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Sample records for aortic cusp guided

  1. Further insights into the syndrome of prolapsing non-coronary aortic cusp and ventricular septal defect

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    Akhlaque N Bhat

    2012-03-01

    Full Text Available Ventricular septal defect ( VSD with prolapse of the right coronary cusp and aortic regurgitation can be managed surgically with the anatomical correction technique . However when the VSD is located underneath the non coronary cusp surgical management differs due to anatomical constraints and secondary pathological changes seen in the non coronary cusp. It is therefore important that the location of the VSD and the morphology of prolapsing cusp be characterised preoperatively in order to plan appropriate surgical repair. We present a case study in which we discuss the salient differences in the surgical management of the prolapsing right and the prolapsing non coronary cusps.

  2. 3D-echo in preoperative assessment of aortic cusps effective height

    Institute of Scientific and Technical Information of China (English)

    Jan; Nijs; Sandro; Gelsomino; Bastian; BLJH; Kietselaer; Orlando; Parise; Fabiana; Lucà; Jos; G; Maessen; Mark; La; Meir

    2014-01-01

    Effective height,which represents the height difference between the central free margins and the aortic insertion lines can be easily determined by 2-D echocardiography and allows for identification of prolapse in the native cusps and assessment of prolapse correction after valve repair.Nonetheless,it allows to see only two of three aortic valve(AV)coaptation planes and this may lead to misunderstanding of the underlying pathophysiological mechanism for aortic regurgitation and hence in unsuccessful repair.In contrast,3D transoesophageal echocardiography and multiple plane reconstruction lets visualize all the three coaptation planes between the AV cusps and it represents an invaluable tool in the assessment of aortic valve geometry.It is highly recommendable before AV repair to accurately study the complex three dimensional cusps anatomy and their geometric interrelation with aortic root.

  3. Ruptured aortic valve cusp: a complication of the Heimlich maneuver.

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    Chapman, J H; Menapace, F J; Howell, R R

    1983-07-01

    A case of traumatic rupture of the aortic valve as a complication of the Heimlich maneuver is presented. Conformation was made by comparative echocardiographic studies available from three months before and immediately following the incident. The patient refused surgical intervention and died one month later with severe congestive heart failure despite vigorous medical therapy.

  4. Cardiomyopathy Due to Nonsustained Ventricular Tachycardia Originating from the Aortic Sinus Cusp

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    Hamidreza Bonakdar

    2013-03-01

    Full Text Available We report a case of idiopathic nonsustained ventricular tachycardia (VT originating from the aortic sinus cusp referred for presyncope and LV dysfunction and frequent premature ventricular complex with no response to 3 months anti-arrhythmic medication for heart failure and arrhythmia. She was then referred to us for frequent PVC's and runs of nonsustained VT. ECG recorded during the nonsustained VT showed a left bundle branch block pattern in the precordial leads and an inferior axis and early transition in precordial leads in V3-V4. QS morphology in lead V1 was noticed with notching on the downward deflection. Electrophysiologic study was conducted to map ventricular outflow tract as a classic method, although pace map failed to find any matched QRS with the spontaneous PVCs. The mapping of aortic cusps was also performed. The best potential was recorded in a region located at the commissure of left-right aortic cusps. A single radiofrequency energy was delivered which resulted in immediate elimination of PVCs. The patient was discharged the day after ablation without any PVC recorded on monitor. Left ventricular ejection fraction(LVEF improved to normal level two months later. There was no PVC detected at serial holter monitoring. It seems logical not to overlook even an isolated or nonsustained ventricular arrhythmia considering the available and effective treatments such as ablation rather than congestive heart failure(CHF therapy especially in a young patient.

  5. Successful implantation of a second-generation aortic valve in severe aortic regurgitation secondary to a traumatic cusp lesion

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    Mangieri, Antonio [Cardio-Thoracic-Vascular Department, San Raffaele Institute, Milan (Italy); Latib, Azeem, E-mail: info@emocolumbus.it [Cardio-Thoracic-Vascular Department, San Raffaele Institute, Milan (Italy); EMO-GVM Centro Cuore Columbus, Milan (Italy); Aurelio, Andrea [Cardio-Thoracic-Vascular Department, San Raffaele Institute, Milan (Italy); Figini, Filippo [Cardio-Thoracic-Vascular Department, San Raffaele Institute, Milan (Italy); EMO-GVM Centro Cuore Columbus, Milan (Italy); Agricola, Eustachio; Rosa, Isabella; Stella, Stefano; Spagnolo, Pietro; Castiglioni, Alessandro [Cardio-Thoracic-Vascular Department, San Raffaele Institute, Milan (Italy); Colombo, Antonio [Cardio-Thoracic-Vascular Department, San Raffaele Institute, Milan (Italy); EMO-GVM Centro Cuore Columbus, Milan (Italy)

    2015-10-15

    A 67-year-old man with a dilated cardiomyopathy and severe aortic regurgitation (AR) secondary to a traumatic cusp lesion was referred to our institution because of progressive worsening of dyspnea. After formal discussion in the heart team, the patient was scheduled for TAVI (transcatheter aortic valve implantation). The pre procedural computed tomography scan revealed a minimum amount of calcium on the aortic valve and low position of coronary ostia. The TAVI procedure was performed with the implantation of a fully retrievable and repositionable aortic valve prosthesis (Direct Flow 29 mm, Direct Flow Medical, Santa Rosa, California) with an excellent result and no paravalvular leak. The TAVI devices designed for the treatment of calcific aortic stenosis have numerous limitations for the treatment of pure AR such as the risk of residual AR, the lack of repositionability and retrievability, and the need for valve- in-valve implantation. We believe that treatment of selected cases of pure AR with the Direct Flow valve is feasible and takes advantage of the retrievability of the prosthesis.

  6. Streptococcus agalactiae infective endocarditis complicated by large vegetations at aortic valve cusps along with intracoronary extension: An autopsy case report.

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    Ro, Ayako

    2016-01-01

    Streptococcus agalactiae infective endocarditis is a rare condition with high mortality owing to complications of large vegetations and systemic emboli. A 49-year-old man was found dead in his house. He had a history of hepatic cirrhosis and had been diagnosed with type 2 diabetes 2years previously. He had presented with a high fever 10days before his death. An autopsy revealed 50mL of purulent pericardial effusion, and S. agalactiae was detected from the culture of this pericardial effusion. Two slender rope-like vegetations were present at the right aortic valve cusp and noncoronary aortic valve cusp. The vegetation at the right aortic valve cusp extended into the right coronary artery. The right coronary artery was broadly occluded by white rod-like material. The mitral valves were also affected, and the posterior papillary muscle was ruptured. Myocardial infarction was not observed. Systemic microscopic Gram-positive bacterial masses were observed in several organs. The death was attributed to acute myocardial ischemia caused by occlusive intracoronary extension of the vegetation at the proximal right coronary artery.

  7. Fluid-structure interaction model of aortic valve with porcine-specific collagen fiber alignment in the cusps.

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    Marom, Gil; Peleg, Mor; Halevi, Rotem; Rosenfeld, Moshe; Raanani, Ehud; Hamdan, Ashraf; Haj-Ali, Rami

    2013-10-01

    Native aortic valve cusps are composed of collagen fibers embedded in their layers. Each valve cusp has its own distinctive fiber alignment with varying orientations and sizes of its fiber bundles. However, prior mechanical behavior models have not been able to account for the valve-specific collagen fiber networks (CFN) or for their differences between the cusps. This study investigates the influence of this asymmetry on the hemodynamics by employing two fully coupled fluid-structure interaction (FSI) models, one with asymmetric-mapped CFN from measurements of porcine valve and the other with simplified-symmetric CFN. The FSI models are based on coupled structural and fluid dynamic solvers. The partitioned solver has nonconformal meshes and the flow is modeled by employing the Eulerian approach. The collagen in the CFNs, the surrounding elastin matrix, and the aortic sinus tissues have hyperelastic mechanical behavior. The coaptation is modeled with a master-slave contact algorithm. A full cardiac cycle is simulated by imposing the same physiological blood pressure at the upstream and downstream boundaries for both models. The mapped case showed highly asymmetric valve kinematics and hemodynamics even though there were only small differences between the opening areas and cardiac outputs of the two cases. The regions with a less dense fiber network are more prone to damage since they are subjected to higher principal stress in the tissues and a higher level of flow shear stress. This asymmetric flow leeward of the valve might damage not only the valve itself but also the ascending aorta.

  8. Imaging analysis of collagen fiber networks in cusps of porcine aortic valves: effect of their local distribution and alignment on valve functionality.

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    Mega, Mor; Marom, Gil; Halevi, Rotem; Hamdan, Ashraf; Bluestein, Danny; Haj-Ali, Rami

    2016-01-01

    The cusps of native aortic valve (AV) are composed of collagen bundles embedded in soft tissue, creating a heterogenic tissue with asymmetric alignment in each cusp. This study compares native collagen fiber networks (CFNs) with a goal to better understand their influence on stress distribution and valve kinematics. Images of CFNs from five porcine tricuspid AVs are analyzed and fluid-structure interaction models are generated based on them. Although the valves had similar overall kinematics, the CFNs had distinctive influence on local mechanics. The regions with dilute CFN are more prone to damage since they are subjected to higher stress magnitudes.

  9. Bovine Pericardial Patch Augmentation of One Insufficient Aortic Valve Cusp with Twenty-three-year Positive Clinical Follow-up Independent of the Patch Degeneration

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    Evora, Paulo Roberto Barbosa; Arcêncio, Lívia; Evora, Patrícia Martinez; Menardi, Antônio Carlos; Chahud, Fernando

    2017-01-01

    Scientific progress shall ultimately boost the current acceptance level for conservative aortic valve surgery. The present text aimed to report the 23-year long-term follow-up of one patient operated with bovine pericardium cusp extension. Growing confidence in the efficacy of the operation will allow a more expeditious indication for surgical treatment, as is already the case in mitral valve repair. This change of attitude will certainly make it possible for patients to be sent for operation in mild aortic valve regurgitation. The present report reinforces the concept and highlights the impression that the aortic valvoplasty, independent of the progressive bovine pericardium degeneration, may positively change the natural history of the aortic valve insufficiency.

  10. Loss of Guide Wire: A Rare Complication of Intra-Aortic Balloon Pump Insertion

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    Manouchehr Hekmat

    2015-10-01

    Full Text Available At the final stages of a coronary artery bypass graft operation on a 64-year-old man, an experienced physician attempted to insert an intra-aortic balloon pump into the femoral artery via the Seldinger technique. However, while the balloon pump was being passed over the guide wire, the latter was completely lost.The guide wire should be held at the tip at all times to prevent passage into the vessel. Strict adherence to this rule will prevent guide-wire loss, which is, albeit rare and completely avoidable, a potentially life-threatening complication of central vein or artery catheterization, with reported fatality rates of up to 20% when the whole wire is lost. The literature contains several reports on guide-wire loss during central venous, arterial, and hemodialysis catheterization, but we report for the first time the loss of a guide wire as a rare complication of intra-aortic balloon pump insertion.

  11. Feature identification for image-guided transcatheter aortic valve implantation

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    Lang, Pencilla; Rajchl, Martin; McLeod, A. Jonathan; Chu, Michael W.; Peters, Terry M.

    2012-02-01

    Transcatheter aortic valve implantation (TAVI) is a less invasive alternative to open-heart surgery, and is critically dependent on imaging for accurate placement of the new valve. Augmented image-guidance for TAVI can be provided by registering together intra-operative transesophageal echo (TEE) ultrasound and a model derived from pre-operative CT. Automatic contour delineation on TEE images of the aortic root is required for real-time registration. This study develops an algorithm to automatically extract contours on simultaneous cross-plane short-axis and long-axis (XPlane) TEE views, and register these features to a 3D pre-operative model. A continuous max-flow approach is used to segment the aortic root, followed by analysis of curvature to select appropriate contours for use in registration. Results demonstrate a mean contour boundary distance error of 1.3 and 2.8mm for the short and long-axis views respectively, and a mean target registration error of 5.9mm. Real-time image guidance has the potential to increase accuracy and reduce complications in TAVI.

  12. Aortic stenosis: From diagnosis to optimal treatment

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    Tavčiovski Dragan

    2008-01-01

    Full Text Available Aortic stenosis is the most frequent valvular heart disease. Aortic sclerosis is the first characteristic lesion of the cusps, which is considered today as the process similar to atherosclerosis. Progression of the disease is an active process leading to forming of bone matrix and heavily calcified stiff cusps by inflammatory cells and osteopontin. It is a chronic, progressive disease which can remain asymptomatic for a long time even in the presence of severe aortic stenosis. Proper physical examination remains an essential diagnostic tool in aortic stenosis. Recognition of characteristic systolic murmur draws attention and guides further diagnosis in the right direction. Doppler echocardiography is an ideal tool to confirm diagnosis. It is well known that exercise tests help in stratification risk of asymptomatic aortic stenosis. Serial measurements of brain natriuretic peptide during a follow-up period may help to identify the optimal time for surgery. Heart catheterization is mostly restricted to preoperative evaluation of coronary arteries rather than to evaluation of the valve lesion itself. Currently, there is no ideal medical treatment for slowing down the disease progression. The first results about the effect of ACE inhibitors and statins in aortic sclerosis and stenosis are encouraging, but there is still not enough evidence. Onset symptoms based on current ACC/AHA/ESC recommendations are I class indication for aortic valve replacement. Aortic valve can be replaced with a biological or prosthetic valve. There is a possibility of percutaneous aortic valve implantation and transapical operation for patients that are contraindicated for standard cardiac surgery.

  13. Facial talon cusps.

    LENUS (Irish Health Repository)

    McNamara, T

    1997-12-01

    This is a report of two patients with isolated facial talon cusps. One occurred on a permanent mandibular central incisor; the other on a permanent maxillary canine. The locations of these talon cusps suggests that the definition of a talon cusp include teeth in addition to the incisor group and be extended to include the facial aspect of teeth.

  14. Management of bicuspid aortic valve with or without involvement of ascending aorta and aortic root.

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    Neragi-Miandoab, S

    2014-06-01

    Patients with a bicuspid aortic valve (BAV) constitute a heterogeneous population with variable clinical presentation and complications. More than 50% of the patients who require aortic valve replacement have a BAV, a condition that may be associated with dilation of ascending aorta and aortic insufficiency caused by cusp disease or aortic root pathology. Of the potential BAV-related complications, dilation of the aortic root and ascending aorta are among the most serious. The dilation of ascending aorta and aortic root have been the subject of controversy. Whereas some surgeons believe that the dilation of the aorta is caused by the hemodynamic properties of the BAV, others believe that the dilation of the aortic root is secondary to genetic defects associated with the BAV. Management of a BAV should be tailored to each patient's clinical condition. The surgical approach varies from aortic valve replacement to combined aortic valve and root replacement to aortic-valve-sparing root replacement.

  15. Magnetosheath-cusp interface

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    S. Savin

    2004-01-01

    Full Text Available We advance the achievements of Interball-1 and other contemporary missions in exploration of the magnetosheath-cusp interface. Extensive discussion of published results is accompanied by presentation of new data from a case study and a comparison of those data within the broader context of three-year magnetopause (MP crossings by Interball-1. Multi-spacecraft boundary layer studies reveal that in ∼80% of the cases the interaction of the magnetosheath (MSH flow with the high latitude MP produces a layer containing strong nonlinear turbulence, called the turbulent boundary layer (TBL. The TBL contains wave trains with flows at approximately the Alfvén speed along field lines and "diamagnetic bubbles" with small magnetic fields inside. A comparison of the multi-point measurements obtained on 29 May 1996 with a global MHD model indicates that three types of populating processes should be operative:

    • large-scale (∼few RE anti-parallel merging at sites remote from the cusp;
    • medium-scale (few thousandkm local TBL-merging of fields that are anti-parallel on average;
    • small-scale (few hundredkm bursty reconnection of fluctuating magnetic fields, representing a continuous mechanism for MSH plasma inflow into the magnetosphere, which could dominate in quasi-steady cases.

    The lowest frequency (∼1–2mHz TBL fluctuations are traced throughout the magnetosheath from the post-bow shock region up to the inner magnetopause border. The resonance of these fluctuations with dayside flux tubes might provide an effective correlative link for the entire dayside region of the solar wind interaction with the magnetopause and cusp ionosphere. The TBL disturbances are characterized by kinked, double-sloped wave power spectra and, most probably, three-wave cascading. Both elliptical polarization and nearly Alfvénic phase velocities with characteristic dispersion indicate the

  16. Bicuspid aortic valves: Diagnostic accuracy of standard axial 64-slice chest CT compared to aortic valve image plane ECG-gated cardiac CT

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    Murphy, David J., E-mail: david.murphy@st-vincents.ie [Department of Radiology, St Vincent' s University Hospital, Elm Park, Dublin 4 (Ireland); McEvoy, Sinead H., E-mail: s.mcevoy@st-vincents.ie [Department of Radiology, St Vincent' s University Hospital, Elm Park, Dublin 4 (Ireland); Iyengar, Sri, E-mail: sri.iyengar@nhs.net [Department of Radiology, Plymouth Hospitals NHS Trust, Plymouth Devon PL6 8DH (United Kingdom); Feuchtner, Gudrun, E-mail: Gudrun.Feuchtner@i-med.ac.at [Department of Radiology, Innsbruck Medical University, Anichstr. 35, A-6020 Innsbruck (Austria); Cury, Ricardo C., E-mail: r.cury@baptisthealth.net [Department of Radiology, Baptist Cardiac and Vascular Institute, 8900 North Kendall Drive, Miami, FL 33176 (United States); Roobottom, Carl, E-mail: carl.roobottom@nhs.net [Department of Radiology, Plymouth Hospitals NHS Trust, Plymouth Devon PL6 8DH (United Kingdom); Plymouth University Peninsula Schools of Medicine and Dentistry (United Kingdom); Baumueller, Stephan, E-mail: Hatem.Alkadhi@usz.ch [Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich (Switzerland); Alkadhi, Hatem, E-mail: stephan.baumueller@usz.ch [Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich (Switzerland); Dodd, Jonathan D., E-mail: jonniedodd@gmail.com [Department of Radiology, St Vincent' s University Hospital, Elm Park, Dublin 4 (Ireland)

    2014-08-15

    Objectives: To assess the diagnostic accuracy of standard axial 64-slice chest CT compared to aortic valve image plane ECG-gated cardiac CT for bicuspid aortic valves. Materials and methods: The standard axial chest CT scans of 20 patients with known bicuspid aortic valves were blindly, randomly analyzed for (i) the appearance of the valve cusps, (ii) the largest aortic sinus area, (iii) the longest aortic cusp length, (iv) the thickest aortic valve cusp and (v) valve calcification. A second blinded reader independently analyzed the appearance of the valve cusps. Forty-two age- and sex-matched patients with known tricuspid aortic valves were used as controls. Retrospectively ECG-gated cardiac CT multiphase reconstructions of the aortic valve were used as the gold-standard. Results: Fourteen (21%) scans were scored as unevaluable (7 bicuspid, 7 tricuspid). Of the remainder, there were 13 evaluable bicuspid valves, ten of which showed an aortic valve line sign, while the remaining three showed a normal Mercedes-Benz appearance owing to fused valve cusps. The 35 evaluable tricuspid aortic valves all showed a normal Mercedes-Benz appearance (P = 0.001). Kappa analysis = 0.62 indicating good interobserver agreement for the aortic valve cusp appearance. Aortic sinus areas, aortic cusp lengths and aortic cusp thicknesses of ≥3.8 cm{sup 2}, 3.2 cm and 1.6 mm respectively on standard axial chest CT best distinguished bicuspid from tricuspid aortic valves (P < 0.0001 for all). Of evaluable scans, the sensitivity, specificity, positive and negative predictive values of standard axial chest CT in diagnosing bicuspid aortic valves was 77% (CI 0.54–1.0), 100%, 100% and 70% respectively. Conclusion: The aortic valve is evaluable in approximately 80% of standard chest 64-slice CT scans. Bicuspid aortic valves may be diagnosed on evaluable scans with good diagnostic accuracy. An aortic valve line sign, enlarged aortic sinuses and elongated, thickened valve cusps are specific CT

  17. Randomized trial of guiding hypertension management using central aortic blood pressure compared with best-practice care: principal findings of the BP GUIDE study.

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    Sharman, James E; Marwick, Thomas H; Gilroy, Deborah; Otahal, Petr; Abhayaratna, Walter P; Stowasser, Michael

    2013-12-01

    Arm cuff blood pressure (BP) may overestimate cardiovascular risk. Central aortic BP predicts mortality and could be a better method for patient management. We sought to determine the usefulness of central BP to guide hypertension management. This was a prospective, open-label, blinded-end point study in 286 patients with hypertension randomized to treatment decisions guided by best-practice usual care (n=142; using office, home, and 24-hour ambulatory BP) or, in addition, by central BP intervention (n=144; using SphygmoCor). Therapy was reviewed every 3 months for 12 months, and recommendations were provided to each patient and his/her doctor on antihypertensive medication titration. Outcome measures were as follows: medication quantity (daily defined dose), quality of life, and left ventricular mass (3-dimensional echocardiography). There was 92% compliance with recommendations on medication titration, and quality of life improved in both groups (post hoc P0.10), but with intervention there was a significant stepwise decrease in daily defined dose from baseline to 3 months (P=0.008) and each subsequent visit (all P0.05). We conclude that guidance of hypertension management with central BP results in a significantly different therapeutic pathway than conventional cuff BP, with less use of medication to achieve BP control and no adverse effects on left ventricular mass, aortic stiffness, or quality of life.

  18. Least cost cusp concentrator design

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    Nanda, S.K.; Mullick, S.C.; Annamalai, M.; Iyer, M.V.; Nirmala, K.A.; Venkatesh, P.; Prasad, C.R.; Subramani, C.

    1982-01-01

    Cusp concentrators require larger reflector areas, but can be designed for larger acceptance angles, allowing large mirror tolerances. Design procedures are outlined to compute the optimum combination of acceptance angle and maximum mirror slope for any required concentration ratio, taking into account the material as well as fabrication costs. The cusps are compared with the parabola.

  19. Fused aortic valve without an elliptical-shaped systolic orifice in patients with severe aortic stenosis: cardiac computed tomography is useful for differentiation between bicuspid aortic valve with raphe and tricuspid aortic valve with commissural fusion

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    Bak, So Hyeon; Ko, Sung Min [Konkuk University School of Medicine, Departments of Radiology, Konkuk University Medical Center, Seoul (Korea, Republic of); Song, Meong Gun; Shin, Je Kyoun; Chee, Hyun Kun; Kim, Jun Suk [Konkuk University School of Medicine, Departments of Thoracic Surgery, Konkuk University Medical Center, Seoul (Korea, Republic of)

    2015-04-01

    The objective is to determine cardiac computed tomography (CCT) features capable of differentiating between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) in severe aortic stenosis (AS) patients with fused cusp and without elliptical-shaped systolic orifices. We retrospectively enrolled 53 patients who had severe AS with fused cusps and without an elliptical-shaped systolic orifice on CCT and who had undergone surgery. CCT features were analyzed using: (1) aortic valve findings including cusp size, cusp area, opening shape, midline calcification, fusion length, calcium volume score, and calcium grade; (2) diameters of ascending and descending aorta, and main pulmonary artery; and (3) rheumatic mitral valve findings. The variables were evaluated using univariate and multivariate logistic regression analyses. At surgery, 19 patients had BAV and 34 had TAV. CCT features including uneven cusp size, uneven cusp area, round-shaped systolic orifice, longer cusp fusion, and dilatation of ascending aorta were significantly associated with BAV (P < 0.05). In particular, fusion length (OR, 1.76; P = 0.001), uneven cusp area (OR, 10.46; P = 0.012), and midline calcification (OR, 0.08; P = 0.013) were strongly associated with BAV. CCT provides diagnostic clues that helps differentiate between BAV with raphe and TAV with commissural fusion in patients with severe AS. (orig.)

  20. Paramodular Cusp Forms

    CERN Document Server

    Poor, Cris

    2009-01-01

    We classify Siegel modular cusp forms of weight two for the paramodular group K(p) for primes p< 600. We find that weight two Hecke eigenforms beyond the Gritsenko lifts correspond to certain abelian varieties defined over the rationals of conductor p. The arithmetic classification is in a companion article by A. Brumer and K. Kramer. The Paramodular Conjecture, supported by these computations and consistent with the Langlands philosophy and the work of H. Yoshida, is a partial extension to degree 2 of the Shimura-Taniyama Conjecture. These nonlift Hecke eigenforms share Euler factors with the corresponding abelian variety $A$ and satisfy congruences modulo \\ell with Gritsenko lifts, whenever $A$ has rational \\ell-torsion.

  1. Cusp effects in meson decays

    CERN Document Server

    Kubis, Bastian

    2009-01-01

    The pion mass difference generates a pronounced cusp in the pi0 pi0 invariant mass distribution of K+ --> pi0 pi0 pi+ decays. As originally pointed out by Cabibbo, an accurate measurement of the cusp may allow one to pin down the S-wave pion-pion scattering lengths to high precision. We present the non-relativistic effective field theory framework that permits to determine the structure of this cusp in a straightforward manner, including the effects of radiative corrections. Applications of the same formalism to other decay channels, in particular eta and eta' decays, are also discussed.

  2. Aortic valve replacement for Libman-Sacks endocarditis

    Science.gov (United States)

    Keenan, Jack B; Janardhanan, Rajesh; Larsen, Brandon T; Khalpey, Zain

    2016-01-01

    A 24-year-old man with systemic lupus erythematosus and antiphospholipid syndrome complicated by lupus nephritis presented with acute limb ischaemia secondary to an embolus. Following embolectomy, the patient underwent a transthoracic echocardiogram which revealed a large vegetation on all three cusps of the aortic valve. The patient was taken for an urgent aortic valve replacement with a mechanical valve. Cultures of one cusp remained sterile. Histopathological examination of the remaining two cusps revealed sterile fibrin-rich thrombotic vegetations characteristic of non-bacterial thrombotic endocarditis. PMID:27702929

  3. Patch annulo-aortoplasty in an adult patient with congenital supravalvular aortic stenosis and a small aortic annulus.

    Science.gov (United States)

    Morimoto, Naoto; Morimoto, Keisuke; Morimoto, Yoshihisa; Tanaka, Akiko; Sakamoto, Toshihito; Okada, Kenji; Okita, Yutaka

    2011-08-01

    A 39-year-old woman with familial homozygous hypercholesterolemia had supravalvular and valvular aortic stenosis. Modified Nick's procedure and aortic valve replacement was performed to relieve both the supravalvular and annular stenoses. At surgery, the ascending aorta was found to be narrowing at the level of the sinotubular junction, which was compatible with congenital supravalvular aortic stenosis. Histological examination of the aortic cusps showed sclerotic change due to hypercholesterolemia. These findings indicated that familial homozygous hypercholesterolemia caused valvular aortic stenosis and exacerbated congenital supravalvular aortic stenosis.

  4. Aortic insufficiency

    Science.gov (United States)

    ... page, please enable JavaScript. Aortic insufficiency is a heart valve disease in which the aortic valve does not close ... aortic insufficiency Images Aortic insufficiency References Carabello BA. Valvular heart disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil ...

  5. Fitting the Cusp Catastrophe in R: A cusp Package Primer

    Directory of Open Access Journals (Sweden)

    Raoul P. P. P. Grasman

    2009-11-01

    Full Text Available Of the seven elementary catastrophes in catastrophe theory, the “cusp” model is the most widely applied. Most applications are however qualitative. Quantitative techniques for catastrophe modeling have been developed, but so far the limited availability of flexible software has hindered quantitative assessment. We present a package that implements and extends the method of Cobb (Cobb and Watson 1980; Cobb, Koppstein, and Chen 1983, and makes it easy to quantitatively fit and compare different cusp catastrophe models in a statistically principled way. After a short introduction to the cusp catastrophe, we demonstrate the package with two instructive examples.

  6. Bacillus cereus endocarditis in native aortic valve.

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    Ngow, H A; Wan Khairina, W M N

    2013-02-01

    Bacillus cereus endocarditis is rare. It has been implicated in immunocompromised individuals, especially in intravenous drug users as well as in those with a cardiac prosthesis. The patient was a 31-year-old ex-intravenous drug addict with a past history of staphylococcal pulmonary valve endocarditis, who presented with symptoms of decompensated cardiac failure. Echocardiography showed severe aortic regurgitation with an oscillating vegetation seen on the right coronary cusp of the aortic valve. The blood cultures grew Bacillus cereus. We report this as a rare case of Bacillus cereus endocarditis affecting a native aortic valve.

  7. Aortic dissection

    Science.gov (United States)

    ... linked to aortic dissection include: Bicuspid aortic valve Coarctation (narrowing) of the aorta Connective tissue disorders (such ... failure Aneurysm Aortic insufficiency Blood clots Cardiac tamponade Coarctation of the aorta Hardening of the arteries High ...

  8. Transretroperitoneal CT-guided Embolization of Growing Internal Iliac Artery Aneurysm after Repair of Abdominal Aortic Aneurysm: A Transretroperitoneal Approach with Intramuscular Lidocaine Injection Technique

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    Park, Joon Young, E-mail: pjy1331@hanmail.net; Kim, Shin Jung, E-mail: witdd2@hanmail.net; Kim, Hyoung Ook, E-mail: chaos821209@hanmail.net [Chonnam National University Hospital, Department of Radiology (Korea, Republic of); Kim, Yong Tae, E-mail: mono-111@hanmail.net [Chonnam National University Hwasun Hospital, Department of Radiology (Korea, Republic of); Lim, Nam Yeol, E-mail: apleseed@hanmail.net; Kim, Jae Kyu, E-mail: kjkrad@jnu.ac.kr [Chonnam National University Hospital, Department of Radiology (Korea, Republic of); Chung, Sang Young, E-mail: sycpvts@jnu.ac.kr; Choi, Soo Jin Na, E-mail: choisjn@jnu.ac.kr; Lee, Ho Kyun, E-mail: mhaha@hanmail.net [Chonnam National University Hospital, Department of Surgery (Korea, Republic of)

    2015-02-15

    This study was designed to evaluate the efficacy and safety of CT-guided embolization of internal iliac artery aneurysm (IIAA) after repair of abdominal aortic aneurysm by transretroperitoneal approach using the lidocaine injection technique to iliacus muscle, making window for safe needle path for three patients for whom CT-guided embolization of IIAA was performed by transretroperitoneal approach with intramuscular lidocaine injection technique. Transretroperitoneal access to the IIAA was successful in all three patients. In all three patients, the IIAA was first embolized using microcoils. The aneurysmal sac was then embolized with glue and coils without complication. With a mean follow-up of 7 months, the volume of the IIAAs remained stable without residual endoleaks. Transretroperitoneal CT-guided embolization of IIAA using intramuscular lidocaine injection technique is effective, safe, and results in good outcome.

  9. Transretroperitoneal CT-guided embolization of growing internal iliac artery aneurysm after repair of abdominal aortic aneurysm: a transretroperitoneal approach with intramuscular lidocaine injection technique.

    Science.gov (United States)

    Park, Joon Young; Kim, Shin Jung; Kim, Hyoung Ook; Kim, Yong Tae; Lim, Nam Yeol; Kim, Jae Kyu; Chung, Sang Young; Choi, Soo Jin Na; Lee, Ho Kyun

    2015-02-01

    This study was designed to evaluate the efficacy and safety of CT-guided embolization of internal iliac artery aneurysm (IIAA) after repair of abdominal aortic aneurysm by transretroperitoneal approach using the lidocaine injection technique to iliacus muscle, making window for safe needle path for three patients for whom CT-guided embolization of IIAA was performed by transretroperitoneal approach with intramuscular lidocaine injection technique. Transretroperitoneal access to the IIAA was successful in all three patients. In all three patients, the IIAA was first embolized using microcoils. The aneurysmal sac was then embolized with glue and coils without complication. With a mean follow-up of 7 months, the volume of the IIAAs remained stable without residual endoleaks. Transretroperitoneal CT-guided embolization of IIAA using intramuscular lidocaine injection technique is effective, safe, and results in good outcome.

  10. Comparison of echocardiography and angiography in determining the cause of severe aortic regurgitation.

    Science.gov (United States)

    DePace, N L; Nestico, P F; Kotler, M N; Mintz, G S; Kimbiris, D; Goel, I P; Glazier-Laskey, E E; Ross, J

    1984-01-01

    To assess the accuracy of echocardiography in determining the cause of aortic regurgitation M mode and cross sectional echocardiography were compared with angiography in 43 patients with predominant aortic regurgitation. Each patient had all three investigations performed during the same admission to hospital. In each instance, the cause of aortic regurgitation was confirmed at surgery or necropsy. Seventeen patients had rheumatic aortic valve disease, 13 bacterial endocarditis with a perforated or partially destroyed cusp, five a bicuspid aortic valve (four with a history of endocarditis), and eight aortic regurgitation secondary to aortic root dilatation or aneurysm. Overall sensitivity of echocardiography and aortography was 84% in determining the cause of aortic regurgitation. Thus, rheumatic valve disease and endocarditis appear to be the most common causes of severe aortic regurgitation in this hospital based population. Furthermore, echocardiography is a sensitive non-invasive technique for determining the cause of aortic regurgitation and allows differentiation of valvular from root causes of aortic regurgitation.

  11. Estudo comparativo da eficácia do etanol e do ácido L-glutâmico na prevenção da calcificação das cúspides e parede aórtica porcina: estudo experimental em ratos Comparative study on the efficacy of ethanol and of l-glutamic acid for preventing calcification of pig cusps and aortic wall: experimental study in rats

    Directory of Open Access Journals (Sweden)

    George Ronald Soncini da ROSA

    2002-06-01

    álcio/ mg tecido, E80% 30 dias (9,47 ± 2,59mg cálcio/mg tecido e E80% 60 dias (23,56±7,75 mg cálcio/mg tecido no grupo de AG 0,8% 15 dias (4,31±0,85 mg cálcio/mg tecido, AG 0,8% 30 dias (7,69±1,48 mg cálcio/mg tecido e AG 0,8% 60 dias (20,50± 1,22 mg cálcio/mg tecido com o grupo controle GDA 15 dias (7,34±1,32 mg cálcio/mg tecido, GDA 30 dias (9,28±0,76 mg cálcio/mg tecido e GDA 60 dias (27,60±1,08 mg cálcio/mg tecido. Na avaliação microscópica da cúspide aórtica houve uma progressiva calcificação naquelas submetidas à fixação com GDA. Este processo foi parcialmente encontrado com o AG 0,8% e totalmente ausente com o E80%. Quanto à avaliação referente aos segmentos da parede aórtica, também evidenciou-se progressiva calcificação, não sendo inibida pelos tratamentos com AG 0,8% e E80%. CONCLUSÕES: O pré-tratamento com etanol a 80% inibiu a calcificação nas cúspides aórticas porcinas, entretanto, não teve a mesma eficácia na parede aórtica. Contudo, o ácido L-glutâmico a 0,8% demonstrou minimizar a calcificação na parede aórtica. Estudos devem ser feitos para evidenciar se a ação anticalcificante do etanol a 80% mantém-se nas biopróteses aórticas porcinas se estas forem implantadas no sistema circulatório.INTRODUCTION: The glutataldehyde (GDA treated pigs cusps are one of most employed tissues in bioprosthesis, but is late post-implant calcification is main cause of its failure. BACKGROUND: This study aims at comparing and analyzing two methods (ethanol 80% and l-glutamic acid 0.8% to prevent calcification in pig cusps and aortic wall implanted subcutaneously in rats, the cusps and aortic wall segments of the control were in glutaraldehyde (GDA, during a 15, 30 and 60 days period after the implant. MATERIAL AND METHODS: We used 45 young rats, distributed in 3 groups of 15 rats each, which in turn were subdivided in 3 subgroups of 5 rats each, in which we implanted one cusp and one aortic wall segment in 2 subcutaneous

  12. Cusp solitons and cusp-like singular solutions for nonlinear equations

    Energy Technology Data Exchange (ETDEWEB)

    Qiao Zhijun [Department of Mathematics, University of Texas Pan-American, 1201 West University Drive, Edinburg, TX 78539 (United States) and Institute of Mathematics, Fudan University, Shanghai 200433 (China)]. E-mail: qiao@utpa.edu; Qiao, Xin Brian [Memorial High School, 101E Hackberry, McAllen TX 78501 (United States)

    2005-07-01

    This paper gives two new families of nonlinear partial differential equations (PDEs). One has cusp soliton solution while the other possesses the cusp-like singular traveling wave solution. A typical integrable system: Harry-Dym (HD) equation is able to be contained in both families and has cusp soliton solution as well as cusp-like singular traveling wave solution. We prove that the cusp solution of the HD equation is not stable and the cusp-like solution is not included in the parametric solutions of the HD equati0008.

  13. Delayed aortic regurgitation caused by a right coronary stent protruding into the aorta.

    Science.gov (United States)

    Quintana, Eduard; Mestres, Carlos A; Congiu, Stefano; Josa, Miguel; Cartañá, Ramon

    2009-11-01

    Aortic valve perforation is an extremely rare complication after percutaneous coronary intervention. The case is presented of a 49-year-old male with aortic valve regurgitation secondary to the intra-aortic protrusion of a right coronary stent. The patient had undergone an apparently successful rescue percutaneous transluminal coronary angioplasty with a drug-eluting stent following failed fibrinolysis, but one month later was readmitted for acute pulmonary edema. Further investigations demonstrated new-onset aortic regurgitation. Medical stabilization was achieved and an elective aortic valve replacement and coronary revascularization performed. Intraoperatively, the stent was found to be partially deployed within the aortic lumen, causing perforation to the non-coronary cusp.

  14. Cusps in K --> 3 pi decays

    CERN Document Server

    Colangelo, G; Kubis, B; Rusetsky, A; Colangelo, Gilberto; Gasser, Juerg; Kubis, Bastian; Rusetsky, Akaki

    2006-01-01

    The pion mass difference generates a pronounced cusp in K --> 3 pi decays. As has recently been pointed out by Cabibbo and Isidori, an accurate measurement of the cusp may allow one to pin down the S-wave pi pi scattering lengths to high precision. Here, we present and illustrate an effective field theory framework that allows one to determine the structure of this cusp in a straightforward manner. The strictures imposed by analyticity and unitarity are respected automatically.

  15. Understanding the focusing of charged particle for 2D sheet beam in a cusped magnetic field

    CERN Document Server

    Banerjee, Tusharika S; Reddy, K T V

    2016-01-01

    The requirement of axial magnetic field for focusing and transportation of sheet beam using cusped magnets is less as compared to solenoid magnetic fields which is uniform. There is often some confusion about how a cusped magnetic field focuses high current density sheet beam because it is generally understood that non-uniform magnetic field cannot guide the particle beam along its axis of propagation .In this paper, we perform simple analysis of the dynamics of sheet beam in a cusped magnetic field with single electron model and emphasize an intuitive understanding of interesting features (as beam geometry, positioning of permanent magnets, particle radius,particle velocity,radius of curvature of particle inside cusped magnetic field)

  16. Extended contrast detection on fluoroscopy and angiography for image-guided trans-catheter aortic valve implantations (TAVI)

    Science.gov (United States)

    Liu, Yinxiao; Liao, Rui; Lv, Xudong

    2012-02-01

    Navigation and deployment of the prosthetic valve during trans-catheter aortic valve implantation (TAVI) can be greatly facilitated with 3-D models showing detailed anatomical structures. Fast and robust automatic contrast detection at the aortic root on X-ray images is indispensable for automatically triggering a 2-D/3-D registration to align the 3-D model. Previously, we have proposed an automatic method for contrast detection at the aortic root on fluoroscopic and angiographic sequences [4]. In this paper, we extend that algorithm in several ways, making it more robust to handle more general and difficult cases. Specifically, the histogram likelihood ratio test is multiplied with the histogram portion computation to handle faint contrast cases. Histogram mapping corrects sudden changes in the global brightness, thus avoiding potential false positives. Respiration and heart beating check further reduces the false positive rate. In addition, a probe mask is introduced to enhance the contrast feature curve when the dark ultrasound probe partially occludes the aortic root. Lastly, a semi-global registration method for aligning the aorta shape model is implemented to improve the robustness of the algorithm with respect to the selection of region of interest (ROI) containing the aorta. The extended algorithm was evaluated on 100 sequences, and improved the detection accuracy from 94% to 100%, compared to the original method. Also, the robustness of the extended algorithm was tested with 20 different shifts of the ROI, and the error rate was as low as 0.2%, in comparison to 6.6% for the original method.

  17. [Surgical treatment of traumatic rupture of the aortic valve with dove-coo murmur--case report].

    Science.gov (United States)

    Shigemitsu, O; Hadama, T; Mori, Y; Miyamoto, S; Sako, H; Uchida, Y

    1995-03-01

    Aortic regurgitation due to traumatic rupture of the aortic valve with dove-coo murmur is rare. A 71-year-old man was admitted for cardiac failure due to aortic regurgitation with dove-coo murmur, 4 years after the traffic accident. The aortic valve replacement was performed and his postoperative course was good. The aortic valve was tricuspid valve with the tear in the left side of right coronary cusp, and the size of the tear was 7 mm. The aortic valve was not recognized the findings of inflammatory or rheumatic change in the pathological study.

  18. Assessment of radiation doses to the para-aortic, pelvic, and inguinal lymph nodes delivered by image-guided adaptive brachytherapy in locally advanced cervical cancer

    DEFF Research Database (Denmark)

    Mohamed, Sandy M I; Aagaard, Torben; Fokdal, Lars U;

    2015-01-01

    PURPOSE: This study evaluated the dose delivered to lymph nodes (LNs) by brachytherapy (BT) and the effect of BT image-guided optimization on the LN dose. METHODS AND MATERIALS: Twenty-five patients with locally advanced cervical cancer were retrospectively analyzed, 16 patients of them had LN...... group, D98%, D50%, and D2% (the dose that covers 98%, 50%, and 2% of the volume, respectively) were evaluated for optimized and standard BT plans. The correlation between total reference air kerma (TRAK) and D50% of the LN groups was evaluated. RESULTS: BT contributed considerable dose (mean D50% was 3.......8-6.2 Gy equivalent total dose in 2-Gy fractions) to the pelvic LN (external iliac, internal iliac, obturator, and presacral) in optimized plans, whereas less-dose contribution to CI, para-aortic, and inguinal (mean D50% was 0.5-1.9 Gy equivalent total dose in 2-Gy fractions) was observed. Optimized plans...

