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Objective@#To analyze the clinical features and summarize the experience on the diagnosis and treatment of aortic stenosis caused by Takayasu arteritis in pediatric patients.@*Methods@#This study was a retrospective study. Five pediatric patients diagnosed as aortic stenosis caused by Takayasu arteritis in Fuwai Hospital of Chinese Academy of Medical Sciences from January 2016 to August 2018 were included. The clinical features, methods of examination, treatment and outcome were analyzed.@*Results@#There were 2 male and 3 female patients in this cohort. The age of onset ranged from 10 to 13 years. The main clinical symptoms were as follows: intermittent claudication and hypertension (5 patients), heart failure (3 patients). Three patients with heart failure were misdiagnosed with dilated cardiomyopathy in other hospitals. Except 1 patient died due to disease aggravation before operation, the other 4 patients received interventional therapy for severe heart failure or refractory hypertension on the basis of hormone anti-inflammatory treatment, including 2 patients treated with aortic balloon dilatation and 2 patients treated with aortic balloon dilatation and stent implantation. In post-operational follow-up, clinical symptoms and laboratory examination values of the 4 patients treated with interventional therapy were significantly improved.@*Conclusions@#The clinical symptoms of pediatric patients with aortic stenosis caused by Takayasu arteritis mainly present with intermittent claudication, hypertension and heart failure. Aortic intervention strategy should be applied for pediatric patients with severe heart failure or refractory hypertension as early as possible.
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Objective@#To evaluate the effect of stenting for proximal atherosclerotic extracranial vertebral artery stenosis.@*Methods@#A total of 204 proximal atherosclerotic extracranial vertebral artery stenosis patients underwent stent implantation at Fuwai Hospital were enrolled consecutively between August 2007 and June 2014 prospectively. Medical records were collected and the clinical results were obtained through outpatient and telephone follow up.@*Results@#(1) The patients were (64.1±7.9) years old, and 179 were male (87.7%). (2) Stent implantation was performed on 210 proximal atherosclerotic extracranial vertebral artery stenosis lesions with 210 stents (156 on the left, 54 on the right), and 6 patients received both sides stent implantations. Technical success rate was 100%(210/210). The stenosis of the lesions was decreased from (85.1±6.4) % to (6.5±3.2) % after the stent implantation (P<0.01). (3) Three (1.5%) patients experienced transient ischemic attack during the procedure, and two (1.0%) patients suffered from minor posterior circulation ischemic strokes on the 2nd and 10th day after the procedure, respectively. (4)The median follow-up was 1.5 (0.8-2.5) years. Three(1.5%) patients died (two non-vacular deaths, and the other one due to sudden cardiac death). Three (1.5%) patients developed stroke (one case ipsilateral posterior circulation stroke, and two cases unrelated area stroke). Four (2.0%) patients experienced transient ischemic attack. One patient suffered nonfatal myocardial infraction. In-stent restenosis occurred in thirty nine (19.4%) patients, of which fourteen (35.9%) patients were totally occluded and four (10.3%) patients with symptomatic restenosis. Kaplan-Meier survival curve showed that the primary patency rate of the vertebral artery were 85.6%, 78.6%, 72.2% and 64.4% at 1, 2, 3 and 5 years, respectively.@*Conclusions@#Stenting for proximal atherosclerotic extracranial vertebral artery stenosis is safe and feasible, with a good middle to long-term patency rate. However, further trials are required to validate the effective results found in this patients cohort.
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Objective: To evaluate chemiluminescence immunoassay (CLIA) for detecting blood levels of aldosterone and rennin with its diagnostic value of primary aldosteronism (PA) with comparison to radio immunoassay (RIA). Methods: According to American protocols of CLSI, we conducted a veriifcation study between RIA and CLIA for their precision, accuracy, linearity and reference ranges; meanwhile, taking clinical diagnosis as golden standard, examined renin activity or concentration and aldosterone concentration in 20 healthy volunteers and 40 hypertension patients by both RIA and CLIA, compared the ratios of ARR (aldosterone concentration/renin activity) or ADRR (aldosterone concentration/renin concentration) for the speciifcity and sensitivity of PA diagnosis. Results: Within-lot and between-lot accuracies of CLIA for detecting aldosterone levels were below 5% and 10%, the recoveries were 102% and 95% respectively. There was a good linear correlation in the range of aldosterone at (3-74) ng/dl and renin at (0.99-330) μIU/ml. In healthy volunteers, renin level was higher in 2 subjects, while aldosterone level and ADRR ratio were within normal references in all subjects by the manufacturer. In hypertension patients, the sensitivity and speciifcity for aldosterone and rennin detections by CLIA were at 85.7% and 97.0%, by RIA were at 85.7% and 94.0%. Conclusion: CLIA has the superiority of simple performance, repeatable and without radioactive contamination; it is recommended for replacing RIA as necessity.
