction (MI), ischemic stroke (AI) or other conditions caused by artery stenosis. Despite significant advances in prevention and treatment, coronary heart disease (CHD) remain the leading causes of morbidity worldwide, accounting for about a third of all deaths. The aim of the study is to determine antibodies to herpes virus 1 (HSV-1) in patients with CHD who have undergone MI as a possible marker of the course of the disease.

Construction and Evaluation of Small-Diameter Bioartificial Arteries Based on a Combined-Mold Technology.

Arterial stenosis or blockage is the leading cause of cardiovascular disease, and the common solution is to substitute the arteries by autologous veins or bypass the blood vessels physically. With the development of science and technology, arteries with diameter larger than 6 mm can be substituted by unbiodegradable polymers, such as polytetrafluoroethylene, clinically. Nevertheless, the construction of a small-diameter (less than 6 mm) artery with living cells has always been a thorny problem. In this study, a suit of combined mold was designed and forged for constructing small-diameter arterial vessels. Based on this combined mold, bioactive arterial vessels containing adipose-derived stem cells (ASCs) and different growth factors (GFs) were assembled together to mimic the inner and middle layers of the natural arteries. Before assembling, ASCs and GFs were loaded into a gelatin/alginate hydrogel. To enhance the mechanical property of the bilayer arterial vessels, polylactic–glycolic acid (PLGA) was applied on the surface of the bilayer vessels to form the outer third layer. The biocompatibility, morphology and mechanical property of the constructed triple-layer arterial vessels were characterized. The morphological results manifested that cells grow well in the gelatin/alginate hydrogels, and ASCs were differentiated into endothelial cells (ECs) and smooth muscle cells (SMCs), respectively. In addition, under the action of shear stress produced by the flow of the culture medium, cells in the hydrogels with high density were connected to each other, similar to the natural vascular endothelial tissues (i.e., endothelia). Especially, the mechanical property of the triple-layer arterial vessels can well meet the anti-stress requirements as human blood vessels. In a word, a small-diameter arterial vessel was successfully constructed through the combined mold and has a promising application prospect as a clinical small-diameter vessel graft.

Lifelong impact of ENPP1 Deficiency and the early onset form of ABCC6 Deficiency from patient or caregiver perspective.

The ectonucleotide pyrophosphatase/phosphodiesterase family member 1 (ENPP1) and ATP-binding cassette subfamily C member 6 (ABCC6) proteins play a prominent role in inhibiting ectopic calcification and arterial stenosis. Patients with ENPP1 Deficiency or infant onset ABCC6 Deficiency often present with pathological calcification, narrowed blood vessels, multiorgan dysfunction and high infant mortality. The heterogenous presentation and progression is well documented. Our objective was to characterize how these morbidities lead to burden of illness and poor quality of life across ages from the patient/caregiver perspective. Patients/caregivers were interviewed via phone using Institutional Review Board–approved questionnaires. Patient-reported outcomes were collected via validated instruments. Thirty-one caregivers and 7 patients participated: infant onset ABCC6 Deficiency, n = 6 (infants/children); ENPP1 Deficiency, n = 32 (13 infants, 12 children, 7 adults). ENPP1 and ABCC6-deficient children aged <8 years and aged 8–18 years reported poor school functioning (0.69 vs 0.72 effect size, respectively) and poor physical health (0.88 vs 1, respectively). In the total ENPP1 cohort, 72% (23/32) reported bone/joint pain and/or mobility/fatigue issues. Three of seven ENPP1-deficient adults reported moderate to severe pain (>4), as measured by the Brief Pain Inventory (BPI), that interfered with daily activities despite pain medication. Top reported burdens for caregivers of infants with ABCC6/ENPP1 Deficiencies included heart-related issues and hospitalizations. Treatment/medications, and hearing loss were the highest burdens reported by caregivers/families of the pediatric ENPP1 Deficiency cohort, whereas adults reported bone/joint pain and mobility impairment as the greatest burdens. Individuals with ENPP1 Deficiency or infant onset ABCC6 Deficiency experience lifelong morbidity causing substantial physical and emotional burden to patients/caregivers.