  19. Towards real-time cardiovascular magnetic resonance-guided transarterial aortic valve implantation: In vitro evaluation and modification of existing devices

    Directory of Open Access Journals (Sweden)

    Ladd Mark E

    2010-10-01

    Full Text Available Abstract Background Cardiovascular magnetic resonance (CMR is considered an attractive alternative for guiding transarterial aortic valve implantation (TAVI featuring unlimited scan plane orientation and unsurpassed soft-tissue contrast with simultaneous device visualization. We sought to evaluate the CMR characteristics of both currently commercially available transcatheter heart valves (Edwards SAPIEN™, Medtronic CoreValve® including their dedicated delivery devices and of a custom-built, CMR-compatible delivery device for the Medtronic CoreValve® prosthesis as an initial step towards real-time CMR-guided TAVI. Methods The devices were systematically examined in phantom models on a 1.5-Tesla scanner using high-resolution T1-weighted 3D FLASH, real-time TrueFISP and flow-sensitive phase-contrast sequences. Images were analyzed for device visualization quality, device-related susceptibility artifacts, and radiofrequency signal shielding. Results CMR revealed major susceptibility artifacts for the two commercial delivery devices caused by considerable metal braiding and precluding in vivo application. The stainless steel-based Edwards SAPIEN™ prosthesis was also regarded not suitable for CMR-guided TAVI due to susceptibility artifacts exceeding the valve's dimensions and hindering an exact placement. In contrast, the nitinol-based Medtronic CoreValve® prosthesis was excellently visualized with delineation even of small details and, thus, regarded suitable for CMR-guided TAVI, particularly since reengineering of its delivery device toward CMR-compatibility resulted in artifact elimination and excellent visualization during catheter movement and valve deployment on real-time TrueFISP imaging. Reliable flow measurements could be performed for both stent-valves after deployment using phase-contrast sequences. Conclusions The present study shows that the Medtronic CoreValve® prosthesis is potentially suited for real-time CMR-guided placement

  20. Cusped Wilson lines in symmetric representations

    CERN Document Server

    Correa, Diego H; Trancanelli, Diego

    2015-01-01

    We study the cusped Wilson line operators and Bremsstrahlung functions associated to particles transforming in the rank-$k$ symmetric representation of the gauge group $U(N)$ for ${\\cal N} = 4$ super Yang-Mills. We find the holographic D3-brane description for Wilson loops with internal cusps in two different limits: small cusp angle and $k\\sqrt{\\lambda}\\gg N$. This allows for a non-trivial check of a conjectured relation between the Bremsstrahlung function and the expectation value of the 1/2 BPS circular loop in the case of a representation other than the fundamental. Moreover, we observe that in the limit of $k\\gg N$, the cusped Wilson line expectation value is simply given by the exponential of the 1-loop diagram. Using group theory arguments, this eikonal exponentiation is conjectured to take place for all Wilson loop operators in symmetric representations with large $k$, independently of the contour on which they are supported.

  1. Reconstructive surgery of the aortic valve

    Directory of Open Access Journals (Sweden)

    Mendonça José Teles de

    2003-01-01

    Full Text Available OBJECTIVE: Lacking an ideal valve substitute and motivated by the good results of mitral valve repair since 1990, we faced with determination aortic valve reconstruction surgery. The objective of this paper is to show our experience with this procedure. METHOD: Between January of 1990 and December of 2001; 136 aortic valve repair surgeries were performed. Seventy-five (55.1% of the patients were female and the ages ranged from 4 to 70 years (mean 23.3 ± 1.2 years. Every patient had rheumatic valve disease and insufficiency was the most prevalent type (108 patients - 79.4%, followed by double aortic lesion in 16 (11.7% patients and stenosis in 12 (8.8%. The surgical techniques used were: subcommissural annuloplasty in 74 (54.4% patients, commissurotomy in 38 (27.9%, cusp extension with pericardium in 17 (12.5%, substitution of one cusp in 2 (1.4%, cusp suspension by annuloplasty in 37 (27.2% and Valsalva sinus remodeling in 27 (19.8%. The surgery exclusively involved the aortic valve in 57 (41.9% patients and was associated in 79 (mitral valve replacement in 12, mitral repair in 65, coronary artery bypass grafting in 1 and pulmonary commissurotomy in 1. RESULTS: Hospital mortality was 2.2% and 22 (16.2% patients underwent a new surgery during the follow-up period (57.7 ± 3.5 months. CONCLUSIONS: Aortic valve repair is a safe surgical procedure that can be used in an increasing number of patients with promising results.

  2. The Energetics of Cusp Destruction

    CERN Document Server

    Maxwell, Aaron J; Couchman, H M P

    2015-01-01

    We present a new analytic estimate for the energy required to create a constant density core within a dark matter halo. Our new estimate, based on more realistic assumptions, leads to a required energy that is orders of magnitude lower than is claimed in earlier work. We define a core size based on the logarithmic slope of the dark matter density profile so that it is insensitive to the functional form used to fit observed data. The energy required to form a core depends sensitively on the radial scale over which dark matter within the cusp is redistributed within the halo. Simulations indicate that within a region of comparable size to the active star forming regions of the central galaxy that inhabits the halo, dark matter particles have their orbits radially increased by a factor of 2--3 during core formation. Thus the inner properties of the dark matter halo, such as halo concentration, and final core size, set the energy requirements. As a result, the energy cost increases slowly with halo mass as M$_{\\r...

  3. Automatic detection of contrast injection on fluoroscopy and angiography for image guided trans-catheter aortic valve implantations (TAVI)

    Science.gov (United States)

    Liao, Rui; You, Wei; Yan, Michelle; John, Matthias

    2011-03-01

    Presentation of detailed anatomical structures via 3-D models helps navigation and deployment of the prosthetic valve in TAVI procedures. Fast and automatic contrast detection in the aortic root on X-ray images facilitates a seamless workflow to utilize the 3-D models by triggering 2-D/3-D registration automatically when motion compensation is needed. In this paper, we propose a novel method for automatic detection of contrast injection in the aortic root on fluoroscopic and angiographic sequences. The proposed method is based on histogram analysis and likelihood ratio test, and is robust to variations in the background, the density and volume of the injected contrast, and the size of the aorta. The performance of the proposed algorithm was evaluated on 26 sequences from 5 patients and 3 clinical sites, with 16 out of 17 contrast injections correctly detected and zero false detections. The proposed method is of general form and can be extended for detection of contrast injection in other organs and/or applications.

  4. Quadricuspid aortic valve complicated with infective endocarditis: report of a case.

    Science.gov (United States)

    Mizoguchi, Hiroki; Sakaki, Masayuki; Inoue, Kazushige; Kobayashi, Yasuhiko; Iwata, Takashi; Suehiro, Yasuo; Miura, Takuya

    2014-12-01

    Congenital quadricuspid aortic valve is a rare cardiac malformation with an unknown risk of infective endocarditis. We report a case of quadricuspid aortic valve complicated with infective endocarditis. A 53-year-old Japanese woman was hospitalized with leg edema and a fever of unknown origin. Corynebacterium striatum was detected in the blood culture. Echocardiography demonstrated a quadricuspid aortic valve with vegetation and severe functional regurgitation. The condition was diagnosed as a quadricuspid aortic valve with infective endocarditis, for which surgery was performed. The quadricuspid aortic valve had three equal-sized cusps and one smaller cusp (type B according to Hurwitz classification). We dissected the vegetation and infectious focus and implanted a mechanical valve. Following the case report, we review the literature.

  5. Dependency of the Cusp Density Anomaly on the Variability of Forcing Inside and Outside the Cusp

    Science.gov (United States)

    Brinkman, D. G.; Walterscheid, R. L.; Clemmons, J. H.

    2014-12-01

    The Earth's magnetospheric cusp provides direct access of energetic particles to the thermosphere. These particles produce ionization and kinetic (particle) heating of the atmosphere. The increased ionization coupled with enhanced electric fields in the cusp produces increased Joule heating and ion drag forcing. These energy inputs largely determine the neutral density structure in the cusp region. Measurements by the CHAMP satellite (460-390- km altitude) have shown a region of strong enhanced density attributed to the combination of cusp particle and Joule heating. The Streak mission (325-123 km), on the other hand, observed a relative depletion in density in the cusp. While particle precipitation in the cusp is comparatively well constrained, the characteristics of the steady and fluctuating components of the electric field in the cusp are poorly constrained. Also, the significance of harder particle precipitation in areas adjacent to the cusp in particular at lower altitudes has not been addressed as it relates to the cusp density anomaly. We address the response of the cusp region to a range electrodynamical forcing with our high resolution two-dimensional time-dependent nonhydrostatic nonlinear dynamical model. We take advantage of our model's high resolution and focus on a more typical cusp width of 2 degrees in latitude. Earlier simulations have also shown a significant contribution from soft particle precipitation. We simulate the atmospheric response to a range of realizable magnitudes of the fluctuating and steady components of the electric field to examine the dependence of the magnitude of the cusp density anomaly on a large range of observed characteristics of the electrodynamical forcing and examine, in particular, the importance of particle heating relative to Joule heating. In addition we investigate the role of harder particle precipitation in areas adjacent to the cusp in determining the lower altitude cusp density and wind structure. We compare

  6. Inhibitory role of Notch1 in calcific aortic valve disease.

    Directory of Open Access Journals (Sweden)

    Asha Acharya

    Full Text Available Aortic valve calcification is the most common form of valvular heart disease, but the mechanisms of calcific aortic valve disease (CAVD are unknown. NOTCH1 mutations are associated with aortic valve malformations and adult-onset calcification in families with inherited disease. The Notch signaling pathway is critical for multiple cell differentiation processes, but its role in the development of CAVD is not well understood. The aim of this study was to investigate the molecular changes that occur with inhibition of Notch signaling in the aortic valve. Notch signaling pathway members are expressed in adult aortic valve cusps, and examination of diseased human aortic valves revealed decreased expression of NOTCH1 in areas of calcium deposition. To identify downstream mediators of Notch1, we examined gene expression changes that occur with chemical inhibition of Notch signaling in rat aortic valve interstitial cells (AVICs. We found significant downregulation of Sox9 along with several cartilage-specific genes that were direct targets of the transcription factor, Sox9. Loss of Sox9 expression has been published to be associated with aortic valve calcification. Utilizing an in vitro porcine aortic valve calcification model system, inhibition of Notch activity resulted in accelerated calcification while stimulation of Notch signaling attenuated the calcific process. Finally, the addition of Sox9 was able to prevent the calcification of porcine AVICs that occurs with Notch inhibition. In conclusion, loss of Notch signaling contributes to aortic valve calcification via a Sox9-dependent mechanism.

  7. The ASACUSA CUSP: an antihydrogen experiment

    Energy Technology Data Exchange (ETDEWEB)

    Kuroda, N., E-mail: kuroda@phys.c.u-tokyo.ac.jp [University of Tokyo, Graduate School of Arts and Sciences (Japan); Ulmer, S. [RIKEN, Ulmer Initiative Research Unit (Japan); Murtagh, D. J.; Gorp, S. Van [RIKEN, Atomic Physics Laboratory (Japan); Nagata, Y. [Tokyo University of Agriculture and Technology, Department of Applied Physics (Japan); Diermaier, M. [Boltzmangasse 3, Stefan Meyer Institut für Subatomare Physik (Austria); Federmann, S. [CERN (Switzerland); Leali, M. [Università di Brescia & Instituto Nazionale di Fisica Nucleare, Dipartimento di Chimica e Fisica per l’Ingegneria e per i Materiali (Italy); Malbrunot, C. [CERN (Switzerland); Mascagna, V. [Università di Brescia & Instituto Nazionale di Fisica Nucleare, Dipartimento di Chimica e Fisica per l’Ingegneria e per i Materiali (Italy); Massiczek, O. [Boltzmangasse 3, Stefan Meyer Institut für Subatomare Physik (Austria); Michishio, K. [Tokyo University of Science, Department of Physics (Japan); Mizutani, T. [University of Tokyo, Graduate School of Arts and Sciences (Japan); Mohri, A. [Kyoto University, Graduate School of Human and Environmental Sciences (Japan); Nagahama, H.; Ohtsuka, M. [University of Tokyo, Graduate School of Arts and Sciences (Japan); Radics, B. [RIKEN, Atomic Physics Laboratory (Japan); Sakurai, S. [Hiroshima University, Graduate School of Advanced Science of Matter (Japan); Sauerzopf, C.; Suzuki, K. [Boltzmangasse 3, Stefan Meyer Institut für Subatomare Physik (Austria); and others

    2015-11-15

    In order to test CPT symmetry between antihydrogen and its counterpart hydrogen, the ASACUSA collaboration plans to perform high precision microwave spectroscopy of ground-state hyperfine splitting of antihydrogen atom in-flight. We have developed an apparatus (“cusp trap”) which consists of a superconducting anti-Helmholtz coil and multiple ring electrodes. For the preparation of slow antiprotons and positrons, Penning-Malmberg type traps were utilized. The spectrometer line was positioned downstream of the cusp trap. At the end of the beamline, an antihydrogen beam detector was located, which comprises an inorganic Bismuth Germanium Oxide (BGO) single-crystal scintillator housed in a vacuum duct and surrounding plastic scintillators. A significant fraction of antihydrogen atoms flowing out the cusp trap were detected.

  8. Cusps in eta' --> eta pi pi decays

    CERN Document Server

    Schneider, Sebastian P

    2009-01-01

    The discovery of the cusp effect in the decay K+ --> pi+ pi0 pi0 has spurred the search for other decay channels, where this phenomenon, which is generated by strong final-state interactions, should also occur. A very promising candidate is eta' --> eta pi0 pi0. The cusp effect offers an excellent opportunity to experimentally extract pi pi S-Wave scattering lengths. We adapt and generalize the non-relativistic effective field theory framework developed for K --> 3 pi decays to eta' --> eta pi pi. The cusp effect is predicted to have an effect of more than 8 % on the decay spectrum below the pi+ pi- threshold. We also show that with our current theoretical information about eta' --> eta pi pi decays, it is not possible to extract pi eta threshold parameters.

  9. Asymptomatic papillary fibroelastoma of the Aortic valve in a young woman - a case report

    Directory of Open Access Journals (Sweden)

    Pitsis Antonis

    2009-09-01

    Full Text Available Abstract Echocardiography represents an invaluable diagnostic tool for the detection of intracardiac masses while simultaneously provides information about their size, location, mobility and attachment site as well as the presence and extent of any consequent hemodynamic derangement. A 29-year-old asymptomatic young woman with incidental transthoracic echocardiographic (TTE discovery of an aortic valve mass is presented. The 2-dimensional TTE showed a mobile, pedunculated mass, attached by a thin stalk to the aortic surface of the right coronary aortic cusp at the junction of its base with the anterior aortic wall. The importance of valve sparing tumour resection even in asymptomatic patients is emphasised.

  10. Opening the cusp. [using magnetic field topology

    Science.gov (United States)

    Crooker, N. U.; Toffoletto, F. R.; Gussenhoven, M. S.

    1991-01-01

    This paper discusses the magnetic field topology (determined by the superposition of dipole, image, and uniform fields) for mapping the cusp to the ionosphere. The model results are compared to both new and published observations and are then used to map the footprint of a flux transfer event caused by a time variation in the merging rate. It is shown that the cusp geometry distorts the field lines mapped from the magnetopause to yield footprints with dawn and dusk protrusions into the region of closed magnetic flux.

  11. A facial talon cusp on maxillary permanent central incisors

    Directory of Open Access Journals (Sweden)

    Suneelkumar Chinni

    2012-01-01

    Full Text Available Talon cusp is a dental anomaly that occurs as an accessory cusp like structure, from the cingulum of maxillary and mandibular anterior teeth. Lingual location is usually considered pathognomic. This case report discuss about the unusual appearance of talon cusp on the facial surface of the maxillary left permanent central incisor and a mild talon cusp on the facial surface of the maxillary right permanent central incisor.

  12. 21 CFR 872.3350 - Gold or stainless steel cusp.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Gold or stainless steel cusp. 872.3350 Section 872...) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3350 Gold or stainless steel cusp. (a) Identification. A gold or stainless steel cusp is a prefabricated device made of austenitic alloys or...

  13. ANALYSIS OF TRANSONIC FLOW PAST CUSPED AIRFOILS

    Directory of Open Access Journals (Sweden)

    Jiří Stodůlka

    2015-06-01

    Full Text Available Transonic flow past two cusped airfoils is numerically solved and achieved results are analyzed by means of flow behavior and oblique shocks formation.Regions around sharp trailing edges are studied in detail and parameters of shock waves are solved and compared using classical shock polar approach and verified by reduction parameters for symmetric configurations.

  14. Cusp formation in drops inside Taylor cones

    Science.gov (United States)

    Marin, Alvaro G.; Loscertales, Ignacio G.; Barrero, Antonio

    2005-11-01

    Here, we report the formation of cusp in insulating drops inside compound Taylor cones. The action of the electrical shear stress acting on the outer interface, which is transmitted by viscous forces inside the Taylor cone, tends to deform the drop of insulating liquid placed inside. For appropriate values of the capillary number, the insulating drop develops a steady cusp angle which depends on both the capillary number and the conducting to insulating viscosity ratio. A self-similar analysis has been developed to qualitatively describe the flow inside these compounds Taylor cones. Any perturbation of the cusp gives rise to an intermittent emission of tiny droplets; this effect may recall the tip-streaming observed by G.I. Taylor in his four-roll mill device. This emission can be stabilized by an appropriate control of the injected flow rate of the insulating liquid. When the capillary number increases, the cusped interface turns into a spout which flows coated by the conducting liquid forming the electrified coaxial jet which has been successfully employed for the production of nanocapsules, coaxial nanofibers and nanotubes (Science 295, n. 5560, 1695, 2002; JACS 126, 5376, 2004).

  15. Aortic stenosis

    Science.gov (United States)

    ... Images Aortic stenosis Heart valves References Carabello BA. Valvular heart disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil ... ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/ ...

  16. Abdominal Aortic Aneurysm (AAA)

    Science.gov (United States)

    ... News Physician Resources Professions Site Index A-Z Abdominal Aortic Aneurysm (AAA) Abdominal aortic aneurysm (AAA) occurs when atherosclerosis ... an abdominal aortic aneurysm treated? What is an abdominal aortic aneurysm? The aorta, the largest artery in the body, ...

  17. Medical treatments in aortic stenosis: Role of statins and angiotensin-converting enzyme inhibitors

    Directory of Open Access Journals (Sweden)

    Davičević Žaklina

    2010-01-01

    Full Text Available Calcific arotic stenosis and atherosclerosis. Aortic stenosis is the most frequent valvular heart disease in-western world and its incidence continues to rise. Aortic sclerosis is the first characteristic lesion of the cusps, which is today considered a process similar to atherosclerosis. The progression of the disease is an active process leading to forming of bone matrix and heavily calcified stiff cusps by inflammatory cells and osteopontin. Aortic stenosis is a chronic, progressive disease which can remain asymptomatic for a long time even in the presence of severe aortic stenosis. Medical treatment for aortic stenosis. The need for alternative to aortic valve surgery is highlighted by increasing longevity of the population and new therapeutic strategies to limit disease progression are needed to delay or potentially avoid, the need for valve surgery. Currently, there are no established disease modifying treatments in regard to the progression of aortic stenosis. The first results about influence of angiotenzin-converting enzyme inhibitors and statins on aortic sclerosis and stenosis progression are promising. Statins are likely to reduce cardiovascular events rather than disease progression, but may be potentially a valuable preventive treatment in these patients. The prejudice against the use of angiotenzin-converting enzyme inhibitors by patients with aortic stenosis is changing. The cautious use of angiotenzin-converting enzyme inhibition by patients with concomitant hypertension, coronary artery disease, and heart failure seems appropriate. Definite evidence from large clinical trials is awaited.

  18. Traumatic rupture of Ionescu-Shiley aortic valve after the Heimlich maneuver.

    Science.gov (United States)

    Passik, C S; Ackermann, D M; Piehler, J M; Edwards, W D

    1987-05-01

    A 74-year-old woman who had undergone aortic valve replacement with an Ionescu-Shiley bioprosthesis was evaluated and treated because aortic insufficiency developed after the application of the Heimlich maneuver. Pathologic examination of the explanted valve disclosed a cuspid perforation and an adjacent tear of a second cusp at its insertion into the valve strut. Patients with unexplained acute prosthetic insufficiency should be questioned as to whether the Heimlich maneuver has been previously performed.

  19. Chaotic musical murmur in aortic regurgitation.

    Science.gov (United States)

    Miyahara, K; Amitani, S; Sohara, H; Kurose, M; Iwamura, H; Toyohira, H; Taira, A

    1996-12-01

    We report an interesting case of aortic regurgitation. Phonocardiographically, the shape of the diastolic musical murmur in this case changed in each cardiac cycle despite being in sinus rhythm, in the same posture and in the same breathing phase. Experimentally, we were able to obtain a similar noise pattern using an artificial respirator and a hemispherical silicone membrane. We concluded that the irregular and chaotic change in the shape of the diastolic musical murmur in the present case occurred due to irregular swaying of the non-coronary cusp under the influence of the Venturi effect owing to a regurgitant jet stream.

  20. Talon Cusp Type I: Restorative Management

    Directory of Open Access Journals (Sweden)

    Rafael Alberto dos Santos Maia

    2015-01-01

    Full Text Available The teeth are formed during intrauterine life (i.e., gestation during the odontogenesis stage. During this period, the teeth move until they enter the oral cavity. This course covers various stages of dental development, namely, initiation, proliferation, histodifferentiation, morphodifferentiation, and apposition. The talon cusp is an anomaly that occurs during morphodifferentiation, and this anomaly may have numerous adverse clinical effects on oral health. The objective of this study was to report a case of “Talon Cusp Type I” and to discuss diagnostic methods, treatment options for this anomaly, and the importance of knowledge of this morphological change among dental professionals so that it is not confused with other morphological changes; such knowledge is required to avoid unnecessary surgical procedures, to perform treatments that prevent caries and malocclusions as well as enhancing aesthetics, and to improve the oral health and quality of life of the patient.

  1. Lowering plasma cholesterol levels halts progression of aortic valve disease in mice

    Science.gov (United States)

    Miller, Jordan D.; Weiss, Robert M.; Serrano, Kristine M.; Brooks, Robert M.; Berry, Christopher J.; Zimmerman, Kathy; Young, Stephen G.; Heistad, Donald D.

    2009-01-01

    Background Treatment of hyperlipidemia produces functional and structural improvements in atherosclerotic vessels. However, the effects of treating hyperlipidemia on the structure and function of the aortic valve has been controversial, and any effects could be confounded by pleiotropic effects of hypolipidemic treatment. The goal of this study was to determine whether reducing elevated plasma lipid levels with a “genetic switch” in Reversa mice (Ldlr−/−/Apob100/100/Mttpfl/fl/Mx1Cre+/+) reduces oxidative stress, reduces proosteogenic signaling, and retards the progression of aortic valve disease. Methods and Results After 6 months of hypercholesterolemia, Reversa mice exhibited increases in superoxide, lipid deposition, myofibroblast activation, calcium deposition, and pro-osteogenic protein expression in the aortic valve. Maximum aortic valve cusp separation, as judged by echocardiography, was not altered. During an additional 6 months of hypercholesterolemia, superoxide levels, valvular lipid deposition, and myofibroblast activation remained elevated. Furthermore, calcium deposition and pro-osteogenic gene expression became more pronounced and the aortic cusp separation decreased from 0.85 ± 0.04 to 0.70 ± 0.04 mm (mean ± SE; p < 0.05). Rapid normalization of cholesterol levels at 6 months of age (by inducing expression of Cre recombinase) normalized aortic valve superoxide levels, decreased myofibroblast activation, reduced valvular calcium burden, suppressed pro-osteogenic signaling cascades, and prevented the reductions in aortic valve cusp separation. Conclusions Collectively, these data indicate that reducing plasma lipid levels by genetic inactivation of the mttp gene in hypercholesterolemic mice with early aortic valve disease normalizes oxidative stress, reduces pro-osteogenic signaling, and halts the progression of aortic valve stenosis. PMID:19433756

  2. Extended aortic valvuloplasty: a new approach for the management of congenital valvar aortic stenosis.

    Science.gov (United States)

    Ilbawi, M N; DeLeon, S Y; Wilson, W R; Roberson, D A; Husayni, T S; Quinones, J A; Arcilla, R A

    1991-09-01

    A new technique for the treatment of congenital valvar aortic stenosis is described. It consists of augmenting the aortic cusp by extending the commissurotomy incision into the aortic wall around the leaflet insertion, mobilizing the valve cusp attachment at the commissures, and freeing the aortic insertion of the rudimentary commissure. The results of standard valvotomy performed on 48 patients (group 1) were compared with those of the new extended valvuloplasty carried out on 16 patients (group 2). The two groups were comparable in age at operation (2.7 +/- 2.1 years for group 1 versus 2.1 +/- 1.7 years for group 2; p = not significant) and in preoperative pressure gradient (58 +/- 25 mm Hg for group 1 versus 61 +/- 36 mm Hg for group 2; p = not significant). There was no operative mortality in either group. Follow-up is available on all patients, with a mean of 4.3 +/- 2.6 years for group 1 versus 1.7 +/- 0.5 years for group 2 (p = 0.05). There was one late death in group 1. Postoperative gradient was 47 +/- 13 mm Hg in group 1 versus 19 +/- 13 mm Hg in group 2 (p = 0.05). Moderate or severe regurgitation was present in 18 patients (38%) in group 1 and 2 patients (13%) in group 2 (p = not significant). Reoperation was needed in 8 patients (17%) in group 1 versus 2 patients (13%) in group 2 (p = not significant). The described valvuloplasty procedure addresses the unique pathological features of valvar aortic stenosis and provides better relief of the obstruction than the presently available techniques. Longer follow-up is needed to determine the late results of this approach.

  3. Wilson loops at strong coupling for curved contours with cusps

    CERN Document Server

    Dorn, Harald

    2015-01-01

    We construct the minimal surface in AdS, relevant for the strong coupling behaviour of local supersymmetric Wilson loops in N=4 SYM for a closed contour formed out of segments of two intersecting circles. Its regularised area is calculated including all divergent parts and the finite renormalised term. Furthermore we prove, that for generic planar curved contours with cusps the cusp anomalous dimensions are functions of the respective cusp angles alone. They do not depend on other local data of the cusps.

  4. From cusps to cores: a stochastic model

    Science.gov (United States)

    El-Zant, Amr A.; Freundlich, Jonathan; Combes, Françoise

    2016-09-01

    The cold dark matter model of structure formation faces apparent problems on galactic scales. Several threads point to excessive halo concentration, including central densities that rise too steeply with decreasing radius. Yet, random fluctuations in the gaseous component can `heat' the centres of haloes, decreasing their densities. We present a theoretical model deriving this effect from first principles: stochastic variations in the gas density are converted into potential fluctuations that act on the dark matter; the associated force correlation function is calculated and the corresponding stochastic equation solved. Assuming a power-law spectrum of fluctuations with maximal and minimal cutoff scales, we derive the velocity dispersion imparted to the halo particles and the relevant relaxation time. We further perform numerical simulations, with fluctuations realized as a Gaussian random field, which confirm the formation of a core within a time-scale comparable to that derived analytically. Non-radial collective modes enhance the energy transport process that erases the cusp, though the parametrizations of the analytical model persist. In our model, the dominant contribution to the dynamical coupling driving the cusp-core transformation comes from the largest scale fluctuations. Yet, the efficiency of the transformation is independent of the value of the largest scale and depends weakly (linearly) on the power-law exponent; it effectively depends on two parameters: the gas mass fraction and the normalization of the power spectrum. This suggests that cusp-core transformations observed in hydrodynamic simulations of galaxy formation may be understood and parametrized in simple terms, the physical and numerical complexities of the various implementations notwithstanding.

  5. Reproducibility of aortic annulus measurements by computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Schuhbaeck, Annika; Achenbach, Stephan [University of Erlangen, Department of Cardiology, Erlangen (Germany); University of Giessen, Department of Cardiology, Giessen (Germany); Pflederer, Tobias; Marwan, Mohamed; Schmid, Jasmin; Arnold, Martin [University of Erlangen, Department of Cardiology, Erlangen (Germany); Nef, Holger; Rixe, Johannes; Hecker, Franziska [University of Giessen, Department of Cardiology, Giessen (Germany); Schneider, Christian [University of Giessen, Department of Radiology, Giessen (Germany); Lell, Michael; Uder, Michael [University of Erlangen, Department of Radiology, Erlangen (Germany)

    2014-08-15

    To evaluate a systematic approach for measurement of aortic annulus dimensions by cardiac computed tomography. CT data sets of 64 patients were evaluated. An oblique cross-section aligned with the aortic root was created by systematically identifying the caudal insertion points of the three aortic cusps and sequentially aligning them in a double oblique plane. Aortic annulus dimensions, distances of coronary ostia and a suitable fluoroscopic projection angle were independently determined by two observers. Interobserver intraclass correlation coefficients (ICC) for aortic annulus diameters were excellent (ICC 0.89-0.93). Agreement for prosthesis size selection was excellent (k = 0.86 for mean, k = 0.84 for area-derived and k = 0.91 for circumference-derived diameter). Mean distances of the left/right coronary ostium were 13.4 ± 2.4/14.4 ± 2.8 mm for observer 1 and 13.2 ± 2.7/13.5 ± 3.2 mm for observer 2 (p = 0.30 and p = 0.0001, respectively; ICC 0.76/0.77 for left/right coronary artery). A difference of less than 10 for fluoroscopic projection angle was achieved in 84.3 % of patients. A systematic approach to generate a double oblique imaging plane exactly aligned with the aortic annulus demonstrates high interobserver and intraobserver agreements for derived measurements which are not influenced by aortic root calcification. (orig.)

  6. Bicuspid Aortic Valve

    Science.gov (United States)

    2006-08-01

    aortic valvular disease, endocarditis, ascending aortic aneurysm and aortic dissection.1-4 There is also an association of BAV with coarctation of...for aortic aneurysm , patients with BAV appear to have additional risks for aortic disease. Nistri et al.12 reported significant aortic root...Congenital heart disease in patients with Turner’s syndrome. Italian study group for Turner syndrome (ISGTS). J Pediatr 1998; 133:688-692. 7. Schmid

  7. Aortic Stenosis.

    Science.gov (United States)

    Bakaeen, Faisal G; Rosengart, Todd K; Carabello, Blase A

    2017-01-03

    This issue provides a clinical overview of aortic stenosis, focusing on screening, diagnosis, treatment, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.

  8. Talon′s cusp: Report of four unusual cases

    Directory of Open Access Journals (Sweden)

    Tulunoglu O

    2007-03-01

    Full Text Available Talon cusp is a developmental dental anomaly thought to arise as a result of evagination on the surface of a tooth crown before calcification has occurred. The etiology remains unknown. The incidence is 0.04-10%. Any tooth may have a talon cusp but most of the cases involve maxillary lateral incisors, with some instances of bilateral involvement. The anomaly has been reported to be rare in the mandible. This article reports four cases of talon cusp. The first and the second cases describe bilateral involvement of talon cusp on palatal surfaces of maxillary primary centrals; in the third case talon tubercle occurs on palatal surfaces of both maxillary permanent lateral incisors and the maxillary left central incisor and in the last case a talon cusp in the lingual surface of mandibular permanent lateral incisor.

  9. High Energy Electron Confinement in a Magnetic Cusp Configuration

    CERN Document Server

    Park, Jaeyoung; Sieck, Paul E; Offermann, Dustin T; Skillicorn, Michael; Sanchez, Andrew; Davis, Kevin; Alderson, Eric; Lapenta, Giovanni

    2014-01-01

    We report experimental results validating the concept that plasma confinement is enhanced in a magnetic cusp configuration when beta (plasma pressure/magnetic field pressure) is order of unity. This enhancement is required for a fusion power reactor based on cusp confinement to be feasible. The magnetic cusp configuration possesses a critical advantage: the plasma is stable to large scale perturbations. However, early work indicated that plasma loss rates in a reactor based on a cusp configuration were too large for net power production. Grad and others theorized that at high beta a sharp boundary would form between the plasma and the magnetic field, leading to substantially smaller loss rates. The current experiment validates this theoretical conjecture for the first time and represents critical progress toward the Polywell fusion concept which combines a high beta cusp configuration with an electrostatic fusion for a compact, economical, power-producing nuclear fusion reactor.

  10. Aortic valve bypass

    DEFF Research Database (Denmark)

    Lund, Jens T; Jensen, Maiken Brit; Arendrup, Henrik;

    2013-01-01

    In aortic valve bypass (AVB) a valve-containing conduit is connecting the apex of the left ventricle to the descending aorta. Candidates are patients with symptomatic aortic valve stenosis rejected for conventional aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI...

  11. Source of the dayside cusp aurora

    Science.gov (United States)

    Mende, S. B.; Frey, H. U.; Angelopoulos, V.

    2016-08-01

    Monochromatic all-sky imagers at South Pole and other Antarctic stations of the Automatic Geophysical Observatory chain recorded the aurora in the region where the Time History of Events and Macroscale Interactions during Substorms (THEMIS) satellites crossed the dayside magnetopause. In several cases the magnetic field lines threading the satellites when mapped to the atmosphere were inside the imagers' field of view. From the THEMIS magnetic field and the plasma density measurements, we were able to locate the position of the magnetopause crossings and map it to the ionosphere using the Tsyganenko-96 field model. Field line mapping is reasonably accurate on the dayside subsolar region where the field is strong, almost dipolar even though compressed. From these coordinated observations, we were able to prove that the dayside cusp aurora of high 630 nm brightness is on open field lines, and it is therefore direct precipitation from the magnetosheath. The cusp aurora contained significant highly structured N2+ 427.8 nm emission. The THEMIS measurements of the magnetosheath particle energy and density taken just outside the magnetopause compared to the intensity of the structured N2+ 427.8 nm emissions showed that the precipitating magnetosheath particles had to be accelerated. The most likely electron acceleration mechanism is by dispersive Alfvén waves propagating along the field line. Wave-accelerated suprathermal electrons were seen by FAST and DMSP. The 427.8 nm wavelength channel also shows the presence of a lower latitude hard-electron precipitation zone originating inside the magnetosphere.

  12. High-Energy Electron Confinement in a Magnetic Cusp Configuration

    Science.gov (United States)

    Park, Jaeyoung; Krall, Nicholas A.; Sieck, Paul E.; Offermann, Dustin T.; Skillicorn, Michael; Sanchez, Andrew; Davis, Kevin; Alderson, Eric; Lapenta, Giovanni

    2015-04-01

    We report experimental results validating the concept that plasma confinement is enhanced in a magnetic cusp configuration when β (plasma pressure/magnetic field pressure) is of order unity. This enhancement is required for a fusion power reactor based on cusp confinement to be feasible. The magnetic cusp configuration possesses a critical advantage: the plasma is stable to large scale perturbations. However, early work indicated that plasma loss rates in a reactor based on a cusp configuration were too large for net power production. Grad and others theorized that at high β a sharp boundary would form between the plasma and the magnetic field, leading to substantially smaller loss rates. While not able to confirm the details of Grad's work, the current experiment does validate, for the first time, the conjecture that confinement is substantially improved at high β . This represents critical progress toward an understanding of the plasma dynamics in a high-β cusp system. We hope that these results will stimulate a renewed interest in the cusp configuration as a fusion confinement candidate. In addition, the enhanced high-energy electron confinement resolves a key impediment to progress of the Polywell fusion concept, which combines a high-β cusp configuration with electrostatic fusion for a compact, power-producing nuclear fusion reactor.

  13. Histopathological study of congenital aortic valve malformations in 32 children

    Institute of Scientific and Technical Information of China (English)

    HUANG Ping; WANG Hongwei; LI Yanping; CHENG Peixuan; LIU Qingjun; ZHANG Zhenlu; LIU Jianying

    2007-01-01

    The histopathological characteristics of congenital aortic valve malformations in children were investigated.All the native surgically excised aortic valves from 32 pediatric patients suffering from symptomatic aortic valve dysfunction due to congenital aortic valve malformations between January 2003 and December 2005 were studied macroscopically and microscopically.The patients' medical records were reviewed and the clinical information was extracted.The diagnosis was made by the clinical presentation,preoperative echocardiography,intraoperative examination,and postoperative histopathological study,excluding rheumatic ot degenerative aortic valve diseases,infective endocarditis and primary connective tissue disorders,e.g.Marfan syndrome.Among 32 children with congenital aortic valve malformations,the age was ranged from six to 18 years,with a mean of 14.9 years,and there were 27 boys and five girls (male:female = 5.4:1).There were five cases of aortic stenosis (AS,15.62%),25 cases of aortic insufficiency (AI,78.13 %)and two cases of AS-AI (6.25%),without other valve diseases.Twenty cases still had other congenital heart diseases:ventricular septal defect (19 cases),patent ductus arteriosus (two cases),double-chambered right ventricle (one case),aneurysm of the right anterior aortic sinus of valsalva (three cases).Histopathological examination indicated that the cusps became thickening with unequal size,irregular shape (coiling and prolapse edge),enhanced hardness,and partly calcification.Microscopic investigation revealed the unsharp structure of valve tissue,fibrosis,myxomatous,reduced collagen fiber,rupture of elastic fibers,different degrees of infiltration of inflammatory cells,secondary calcareous and lipid deposit,and secondary fibrosis.Congenital aortic valve malformations in children involve males more than females,mostly associated with other congenital heart diseases.Aortic insufficiency is more common in children with congenital aortic valve

  14. Cusp Alfven and Plasma Electrodynamics Rocket (CAPER) Project

    Data.gov (United States)

    National Aeronautics and Space Administration — Launch a single rocket from Andoya Rocket Range into an active cusp event. Observe electric and magnetic fields, HF waves, electron and ion distributions and...

  15. Rational cuspidal curves with four cusps on Hirzebruch surfaces

    Directory of Open Access Journals (Sweden)

    Torgunn Karoline Moe

    2014-10-01

    Full Text Available The purpose of this article is to shed light on the question of how many and what kind of cusps a rational cuspidal curve on a Hirzebruch surface can have. Our main result is a list of rational cuspidal curves with four cusps, their type, cuspidal congurations and the surfaces they lie on. We use birational transformations to construct these curves. Moreover, we find a general expression for and compute the Euler characteristic of the logarithmic tangent sheaf in these cases. Additionally, we show that there exists a real rational cuspidal curve with four real cusps. Last, we show that for rational cuspidal curves with two or more cusps on a Hirzebruch surface, there is a lower bound on one of the multiplicities.

  16. Observations of the cusp region under northward IMF

    Directory of Open Access Journals (Sweden)

    F. Pitout

    Full Text Available We present a comparative study of the cusp region using the EISCAT Svalbard Radars (ESR and the Cluster spacecraft. We focus in this paper on 2 February 2001, over the time period from 07:30 UT to 12:00 UT when the oblique ESR antenna pointing northward at a low elevation recorded latitudinal motions of the cusp region in response to the IMF. Meanwhile, the Cluster satellites were flying over the EISCAT Svalbard Radar field-of-view around local magnetic noon. The spacecraft first flew near ESR, northeast of Svalbard and then passed over the field-of-view of the antenna at about 11:30 UT. From 08:00 UT to 09:00 UT, the IMF remains primarily southward yet several variations in the Z-component are seen to move the cusp. Around 09:00 UT, an abrupt northward turning of the IMF moves the cusp region to higher latitudes. As a result, the Cluster satellites ended up in the northernmost boundary of the high-altitude cusp region where the CIS instrument recorded highly structured plasma due to ion injections in the lobe of the magnetosphere. After 09:00 UT, the IMF remains northward for more than two hours. Over this period, the ESR records sunward plasma flow in the cusp region due to lobe reconnection, while Cluster spacecraft remain in the high-altitude cusp.

    Key words. Magnetospheric physics (magnetopause, cusp, and boundary layers; plasma convection Ionosphere (polar ionosphere

  17. The cusp effect in eta' --> eta pi pi decays

    CERN Document Server

    Kubis, Bastian

    2009-01-01

    Strong final-state interactions create a pronounced cusp in eta' --> eta pi0 pi0 decays. We adapt and generalize the non-relativistic effective field theory framework developed for the extraction of pi pi scattering lengths from K --> 3 pi decays to this case. The cusp effect is predicted to have an effect of more than 8% on the decay spectrum below the pi+ pi- threshold.

  18. Aortic Annular Enlargement during Aortic Valve Replacement

    Directory of Open Access Journals (Sweden)

    Selman Dumani

    2016-09-01

    Full Text Available In the surgery of aortic valve replacement is always attempted, as much as possible, to implant the larger prosthesis with the mains goals to enhance the potential benefits, to minimise transvalvular gradient, decrease left ventricular size and avoid the phenomenon of patient-prosthesis mismatch. Implantation of an ideal prosthesis often it is not possible, due to a small aortic annulus. A variety of aortic annulus enlargement techniques is reported to avoid patient-prosthesis mismatch. We present the case that has submitted four three times open heart surgery. We used Manouguian technique to enlarge aortic anulus with excellent results during the fourth time of surgery.

  19. Cusp observations during a sequence of fast IMF BZ reversals

    Directory of Open Access Journals (Sweden)

    S. E. Milan

    2009-07-01

    Full Text Available In recent years, a large number of papers have reported the response of the cusp to solar wind variations under conditions of northward or southward Interplanetary Magnetic Field (IMF Z-component (BZ. These studies have shown the importance of both temporal and spatial factors in determining the extent and morphology of the cusp and the changes in its location, connected to variations in the reconnection geometry. Here we present a comparative study of the cusp, focusing on an interval characterised by a series of rapid reversals in the BZ-dominated IMF, based on observations from space-borne and ground-based instrumentation. During this interval, from 08:00 to 12:00 UT on 12 February 2003, the IMF BZ component underwent four reversals, remaining for around 30 min in each orientation. The Cluster spacecraft were, at the time, on an outbound trajectory through the Northern Hemisphere magnetosphere, whilst the mainland VHF and Svalbard (ESR radars of the EISCAT facility were operating in support of the Cluster mission. Both Cluster and the EISCAT were, on occasion during the interval, observing the cusp region. The series of IMF reversals resulted in a sequence of poleward and equatorward motions of the cusp; consequently Cluster crossed the high-altitude cusp twice before finally exiting the dayside magnetopause, both times under conditions of northward IMF BZ. The first magnetospheric cusp encounter, by all four Cluster spacecraft, showed reverse ion dispersion typical of lobe reconnection; subsequently, Cluster spacecraft 1 and 3 (only crossed the cusp for a second time. We suggest that, during this second cusp crossing, these two spacecraft were likely to have been on newly closed field lines, which were first reconnected (opened at low latitudes and later reconnected again (re-closed poleward of the northern cusp. At ionospheric altitudes, the latitudinal excursions of the cusp/cleft region in response to the series of the IMF polarity

  20. Aortic aneurysm repair - endovascular

    Science.gov (United States)

    EVAR; Endovascular aneurysm repair - aorta; AAA repair - endovascular; Repair - aortic aneurysm - endovascular ... Endovascular aortic repair is done because your aneurysm is very large, growing quickly, or is leaking or bleeding. You may have ...