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Objective: To explore the clinical features and prognosis in patients with Takayasu arteritis (TA) combining neurological symptoms. Methods: We retrospectively studied 274 TA patients combining neurological symptoms who admitted to our hospital from 2002-01 to 2013-10 for their clinical and imaging features with prognosis. Results: The ratio of male to female was 1:4.3 and the mean age of disease onset was at (28.2±11.2) years. The most common neurological symptom was dizziness (214/274 cases, 78.1%), most frequent type was type III TA (112 cases, 40.9%), most common affected artery was left subclavian artery (147 cases, 53.6%), and there were 77 cases (28.1%) with (3-4) branches of the aortic arch involvement. For stroke conditions, ischemic stroke was more frequently observed in patients with steno-occlusive lesions in subclavian artery and common carotid artery, while hemorrhagic stroke was more frequently found in patients with steno-occlusive lesions in descending aorta, abdominal aorta and/or renal artery. Heart failure was the most common cause of death, it was also the most common cardiovascular event in surviving cohorts. Conclusion: TA patients could have many neurological symptoms, which were related to the number and site of artery involvement.
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Objective: To evaluatethe efficacy of renal artery stenting combining optimal drug therapy in patients with atherosclerotic renal artery stenosis. Methods:This is a prospective cohort study for patients who received percutaneous renal artery stenting in our hospital from 2011-09 to 2013-03. All patients had conifrmed diagnosis of atherosclerotic renal artery stenosis combing hypertension and/or renal functional damage. Thepatients received optimal drug therapy for anti-platelet and blood pressure, lipids, glucose controlling, and they were followed-up for at least 12 months to observe the improvement of blood pressure and renal function. Results:There were 149 patients at the mean age of (61.54 ± 9.63) years and 185 renal artery stenosis with stent implantation;the average stenosis rate was (83.11±7.30)%and the success rate of operation was 99.32%(148/149). During follow-up period, the patients had increased estimated glomerular ifltration rate (GFR) compared to base line from (76.49 ± 22.50) ml/(min·1.73 m2) to (84.09 ± 28.79) ml/(min·1.73 m2), P Conclusion:Renal artery stenting combining optimal drug therapy may improve blood pressure controlling and renal function in strictly selected patients with atherosclerotic renal artery stenosis.
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Objective: To explore a single center large cohort of patients with Takayasu’s arteritis for their clinical manifestation and long-term outcome in China. Methods: We retrospectively analyzed 566 patients with Takayasu’s arteritis admitted in our hospital from 2002-01 to 2013-11 for their clinical characteristics, laboratory ifndings, angiographic features, treatment and long-term outcomes. Results: The patient’s ratio for female to male gender was 1 to 3.8 and the average onset age was (28.9 ± 12.0) years. The most common non-speciifc symptom, initial symptom and complication were fever (52/566 patients, 9.2%), dizziness (214 patients, 37.8%) and hypertension (392 patients, 69.3%) respectively. The patients with pulmonary artery and coronary artery involvement were 83 (14.7%) and 66 (11.7%) respectively, and 131 (23.1%) patients had faster erythrocyte sedimentation rate. The major vascular damage was steno-occlusive lesion and the most common involvement was left sub-clavian artery, which was observed in 278 (49.1%) patients. The treatments were mainly included in medication, interventional therapy, autologous blood vessel transplantation, artiifcial blood vessel transplantation and aortic valve replacement. There were 32 patients died during the mean follow-up period of (5.0 ± 0.2) years. Hypertension, complication and the progressive stage of disease were the major factors affecting prognosis in relevant patients (regression coefifcients: 4.664, 1.959 and 1.870 respectively, allP<0.05). Conclusion: Hypertension was the leading reason for patients’ hospital visit. Takayasu’s arteritis was closely related to cardiovascular disease, the early diagnosis and treatment were really important in clinical practice.
