Stenosis In Association Research Articles

Subaortic Stenosis in Association with Patent Ductus Arteriosus in a Young Woman from the Andes Region

Subaortic Stenosis in Association with Patent Ductus Arteriosus in a Young Woman from the Andes Region

Strategy of cerebral endovascular treatment for cervical internal carotid artery stenosis with a persistent primitive hypoglossal artery.

Persistent primitive hypoglossal artery (PPHA) is a rare residual arterial anastomosis. We placed a CASPER stent using Spider FX as an embolic protection device (EPD) in a patient with internal carotid artery (ICA) stenosis and PPHA. There are no reports of carotid artery stenting (CAS) using a CASPER stent for ICA stenosis with PPHA. We report the EPD strategy used in this case and the usefulness and precautions of CASPER stent insertion for cervical ICA stenosis in association with PPHA. A 9Fr sheath was placed in the right femoral artery and a 9Fr Branchor balloon guide catheter was guided to the common carotid artery. A Spider FX was placed proximal to the bifurcation of the ICA and the PPHA. A 10 mm × 20 mm CASPER stent was deployed at the site of the stricture with no postoperative ischemic complications. There was no intra-stent occlusion, stenosis, or plaque protrusion immediately after surgery, and no postoperative ischemic complications were observed. CASPER stent deployment with the Spider FX in the ICA and PPHA bifurcation can be considered to be an effective treatment method for ICA stenosis associated with PPHA. However, care should be taken in selecting the appropriate EPDs and stents depending on the location of the stenosis and bifurcation of the PPHA.

Surgical Repair of Supravalvar Aortic Stenosis in Association With Transverse and Proximal Descending Aortic Abnormalities.

Supravalvar aortic stenosis (SVAS) may be an isolated defect of the proximal ascending aorta. However, more severe cases have extension of the arteriopathy into the transverse and proximal descending aorta. The purpose of this study was to review our experience with SVAS with and without aortic arch arteriopathy. This was a retrospective review of 58 patients who underwent surgical repair of SVAS. The median age at repair was 18 months. A total of 37 patients had Williams syndrome. A total of 31 (53%) patients had associated peripheral pulmonary artery stenosis and 23 (39%) had coronary artery ostial stenosis (CAOS). A total of 37 of 58 (64%) patients had surgical repair of SVAS without the need for arch intervention while 21 (36%) patients had repair of the distal aortic arch. There were 3 (5.2%) operative deaths, 2 of whom had aortic arch involvement and one without arch involvement. There were 2 deaths after discharge from the hospital. Patients who needed arch surgery were more likely to have severe arch gradients compared to those without arch involvement (71% vs 30%, P < .05), were more likely to undergo concomitant procedures for peripheral pulmonary artery stenosis or CAOS (90% vs 62%, P < .05), and to have Williams syndrome (86% vs 51%, P < .05). More than one-third of patients who had SVAS repair at our institution had procedures directed at the transverse or proximal descending aorta. Patients with arch involvement had more severe arch obstruction, required more concomitant procedures, and were more likely to have Williams syndrome.

Virtual Transcatheter Interventions for Peripheral Pulmonary Artery Stenosis in Williams and Alagille Syndromes.

BackgroundDespite favorable outcomes of surgical pulmonary artery (PA) reconstruction, isolated proximal stenting of the central PAs is common clinical practice for patients with peripheral PA stenosis in association with Williams and Alagille syndromes. Given the technical challenges of PA reconstruction and the morbidities associated with transcatheter interventions, the hemodynamic consequences of all treatment strategies must be rigorously assessed. Our study aims to model, assess, and predict hemodynamic outcomes of transcatheter interventions in these patients.Methods and ResultsIsolated proximal and “extensive” interventions (stenting and/or balloon angioplasty of proximal and lobar vessels) were performed in silico on 6 patient‐specific PA models. Autoregulatory adaptation of the cardiac output and downstream arterial resistance was modeled in response to intervention‐induced hemodynamic perturbations. Postintervention computational fluid dynamics predictions were validated in 2 stented patients and quantitatively assessed in 4 surgical patients. Our computational methods accurately predicted postinterventional PA pressures, the primary indicators of success for treatment of peripheral PA stenosis. Proximal and extensive treatment achieved median reductions of 14% and 40% in main PA systolic pressure, 27% and 56% in pulmonary vascular resistance, and 10% and 45% in right ventricular stroke work, respectively.ConclusionsIn patients with Williams and Alagille syndromes, extensive transcatheter intervention is required to sufficiently reduce PA pressures and right ventricular stroke work. Transcatheter therapy was shown to be ineffective for long‐segment stenosis and pales hemodynamically in comparison with published outcomes of surgical reconstruction. Regardless of the chosen strategy, a virtual treatment planning platform could identify lesions most critical for optimizing right ventricular afterload.