  1. Abdominal aortic aneurysm

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/000162.htm Abdominal aortic aneurysm To use the sharing features on this page, ... blood to the abdomen, pelvis, and legs. An abdominal aortic aneurysm occurs when an area of the aorta becomes ...

  2. Aortic growth rates in chronic aortic dissection

    Energy Technology Data Exchange (ETDEWEB)

    Kelly, A.M. [Department of Radiology, Division of Thoracic Radiology, University of Michigan Medical Center (United States)]. E-mail: ainekell@med.umich.edu; Quint, L.E. [Department of Radiology, Division of Thoracic Radiology, University of Michigan Medical Center (United States); Nan, B. [School of Public Health, University of Michigan, Ann Arbor, Michigan (United States); Zheng, J. [School of Public Health, University of Michigan, Ann Arbor, Michigan (United States); Cronin, P. [Department of Radiology, Division of Thoracic Radiology, University of Michigan Medical Center (United States); Deeb, G.M. [Division of Cardiac Surgery, University of Michigan Medical Center (United States); Williams, D.M. [Division of Vascular Interventional Imaging, University of Michigan Medical Center (United States)

    2007-09-15

    Aim: To determine and compare rates of descending aortic enlargement and complications in chronic aortic dissection with and without a proximal aortic graft. Methods and materials: Fifty-two patients with dissection involving the descending aorta and who had undergone at least two computed tomography (CT) examinations at our institution between November, 1993 and February, 2004 were identified, including 24 non-operated patients (four type A, 20 type B) and 28 operated patients (type A). CT examinations per patient ranged from two to 10, and follow-up ranged from 1-123 months (mean 49 months, median 38.5 months). On each CT image, the aortic short axis (SA), false lumen (FL), and true lumen (TL) diameters were measured at the longitudinal midpoint of the dissection and at the point of maximum aortic diameter. Complications were tabulated, including aortic rupture and aortic enlargement requiring surgery. Results: For non-operated patients, the midpoint and maximum point SA, TL, and FL diameters increased significantly over time. For operated patients, the midpoint and maximum point SA and FL diameters increased significantly over time. In both groups, aortic enlargement was predominantly due to FL expansion. Diameter increases in non-operated patients were significantly larger than those in operated patients. The rate of change in aortic diameter was constant, regardless of aortic size. Four non-operated and six operated patients developed aortic complications. Conclusions: In patients with a dissection involving the descending thoracic aorta, the FL increased in diameter over time, at a constant rate, and to a greater degree in non-operated patients (mostly type B) compared with operated patients (all type A)

  3. Aortic and Pulmonary Root Aneurysms in a Child With Loeys-Dietz Syndrome.

    Science.gov (United States)

    Rizzo, Stefania; Stellin, Giovanni; Milanesi, Ornella; Padalino, Massimo; Vricella, Luca A; Thiene, Gaetano; Cameron, Duke E; Basso, Cristina; Vida, Vladimiro L

    2016-03-01

    We report the case of an 11-year-old boy with Loeys-Dietz syndrome, with both aortic and pulmonary aneurysms requiring cardiac operation because of progressive valve incompetence resulting from loss of coaptation of the cusps. Arterial medial changes, consisting of disarray of elastic fibers and increased collagen deposition, were observed in surgical specimens from both the aorta and the pulmonary artery of our patient, and the strong pSmad2 nuclear staining of smooth muscle cells of both aortic and pulmonary tunica media are the best evidence of transforming growth factor-β pathway activation in Loeys-Dietz syndrome.

  4. Characteristics of aortic valve dysfunction and ascending aorta dimensions according to bicuspid aortic valve morphology

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Hong Ju [Konkuk University Medical Center, Konkuk University School of Medicine, Department of Cardiovascular Surgery, Seoul (Korea, Republic of); Yonsei University College of Medicine, Department of Cardiovascular Surgery, Seoul (Korea, Republic of); Shin, Je Kyoun; Chee, Hyun Kun; Kim, Jun Suk [Konkuk University Medical Center, Konkuk University School of Medicine, Department of Cardiovascular Surgery, Seoul (Korea, Republic of); Ko, Sung Min [Konkuk University Medical Center, Konkuk University School of Medicine, Department of Radiology, Seoul (Korea, Republic of)

    2015-07-15

    To characterize aortic valve dysfunction and ascending aorta dimensions according to bicuspid aortic valve (BAV) morphology using computed tomography (CT) and surgical findings. We retrospectively enrolled 209 patients with BAVs who underwent transthoracic echocardiography (TTE) and CT. BAVs were classified as anterior-posterior (BAV-AP) or lateral (BAV-LA) orientation of the cusps and divided according to the presence (raphe+) or absence (raphe-) of a raphe. Ascending aortic dimensions were measured by CT at four levels. BAV-AP was present in 129 patients (61.7 %) and raphe+ in 120 (57.4 %). Sixty-nine patients (33.0 %) had aortic regurgitation (AR), 70 (33.5 %) had aortic stenosis (AS), and 58 (27.8 %) had combined AS and AR. AR was more common in patients with BAV-AP and raphe+; AS was more common with BAV-LA and raphe-.Annulus/body surface area and tubular portion/body surface area diameters in patients with BAV-AP (17.1 ± 2.3 mm/m{sup 2} and 24.2 ± 5.3 mm/m{sup 2}, respectively) and raphe+ (17.3 ± 2.2 mm/m{sup 2} and 24.2 ± 5.5 mm/m{sup 2}, respectively) were significantly different from those with BAV-LA (15.8 ± 1.9 mm/m{sup 2} and 26.4 ± 5.5 mm/m{sup 2}, respectively) and raphe- (15.7 ± 1.9 mm/m{sup 2} and 26.2 ± 5.4 mm/m{sup 2}, respectively). The morphological characteristics of BAV might be associated with the type of valvular dysfunction, and degree and location of an ascending aorta dilatation. (orig.)

  5. Gauss images of hyperbolic cusps with convex polyhedral boundary

    CERN Document Server

    Fillastre, François

    2009-01-01

    We prove that a 3--dimensional hyperbolic cusp with convex polyhedral boundary is uniquely determined by its Gauss image. Furthermore, any spherical metric on the torus with cone singularities of negative curvature and all closed contractible geodesics of length greater than $2\\pi$ is the metric of the Gauss image of some convex polyhedral cusp. This result is an analog of the Rivin-Hodgson theorem characterizing compact convex hyperbolic polyhedra in terms of their Gauss images. The proof uses a variational method. Namely, a cusp with a given Gauss image is identified with a critical point of a functional on the space of cusps with cone-type singularities along a family of half-lines. The functional is shown to be concave and to attain maximum at an interior point of its domain. As a byproduct, we prove rigidity statements with respect to the Gauss image for cusps with or without cone-type singularities. In a special case, our theorem is equivalent to existence of a circle pattern on the torus, with prescrib...

  6. The behaviour of curvature functions at cusps and inflection points

    CERN Document Server

    Shiba, Shohei

    2011-01-01

    At a 3/2-cusp of a given plane curve $\\gamma(t)$, both of the Euclidean curvature $\\kappa_g$ and the affine curvature $\\kappa_A$ diverge. In this paper, we show that each of $\\sqrt{|s_g|}\\kappa_g$ and $(s_A)^2 \\kappa_A$ (called the Euclidean and affine normalized curvature, respectively) at a 3/2-cusp is a smooth function of the variable $t$, where $s_g$ (resp. $s_A$) is the Euclidean (resp. affine) arclength parameter of the curve corresponding to the 3/2-cusp $s_g=0$ (resp. $s_A=0$). Moreover, we give a characterization of the behaviour of the curvature functions $\\kappa_g$ and $\\kappa_A$ at 3/2-cusps. On the other hand, inflection points are also singular points of curves in affine geometry. We give a similar characterization of affine curvature functions near generic inflection points. As an application, new affine invariants of 3/2-cusps and generic inflection points are given.

  7. Tin LPP plasma control in the argon cusp source

    Science.gov (United States)

    McGeoch, Malcolm W.

    2016-03-01

    The argon cusp plasma has been introduced [1,2] for 500W class tin LPP exhaust control in view of its high power handling, predicted low tin back-scatter from a beam dump, and avoidance of hydrogen usage. The physics of tin ion control by a plasma is first discussed. Experimentally, cusp stability and exhaust disc geometry have previously been proved at full scale [2], the equivalent of 300W-500W usable EUV. Here we verify operation of the plasma barrier that maintains a high argon density next to the collector, for its protection, and a low density in the long path toward the intermediate focus, for efficiency. A pressure differential of 2Pa has been demonstrated in initial work. Other aspects of tin LPP plasma control by the cusp have now been demonstrated using tin ions from a low Hz 130mJ CO2 laser pulse onto a solid tin surface at the cusp center. Plasma is rejected at the design to match a specified exhaust power is discussed. In view of this work, argon cusp exhaust control appears to be very promising for 500W class tin LPP sources.

  8. Cusped light-like Wilson loops in gauge theories

    CERN Document Server

    Cherednikov, I O; Van der Veken, F F

    2012-01-01

    We propose and discuss a new approach to the analysis of the correlation functions which contain light-like Wilson lines or loops, the latter being cusped in addition. The objects of interest are therefore the light-like Wilson null-polygons, the soft factors of the parton distribution and fragmentation functions, high-energy scattering amplitudes in the eikonal approximation, gravitational Wilson lines, etc. Our method is based on a generalization of the universal quantum dynamical principle by J. Schwinger and allows one to take care of extra singularities emerging due to light-like or semi-light-like cusps. We show that such Wilson loops obey a differential equation which connects the area variations and renormalization group behavior of those objects and discuss the possible relation between geometrical structure of the loop space and area evolution of the light-like cusped Wilson loops.

  9. The interaction between transpolar arcs and cusp spots

    CERN Document Server

    Fear, R C; Carter, J A; Maggiolo, R

    2016-01-01

    Transpolar arcs and cusp spots are both auroral phenomena which occur when the interplanetary magnetic field is northward. Transpolar arcs are associated with magnetic reconnection in the magnetotail, which closes magnetic flux and results in a "wedge" of closed flux which remains trapped, embedded in the magnetotail lobe. The cusp spot is an indicator of lobe reconnection at the high-latitude magnetopause; in its simplest case, lobe reconnection redistributes open flux without resulting in any net change in the open flux content of the magnetosphere. We present observations of the two phenomena interacting--i.e., a transpolar arc intersecting a cusp spot during part of its lifetime. The significance of this observation is that lobe reconnection can have the effect of opening closed magnetotail flux. We argue that such events should not be rare.

  10. Kinematic Cusps: Determining the Missing Particle Mass at the LHC

    CERN Document Server

    Han, Tao; Song, Jeonghyeon

    2009-01-01

    Neutral massive stable particles (dark matter candidates) are produced at colliders in pairs, due to an exact symmetry called a ``parity''. They escape from detection, rendering their mass measurement difficult. We consider the pair production of these stable particles associated with two observable particles, from a two-step cascade decay of a heavier particle with even parity, via an intermediate particle with odd parity. We observe kinematic cusp structures in the invariant mass and angular distributions of the observable particles. Knowing the parent mass from direct resonant decay into Standard Model particles, one can determine the missing particle mass as well as the intermediate particle mass by using the cusped peak and end point of the distributions. The shape of the cusp distribution does not depend on the spin correlation.

  11. Talon Cusp On Permanent Maxillary Canine: A Rare Case Report

    Directory of Open Access Journals (Sweden)

    D.N. Chandan

    2012-07-01

    Full Text Available teeth are varied. One such rare anomaly affecting the shape of anterior teeth is taloncusp. It is an accessory cusp-like projection found on lingual or labial surfaces of theupper or lower incisors, unilaterally or bilaterally in both dentitions. It is composed ofnormal enamel and dentine, with or without pulp. It is thought to develop as a result ofevagination on the surface of a tooth during morphodifferentiation stage. Reportedincidence is 0.04-10%, with higher prevalence in males. It is more common inpermanent dentition with a predilection for maxillary lateral incisors (55%, followed bycentral incisors (36% and canines (9%. Talon cusp may cause problems like irritationof tongue during speech and mastication, occlusal interference, caries susceptibility anddisplacement of the affected tooth, and esthetics. Its treatment ranges from applicationof sealant to gradual reduction to root canal therapy. Early diagnosis of talon cusp andits treatment can avoid complications related to this anomaly.

  12. Energetic particle sounding of the magnetospheric cusp with ISEE-1

    Directory of Open Access Journals (Sweden)

    K. E. Whitaker

    2007-06-01

    Full Text Available Observations on 30 October 1978 show the ISEE-1 spacecraft passing though the high-altitude dayside northern magnetospheric cusp region from roughly 16:00 to 18:30 UT, during a slow solar wind period (~380 km/s. More than two orders of magnitude enhancements of the cusp energetic particle (CEP fluxes were observed along with a depressed and turbulent local magnetic field. The observed variations of the pitch angle distributions (PAD provide a unique opportunity to determine the structure of the cusp and the origin of the CEP. Through a boundary sounding technique, the location and orientation of the cusp poleward (or backside boundary was observed for almost 10 min during which time it appeared initially to be stationary in the GSM/GSE X-direction and then moved sunward about 0.12 Earth radii (RE. The orientation remained approximately perpendicular to the GSM/GSE X-axis until it was observed to rotate by 60 degrees in ~3 min before ISEE-1 was fully inside the cusp cavity. The cavity itself was filled with CEP fluxes displaying large anisotropies, indicative of their source being located below (Earthward of the satellite location. The spacecraft entered from the backside of the cusp, then traveled ~4 RE through the cavity, and exited through the "top" of the cavity leaving a region of energetic ions below. The PADs demonstrate that the bow shock cannot be the main source of the observed CEPs. The CEP fluxes were measured at about 8.5 h MLT when the IMF had both an 8–10 nT duskward and southward component.

  13. Anatomia da valva atrioventricular esquerda: I. As cúspides Anatomy of the left atrio-ventricular valve: I. The cusps

    Directory of Open Access Journals (Sweden)

    Antônio B. Prado Fortuna

    1988-12-01

    Full Text Available Os resultados de um estudo anatômico da valva atrioventricular esquerda, realizado em 30 corações aparentemente normais, conservados em formalina, são comparados aos dados da literatura, tendo por objetivo adequar a nomenclatura e os conceitos anatômicos clássicos aos atuais, baseados na ultra-sonografia e na prática cirúrgica corrente. O presente artigo tratará apenas das cúspides, sendo que os demais elementos anatômicos dessa valva atrioventricular esquerda fazem parte de uma "unidade aortoventricular", onde distinguimos a cúspide anterior, em continuidade com o trígono intervalvar e o anel aórtico, e um grupo de cúspides posteriores, em relação com a parede posterior do ventrículo esquerdo. A cúspide anterior está separada do grupo de cúspides posteriores, tanto no polo valvar superior como no inferior, por uma estrutura anatômica bem definida: a "lâmina juncional", superior e inferior, respectivamente. As cúspides do grupo posterior são designadas pela ordem numeral ordinal, a partir da lâmina juncional superior. Esta nomenclatura tem por objetivo destacar a cúspide como unidade funcional da valva e facilitar as referências ecocardiográficas e cirúrgicas, particularmente nos casos em que mais de 3 cúspides posteriores são encontradas.A review of the left atrio-ventricular valve anatomy is compared to a clinical oriented morphological study on 30 normal adult heart, preserved in formalin. The results will be presented in five separated sections: I. The cusps; II. The comissures; III. The chordae tendinae; IV. The papilary muscles; V. The valvar annulus. The present publication will deal with the cusps. The terms "left atrio-ventricular valve" and "cusps" are to be prefered to the more descriptive and traditional "mitral valve" and "leaflets". The anterior cusp, in continuity with the aortic annulus, and a group of posterior cusps, attached to the posterior left wall, are described. An ordinal numerical

  14. Around the cusp singularity and the breaking of waves

    CERN Document Server

    Tejerina-Risso, J

    2012-01-01

    We record the breaking of water waves focusing at the Huygens Cusp of a parabolic wave maker using a fast video camera at a rate of 2000 images per second. The movie shows the very early time of the water tongue plunging ahead of the wave crest. Soon after, some capillarity wavelets are clearly visible. The image analysis of these space time data permits the measurement of the expected 3/2 power of time law as dictated by the cusp singular geometry given by the Catastrophe Theory. To our knowledge this is the first time that this scaling law is measured from fluid dynamics videos.

  15. Supravalvular aortic stenosis in adult with anomalies of aortic arch vessels and aortic regurgitation

    Science.gov (United States)

    Valente, Acrisio Sales; Alencar, Polyanna; Santos, Alana Neiva; Lobo, Roberto Augusto de Mesquita; de Mesquita, Fernando Antônio; Guimarães, Aloyra Guedis

    2013-01-01

    The supravalvular aortic stenosis is a rare congenital heart defect being very uncommon in adults. We present a case of supravalvular aortic stenosis in adult associated with anomalies of the aortic arch vessels and aortic regurgitation, which was submitted to aortic valve replacement and arterioplasty of the ascending aorta with a good postoperative course. PMID:24598962

  16. The Stellar Cusp in the Galactic Center: Three-Dimensional Orbits of Stars

    Science.gov (United States)

    Chappell, Samantha; Ghez, Andrea M.; Boehle, Anna; Yelda, Sylvana; Sitarski, Breann; Witzel, Gunther; Do, Tuan; Lu, Jessica R.; Morris, Mark; Becklin, Eric E.

    2015-01-01

    We present new findings from our long term study of the nuclear star cluster around the Galaxy's central supermassive blackhole (SMBH). Measurements where made using speckle and laser guided adaptive optics imaging and integral field spectroscopy on the Keck telescopes. We report 13 new measurable accelerating sources around the SMBH, down to ~17 mag in K band, only 4 of which are known to be young stars, the rest are either known to be old stars or have yet to be spectral typed. Thus we more than double the number of measured accelerations for the known old stars and unknown spectral type population (increasing the number from 6 to 15). Previous observations suggest a flat density profile of late-type stars, contrary to the theorized Bahcall-Wolf cusp (Bahcall & Wolf 1976, 1977; Buchholz et al. 2009; Do et al. 2009; Bartko et al. 2010). With three-dimensional orbits of significantly accelerating sources, we will be able to better characterize the stellar cusp in the Galactic center, including the slope of the stellar density profile.

  17. Svensson Class IV Ascending Aortic Dissection, Often Confused With Penetrating Ulcer

    Directory of Open Access Journals (Sweden)

    Mitsomoy Michel Francklyn

    2015-03-01

    Full Text Available We present the case of a 64 years old male patient who had recently suffered an infective aortic valve endocarditis (Streptococcus agalactiae complicated by embolic arthritis of the right hip. Initial echocardiography revealed moderate aortic insufficiency developed on a tricuspidaortic valve with a small vegetation (5 mm × 4 mm on the left coronary cusp. Furthermore, ananeurysmal dilatation of the ascending aorta (maximal diameter, 54 mm was noted. Other heartvalves and left ventricular function were considered normal. The patient completed a 4 weekscourse of antibiotherapy, and the right hip arthritis was treated by drainage and synovectomy.The patient was subsequently referred to surgery on an outpatient basis for the aneurysm of theascending aorta. Preoperative computed tomography showed localized aortic dissection of thetubular ascending aorta characterized by an intimal tear without medial hematoma but excentricbulging of the aortic wall. This lesion was initially considered a penetrating ulcer of the aortic wallThe operative specimen allowed to make differential diagnosis with a penetrating aortic ulcer byshowing that the lesion did not develop within an atherosclerotic plaque. However, downstreamextension of the dissection was probably limited by the presence of transmural calcifications on itsdistal side. The patient underwent successful complete aortic root replacement using a stentlessFreestyle bioprosthesis with Dacron graft extension as reported previously

  18. A rare report of mandibular facial talon cusp and its management

    Directory of Open Access Journals (Sweden)

    Sivakumar Nuvvula

    2014-01-01

    Full Text Available Talon cusp is an uncommon dental anomaly showing morphologically well delineated, accessory cusp-like structure projecting from cingulum to the incisal edge of anterior teeth. This anomaly is rare in the mandibular dentition and rarer on the facial aspect. A case of this infrequent entity of mandibular facial talon cusp and its management is reported here.

  19. Simulation of cusp formation in mode II delamination

    NARCIS (Netherlands)

    Sluys, L.J.; Van der Meer, F.P.

    2014-01-01

    On the microlevel, cusps are formed during delamination crack growth under mode II loading conditions. In this work, two different approaches to simulate this process are presented. Firstly a cohesive zone method where cohesive segments are introduced between a pair of neighbouring elements when the

  20. On cusped solitary waves in finite water depth

    CERN Document Server

    Liao, Shijun

    2013-01-01

    It is well-known that the Camassa-Holm (CH) equation admits both of the peaked and cusped solitary waves in shallow water. However, it was an open question whether or not the exact wave equations can admit them in finite water depth. Besides, it was traditionally believed that cusped solitary waves, whose 1st-derivative tends to infinity at crest, are essentially different from peaked solitary ones with finite 1st-derivative. Currently, based on the symmetry and the exact water wave equations, Liao [1] proposed a unified wave model (UWM) for progressive gravity waves in finite water depth. The UWM admits not only all traditional smooth progressive waves but also the peaked solitary waves in finite water depth: in other words, the peaked solitary progressive waves are consistent with the traditional smooth ones. In this paper, in the frame of the linearized UWM, we further give, for the first time, the cusped solitary waves in finite water depth, and besides reveal a close relationship between the cusped and p...

  1. Cusp expression of protostylid in deciduous and permanent molars

    Science.gov (United States)

    Moreno, Sandra; Reyes, María Paula; Moreno, Freddy

    2016-01-01

    The present article is a case report on the cusp expression of protostylid in the deciduous inferior molars and in the first permanent inferior molar, in which the correspondence and bilateral symmetry of the mentioned expression can be evidenced, as well as the their relation with the foramen cecum of the mesiobuccal furrows of the deciduous and of the permanent inferior molars. PMID:28123270

  2. The dependence of cusp ion signatures on the reconnection rate

    Directory of Open Access Journals (Sweden)

    S. K. Morley

    Full Text Available The interpretation of structure in cusp ion dispersions is important for helping to understand the temporal and spatial structure of magnetopause reconnection. "Stepped" and "sawtooth" signatures have been shown to be caused by temporal variations in the reconnection rate under the same physical conditions for different satellite trajectories. The present paper shows that even for a single satellite path, a change in the amplitude of any reconnection pulses can alter the observed signature and even turn sawtooth into stepped forms and vice versa. On 20 August 1998, the Defense Meteorological Satellite Program (DMSP craft F-14 crossed the cusp just to the south of Longyearbyen, returning on the following orbit. The two passes by the DMSP F-14 satellites have very similar trajectories and the open-closed field line boundary (OCB crossings, as estimated from the SSJ/4 precipitating particle data and Polar UVI images, imply a similarly-shaped polar cap, yet the cusp ion dispersion signatures differ substantially. The cusp crossing at 08:54 UT displays a stepped ion dispersion previously considered to be typical of a meridional pass, whereas the crossing at 10:38 UT is a sawtooth form ion dispersion, previously considered typical of a satellite travelling longitudinally with respect to the OCB. It is shown that this change in dispersed ion signature is likely to be due to a change in the amplitude of the pulses in the reconnection rate, causing the stepped signature. Modelling of the low-energy ion cutoff under different conditions has reproduced the forms of signature observed.

    Key words. Ionosphere (particle precipitation Magnetospheric physics (energetic particles, precipitating, magnetopause, cusp and boundary layers

  3. Cusp-like plasma in high altitudes: a statistical study of the width and location of the cusp from Magion-4

    Directory of Open Access Journals (Sweden)

    J. Mĕrka

    Full Text Available The width of the cusp region is an indicator of the strength of the merging process and the degree of opening of the magnetosphere. During three years, the Magion-4 satellite, as part of the Interball project, has collected a unique data set of cusp-like plasma observations in middle and high altitudes. For a comparison of high- and low-altitude cusp determination, we map our observations of cusp-like plasma along the magnetic field lines down to the Earth’s surface. We use the Tsyganenko and Stern 1996 model of the magnetospheric magnetic field for the mapping, taking actual solar wind and IMF parameters from the Wind observations. The footprint positions show substantial latitudinal dependence on the dipole tilt angle. We fit this dependence with a linear function and subtract this function from observed cusp position. This process allows us to study both statistical width and location of the inspected region as a function of the solar wind and IMF parameters. Our processing of the Magion-4 measurements shows that high-altitude regions occupied by the cusp-like plasma (cusp and cleft are projected onto a much broader area (in magnetic local time as well as in a latitude than that determined in low altitudes. The trends of the shift of the cusp position with changes in the IMF direction established by low-altitude observations have been confirmed.

    Key words. Magnetospheric physics (magnetopause, cusp and boundary layer; solar wind – magnetosphere interactions

  4. Interhemispheric Comparison of Dipole Tilt Angle Effects on Latitude of Mid-Altitude Cusp

    Institute of Scientific and Technical Information of China (English)

    GUO Jian-Guang; SHI Jian-Kui; ZHANG Tie-Long; LIU Zhen-Xing

    2008-01-01

    A statistical study of interhemispheric comparison of dipole tilt angle effect on the latitude of the mid-altitude cusp is preformed by a data set of the Cluster cusp crossings over a 5-year period.The result shows that the dipole tilt angle has a clear control of the cusp latitudinal location.When the dipole tilts sunwards,the cusp is shifted poleward.The northern cusp moves 1° ILAT for every 15.4° increase in the dipole tilt angle,while the southern cusp moves 1° ILAT for every 20.8° increase in the dipole tilt angle. This suggests that an interhemispheric difference appears in the dependence of cusp latitudinal location on the dipole tilt angle.

  5. Hodge cohomology of some foliated boundary and foliated cusp metrics

    CERN Document Server

    Gell-Redman, Jesse

    2012-01-01

    For fibred boundary and fibred cusp metrics, Hausel, Hunsicker, and Mazzeo identified the space of L^2 harmonic forms of fixed degree with the images of maps between intersection cohomology groups of an associated stratified space obtained by collapsing the fibres of the fibration at infinity onto its base. In the present paper, we obtain a generalization of this result to situations where the fibration at infinity is replaced by a foliation with compact leaves admitting a resolution by a fibration.

  6. Second order average estimates on local data of cusp forms

    OpenAIRE

    2005-01-01

    We specify sufficient conditions for the square modulus of the local parameters of a family of GL(n) cusp forms to be bounded on average. These conditions are global in nature and are at present satisfied for n less than or equal to 4. As an application, we show that Rankin-Selberg L-functions on GL(m) x GL(n), when m and n are less than or equal to 4, satisfy the standard convexity bound.

  7. Scheme for adding electron-nucleus cusps to Gaussian orbitals

    OpenAIRE

    Ma, A.; Towler, M. D.; Drummond, N. D.; Needs, R. J.

    2008-01-01

    A simple scheme is described for introducing the correct cusps at nuclei into orbitals obtained from Gaussian basis set electronic structure calculations. The scheme is tested with all-electron variational quantum Monte Carlo (VMC) and diffusion quantum Monte Carlo (DMC) methods for the Ne atom, the H2 molecule, and 55 molecules from a standard benchmark set. It greatly reduces the variance of the local energy in all cases and slightly improves the variational energy. This scheme yields a gen...

  8. Cusps in $\\K_{L}\\to$3$\\pi$ decays

    CERN Document Server

    Bissegger, M; Gasser, J; Kubis, B; Rusetsky, A

    2008-01-01

    The pion mass difference generates a pronounced cusp in K --> 3 pi decays, the strength of which is related to the pi pi S-wave scattering lengths. We apply an effective field theory framework developed earlier to evaluate the amplitudes for K_L --> 3 pi decays in a systematic manner, where the strictures imposed by analyticity and unitarity are respected automatically. The amplitudes for the decay eta --> 3 pi are also given.

  9. The Kamchatka-Aleutian Collision Zone: Mother of All Cusps

    Science.gov (United States)

    Lees, J. M.

    2008-12-01

    The Kamchatka subduction zone represents a key to the understanding of volcanism, tectonics and mantle dynamics. The termination of the Pacific plate in the northern part of the Kamchatka slab is the prime location to investigate the cusp-ward shoaling of seismicity, the volumetrically spectacular production of magma with unusual geochemical signatures and slab edge ablation associated with mantle flow around the leading edge of the plate. In addition, the Kamchatka subduction zone is further complicated by the subduction of the aseismic ridge, the Meiji Seamounts. The three-dimensional structural configuration of the subducting pacific slab, the Komandorsky basin and the volcanic arc all suggest that absence of Pacific slab north of latitude. Tomographic analyses show a deep low velocity zone below Kliuchevskoi Volcano, suggesting a deep source near the crust-mantle interface. The intense volcanic production rates of the northern part of the Kamchatka Arc indicate that a prolific source feeds the surface expression of the cusp. Extensive heating at the exposed slab edge provides a source of heat for the Kliuchevskoi group. In this presentation I will review the critical observations and conclusions regarding cusp dynamics in Kamchatka and the Pacific Rim.

  10. Cusp-core problem and strong gravitational lensing

    Institute of Scientific and Technical Information of China (English)

    Nan Li; Da-Ming Chen

    2009-01-01

    Cosmological numerical simulations of galaxy formation have led to the cuspy density profile of a pure cold dark matter halo toward the center,which is in sharp contradiction with the observations of the rotation curves of cold dark matter-dominated dwarf and low surface brightness disk galaxies,with the latter tending to favor mass profiles with a fiat central core.Many efforts have been devoted to resolving this cusp-core problem in recent years,among them,baryon-cold dark matter interactions are considered to be the main physical mechanisms erasing the cold dark matter (CDM) cusp into a flat core in the centers of all CDM halos.Clearly,baryon-cold dark matter interactions are not customized only for CDM-dominated disk galaxies,but for all types,including giant ellipticals.We first fit the most recent high resolution observations of rotation curves with the Burkert profile,then use the constrained core size-halo mass relation to calculate the lensing frequency,and compare the predicted results with strong lensing observations.Unfortunately,it turns out that the core size constrained from rotation curves ofdisk galaxies cannot be extrapolated to giant ellipticals.We conclude that,in the standard cosmological paradigm,baryon-cold dark matter interactions are not universal mechanisms for galaxy formation,and therefore,they cannot be true solutions to the cusp-core problem.

  11. Dental management of a talon cusp on a primary incisor.

    Science.gov (United States)

    Yoon, Richard K; Chussid, Steven

    2007-01-01

    There are many treatment options for the pediatric patient with a talon cusp (TC). The purpose of this paper was to report the case of a TC involving a primary maxillary right central incisor in a 14-month-old male causing displacement of the affected tooth. The etiology of a TC is thought to be a disturbance during the morphodifferentiation stage of tooth development. Clinical problems include: (1) occlusal interferences; (2) esthetic disturbances; (3) accidental cusp fracture; (4) tongue irritation; (5) nursing difficulty; (6) caries; and (7) displacement of the affected tooth. The TC affecting the central incisor was reduced over a period of 4 visits, followed by immediate placement of a 5% sodium fluoride varnish at the conclusion of each reduction visit. Restoration of esthetics and function was evident within 1 month following complete cusp reduction. There were no clinical signs of any problems related to the reduction, and the prognosis was considered to be guarded. The pediatric patient was placed on a 6-month oral hygiene maintenance follow-up.

  12. 3-D mesoscale MHD simulations of magnetospheric cusp-like configurations: cusp diamagnetic cavities and boundary structure

    Directory of Open Access Journals (Sweden)

    E. Adamson

    2012-02-01

    Full Text Available We present results from mesoscale simulations of the magnetospheric cusp region for both strongly northward and strongly southward interplanetary magnetic field (IMF. Simulation results indicate an extended region of depressed magnetic field and strongly enhanced plasma β which exhibits a strong dependence on IMF orientation. These structures correspond to the Cusp Diamagnetic Cavities (CDC's. The typical features of these CDC's are generally well reproduced by the simulation. The inner boundaries between the CDC and the magnetosphere are gradual transitions which form a clear funnel shape, regardless of IMF orientation. The outer CDC/magnetosheath boundary exhibits a clear indentation in both the x-z and y-z planes for southward IMF, while it is only indented in the x-z plane for northward, with a convex geometry in the y-z plane. The outer boundary represents an Alfvénic transition, mostly consistent with a slow-shock, indicating that reconnection plays an important role in structuring the high-altitude cusp region.

  13. Aortic Valve Disease

    Science.gov (United States)

    ... that is safest for you based on your individual symptoms and circumstances. Recovery Recovery Most aortic valve ... is safe to do so. You should anticipate spending several days, but likely not more than a ...

  14. Bicuspid aortic valve

    Science.gov (United States)

    ... aortic disease. In: Otto CM, Bonow RO, eds. Valvular Heart Disease: A Companion to Braunwald's Heart Disease . 4th ed. ... PA: Elsevier Saunders; 2014:chap 13. Carabello BA. Valvular heart disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil ...

  15. Aortic Valve Regurgitation

    Science.gov (United States)

    ... inside your heart that involves heart valves. Rheumatic fever. Rheumatic fever — a complication of strep throat and once a ... the United States — can damage the aortic valve. Rheumatic fever is still prevalent in developing countries but rare ...

  16. Aortic Valve Stenosis

    Science.gov (United States)

    ... evaluation of aortic stenosis in adults. http://www.uptodate.com/home. Accessed April 29, 2014. Mohty D, ... Valvular heart disease in elderly adults. http://www.uptodate.com/home. Accessed May 2, 2014. Bonow RO, ...

  17. [Inflammatory abdominal aortic aneurysm].

    Science.gov (United States)

    Ziaja, K; Sedlak, L; Urbanek, T; Kostyra, J; Ludyga, T

    2000-01-01

    The reported incidence of inflammatory abdominal aortic aneurysm (IAAA) is from 2% to 14% of patients with abdominal aortic aneurysm and the etiology of this disease is still discussed--according to the literature several pathogenic theories have been proposed. From 1992 to 1997 32 patients with IAAA were operated on. The patients were mostly symptomatic--abdominal pain was present in 68.75% cases, back pain in 31.25%, fever in 12.5% and weight loss in 6.25% of the operated patients. In all the patients ultrasound examination was performed, in 4 patients CT and in 3 cases urography. All the patients were operated on and characteristic signs of inflammatory abdominal aortic aneurysm like: thickened aortic wall, perianeurysmal infiltration or retroperitoneal fibrosis with involvement of retroperitoneal structures were found. In all cases surgery was performed using transperitoneal approach; in three cases intraoperatively contiguous abdominal organs were injured, which was connected with their involvement into periaortic inflammation. In 4 cases clamping of the aorta was done at the level of the diaphragmatic hiatus. 3 patients (9.37%) died (one patient with ruptured abdominal aortic aneurysm). Authors present diagnostic procedures and the differences in the surgical tactic, emphasizing the necessity of the surgical therapy in patients with inflammatory abdominal aortic aneurysm.

  18. Labial Talon Cusp on Maxillary Central Incisors: A Rare Developmental Dental Anomaly

    OpenAIRE

    Glavina, Domagoj; Škrinjarić, Tomislav

    2005-01-01

    Labial talon cusp, or dens evaginatus is a very rare dental anomaly of unclear etiology and significance. It can occur as an isolated finding or be associated with other dental anomalies or some syndromes. The present report describes two Caucasian males with labial talon cusp on maxillary permanent left central incisors. In both cases accessory cusp caused plaque accumulation and marginal gingivitis. One case displayed affected tooth to be in cross bite position causing occlusal trauma. No o...

  19. LARGE VALUES OF CUSP FORMS ON GL n

    OpenAIRE

    2014-01-01

    We establish lower bounds on the sup norm of Hecke-Maass cusp forms on congruence quotients of ${\\rm GL}_n(\\mathbb{R})$. The argument relies crucially on uniform estimates for Jacquet-Whittaker functions. These purely local results are of independent interest, and are valid in the more general context of split semi-simple Lie groups. Furthermore, we undertake a fine study of self-dual Jacquet-Whittaker functions on ${\\rm GL}_3(\\mathbb{R})$, showing that their large values are governed by the ...

  20. Cusps of Bishop Spherical Indicatrixes and Their Visualizations

    OpenAIRE

    Haiming Liu; Donghe Pei

    2013-01-01

    The main result of this paper is using Bishop Frame and “Type-2 Bishop Frame” to study the cusps of Bishop spherical images and type-2 Bishop spherical images which are deeply related to a space curve and to make them visualized by computer. We find that the singular points of the Bishop spherical images and type-2 Bishop spherical images correspond to the point where Bishop curvatures and type-2 Bishop curvatures vanished and their derivatives are not equal to zero. As applications and illus...

  1. Distribution of cusp sections in the Hilbert modular orbifold

    CERN Document Server

    Arias, Samuel Estala

    2011-01-01

    Let K be a number field, let M be the Hilbert modular orbifold of K, and let m(q) be the probability measure uniformly supported on the cusp cross sections of M at height q. We generalize a method of Zagier and show that m(q) distributes uniformly with respect to the normalized Haar measure m on M as q tends to zero, and relate the rate by which m(q) approaches m to the Riemann hypothesis for the Dedekind zeta function of K.

  2. Screening for Abdominal Aortic Aneurysm

    Science.gov (United States)

    Understanding Task Force Recommendations Screening for Abdominal Aortic Aneurysm The U.S. Preventive Services Task Force (Task Force) has issued a final recommendation statement on Screening for Abdominal Aortic Aneurysm. This final ...

  3. Abdominal aortic aneurysm repair - open

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/007392.htm Abdominal aortic aneurysm repair - open To use the sharing features on this page, please enable JavaScript. Open abdominal aortic aneurysm repair is surgery to fix a widened part ...

  4. [Congenital aortic stenosis].

    Science.gov (United States)

    Yamaguchi, M

    2001-08-01

    Recent advances in and controversies concerning the management of children with congenital valvular aortic stenosis are discussed. In neonates with critical aortic stenosis, improved survival has recently been reported after surgical open valvotomy and balloon valvuloplasty, although it is difficult at this point to compare the results of the two procedures and determine their differential indications. Good results have also been achieved after extended aortic valvuloplasty for recurrent aortic stenosis and/or insufficiency, but the length of follow-up in these patients is still short. The technique first reported in 1991 for bilateral enlargement fo a small annulus permits the insertion of an aortic valve 3-4 sizes larger than the native annulus. It entails no risk of distorting the mitral valve, damaging the conduction system or important branches of the coronary arteries, or resulting in left ventricular dysfunction. The Ross procedure is now widely applied in the West, with reports of early mortality rates of less than 5% and event-free survival rates of 80-90% during follow-up of 4-8 years. Longer follow-up and continued careful evaluation are required to resolve the issue of possible dilatation and subsequent neoaortic valve dysfunction and pulmonary stenosis due to allograft degeneration after pulmonary autograft root replacement in children.

  5. Multi-embolic ST-elevation myocardial infarction secondary to aortic valve endocarditis.

    Science.gov (United States)

    Rischin, Adam P; Carrillo, Philip; Layland, Jamie

    2015-01-01

    We present the case of a 42 year-old woman admitted to hospital with ST-elevation myocardial infarction involving two separate coronary territories. Angiography revealed multi-embolic occlusions of her left anterior descending (LAD) and first obtuse marginal (OM1) coronary arteries. Transoesophageal echocardiogram (TOE) showed a lesion attached to the left cusp of the aortic valve and she was treated for infective endocarditis. We discuss the management issues raised from this unique patient, including reperfusion strategies in endocarditis-associated myocardial infarction.

  6. Predictive Significance of Abnormal Potentials for Guiding Ablation Target Sites in Patients With Idiopathic Ventricular Arrhythmias From Aortic Sinus Cusp%异常电位对主动脉窦起源室性心律失常消融靶点的预测价值

    Institute of Scientific and Technical Information of China (English)

    刘霄燕; 王靖; 楚建民; 赵英杰; 郭琦; 浦介麟; 张澍

    2014-01-01

    目的:探讨异常电位对主动脉窦起源室性心律失常(ASC-IVAs)消融靶点的预测价值.方法:连续入选成功消融ASC-IVAs患者29例(ASC-IVAs组),另选我院同期成功消融的右心室流出道IVAs患者10例(IVAs对照亚组)和左侧旁道参与的房室折返性心动过速患者10例[室上性心动过速(室上速)对照亚组]作为对照组.建立三维激动/解剖标测图,分析两组间异常电位的发生和分布,及ASC-IVAs组中异常电位与消融靶点的关系.结果:ASC-IVAs组患者前电位发生率、消融前后晚电位平均振幅和消融后QRS-晚电位间期显著大于对照组(P<0.05).ASC-IVAs组中,与非成功消融点相比,成功消融靶点的前电位平均振幅较小(P<0.05),且消融前后晚电位发生率显著增高(P<0.05).QRS-晚电位延迟对ASC-IVAs患者成功靶点的预测敏感度为72%,特异度为100%.结论:ASC-IVAs消融靶点处常可记录到前电位和晚电位,其中晚电位指导消融的意义较大,晚电位延迟可作为成功消融靶点较为敏感和特异的预测指标.