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Objective: To explore the effect of the aortic arch type on technical indicators in patients with carotid artery stent implantation. Methods: We retrospectively analyzed 224 consecutive patients treated in Fu Wai hospital for unilateral carotid artery stent implantation from 2011-01 to 2012-12. We summarized the catheter category, type and the operating techniques including ① retracement, turn and insertion of the catheter, ② retracement, turn of catheter+the guidance of guide wire,③ retracement, turn of catheter+the guidance of guide wire+the supporting of another catheter, ④ using special graphic catheter+the guidance of guide wire+the supporting of another catheter. The procedural X-ray exposure time, dosage of contrast agent and operation related complications were recorded. According to Myla classiifcation, the aortic arches were divided into Myla I, Myla II and Myla III types. Results: There were 7/224 (3.1%) patients with Myla I aortic arch, 113 (50.4%) with Myla II aortic arch and 104 (46.4%) with Myla III aortic arch. A total of 48/104 (46.2%) Myla III patients used special techniques (tech③, tech④), it was more than the patients with Myla I, (1/7,14.3%) and Myla II (17/113, 15.0%), P Myla III was 96.2%, it was lower than those with Myla I (100%) and Myla II (100%), P=0.045. The procedural complication rate in patients with Myla III was 22.1%, it was higher than those with Myla I (0%) and Myla II (8.9%), P=0.007. Conclusion: The aortic arch type is the important inlfuential factor for the techniques used in carotid stent implantation. There were more dififculties and complications for stent implantation in patients with Myla III aortic arch.
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<p><b>OBJECTIVE</b>To evaluate efficacy and outcome of endovascular therapy for complex arteriosclerosis obliterans of the lower extremities.</p><p><b>METHODS</b>In this single-center retrospective study, the clinical data of consecutive 114 cases with TASC II type C/D lower extremity obstructive disease and clinical stage of Fontaine ≥ IIb and ankle brachial index <0.9 underwent endovascular therapy from December 2011 to January 2013 were collected. Telephone or clinic interviews were conducted to investigate the clinical outcomes.</p><p><b>RESULTS</b>There were 39 TASC II type C patients and 75 TASC II type D patients, 78 patients were in Fontaine IIb, 30 patients in Fontaine III and 6 patients in Fontaine IV stages. Immediate procedural success rate was 94.9% (131/138). Ankle brachial index was increased from 0.54 ± 0.26 at baseline to 0.83 ± 0.30 at discharge (P < 0.01). No adverse event was observed during the perioperative period. During (15.7 ± 8.7) months follow-up, cumulative patency rate of 6, 12 and 18 months was 75.8% (94/124) , 68.7% (68/99) and 39.2% (20/51) respectively and limb salvage rate was 100%.</p><p><b>CONCLUSION</b>Endovascular therapy for complex arteriosclerosis obliterans of the lower extremities is effective and safe.</p>
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Humans , Ankle Brachial Index , Arteriosclerosis Obliterans , Therapeutics , Femoral Artery , Limb Salvage , Lower Extremity , Retrospective Studies , Risk Factors , Treatment OutcomeABSTRACT
<p><b>BACKGROUND</b>As a novel device-based approach targeting the renal sympathetic nerves, percutaneous renal denervation (RDN) has been shown to be effective and safe for reducing blood pressure. However, while considerable data on RDN have been obtained from Western populations, there is limited findings from East Asian populations. The purpose of this study was to evaluate one-year outcomes of RDN for the treatment of resistant hypertension in Chinese patients.</p><p><b>METHODS</b>Between February and August 2012, 14 patients (mean age 39 ± 8 years, 10 males) with resistant hypertension underwent successful RDN at the Fuwai Hospital. All 14 patients were followed up at 1, 3, 6 and 12 months post-procedure. Blood pressure, use of antihypertensive agents, renal function, and complications were investigated.