1α,25-Dihydroxyvitamin D3 Encapsulated in Nanoparticles Prevents Venous Neointimal Hyperplasia and Stenosis in Porcine Arteriovenous Fistulas.

Few therapies prevent venous neointimal hyperplasia (VNH) and venous stenosis (VS) formation in arteriovenous fistulas (AVF). Expression of the immediate early response gene X-1 (Iex-1), also known as Ier3, is associated with VNH and stenosis in murine AVFs. The study aimed to determine if local release of Ier3 long-acting inhibitor 1α,25(OH)2D3 from poly(lactic-co-glycolic acid) (PLGA) nanoparticles embedded in a thermosensitive Pluronic F127 hydrogel (1,25 NP) could affect VNH/VS formation in a large animal model. Immediately after AVF creation in a porcine model of renal failure, 1,25 NP or vehicle control was injected into the adventitia space of AVF outflow veins. Scanning electron microscopy and dynamic light scattering characterized drug and control nanoparticles. Animals were sacrificed 3 and 28 days later for gene expression, immunohistologic, magnetic resonance imaging and angiography, and ultrasound analyses. Whole transcriptome RNA sequencing with differential gene expression analysis was performed on outflow veins of AVF. Encapsulation of 1α,25(OH)2D3 in PLGA nanoparticles formed nanoparticles of uniform size that were similar to nanoparticles without 1α,25(OH)2D3. The 1,25 NP-treated AVFs exhibited lower VNH/VS, Ier3 gene expression, and IER-3, MCP-1, CD68, HIF-1α, and VEGF-A immunostaining, fibrosis, and proliferation. Blood flow and lumen area increased significantly, whereas peak systolic velocity and wall shear stress decreased. Treatment increased Young's modulus and correlated with histologic assessment of fibrosis and with no evidence of vascular calcification. RNA sequencing analysis showed changes in the expression of genes associated with inflammatory, TGFβ1, and apoptotic pathways. Local release of 1,25 NP improves AVF flow and hemodynamics, and reduces stenosis in association with reduction in inflammation, apoptosis, and fibrosis in a porcine model of arteriovenous fistula.

Prevalence, risk factors and association of renal artery stenosis with coronary artery disease in patients undergoing coronary angiography in Ibn-Al Bitar center for cardiac surgery

Background:-Atherosclerosis is a systemic disease that often affects multiple vascular distributions in a single patient. The increased prevalence of renal artery stenosis in association with coronary artery disease has been well documented.Objectives:-To examine in detail the prevalence of renal artery stenosis in patients undergoing cardiac catheterization for suspected coronary artery disease.Patients &amp;methods:-Between April 2010 and February 2011, two hundred patients underwent coronary and renal angiography at the same session in Ibn Al-bitar Hospital for Cardiac Surgery. Clinical and procedural data for patients undergoing renal angiography were prospectively collected and entered into database specially designed for the present study.Results:-Two hundred patients were included in this study, 133 (66.5%) were males and a mean age of 53±12 years, age range (42-73 year). Significant renal artery stenosis (≥ 50% luminal narrowing) was identified in 18 patients (9%) made up the renal artery stenosis group. Age, hypertension, diabetes mellitus and renal impairment were significantly associated risk factors for renal artery stenosis. Gender, smoking and hyperlipidemia were not significantly associated with either group. The frequency of renal artery stenosis is significantly increased with the number of stenotic coronary segments; patient with two and three vessel disease had more frequent renal artery stenosis than the others.Conclusion:-Renal artery stenosis is prevalent in a significant proportion of patients undergoing cardiac catheterization for suspected coronary artery disease &amp; the number of coronary arteries with stenotic lesions is a remarkable predictor of significant renal artery stenosis.

The association between pro-arrhythmic agents and aortic stenosis in young adults: is it sufficient to clarify the sudden unexpected deaths?