  7. Biomechanical and Clinical Studies in EndoVascular Aortic Repair

    NARCIS (Netherlands)

    Nauta, FJH

    2016-01-01

    Objectives This thesis investigates biomechanical and clinical performances of endovascular repair for thoracic aortic dissection (AD) and aneurysm. Insights from both medical and bio-engineering perspectives are pursued with the aim of providing scientific data that will help guide endovascular aor

  8. Aortic valve replacement

    DEFF Research Database (Denmark)

    Kapetanakis, Emmanouil I; Athanasiou, Thanos; Mestres, Carlos A;

    2008-01-01

    mortality were collected. Group analysis by patient geographic distribution and by annular diameter of the prosthesis utilized was conducted. Patients with a manufacturer's labeled prosthesis size > or = 21 mm were assigned to the 'large' aortic size subset, while those with a prosthesis size ... assigned to the 'small' aortic size subset. Effective orifice area indices were calculated for all patients to assess the geographic distribution of patient-prosthesis mismatch. Univariable and multivariable logistic regression analyses adjusting for possible confounding variables were performed. RESULTS...... differences in the distribution of either gender or BSA. In the multivariable model, south European patients were seven times more likely to receive a smaller-sized aortic valve (OR = 6.5, 95% CI = 4.82-8.83, p

  9. Robotic aortic surgery.

    Science.gov (United States)

    Duran, Cassidy; Kashef, Elika; El-Sayed, Hosam F; Bismuth, Jean

    2011-01-01

    Surgical robotics was first utilized to facilitate neurosurgical biopsies in 1985, and it has since found application in orthopedics, urology, gynecology, and cardiothoracic, general, and vascular surgery. Surgical assistance systems provide intelligent, versatile tools that augment the physician's ability to treat patients by eliminating hand tremor and enabling dexterous operation inside the patient's body. Surgical robotics systems have enabled surgeons to treat otherwise untreatable conditions while also reducing morbidity and error rates, shortening operative times, reducing radiation exposure, and improving overall workflow. These capabilities have begun to be realized in two important realms of aortic vascular surgery, namely, flexible robotics for exclusion of complex aortic aneurysms using branched endografts, and robot-assisted laparoscopic aortic surgery for occlusive and aneurysmal disease.

  10. In vitro fracture resistance of fiber reinforced cusp-replacing composite restorations.

    NARCIS (Netherlands)

    Fennis, W.M.M.; Tezvergil, A.; Kuijs, R.H.; Lassila, L.V.; Kreulen, C.M.; Creugers, N.H.J.; Vallittu, P.K.

    2005-01-01

    OBJECTIVES: To assess the fracture resistance and failure mode of fiber reinforced composite (FRC) cusp-replacing restorations in premolars. METHODS: Forty-five extracted sound upper premolars were randomly divided into three groups. Identical MOD cavities with simulated buccal cusp fracture and hei

  11. Relationship between cusp size and occlusal wear pattern in Neanderthal and Homo sapiens first maxillary molars.

    Science.gov (United States)

    Fiorenza, Luca; Benazzi, Stefano; Viola, Bence; Kullmer, Ottmar; Schrenk, Friedemann

    2011-03-01

    Tooth wear studies in mammals have highlighted the relationship between wear facets (attritional areas produced during occlusion by the contact between opposing teeth) and physical properties of the ingested food. However, little is known about the influence of tooth morphology on the formation of occlusal wear facets. We analyzed the occlusal wear patterns of first maxillary molars (M(1) s) in Neanderthals, early Homo sapiens, and contemporary modern humans. We applied a virtual method to analyze wear facets on the crown surface of three-dimensional digital models. Absolute and relative wear facet areas are compared with cusp area and cusp height. Although the development of wear facets partially follows the cusp pattern, the results obtained from the between-group comparisons do not reflect the cusp size differences characterizing these groups. In particular, the wear facets developed along the slopes of the most discriminate cusp between Neanderthals and Homo sapiens (hypocone) do not display any significant difference. Moreover, no correlations have been found between cusp size and wear facet areas (with the exception of the modern sample) and between cusp height and wear facet areas. Our results suggest that cusp size is only weakly related to the formation of the occlusal wear facets. Other factors, such as, diet, food processing, environmental abrasiveness, and nondietary habits are probably more important for the development and enlargement of wear facets, corroborating the hypotheses suggested from previous dental wear studies.

  12. Hippo pathway/Yap regulates primary enamel knot and dental cusp patterning in tooth morphogenesis.

    Science.gov (United States)

    Kwon, Hyuk-Jae Edward; Li, Liwen; Jung, Han-Sung

    2015-11-01

    The shape of an individual tooth crown is primarily determined by the number and arrangement of its cusps, i.e., cusp patterning. Enamel knots that appear in the enamel organ during tooth morphogenesis have been suggested to play important roles in cusp patterning. Animal model studies have shown that the Hippo pathway effector Yap has a critical function in tooth morphogenesis. However, the role of the Hippo pathway/Yap in cusp patterning has not been well documented and its specific roles in tooth morphogenesis remain unclear. Here, we provide evidence that Yap is a key mediator in tooth cusp patterning. We demonstrate a correlation between Yap localization and cell proliferation in developing tooth germs. We also show that, between the cap stage and bell stage, Yap is crucial for the suppression of the primary enamel knot and for the patterning of secondary enamel knots, which are the future cusp regions. When Yap expression is stage-specifically knocked down during the cap stage, the activity of the primary enamel knot persists into the bell-stage tooth germ, leading to ectopic cusp formation. Our data reveal the importance of the Hippo pathway/Yap in enamel knots and in the proper patterning of tooth cusps.

  13. Node dynamics and cusps size distribution at the border of liquid sheets

    Science.gov (United States)

    Villermaux, E.; Almarcha, C.

    2016-08-01

    We study the intrinsic dynamics of cusps, or indentations, moving along a liquid sheet border, and characterize their ensemble statistics. Gordillo and collaborators [J. Fluid Mech. 754, R1 (2014), 10.1017/jfm.2014.397] have shown that the symmetrical stationary cusp is the only structure accommodating for both mass and momentum conservation at a steadily receding liquid sheet rim. Cusps are also known to typically move along a sheet border, to present an asymmetry, and to be distributed in size around a mean. We show here why a heterogeneous assembly of cusps traveling along the sheet rim occurs spontaneously, why big and small cusps coexist at the same time, and, more precisely, we establish a specific link between the microscopic dynamics directing their motion, and the ensemble averaged distribution of their sizes.

  14. Mineral trioxide aggregate pulpotomy: An ideal treatment option for management of talon cusp

    Directory of Open Access Journals (Sweden)

    Vijay Kumar

    2012-01-01

    Full Text Available To use mineral trioxide aggregate (MTA in prophylactic management of talon cusp. Talon cusp is an endodontic oddity that possesses a treatment challenge to the clinician, especially when it causes esthetic and functional problems. Management ranges from periodic gradual reduction to radical removal followed by vital pulp/endodontic therapy. MTA has replaced calcium hydroxide as pulp capping material because of its superior properties. A 12-year-old boy reported with a complaint of irregular teeth. Clinical and radiographic examination revealed talon cusp on maxillary left central incisor. Radical removal of talon cusp and MTA pulpotomy was performed. The 4-year follow-up showed the positive pulp vitality test without any radiographic changes, emphasizing the use of MTA pulpotomy in successful management of talon cusp.

  15. [Dislocation of the closing element of the disk mechanical graft at aortic valve replacement].

    Science.gov (United States)

    Korostelev, A N; Kuntsevich, G I; Zotikov, A E; Chernyak, B B; Il'ina, M V; Ter-Khachaturova, I E; Solopova, G V

    2003-01-01

    Presented herein is the first case of dislocation of the closing element of the artificial low-profile aortic valve to the abdominal aorta, which happened during replacement. Toward completion of extracorporeal circulation a 37-year-old man showed the signs of aortic insufficiency because of dislocation of the closing element. After resumption of extracorporeal circulation repeated replacement was accomplished. To detect the site of graft cusp embolism, transesophageal echocardiography and duplex scanning of the abdominal aorta were employed. On the 18th day following the first intervention the patient developed thromboembolism to the distal arterial bed. Emergency thrombectomy from the arteries of the right lower extremity was performed and a foreign body was removed from the abdominal aorta, using left-sided thoracophrenolumbotomy. The patient was discharged from the clinic in a satisfactory condition.

  16. Feedbacks of Composition and Neutral Density Changes on the Structure of the Cusp Density Anomaly

    Science.gov (United States)

    Brinkman, D. G.; Walterscheid, R. L.; Clemmons, J. H.

    2015-12-01

    The Earth's magnetospheric cusp provides direct access of energetic particles to the thermosphere. These particles produce ionization and kinetic (particle) heating of the atmosphere. The increased ionization coupled with enhanced electric fields in the cusp produces increased Joule heating and ion drag forcing. These energy inputs cause large wind and temperature changes in the cusp region. Measurements by the CHAMP satellite (460-390- km altitude) have shown strongly enhanced density in the cusp region. The Streak mission (325-123 km), on the other hand, showed a relative depletion. The atmospheric response in the cusp can be sensitive to composition and neutral density changes. In response to heating in the cusp, air of heavier mean molecular weight is brought up from lower altitudes significantly affecting pressure gradients. This opposes the effects of temperature change due to heating and in-turn affects the density and winds produced in the cusp. Also changes in neutral density change the interaction between precipitating particles and the atmosphere and thus change heating rates and ionization in the region affected by cusp precipitation. In this study we assess the sensitivity of the wind and neutral density structure in the cusp region to changes in the mean molecular weight induced by neutral dynamics, and the changes in particle heating rates and ionization which result from changes in neutral density. We use a high resolution two-dimensional time-dependent nonhydrostatic nonlinear dynamical model where inputs can be systematically altered. The resolution of the model allows us to examine the complete range of cusp widths. We compare the current simulations to observations by CHAMP and Streak. Acknowledgements: This research was supported by The Aerospace Corporation's Technical Investment program

  17. Variation in Cuspal Morphology in Maxillary First Permanent Molar with Report of 3 Cusp Molar- A Prevalence Study

    Science.gov (United States)

    2016-01-01

    Introduction Human teeth has always been known for morphological variations in both the crown and root structures. The corono-morphological variations can be in the form of extra cusp or missing cusp. Permanent maxillary first molars are the biggest teeth in maxillary arch and have a high anchorage value and are known for their four cusp and five cusp patterns, if present with cusp of Carebelli. Aim The aim of this study was to determine the prevalence of cuspal variations and quantification of cusps of permanent maxillary first molar in Malwa population. Materials and Methods A total of 1249 individuals were studied at Government College of Dentistry, Indore, Madhya Pradesh, India, to evaluate the number of cusps in permanent maxillary first molars. Results Of the studied 1249 individuals, permanent maxillary first molars had five cusps in 407 (32.6%) cases while 838 (67.08%) cases had four cusp and four (0.32%) cases had three cusps. The four cases having three cusp permanent maxillary first molars were present unilaterally and only in females. Conclusion This article emphasizes the presence of permanent maxillary first molar with only three cusps in the Malwa population of India. It also reviews the literature in respect to this rare anomaly and calls for continuous and close monitoring to report such cases in the future. PMID:27790576

  18. Unoperated aortic aneurysm

    DEFF Research Database (Denmark)

    Perko, M J; Nørgaard, M; Herzog, T M;

    1995-01-01

    From 1984 to 1993, 1,053 patients were admitted with aortic aneurysm (AA) and 170 (15%) were not operated on. The most frequent reason for nonoperative management was presumed technical inoperability. Survivals for patients with thoracic, thoracoabdominal, and abdominal AA were comparable...... hypertension were predictive of mortality, whereas...

  19. Morphotype-Dependent Flow Characteristics in Bicuspid Aortic Valve Ascending Aortas: A Benchtop Particle Image Velocimetry Study

    Science.gov (United States)

    McNally, Andrew; Madan, Ashish; Sucosky, Philippe

    2017-01-01

    The bicuspid aortic valve (BAV) is a major risk factor for secondary aortopathy such as aortic dilation. The heterogeneous BAV morphotypes [left-right-coronary cusp fusion (LR), right-non-coronary cusp fusion (RN), and left-non-coronary cusp fusion (LN)] are associated with different dilation patterns, suggesting a role for hemodynamics in BAV aortopathogenesis. However, assessment of this theory is still hampered by the limited knowledge of the hemodynamic abnormalities generated by the distinct BAV morphotypes. The objective of this study was to compare experimentally the hemodynamics of a normal (i.e., non-dilated) ascending aorta (AA) subjected to tricuspid aortic valve (TAV), LR-BAV, RN-BAV, and NL-BAV flow. Tissue BAVs reconstructed from porcine TAVs were subjected to physiologic pulsatile flow conditions in a left-heart simulator featuring a realistic aortic root and compliant aorta. Phase-locked particle image velocimetry experiments were carried out to characterize the flow in the aortic root and in the tubular AA in terms of jet skewness and displacement, as well as mean velocity, viscous shear stress and Reynolds shear stress fields. While all three BAVs generated skewed and asymmetrical orifice jets (up to 1.7- and 4.0-fold increase in flow angle and displacement, respectively, relative to the TAV at the sinotubular junction), the RN-BAV jet was out of the plane of observation. The LR- and NL-BAV exhibited a 71% increase in peak-systolic orifice jet velocity relative to the TAV, suggesting an inherent degree of stenosis in BAVs. While these two BAV morphotypes subjected the convexity of the aortic wall to viscous shear stress overloads (1.7-fold increase in maximum peak-systolic viscous shear stress relative to the TAV-AA), the affected sites were morphotype-dependent (LR-BAV: proximal AA, NL-BAV: distal AA). Lastly, the LR- and NL-BAV generated high degrees of turbulence in the AA (up to 2.3-fold increase in peak-systolic Reynolds shear stress relative

  20. Antiparallel magnetic merging signatures during IMF BY>>0: longitudinal and latitudinal cusp aurora bifurcations

    Directory of Open Access Journals (Sweden)

    S. Massetti

    2006-09-01

    Full Text Available A prominent dayside auroral event, occurred during an IMF BY-dominated time interval, and characterized by the contemporaneous longitudinal and latitudinal cusp bifurcations, is reported. The event was recorded the 19 December 2002, between about 09:30–10:45 UT, by the ITACA2 twin auroral monitors system, in the Greenland-Svalbard zone. The splitting of the ionospheric footprint of the geomagnetic cusp, traced by the dayside auroral activity, was recently identified with the signatures of antiparallel reconnection episodes ongoing at different magnetopause locations, during large IMF BY periods. The first part of the event showed a broad longitudinal bifurcation of the red-dominated cusp aurora, displaced in the prenoon and postnoon, with a separation up to ~1800 km, during northeast directed IMF (clock-angle rotating from 45° to 90°. This observation widens the range of IMF regimes that are known to drive a longitudinal bifurcation of the cusp, since previous case-studies reported these events to occur during southeast/southwest oriented IMF (clock-angle ≈135°. The second part of the event, developed when the IMF turned to a nearly horizontal orientation (BY>>0, BZ~0, clock-angle ~90°, and exhibited the simultaneous activation of the cusp auroras in three distinct areas: i two of them associated to the above-mentioned longitudinally bifurcated cusp (~73°–75° CGM latitude, type 1 cusp aurora, and linked to (nearantiparallel magnetic reconnection patches equatorward the northern and the southern cusp, ii the other one characterized by isolated high-latitude (~76°–77° CGM latitude, type 2 cusp aurora rayed arc(s with intense green emission, and triggered by (nearantiparallel merging at the northern lobe (usually observed during positive IMF BZ, poleward the local cusp. During this phase, the longitudinal separation of the low-latitude type~1 cusp aurora was about 1000 km wide, with a 500 km gap, while the latitudinal separation

  1. Degeneracies of parametric lens model families near folds and cusps

    CERN Document Server

    Wagner, Jenny

    2015-01-01

    We develop an approach to select families of lens models that can describe doubly and triply gravitationally lensed images near folds and cusps using the model-independent ratios of lensing-potential derivatives derived in Wagner & Bartelmann (2015). Models are selected by comparing these model-independent ratios of potential derivatives to (numerically determined) ratios of potential derivatives along critical curves for entire lens model families in a given range of parameter values. This comparison returns parameter ranges which lens model families can reproduce observation within, as well as sections of the critical curve where image sets of the observed type can appear. If the model-independent potential-derivative ratios inferred from the observation fall outside the range of these ratios derived for the lens model family, the entire family can be excluded as a feasible model in the given volume in parameter space. We employ this approach for the family of singular isothermal spheres with external s...

  2. Singular surfaces and cusps in symmetric planar 3-RPR manipulators

    CERN Document Server

    Coste, Michel; Chablat, Damien

    2011-01-01

    We study in this paper a class of 3-RPR manipulators for which the direct kinematic problem (DKP) is split into a cubic problem followed by a quadratic one. These manipulators are geometrically characterized by the fact that the moving triangle is the image of the base triangle by an indirect isometry. We introduce a specific coordinate system adapted to this geometric feature and which is also well adapted to the splitting of the DKP. This allows us to obtain easily precise descriptions of the singularities and of the cusp edges. These latter second order singularities are important for nonsingular assembly mode changing. We show how to sort assembly modes and use this sorting for motion planning in the joint space.

  3. Dual cusped protostylid: Case report and clinical significance

    Directory of Open Access Journals (Sweden)

    Preeti Bhattacharya

    2016-01-01

    Full Text Available Protostylids are superstructures on maxillary or mandibular molars, which have rarely been reported in literature, and the significance of their presence has also been underestimated. The dental practitioners may easily misdiagnose a tooth, with such conical tubercles as malformed tooth. Interestingly, this is neither a malformation nor an anomaly but rather an important morphological trait of an individual. Once in a while, one may come across such a distinct morphological trait without being able to diagnose. To the authors' best knowledge, only one similar case has been reported previously, and the second such case internationally. Bearing all such facts in mind, the authors attempt to educate the readers towards the existence of such a trait so that it can be identified and studied in larger numbers. Hence, it is the authors' endeavor to report an unusual case of dual cusped maxillary protostylid along with its clinical significance.

  4. MHD Flow Visualization of Magnetopause and Polar Cusps Vortices

    Science.gov (United States)

    Collado-Vega, Y. M.; Kessel, R. L.; Shao, X.; Boller, R. A.

    2007-01-01

    Detailed analysis of Wind, Geotail, and Cluster data shows how magnetopause boundary and polar cusps vortices associated with high speed streams can be a carrier of energy flux to the Earth's magnetosphere. For our analysis time interval, March 29 . - April 5 2002, the Interplanetary Magnetic Field (IMF) is primarily northward and MHD simulations of vortices along the flanks within nine hours of the time interval suggest that a Kelvin Helmholtz (KH) instability is likely present. Vortices were classified by solar wind input provided by the Wind satellite located 70-80 RE upstream from Earth. We present statistics for a total of 304 vortices found near the ecliptic plane on the magnetopause flanks, 273 with northward IMF and 31 with southward IMF. The vortices generated under northward IMF were more driven into the dawnside than into the duskside, being substantially more ordered on the duskside. Most of the vortices were large in scale, up to 10 RE, and with a rotation axis closely aligned with the Z(sub GSE) direction. They rotated preferentially clockwise on the dawnside, and. counter-clockwise on the duskside. Those generated under southward IMF were less ordered, fewer in number, and also smaller in diameter. Significant vortex activity occurred on the nightside region of the magnetosphere for these southward cases in contrast to the northward IMF cases on which most of the activity was driven onto the magnetopause flanks. Magnetopause crossings seen by the Geotail spacecraft for the time interval were analyzed and compared with the MHD simulation to validate our results. Vortices over the polar cusps are also being analyzed and the simulation results will be compared to the multi-point measurements of the four Cluster satellites.

  5. Post-stenotic aortic dilatation

    Directory of Open Access Journals (Sweden)

    Jahangiri Marjan

    2006-03-01

    Full Text Available Abstract Aortic stenosis is the most common valvular heart disease affecting up to 4% of the elderly population. It can be associated with dilatation of the ascending aorta and subsequent dissection. Post-stenotic dilatation is seen in patients with AS and/or aortic regurgitation, patients with a haemodynamically normal bicuspid aortic valve and following aortic valve replacement. Controversy exists as to whether to replace the aortic root and ascending aorta at the time of aortic valve replacement, an operation that potentially carries a higher morbidity and mortality. The aetiology of post-stenotic aortic dilatation remains controversial. It may be due to haemodynamic factors caused by a stenotic valve, involving high velocity and turbulent flow downstream of the stenosis, or due to intrinsic pathology of the aortic wall. This may involve an abnormality in the process of extracellular matrix remodelling in the aortic wall including inadequate synthesis, degradation and transport of extracellular matrix proteins. This article reviews the aetiology, pathology and management of patients with post-stenotic aortic dilatation.

  6. Thoracic aortic aneurysm: reading the enemy's playbook.

    Science.gov (United States)

    Elefteriades, John A

    2008-05-01

    The vast database of the Yale Center for Thoracic Aortic Disease--which includes information on 3000 patients with thoracic aortic aneurysm or dissection, with 9000 catalogued images and 9000 patient-years of follow-up--has, over the last decade, permitted multiple glimpses into the "playbook" of this virulent disease. Understanding the precise behavioral features of thoracic aortic aneurysm and dissection permits us more effectively to combat this disease. In this monograph, we will first review certain fundamentals--in terms of anatomy, nomenclature, imaging, diagnosis, medical, surgical, and stent treatment. After reviewing these fundamentals, we will proceed with a detailed exploration of lessons learned by peering into the operational playbook of thoracic aortic aneurysm and dissection. Among the glimpses afforded in the behavioral playbook of this disease are the following: 1 Thoracic aortic aneurysm, while lethal, is indolent. Mortality usually does not occur until after years of growth. 2 The aneurysmal ascending thoracic aorta grows slowly: about 0.1 cm per year (the descending aorta grows somewhat faster). 3 Over a patient's lifetime, "hinge points" at which the likelihood of rupture or dissection skyrockets are seen at 5.5 cm for the ascending and 6.5 cm for the descending aorta. Intervening at 5 cm diameter for the ascending and 6 cm for the descending prevents most adverse events. 4 Symptomatic aneurysms require resection regardless of size. 5 The yearly rate of rupture, dissection, or death is 14.1% for a patient with a thoracic aorta of 6 cm diameter. 6 The mechanical properties of the aorta deteriorate markedly at 6 cm diameter (distensibility falls, and wall stress rises)--a finding that "dovetails" perfectly with observations of the clinical behavior of the thoracic aorta. 7 Thoracic aortic aneurysm and dissection are largely inherited diseases, with a predominantly autosomal-dominant pattern. The specific genetics are being elucidated at the

  7. Cluster survey of the mid-altitude cusp – Part 2: Large-scale morphology

    Directory of Open Access Journals (Sweden)

    I. Dandouras

    2009-05-01

    Full Text Available In this second part of our statistical study of the mid-altitude cusp, we compare the cusp morphology, as seen in the Cluster ion spectrometer (CIS, to the interplanetary magnetic field (IMF orientation. We first recall the method we have used a to define the cusp properties, b to sort IMF conditions or behaviour in classes, c to determine the proper time delay between the solar wind monitors and Cluster. Then, we define a few morphological features of the cusp and we relate these to the prevailing IMF. Our results reveal, among other things, that the occurrence of clearly dispersed ion structures in the cusp is 48%. From these dispersions, we infer the distance to reconnection site, which we relate to external conditions. In all other cases, the cusp exhibits a more disturbed behaviour in terms of ion structures and fall in our "discontinuous" or "irregular" categories. Among these, a few interesting cases of discontinuous cusps occurring under stable IMF conditions have been identified. They all occur when the IMF is dominated by its Y-component, which plays in principle in favour of anti-parallel reconnection but their wide MLT and latitudinal distributions is a priori incompatible with the anti-parallel reconnection hypothesis solely.

  8. Cusp currents from ionospheric vorticity generated by gasdynamic and merging flow fields at the magnetopause

    Energy Technology Data Exchange (ETDEWEB)

    Mie, Y. [Univ. of California, Los Angeles, CA (United States); Crooker, N.U.; Siscoe, G.L. [Boston Univ., MA (United States)

    1995-05-01

    Cusp currents that arise from ionospheric vorticity generated by the combined merging outflow and gasdynamic flow fields at the magnetopause are quantified and compared with those calculated from vorticity generated by mapping the solar wind electric field into a limited cusp region of the polar cap, as proposed in the synthesis view of Banks. The results are essentially identical for strong interplanetary magnetic field (IMF) B{sub Y}, thus demonstrating equivalence between mechanical and electrical descriptions of reconnection-driven convection. For southward IMF, however, the mechanical description yields weak cusp currents with dawn-dusk bipolarity, as deduced from early observations by Iijima and Potemra, whereas the electrical description yields none. The bipolar currents arise from the diverging pattern of gasdynamic flow. The currents become unipolar as B{sub Y} increases and the asymmetry of the merging outflow dominates. Additional cusp currents in both models arise at kinks in the flow contours (additional ionospheric vorticity) around the border of the cusp region, owing to limiting the area of mapping from the magnetopause. The border currents form a bipolar pair that rotates around the circumference of the cusp as the IMF rotates in clock angle. They dominate the currents arising from vorticity within the cusp. 17 refs., 3 figs.

  9. Papillary fibroelastoma of the aortic valve - a case report and literature review

    Directory of Open Access Journals (Sweden)

    Von Canal Friederike

    2010-10-01

    Full Text Available Abstract The prevalence of primary cardiac tumour ranges from 0.0017-0.28% and papillary fibroelastoma is rare but not uncommon benign cardiac neoplasm. Currently, with the advent of higher-resolution imaging technology especially transoesophageal echocardiography such cases being recognized frequently. The clinical presentation of these tumours varies from asymptomatic to severe ischaemic or embolic complications. We herein, present a 50-year-old female patient with a papillary fibroelastoma of the aortic valve arising from the endocardium of the right coronary cusp very close to the commissure between the right and non-coronary cusps. The patient presented with angina-like chest pain and was investigated using echocardiography and CT angiographic modalities in addition to the usual investigations. The differential diagnosis considered was a thrombus, myxoma, Lambl's excrescence and infective vegetation. The surgical management included a prompt resection of the tumour on cardiopulmonary bypass avoiding injury to the aortic valve. The patient recovered well. A review of the literature suggests that the cardiac papillary fibroelastoma is a rare but potentially treatable cause of embolic stroke and other fatal complications, therefore, a strong suspicion; appropriate use of imaging modality, preoperative anticoagulation and urgent surgical resection is warranted. Also, possibility of this diagnosis should be kept in mind while managing cardiac or valvular tumours.

  10. Singular Curves in the Joint Space and Cusp Points of 3-RPR parallel manipulators

    CERN Document Server

    Zein, Mazen; Chablat, Damien

    2007-01-01

    This paper investigates the singular curves in the joint space of a family of planar parallel manipulators. It focuses on special points, referred to as cusp points, which may appear on these curves. Cusp points play an important role in the kinematic behavior of parallel manipulators since they make possible a nonsingular change of assembly mode. The purpose of this study is twofold. First, it exposes a method to compute joint space singular curves of 3-RPR planar parallel manipulators. Second, it presents an algorithm for detecting and computing all cusp points in the joint space of these same manipulators.

  11. Cusp Points in the Parameter Space of Degenerate 3-RPR Planar Parallel Manipulators

    CERN Document Server

    Manubens, Montserrat; Chablat, Damien; Wenger, Philippe; Rouillier, Fabrice

    2012-01-01

    This paper investigates the conditions in the design parameter space for the existence and distribution of the cusp locus for planar parallel manipulators. Cusp points make possible non-singular assembly-mode changing motion, which increases the maximum singularity-free workspace. An accurate algorithm for the determination is proposed amending some imprecisions done by previous existing algorithms. This is combined with methods of Cylindric Algebraic Decomposition, Gr\\"obner bases and Discriminant Varieties in order to partition the parameter space into cells with constant number of cusp points. These algorithms will allow us to classify a family of degenerate 3-RPR manipulators.

  12. Labial talon cusp on maxillary central incisors: a rare developmental dental anomaly.

    Science.gov (United States)

    Glavina, Domagoj; Skrinjarić, Tomislav

    2005-06-01

    Labial talon cusp, or dens evaginatus is a very rare dental anomaly of unclear etiology and significance. It can occur as an isolated finding or be associated with other dental anomalies or some syndromes. The present report describes two Caucasian males with labial talon cusp on maxillary permanent left central incisors. In both cases accessory cusp caused plaque accumulation and marginal gingivitis. One case displayed affected tooth to be in cross bite position causing occlusal trauma. No other dental anomalies in either case, neither association with some syndromes were noted. This rare anomaly requires careful dental and physical examination of the affected patient since its finding can be of clinical and genetic significance.

  13. Talon cusp: A case report with management guidelines for practicing dentists

    Directory of Open Access Journals (Sweden)

    Reecha Gupta

    2013-01-01

    Full Text Available Introduction: Talon cusp is an uncommon odontogenic anomaly which most frequently affects maxillary permanent incisors. Its presence causes the problem in esthetics, prevention of caries, and occlusal accommodation for the patient and problems in the diagnosis and clinical management for the dentist. Case Report: This article reports a case of talon cusp on the palatal surface of the permanent maxillary central incisor. Discussion: Since, the presence of talon cusp usually demands that definitive treatment be instituted; it represents a problem of clinical significance. The dentist should be able to diagnose it as the maxillary incisor is also the principal site for supernumerary tooth.

  14. Numerical Prediction of cusps or kinks in the Nambu-Goto dynamics

    CERN Document Server

    Cervantes, Aldrin

    2014-01-01

    It is known that Nambu-Goto world-sheet present some pathological structures, such as cusps and kinks, during its evolution. We propose a method through the Raychaudhuri equation for membranes to determine if there are cusps and kinks in the world-sheet. We generalize the Raychaudhuri equation for non-extremal membranes and use it as a tool for determining when a string in the Nambu-Goto action will form cusps or kinks in its evolution. Furthermore, we present two examples where we test graphically this method.

  15. Cross Talk between NOTCH Signaling and Biomechanics in Human Aortic Valve Disease Pathogenesis

    Directory of Open Access Journals (Sweden)

    Richard C. Godby

    2014-12-01

    Full Text Available Aortic valve disease is a burgeoning public health problem associated with significant mortality. Loss of function mutations in NOTCH1 cause bicuspid aortic valve (BAV and calcific aortic valve disease. Because calcific nodules manifest on the fibrosa side of the cusp in low fluidic oscillatory shear stress (OSS, elucidating pathogenesis requires approaches that consider both molecular and mechanical factors. Therefore, we examined the relationship between NOTCH loss of function (LOF and biomechanical indices in healthy and diseased human aortic valve interstitial cells (AVICs. An orbital shaker system was used to apply cyclic OSS, which mimics the cardiac cycle and hemodynamics experienced by AVICs in vivo. NOTCH LOF blocked OSS-induced cell alignment in human umbilical vein endothelial cells (HUVECs, whereas AVICs did not align when subjected to OSS under any conditions. In healthy AVICs, OSS resulted in decreased elastin (ELN and α-SMA (ACTA2. NOTCH LOF was associated with similar changes, but in diseased AVICs, NOTCH LOF combined with OSS was associated with increased α-SMA expression. Interestingly, AVICs showed relatively higher expression of NOTCH2 compared to NOTCH1. Biomechanical interactions between endothelial and interstitial cells involve complex NOTCH signaling that contributes to matrix homeostasis in health and disorganization in disease.

  16. [Discrete type subaortic stenosis disclosed by hemolytic anemia after aortic and mitral valve replacement].

    Science.gov (United States)

    Kawahara, Yu; Inage, Yuichi; Masaki, Naoki; Kobayashi, Yuriko; Jinbu, Ryota; Toyama, Shuji; Fukasawa, Manabu

    2014-03-01

    We report a case of discrete type subaortic stenosis disclosed by hemolytic anemia 7 years after aortic and mitral prosthetic valve replacement. A 53-year-old female complained of general fatigue, dyspnea, macrohematuria and hemolysis. She had undergone aortic valve replacement for non-coronary cusp perforation 15 years before, and mitral valve replacement and tricuspid annuloplasty 7 years before. Echocardiography showed mitral prosthetic valve regurgitation (III/IV degree) and symptomatic hemolysis might be caused by accelerated blood flow through the prosthetic valve. A mild aortic stenosis (peak flow verocity:3.73 m/s) was also pointed out. The redo double valve replacement was performed. Intraoperative findings showed discrete type subaortic stenosis due to extensive pannus formation, but that the previously implanted prosthetic valves were intact. The blood flow biased by the interference of the subaortic stenosis might have obstructed closure of the mitral prosthetic valve and caused mitral regurgitation. Postoperatively, hemolysis and mitral regurgitation were diminished, and aortic stenosis was improved.

  17. Tobacco smoking and aortic aneurysm

    DEFF Research Database (Denmark)

    Sode, Birgitte F; Nordestgaard, Børge G; Grønbæk, Morten

    2012-01-01

    General Population Study, respectively. According to the magnitude of the hazard ratios, tobacco consumption was the most important risk factor for hospitalization and death from aortic aneurysm, followed by male sex and hypertension in both cohorts. The population attributable risk of aortic aneurysm...... outcomes due to tobacco consumption was 64% and 47% in the Copenhagen City Heart Study and Copenhagen General Population Study, respectively, and ranked highest among population attributable risks of aortic aneurysm in both cohorts. The absolute 10-year risk for hospitalization or death from aortic......BACKGROUND: We determined the predictive power of tobacco smoking on aortic aneurysm as opposed to other risk factors in the general population. METHODS: We recorded tobacco smoking and other risk factors at baseline, and assessed hospitalization and death from aortic aneurysm in 15,072 individuals...

  18. Ruptured abdominal aortic aneurysm.

    Science.gov (United States)

    Sachs, T; Schermerhorn, M

    2010-06-01

    Ruptured abdominal aortic aneurysm (AAA) continues to be one of the most lethal vascular pathologies we encounter. Its management demands prompt and efficient evaluation and repair. Open repair has traditionally been the mainstay of treatment. However, the introduction of endovascular techniques has altered the treatment algorithm for ruptured AAA in most major medical centers. We present recent literature and techniques for ruptured AAA and its surgical management.

  19. Infrarenal Aortic Occlusion

    Science.gov (United States)

    Traverso, L. W.; Baker, J. D.; Dainko, E. A.; Machleder, H. I.

    1978-01-01

    Twenty-eight patients with total occlusion of the infrarenal aorta have been seen at the UCLA Hospitals in the past 11 years. Claudication was the presenting complaint in all but one patient, with one-third having ischemic rest pain. The average age of these patients was 54 years, and their histories revealed a surprising absence of myocardial infarction, stroke, or diabetes, although 40% had essential hypertension. Heavy tobacco use, however, was characteristic of the entire group. Arteriography proved valuable in identifying and characterizing the vascular abnormalities, but posed problems in technique and interpretation. Significant distal arterial disease was detected radiographically in only 21% of these patients. Operative correction of the aortic occlusion was performed on 26 patients, 18 by aortic bypass grafts and eight by aorto-iliac endarterectomy, with one early postoperative death. Although the thrombus extended to the renal artery origins in 77% of the cases, a well-designed technical approach did not require renal artery occlusion. Using serial creatinine determinations, one case of renal insufficiency was detected which was associated with prolonged postoperative hypotension. Although the extent of distal disease was more severe in those who underwent bypass, symptoms of claudication returned earlier and were more prominent in the endarterectomy group. This recurrence of systems was not favorably altered by sympathectomy performed concomitantly with the initial procedure. Even though this condition seems to pose difficult technical obstacles and has a poor prognosis, infrarenal aortic occlusion can be successfully treated by aortic bypass, with favorable long-term results, if particular attention is paid to elements of the preoperative evaluation and the intraoperative technical requirements peculiar to this relatively uncommon disease entity. ImagesFig. 1.Fig. 2.Fig. 3. PMID:646479

  20. CT of thoracic aortic aneurysms.

    Science.gov (United States)

    Posniak, H V; Olson, M C; Demos, T C; Benjoya, R A; Marsan, R E

    1990-09-01

    Aneurysms of the thoracic aorta are most often the result of arteriosclerotic disease. Other causes include degeneration of the medial layer of the aortic wall, either idiopathically or due to genetic disorders such as Marfan syndrome; aortic dissection; trauma; syphilis and other bacterial infection; noninfective aortitis; and congenital anomaly. We review normal anatomy of the aorta and discuss our technique and interpretation of computed tomography (CT) in the evaluation of the thoracic aorta. We illustrate the CT appearance of different types of aortic aneurysms as well as discuss the use of CT for assessing complications of aneurysms, for postoperative follow-up, and in the differentiation of aortic aneurysm from a paraaortic mass.

  1. Micromanaging Abdominal Aortic Aneurysms

    Directory of Open Access Journals (Sweden)

    Lars Maegdefessel

    2013-07-01

    Full Text Available The contribution of abdominal aortic aneurysm (AAA disease to human morbidity and mortality has increased in the aging, industrialized world. In response, extraordinary efforts have been launched to determine the molecular and pathophysiological characteristics of the diseased aorta. This work aims to develop novel diagnostic and therapeutic strategies to limit AAA expansion and, ultimately, rupture. Contributions from multiple research groups have uncovered a complex transcriptional and post-transcriptional regulatory milieu, which is believed to be essential for maintaining aortic vascular homeostasis. Recently, novel small noncoding RNAs, called microRNAs, have been identified as important transcriptional and post-transcriptional inhibitors of gene expression. MicroRNAs are thought to “fine tune” the translational output of their target messenger RNAs (mRNAs by promoting mRNA degradation or inhibiting translation. With the discovery that microRNAs act as powerful regulators in the context of a wide variety of diseases, it is only logical that microRNAs be thoroughly explored as potential therapeutic entities. This current review summarizes interesting findings regarding the intriguing roles and benefits of microRNA expression modulation during AAA initiation and propagation. These studies utilize disease-relevant murine models, as well as human tissue from patients undergoing surgical aortic aneurysm repair. Furthermore, we critically examine future therapeutic strategies with regard to their clinical and translational feasibility.

  2. An Algorithm for Computing Cusp Points in the Joint Space of 3-RPR Parallel Manipulators

    CERN Document Server

    Zein, Mazen; Chablat, Damien

    2006-01-01

    This paper presents an algorithm for detecting and computing the cusp points in the joint space of 3-RPR planar parallel manipulators. In manipulator kinematics, cusp points are special points, which appear on the singular curves of the manipulators. The nonsingular change of assembly mode of 3-RPR parallel manipulators was shown to be associated with the existence of cusp points. At each of these points, three direct kinematic solutions coincide. In the literature, a condition for the existence of three coincident direct kinematic solutions was established, but has never been exploited, because the algebra involved was too complicated to be solved. The algorithm presented in this paper solves this equation and detects all the cusp points in the joint space of these manipulators.

  3. Singular curves and cusp points in the joint space of 3-RPR parallel manipulators

    CERN Document Server

    Zein, Mazen; Chablat, Damien

    2006-01-01

    This paper investigates the singular curves in two-dimensional slices of the joint space of a family of planar parallel manipulators. It focuses on special points, referred to as cusp points, which may appear on these curves. Cusp points play an important role in the kinematic behavior of parallel manipulators since they make possible a nonsingular change of assembly mode. The purpose of this study is twofold. First, it reviews an important previous work, which, to the authors' knowledge, has never been exploited yet. Second, it determines the cusp points in any two-dimensional slice of the joint space. First results show that the number of cusp points may vary from zero to eight. This work finds applications in both design and trajectory planning.

  4. Esthetic management of double tooth associated with talon cusp using a laminate veneer.

    Science.gov (United States)

    Cordeiro, Wayne José Batista; do Couto, Cintia Fernandes; Barros, Renata Nunes; Zarranz, Laila; Jorge, Mônica Zacharias; de Gouvêa, Cresus Vínicius Depes

    2014-01-01

    Double tooth and talon cusp are tooth shape anomalies with rare co-occurrences in a single tooth. Double tooth is a developmental anomaly that leads to the eruption of fused teeth and may contribute to compromised esthetics, pain, caries, and tooth crowding. Talon cusp is a rare developmental extra cusp-like projection on the cingulum area that may cause functional and esthetic problems. Differential diagnosis of these anomalies may be complicated. A multidisciplinary approach for the esthetic and functional rehabilitation of double teeth is important. Various treatment methods have been described in the literature for the different types and morphological variations of double teeth. The purpose of this paper is to report the case of an unusual combination of double tooth and talon cusp on a permanent maxillary incisor and describe its esthetic and functional rehabilitation using a porcelain laminate veneer.

  5. On the determination of cusp points of 3-R\\underline{P}R parallel manipulators

    CERN Document Server

    Moroz, Guillaume Inria; Chablat, Damien; Wenger, Philippe; 10.1016/j.mechmachtheory.2010.06.016

    2010-01-01

    This paper investigates the cuspidal configurations of 3-RPR parallel manipulators that may appear on their singular surfaces in the joint space. Cusp points play an important role in the kinematic behavior of parallel manipulators since they make possible a non-singular change of assembly mode. In previous works, the cusp points were calculated in sections of the joint space by solving a 24th-degree polynomial without any proof that this polynomial was the only one that gives all solutions. The purpose of this study is to propose a rigorous methodology to determine the cusp points of 3-R\\underline{P}R manipulators and to certify that all cusp points are found. This methodology uses the notion of discriminant varieties and resorts to Gr\\"obner bases for the solutions of systems of equations.

  6. Correlated electric field and low-energy electron measurements in the low-altitude polar cusp

    Science.gov (United States)

    Kintner, P. M.; Ackerson, K. L.; Gurnett, D. A.; Frank, L. A.

    1978-01-01

    Correlated electric field and low-energy electron measurements are presented for two passes of Hawkeye 1 through the south polar cusp at 2000-km altitude during local morning. In one case the electric field reversal coincides with the boundary of detectable 5.2keV electron intensities and the equatorward boundary of the cusp. In the other case the electric field reversal and the 5.2 keV electron trapping boundary coincide, but the equatorward edge of the cusp as determined from the presence of 180 eV electron intensities is 5 degrees invariant latitude equatorward of the electric field reversal. It is concluded that in the second case, electron intensities associated with the polar cusp populate closed dayside field lines, and hence the corresponding equatorward edge of these electron intensities is not always an indicator of the boundary between closed dayside field lines and polar cap field lines.

  7. Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve Disease

    DEFF Research Database (Denmark)

    Mylotte, Darren; Lefevre, Thierry; Søndergaard, Lars

    2014-01-01

    BACKGROUND: Limited information exists describing the results of transcatheter aortic valve (TAV) replacement in patients with bicuspid aortic valve (BAV) disease (TAV-in-BAV). OBJECTIVES: This study sought to evaluate clinical outcomes of a large cohort of patients undergoing TAV-in-BAV. METHODS...