</p><p><b>RESULTS</b>Baseline values included mean office blood pressure of 164/103 ± 14/10 mmHg, mean 3.9 ± 0.6 anti-hypertensive agents, and an estimated glomerular filtration rate of (79 ± 19) ml × min(-1)×1.73 m(-2). Office blood pressure after the procedure was reduced by -14/-10, -17/-11, -21/-12, and -24/-14 mmHg at 1, 3, 6, and 12 months respectively, and the reduction of the number of antihypertensive agents at the above corresponding time points was -1.3, -1.5, -1.7 and -1.8 respectively (all P < 0.001). The mean reduction of 24-hour ambulatory blood pressure was similar to the reduction of office blood pressure at the four corresponding time points. Renal function did not significantly change at any time point (all P > 0.05). No clinical complications were observed at 12-month follow-up.</p><p><b>CONCLUSION</b>This study showed that RDN seems to be effective in reducing blood pressure of Chinese patients with resistant hypertension, with minimal adverse events at 12-month follow-up.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Antihypertensive Agents , Therapeutic Uses , Blood Pressure , Glomerular Filtration Rate , Physiology , Hypertension , Drug TherapyABSTRACT
<p><b>OBJECTIVE</b>To identify the casual mutation of a Chinese pedigree with hypertrophic cardiomyopathy (HCM), and to analyze the genotype-phenotype relationship.</p><p><b>METHODS</b>The coding exons of 26 reported disease genes were sequenced by targeted resequencing in the proband and the identified mutation were detected with bi-directional Sanger sequencing in all family members and 307 healthy controls. The genotype-phenotype correlation was analyzed in the family.</p><p><b>RESULTS</b>A missense mutation (c.2191C > T, p. Pro731Ser) in the 20th exon of MYH7 gene was identified. This mutation was absent in 307 healthy controls and predicted to be pathogenic by PolyPhen-HCM. Totally 13 family members carried this mutation, including 10 patients with HCM and 3 asymptomatic mutation carriers. The proband manifested severe congestive heart failure and 8 patients expressed various clinical manifestations of heart failure, including dyspnea, palpitations, chest pain, amaurosis or syncope. Five patients were diagnosed as HCM at the age of 16 or younger. One family member suffered sudden cardiac death.</p><p><b>CONCLUSIONS</b>The Pro731Ser of MYH7 gene mutation is a causal and malignant mutation linked with familiar HCM.</p>
Subject(s)
Adolescent , Humans , Asian People , Base Sequence , Cardiomyopathy, Hypertrophic , Ethnology , Genetics , Death, Sudden, Cardiac , Exons , Mutation, Missense , Myosin Heavy Chains , Genetics , Pedigree , Phenotype , Research Design , Ventricular MyosinsABSTRACT
Objective:To explore the effect of sarpogrelate on platelet function in patients at the bridging stage before coronary artery bypass grafting (CABG). Methods: A total of 40 consecutive patients with peripheral artery stent and scheduled for CABG in our hospital from 2011-05 to 2013-04 were enrolled in this study. The patients were randomly divided into 2 groups, Low molecular weight heparin (LMWH) alone group, n=19 and Sarpogrelate+LMWH group, n=21. The medications started at 5-7 days before CABG and stopped at 24 h before CABG. The platelet inhibition rates (platelet aggregation induced by collagen+ serotonin) were examined and compared between 2 groups at the baseline (before randomization), 24h and 1h before CABG respectively. Results: The platelet inhibition rates were similar between 2 groups at the baseline (87.33 ± 6.82) % vs (86.11 ± 6.87) %, P=0.577 and 1h before CABG (62.60 ± 12.39) % vs (56.19 ± 14.99) %, P=0.148. At 24h before CABG, the platelet inhibition rate in Sarpogrelate+LMWH group was higher than that in LMWH alone group (83.87 ± 8.99)%vs (63.13 ± 10.88)%, P Conclusion: Sarpogrelate + LMWH may result better platelet inhibition rate with quicker recovery of platelet function upon the medication stopping, which might be a feasible management in patients at the bridging stage before CABG.