Modern aspects of the problem of obliterating thrombangiitis

To present some pathogenesis, diagnostics and treatment of thromboangiitis obliterans (TAO) discussion items in accordance with the contemporary views on the nomenclature, classification, pathogenesis and treatment of rheumatic diseases. Materials and methods. 115 patients with thromboangiitis obliterans under observation in Interregional Consultative Center for the patients with systemic rheumatic diseases were examined. The complex analysis of peripheral circulation was carried out by ultrasonic scintiangiography. The methods of study included: morphological analysis of biopsy, autopsic and operating material by histochemical methods; immunofluorescent method was used for detecting the immune complexes. In 224 patients with systemic vasculitides (SV) serological markers, including the wide spectrum of autoantibodies, C-reactive protein, complement, von Willebrand factor antigen as a marker of defeat of vascular wall were detected. Results. Most diagnostically significant criteria were: age younger than 45 years, male sex, smoking, distal vascular lesions of the extremities and confirmation of thromboangiitis obliterans by musculocutaneous biopsy. The involvement of small- and medium-sized arteries and also thrombophlebitis and phlebemphraxis were typical. Reliable diagnosis could have been considered when scintiangiography data that testified about the contraction or occlusion of distal arteries of extremities, and the results of biopsy were presented. Morphological substratum was a destructive-productive or productive thrombovasculitis of middleand small-sized arteries and veins. Necrotic destructive-infiltrative and destructive-proliferative arteriitis, accompanied by fibrinoid necrosis of the arterial wall and by its infiltration with neutrophils were revealed with the productive. The thromboses were revealed with these arteriitis more frequently, and in the wall of such arteries immune complexes were observed. Ischemic manifestations were connected not only with arterial stenosis, but also with microangiosclerosis. Differential diagnostic signs of atherosclerosis were represented. Involving of small- and middle-sized arteries was typical for thromboangiitis obliterans and large- and middle- sized arteries — for atherosclerosis. The thrombophlebitis and phlebothrombosis were characteristic for TAO. No specific laboratory tests were available to confirm TAO diagnosis. It should be noted the specific diagnostic tests and positive serological markers, characteristic for other SV nosologic forms were absent. Some questions of nosologic specification, pathogenesis and principles of therapy were discussed. It should also be noted that the spectrum of TAO interpretation changed since the beginning of the XXI century. The disease requires multidistsiplinary approach both in diagnostics and refinement of nosologic belonging, pathogenesis and designation of pathogenetic therapy.

A mathematical model of blood flow in a stenosed artery with post-stenotic dilatation and a forced field.

Arterial stenosis is a common cardiovascular disease that restricts blood flow. A stenotic blood vessel creates tangent stress pressure, which lessens the arterial side and causes an aneurysm. The primary purpose of this study is to investigate blood flowing via an inclination pipe with stricture and expansion after stricture (widening) underneath the influence of a constant incompressible Casson liquid flowing with the magnetism field. The relations for surface shearing stress, pressure drop, flow resistance, and velocity are calculated analytically by applying a mild stenosis approximation. The effect of different physical characteristics on liquid impedance to flowing, velocity, and surface shearing stress are studied. With a non-Newtonian aspect of the Casson liquid, the surface shearing stress declines, and an impedance upturn. Side resistivity and shear-stress increase with the elevations of stricture, whilst together decreasing with a dilatation height.

Evaluation of Oxidative Status in Elderly Patients with Multiple Cerebral Infarctions and Multiple Chronic Total Coronary Occlusions.

Background Oxidative stress plays a key role in atherosclerosis. Acting via high level of reactive oxygen species, an increase of oxidative stress is involved in the pathogenesis and progression of atherosclerostic stenosis or occlusion of arteries. Oxidative stress leads to an accumulation of oxidized low-density lipoprotein, which plays important roles in steno-occlusion of cerebral and coronary arteries. However, the exact reasons for multiple cerebral and coronary artery steno-occlusion in elderly patients remain unclear. The aim was to evaluate the effects of imbalance of oxidative/antioxidative status on concomitant multiple brain infarcts and multiple chronic total coronary occlusions in elderly patients. Methods We measured the circulating levels of malondialdehyde (MDA), reactive oxygen species (ROS), thiobarbituric acid reactive substance (TBARS), advanced oxidation protein products (AOPP), superoxide dismutase 1 (SOD 1), superoxide dismutase 2 (SOD 2), superoxide dismutase 3 (SOD 3), and paraoxonase 1 (PON 1) in patients with concomitant multiple cerebral infarcts and multiple chronic total coronary occlusions. Results Circulating levels of oxidative stress markers (MDA, ROS, TBARS, and AOPP) were increased (P < 0.001) and antioxidative stress markers (SOD 1, SOD 2, SOD 3, and PON 1) were decreased (P < 0.001) in elderly patients with concomitant multiple brain infarcts and multiple chronic total coronary occlusions. Conclusions The findings suggested that the imbalance of oxidative/antioxidative status may be associated with multiple cerebral infarcts and multiple chronic total coronary occlusions and may contribute to the development of concomitant multiple brain infarcts and multiple chronic total coronary occlusions in elderly patients.