  8. The cusp: a window for particle exchange between the radiation belt and the solar wind

    Directory of Open Access Journals (Sweden)

    X.-Z. Zhou

    2006-11-01

    Full Text Available The study focuses on a single particle dynamics in the cusp region. The topology of the cusp region in terms of magnetic field iso-B contours has been studied using the Tsyganenko 96 model (T96 as an example, to show the importance of an off-equatorial minimum on particle trapping. We carry out test particle simulations to demonstrate the bounce and drift motion. The "cusp trapping limit" concept is introduced to reflect the particle motion in the high latitude magnetospheric region. The spatial distribution of the "cusp trapping limit" shows that only those particles with near 90° pitch-angles can be trapped and drift around the cusp. Those with smaller pitch angles may be partly trapped in the iso-B contours, however, they will eventually escape along one of the magnetic field lines. There exist both open field lines and closed ones within the same drift orbit, indicating two possible destinations of these particles: those particles being lost along open field lines will be connected to the surface of the magnetopause and the solar wind, while those along closed ones will enter the equatorial radiation belt. Thus, it is believed that the cusp region can provide a window for particle exchange between these two regions. Some of the factors, such as dipole tilt angle, magnetospheric convection, IMF and the Birkeland current system, may influence the cusp's trapping capability and therefore affect the particle exchanging mechanism. Their roles are examined by both the analysis of cusp magnetic topology and test particle simulations.

  9. Aortic root geometry in aortic stenosis patients (a SEAS substudy)

    DEFF Research Database (Denmark)

    Bahlmann, Edda; Nienaber, Christoph A; Cramariuc, Dana

    2011-01-01

    AIMS: To report aortic root geometry by echocardiography in a large population of healthy, asymptomatic aortic stenosis (AS) patients in relation to current vendor-specified requirements for transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS: Baseline data in 1481 patients...... with asymptomatic AS (mean age 67 years, 39% women) in the Simvastatin Ezetimibe in AS study were used. The inner aortic diameter was measured at four levels: annulus, sinus of Valsalva, sinotubular junction and supracoronary, and sinus height as the annulo-junctional distance. Analyses were based on vendor......-specified requirements for the aortic root geometry for current available prostheses, CoreValve and Edwards-Sapien. The ratio of sinus of Valsalva height to sinus width was 1:2. In multivariate linear regression analysis, larger sinus of Valsalva height was associated with older age, larger sinus of Valsalva diameter...

  10. Fracture resistance of weakened teeth restored with condensable resin with and without cusp coverage

    Directory of Open Access Journals (Sweden)

    Rafael Francisco Lia Mondelli

    2009-06-01

    Full Text Available OBJECTIVES: This in vitro study evaluated the fracture resistance of weakened human premolars (MOD cavity preparation and pulp chamber roof removal restored with condensable resin composite with and without cusp coverage. MATERIAL AND METHODS: Thirty human maxillary premolars were divided into three groups: Group A (control, sound teeth; Group B, wide MOD cavities prepared and the pulp chamber roof removed and restored with resin composite without cusp coverage; Group C, same as Group B with 2.0 mm of buccal and palatal cusps reduced and restored with the same resin. The teeth were included in metal rings with self-curing acrylic resin, stored in water for 24 h and thereafter subjected to a compressive axial load in a universal testing machine at 0.5 mm/min. RESULTS: The mean fracture resistance values ± standart deviation (kgf were: group A: 151.40 ± 55.32, group B: 60.54 ± 12.61, group C: 141.90 ± 30.82. Statistically significant differences were found only between Group B and the other groups (p<0.05. The condensable resin restoration of weakened human premolars with cusp coverage significantly increased the fracture resistance of the teeth as compared to teeth restored without cusp coverage. CONCLUSION: The results showed that cusp coverage with condensable resin might be a safe option for restoring weakened endodontically treated teeth.

  11. The three-loop cusp anomalous dimension in QCD and its supersymmetric extensions

    Energy Technology Data Exchange (ETDEWEB)

    Grozin, Andrey G. [SB RAS, Novosibirsk (Russian Federation). Budker Intitute for Nuclear Physics; Novosibirsk State Univ. (Russian Federation); Henn, Johannes M. [Mainz Univ. (Germany). PRISMA Cluster of Excellence; Korchemsky, Gregory P. [CEA Saclay, Gif-sur-Yvette (France). Inst. de Physique Theorique; Marquard, Peter [DESY Zeuthen (Germany)

    2015-11-15

    We present the details of the analytic calculation of the three-loop angledependent cusp anomalous dimension in QCD and its supersymmetric extensions, including the maximally supersymmetric N=4 super Yang-Mills theory. The three-loop result in the latter theory is new and confirms a conjecture made in our previous paper. We study various physical limits of the cusp anomalous dimension and discuss its relation to the quark-antiquark potential including the effects of broken conformal symmetry in QCD. We find that the cusp anomalous dimension viewed as a function of the cusp angle and the new effective coupling given by light-like cusp anomalous dimension reveals a remarkable universality property - it takes the same form in QCD and its supersymmetric extensions, to three loops at least. We exploit this universality property and make use of the known result for the three-loop quark-antiquark potential to predict the special class of nonplanar corrections to the cusp anomalous dimensions at four loops. Finally, we also discuss in detail the computation of all necessary Wilson line integrals up to three loops using the method of leading singularities and differential equations.

  12. Design of a cusped field thruster for drag-free flight

    Science.gov (United States)

    Liu, H.; Chen, P. B.; Sun, Q. Q.; Hu, P.; Meng, Y. C.; Mao, W.; Yu, D. R.

    2016-09-01

    Drag-free flight has played a more and more important role in many space missions. The thrust control system is the key unit to achieve drag-free flight by providing a precise compensation for the disturbing force except gravity. The cusped field thruster has shown a significant potential to be capable of the function due to its long life, high efficiency, and simplicity. This paper demonstrates a cusped field thruster's feasibility in drag-free flight based on its instinctive characteristics and describes a detailed design of a cusped field thruster made by Harbin Institute of Technology (HIT). Furthermore, the performance test is conducted, which shows that the cusped field thruster can achieve a continuously variable thrust from 1 to 20 mN with a low noise and high resolution below 650 W, and the specific impulse can achieve 1800 s under a thrust of 18 mN and discharge voltage of 1000 V. The thruster's overall performance indicates that the cusped field thruster is quite capable of achieving drag-free flight. With the further optimization, the cusped field thruster will exhibit a more extensive application value.

  13. How supernova feedback turns dark matter cusps into cores

    Science.gov (United States)

    Pontzen, Andrew; Governato, Fabio

    2012-04-01

    We propose and successfully test against new cosmological simulations a novel analytical description of the physical processes associated with the origin of cored dark matter density profiles. In the simulations, the potential in the central kiloparsec changes on sub-dynamical time-scales over the redshift interval 4 > z > 2, as repeated, energetic feedback generates large underdense bubbles of expanding gas from centrally concentrated bursts of star formation. The model demonstrates how fluctuations in the central potential irreversibly transfer energy into collisionless particles, thus generating a dark matter core. A supply of gas undergoing collapse and rapid expansion is therefore the essential ingredient. The framework, based on a novel impulsive approximation, breaks with the reliance on adiabatic approximations which are inappropriate in the rapidly changing limit. It shows that both outflows and galactic fountains can give rise to cusp flattening, even when only a few per cent of the baryons form stars. Dwarf galaxies maintain their core to the present time. The model suggests that constant density dark matter cores will be generated in systems of a wide mass range if central starbursts or active galactic nucleus phases are sufficiently frequent and energetic.

  14. Transfer of Siegel cusp forms of degree 2

    CERN Document Server

    Pitale, Ameya; Schmidt, Ralf

    2011-01-01

    Using Furusawa's integral representation for $\\GSp_4\\times\\GL_2$ combined with a pullback formula involving a unitary group $\\GU(3,3)$, we prove that the $L$-functions $L(s,\\pi\\times\\tau)$ are "nice", where $\\pi$ is the automorphic representation of $\\GSp_4(\\A)$ generated by a full level cuspidal Siegel eigenform that is not a Saito-Kurokawa lift, and $\\tau$ is an arbitrary cuspidal, automorphic representation of $\\GL_2(\\A)$. The converse theorem of Cogdell and Piatetski-Shapiro then implies that such representations $\\pi$ have a functorial lifting to a cuspidal representation of $\\GL_4(\\A)$. Combined with the exterior-square lifting of Kim, this also leads to a functorial lifting of $\\pi$ to a cuspidal representation of $\\GL_5(\\A)$. As an application, we obtain analytic properties of various $L$-functions related to full level Siegel cusp forms. We also obtain special value results for $\\GSp_4\\times\\GL_1$ and $\\GSp_4\\times\\GL_2$.

  15. Axion dark matter, solitons, and the cusp-core problem

    CERN Document Server

    Marsh, David J E

    2015-01-01

    Self-gravitating bosonic fields can support stable and localised field configurations. For real fields, these solutions oscillate in time and are known as oscillatons. The density profile is static, and is soliton. Such solitons should be ubiquitous in models of axion dark matter, with the soliton characteristic mass and size depending on some inverse power of the axion mass. Stable configurations of non-relativistic axions are studied numerically using the Schr\\"{o}dinger-Poisson system. This method, and the resulting soliton density profiles, are reviewed. Using a scaling symmetry and the uncertainty principle, the core size of the soliton can be related to the central density and axion mass, $m_a$, in a universal way. Solitons have a constant central density due to pressure-support, unlike the cuspy profile of cold dark matter (CDM). One consequence of this fact is that solitons composed of ultra-light axions (ULAs) may resolve the `cusp-core' problem of CDM. In DM halos, thermodynamics will lead to a CDM-...

  16. Intravascular ultrasound in guiding endovascular aortic aneurysm repair-a case report of interventional therapy without contrast media%血管内超声介导下主动脉夹层腔内修复术无造影剂介入治疗1例报道

    Institute of Scientific and Technical Information of China (English)

    罗建方; 黄文晖; 谢年谨; 胡孜阳; 刘媛; 杨峻青; 范瑞新; 陈纪言

    2011-01-01

    Objectives To investigate the feasibility and clinical value of intravascular ultrasound (IVUS) in guiding endovascular aortic aneurysm repair (EVAR). Methods With EVAR procedure for a patient suffered from Standford type B aortic dissection and renal insufficiency, we utilized IVUV to guide the lumen tracking, rupture site localization, stent delivery and intra-procedure examination of anatomic result. We attempted to avoid any dose of iodic contrast. Results Zero milliliter iodic contrast was consumed in the procedure and this procedure lasted for 12S minutes. The operation was smoothly performed and anatomic result was satisfactory. No complication occurred after operation. The patient's concentration of serum creatinine did not increase within a week monitor. Conclusions IVUS guided EVAR is feasible in this patients. Iodic contrast may be avoided with the utilization of this technique and sequentially renal function be protected.%目的 探讨血管内超声代替基于造影剂的血管显影指引主动脉腔内修复术的可行性和价值.方法 我们对1例Standford B型主动脉夹层合并肾功能不全患者行主动脉腔内修复术,术中使用血管内超声指引寻腔、定位、支架释放和进行解剖学检查,全程避免使用造影剂.结果 手术使用造影剂0 mL,手术时间125 min,寻腔、定位及支架释放过程顺利.支架到位准确,扩张及贴壁良好.术后无内漏或新发夹层,无其他并发症.术后1周患者血清肌酐浓度无增高.结论在本例患者中,血管内超声代替基于造影剂的血管显影指引主动脉腔内修复术可行,该技术可能避免肾功能不全患者肾功能恶化.

  17. Abdominal aortic aneurysm surgery

    DEFF Research Database (Denmark)

    Gefke, K; Schroeder, T V; Thisted, B

    1994-01-01

    The goal of this study was to identify patients who need longer care in the ICU (more than 48 hours) following abdominal aortic aneurysm (AAA) surgery and to evaluate the influence of perioperative complications on short- and long-term survival and quality of life. AAA surgery was performed in 553......, 78% stated that their quality of life had improved or was unchanged after surgery and had resumed working. These data justify a therapeutically aggressive approach, including ICU therapy following AAA surgery, despite failure of one or more organ systems....

  18. Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of severe aortic stenosis

    DEFF Research Database (Denmark)

    Siontis, George C M; Praz, Fabien; Pilgrim, Thomas

    2016-01-01

    AIMS: In view of the currently available evidence from randomized trials, we aimed to compare the collective safety and efficacy of transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) across the spectrum of risk and in important subgroups. METHODS AND RESULTS...

  19. [Aortic valve replacement for the small aortic annulus].

    Science.gov (United States)

    Oshima, H; Usui, A; Akita, T; Ueda, Y

    2006-04-01

    Aortic valve surgery for the small aortic annulus is still challenging for surgeons. Recently, the new types of high performance prosthesis have been developed and the chance of an aortic root enlargement (ARE) is decreasing. In this study, we propose the ideal strategy of the aortic surgery for the small aortic annulus. We analyzed the clinical records of 158 patients who underwent aortic valve replacement from August 1999 to October 2005 in our institution. The small aortic annulus was observed in 38 patients (24%). Fourteen patients of this group underwent ARE. Patient-prosthesis mismatch (PPM) was less frequently observed in patients with ARE compared to those without ARE. The additional time required for ARE was not considerable, and neither ischemic time nor cardiopulmonary bypass time was significantly prolonged by ARE. In conclusion, we have to select a prosthesis with sufficient orifice area to avoid PPM, otherwise we should choose an option of ARE. For this consideration, we definitely need the chart that demonstrates the relationship between the nominal size of various types of prostheses and the size of a patient's annulus that those prostheses actually fit.

  20. Valve-sparing aortic root replacement and aortic valve repair in a patient with acromegaly and aortic root dilatation

    Directory of Open Access Journals (Sweden)

    Karel Van Praet

    2015-07-01

    Full Text Available Aortic regurgitation and dilatation of the aortic root and ascending aorta are severe complications of acromegaly. The current trend for management of an aortic root aneurysm is valve-sparing root replacement as well as restoring the diameter of the aortic sinotubular junction (STJ and annulus. Our case report supports the recommendation that in patients with acromegaly, severe aortic root involvement may indicate the need for surgery.

  1. Aortic biomechanics in hypertrophic cardiomyopathy

    Science.gov (United States)

    Badran, Hala Mahfouz; Soltan, Ghada; Faheem, Nagla; Elnoamany, Mohamed Fahmy; Tawfik, Mohamed; Yacoub, Magdi

    2015-01-01

    Background: Ventricular-vascular coupling is an important phenomenon in many cardiovascular diseases. The association between aortic mechanical dysfunction and left ventricular (LV) dysfunction is well characterized in many disease entities, but no data are available on how these changes are related in hypertrophic cardiomyopathy (HCM). Aim of the work: This study examined whether HCM alone is associated with an impaired aortic mechanical function in patients without cardiovascular risk factors and the relation of these changes, if any, to LV deformation and cardiac phenotype. Methods: 141 patients with HCM were recruited and compared to 66 age- and sex-matched healthy subjects as control group. Pulse pressure, aortic strain, stiffness and distensibility were calculated from the aortic diameters measured by M-mode echocardiography and blood pressure obtained by sphygmomanometer. Aortic wall systolic and diastolic velocities were measured using pulsed wave Doppler tissue imaging (DTI). Cardiac assessment included geometric parameters and myocardial deformation (strain and strain rate) and mechanical dyssynchrony. Results: The pulsatile change in the aortic diameter, distensibility and aortic wall systolic velocity (AWS') were significantly decreased and aortic stiffness index was increased in HCM compared to control (P < .001) In HCM AWS' was inversely correlated to age(r = − .32, P < .0001), MWT (r = − .22, P < .008), LVMI (r = − .20, P < .02), E/Ea (r = − .16, P < .03) LVOT gradient (r = − 19, P < .02) and severity of mitral regurg (r = − .18, P < .03) but not to the concealed LV deformation abnormalities or mechanical dyssynchrony. On multivariate analysis, the key determinant of aortic stiffness was LV mass index and LVOT obstruction while the role LV dysfunction in aortic stiffness is not evident in this population. Conclusion: HCM is associated with abnormal aortic mechanical properties. The severity of cardiac

  2. Anesthetic management for combined mitral valve replacement and aortic valve repair in a patient with osteogenesis imperfecta

    Directory of Open Access Journals (Sweden)

    Huang Jiapeng

    2011-01-01

    Full Text Available Osteogenesis imperfecta is a rare disorder of connective tissues and presents multiple challenges, including difficult airway, hyperthermia, coagulopathy and respiratory dysfunction, for anesthesiologists, especially during cardiac surgery. We present anesthetic management of a patient with osteogenesis impertecta during double valve surgery. Dexmedetomidine infusion minimized the risks of malignant hyperthermia. Glidescope and in-line stabilization facilitated endotracheal intubation and protected his oral structures and cervical spine. Transesophageal echocardiography (TEE diagnosed a flail A3 segment and redundant left coronary cusp causing mitral and aortic regurgitation. The mitral valve was replaced and the aortic valve repaired. Coagulopathy was corrected according to comprehensive coagulation analysis. Glidescope, dexmedetomidine, coagulation analysis and TEE could facilitate anesthetic management in these patients.

  3. Reinforced aortic root reconstruction for acute type A aortic dissection involving the aortic root

    Directory of Open Access Journals (Sweden)

    Han Qing-qi

    2013-06-01

    Full Text Available OBJECTIVE: There are debates regarding the optimal approach for AAAD involving the aortic root. We described a modified reinforced aortic root reconstruction approach for treating AAAD involving the aortic root. METHODS: A total of 161 patients with AAAD involving the aortic root were treated by our modified reinforced aortic root reconstruction approach from January 1998 to December 2008. Key features of our modified approach were placement of an autologous pericardial patch in the false lumen, lining of the sinotubular junction lumen with a polyester vascular ring, and wrapping of the vessel with Teflon strips. Outcome measures included post-operative mortality, survival, complications, and level of aortic regurgitation. RESULTS: A total of 161 patients were included in the study (mean age: 43.3 1 15.5 years. The mean duration of follow-up was 5.1 1 2.96 years (2-12 years. A total of 10 (6.2% and 11 (6.8% patients died during hospitalization and during follow-up, respectively. Thirty-one (19.3% patients experienced postoperative complications. The 1-, 3-, 5-, and 10-year survival rates were 99.3%, 98%, 93.8%, and 75.5%, respectively. There were no instances of recurrent aortic dissection, aortic aneurysm, or pseudoaneurysm during the entire study period. The severity of aortic regurgitation dramatically decreased immediately after surgery (from 28.6% to 0% grade 3-4 and thereafter slightly increased (from 0% to 7.2% at 5 years and 9.1% at 10 years. CONCLUSION: This modified reinforced aortic root reconstruction was feasible, safe and durable/effective, as indicated by its low mortality, low postoperative complications and high survival rate.

  4. Cusp-core transformations in dwarf galaxies: observational predictions

    Science.gov (United States)

    Teyssier, Romain; Pontzen, Andrew; Dubois, Yohan; Read, Justin I.

    2013-03-01

    The presence of a dark matter core in the central kiloparsec of many dwarf galaxies has been a long-standing problem in galaxy formation theories based on the standard cold dark matter paradigm. Recent simulations, based on smooth particle hydrodynamics and rather strong feedback recipes, have shown that it was indeed possible to form extended dark matter cores using baryonic processes related to a more realistic treatment of the interstellar medium. Using adaptive mesh refinement, together with a new, stronger supernova feedback scheme that we have recently implemented in the RAMSES code, we show that it is also possible to form a prominent dark matter core within the well-controlled framework of an isolated, initially cuspy, 1010 M⊙ dark matter halo. Although our numerical experiment is idealized, it allows a clean and unambiguous identification of the dark matter core formation process. Our dark matter inner profile is well fitted by a pseudo-isothermal profile with a core radius of 800 pc. The core formation mechanism is consistent with the one proposed by Pontzen & Governato. We highlight two key observational predictions of all simulations that find cusp-core transformations: (i) a bursty star formation history with a peak-to-trough ratio of 5 to 10 and a duty cycle comparable to the local dynamical time and (ii) a stellar distribution that is hot with v/σ ˜ 1. We compare the observational properties of our model galaxy with recent measurements of the isolated dwarf Wolf-Lundmark-Mellote (WLM). We show that the spatial and kinematical distribution of stars and H I gas are in striking agreement with observations, supporting the fundamental role played by stellar feedback in shaping both the stellar and dark matter distribution.

  5. Reliability and Identification of Aortic Valve Prolapse in the Horse

    Directory of Open Access Journals (Sweden)

    Hallowell Gayle D

    2013-01-01

    Full Text Available Abstract Background The objectives were to determine and assess the reliability of criteria for identification of aortic valve prolapse (AVP using echocardiography in the horse. Results Opinion of equine cardiologists indicated that a long-axis view of the aortic valve (AoV was most commonly used for identification of AVP (46%; n=13. There was consensus that AVP could be mimicked by ultrasound probe malignment. This was confirmed in 7 healthy horses, where the appearance of AVP could be induced by malalignment. In a study of a further 8 healthy horses (5 with AVP examined daily for 5 days, by two echocardiographers standardized imaging guidelines gave good to excellent agreement for the assessment of AVP (kappa>0.80 and good agreement between days and observers (kappa >0.6. The technique allowed for assessment of the degree of prolapse and measurement of the prolapse distance that provided excellent agreement between echocardiographers, days and observers (kappa/ICC>0.8. Assessments made using real-time zoomed images provided similar measurements to the standard views (ICC=0.9, with agreement for the identification of AVP (kappa>0.8. Short axis views of the AoV were used for identification of AVP by fewer respondents (23%, however provided less agreement for the identification of AVP (kappa>0.6 and only adequate agreement with observations made in long axis (kappa>0.5, with AVP being identified more often in short axis (92% compared to long axis (76%. Orthogonal views were used by 31% of respondents to identify the presence of AVP, and 85% to identify cusp. Its identification on both views on 4 days was used to categorise horses as having AVP, providing a positive predictive value of 79% and negative predictive value of 18%. Only the non-coronary cusp (NCC of the AoV was observed to prolapse in these studies. Prolapse of the NCC was confirmed during the optimisation study using four-dimensional echocardiography, which concurred with the findings

  6. THE NONLINEAR CUSP-CATASTROPHE MODEL OF THE SEDIMENT TRANSPORT RATE

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    In the catastrophe theory of nonlinear science,the intensity of water-flow and the coefficient of non-uniformsediment m are regarded as two bound variables, and the in-tensity of bed-load transport Φ as the state variable in the mo-tion of non-uniform sediment in cusp-catastrophe model.Based on the standard equation of the cusp-catastrophe theo-ry, the relation equation between the intensity of bed-loadtransport Φ and the intensity of water-flow has been derivedby used coordinate transform and topology transform. The e-quation of bed load transport rate was built on the cusp-catas-trophe theory of nonlinear science. The others are applied toverify this equation, that the results calculated by the cusp-ca-tastrophe equation agree well with the other equations. Thisindicates that the cusp-catastrophe equation is reasonable, and the results fully reflect the characteristics of threshold motionand transport of non-uniform sediment. The purpose of thispaper is to explore the incipient motion and transport laws ofnon-uniform sediment from the viewpoint of nonlinear science.

  7. On the cusp anomalous dimension in the ladder limit of $\\mathcal N=4$ SYM

    CERN Document Server

    Beccaria, Matteo; Macorini, Guido

    2016-01-01

    We analyze the cusp anomalous dimension in the (leading) ladder limit of $\\mathcal N=4$ SYM and present new results for its higher-order perturbative expansion. We study two different limits with respect to the cusp angle $\\phi$. The first is the light-like regime where $x = e^{i\\,\\phi}\\to 0$. This limit is characterised by a non-trivial expansion of the cusp anomaly as a sum of powers of $\\log x$, where the maximum exponent increases with the loop order. The coefficients of this expansion have remarkable transcendentality features and can be expressed by products of single zeta values. We show that the whole logarithmic expansion is fully captured by a solvable Woods-Saxon like one-dimensional potential. From the exact solution, we extract generating functions for the cusp anomaly as well as for the various specific transcendental structures appearing therein. The second limit that we discuss is the regime of small cusp angle. In this somewhat simpler case, we show how to organise the quantum mechanical pert...

  8. Idiopathic mitral valve prolapse with tricuspid, aortic and pulmonary valve involvement: An autopsy case report

    Directory of Open Access Journals (Sweden)

    Heena M Desai

    2015-01-01

    Full Text Available Mitral valve prolapse (MVP is usually asymptomatic, but can be associated with complications such as infective endocarditis, mitral regurgitation, thromboembolism and sudden cardiac death. It has been very rarely reported to occur in association with other valvular involvement. A 55-year-old male patient was brought dead and at autopsy the mitral valve orifice was stenotic and the leaflets were enlarged, myxoid and bulging suggestive of MVP and chordae tendinae were thickened, stretched and elongated. Similar changes were seen in the tricuspid valve. The pulmonary and aortic valves also showed myxomatous degeneration of their cusps. Myxomatous degeneration is the most common cause of MVP and it can be associated with involvement of the other valves. Concomitant involvement of the aortic valve has been reported, however it is very rare and simultaneous involvement of the pulmonary valve has not been reported in the literature so far. We report a case of MVP associated with myxomatous degeneration of the tricuspid, pulmonary and aortic valves.

  9. Aortic root performance after valve sparing procedure: a comparative finite element analysis.

    Science.gov (United States)

    Soncini, Monica; Votta, Emiliano; Zinicchino, Silvia; Burrone, Valeria; Mangini, Andrea; Lemma, Massimo; Antona, Carlo; Redaelli, Alberto

    2009-03-01

    David and Yacoub sparing techniques are the most common procedures adopted for the surgical correction of aortic root aneurysms. These surgical procedures entail the replacement of the sinuses of Valsalva with a synthetic graft, inside which the cusps are re-suspended. Root replacement by a synthetic graft may result in altered valve behaviour both in terms of coaptation and stress distribution, thus leading to the failure of the correction. A finite element approach was used to investigate this phenomenon; four 3D models of the aortic root were developed to simulate the root in physiological, pathological and post-operative conditions after the two different surgical procedures. The physiological 3D geometrical model was developed on the basis of anatomical data obtained from echocardiographic images; it was then modified to obtain the pathological and post-operative models. The effectiveness of both techniques was assessed by comparison with the first two simulated conditions, in terms of stresses acting on the root, leaflet coaptation and interaction between leaflets and the graft during valve opening. Results show that both sparing techniques are able to restore aortic valve coaptation and to reduce stresses induced by the initial root dilation. Nonetheless, both techniques lead to altered leaflet kinematics, with more evident alterations after David repair.

  10. Abdominal aortic aneurysms

    DEFF Research Database (Denmark)

    Lindholt, Jes Sanddal

    2010-01-01

    Although the number of elective operations for abdominal aortic aneurysms (AAA) is increasing, the sex- and age-standardised mortality rate of AAAs continues to rise, especially among men aged 65 years or more. The lethality of ruptured AAA continues to be 80-95%, compared with 5-7% by elective....... The acceptance rate was 77%, and 95% accept control scans. Furthermore, persons at the highest risk of having an AAA attend screening more frequently. We found that 97% of the interval cases developed from aortas that initially measured 2.5-2.9 cm - i.e. approx. only 5% attenders need re-screening at 5-year...... methods for measuring the degree of wall calcification must be developed and validated....

  11. CONGENITAL QUADRICUSPID AORTIC-VALVE

    NARCIS (Netherlands)

    BROUWER, MHJ; DEGRAAF, JJ; EBELS, T

    1993-01-01

    Two patients with a quadricuspid aortic valve are described, one of them with concomitant juxtaposed coronary orifices facing the right hand facing sinus. The etiology and incidence of this congenital anomaly will be discussed.

  12. Transcatheter Aortic Heart Valve Thrombosis

    DEFF Research Database (Denmark)

    Hansson, Nicolaj C; Grove, Erik L; Andersen, Henning R;

    2016-01-01

    BACKGROUND: There is increasing focus on transcatheter heart valve (THV) thrombosis. However, there are limited data on incidence, clinical implications and predisposing factors of THV thrombosis following transcatheter aortic valve replacement (TAVR). OBJECTIVES: We assessed the incidence...

  13. Adult thoracic and abdominal aortic

    Directory of Open Access Journals (Sweden)

    Randa O. Kaddah

    2016-06-01

    Conclusion: Aortic COA could be found in any segment of the aorta. Proper identification of the anatomical details and pressure gradient studies are important factors affecting the plan of management.

  14. Minimally invasive aortic valve replacement

    DEFF Research Database (Denmark)

    Foghsgaard, Signe; Schmidt, Thomas Andersen; Kjaergard, Henrik K

    2009-01-01

    In this descriptive prospective study, we evaluate the outcomes of surgery in 98 patients who were scheduled to undergo minimally invasive aortic valve replacement. These patients were compared with a group of 50 patients who underwent scheduled aortic valve replacement through a full sternotomy....... The 30-day mortality rate for the 98 patients was zero, although 14 of the 98 mini-sternotomies had to be converted to complete sternotomies intraoperatively due to technical problems. Such conversion doubled the operative time over that of the planned full sternotomies. In the group of patients whose...... is an excellent operation in selected patients, but its true advantages over conventional aortic valve replacement (other than a smaller scar) await evaluation by means of randomized clinical trial. The "extended mini-aortic valve replacement" operation, on the other hand, is a risky procedure that should...

  15. A Cusp Density Enhancement Study using e-POP Satellite Data

    Science.gov (United States)

    Sadler, B.

    2015-12-01

    CHAMP satellite observations have confirmed neutral density enhancements which are localized to the high latitude polar cusp region. These small-scale density structures are consistently correlated with strong fine-scale field-aligned currents. A possible driver of these density enhancements is soft electron precipitation which, through processes associated with ion-outflow, results in a density enhancement in the cusp vicinity at the altitudes observed by CHAMP. We investigate this mechanism with recent observations from the CASSIOPE / e-POP satellite and numerical simulations. In-situ data for selected cusp transit events are presented. Numerical simulation predictions are discussed comparing two electron-precipitation models: a fine-scale ion-outflow model and a global-scale Joule heating / increased conductivity model (CMIT).

  16. A Cusp Catastrophe Model for Team Learning, Team Potency and Team Culture.

    Science.gov (United States)

    Rebelo, Teresa; Stamovlasis, Dimitrios; Lourenco, Paulo Renato; Dimas, Isabel; Pinheiro, Margarida

    2016-10-01

    This paper examines team learning behaviors within a nonlinear dynamical system (NDS) perspective. The present research is based on a sample of 36 project workgroups, where data were collected at two moments of their life cycle, with visual analogue scales. Using both the least squares method and maximum likelihood, it proposes a cusp catastrophe model for explaining team learning. The cusp model is superior to its linear alternatives and implements team culture as the asymmetry variable and team potency as bifurcation. The findings of cusp structure in the data support the existence of discontinuous shifts in learning behavior and furthermore a proposition that the punctuated equilibrium model (PEM) might be a reasonable model for describing group functioning, since it encompasses such sudden changes between distinct stages (attractors). A discussion on small group research is also provided by highlighting the nonlinear dynamics of team processes, along with further implications for research and practice.

  17. Detecting inter-cusp and inter-tooth wear patterns in rhinocerotids.

    Directory of Open Access Journals (Sweden)

    Lucy A Taylor

    Full Text Available Extant rhinos are the largest extant herbivores exhibiting dietary specialisations for both browse and grass. However, the adaptive value of the wear-induced tooth morphology in rhinos has not been widely studied, and data on individual cusp and tooth positions have rarely been published. We evaluated upper cheek dentition of browsing Diceros bicornis and Rhinoceros sondaicus, mixed-feeding R. unicornis and grazing Ceratotherium simum using an extended mesowear method adapted for rhinos. We included single cusp scoring (EM(R-S to investigate inter-cusp and inter-tooth wear patterns. In accordance with previous reports, general mesowear patterns in D. bicornis and R. sondaicus were attrition-dominated and C. simum abrasion-dominated, reflecting their respective diets. Mesowear patterns for R. unicornis were more attrition-dominated than anticipated by the grass-dominated diet, which may indicate a low intake of environmental abrasives. EM(R-S increased differentiation power compared to classical mesowear, with significant inter-cusp and inter-tooth differences detected. In D. bicornis, the anterior cusp was consistently more abrasion-dominated than the posterior. Wear differences in cusp position may relate to morphological adaptations to dietary regimes. Heterogeneous occlusal surfaces may facilitate the comminution of heterogeneous browse, whereas uniform, broad grinding surfaces may enhance the comminution of physically more homogeneous grass. A negative tooth wear gradient was found in D. bicornis, R. sondaicus and R. unicornis, with wear patterns becoming less abrasion-dominated from premolars to molars. No such gradients were evident in C. simum which displayed a uniform wear pattern. In browsers, premolars may be exposed to higher relative grit loads, which may result in the development of wear gradients. The second premolar may also have a role in food cropping. In grazers, high absolute amounts of ingested abrasives may override other

  18. First Cluster results of the magnetic field structure of the mid- and high-altitude cusps

    Directory of Open Access Journals (Sweden)

    P. J. Cargill

    Full Text Available Magnetic field measurements from the four Cluster spacecraft from the mid- and high-altitude cusp are presented. Cluster underwent two encounters with the mid-altitude cusp during its commissioning phase (24 August 2000. Evidence for field-aligned currents (FACs was seen in the data from all three operating spacecraft from northern and southern cusps. The extent of the FACs was of the order of 1 RE in the X-direction, and at least 300 km in the Y-direction. However, fine-scale field structures with scales of the order of the spacecraft separation (300 km were observed within the FACs. In the northern crossing, two of the spacecraft appeared to lie along the same magnetic field line, and observed very well matched signals. However, the third spacecraft showed evidence for structuring transverse to the field on scales of a few hundred km. A crossing of the high-altitude cusp from 13 February 2001 is presented. It is revealed to be a highly dynamic structure with the boundaries moving with velocities ranging from a few km/s to tens of km/s, and having structure on timescales ranging from less than one minute up to several minutes. The cusp proper is associated with the presence of a very disordered magnetic field, which is entirely different from the magnetosheath turbulence.

    Key words. Magnetospheric physics (current systems; magnetopause, cusp, and boundary layers – Space plasma physics (discontinuities

  19. [New aspects in aortic valve disease].

    Science.gov (United States)

    Tornos, P

    2001-01-01

    Renewed interest for aortic valve disease has evolved in recent years. Aortic valve replacement has become the second most frequent cause of cardiac surgery, following coronary bypass surgery. In addition, the etiologic and physiopathologic knowledge of this disorder has improved. In the present paper we analyze three aspects of the disease which are, at present, the subject of study and controversy: first, we discuss the possible relationship between degenerative aortic stenosis and atherosclerosis; second, the involvement of the aortic root in cases of bicuspid aortic valve; and third, the surgical indications in asymptomatic patients with either aortic stenosis or regurgitation.

  20. Single Peak Soliton and Periodic Cusp Wave of the Generalized Schrodinger-Boussinesq Equations

    Science.gov (United States)

    Qiao, Li-Jing; Tang, Sheng-Qiang; Zhao, Hai-Xia

    2015-06-01

    In this paper, we study peakon, cuspon, smooth soliton and periodic cusp wave of the generalized Schrödinger-Boussinesq equations. Based on the method of dynamical systems, the generalized Schrödinger-Boussinesq equations are shown to have new the parametric representations of peakon, cuspon, smooth soliton and periodic cusp wave solutions. Under different parametric conditions, various sufficient conditions to guarantee the existence of the above solutions are given. Supported by National Natural Science Foundation of China under Grant Nos. 11361017, 11161013 and Natural Science Foundation of Guangxi under Grant Nos. 2012GXNSFAA053003, 2013GXNSFAA019010, and Program for Innovative Research Team of Guilin University of Electronic Technology

  1. Cusp Anomalous dimension and rotating open strings in AdS/CFT

    CERN Document Server

    Espíndola, R

    2016-01-01

    In the context of AdS/CFT we provide analytical support for the proposed duality between a Wilson loop with a cusp, the cusp anomalous dimension, and the meson model constructed from a rotating open string with high angular momentum. This duality was previously studied using numerical tools in [1]. Our result implies that the minimum of the profile function of the minimal area surface dual to the Wilson loop, is related to the inverse of the bulk penetration of the dual string that hangs from the quark--anti-quark pair (meson) in the gauge theory.

  2. The exterior cusp and its boundary with the magnetosheath: Cluster multi-event analysis

    Directory of Open Access Journals (Sweden)

    B. Lavraud

    2004-09-01

    Full Text Available We report on the observation of three high-altitude cusp crossings by the Cluster spacecraft under steady northward IMF conditions. The focus of this study is on the exterior cusp and its boundaries. At the poleward edge of the cusp, large downward jets are present; they are characterized by a dawn-dusk component of the convection velocity opposite to the IMF By direction and a gradual evolution (velocity filter effect corresponding to an injection site located at the high-latitude magnetopause tailward of the cusp, with subsequent sunward convection. As one moves from the poleward edge into the exterior cusp proper, the plasma gradually becomes stagnant as the result of the mirroring and scattering of the aforementioned plasma flows. The existence of such a stagnant region (Stagnant Exterior Cusp: SEC is found in all events studied here even when the IMF By is large and the clock angle is ~90°. The SEC-magnetosheath boundary appears as a spatial structure that has a normal component of the magnetic field pointing inward, in accordance with a probable connection between the region and the magnetosheath (with northward field. This boundary generally has a deHoffmann-Teller velocity that is slow and oriented sunward and downward, compatible with a discontinuity propagating from a location near the high-latitude magnetopause. Although the tangential stress balance is not always satisfied, the SEC-magnetosheath boundary is possibly a rotational discontinuity. Just outside this boundary, there exists a clear sub-Alfvénic plasma depletion layer (PDL. These results are all consistent with the existence of a nearly steady reconnection site at the high-latitude magnetopause tailward of the cusp. We suggest that the stability of the external discontinuity (and of the whole region is maintained by the presence of the sub-Alfvénic PDL. However, examination of the electron data shows the presence of heated electrons

  3. Cusp points in the parameter space of RPR-2PRR parallel manipulator

    CERN Document Server

    Moroz, Guillaume Inria; Wenger, Philippe; Rouiller, Fabrice; 10.1007/978-90-481-9689-0

    2010-01-01

    This paper investigates the existence conditions of cusp points in the design parameter space of the R\\underline{P}R-2P\\underline{R}R parallel manipulators. Cusp points make possible non-singular assembly-mode changing motion, which can possibly increase the size of the aspect, i.e. the maximum singularity free workspace. The method used is based on the notion of discriminant varieties and Cylindrical Algebraic Decomposition, and resorts to Gr\\"obner bases for the solutions of systems of equations.

  4. Real time evolvable hardware for optimal reconfiguration of cusp-like pulse shapers

    Energy Technology Data Exchange (ETDEWEB)

    Lanchares, Juan, E-mail: julandan@dacya.ucm.es; Garnica, Oscar, E-mail: ogarnica@dacya.ucm.es; Risco-Martín, José L., E-mail: jlrisco@dacya.ucm.es; Hidalgo, J. Ignacio, E-mail: hidalgo@dacya.ucm.es; Colmenar, J. Manuel, E-mail: jmcolmenar@ajz.ucm.es; Cuesta-Infante, Alfredo, E-mail: acuestai@pdi.ucm.es

    2014-11-01

    The design of a cusp-like digital pulse shaper for particle energy measurements requires the definition of four parameters whose values are defined based on the nature of the shaper input signal (timing, noise, …) provided by a sensor. However, after high doses of radiation, sensors degenerate and their output signals do not meet the original characteristics, which may lead to erroneous measurements of the particle energies. We present in this paper an evolvable cusp-like digital shaper, which is able to auto-recalibrate the original hardware implementation into a new design that match the original specifications under the new sensor features.

  5. Semiclassical partition function for strings dual to Wilson loops with small cusps in ABJM

    Science.gov (United States)

    Aguilera-Damia, Jeremías; Correa, Diego H.; Silva, Guillermo A.

    2015-03-01

    We compute the 1-loop partition function for strings in , whose worldsheets end along a line with small cusp angles in the boundary of AdS. We obtain these 1-loop results in terms of the vacuum energy for on-shell modes. Our results verify the proposal by Lewkowycz and Maldacena in arXiv:1312.5682 for the exact Bremsstrahlung function up to the next to leading order in the strong coupling expansion. The agreement is observed for cusps distorting either the 1/2 BPS or the 1/6 BPS Wilson line.

  6. Semiclassical partition function for strings dual to Wilson loops with small cusps in ABJM

    CERN Document Server

    Aguilera-Damia, Jeremias; Silva, Guillermo A

    2014-01-01

    We compute the 1-loop partition function for strings in $AdS_4\\times\\mathbb{CP}^3$, whose worldsheets end along a line with small cusp angles in the boundary of AdS. We obtain these 1-loop results in terms of the vacuum energy for on-shell modes. Our results verify the proposal by Lewkowycz and Maldacena in arXiv:1312.5682 for the exact Bremsstrahlung function up to the next to leading order in the strong coupling expansion. The agreement is observed for cusps distorting either the 1/2 BPS or the 1/6 BPS Wilson line.

  7. Numerical modelling of the thermospheric and ionospheric effects of magnetospheric processes in the cusp region

    Directory of Open Access Journals (Sweden)

    A. A. Namgaladze

    Full Text Available The thermospheric and ionospheric effects of the precipitating electron flux and field-aligned-current variations in the cusp have been modelled by the use of a new version of the global numerical model of the Earth's upper atmosphere developed for studies of polar phenomena. The responses of the electron concentration, ion, electron and neutral temperature, thermospheric wind velocity and electric-field potential to the variations of the precipitating 0.23-keV electron flux intensity and field-aligned current density in the cusp have been calculated by solving the corresponding continuity, momentum and heat balance equations. Features of the atmospheric gravity wave generation and propagation from the cusp region after the electron precipitation and field-aligned current-density increases have been found for the cases of the motionless and moving cusp region. The magnitudes of the disturbances are noticeably larger in the case of the moving region of the precipitation. The thermospheric disturbances are generated mainly by the thermospheric heating due to the soft electron precipitation and propagate to lower latitudes as large-scale atmospheric gravity waves with the mean horizontal velocity of about 690 m s–1. They reveal appreciable magnitudes at significant distances from the cusp region. The meridional-wind-velocity disturbance at 65° geomagnetic latitude is of the same order (100 m s–1 as the background wind due to the solar heating, but is oppositely directed. The ionospheric disturbances have appreciable magnitudes at the geomagnetic latitudes 70°–85°. The electron-concentration and -temperature disturbances are caused mainly by the ionization and heating processes due to the precipitation, whereas the ion-temperature disturbances are influence strongly by Joule heating of the ion gas due to the electric-field disturbances in the cusp. The latter strongly influence the

  8. Abdominal aortic aneurysm repair - open - discharge

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000240.htm Abdominal aortic aneurysm repair - open - discharge To use the sharing features ... References Orandi BJ, Black JH. Open repair of abdominal aortic aneurysms. In: Cameron JL, Cameron AM, eds. Current Surgical ...