Most young patients with mild-to-moderate aortic stenosis show no symptoms, and sudden death appears only occasionally. We hypothesised that malignant ventricular arrhythmias could be responsible for the high incidence of sudden death in such patients. If multiple factors such as asymptomatic aortic stenosis in association with arrhythmia-provoking agents are involved, could it be sufficient to account for sudden unexpected death? In this study, eight cases of sudden death in young adults, with ages ranging from 22 to 36 years, who had never reported any symptoms that could be related to aortic stenosis, were investigated. Full autopsies were performed, and congenital aortic stenosis in all eight cases was confirmed. DNA testing for channelopathies was negative. Comprehensive toxicological analyses found an electrolyte imbalance, or non-toxic concentrations of amitriptyline, terfenadine, caffeine, and ethanol. Collectively, these results suggest that congenital asymptomatic aortic stenosis without cardiac hypertrophy in young adults is not sufficient to cause sudden death merely on its own; rather, an additional provoking factor is necessary. According to our findings, the provoking factor may be a state of physical or emotional stress, a state of electrolyte imbalance, or even taking a therapeutic dose of a particular drug.

Aortic valve stenosis in association with inflammatory process and biochemical markers

Aortic valve stenosis in association with inflammatory process and biochemical markers

Prevalence of Significant Carotid Stenosis and Other Risk Factors in Patients with Acute Ischemic Stroke in Yaounde, Cameroon

The prevalence and incidence of cardiovascular disease have been increasing in sub Saharan Africa for the last past twenty years. One of the most common manifestations of cardiovascular disease is stroke. Very few studies have addressed the major causes of ischemic stroke in this region. The objective of this study was to determine the prevalence of significant extra cranial carotid stenosis in a population of patients with acute ischemic stroke. Patients and methods: we conducted a prospective study at the University Hospital Centre of Yaounde from January 2013 to October 2013. We included all consenting patients with acute onset of neurological deficit with a CT scan of the head showing an ischemic stroke. We excluded all patients with hemorrhagic stroke on CT scan, or who did not have a head CT scan. The study was approved by the National ethics committee. Results: During that period, 35 patients met the criteria for acute ischemic stroke from which 51.4% were women with a sex ratio of 0.94. The mean age in this series was 66.6 years. Thirty five patients over 76 had an ischemic stroke on the CT scan, with a prevalence of 46%. Hypertension was present in 21 (60%) cases and it was a major risk factor. Only 3 patients had a carotid stenosis between 50-75%, there was no patient with a stenosis above 75%. Elevated cholesterol was found in 3.3% of patients while 30 (86%) patients had an abnormal electrocardiogram: 9 patients were found to have a tachyarrhythmia and 6 atrial fibrillation. There was no intracardiac clot even though the echocardiogram was abnormal in 26 (77%) patients. Concerning the CT scan of the head results, hypo densities were found in 26 (74.3%) patients and the CT was normal in 9 (9.9%) patients with a sudden neurological deficit. Conclusion: From this pilot study, we have found that carotid stenosis in association with hypercholesterolemia and arteriosclerosis may not be a major risk factor for ischemic stroke in our environment, while age, hypertension and arrhythmia are the most important risk factors for this disease in Cameroon. Further and larger study is needed to confirm this preliminary finding.

Idiopathic subglottic stenosis in a patient with generalized port-wine stain (PWS): A case report and review of literature

Background: Subglottic stenosis is defined as inflammatory narrowing of the airway. It can be related to trauma, intubation, autoimmune disorders, vascular malformations, infection and congenital abnormalities. Pot-Wine Stain (PWS) is a small dermis venous malformation which is present at birth. PWS is found on face and neck, but can occur in throat and can cause subglottic stenosis. Case Report: Authors describe an 18-year-old girl with progressive dyspnea misdiagnosed with asthma having no response to medication. She has no histories of trauma, intubation, gastro-esophageal reflux disease (GERD) or allergy symptoms. Conclusion: Evaluations revealed subglottic stenosis in association with generalized PWS. To the best of our knowledge, this finding has not been reported in English medical literature. [GMJ.2015;4(2):126-28]

Simultaneous transcatheter valvuloplasty and Amplatzer septal occlusion for pulmonary valvar stenosis and secundum atrial septal defect: A case report

Severe pulmonary valve stenosis in association with a large atrial septal defect is uncommon. Simultaneous percutaneous closure of the atrial septal defect and pulmonary valvuloplasty appears to be an attractive modality when compared to patients with these two lesions being subjected to surgery or being treated percutaneously at different sittings. We encountered a case of 40 years female, with significant pulmonary valvular stenosis associated with large 27 mm ostium secundum atrial septal defect. Both lesions were successfully treated percutaneously in the same sitting. Pulmonary valvuloplasty was done initially and the atrial septal defect closed later to minimize catheter manipulation after device implantation.