Awake intubation for thoracic aortic aneurysm causing esophageal stenosis with food residues and compression of the pulmonary artery and left bronchi: a case report

BackgroundAnesthetic management of thoracic aortic aneurysms (TAAs) is sometimes difficult due to fatal complications, including hypovolemic shock secondary to aneurysm rupture. We report the successful management of an impending rupture of a TAA with associated esophageal stenosis and compression of the pulmonary artery and left bronchi.Case presentationAn 83-year-old woman, diagnosed with an impending rupture of the ascending TAA, was scheduled to undergo emergency total aortic arch replacement. Computed tomography showed esophageal stenosis with significant amounts of food residues in the thoracic esophagus and compression of the pulmonary artery and bronchi. We performed awake intubation and superior laryngeal nerve block with light sedation to prevent aspiration and aneurysmal rupture, respectively. General anesthesia was induced immediately after the intubation. No intraoperative complications occurred.ConclusionsPerforming awake intubation with a superior laryngeal nerve block and sedation may prevent aspiration of food residues and hemodynamic changes that may lead to rupture.

Acute coronary syndrome after liver transplantation in a young primary biliary cholangitis recipient with dyslipidemia: a case report

BackgroundPrimary biliary cholangitis (PBC) is a chronic, progressive liver disease associated with dyslipidemia. There is a consensus that PBC does not accelerate coronary artery disease despite high cholesterol levels, so the screening test for the coronary artery is not routinely performed before liver transplantation (LT). To date, no report has described the potential risk of PBC-related dyslipidemia for developing acute coronary syndrome (ACS) after LT.Case presentationA 40-year-old Asian female with a known history of PBC underwent ABO-incompatible living-donor LT, with her husband as the donor. Although she had high cholesterol and triglyceride levels that were refractory to medications, she passed all routine preoperative examinations, including cardiopulmonary function tests and infection screenings. One week after LT, she developed ACS with 90% stenosis of both the left anterior descending artery and left circumflex artery. Emergent stent implantation was successfully performed followed by dual antiplatelet therapy. The long history of PBC and associated severe dyslipidemia for 10 years would have accelerated the atherosclerosis, causing latent stenosis in the coronary artery. Inapparent stenosis might have become apparent due to unstable hemodynamics during the acute phase after LT.ConclusionsPBC-related dyslipidemia potentially brings a risk for developing ACS after LT. This experience suggests that the preoperative evaluation of the coronary artery should be considered for high-risk patients, especially those who have drug-resistant dyslipidemia.

Role of circulating polyunsaturated fatty acids on cardiovascular diseases risk: analysis using Mendelian randomization and fatty acid genetic association data from over 114,000 UK Biobank participants

BackgroundDespite early interest in the health effects of polyunsaturated fatty acids (PUFA), there is still substantial controversy and uncertainty on the evidence linking PUFA to cardiovascular diseases (CVDs). We investigated the effect of plasma concentration of omega-3 PUFA (i.e. docosahexaenoic acid (DHA) and total omega-3 PUFA) and omega-6 PUFA (i.e. linoleic acid and total omega-6 PUFA) on the risk of CVDs using Mendelian randomization.MethodsWe conducted the largest genome-wide association study (GWAS) of circulating PUFA to date including a sample of 114,999 individuals and incorporated these data in a two-sample Mendelian randomization framework to investigate the involvement of circulating PUFA on a wide range of CVDs in up to 1,153,768 individuals of European ancestry (i.e. coronary artery disease, ischemic stroke, haemorrhagic stroke, heart failure, atrial fibrillation, peripheral arterial disease, aortic aneurysm, venous thromboembolism and aortic valve stenosis).ResultsGWAS identified between 46 and 64 SNPs for the four PUFA traits, explaining 4.8–7.9% of circulating PUFA variance and with mean F statistics >100. Higher genetically predicted DHA (and total omega-3 fatty acids) concentration was related to higher risk of some cardiovascular endpoints; however, these findings did not pass our criteria for multiple testing correction and were attenuated when accounting for LDL-cholesterol through multivariable Mendelian randomization or excluding SNPs in the vicinity of the FADS locus. Estimates for the relation between higher genetically predicted linoleic acid (and total omega-6) concentration were inconsistent across different cardiovascular endpoints and Mendelian randomization methods. There was weak evidence of higher genetically predicted linoleic acid being related to lower risk of ischemic stroke and peripheral artery disease when accounting by LDL-cholesterol.ConclusionsWe have conducted the largest GWAS of circulating PUFA to date and the most comprehensive Mendelian randomization analyses. Overall, our Mendelian randomization findings do not support a protective role of circulating PUFA concentration on the risk of CVDs. However, horizontal pleiotropy via lipoprotein-related traits could be a key source of bias in our analyses.