  9. Abdominal aortic feminism.

    Science.gov (United States)

    Mortimer, Alice Emily

    2014-01-01

    A 79-year-old woman presented to a private medical practice 2 years previously for an elective ultrasound screening scan. This imaging provided the evidence for a diagnosis of an abdominal aortic aneurysm (AAA) to be made. Despite having a number of recognised risk factors for an AAA, her general practitioner at the time did not follow the guidance set out by the private medical professional, that is, to refer the patient to a vascular specialist to be entered into a surveillance programme and surgically evaluated. The patient became symptomatic with her AAA, was admitted to hospital and found to have a tender, symptomatic, 6 cm leaking AAA. She consented for an emergency open AAA repair within a few hours of being admitted to hospital, despite the 50% perioperative mortality risk. The patient spent 4 days in intensive care where she recovered well. She was discharged after a 12 day hospital stay but unfortunately passed away shortly after her discharge from a previously undiagnosed gastric cancer.

  10. Stenting of Variant Left Carotid Artery Using Brachial Artery Approach in a Patient with Unusual Type of Bovine Aortic Arch

    Directory of Open Access Journals (Sweden)

    Emre Gürel

    2016-01-01

    Full Text Available Bovine aortic arch is the most frequently encountered variation in human aortic arch branching. A 63-year-old Asian male presented with symptomatic severe stenosis of left carotid artery originating from the brachiocephalic trunk. Selective engagement to the left carotid artery was unsuccessful using transfemoral approach. We reported on a successful left carotid artery stenting case using right brachial artery approach in a bovine aortic arch. This paper is worthy of reporting in terms of guiding physicians for interventional procedures in these types of challenging cases.

  11. Custom Fenestration Templates for Endovascular Repair of Juxtarenal Aortic Aneurysms

    Science.gov (United States)

    Leotta, Daniel F.; Starnes, Benjamin W.

    2015-01-01

    Physician-modified endovascular grafts, with fenestrations added to accommodate major branch vessels, provide a means for endovascular treatment of abdominal aortic aneurysms that are adjacent to the renal arteries. Manual measurements of vessel origin locations from CT images, however, take time and can lead to errors in the positions of the fenestrations. To make the fenestration process faster and more accurate, we have developed a procedure to create custom templates that serve as patient-specific guides for graft fenestration. We use a 3D printer to create a clear rigid sleeve that replicates the patient’s aorta and includes holes placed precisely at the locations of the branch vessels. The sleeve is slipped over the graft, the locations of the openings are marked with a pen, and the fenestrations are created after removing the sleeve. Custom fenestration templates can potentially save procedural costs and make minimally-invasive aortic aneurysm repair available to more patients. PMID:25864045

  12. Open aortic surgery after thoracic endovascular aortic repair.

    Science.gov (United States)

    Coselli, Joseph S; Spiliotopoulos, Konstantinos; Preventza, Ourania; de la Cruz, Kim I; Amarasekara, Hiruni; Green, Susan Y

    2016-08-01

    In the last decade, thoracic endovascular aortic aneurysm repair (TEVAR) has emerged as an appealing alternative to the traditional open aortic aneurysm repair. This is largely due to generally improved early outcomes associated with TEVAR, including lower perioperative mortality and morbidity. However, it is relatively common for patients who undergo TEVAR to need a secondary intervention. In select circumstances, these secondary interventions are performed as an open procedure. Although it is difficult to assess the rate of open repairs after TEVAR, the rates in large series of TEVAR cases (>300) have ranged from 0.4 to 7.9 %. Major complications of TEVAR that typically necessitates open distal aortic repair (i.e., repair of the descending thoracic or thoracoabdominal aorta) include endoleak (especially type I), aortic fistula, endograft infection, device collapse or migration, and continued expansion of the aneurysm sac. Conversion to open repair of the distal aorta may be either elective (as for many endoleaks) or emergent (as for rupture, retrograde complicated dissection, malperfusion, and endograft infection). In addition, in select patients (e.g., those with a chronic aortic dissection), unrepaired sections of the aorta may progressively dilate, resulting in the need for multiple distal aortic repairs. Open repairs after TEVAR can be broadly classified as full extraction, partial extraction, or full salvage of the stent-graft. Although full and partial stent-graft extraction imply failure of TEVAR, such failure is generally absent in cases where the stent-graft can be fully salvaged. We review the literature regarding open repair after TEVAR and highlight operative strategies.

  13. Aortic or Mitral Valve Replacement With the Biocor and Biocor Supra

    Science.gov (United States)

    2016-03-09

    Aortic Valve Insufficiency; Aortic Valve Regurgitation; Aortic Valve Stenosis; Aortic Valve Incompetence; Mitral Valve Insufficiency; Mitral Valve Regurgitation; Mitral Valve Stenosis; Mitral Valve Incompetence

  14. The Cubesat mission to study Solar Particles (CuSP), an interplanetary cubesat

    Science.gov (United States)

    Christian, E. R.; Desai, M. I.; Allegrini, F.; Jahn, J. M.; Kanekal, S.; Livi, S. A.; Murphy, N.; Ogasawara, K.; Paschalidis, N.

    2015-12-01

    The Cubesat mission to study Solar Particles (CuSP) is a funded 6U interplanetary cubesat scheduled to fly on the EM-1 SLS launch in 2018. CuSP has three small but capable instruments from the Southwest Research Institute (SwRI), NASA Goddard Space Flight Center (GSFC), and the NASA Jet Propulsion Laboratory (JPL). Its primary scientific goal is high-cadence precise measurements of the suprathermal (ST) tail in the solar wind. The suprathermal tail is the critical bridge between the thermal solar wind plasma and the dangerous high-energy solar energetic particles. CuSP also measures the energy spectra and composition of the ~1-50 MeV/nucleon H-Fe ions that evolve from the STs and the interplanetary magnetic field that is closely coupled to the particle distributions. CuSP is a stepping-stone to future interplanetary cubesats, smallsats, and constellations for both scientific and space weather applications. The challenges for this mission and future missions will also be discussed.

  15. Prevalence of talon cusps in a Portuguese population: Forensic identification significance of a rare trait

    Science.gov (United States)

    Simões, Ricardo Jorge; Cardoso, Hugo F.V.; Caldas, Inês Morais

    2014-01-01

    Background: Dental techniques are frequently used in human identification; some of those include comparative analyses of dental features that, being rare or unique to an individual, can establish a positive identification. The usefulness of each feature depends on its population, frequency, and uniqueness. The aim of this study was to determine the prevalence of talon cusps in a Portuguese population. Materials and Methods: A prospective study was performed. Three hundred and two patients were studied, and talon cusps presence was assessed. Statistical tests were carried out using Statistical Package for the Social Sciences (SPSS) 17 software (SPSS Inc., Chicago, IL, USA). Statistical analysis relied primarily on descriptive statistics and crosstabs, with Chi-square analysis. Results: Results showed that talon cusps were observed in only 6.3% of patients. The maxillary lateral incisors were the most common teeth showing this feature (82.1% of all teeth). Conclusion: It can be concluded that talon cusps are an uncommon trait in these Portuguese population, and therefore, it is a feature that can be potentially very useful in forensic human identification, when antemortem dental records are available. PMID:24688559

  16. Synodontia With Talon Cusp – A Case Report And Review Of Literature

    Directory of Open Access Journals (Sweden)

    Deepinder Singh Duggal

    2011-07-01

    Full Text Available Synodontia or Fusion is more commonly seen in the anterior and maxillary region.. Fusion of a supernumerary tooth to one in the normal series is not an uncommon finding, but these anomalies in conjunction with a talon cusp form a rare case. The etiology, prevalence and clinical features of the aforementioned anomalies have been reviewed in detail.

  17. EISCAT observations of plasma patches at sub-auroral cusp latitudes

    Directory of Open Access Journals (Sweden)

    J. Moen

    2006-09-01

    Full Text Available A sequence of 3 patches of high-density (1012 m−3 cold plasma on a horizontal scale-size of 300–700 km was observed near magnetic noon by the EISCAT VHF radar above Svalbard on 17 December 2001. The patches followed a trajectory towards the cusp inflow region. The combination of radar and all-sky observations demonstrates that the patches must have been segmented equatorward of the cusp/cleft auroral display, and hence their properties had not yet been influenced by cusp particle showers and electrodynamics on open flux tubes. The last patch in the sequence was intersected by radio tomography observations, and was found to be located adjacent to a broader region of the same high electron density further south. The patches occurred under moderately active conditions (Kp=3 and the total electron content (TEC of the high-density plasma was 45 TEC units. The train of patches appeared as a segmentation of the tongue of ionization. The sequence of patches occurred in association with a sequence of flow bursts in the dusk cell return flow. It is proposed that reconnection driven pulsed convection is able to create sub-auroral patches in the region where high density mid-latitude plasma is diverted poleward toward the cusp. It is the downward Birkeland current sheet located at the equatorward boundary of the flow disturbance that represents the actual cutting mechanism.

  18. A survey of cusp fractures in a population of general dental practices.

    NARCIS (Netherlands)

    Fennis, W.M.M.; Kuys, R.H.; Kreulen, C.M.; Roeters, F.J.M.; Creugers, T.J.; Burgersdijk, R.C.W.

    2002-01-01

    PURPOSE: This study was conducted to expand the knowledge on the incidence of complete cusp fractures of posterior teeth in Dutch general practices. MATERIALS AND METHODS: During a 3-month period, data were obtained from 28 general practitioners, representing 46,394 patients. For each new case of co

  19. Prevalence of talon cusps in a Portuguese population: Forensic identification significance of a rare trait

    Directory of Open Access Journals (Sweden)

    Ricardo Jorge Simões

    2014-01-01

    Full Text Available Background: Dental techniques are frequently used in human identification; some of those include comparative analyses of dental features that, being rare or unique to an individual, can establish a positive identification. The usefulness of each feature depends on its population, frequency, and uniqueness. The aim of this study was to determine the prevalence of talon cusps in a Portuguese population. Materials and Methods: A prospective study was performed. Three hundred and two patients were studied, and talon cusps presence was assessed. Statistical tests were carried out using Statistical Package for the Social Sciences (SPSS 17 software (SPSS Inc., Chicago, IL, USA. Statistical analysis relied primarily on descriptive statistics and crosstabs, with Chi-square analysis. Results: Results showed that talon cusps were observed in only 6.3% of patients. The maxillary lateral incisors were the most common teeth showing this feature (82.1% of all teeth. Conclusion: It can be concluded that talon cusps are an uncommon trait in these Portuguese population, and therefore, it is a feature that can be potentially very useful in forensic human identification, when antemortem dental records are available.

  20. Antihydrogen synthesis in a double-CUSP trap towards test of the CPT-symmetry

    Science.gov (United States)

    Radics, B.; Ishikawa, S.; Kuroda, N.; Murtagh, D. J.; Nagata, Y.; Tajima, M.; Van Gorp, S.; Abo, Y.; Dupre, P.; Higashi, Y.; Kaga, C.; Leali, M.; Mascagna, V.; Venturelli, L.; Zurlo, N.; Breuker, H.; Higaki, H.; Kanai, Y.; Rizzini, E. Lodi; Matsuda, Y.; Ulmer, S.; Yamazaki, Y.

    2016-12-01

    The aim of the ASACUSA-CUSP experiment at CERN is to produce a cold, polarised antihydrogen beam and perform a high precision measurement of the ground-state hyperfine transition frequency of the antihydrogen atom and compare it with that of the hydrogen atom using the same spectroscopic beam line. Towards this goal a significant step was successfully accomplished: synthesised antihydrogen atoms have been produced in a CUSP magnetic configuration and detected at the end of our spectrometer beam line in 2012 [1]. During a long shut down at CERN the ASACUSA-CUSP experiment had been renewed by introducing a new double-CUSP magnetic configuration and a new semi-cylindrical tracking detector (AMT) [2], and by improving the transport feature of low energy antiproton beams. The new tracking detector monitors the antihydrogen synthesis during the mixing cycle of antiprotons and positrons. In this work the latest results and improvements of the antihydrogen synthesis will be presented including highlights from the last beam time.

  1. X-rays from cusps of compact remnants near galactic centres

    CERN Document Server

    Nayakshin, S; Nayakshin, Sergei; Sunyaev, Rashid

    2006-01-01

    Compact remnants -- stellar mass black holes and neutron stars formed in the inner few parsec of galactic centres are predicted to sink into the central parsec due to dynamical friction on low mass stars, forming a high concentration cusp (Morris 1993). Same physical region may also contain very high density molecular clouds and accretion discs that are needed to fuel SMBH activity. Here we estimate gas capture rates onto the cusp of stellar remnants, and the resulting X-ray luminosity, as a function of the accretion disc mass. At low disc masses, most compact objects are too dim to be observable, whereas in the high disc case most of them are accreting at their Eddington rates. We find that for low accretion disc masses, compact remnant cusps may be more luminous than the central SMBHs. This ``diffuse'' emission may be of importance for local moderately bright AGN, especially Low Luminosity AGN. We also briefly discuss how this expected emission can be used to put constraints on the black hole cusp near our ...

  2. Swarm in situ observations of F region polar cap patches created by cusp precipitation

    CERN Document Server

    Goodwin, L V; Miles, D M; Patra, S; van der Meeren, C; Buchert, S C; Burchill, J K; Clausen, L B N; Knudsen, D J; McWilliams, K A; Moen, J

    2016-01-01

    High-resolution in situ measurements from the three Swarm spacecraft, in a string-of-pearls configuration, provide new insights about the combined role of flow channel events and particle impact ionization in creating $\\textit{F}$ region electron density structures in the northern Scandinavian dayside cusp. We present a case of polar cap patch formation where a reconnection-driven low-density relative westward flow channel is eroding the dayside solar-ionized plasma but where particle impact ionization in the cusp dominates the initial plasma structuring. In the cusp, density features are observed which are twice as dense as the solar-ionized background. These features then follow the polar cap convection and become less structured and lower in amplitude. These are the first in situ observations tracking polar cap patch evolution from creation by plasma transport and enhancement by cusp precipitation, through entrainment in the polar cap flow and relaxation into smooth patches as they approach the nightside a...

  3. Cusp-like singular soliton solutions of Jaulent-Miodek equation using symbolic computation

    Energy Technology Data Exchange (ETDEWEB)

    Kavitha, L; Sathishkumar, P; Nathiyaa, T [Department of Physics, Periyar University, Salem 636 011 (India); Gopi, D [Department of Chemistry, Periyar University, Salem 636 011 (India)], E-mail: louiskavitha@yahoo.co.in

    2009-03-15

    In this paper, the sine-cosine method is employed to construct a series of exact solitary solutions to the celebrated Jaulent-Miodek equation. Solitons, anti-solitons and cusp-like singular solutions are obtained with the aid of symbolic computation.

  4. Aortic root replacement with a pulmonary autograft

    NARCIS (Netherlands)

    R.B. Hokken (Raymond)

    1997-01-01

    textabstractAortic valve disease in the pediatric age group is usually a consequence of congenital aortic stenosis, which may be isolated or may be a part of an anomaly of the left ventricular outflow tract or the aortic root. Management of these patients is difficult. Neonates and infants with seve

  5. An unusual geometry of the ionospheric signature of the cusp: implications for magnetopause merging sites

    Directory of Open Access Journals (Sweden)

    G. Chisham

    Full Text Available The HF radar Doppler spectral width boundary (SWB in the cusp represents a very good proxy for the equatorward edge of cusp ion precipitation in the dayside ionosphere. For intervals where the Interplanetary Magnetic Field (IMF has a southward component (Bz < 0, the SWB is typically displaced poleward of the actual location of the open-closed field line boundary (or polar cap boundary, PCB. This is due to the poleward motion of newly-reconnected magnetic field lines during the cusp ion travel time from the reconnection X-line to the ionosphere. This paper presents observations of the dayside ionosphere from SuperDARN HF radars in Antarctica during an extended interval ( ~ 12 h of quasi-steady IMF conditions (By ~ Bz < 0. The observations show a quasi-stationary feature in the SWB in the morning sector close to magnetic local noon which takes the form of a 2° poleward distortion of the boundary. We suggest that two separate reconnection sites exist on the magnetopause at this time, as predicted by the anti-parallel merging hypothesis for these IMF conditions. The observed cusp geometry is a consequence of different ion travel times from the reconnection X-lines to the southern ionosphere on either side of magnetic local noon. These observations provide strong evidence to support the anti-parallel merging hypothesis. This work also shows that mesoscale and small-scale structure in the SWB cannot always be interpreted as reflecting structure in the dayside PCB. Localised variations in the convection flow across the merging gap, or in the ion travel time from the reconnection X-line to the ionosphere, can lead to localised variations in the offset of the SWB from the PCB. These caveats should also be considered when working with other proxies for the dayside PCB which are associated with cusp particle precipitation, such as the 630 nm cusp auroral emission.

    Key words. Ionosphere (plasma convection – Magnetospheric physics (magnetopause

  6. [MINIMALLY INVASIVE AORTIC VALVE REPLACEMENT].

    Science.gov (United States)

    Tabata, Minoru

    2016-03-01

    Minimally invasive aortic valve replacement (MIAVR) is defined as aortic valve replacement avoiding full sternotomy. Common approaches include a partial sternotomy right thoracotomy, and a parasternal approach. MIAVR has been shown to have advantages over conventional AVR such as shorter length of stay and smaller amount of blood transfusion and better cosmesis. However, it is also known to have disadvantages such as longer cardiopulmonary bypass and aortic cross-clamp times and potential complications related to peripheral cannulation. Appropriate patient selection is very important. Since the procedure is more complex than conventional AVR, more intensive teamwork in the operating room is essential. Additionally, a team approach during postoperative management is critical to maximize the benefits of MIAVR.

  7. Paradoxical low flow aortic valve stenosis: incidence, evaluation, and clinical significance.

    Science.gov (United States)

    Clavel, Marie-Annick; Pibarot, Philippe; Dumesnil, Jean G

    2014-01-01

    Paradoxical low-flow (PLF) aortic stenosis is defined by a stroke volume index <35 ml/m(2) despite the presence of preserved LV ejection fraction (≥ 50 %). This entity is typically characterized by pronounced LV concentric remodeling with small LV cavity, impaired LV filling, increased arterial load, and reduced LV longitudinal shortening. Patients with PLF also have a worse prognosis compared to patients with normal flow. Because of the low flow state, these patients often have a low gradient despite the presence of severe stenosis, thus leading to discordant AS grading (i.e., aortic valve area < 1.0 cm(2) but mean gradient < 40 mmHg) and thus uncertainty about the indication of aortic valve replacement. Stress echocardiography and aortic valve calcium score by computed tomography may be helpful to differentiate true from pseudo severe stenosis and thereby guide therapeutic management in these patients. Aortic valve replacement improves outcomes in patients with PLF low gradient AS having evidence of severe stenosis. Transcatheter aortic valve replacement may provide an interesting alternative to surgery in these patients.

  8. Transfemoral transcatheter aortic valve implantation in a patient with a severe aortic stenosis and cardiogenic shock requiring intra-aortic balloon pump support.

    Science.gov (United States)

    Chodór, Piotr; Wilczek, Krzysztof; Przybylski, Roman; Świątkowski, Andrzej; Głowacki, Jan; Kalarus, Zbigniew; Zembala, Marian

    2015-01-01

    The following paper presents a patient with severe aortic stenosis and severely reduced left ventricular ejection fraction with intra-aortic balloon pump counterpulsation support, who underwent transfemoral aortic valve implantation of a CoreValve prosthesis.

  9. Transfemoral transcatheter aortic valve implantation in a patient with a severe aortic stenosis and cardiogenic shock requiring intra-aortic balloon pump support

    OpenAIRE

    Chodór, Piotr; Wilczek, Krzysztof; Przybylski, Roman; Świątkowski, Andrzej; Głowacki, Jan; Kalarus, Zbigniew; Zembala, Marian

    2015-01-01

    The following paper presents a patient with severe aortic stenosis and severely reduced left ventricular ejection fraction with intra-aortic balloon pump counterpulsation support, who underwent transfemoral aortic valve implantation of a CoreValve prosthesis.

  10. Large patent ductus arteriosus in a 44-year-old woman leading to calcium deposition in the left atrium and mitral and aortic valves.

    Science.gov (United States)

    Roberts, Carey Camille; Roberts, William Clifford

    2015-06-01

    This report describes unusual autopsy findings in a 44-year-old woman who had a large, calcified patent ductus arteriosus that produced substantial left-to-right shunting. The patient died in 1962, 7 days after patch closure of the aortic orifice of the ductus. Numerous calcific deposits were present in the mural left atrial endocardium, the mitral valve leaflets and annulus, and the aortic valve cusps. The cause of the left-sided calcific deposits was perhaps related to the patient's several-decades-old giant aortopulmonary shunt, causing a major increase in the volume of blood passing through the left-sided cardiac chambers in comparison with the volume in the right side. To our knowledge, such findings in a patient with patent ductus arteriosus have not been reported previously.

  11. Genetic and Epigenetic Regulation of Aortic Aneurysms

    Science.gov (United States)

    Kim, Ha Won

    2017-01-01

    Aneurysms are characterized by structural deterioration of the vascular wall leading to progressive dilatation and, potentially, rupture of the aorta. While aortic aneurysms often remain clinically silent, the morbidity and mortality associated with aneurysm expansion and rupture are considerable. Over 13,000 deaths annually in the United States are attributable to aortic aneurysm rupture with less than 1 in 3 persons with aortic aneurysm rupture surviving to surgical intervention. Environmental and epidemiologic risk factors including smoking, male gender, hypertension, older age, dyslipidemia, atherosclerosis, and family history are highly associated with abdominal aortic aneurysms, while heritable genetic mutations are commonly associated with aneurysms of the thoracic aorta. Similar to other forms of cardiovascular disease, family history, genetic variation, and heritable mutations modify the risk of aortic aneurysm formation and provide mechanistic insight into the pathogenesis of human aortic aneurysms. This review will examine the relationship between heritable genetic and epigenetic influences on thoracic and abdominal aortic aneurysm formation and rupture. PMID:28116311

  12. Aortic Root Enlargement or Sutureless Valve Implantation?

    Directory of Open Access Journals (Sweden)

    Nikolaos G. Baikoussis

    2016-11-01

    Full Text Available Aortic valve replacement (AVR in patients with a small aortic annulus is a challenging issue. The importance of prosthesis–patient mismatch (PPM post aortic valve replacement (AVR is controversial but has to be avoided. Many studies support the fact that PPM has a negative impact on short and long term survival. In order to avoid PPM, aortic root enlargement may be performed. Alternatively and keeping in mind that often some comorbidities are present in old patients with small aortic root, the Perceval S suturelles valve implantation could be a perfect solution. The Perceval sutureless bioprosthesis provides reasonable hemodynamic performance avoiding the PPM and providing the maximum of aortic orifice area. We would like to see in the near future the role of the aortic root enlargement techniques in the era of surgical implantation of the sutureless valve (SAVR and the transcatheter valve implantation (TAVI.

  13. Aortic Wall Injury Related to Endovascular Therapy for Aortic Coarctation.

    Science.gov (United States)

    Tretter, Justin T; Jones, Thomas K; McElhinney, Doff B

    2015-09-01

    Aortic wall complications can occur in unrepaired aortic coarctation (CoA) and after surgical repair or endovascular treatment. This review summarizes the available literature and current understanding of aortic wall injury (AWI) surrounding the management of CoA, focusing specifically on acute and follow-up AWI after endovascular treatment. There have been 23 reported cases of aortic rupture after endovascular treatment for CoA, including angioplasty alone, bare metal stenting, and primary covered stent therapy. Even if these published cases represent only a minority of ruptures that have actually occurred, the incidence is substantially <1%. The incidence of acute aneurysm formation was 0% to 13% after angioplasty, 0% to 5% after bare metal stent placement, and <1% after covered stent placement. The reported incidence and natural history of both acute and new AWI during follow-up after endovascular therapy for CoA varies considerably, likely secondary to ascertainment and reporting biases and inconsistent definitions. Although important AWI after endovascular treatment of CoA seems to be declining in frequency with increasing experience and improving technology, it remains one of the most important potential adverse outcomes. Long-term surveillance for new AWI and monitoring of existing AWI is mandatory, with institution of appropriate treatment when necessary. A central research focus in this population should be determination of the appropriate treatment for both native and recurrent CoA across various ages with regard to limiting recurrent CoA and preventing associated aortic wall complications, in addition to determining the appropriate treatment of various AWI. Consistent definitions and reporting are necessary to truly understand the incidence of, risk factors for, and measures protective against AWI after angioplasty or stent implantation for CoA.

  14. Remodelling of the aortic root in severe tricuspid aortic stenosis: implications for transcatheter aortic valve implantation

    Energy Technology Data Exchange (ETDEWEB)

    Stolzmann, Paul; Desbiolles, Lotus; Scheffel, Hans; Leschka, Sebastian; Marincek, Borut; Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic Radiology, Zurich (Switzerland); Knight, Joseph; Kurtcuoglu, Vartan; Poulikakos, Dimos [Laboratory of Thermodynamics in Emerging Technologies, Department of Mechanical and Process Engineering, ETH Zurich (Switzerland); Maier, Willibald [University Hospital Zurich, Cardiovascular Center, Zurich (Switzerland); Plass, Andre [University Hospital Zurich, Clinic for Cardiovascular Surgery, Zurich (Switzerland)

    2009-06-15

    Detailed knowledge of aortic root geometry is a prerequisite to anticipate complications of transcatheter aortic valve (TAV) implantation. We determined coronary ostial locations and aortic root dimensions in patients with aortic stenosis (AS) and compared these values with normal subjects using computed tomography (CT). One hundred consecutive patients with severe tricuspid AS and 100 consecutive patients without valvular pathology (referred to as the controls) undergoing cardiac dual-source CT were included. Distances from the aortic annulus (AA) to the left coronary ostium (LCO), right coronary ostium (RCO), the height of the left coronary sinus (HLS), right coronary sinus (HRS), and aortic root dimensions [diameters of AA, sinus of Valsalva (SV), and sino-tubular junction(STJ)] were measured. LCO and RCO were 14.9 {+-} 3.2 mm (8.2-25.9) and 16.8 {+-} 3.6 mm (12.0-25.7) in the controls, 15.5 {+-} 2.9 mm (8.8-24.3) and 17.3 {+-} 3.6 mm (7.3-26.0) in patients with AS. Controls and patients with AS had similar values for LCO (P = 0.18), RCO (P = 0.33) and HLS (P = 0.88), whereas HRS (P < 0.05) was significantly larger in patients with AS. AA (r = 0.55,P < 0.001), SV (r = 0.54,P < 0.001), and STJ (r = 0.52,P < 0.001) significantly correlated with the body surface area in the controls; whereas no correlation was found in patients with AS. Patients with AS had significantly larger AA (P < 0.01) and STJ (P < 0.01) diameters when compared with the controls. In patients with severe tricuspid AS, coronary ostial locations were similar to the controls, but a transverse remodelling of the aortic root was recognized. Owing to the large distribution of ostial locations and the dilatation of the aortic root, CT is recommended before TAV implantation in each patient. (orig.)

  15. Reference Values for Cardiac and Aortic Magnetic Resonance Imaging in Healthy, Young Caucasian Adults

    Science.gov (United States)

    Eikendal, Anouk L. M.; Bots, Michiel L.; Haaring, Cees; Saam, Tobias; van der Geest, Rob J.; Westenberg, Jos J. M.; den Ruijter, Hester M.; Hoefer, Imo E.; Leiner, Tim

    2016-01-01

    Background Reference values for morphological and functional parameters of the cardiovascular system in early life are relevant since they may help to identify young adults who fall outside the physiological range of arterial and cardiac ageing. This study provides age and sex specific reference values for aortic wall characteristics, cardiac function parameters and aortic pulse wave velocity (PWV) in a population-based sample of healthy, young adults using magnetic resonance (MR) imaging. Materials and Methods In 131 randomly selected healthy, young adults aged between 25 and 35 years (mean age 31.8 years, 63 men) of the general-population based Atherosclerosis-Monitoring-and-Biomarker-measurements-In-The-YOuNg (AMBITYON) study, descending thoracic aortic dimensions and wall thickness, thoracic aortic PWV and cardiac function parameters were measured using a 3.0T MR-system. Age and sex specific reference values were generated using dedicated software. Differences in reference values between two age groups (25–30 and 30–35 years) and both sexes were tested. Results Aortic diameters and areas were higher in the older age group (all p<0.007). Moreover, aortic dimensions, left ventricular mass, left and right ventricular volumes and cardiac output were lower in women than in men (all p<0.001). For mean and maximum aortic wall thickness, left and right ejection fraction and aortic PWV we did not observe a significant age or sex effect. Conclusion This study provides age and sex specific reference values for cardiovascular MR parameters in healthy, young Caucasian adults. These may aid in MR guided pre-clinical identification of young adults who fall outside the physiological range of arterial and cardiac ageing. PMID:27732640

  16. Are small-scale field-aligned currents and magneto sheath-like particle precipitation signatures of the same low-altitude cusp?

    DEFF Research Database (Denmark)

    Watermann, J.; Stauning, P.; Luhr, H.

    2009-01-01

    We examined some 75 observations from the low-altitude Earth orbiting DMSP, Orsted and CHAMP satellites which were taken in the region of the nominal cusp. Our objective was to determine whether the actually observed cusp locations as inferred from magnetosheath-like particle precipitation...... of the satellites were converted into AACGM coordinates, and the geomagnetic latitude of the cusp boundaries (as indicated by precipitating particles and small-scale field-aligned currents) set in relation to the IMF-B-z dependent latitude of the equatorward boundary of the statistical cusp. We find...... that intense small-scale field-aligned currents are generated in the cusp but also in the transition zone between the low-latitude boundary layer (LLBL) and the cusp, probably within both regimes, the cusp and the open LLBL. The small-scale field-aligned currents are possibly a consequence of turbulence and...

  17. Spectrum of Aortic Valve Abnormalities Associated with Aortic Dilation Across Age Groups in Turner Syndrome

    Science.gov (United States)

    Olivieri, Laura J.; Baba, Ridhwan Y.; Arai, Andrew E.; Bandettini, W. Patricia; Rosing, Douglas R.; Bakalov, Vladimir; Sachdev, Vandana; Bondy, Carolyn A.

    2014-01-01

    Background Congenital aortic valve fusion is associated with aortic dilation, aneurysm and rupture in girls and women with Turner syndrome (TS). Our objective was to characterize aortic valve structure in subjects with TS, and determine the prevalence of aortic dilation and valve dysfunction associated with different types of aortic valves. Methods and Results The aortic valve and thoracic aorta were characterized by cardiovascular magnetic resonance imaging in 208 subjects with TS in an IRB-approved natural history study. Echocardiography was used to measure peak velocities across the aortic valve, and the degree of aortic regurgitation. Four distinct valve morphologies were identified: tricuspid aortic valve (TAV) 64%(n=133), partially fused aortic valve (PF) 12%(n=25), bicuspid aortic valve (BAV) 23%(n=47), and unicuspid aortic valve (UAV) 1%(n=3). Age and body surface area (BSA) were similar in the 4 valve morphology groups. There was a significant trend, independent of age, towards larger BSA-indexed ascending aortic diameters (AADi) with increasing valve fusion. AADi were (mean +/− SD) 16.9 +/− 3.3 mm/m2, 18.3 +/− 3.3 mm/m2, and 19.8 +/− 3.9 mm/m2 (p<0.0001) for TAV, PF and BAV+UAV respectively. PF, BAV, and UAV were significantly associated with mild aortic regurgitation and elevated peak velocities across the aortic valve. Conclusions Aortic valve abnormalities in TS occur with a spectrum of severity, and are associated with aortic root dilation across age groups. Partial fusion of the aortic valve, traditionally regarded as an acquired valve problem, had an equal age distribution and was associated with an increased AADi. PMID:24084490

  18. Basal longitudinal strain predicts future aortic valve replacement in asymptomatic patients with aortic stenosis

    DEFF Research Database (Denmark)

    Carstensen, Helle Gervig; Larsen, Linnea Hornbech; Hassager, Christian

    2016-01-01

    of myocardial dysfunction and predictors of outcome in asymptomatic aortic stenosis. Aortic stenosis and ischaemic heart disease share risk factors and longitudinal function can be severely reduced in both conditions, why some of the previous findings of impaired regional longitudinal function in asymptomatic...... aortic stenosis could in fact be explained by silent ischaemic heart disease. METHODS AND RESULTS: Prospective follow-up of 104 asymptomatic patients with moderate-severe aortic stenosis defined as an aortic valve area ...: In contrast to GLS, reduced BLS is a significant predictor of future AVR in asymptomatic patients with aortic stenosis, independently of clinical characteristics, conventional echocardiographic measures, and coronary pathology....

  19. Hubble Space Telescope Observations of Globular Clusters with Central Density Cusps

    Science.gov (United States)

    Sosin, Craig Anthony

    1997-07-01

    We use the Hubble Space Telescope to observe crowded fields in globular clusters with central density cusps, and use the observed stellar distributions to study the internal dynamics of clusters in advanced stages of evolution. We begin by discussing images of the cusp of NGC 6624. From the positions of individual stars, we measure the logarithmic slope of the central density cusp, but do not resolve the cluster core. We also detect a central population of blue stragglers, and compare the frequencies of such stars in several clusters. NGC 6397, as well as photometric techniques for use with diffraction-limited HST images. We measure logarithmic cusp slopes for various groups of main-sequence stars in each cluster; we also set upper limits on the core radii of M15 and M30, and measure a radius of ~5' for the NGC 6397 core. We compare mass functions (MFs) measured at several radii in each cluster, and find substantial mass segregation. In M30, the observed segregation is well matched by the predictions of a King-Michie model, but similar models of M15 and NGC 6397 predict more mass segregation than we observe. We then use the Jeans equation and our MFs to investigate the degree of equipartition of energy between stellar species in each cluster. We find that M30 is very close to equipartition over the observed radial range between the cusp and the envelope, while M15 and NGC 6397 are not. The difference between M30 and M15 might be explained by the difference in relaxation times at the observed radii, but this scenario fails to explain the NGC 6397 data. We discuss the possibility that post-collapse clusters remain subject to the Spitzer instability, and the possibility that the tidal shocks suffered by NGC 6397 have affected its degree of mass segregation. We also propose that the observed differences between the central cusps of the clusters could be due to gravothermal oscillations, to differences in binary populations, or to the presence of a ~103Msolar black hole

  20. Statins for aortic valve stenosis

    Directory of Open Access Journals (Sweden)

    Luciana Thiago

    Full Text Available ABSTRACT BACKGROUND: Aortic valve stenosis is the most common type of valvular heart disease in the USA and Europe. Aortic valve stenosis is considered similar to atherosclerotic disease. Some studies have evaluated statins for aortic valve stenosis. OBJECTIVES: To evaluate the effectiveness and safety of statins in aortic valve stenosis. METHODS: Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, MEDLINE, Embase, LILACS - IBECS, Web of Science and CINAHL Plus. These databases were searched from their inception to 24 November 2015. We also searched trials in registers for ongoing trials. We used no language restrictions. Selection criteria: Randomized controlled clinical trials (RCTs comparing statins alone or in association with other systemic drugs to reduce cholesterol levels versus placebo or usual care. Data collection and analysis: Primary outcomes were severity of aortic valve stenosis (evaluated by echocardiographic criteria: mean pressure gradient, valve area and aortic jet velocity, freedom from valve replacement and death from cardiovascular cause. Secondary outcomes were hospitalization for any reason, overall mortality, adverse events and patient quality of life. Two review authors independently selected trials for inclusion, extracted data and assessed the risk of bias. The GRADE methodology was employed to assess the quality of result findings and the GRADE profiler (GRADEPRO was used to import data from Review Manager 5.3 to create a 'Summary of findings' table. MAIN RESULTS: We included four RCTs with 2360 participants comparing statins (1185 participants with placebo (1175 participants. We found low-quality evidence for our primary outcome of severity of aortic valve stenosis, evaluated by mean pressure gradient (mean difference (MD -0.54, 95% confidence interval (CI -1.88 to 0.80; participants = 1935; studies = 2, valve area (MD -0.07, 95% CI -0.28 to 0.14; participants = 127; studies = 2

  1. Thoracic type Ia endoleak: direct percutaneous coil embolization of the aortic arch at the blood entry site after TEVAR and double-chimney stent-grafts

    Energy Technology Data Exchange (ETDEWEB)

    Bangard, Christopher; Franke, Mareike; Maintz, David; Chang, De-Hua [University Hospital, University of Cologne, Department of Radiology, Cologne (Germany); Pfister, Roman [University Hospital, University of Cologne, Department of Internal Medicine III, Cologne (Germany); Deppe, Antje-Christin [University Hospital, University of Cologne, Department of Cardiothoracic Surgery, Cologne (Germany); Matoussevitch, Vladimir [University Hospital, University of Cologne, Department of Vascular Surgery, Cologne (Germany)

    2014-06-15

    To introduce a novel percutaneous technique to stop blood entry at the lesser aortic arch curvature by coil embolisation in type Ia endoleak after TEVAR. A 61-year-old Marfan patient presented with type Ia endoleak of the aortic arch and a growing aortic arch pseudoaneurysm after TEVAR. Multiple preceding operations and interventions made an endovascular approach unsuccessful. Direct percutaneous puncture of the aneurysmal sac would have cured the sign, but not the cause of blood entry at the lesser curvature of the aortic arch. Direct CT-guided percutaneous puncture of the blood entry site in the aortic arch with fluoroscopically guided coil embolisation using detachable extra-long coils was successfully performed. Three weeks after the intervention, the patient developed fever because of superinfection of the pseudoaneurysm. The blood cultures and CT-guided mediastinal aspirate were sterile. After intravenous administration of antibiotics, the fever disappeared and the patient recovered. Six-month follow-up showed permanent closure of the endoleak and a shrinking aneurysmal sac. Direct percutaneous puncture of the aortic arch at the blood entry site of a thoracic type Ia endoleak after TEVAR and double-chimney stent-grafts with coil embolisation of the wedge-shaped space between the lesser aortic curvature and the stent-graft is possible. (orig.)

  2. Decreased expression of fibulin-4 in aortic wall of aortic dissection.

    Science.gov (United States)

    Huawei, P; Qian, C; Chuan, T; Lei, L; Laing, W; Wenlong, X; Wenzhi, L

    2014-02-01

    In this research, we will examine the expression of Fibulin-4 in aortic wall to find out its role in aortic dissection development. The samples of aortic wall were obtained from 10 patients operated for acute ascending aortic dissection and five patients for chronic ascending aortic dissection. Another 15 pieces of samples from patients who had coronary artery bypass were as controls. The aortic samples were stained with aldehyde magenta dyeing to evaluate the arrangement of elastic fibers. The Fibulin-4 protein and mRNA expression were both determined by Western blot and realtime quantitative polymerase chain reaction. Compared with the control group, both in acute and chronic ascending aortic dissection, elastic fiber fragments increased and the expression of fibulin-4 protein significantly decreased (P= 0.045 < 0.05). The level of fibulin-4 mRNA decreased in acute ascending aortic dissection (P= 0.034 < 0.05), while it increased in chronic ascending aortic dissection (P=0.004 < 0.05). The increased amounts of elastic fiber fragments were negatively correlated with the expression of fibulin-4 mRNA in acute ascending aortic dissection. In conclusion, in aortic wall of ascending aortic dissection, the expression of fibulin-4 protein decreased and the expression of fibulin-4 mRNA was abnormal. Fibulin-4 may play an important role in the pathogenesis of aortic dissection.

  3. High-resolution modeling of the cusp density anomaly: Response to particle and Joule heating under typical conditions

    Science.gov (United States)

    Brinkman, Douglas G.; Walterscheid, Richard L.; Clemmons, James H.; Hecht, James. H.

    2016-03-01

    An established high-resolution dynamical model is employed to understand the behavior of the thermosphere beneath the Earth's magnetic cusps, with emphasis on the factors contributing to the density structures observed by the CHAMP and Streak satellite missions. In contrast to previous modeling efforts, this approach combines first principles dynamical modeling with the high spatial resolution needed to describe accurately mesoscale features such as the cusp. The resulting density structure is shown to be consistent with observations, including regions of both enhanced and diminished neutral density along the satellite track. This agreement is shown to be the result of a straightforward application of input conditions commonly found in the cusp rather than exaggerated or extreme conditions. It is found that the magnitude of the density change is sensitive to the width of the cusp region and that models that can resolve widths on the order of 2° of latitude are required to predict density variations that are consistent with the observations.

  4. Cusp electron production in Coincidence with Target Recoil Ions for 3 MeV C^+ + Ar Collisions

    Science.gov (United States)

    Wig, A. G.; Desai, D. D.; Breinig, M.

    1996-11-01

    The production cross section and energy distribution of ionized projectile electrons are measured in coincidence with the target recoil ion charge state for 3 MeV C^+ projectiles colliding with Ar. Evidence for the importance of the electron-electron interaction is sought in the dependence of the cross section on the target recoil ion charge state and the shape of the energy distribution as a function of recoil ion charge state. While the coincidence yields suggest that the projectile electron-target electron interaction produces a significant fraction of the cusp electrons which have energy < 1 eV in the projectile frame, the measured cusp shapes are independent of recoil ion charge state. This suggest that the cusp shape is independent of the production mechanism and depends only on the interaction of the cusp electron with the remaining projectile ion.

  5. A solution of the cusp problem in relaxed halos of dark matter

    CERN Document Server

    Mikheeva, E; Lukash, V

    2007-01-01

    We propose a solution of the cusp problem in framework of the standard $\\Lambda$CDM cosmology. To do this we describe the linear and nonlinear periods of halo formation by the entropy function of dark matter particles. This approach allows us to take into account together the impact of both the processes of nonlinear relaxation of compressed matter and the small scale initial velocity perturbations in collapsed halos. We show that such random velocities lead to the random variations of the density profile of relaxed halos. As a rule, they suppress the formation of cusp--like halos and favor the creation of core--like ones. This approach allows us to reproduce observed rotation curves, to explain their random scatter and deviations from simulated ones.