Feasibility of Using Lumbar Magnetic Resonance Imaging Severity of Disc Protrusion and Foraminal Stenosis in Association with Pain Reduction Following Lumbar Transforaminal Epidural Steroid Injection (LTFESI)

PM&RVolume 5, Issue 9S p. S293-S293 Pain and Spine Medicine Feasibility of Using Lumbar Magnetic Resonance Imaging Severity of Disc Protrusion and Foraminal Stenosis in Association with Pain Reduction Following Lumbar Transforaminal Epidural Steroid Injection (LTFESI) Robert E. Moore MD, Robert E. Moore MD MetroHealth Rehab Institute of Ohio, Cleveland, OH, United StatesSearch for more papers by this authorMoeid Khan MD, Moeid Khan MD MetroHealth Rehab Institute of Ohio, Cleveland, OH, United StatesSearch for more papers by this authorKermit W. Fox MD, Kermit W. Fox MD MetroHealth Rehab Institute of Ohio, Cleveland, OH, United StatesSearch for more papers by this authorBrian Snitily MD, Brian Snitily MD MetroHealth Rehab Institute of Ohio, Cleveland, OH, United StatesSearch for more papers by this authorRichard D. Wilson MD, Richard D. Wilson MD MetroHealth Rehab Institute of Ohio, Cleveland, OH, United StatesSearch for more papers by this author Robert E. Moore MD, Robert E. Moore MD MetroHealth Rehab Institute of Ohio, Cleveland, OH, United StatesSearch for more papers by this authorMoeid Khan MD, Moeid Khan MD MetroHealth Rehab Institute of Ohio, Cleveland, OH, United StatesSearch for more papers by this authorKermit W. Fox MD, Kermit W. Fox MD MetroHealth Rehab Institute of Ohio, Cleveland, OH, United StatesSearch for more papers by this authorBrian Snitily MD, Brian Snitily MD MetroHealth Rehab Institute of Ohio, Cleveland, OH, United StatesSearch for more papers by this authorRichard D. Wilson MD, Richard D. Wilson MD MetroHealth Rehab Institute of Ohio, Cleveland, OH, United StatesSearch for more papers by this author First published: 17 September 2013 https://doi.org/10.1016/j.pmrj.2013.08.526Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume5, Issue9SSeptember 2013Pages S293-S293 RelatedInformation

Multivalvular rheumatic heart disease in case of congenital rubella syndrome with congenital valvular pulmonary stenosis

Congenital rubella syndrome with congenital valvular pulmonary stenosis in association with Multivalvular rheumatic heart disease is unusual. Herein we describe a case of 30-year-old female with mental retardation, sensory-neural hearing loss and visual impairment, diagnosed as valvular pulmonary stenosis at the age of 6 years and subsequently developed NYHA class II/IV symptoms since last 2 years, progressed to III/IV since 2 months. Evaluation revealed rheumatic severe mitral stenosis, mild aortic stenosis, dome shaped thickened pulmonary valve with severe pulmonary stenosis and stigma of congenital rubella syndrome along with right ventricular failure. Role of preventive aspects in general & optimal management and serial noninvasive follow up in particular is emphasized.

A case of double right coronary artery with bifurcation stenosis in association with complete heart block

Congenital coronary artery anomalies are present at birth, but most anomalies are discovered as incidental findings during coronary angiography or at autopsy. Double right coronary artery (RCA) is a rare coronary anomaly. Double RCA with bifurcation stenosis in association with degenerative complete heart block (CHB) have never been reported in literature to the best of our knowledge. We therefore report an interesting case of a patient with double RCA and degenerative CHB.

Surgical Reconstruction of Tracheal Stenosis in Conjunction With Congenital Heart Defects

Surgical reconstruction is the primary method of treating airway obstruction in children. Tracheal stenosis is frequently associated with congenital heart defects, which may further complicate the overall management strategy. The purpose of this study was to review our experience with surgical reconstruction of airway obstruction in conjunction with congenital heart defects. This was a retrospective review of our surgical experience with tracheal stenosis from February 2003 to August 2011. Twenty-seven patients were identified in our database. Six patients had isolated, congenital tracheal stenosis, and 21 had tracheal stenosis in association with congenital heart defects. There were two identifiable subgroups. Thirteen patients had airway stenoses identified concurrently with congenital heart defects and underwent combined repair. The second group comprised 8 patients who had previous correction of their congenital heart defects and experienced delayed presentation of tracheal (n = 6) or bronchial (n = 2) obstruction. The median age at surgery was 9 months. There were 2 postoperative deaths, both in children with single ventricle. The median duration of follow-up for the entire cohort of 25 surviving patients was 4 years. None of the patients have required reoperations on the trachea; 5 have had minor reinterventions. The data demonstrate that tracheal obstruction is frequently found in conjunction with congenital heart defects. Nearly one third of our patients had delayed presentation of airway obstruction that was identified subsequent to previous congenital heart defect repair. Tracheal reconstructive techniques were effective regardless of the cause of the airway obstruction.