  6. On the {Sigma}N cusp in the pp {yields} pK{sup +}{Lambda} reaction

    Energy Technology Data Exchange (ETDEWEB)

    Abd El-Samad, S. [Atomic Energy Authority NRC Cairo, Cairo (Egypt); Borodina, E.; Dzhygadlo, R.; Gast, W.; Gillitzer, A.; Grzonka, D.; Kilian, K.; Ritman, J.; Roderburg, E.; Roeder, M.; Sefzick, T.; Wintz, P. [Forschungszentrum Juelich, Institut fuer Kernphysik, Juelich (Germany); Forschungszentrum Juelich, Juelich Center for Hadron Physics, Juelich (Germany); Brinkmann, K.T. [Physikalisches Institut Justus-Liebig-Universitaet, Giessen (Germany); Clement, H.; Doroshkevich, E.; Ehrhardt, K.; Erhardt, A.; Wagner, G.J. [Physikalisches Institut der Universitaet Tuebingen, Tuebingen (Germany); University of Tuebingen, Kepler Center for Astro and Particle Physics, Tuebingen (Germany); Eyrich, W.; Krapp, M.; Schulte-Wissermann, M. [Friedrich-Alexander-Universitaet Erlangen-Nuernberg, Erlangen (Germany); Freiesleben, H. [Technische Universitaet Dresden, Institut fuer Kern- und Teilchenphysik, Dresden (Germany); Hanhart, C. [Forschungszentrum Juelich, Institut fuer Kernphysik, Juelich (Germany); Forschungszentrum Juelich, Juelich Center for Hadron Physics, Juelich (Germany); Forschungszentrum Juelich, Institute for Advanced Simulation, Juelich (Germany); Hauenstein, F.; Klaja, P.; Schroeder, W. [Forschungszentrum Juelich, Institut fuer Kernphysik, Juelich (Germany); Forschungszentrum Juelich, Juelich Center for Hadron Physics, Juelich (Germany); Friedrich-Alexander-Universitaet Erlangen-Nuernberg, Erlangen (Germany); Wuestner, P. [Forschungszentrum Juelich, Institut fuer Kernphysik, Juelich (Germany); Forschungszentrum Juelich, Juelich Center for Hadron Physics, Juelich (Germany); Forschungszentrum Juelich, Zentralinstitut fuer Elektronik, Juelich (Germany); Collaboration: COSY-TOF Collaboration

    2013-03-15

    Measurements of the pp {yields} pK {sup +} {Lambda} reaction at T{sub p} = 2.28 GeV have been carried out at COSY-TOF. In addition to the {Lambda}p FSI and N {sup *} resonance excitation effects a pronounced narrow structure is observed in the Dalitz plot and in its projection on the p {Lambda} invariant mass. The strongly asymmetric structure appears at the pp {yields} NK {sup +} {Sigma} threshold and is interpreted as the {Sigma}N cusp effect. The observed width of about 20 MeV/c {sup 2} is substantially broader than anticipated from previous measurements as well as theoretical predictions. Angular distributions of this cusp structure are shown to be dissimilar to those in the residual pK {sup +} {Lambda} channel, but similar to those observed in the pK {sup +} {Sigma} {sup 0} channel. (orig.)

  7. On the SigmaN cusp in the pp -> pK+Lambda reaction

    CERN Document Server

    El-Samad, S Abd; Brinkmann, K -Th; Clement, H; Doroshkevich, E; Dzhygadlo, R; Ehrhardt, K; Erhardt, A; Eyrich, W; Freiesleben, H; Gast, W; Gillitzer, A; Grzonka, D; Hanhart, C; Hauenstein, F; Klja, P; Kilian, K; Krapp, M; Ritman, J; Roderburg, E; Roeder, M; Schulte-Wissermann, M; Schroeder, W; Sfzick, T; Wagner, G J; Wintz, P; Wuestner, P

    2012-01-01

    Measurements of the $pp \\to pK^+\\Lambda$ reaction at $T_p$ = 2.28 GeV have been carried out at COSY-TOF. In addition to the $\\Lambda p$ FSI and $N^*$ resonance excitation effects a pronounced narrow structure is observed in the Dalitz plot and in its projection on the $p\\Lambda$-invariant mass. The structure appears at the $pp \\to $N$K^+\\Sigma$ threshold and is interpreted as $\\Sigma$N cusp effect. The observed width of 20 MeV/$c^2$ is substantially broader than anticipated from previous inclusive measurements. Angular distributions of this cusp structure are shown to be dissimilar to those in the residual $pK^+\\Lambda$ channel, but similar to those observed in the $pK^+\\Sigma^0$ channel.

  8. On the ΣN cusp in the pp → pK+Λ reaction

    Science.gov (United States)

    Abd El-Samad, S.; Borodina, E.; Brinkmann, K.-Th.; Clement, H.; Doroshkevich, E.; Dzhygadlo, R.; Ehrhardt, K.; Erhardt, A.; Eyrich, W.; Freiesleben, H.; Gast, W.; Gillitzer, A.; Grzonka, D.; Hanhart, C.; Hauenstein, F.; Klaja, P.; Kilian, K.; Krapp, M.; Ritman, J.; Roderburg, E.; Röder, M.; Schulte-Wissermann, M.; Schroeder, W.; Sefzick, T.; Wagner, G. J.; Wintz, P.; Wüstner, P.

    2013-03-01

    Measurements of the pp → pK + Λ reaction at T p = 2.28 GeV have been carried out at COSY-TOF. In addition to the Λp FSI and N * resonance excitation effects a pronounced narrow structure is observed in the Dalitz plot and in its projection on the pΛ invariant mass. The strongly asymmetric structure appears at the pp → NK + Σ threshold and is interpreted as the ΣN cusp effect. The observed width of about 20 MeV/ c 2 is substantially broader than anticipated from previous measurements as well as theoretical predictions. Angular distributions of this cusp structure are shown to be dissimilar to those in the residual pK + Λ channel, but similar to those observed in the pK + Σ 0 channel.

  9. Interaction between measurement time and observed Hugoniot cusp due to chemical reactions

    Science.gov (United States)

    McGrane, S. D.; Brown, K. E.; Bolme, C. A.; Moore, D. S.

    2017-01-01

    Chemistry occurring on picosecond timescales can be observed through ultrafast laser shock drive experiments that measure Hugoniot data and transient absorption. The shock stress needed to induce chemical reactions on picosecond time scales is significantly larger than the stress needed to induce reactions on nanosecond time scales typical of gas gun and explosively driven plate impact experiments. This discrepancy is consistent with the explanation that increased shock stress leads to increased temperature, which drives thermally activated processes at a faster rate. While the data are qualitatively consistent with the interpretation of thermally dominated reactions, they are not a critical test of this interpretation. In this paper, we review data from several shocked liquids that illustrate a Hugoniot cusp due to volume changing reactions that occurs at higher shock stress states in picosecond experiments than in nanosecond to microsecond experiments. We also correlate the observed Hugoniot cusp states with transient absorption changes that occur due to the buildup of reaction products.

  10. Central charge from adiabatic transport of cusp singularities in the quantum Hall effect

    CERN Document Server

    Can, Tankut

    2016-01-01

    We study quantum Hall (QH) states on a punctured Riemann sphere. We compute the Berry curvature under adiabatic motion in the moduli space in the large N limit. The Berry curvature is shown to be finite in the large N limit and controlled by the conformal dimension of the cusp singularity, a local property of the mean density. Utilizing exact sum rules obtained from a Ward identity, we show that for the Laughlin wave function, the dimension of a cusp singularity is given by the central charge, a robust geometric response coefficient in the QHE. Thus, adiabatic transport of curvature singularities can be used to determine the central charge of QH states. We also consider the effects of threaded fluxes and spin-deformed wave functions. Finally, we give a closed expression for all moments of the mean density in the integer QH state on a punctured disk.

  11. Cusp form motives in the cohomology of the space of stable maps to BG

    CERN Document Server

    Petersen, Dan

    2010-01-01

    The moduli space of twisted stable maps into the stack $B(\\Z/m\\Z)^2$ carries a natural $S_n$-action and so its cohomology may be decomposed into irreducible $S_n$-representations. Working over $\\Spec \\Z[1/m]$ we show that the alternating part of the cohomology of one of its connected components is exactly the cohomology associated to cusp forms for $\\Gamma(m)$. In particular this offers an alternative to Scholl's construction of the Chow motive associated to such cusp forms. This answers in the affirmative a question of Manin on whether one can replace the Kuga-Sato varieties used by Scholl with some moduli space of pointed stable curves.

  12. Numerical method for computing Maass cusp forms on triply punctured two-sphere

    Energy Technology Data Exchange (ETDEWEB)

    Chan, K. T.; Kamari, H. M. [Department of Physics, Faculty of Science, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor (Malaysia); Zainuddin, H. [Department of Physics, Faculty of Science, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia and Institute for Mathematical Research, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor (Malaysia)

    2014-03-05

    A quantum mechanical system on a punctured surface modeled on hyperbolic space has always been an important subject of research in mathematics and physics. This corresponding quantum system is governed by the Schrödinger equation whose solutions are the Maass waveforms. Spectral studies on these Maass waveforms are known to contain both continuous and discrete eigenvalues. The discrete eigenfunctions are usually called the Maass Cusp Forms (MCF) where their discrete eigenvalues are not known analytically. We introduce a numerical method based on Hejhal and Then algorithm using GridMathematica for computing MCF on a punctured surface with three cusps namely the triply punctured two-sphere. We also report on a pullback algorithm for the punctured surface and a point locater algorithm to facilitate the complete pullback which are essential parts of the main algorithm.

  13. Surprises from the resummation of ladders in the ABJ(M) cusp anomalous dimension

    CERN Document Server

    Bonini, Marisa; Preti, Michelangelo; Seminara, Domenico

    2016-01-01

    We study the cusp anomalous dimension in N=6 ABJ(M) theory, identifying a scaling limit in which the ladder diagrams dominate. The resummation is encoded into a Bethe-Salpeter equation that is mapped to a Schroedinger problem, exactly solvable due to the surprising supersymmetry of the effective Hamiltonian. In the ABJ case the solution implies the diagonalization of the U(N) and U(M) building blocks, suggesting the existence of two independent cusp anomalous dimensions and an unexpected exponentiation structure for the related Wilson loops. While consistent with previous perturbative analysis, the strong coupling limit of our result does not agree with the string theory computation, emphasizing a difference with the analogous resummation in the N=4 case.

  14. Maxillary and Mandibular First Premolars Showing Three-Cusp Pattern: An Unusual Presentation

    Directory of Open Access Journals (Sweden)

    Ramakant Nayak

    2013-01-01

    Full Text Available Dental anatomy is the study of morphology of various teeth in human dentitions. The application of dental anatomy in clinical practice is important, and dentist should have a thorough knowledge regarding the morphology of the teeth. At times as a result of genetic variation, environmental factors, diet of an individual and race, variations in the morphology of the teeth can be observed. These variations have been extensively studied by the researcher in the field of anthropology to define a particular race. The most commonly observed changes include peg-shaped laterals, shovel-shaped incisors, and extra cusp on molar. Common variations documented with regard to maxillary and mandibular first premolars are the variation in the number of roots. But the variations with respect to crown morphology are few. We report a first documented unusual presentation of maxillary and mandibular first premolars with three-cusps pattern in a female patient.

  15. Maxillary and mandibular first premolars showing three-cusp pattern: an unusual presentation.

    Science.gov (United States)

    Nayak, Ramakant; Kotrashetti, Vijayalakshmi; Nayak, Aarati; Patil, Viraj; Kulkarni, Mayuri; Somannavar, Pradeep; Hosmani, Jagadish

    2013-01-01

    Dental anatomy is the study of morphology of various teeth in human dentitions. The application of dental anatomy in clinical practice is important, and dentist should have a thorough knowledge regarding the morphology of the teeth. At times as a result of genetic variation, environmental factors, diet of an individual and race, variations in the morphology of the teeth can be observed. These variations have been extensively studied by the researcher in the field of anthropology to define a particular race. The most commonly observed changes include peg-shaped laterals, shovel-shaped incisors, and extra cusp on molar. Common variations documented with regard to maxillary and mandibular first premolars are the variation in the number of roots. But the variations with respect to crown morphology are few. We report a first documented unusual presentation of maxillary and mandibular first premolars with three-cusps pattern in a female patient.

  16. Scintillation and loss of signal lock from poleward moving auroral forms in the cusp ionosphere

    CERN Document Server

    Oksavik, K; Lorentzen, D A; Baddeley, L J; Moen, J

    2016-01-01

    We present two examples from the cusp ionosphere over Svalbard,where poleward moving auroral forms (PMAFs) are causing significant phase scintillation in signals from navigation satellites. The data were obtained using a combination of ground-based optical instruments and a newly installed multiconstellation navigation signal receiver at Longyearbyen. Both events affected signals from GPS and Global Navigation Satellite System (GLONASS). When one intense PMAF appeared, the signal from one GPS spacecraft also experienced a temporary loss of signal lock. Although several polar cap patches were also observed in the area as enhancements in total electron content, the most severe scintillation and loss of signal lock appear to be attributed to very intense PMAF activity. This shows that PMAFs are locations of strong ionospheric irregularities, which at times may cause more severe disturbances in the cusp ionosphere for navigation signals than polar cap patches.

  17. The surface microstructure of cusps and leaflets in rabbit and mouse heart valves

    Directory of Open Access Journals (Sweden)

    Xia Ye

    2014-05-01

    Full Text Available In this investigation, scanning electron microscopy was used to characterize the microstructure on the surfaces of animal heart valve cusps/leaflets. The results showed that though these surfaces appear smooth to the naked eye, they are actually comprised of a double hierarchical structure consisting of a cobblestone-like microstructure and nano-cilia along with mastoids with a directional arrangement. Such nanostructures could play a very important role in the hemocompatibility characteristics of heart valves. On this basis, the model of the microstructure was constructed and theoretical analysis was used to obtain optimal geometric parameters for the rough surface of artificial valve cusps/leaflets. This model may help improve reconstructive techniques and it may be beneficial in the design and fabrication of valve substitutes or partial substitutes. Namely, the model may help ameliorate heart valve replacement surgery.

  18. Transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis: a meta analysis

    Institute of Scientific and Technical Information of China (English)

    WU Yi-cheng; ZHANG Jian-feng; SHEN Wei-feng; ZHAO Qiang

    2013-01-01

    Background Transcatheter aortic valve implantation (TAVI) has emerged as the treatment choice for non-operable patients with severe symptomatic aortic stenosis (AS) and may be a good alternative to surgery for those at very high or prohibitive surgical risk.We performed a meta-analysis to evaluate the comparative benefits of TAVI versus surgical aortic valve replacement (SAVR) in patients with severe AS.Methods A comprehensive literature search of PubMed,Embase,ScienceDirect and Cochrane Central Register of Controlled trials was performed,and randomized trials as well as cohort studies with propensity score analysis were included.Results One randomized trial (n=699) and six retrospective cohort studies (n=781) were selected for meta-analysis.Mortality at 30-day and 1-year follow-up was comparable between TAVI and SAVR.Despite similar incidences of stroke,myocardial infarction,re-operation for bleeding,and renal failure requiring dialysis,TAVI was associated with a lower occurrence rate of new-onset atrial fibrillation (OR 0.51,95% CI 0.33-0.78) and shorter procedural time (mean difference -67.50 minutes,95% CI-87.20 to-47.81 minutes).Post-operative aortic regurgitation and permanent pacemaker implantation were more common in patients after TAVI than in those with SAVR (OR 5.53,95% CI 3.41-8.97; OR 1.71,95% Cl 1.02-2.84,respectively).Conclusion In patients with severe symptomatic AS,TAVI and SAVR did not differ with respect to short-and mid-term survival,but the incidence of permanent pacemaker implantation and post-procedural aortic regurgitation remain relatively high after TAVI.

  19. Particle-in-cell simulation for different magnetic mirror effects on the plasma distribution in a cusped field thruster

    Science.gov (United States)

    Liu, Hui; Chen, Peng-Bo; Zhao, Yin-Jian; Yu, Da-Ren

    2015-08-01

    Magnetic mirror used as an efficient tool to confine plasma has been widely adopted in many different areas especially in recent cusped field thrusters. In order to check the influence of magnetic mirror effect on the plasma distribution in a cusped field thruster, three different radii of the discharge channel (6 mm, 4 mm, and 2 mm) in a cusped field thruster are investigated by using Particle-in-Cell Plus Monte Carlo (PIC-MCC) simulated method, under the condition of a fixed axial length of the discharge channel and the same operating parameters. It is found that magnetic cusps inside the small radius discharge channel cannot confine electrons very well. Thus, the electric field is hard to establish. With the reduction of the discharge channel’s diameter, more electrons will escape from cusps to the centerline area near the anode due to a lower magnetic mirror ratio. Meanwhile, the leak width of the cusped magnetic field will increase at the cusp. By increasing the magnetic field strength in a small radius model of a cusped field thruster, the negative effect caused by the weak magnetic mirror effect can be partially compensated. Therefore, according to engineering design, the increase of magnetic field strength can contribute to obtaining a good performance, when the radial distance between the magnets and the inner surface of the discharge channel is relatively big. Project supported by the National Natural Science Foundation of China (Grant No. 51006028) and the Foundation for Innovative Research Groups of the National Natural Science Foundation of China (Grant No. 51121004).

  20. Analytic torsion versus Reidemeister torsion on hyperbolic 3-manifolds with cusps

    CERN Document Server

    Pfaff, Jonathan

    2012-01-01

    For a non-compact hyperbolic 3-manifold with cusps we prove an explicit formula that relates the regularized analytic torsion associated to the even symmetric powers of the standard representation of SL_2(C) to the corresponding Reidemeister torsion. Our proof rests on an expression of the analytic torsion in terms of special values of Ruelle zeta functions as well as on recent work of Pere Menal-Ferrer and Joan Porti.

  1. A solution of the cusp problem in relaxed halos of dark matter

    OpenAIRE

    Mikheeva, E; Doroshkevich, A.; Lukash, V.

    2007-01-01

    We propose a solution of the cusp problem in framework of the standard $\\Lambda$CDM cosmology. To do this we describe the linear and nonlinear periods of halo formation by the entropy function of dark matter particles. This approach allows us to take into account together the impact of both the processes of nonlinear relaxation of compressed matter and the small scale initial velocity perturbations in collapsed halos. We show that such random velocities lead to the random variations of the de...

  2. The n{sub f} terms of the three-loop cusp anomalous dimension in QCD

    Energy Technology Data Exchange (ETDEWEB)

    Grozin, Andrey [Russian Academy of Sciences, Novosibirsk (Russian Federation). Budker Inst. of Nuclear Physics; Novosibirsk State Univ. (Russian Federation); Henn, Johannes M. [Institute for Advanced Study, Princeton, NJ (United States); Korchemsky, Gregory P. [CEA Saclay, Gif-sur-Yvette (France). Inst. de Physique Theorique; Marquard, Peter [Deutsches Elektronen-Synchrotron (DESY), Zeuthen (Germany)

    2014-07-15

    In this talk we present the result for the n{sub f} dependent piece of the three-loop cusp anomalous dimension in QCD. Remarkably, it is parametrized by the same simple functions appearing in analogous anomalous dimensions in N=4 SYM at one and two loops. We also compute all required master integrals using a recently proposed refinement of the differential equation method. The analytic results are expressed in terms of harmonic polylogarithms of uniform weight.

  3. Tinkering with cusp patterning : Developmental Genetic Mechanisms in Mouse Molar Development

    OpenAIRE

    Harjunmaa, Enni

    2012-01-01

    Teeth display considerable morphological variability, which mammals have been able to use to their advantage. Consequently, mammal teeth provide a bountiful research subject that combines information on development, functional proper-ties, and thanks to their durable substance, evolutionary history. This thesis work is focused on the patterning of cusps, the peaks that form the shape of the tooth crown, in the mouse. Mouse tooth development has been studied extensively and offers a wide ...

  4. Scattering states of Dirac particle equation with position dependent mass under the cusp potential

    CERN Document Server

    Chabab, M; Hassanabadi, H; Oulne, M; Zare, S

    2016-01-01

    We solved the one-dimensional position-dependent mass Dirac equation in the presence of the cusp potential and reported the solutions in terms of the Whittaker functions. We have derived the reflection and transmission coefficients by making use of the matching conditions on the wave functions. The effect of position dependent mass on the reflection and transmission coefficients of the system is duly investigated.

  5. Scattering States of Schr(o)dinger Equation under the Modified Cusp Potential

    Institute of Scientific and Technical Information of China (English)

    Z.Molaee; H.Hassanabadi; S.Zarrinkamar

    2013-01-01

    We solve the one-dimensional time-independent Schr(o)dinger equation in the presence of the modified Cusp potential and report the solutions in terms of the Whittaker functions.We obtain the reflection and transmission coefficients as well as the bound-state solutions in terms of the Whittaker functions.We comment on the solutions and discuss them in terms of the engaged parameters.

  6. Scattering states of Dirac particle equation with position-dependent mass under the cusp potential

    Science.gov (United States)

    Chabab, M.; El Batoul, A.; Hassanabadi, H.; Oulne, M.; Zare, S.

    2016-11-01

    We solved the one-dimensional position-dependent mass Dirac equation in the presence of the cusp potential and reported the solutions in terms of the Whittaker functions. We have derived the reflection and transmission coefficients by making use of the matching conditions on the wave functions. The effect of the position-dependent mass on the reflection and transmission coefficients of the system is duly investigated.

  7. Wavefields Near Transverse Cusp Caustics Produced by Reflecting Ultrasonic Transients and Tone Bursts from Curved Surfaces.

    Science.gov (United States)

    Frederickson, Carl King

    Ultrasonic wavefields reflected from curved surfaces were studied in the vicinity of caustics. Acoustical and optical transverse cusp diffraction catastrophes produced by reflections from a curved metal surface in water were imaged by displaying the amplitude or intensity in an observation plane transverse to the general direction of propagation. The optical image was used to locate the cusp point in the observation plane. Acoustical diffraction patterns for sine waves, described by the Pearcey function, were calculated with the parameters determined by the experimental setup leaving no adjustable scaling parameters. The calculated and experimental acoustical diffraction patterns showed good agreement near the cusp point. The acoustical diffraction pattern showed the expected mirror symmetry about an axis. The pattern was shown to scale properly with frequency. The transverse cusp caustic separates space into a region with three rays and a region with one ray. Inside the caustic there are three rays, on the curve two of the rays merge and disappear leaving one ray outside. Transient signals reflected from curved surfaces exhibited the merging and disappearance of rays on the caustic. Relative arrival times for signals in calculated and recorded time traces agree well. The relation to the wavefront parameters of the temporal orientation of the travel time surface is discussed. The general shape of the travel time surface is that of the swallow tail caustic surface. The temporal shape of the transient echoes was seen to be generally that of the incident signal or of its Hilbert transform. The Hilbert transform shape identifies the signals that have touched the caustic. The observed arrival sequence of the transient signals was shh inside the caustic and one h outside, where s stands for a signal with the general shape of the incident signal and h for its Hilbert transform. The relation between the surface and wavefront parameters and the arrival sequence is given.

  8. [Surgical technique of aortic valve replacement for small aortic annulus in elderly patients].

    Science.gov (United States)

    Hata, T; Fujiwara, K; Furukawa, H; Tsushima, Y; Yoshitaka, H; Kuinose, M; Minami, H; Ishida, A; Tamura, K; Totsugawa, T; Kanemitsu, H; Ozawa, M

    2006-04-01

    Recent reports have shown that aortic valve replacement in elderly patients over 65 years with atherosclerotic aortic stenosis and a small aortic annulus is possible by using a small sized bioprosthesis (Carpentier-Edwards pericardial valve). Here we present out surgical technique. Firstly, the native calcified aortic valve was removed completely to gain total exposure of the surrounding aortic root and sinus of Valsalva like Bentall procedure. Secondly, a small sized bioprosthesis was implanted with intermittent noneverting mattress 2-0 sutures with spaghetti and small polytetrafluoroethylene (PTFE) felt. Aortic annulus is the dilated by inserting Hegar dilator sizing from 25 to 27 mm. Therefore, aortic valve replacement for small aortic annulus in intra- or supra-annular position should be easily accomplished. Good surgical results and hemodynamic state were achieved in 25 consecutive cases using this technique.

  9. Ion-dispersion and rapid electron fluctuations in the cusp: a case study

    Directory of Open Access Journals (Sweden)

    J. Lunde

    2008-08-01

    Full Text Available We present results from co-ordinated measurements with the low altitude REIMEI satellite and the ESR (EISCAT Svalbard Radar, together with other ground-based instruments carried out in February 2006. The results mainly relate to the dayside cusp where clear signatures of so-called ion-dispersion are seen in the satellite data. The cusp ion-dispersion is important for helping to understand the temporal and spatial structure of magnetopause reconnection. Whenever a satellite crosses boundaries of flux tubes or convection cells, cusp structures such as ion-dispersion will always be encountered. In our case we observed 3 distinct steps in the ion energy, but it includes at least 2 more steps as well, which we interpret as temporal features in relation to pulsed reconnection at the magnetopause. In addition, fast variations of the electron flux and energy occurring during these events have been studied in detail. The variations of the electron population, if interpreted as structures crossed by the REIMEI satellite, would map near the magnetopause to similar features as observed previously with the Cluster satellites. These were explained as Alfvén waves originating from an X-line of magnetic reconnection.

  10. Weak annihilation cusp inside the dark matter spike about a black hole

    CERN Document Server

    Shapiro, Stuart L

    2016-01-01

    We reinvestigate the effect of annihilations on the distribution of collisionless dark matter (DM) in a spherical density spike around a massive black hole. We first construct a very simple, pedagogic, analytic model for an isotropic phase space distribution function that accounts for annihilation and reproduces the "weak cusp" found by Vasiliev for DM deep within the spike and away from its boundaries. The DM density in the cusp varies as $r^{-1/2}$ for $s$-wave annihilation, where $r$ is the distance from the central black hole, and is not a flat "plateau" profile. We then extend this model by incorporating a loss cone that accounts for the capture of DM particles by the hole. The loss cone is implemented by a boundary condition that removes capture orbits, resulting in an anisotropic distribution function. Finally, we evolve an initial spike distribution function by integrating the Boltzmann equation to show how the weak cusp grows and its density decreases with time. We treat two cases, one for $s$-wave a...

  11. Four point measurements of electrons using PEACE in the high-altitude cusp

    Directory of Open Access Journals (Sweden)

    M. G. G. T. Taylor

    Full Text Available We present examples of electron measurements from the PEACE instruments on the Cluster spacecraft in the high-latitude, high-altitude region of the Earth’s magnetosphere. Using electron density and energy spectra measurements, we examine two cases where the orbit of the Cluster tetrahedron is outbound over the northern hemisphere, in the afternoon sector approaching the magnetopause. Data from the magnetometer is also used to pinpoint the position of the spacecraft with respect to magnetospheric boundaries. This preliminary work specifically highlights the benefit of the multipoint measurement capability of the Cluster mission. In the first case, we observe a small-scale spatial structure within the magnetopause boundary layer. The Cluster spacecraft initially straddle a boundary, characterised by a discontinuous change in the plasma population, with a pair of spacecraft on either side. This is followed by a complete crossing of the boundary by all four spacecraft. In the second case, Cluster encounters an isolated region of higher energy electrons within the cusp. The characteristics of this region are consistent with a trapped boundary layer plasma sheet population on closed magnetospheric field lines. However, a boundary motion study indicates that this region convects past Cluster, a characteristic more consistent with open field lines. An interpretation of this event in terms of the motion of the cusp boundary region is presented.

    Key words. Magnetospheric physics (magnetopause, cusp and boundary layers; solar wind-magnetosphere interactions

  12. Aortic endograft sizing in trauma patients with hemodynamic instability

    NARCIS (Netherlands)

    Jonker, Frederik H. W.; Verhagen, Hence J. M.; Mojibian, Hamid; Davis, Kimberly A.; Moll, Frans L.; Muhs, Bart E.

    2010-01-01

    Objectives: To investigate changes in aortic diameter in hemodynamically unstable trauma patients and the implications for sizing of thoracic endovascular aortic repair (TEVAR) in patients with traumatic thoracic aortic injury (TTAI). Methods: We retrospectively evaluated all trauma patients that we

  13. Indexing aortic valve area by body surface area increases the prevalence of severe aortic stenosis

    DEFF Research Database (Denmark)

    Jander, Nikolaus; Gohlke-Bärwolf, Christa; Bahlmann, Edda

    2014-01-01

    To account for differences in body size in patients with aortic stenosis, aortic valve area (AVA) is divided by body surface area (BSA) to calculate indexed AVA (AVAindex). Cut-off values for severe stenosis are......To account for differences in body size in patients with aortic stenosis, aortic valve area (AVA) is divided by body surface area (BSA) to calculate indexed AVA (AVAindex). Cut-off values for severe stenosis are...

  14. The Acute aortic syndrome – what do we know and what should we know?

    DEFF Research Database (Denmark)

    Houlind, Kim Christian

    , complicating the distinction between an IMH and a thrombosed false lumen of an AD. In 2000 Shimizu et al(1) published a series of 96 patients admitted on the diagnosis ”Aortic dissection”. On CT evaluation 51 of these turned out to have an IMH without an intimal tear. Interestingly, this subgroup of patients......Aortic dissection (AD)was first described in 1760. Treatment options have been medical and surgical and are guided by the Stanford and De Bakey classifications based on the location of intimal tears and false lumens. More recently, endovascular treatment options have been suggested. Penetrating....... Intramural hematomas (IMH) are often found on CT-scans in patients with typical aortic pain. They are characterized by the presence of a hematoma in the media , but the absence of flow in the false lumen and the absence of a primary intimal tear. An intimal tear may, however, occur secondary to the IMH...

  15. Transcatheter aortic valve replacement for bicuspid aortic stenosis 13years post heart transplant.

    Science.gov (United States)

    Julien, Maureen B; Desai, Nimesh; Brozena, Susan; Herrmann, Howard C

    2016-12-16

    Despite the widespread use of transcatheter aortic valve replacement (TAVR) for moderate and high-risk patients with severe aortic stenosis, it is utilized less frequently in patients with bicuspid aortic valves (BAV). Orthotopic heart transplant (OHT) donors tend to be younger and may have undiagnosed BAV. We present a case of successful TAVR in a patient with BAV thirteen years after OHT.

  16. Transcatheter valve-in-valve implantation due to severe aortic regurgitation in a degenerated aortic homograft

    DEFF Research Database (Denmark)

    Olsen, Lene Kjaer; Engstrøm, Thomas; Søndergaard, Lars

    2009-01-01

    a successful valve-in-valve implantation of a CoreValve aortic valve prosthesis through the right subclavian artery in a case of severe aortic regurgitation within a degenerated aortic homograft. The case exemplifies the possibilities of expanding the indications for TAVI, as well as other vascular access...

  17. New-onset atrial fibrillation after surgical aortic valve replacement and transcatheter aortic valve implantation

    DEFF Research Database (Denmark)

    Jørgensen, Troels Højsgaard; Thygesen, Julie Bjerre; Thyregod, Hans Gustav;

    2015-01-01

    Surgical aortic valve replacement (SAVR) and, more recently, transcatheter aortic valve implantation (TAVI) have been shown to be the only treatments that can improve the natural cause of severe aortic valve stenosis. However, after SAVR and TAVI, the incidence of new-onset atrial fibrillation...

  18. New-Onset Atrial Fibrillation After Surgical Aortic Valve Replacement and Transcatheter Aortic Valve Implantation

    DEFF Research Database (Denmark)

    Jørgensen, Troels Højsgaard; Thygesen, Julie Bjerre; Thyregod, Hans Gustav;

    2015-01-01

    Surgical aortic valve replacement (SAVR) and, more recently, transcatheter aortic valve implantation (TAVI) have been shown to be the only treatments that can improve the natural cause of severe aortic valve stenosis. However, after SAVR and TAVI, the incidence of new-onset atrial fibrillation...

  19. Aortic valvuloplasty of calcific aortic stenosis with monofoil and trefoil balloon catheters: practical considerations

    NARCIS (Netherlands)

    S. Plante (Sylvain); M.J.B.M. van den Brand (Marcel); L.C.P. van Veen; C. di Mario (Carlo); C.E. Essed; K.J. Beatt (Kevin); P.W.J.C. Serruys (Patrick)

    1990-01-01

    textabstractIn order to evaluate the relation between balloon design (monofoil, trefoil) and valvular configuration, experimental aortic valvuloplasty was performed in four post-mortem hearts with calcific aortic stenosis of various morphology. The degree of obstruction of the aortic orifice was ass

  20. The Efficacy of Autologous Femoropopliteal Vein Reconstruction for Primary Aortic and Aortic Graft Infection

    NARCIS (Netherlands)

    Dirven, M.; Jagt, M.F.P. van der; Barendregt, W.B.; Vliet, D. van der

    2015-01-01

    BACKGROUND: The objective of our study was to analyze the efficacy of autologous superficial femoropopliteal vein reconstruction for primary aortic or aortic graft infection. METHODS: We performed a retrospective analysis of 14 patients treated for an infected aortic prosthesis or primary infected a

  1. Low-gradient aortic stenosis.

    Science.gov (United States)

    Clavel, Marie-Annick; Magne, Julien; Pibarot, Philippe

    2016-09-07

    An important proportion of patients with aortic stenosis (AS) have a 'low-gradient' AS, i.e. a small aortic valve area (AVA <1.0 cm(2)) consistent with severe AS but a low mean transvalvular gradient (<40 mmHg) consistent with non-severe AS. The management of this subset of patients is particularly challenging because the AVA-gradient discrepancy raises uncertainty about the actual stenosis severity and thus about the indication for aortic valve replacement (AVR) if the patient has symptoms and/or left ventricular (LV) systolic dysfunction. The most frequent cause of low-gradient (LG) AS is the presence of a low LV outflow state, which may occur with reduced left ventricular ejection fraction (LVEF), i.e. classical low-flow, low-gradient (LF-LG), or preserved LVEF, i.e. paradoxical LF-LG. Furthermore, a substantial proportion of patients with AS may have a normal-flow, low-gradient (NF-LG) AS: i.e. a small AVA-low-gradient combination but with a normal flow. One of the most important clinical challenges in these three categories of patients with LG AS (classical LF-LG, paradoxical LF-LG, and NF-LG) is to differentiate a true-severe AS that generally benefits from AVR vs. a pseudo-severe AS that should be managed conservatively. A low-dose dobutamine stress echocardiography may be used for this purpose in patients with classical LF-LG AS, whereas aortic valve calcium scoring by multi-detector computed tomography is the preferred modality in those with paradoxical LF-LG or NF-LG AS. Although patients with LF-LG severe AS have worse outcomes than those with high-gradient AS following AVR, they nonetheless display an important survival benefit with this intervention. Some studies suggest that transcatheter AVR may be superior to surgical AVR in patients with LF-LG AS.

  2. Aortic dilatation in children with systemic hypertension.

    Science.gov (United States)

    Gupta-Malhotra, Monesha; Devereux, Richard B; Dave, Archana; Bell, Cynthia; Portman, Ronald; Milewicz, Diana

    2014-04-01

    The aim of the study was to determine the presence of aortic dilatation in hypertensive children, the prevalence of which is 4% to 10% in hypertensive adults. Prospectively enrolled multiethnic children, untreated for their hypertension, underwent an echocardiogram to exclude congenital heart disease and evaluate for end-organ damage and aortic size. The aorta was measured in the parasternal long-axis view at three levels: the sinus of Valsalva, supra-tubular junction, and the ascending aorta. Aortic dilatation was determined by z-score >2 at any one of the levels measured. Hypertension was defined as blood pressure above the 95th percentile based on the Fourth Working Group criteria confirmed by 24-hour ambulatory blood pressure monitoring. Among 142 consecutive hypertensive children (median age, 14 years; 45% females) aortic dilatation was detected in 2.8% (95% confidence interval, 1%-7%; median age, 16 years; 100% females). Children with aortic dilatation, when compared with those without, had significantly more aortic valve insufficiency (P = .005) and left ventricular hypertrophy (P = .018). Prevalence of aortic dilatation was 2.8% and was associated with significantly more aortic insufficiency and left ventricular hypertrophy in comparison to those without aortic dilatation.

  3. Hybrid treatment of penetrating aortic ulcer

    Energy Technology Data Exchange (ETDEWEB)

    Lara, Juan Antonio Herrero; Martins-Romeo, Daniela de Araujo; Escudero, Carlos Caparros; Falcon, Maria del Carmen Prieto; Batista, Vinicius Bianchi, E-mail: jaherrero5@hotmail.com [Unidade de Gestao Clinica (UGC) de Diagnostico por Imagem - Hosppital Universitario Virgen Macarena, Sevilha (Spain); Vazquez, Rosa Maria Lepe [Unit of Radiodiagnosis - Hospital Nuestra Senora de la Merced, Osuna, Sevilha (Spain)

    2015-05-15

    Penetrating atherosclerotic aortic ulcer is a rare entity with poor prognosis in the setting of acute aortic syndrome. In the literature, cases like the present one, located in the aortic arch, starting with chest pain and evolving with dysphonia, are even rarer. The present report emphasizes the role played by computed tomography in the diagnosis of penetrating atherosclerotic ulcer as well as in the differentiation of this condition from other acute aortic syndromes. Additionally, the authors describe a new therapeutic approach represented by a hybrid endovascular surgical procedure for treatment of the disease. (author)

  4. Aortic dissection: magnetic resonance imaging.

    Science.gov (United States)

    Amparo, E G; Higgins, C B; Hricak, H; Sollitto, R

    1985-05-01

    Fifteen patients with suspected or known aortic dissection were imaged with magnetic resonance (MR). Thirteen of these patients were eventually shown to have dissection. In most instances the diagnosis was established by aortography and/or computed tomography (CT) prior to the MR study. Surgical proof (6/13) and/or aortographic proof (10/13) were available in 11/13 patients with aortic dissection. MR demonstrated the intimal flap and determined whether the dissection was type A or type B. In addition, MR: differentiated between the true and false lumens; determined the origins of the celiac, superior mesenteric, and renal arteries from the true or false lumen in the cases where the dissection extended into the abdominal aorta (8/12); allowed post-surgical surveillance of the dissection; and identified aortoannular ectasia in the three patients who had Marfan syndrome. In addition to the 13 cases with dissection, there were two cases in whom the diagnosis of dissection was excluded by MR. Our early experience suggests that MR can serve as the initial imaging test in clinically suspected cases of aortic dissection and that the information provided by MR is sufficient to manage many cases. Additionally, MR obviates the use of iodinated contrast media.

  5. A prospective, randomised trial of transapical transcatheter aortic valve implantation vs. surgical aortic valve replacement in operable elderly patients with aortic stenosis

    DEFF Research Database (Denmark)

    Nielsen, Hans Henrik Møller; Klaaborg, Kaj E; Nissen, Henrik

    2012-01-01

    In a prospective randomised trial we aimed to compare transapical transcatheter aortic valve implantation (a-TAVI) with surgical aortic valve replacement (SAVR) in operable elderly patients.......In a prospective randomised trial we aimed to compare transapical transcatheter aortic valve implantation (a-TAVI) with surgical aortic valve replacement (SAVR) in operable elderly patients....

  6. Aortic valve replacement for aortic stenosis with a small aortic annulus in a patient having Werner's syndrome and liver cirrhosis.

    Science.gov (United States)

    Sogawa, M; Kasuya, S; Yamamoto, K; Koshika, M; Oguma, F; Hayashi, J

    2001-12-01

    Werner's syndrome is a rare genetic disease characterized by premature aging and scleroderma-like involvement of the skin. We report a case of aortic valve replacement for severely calcified aortic valve stenosis with a small annulus in a patient suffering from Werner's syndrome and liver cirrhosis

  7. Clinical outcome of pediatric aortic valve repair%儿童主动脉瓣整形术的临床疗效

    Institute of Scientific and Technical Information of China (English)

    郑景浩; 徐志伟; 刘锦纷; 苏肇伉; 丁文祥

    2011-01-01

    Objective To investigate the clinical application of aortic valve repair in pediatric aortic valve disease. Methods The clinical data of 83 children undergoing aortic valve repair were analysed. Patients aged between 4 months old and 11 years old, with the mean age of (3.6 ±5.0) years old. Patients were evaluated by ultrasound before operation, and single aortic insufficient was found in 24 patients, single aortic stenosis in 26 patients, and aortic insufficient combined with aortic stenosis in 33 patients. The repair techniques included commissurotoray (n = 26), resuspension of commissures ( n = 27), pericardial patch cusp extension ( n - 15), raphe excision (n = 12), cusp plication (n = 6) and annuloplasty (n = 2), and 50 patients required a combination of techniques. Results Patients were followed up for 3 months to 3 years. Two patients died, no patient was discharged with long-term treatment with anticoagulation drugs, and 2 patients underwent aortic valve replacement. Conclusion Aortic valve repair may yield favorable short-term and mid-term outcome in treatment of pediatric aortic valve disease, which can avoid reoperation and anticoagulation therapy. Aortic valve replacement can performed for reoperation during follow up.%目的 总结主动脉瓣整形术在小儿主动脉瓣疾病中的应用经验.方法 分析83例行主动脉瓣整形术患儿的临床资料.患儿年龄4个月~11岁,平均年龄(3.6±5.0)岁.术前均经超声评估,其中单纯主动脉瓣反流24例,单纯主动脉瓣狭窄26例,二者兼有33例.手术方法 为瓣交界切开26例,游离边缘交界悬吊27例,三瓣化瓣缘延长15例,瓣叶切除12例,瓣窦心包扩大6倒,瓣环整形2例,两种及以上方法 50例.结果 随访3个月~3年,有2例患儿死亡,无一例需要长期服用抗凝药,2例行换瓣手术.结论 对主动脉瓣疾病患儿行主动脉瓣整形术尤其是主动脉瓣缘延长是可行的,早、中期效果良好,可避免再次手术和抗

  8. Aortic annuloplasty with aortic root reconstruction to prevent patient-prosthesis mismatch.

    Science.gov (United States)

    Hopkins, Richard A

    2006-07-01

    Part of the ongoing argument concerning patient-prosthesis mismatch (PPM) following aortic valve replacement (AVR) is due to the perception that aortic annulus enlargement procedures increase the risk and technical difficulty of aortic valve surgery. Here, an aortic root reconstruction that involves enlargement of the annulus and tailoring of the aortic root to accommodate larger stented prostheses is presented that has been personally performed in 196 patients with no technique-related surgical deaths or complications, and thus can be carried out without additional risk. This aortic root enlargement aortoplasty and annuloplasty method can be calibrated to all AVRs involving stented manufactured prostheses when these are deemed the prosthesis of choice for the patient with a relatively small annulus and/or aortic root, severe left ventricular hypertrophy, compromised LV function or a very active lifestyle, to achieve predicted EOA values > or = 1.00 cm2/m2.