Subaortic Membrane Late after Surgical Correction of Tetralogy of Fallot

We herein report a rare case of subaortic stenosis in association with a previous tetralogy of Fallot (TOF) surgical repair, which was not taken into account as a differential diagnosis. Echocardiography plays a pivotal role in identification of this rare combination. Therefore, echocardiography should be performed periodically during follow-up of patients with surgically corrected TOF. Given the clinical complications that can result from subaortic stenosis (i.e., aortic regurgitation and infective endocarditis), early and aggressive management of this rare combination should be performed.

Williams-Beuren syndrome: the prenatal phenotype

Using prenatal BACs-on-Beads technology, the first prenatal case of Williams-Beuren syndrome (WBS) was diagnosed. In light of this result, an ultrasound scan confirmed the presence of well-characterized features of WBS. This case report emphasizes the fact that new genomic technologies will generate prenatal information and provide helpful additional information.

Repair of Complex Tracheobronchial Stenosis With Left Pulmonary Artery Sling and Bridging Bronchus

Slide tracheoplasty with reimplantation of the left pulmonary artery is one of the preferred techniques for repair of long-segment congenital tracheal stenosis in association with a pulmonary artery sling. Left pulmonary artery sling associated with a right upper bronchus from the trachea (tracheal bronchus) and stenosis of the bridging bronchus is a more complicated situation. We present an infant with left pulmonary artery sling, and stenosis of the bridging bronchus, carina, and both right and left main bronchi. His condition was successfully repaired using the combination of slide tracheoplasty and tracheal autograft techniques.

Sudden Death After Myocardial Infarction in a High‐School Athlete

This is an unusual case of ischemic heart disease occurring in a young female athlete, aged 14 years, in whom almost the entire posterior wall of the left ventricle was affected. The patient collapsed and died suddenly after a vigorous physical activity while resting at home. The ischemic lesion was apparently owing to right orifice stenosis in association with a small hypoplastic right coronary artery.

Results of endoscopic assisted probing for congenital nasolacrimal duct obstruction in older children

To evaluate the results of lacrimal probing with the use of nasal endoscopy and identify the anatomical anomalies responsible for the symptoms in older children. Fifty-two eyes of 40 children with congenital nasolacrimal duct obstruction underwent primary probing of the lacrimal duct under general anaesthetic in conjunction with nasal endoscopy. Patients followed up for at least 6 months. Cure was defined as complete resolution of symptoms or minimal symptoms brought on by cold or wind. The age range was 12-126 months. In 30/52 (57.7%) eyes the symptoms were attributed to a single mechanical obstruction. Seven eyes had canalicular stenosis. Three eyes had upper nasolacrimal duct obstruction. Nine eyes had narrow duct and nine eyes had atresia of the distal end of the duct. Two eyes had only intranasal abnormalities. In 16/52 (30.76%) eyes a combination of anomalies was responsible for the symptoms. Nine eyes had canalicular stenosis in association with: either a membrane at the valve of Hasner in four, or a narrow duct in three, or intranasal anomalies in two. Two eyes had punctual stenosis and narrow duct. Two eyes had narrow duct and tight inferior turbinate. Three eyes had abnormal openings in association with stenotic ducts. Six (11.54%) eyes had functional blockage. With the use of endonasal endoscopy, intranasal anomalies identified in 12 eyes and treated in nine. One eye had large inferior conchae. One eye had inferior concha adherent to lateral nasal wall. One eye had redundant nasal mucosa. Three eyes had tight inferior turbinate. Three had abnormal openings. In three eyes the probe went submucosally. The overall success rate was 84.6% (44/52 eyes). Eight eyes remained unchanged. Endoscopically treated cases contributed to the overall success by 17.31%. Multiple anatomical anomalies within the lacrimal system and abnormalities of the nose are quite common in older children. Lacrimal probing remains the primary treatment and nasal endoscopy is a useful adjunct to probing increasing the success rate of the procedure.