  9. [Unicuspid Aortic Valve Stenosis Combined with Aortic Coarctation;Report of a Case].

    Science.gov (United States)

    Kubota, Takehiro; Wakasa, Satoru; Shingu, Yasushige; Matsui, Yoshiro

    2016-06-01

    Unicuspid aortic valve in an adult is extremely rare. In addition, 90% of the patients with aortic coarctation are reported to die before the age 50. A 60-year-old woman was admitted to our hospital for further examination of exertional dyspnea which had begun one year before. She had been under medical treatment for hypertension since early thirties, and had been also diagnosed with moderate aortic stenosis at 50 years of age. She was at 1st diagnosed with aortic coarctation combined with bicuspid aortic valve stenosis. The aortic valve was then found unicuspid and was replaced under cardiopulmonary bypass with perfusion to both the ascending aorta and the femoral artery. Repair of aortic coarctation was performed 3 months later through left thoracotomy without extracorporeal circulation due to the rich collateral circulation. She had no postoperative complications, and hypertension as well as ankle-brachial index improved to the normal levels.

  10. Severe aortic stenosis: diagnosis, treatment and prognosis

    NARCIS (Netherlands)

    M.W.A. van Geldorp (Martijn)

    2013-01-01

    textabstractDegenerative aortic stenosis is the most common valvular heart disease in developed countries. The prevalence of severe aortic stenosis increases with age from 1% in people below 65 years of age to nearly 6% in people over the age of 85. Since the population life expectancy continues to

  11. Transcatheter Aortic Valve Replacement in Europe

    DEFF Research Database (Denmark)

    Mylotte, Darren; Osnabrugge, Ruben L J; Windecker, Stephan;

    2013-01-01

    The authors sought to examine the adoption of transcatheter aortic valve replacement (TAVR) in Western Europe and investigate factors that may influence the heterogeneous use of this therapy.......The authors sought to examine the adoption of transcatheter aortic valve replacement (TAVR) in Western Europe and investigate factors that may influence the heterogeneous use of this therapy....

  12. Thoracic aortic catastrophes : towards the endovascular solution

    NARCIS (Netherlands)

    Jonker, F.H.W.

    2010-01-01

    Descending thoracic aortic catastrophes include a variety of acute pathologies of the descending thoracic aorta, which are all associated with high morbidity and mortality rates, requiring immediate intervention. For this thesis, we explored the management and outcomes of several thoracic aortic cat

  13. Thoraco-abdominal aortic aneurysm branched repair

    NARCIS (Netherlands)

    Verhoeven, E. L. G.; Tielliu, I. F. J.; Ferreira, M.; Zipfel, B.; Adam, D. J.

    2010-01-01

    Open thoraco-abdominal aortic aneurysm repair is a demanding procedure with high impact on the patient and the operating team. Results from expert centres show mortality rates between 3-21%, with extensive morbidity including renal failure and paraplegia. Endovascular repair of abdominal aortic aneu

  14. Valvular and aortic diseases in osteogenesis imperfecta.

    Science.gov (United States)

    Lamanna, Arvin; Fayers, Trevor; Clarke, Sophie; Parsonage, William

    2013-10-01

    Osteogenesis imperfecta (OI) is an inheritable connective tissue disorder caused by defective collagen synthesis with the principal manifestations of bone fragility. OI has been associated with left sided valvular regurgitation and aortic dilation. Valve and aortic surgery are technically feasible in patients with OI but are inherently high risk due to the underlying connective tissue defect. This report reviews the valvular and aortic pathology associated with OI and their management. We describe two cases of patients with OI who have significant aortic and mitral valve regurgitation, one of whom has been managed conservatively and the other who has undergone successful mitral valve repair and aortic valve replacement. The latter case represents the fifth case of mitral valve repair in a patient with OI reported in the medical literature.

  15. Stroke in Patients With Aortic Stenosis

    DEFF Research Database (Denmark)

    Greve, Anders Møller; Dalsgaard, Morten; Bang, Casper N

    2014-01-01

    BACKGROUND AND PURPOSE: There are limited data on risk stratification of stroke in aortic stenosis. This study examined predictors of stroke in aortic stenosis, the prognostic implications of stroke, and how aortic valve replacement (AVR) with or without concomitant coronary artery bypass grafting...... influenced the predicted outcomes. METHODS: Patients with mild-to-moderate aortic stenosis enrolled in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Diabetes mellitus, known atherosclerotic disease, and oral anticoagulation were exclusion criteria. Ischemic stroke was the primary end point...... death (HR, 8.1; 95% CI, 4.7-14.0; Paortic stenosis not prescribed oral anticoagulation, atrial fibrillation, AVR with concomitant coronary artery bypass grafting, and CHA2DS2-VASc score were the major predictors of stroke. Incident stroke was strongly associated...

  16. Transcatheter aortic valve replacement in elderly patients

    Institute of Scientific and Technical Information of China (English)

    Dimytri Siqueira; Alexandre Abizaid; Magaly Arrais J.; Eduardo Sousa

    2012-01-01

    Aortic stenosis is the most common native valve disease, affecting up to 5% of the elderly population. Surgical aortic valve replacement reduces symptoms and improves survival, and is the definitive therapy in patients with symptomatic severe aortic stenosis. However, despite the good results of classic surgery, risk is markedly increased in elderly patients with co-morbidities. Transcatheter aortic valve replacement (TAVR) allows implantation of a prosthetic heart valve within the diseased native aortic valve without the need for open heart surgery and cardiopulmonary bypass, offering a new therapeutic option to elderly patients considered at high surgical risk or with contraindications to surgery. To date, several multicenter registries and a randomized trial have confirmed the safety and efficacy of TAVR in those patients. In this chapter, we review the background and clinical applications of TAVR in elderly patients.

  17. On the occurrence of magnetic reconnection equatorward of the cusps at the Earth's magnetopause during northward IMF conditions

    Science.gov (United States)

    Trattner, K. J.; Thresher, S.; Trenchi, L.; Fuselier, S. A.; Petrinec, S. M.; Peterson, W. K.; Marcucci, M. F.

    2017-01-01

    Magnetic reconnection changes the topology of magnetic field lines. This process is most readily observable with in situ instrumentation at the Earth's magnetopause as it creates open magnetic field lines to allow energy and momentum flux to flow from the solar wind to the magnetosphere. Most models use the direction of the interplanetary magnetic field (IMF) to determine the location of these magnetopause entry points, known as reconnection lines. Dayside locations of magnetic reconnection equatorward of the cusps are generally found during sustained intervals of southward IMF, while high-latitude region regions poleward of the cusps are observed for northward IMF conditions. In this study we discuss Double Star magnetopause crossings and a conjunction with a Polar cusp crossing during northward IMF conditions with a dominant IMF BY component. During all seven dayside magnetopause crossings, Double Star detected switching ion beams, a known signature for the presence of reconnection lines. In addition, Polar observed a cusp ion-energy dispersion profile typical for a dayside equatorial reconnection line. Using the cutoff velocities for the precipitating and mirrored ion beams in the cusp, the distance to the reconnection site is calculated, and this distance is traced back to the magnetopause, to the vicinity of the Double Star satellite locations. Our analysis shows that, for this case, the predicted line of maximum magnetic shear also coincides with that dayside reconnection location.

  18. [Modern aortic surgery in Marfan syndrome--2011].

    Science.gov (United States)

    Kallenbach, K; Schwill, S; Karck, M

    2011-09-01

    Marfan syndrome is a hereditary disease with a prevalence of 2-3 in 10,000 births, leading to a fibrillin connective tissue disorder with manifestations in the skeleton, eye, skin, dura mater and in particular the cardiovascular system. Since other syndromes demonstrate similar vascular manifestations, but therapy may differ significantly, diagnosis should be established using the revised Ghent nosology in combination with genotypic analysis in specialized Marfan centres. The formation of aortic root aneurysms with the subsequent risk of acute aortic dissection type A (AADA) or aortic rupture limits life expectancy in patients with Marfan syndrome. Therefore, prophylactic replacement of the aortic root needs to be performed before the catastrophic event of AADA can occur. The goal of surgery is the complete resection of pathological aortic tissue. This can be achieved with excellent results by using a (mechanically) valved conduit that replaces both the aortic valve and the aortic root (Bentall operation). However, the need for lifelong anticoagulation with Coumadin can be avoided using the aortic valve sparing reimplantation technique according to David. The long-term durability of the reconstructed valve is favourable, and further technical improvements may improve longevity. Although results of prospective randomised long-term studies comparing surgical techniques are lacking, the David operation has become the surgical method of choice for aortic root aneurysms, not only at the Heidelberg Marfan Centre. Replacement of the aneurysmal dilated aortic arch is performed under moderate hypothermic circulatory arrest combined with antegrade cerebral perfusion using a heart-lung machine, which we also use in thoracic or thoracoabdominal aneurysms. Close post-operative follow-up in a Marfan centre is pivotal for the early detection of pathological changes on the diseased aorta.

  19. Root abnormalities, talon cusps, dentes invaginati with reduced alveolar bone levels: case report.

    LENUS (Irish Health Repository)

    McNamara, C M

    1998-03-01

    This is a case report of a Caucasian female who presented with an unusual combination of dental anomalies: short roots on the maxillary central incisors and premolars, talon cusps, dentes invaginati, low alveolar bone heights, tubercles of Carabelli on the maxillary first and second permanent molars, with pyramidal root morphology in three of the second permanent molars. None of the anomalies alone are particularly uncommon but they have not previously been reported together. The occurrence of the anomalies is probably incidental as the conditions are aetiologically unrelated.

  20. The correlations of ions density with geomagnetic activity and solar dynamic pressure in cusp region

    Institute of Scientific and Technical Information of China (English)

    GUO JianGuang; SHI JianKui; ZHANG TieLong; LIU ZhenXing; A. FAZAKERLEY; H. R(E)ME; Ⅰ. DANDOURAS; E. LUCEK

    2007-01-01

    A statistical study of the properties of ions (O+, He+ and H+) measured by the Cluster-Ⅱ in cusp region as a function of the solar wind dynamic pressure and geomagnetic index Kp respectively was made during the summer and fall of 2001 -2003. The main results are that: (1) O+ ion density responds in a significant way to geomagnetic index Kp, and He+ ion density is not correlated with geomagnetic index Kp,both of them have a significant positive correlation with solar wind dynamic pressure; (2) H+ ion density is also observed to increase with solar wind dynamic pressure, and not correlated with geomagnetic index Kp.

  1. Pitchfork and winged-cusp singularities in iodate-arsenous acid reaction

    Science.gov (United States)

    Li, Ru-Sheng

    1994-09-01

    The iodate-arsenous acid reaction was reported to be able to exhibit hysteresis bistability, including mushrooms and isolas, in a continuous flow stirred tank reactor (CSTR) when an additional flow of solvent is introduced [N. Ganapathisubramanian and K. Showalter, J. Chem. Phys. 80, 4177 (1984)]. Based on their kinetic data and the empirical rate law, it is shown that the reaction may also exhibit pitchfork-type and winged cusp-type singularities if additional flows of the reactants are introduced to the CSTR.

  2. Reoperation on aortic disease in patients with previous aortic valve surgery

    Institute of Scientific and Technical Information of China (English)

    SUN Xiao-gang; ZHANG Liang; YU Cun-tao; QIAN Xiang-yang; CHANG Qian

    2013-01-01

    Background Aortic valve replacement (AVR) is a safe and effective method in the treatment of aortic valve diseases.This study aimed to increase the understanding on re-treatment of aortic diseases after aortic valve surgery through a retrospective analysis of 47 related cases.Methods Forty-seven patients (38 males and 9 females) with previous aortic valve surgery have received reoperation on aorta from January 2003 to June 2012,and the mean interval time of re-intervention to aortic disease was 6 years ((6.0± 3.8) years).The secondary aortic surgery included aortic root replacement (14 cases),ascending aorta replacement (10 cases),aortic root/ascending aorta plus total arch replacement with stented elephant trunk implantation (21 cases),and total thoracoabdominal aorta replacement (2 cases).All these patients have received outpatient re-exams or follow-up by phone calls.Results After the initial aortic valve replacement,patients suffered from aortic dissection (25 cases,53%),ascending aortic aneurysm (12 cases,26%) or aortic root aneurysm (10 cases,21%).Diameter in ascending aorta increased (5.2±7.1) mm per year and aortic sinus (3.3±3.1) mm per year.The annual growth value of diameter in ascending aorta was higher in patients with rheumatic heart disease than that in Marfan syndrome (P<0.05).All 47 patients have received reoperation on aorta.One patient died in operating room because aortic dissection seriously involved right coronary artery.Seven patients had renal insufficiency after operation; neurological complications occurred in 14 patients including 7 patients with stroke and the others with transient brain dysfunction.All patients were followed up,the mean survival time was (97.25±17.63) months,95% confidence interval was 55.24-73.33 months.Eight cases were died during follow-up and five-year survival rate was 83%.Conclusion To reduce the aortic adverse events after first aortic valve surgery,it is necessary to actively treat and strictly

  3. Quantitative image analysis for planning of aortic valve replacement

    NARCIS (Netherlands)

    Elattar, M.A.I.M.

    2016-01-01

    Aortic stenosis is the most common and frequent cause of sudden death among all valvular heart diseases. Symptomatic aortic stenosis is considered to be a fatal disease if left untreated. Aortic valve replacement is the mainstay of treatment of symptomatic aortic stenosis. Traditional treatment of s

  4. Aortic root size and prevalence of aortic regurgitation in elite strength trained athletes.

    Science.gov (United States)

    Babaee Bigi, Mohammad Ali; Aslani, Amir

    2007-08-01

    Athletes involved in mainly static or isometric exercise (e.g., weight lifting, power lifting, and bodybuilding) develop pressure overloads due to the high systemic arterial pressure found in this type of exercise. It is hypothesized that chronically elevated aortic wall tension in strength-trained athletes is associated with aortic dilatation and regurgitation. The aim of this study was to evaluate aortic root size and the prevalence of aortic regurgitation in elite strength-trained athletes. The cohort included 100 male athletes (mean age 22.1 +/- 3.6 years; all were finalists or medalists in the country) and 128 healthy age- and height-matched subjects (the control group). Aortic root diameters at end-diastole were measured at 4 locations: (1) the aortic annulus, (2) the sinuses of Valsalva, (3) the sinotubular junction, and (4) the maximal diameter of the proximal ascending aorta. Aortic root diameters at all levels were significantly greater in the strength-trained athletes (p 18 and 36 and 54 months), progressive enlargement was found at all aortic diameters. In conclusion, aortic root diameters in all segments of the aortic root were significantly greater in elite strength-trained athletes compared with an age- and height-matched population.

  5. [Aortic valve replacement as an independent predictive factor for later development of aortic dissection].

    Science.gov (United States)

    von Kodolitsch, Y; Simic, O; Bregenzer, T; Dresler, C; Haverich, A; Nienaber, C A

    1998-08-01

    Dissection of the ascending aorta (type A) following later after aortic valve replacement has been described with increasing frequency. This study analyzes the role of aortic valve replacement for the evolution of late dissection. In a series of 80 consecutive patients with type A dissection, a previous aortic valve replacement had been performed in 12 cases (15%). In addition to arterial hypertension (p syndrome (p factor for type A dissection. Dissection occurred 3 +/- 4 years after aortic valve replacement with a clinical and anatomical profile similar to classic dissection as proven by comparison to a group of 62 patients with classic dissection associated with arterial hypertension or Marfan syndrome. With 75% and 66%, respectively, 30 day and 1 year survival of patients with dissection following later after aortic valve replacement was similar to patients with classic type A dissection. Extensive thinning and/or fragility (p associated with a high risk for late dissection; this finding was substantiated by comparison to a control group of 10 consecutive patients with a similarly dilated aortic root but no dissection. Type and diameter of valve prostheses, cross-clamp time, NYHA functional class, and left ventricular ejection fraction were unrelated to late dissection. Previous aortic valve replacement is an independent predisposing factor for a dissection of the ascending aorta later. At the time of aortic valve replacement, prophylactic replacement or wrapping of the ascending aorta should be considered in patients with a thinned/fragile aortic wall even without a markedly dilated aortic root.

  6. Aortic valve and ascending aortic root modeling from 3D and 3D+t CT

    Science.gov (United States)

    Grbic, Saša; Ionasec, Razvan I.; Zäuner, Dominik; Zheng, Yefeng; Georgescu, Bogdan; Comaniciu, Dorin

    2010-02-01

    Aortic valve disorders are the most frequent form of valvular heart disorders (VHD) affecting nearly 3% of the global population. A large fraction among them are aortic root diseases, such as aortic root aneurysm, often requiring surgical procedures (valve-sparing) as a treatment. Visual non-invasive assessment techniques could assist during pre-selection of adequate patients, planning procedures and afterward evaluation of the same. However state of the art approaches try to model a rather short part of the aortic root, insufficient to assist the physician during intervention planning. In this paper we propose a novel approach for morphological and functional quantification of both the aortic valve and the ascending aortic root. A novel physiological shape model is introduced, consisting of the aortic valve root, leaflets and the ascending aortic root. The model parameters are hierarchically estimated using robust and fast learning-based methods. Experiments performed on 63 CT sequences (630 Volumes) and 20 single phase CT volumes demonstrated an accuracy of 1.45mm and an performance of 30 seconds (3D+t) for this approach. To the best of our knowledge this is the first time a complete model of the aortic valve (including leaflets) and the ascending aortic root, estimated from CT, has been proposed.

  7. Bicuspid Aortic Valve Disease and Ascending Aortic Aneurysms: Gaps in Knowledge

    Directory of Open Access Journals (Sweden)

    Katie L. Losenno

    2012-01-01

    Full Text Available The bicuspid aortic valve is the most common congenital cardiac anomaly in developed nations. The abnormal bicuspid morphology of the aortic valve results in valvular dysfunction and subsequent hemodynamic derangements. However, the clinical presentation of bicuspid aortic valve disease remains quite heterogeneous with patients presenting from infancy to late adulthood with variable degrees of valvular stenosis and insufficiency and associated abnormalities including aortic coarctation, hypoplastic left heart structures, and ascending aortic dilatation. Emerging evidence suggests that the heterogeneous presentation of bicuspid aortic valve phenotypes may be a more complex matter related to congenital, genetic, and/or connective tissue abnormalities. Optimal management of patients with BAV disease and associated ascending aortic aneurysms often requires a thoughtful approach, carefully assessing various risk factors of the aortic valve and the aorta and discerning individual indications for ongoing surveillance, medical management, and operative intervention. We review current concepts of anatomic classification, pathophysiology, natural history, and clinical management of bicuspid aortic valve disease with associated ascending aortic aneurysms.

  8. Direct determination of IMF B-Y-related cusp current systems, using SuperDARN radar and multiple ground magnetometer data: A link to theory on cusp current origin

    DEFF Research Database (Denmark)

    Amm, O.; Engebretson, M.J.; Greenwald, R.A.

    1999-01-01

    We analyze an ionospheric "enhanced convection event" in the cusp on November 13, 1996, at 1900 UT, by using data of the SuperDARN radar, and of the IMAGE, Greenland, MACCS and CANOPUS magnetometer arrays; and from other magnetometer stations. The event occurs similar to 20 minutes after a transi......We analyze an ionospheric "enhanced convection event" in the cusp on November 13, 1996, at 1900 UT, by using data of the SuperDARN radar, and of the IMAGE, Greenland, MACCS and CANOPUS magnetometer arrays; and from other magnetometer stations. The event occurs similar to 20 minutes after...

  9. Demonstration of fold and cusp catastrophes in an atomic cloud reflected from an optical barrier in the presence of gravity

    CERN Document Server

    Rosenblum, Serge; Shomroni, Itay; Kaner, Roy; Arusi-Parpar, Talya; Raz, Oren; Dayan, Barak

    2013-01-01

    We experimentally demonstrate first-order (fold) and second-order (cusp) catastrophes in the density of an atomic cloud reflected from an optical barrier in the presence of gravity, and show their corresponding universal asymptotic behavior. The cusp point enables robust, field-free refocusing of an expanding atomic cloud with a wide velocity distribution. Specifically, the density attained at the cusp point in our experiment reached 65% of the peak density of the atoms in the trap prior to their release. We thereby add caustics to the various phenomena with parallels in optics that can be harnessed for manipulation of cold atoms. The structural stability of catastrophes provides inherent robustness against variations in the system's dynamics and initial conditions, making them suitable for manipulation of atoms under imperfect conditions and limited controllability.

  10. Two-Year Outcomes in Patients With Severe Aortic Valve Stenosis Randomized to Transcatheter Versus Surgical Aortic Valve Replacement

    DEFF Research Database (Denmark)

    Søndergaard, Lars; Steinbrüchel, Daniel Andreas; Ihlemann, Nikolaj

    2016-01-01

    BACKGROUND: The Nordic Aortic Valve Intervention (NOTION) trial was the first to randomize all-comers with severe native aortic valve stenosis to either transcatheter aortic valve replacement (TAVR) with the CoreValve self-expanding bioprosthesis or surgical aortic valve replacement (SAVR), inclu...... population. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01057173....

  11. Repair for acquired aortic valve disease.

    Science.gov (United States)

    Antunes, M J

    1996-10-01

    The favorable results of mitral valvuloplasty when compared with valve replacement have renewed the interest of many surgeons in aortic valve repair. However, these efforts have, for the most part, been unsuccessful. Also, the results of aortic valve replacement are usually better than those of mitral valve replacement. Yet, some patients appear to derive benefit from a conservative aortic valve procedure. The best examples are mild or moderate aortic valve disease associated with mitral valve or coronary artery disease, which constitute the primary indication for operation, where "prophylactic" aortic valve replacement does not appear justifiable. Other possible indications for aortic valvuloplasty includes patient's lack of compliance or contraindication to anticoagulation in young patients. Senile aortic stenosis, in very old patients with a small annulus, preserved leaflet morphology and nonsignificant commissural fusion should be considered for repair. However, since the procedure is not easily reproducible and the results not uniformly predictable, it cannot be recommended for generalized use. Nonetheless, experienced surgeons should be encouraged to continue these efforts.

  12. Aortic reconstruction with bovine pericardial grafts

    Directory of Open Access Journals (Sweden)

    Silveira Lindemberg Mota

    2003-01-01

    Full Text Available INTRODUCTION: Glutaraldehyde-treated crimped bovine pericardial grafts are currently used in aortic graft surgery. These conduits have become good options for these operations, available in different sizes and shapes and at a low cost. OBJECTIVE:To evaluate the results obtained with bovine pericardial grafts for aortic reconstruction, specially concerning late complications. METHOD: Between January 1995 and January 2002, 57 patients underwent different types of aortic reconstruction operations using bovine pericardial grafts. A total of 29 (50.8% were operated on an urgent basis (mostly acute Stanford A dissection and 28 electively. Thoracotomy was performed in three patients for descending aortic replacement (two patients and aortoplasty with a patch in one. All remaining 54 underwent sternotomy, cardiopulmonary bypass and aortic resection. Deep hypothermia and total circulatory arrest was used in acute dissections and arch operations. RESULTS: Hospital mortality was 17.5%. Follow-up was 24.09 months (18.5 to 29.8 months confidence interval and complication-free actuarial survival curve was 92.3% (standard deviation ± 10.6. Two patients lately developed thoracoabdominal aneurysms following previous DeBakey II dissection and one died from endocarditis. One "patch" aortoplasty patient developed local descending aortic pseudoaneurysm 42 months after surgery. All other patients are asymptomatic and currently clinically evaluated with echocardiography and CT scans, showing no complications. CONCLUSION: Use of bovine pericardial grafts in aortic reconstruction surgery is adequate and safe, with few complications related to the conduits.

  13. Multi-cusp ion source for doping process of flat panel display manufacturing

    Energy Technology Data Exchange (ETDEWEB)

    Inouchi, Yutaka, E-mail: inouchi-yutaka@nissin.co.jp; Matsumoto, Takeshi; Dohi, Shojiro; Tanii, Masahiro; Takahashi, Genki; Nishimura, Ippei; Tatemichi, Junichi; Konishi, Masashi; Naito, Masao [FPD Machine Business Center, Nissin Ion Equipment Co., Ltd., Shiga 528-0068 (Japan)

    2014-02-15

    We developed a multi-cusp ion source for Nissin ion doping system iG5 which is used in low temperature poly-crystalline silicon processes for flat panel display (FPD) manufacturing. In this ion source, BF{sub 3} or PH{sub 3} diluted H{sub 2} plasmas are produced and large area ribbon ion beams are extracted. In general, ion ratio of B{sup +} in BF{sub 3} plasma is much smaller than BF{sub 2}{sup +} in multi-cusp ion sources. We developed a new method to increase B{sup +} ratio and obtained mass analyzed B{sup +} target current of 130 mA. We employed newly improved multi-slot type electrodes for the beam extraction system and obtained stable beams with the uniformity of below 3%. In BF{sub 3} plasmas, several undesirable metal fluorides are produced in the plasma chamber and deposited on the electrode system, which cause glitches and poor beam uniformity. We introduce several cleaning methods.

  14. Research on traffic flow forecasting model based on cusp catastrophe theory

    Institute of Scientific and Technical Information of China (English)

    张亚平; 裴玉龙

    2004-01-01

    This paper intends to describe the relationship between traffic parameters by using cusp catastrophe theory and to deduce highway capacity and corresponding speed forecasting value through suitable transformation of catastrophe model. The five properties of a catastrophe system are outlined briefly, and then the data collected on freeways of Zhujiang River Delta, Guangdong province, China are examined to ascertain whether they exhibit qualitative properties and attributes of the catastrophe model. The forecasting value of speed and capacity for freeway segments are given based on the catastrophe model. Furthermore, speed-flow curve on freeway is drawn by plotting out congested and uncongested traffic flow and the capacity value for the same freeway segment is also obtained from speed-flow curve to test the feasibility of the application of cusp catastrophe theory in traffic flow analysis. The calculating results of catastrophe model coincide with those of traditional traffic flow models regressed from field observed data, which indicates that the deficiency of traditional analysis of relationship between speed, flow and occupancy in two-dimension can be compensated by analysis of the relationship among speed, flow and occupancy based on catastrophe model in three-dimension. Finally, the prospects and problems of its application in traffic flow research in China are discussed.

  15. Dark-Matter Halo Profiles of a General Cusp/Core with Analytic Velocity and Potential

    CERN Document Server

    Dekel, Avishai; Dutton, Aaron A; Maccio, Andrea V

    2016-01-01

    We present useful functions for the profiles of dark-matter (DM) haloes with a free inner slope, from cusps to cores, where the profiles of density, mass-velocity and potential are simple analytic expressions. Analytic velocity is obtained by expressing the mean density as a simple functional form, and deriving the local density by differentiation. The function involves four shape parameters, with only two or three free: a concentration parameter $c$, inner and outer asymptotic slopes $\\alpha$ and $\\bar{\\gamma}$, and a middle shape parameter $\\beta$. Analytic expressions for the potential and velocity dispersion exist for $\\bar{\\gamma}=3$ and $\\beta$ a natural number. We match the models to the DM haloes in cosmological simulations, with and without baryons, ranging from steep cusps to flat cores. Excellent fits are obtained with three free parameters ($c$, $\\alpha$, $\\bar{\\gamma}$) and $\\beta=2$. For an analytic potential, similar fits are obtained for $\\bar{\\gamma}=3$ and $\\beta=2$ with only two free parame...

  16. LS1 Report: A brand new set-up for ASACUSA-CUSP

    CERN Multimedia

    Antonella Del Rosso

    2014-01-01

    ASACUSA is running for the first time with a totally new set-up. Three new vital instruments have been designed, produced and installed during LS1 in addition to several other major modifications. The collaboration is now ready to perform the first high-precision measurement of the hyperfine structure of antihydrogen – a study that aims at comparing the inner properties of matter and antimatter.   The ASACUSA set-up. The ASACUSA-CUSP collaboration comprises about 30 scientists from various institutes in Europe and Japan. Because of the Japanese contribution, the experiment is often known by its Japanese pronunciation, the experiment’s logo is in Japanese, and the logbook uses Japanese time! This year, for the first time, the experiment is running with a completely new set-up, which now includes a new superconducting double cusp magnet, a new tracking detector and a new final antihydrogen detector. “The magnet is the heart of the ASACUSA experiment,” expl...

  17. Cluster observations of magnetic field fluctuations in the high-altitude cusp

    Directory of Open Access Journals (Sweden)

    K. Nykyri

    2004-07-01

    Full Text Available High-resolution (22 vector/s magnetic field data from Cluster FGM instrument are presented for the high-altitude cusp crossing on 17 March 2001. Despite the quiet solar wind conditions, the cusp was filled with magnetic field turbulence for much of the crossing. Large-scale fluctuations show some correlation between spacecraft but the higher frequency fluctuations show no correlation, indicating that the length scales of these waves are smaller than the spacecraft separation (500km. In many intervals, there are clear peaks in the wave power around the ion cyclotron frequency (~1Hz, and there is some evidence for waves at the first harmonic of this frequency. Both left- and right-hand polarised waves are found, with angles of propagation with respect to the ambient magnetic field that range from parallel to perpendicular. The regions of enhanced magnetic field fluctuations appear to be associated with plasma flows possibly originating from a lobe reconnection site. The most coherent, long lasting wave trains with frequencies close to local ion cyclotron frequency occur at a boundary between a sheared flow and a stagnant plasma.

  18. Cluster observations of bounday layer structure and a flux transfer event near the cusp

    Directory of Open Access Journals (Sweden)

    R. C. Fear

    2005-10-01

    Full Text Available On the 25th January 2002 between 10:00 and 12:00 UT, the four Cluster spacecraft passed through the northern high-latitude cusp, the dayside magnetosphere and into the magnetosheath in a linear formation. In the magnetosphere the PEACE electron spectrometers on the four spacecraft all observed a series of transient bursts of magnetosheath-like plasma, but without bipolar magnetic signatures in the magnetopause normal component as might be expected if the plasma had been injected by transient reconnection (flux transfer events – FTEs. Reordering the data using the magnetopause transition parameter reveals that these plasma observations, the related variations in the magnetic field and the balance of magnetic and thermal gas pressures are consistent with transient entries into a stable high-latitude boundary layer structure. However, once some of the spacecraft entered the magnetosheath, FTE signatures were observed outside the magnetopause at the same time as some of the boundary layer entries occurred at the other spacecraft inside. Thus, (a the lack of a bipolar BN signature is inconsistent with the traditional picture of a magnetospheric FTE, and (b the cause of the observed entry of the spacecraft into the boundary layer (pressure pulse or passing magnetosheath FTE can only be determined by spacecraft observations in the magnetosheath.

    Keywords. Magnetospheric physics (Magnetopause, cusp and bondary layers; Solar wind- magnetosphere interactions; Magnetosheath

  19. Cusp-shaped Structure of a Jet Observed By IRIS and SDO

    Science.gov (United States)

    Zhang, Yuzong; Zhang, Jun

    2017-01-01

    On 2014 August 29, the trigger and evolution of a cusp-shaped jet were captured in detail at 1330 Å by the Interface Region Imaging Spectrograph. At first, two neighboring mini-prominences arose in turn from the low solar atmosphere and collided with a loop-like system over them. The collisions between the loop-like system and the mini-prominences lead to the blowout, and then a cusp-shaped jet formed with a spire and an arch-base. In the spire, many brightening blobs originating from the junction between the spire and the arch-base moved upward in a rotating manner and then in a straight line in the late phase of the jet. In the arch-base, dark and bright material simultaneously tracked in a fan-like structure, and the majority of the material moved along the fan's threads. At the later phase of the jet's evolution, bidirectional flows emptied the arch-base, while downflows emptied the spire, thus making the jet entirely vanish. The extremely detailed observations in this study shed new light on how magnetic reconnection alters the inner topological structure of a jet and provides a beneficial complement for understanding current jet models.

  20. NATO Advanced Research Workshop on The Morphology and Dynamics of the Polar Cusp

    CERN Document Server

    Egeland, Alv

    1985-01-01

    These proceedings are based upon introductory talks, research reports and discussions from the NATO Advanced Workshop on the "Morphology and Dynamics of the Polar Cusp", held at Lillehammer, Norway, 7-12 May, 1984. The upper atmosphere at high latitudes is called the "Earth's win­ dow to outer space". Through various electrodynamic coupling process­ es as well as through direct transfer of particles many geophysical effects displayed there are direct manifestations of phenomena occurring in the deep space. The high latitude ionosphere will also exert a feedback on the regions of the magnetosphere and atmosphere to which it is coupled, acting as a momentum and energy source and sink, and a source of particles. Of particular interest are the sections of the near space known as the Polar Cusp. A vast portion of the earth's magnetic field envelope is electrically connected to these regions. This geometry results in a spatial mapping of the magnetospheric pro­ cesses and a focusing on to the ionosphere. In the ...

  1. Cusp-shaped structure of a jet observed by IRIS and SDO

    CERN Document Server

    Yuzong, Zhang

    2016-01-01

    On 29 August 2014, the trigger and evolution of a cusp-shaped jet were captured in detail at 1330 {\\AA} by the Interface Region Imaging Spectrograph.At first, two neighboring mini-prominences arose in turn from low solar atmosphere and collided with a loop-like system over them. The collisions between the loop-like system and the mini-prominences lead to the blowout and then a cusp-shaped jet formed with a spire and an arch-base. In the spire, many brightening blobs originating from the junction between the spire and the arch-base, moved upward in a rotating manner and then in a straight line in the late phase of the jet. In the arch-base, dark and bright material simultaneously tracked in a fan-like structure and the majority of the material moved along the fan's threads. At the later phase of the jet's evolution, bidirectional flows emptied the arch-base, while down-flows emptied the spire, thus making the jet entirely vanish. The extremely detailed observations in this study shed new light on how magnetic ...

  2. Optical Observation of Oxygen Ion Upflow in the Cusp/Cleft Region

    Science.gov (United States)

    Tashiro, S.; Yamazaki, A.; Yoshikawa, I.; Takizawa, Y.; Ogawa, Y.; Miyake, W.; Nakamura, M.

    2002-12-01

    We built the Extreme ultraviolet scanner (XUV) for imaging oxygen ions to outflow from the polar ionosphere into the magnetosphere. The XUV onboard a sounding rocket SS-520-2 imaged the oxygen ions above 1000 km altitude near the polar cusp on December 4, 2000. The XUV is a normal incidence telescope that has a peak sensitivity at the wavelength 83.4 nm of OII emission and consists of a Mo coated mirror, a band pass filter and a channel electron multiplier. The band pass filter selectively transmits OII emission and eliminates background emissions such as HeI emission at the 30.4 nm, HeII emission at the 58.4 nm, and HI emission at the 121.6 nm. The observed OII emission intensity is proportional to the ion density integrated along the line of sight. Therefore the observed OII emission intensity distribution makes possible to determine the oxygen ion distribution. After 0928UT, the sudden increase in the OII emission intensity was observed from the cusp region identified by the radar observation. In this presentation, we will discuss the cause of the sudden increase in the OII emission intensity in comparison with the result of ground-based observations.

  3. In vivo behavior of epoxy-crosslinked porcine heart valve cusps and walls

    NARCIS (Netherlands)

    van Wachem, PB; Brouwer, LA; Zeeman, R; Dijkstra, PJ; Feijen, J; Hendriks, M; Cahalan, PT; van Luyn, MJA

    2000-01-01

    Calcification limits the long-term durability of xenograft glutaraldehyde-crosslinked heart valves. In this study, epoxy-crosslinked porcine aortic valve tissue was evaluated after subcutaneous implantation in weanling rats, Non-crosslinked valves and valves crosslinked with glutaraldehyde or carbod

  4. Hybrid treatment of recurring thoracoabdominal aortic aneurysm concomitant with retrograde type A aortic dissection

    Institute of Scientific and Technical Information of China (English)

    ZHANG Min-hong; GUO Wei; DU Xin; XIONG Jiang

    2010-01-01

    So far, standard therapy of complex thoracoabdominal aortic disease is open surgical repair requiring aortic clamping and replacement of the involved segment.Despite significant improvements, morbidity and mortality of open surgery remain high.I As a result, open surgery is often withheld owing to severe comorbidities of the patients. Endovascular technique has emerged as an alternative for treatment of these diseases in high risk patients,2 and has enlarged the options of treatment of complex aortic diseases. However, an endovascular approach alone is often deemed unsuitable for some complex aortic disorders because of the close proximity of the supraaortic or visceral branches. A hybrid open-endovascular approach has therefore been proposed as a viable alternative. We present here a unique patient with recurring thoracoabdominal aortic aneurysm (TAAA) concomitant with an aortic dissection (AD) treated by a hybrid open-endovascular approach.

  5. Valvular Aortic Stenosis: A Proteomic Insight

    Directory of Open Access Journals (Sweden)

    Fernando Vivanco

    2010-02-01

    Full Text Available Calcified aortic valve disease is a slowly progressive disorder that ranges from mild valve thickening with no obstruction of blood flow, known as aortic sclerosis, to severe calcification with impaired leaflet motion or aortic stenosis. In the present work we describe a rapid, reproducible and effective method to carry out proteomic analysis of stenotic human valves by conventional 2-DE and 2D-DIGE, minimizing the interference due to high calcium concentrations. Furthermore, the protocol permits the aortic stenosis proteome to be analysed, advancing our knowledge in this area. Summary: Until recently, aortic stenosis (AS was considered a passive process secondary to calcium deposition in the aortic valves. However, it has recently been highlighted that the risk factors associated with the development of calcified AS in the elderly are similar to those of coronary artery disease. Furthermore, degenerative AS shares histological characteristics with atherosclerotic plaques, leading to the suggestion that calcified aortic valve disease is a chronic inflammatory process similar to atherosclerosis. Nevertheless, certain data does not fit with this theory making it necessary to further study this pathology. The aim of this study is to develop an effective protein extraction protocol for aortic stenosis valves such that proteomic analyses can be performed on these structures. In the present work we have defined a rapid, reproducible and effective method to extract proteins and that is compatible with 2-DE, 2D-DIGE and MS techniques. Defining the protein profile of this tissue is an important and challenging task that will help to understand the mechanisms of physiological/pathological processes in aortic stenosis valves.

  6. A study of the singularity locus in the joint space of planar parallel manipulators: special focus on cusps and nodes

    CERN Document Server

    Zaiter, Abdel Kader; Chablat, Damien

    2011-01-01

    Cusps and nodes on plane sections of the singularity locus in the joint space of parallel manipulators play an important role in nonsingular assembly-mode changing motions. This paper analyses in detail such points, both in the joint space and in the workspace. It is shown that a cusp (resp. a node) defines a point of tangency (resp. a crossing point) in the workspace between the singular curves and the curves associated with the so-called characteristics surfaces. The study is conducted on a planar 3-RPR manipulator for illustrative purposes.

  7. Mycotic Aneurysm of the Aortic Arch

    Directory of Open Access Journals (Sweden)

    Ji Hye Seo

    2014-08-01

    Full Text Available A mycotic aneurysm of the thoracic aorta is rare. We report a case of mycotic aneurysm that developed in the aortic arch. An 86-year-old man was admitted with fever and general weakness. Blood culture yielded methicillin-resistant Staphylococcus aureus. Chest X-ray showed an enlarged aortic arch, and computed tomography scan revealed an aneurysm in the aortic arch. The patient was treated only with antibiotics and not surgically. The size of the aneurysm increased rapidly, resulting in bronchial obstruction and superimposed pneumonia. The patient died of respiratory failure.

  8. The future of aortic surgery in Europe

    DEFF Research Database (Denmark)

    Czerny, Martin; Bachet, Jean; Bavaria, Joseph;

    2012-01-01

    the interested reader with an overview of how aortic surgery and (perhaps more accurately) aortic medicine has evolved in Europe, and its present standing; also to provide a glimpse into the future, trying to disseminate the thoughts of a group of people actively involved in the development of aortic medicine......At least every ten years, each specialty should reflect upon its past, its present and its future, in order to be able to reconfirm the direction in which it is headed, to adopt suggestions from inside and outside and, consequently, to improve. As such, the aim of this manuscript is to provide...

  9. Stent graft implantation in an aortic pseudoaneurysm associated with a fractured Cheatham-Platinum stent in aortic coarctation.

    Science.gov (United States)

    Kuhelj, Dimitrij; Berden, Pavel; Podnar, Tomaž

    2016-03-01

    We report a case of aortic pseudoaneurysm associated with a fractured bare Cheatham-Platinum stent following stenting for aortic coarctation. These complications were recognised 6 years after the implantation procedure and were successfully managed by percutaneous stent graft implantation. Staged approach for stent dilatation might prevent development of aortic pseudoaneurysms. In addition, careful follow-up is warranted after stenting for aortic coarctation, particularly in patients with recognised aortic wall injury.

  10. Patient-prosthesis mismatch: surgical aortic valve replacement versus transcatheter aortic valve replacement in high risk patients with aortic stenosis.

    Science.gov (United States)

    Ghanta, Ravi K; Kron, Irving L

    2016-10-01

    Patient prosthesis mismatch (PPM) can occur when a prosthetic aortic valve has an effective orifice area (EOA) less than that of a native valve. A recent study by Zorn and colleagues evaluated the incidence and significance of PPM in high risk patients with severe aortic stenosis who were randomized to transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). TAVR is associated with decreased incidence of severe PPM compared to traditional SAVR valves. Severe PPM increases risk for death at 1 year postoperatively in high risk patients. The increased incidence of PPM is largely due to differences in valve design and should encourage development of newer SAVR valves to reduce risk for PPM. In addition more vigorous approaches to root enlargement in small annulus should be performed with SAVR to prevent PPM.

  11. An implantable aortic valvo-pump for destination therapy.

    Science.gov (United States)

    Qian, Kun-Xi

    2006-03-01

    To investigate the possibility of a long-term applicable left ventricular assist device, a 23 mm outer diameter and 31 g weight implantable aortic valvo-pump was developed. It consists of a rotor and a stator; the rotor has a driven magnets assemble and an impeller, the stator has a motor coil with iron core and a outflow guide vane. The device locates the position of aortic valve, delivers the blood directly from left ventricle to aorta. Neither connecting conduits nor "bypass" circuits are necessary. Therefore, the device has promisingly better antithrombogenicity than other heart pumps. In hemodynamic testing, the pump can produce a blood flow of 7 l/min volume with 50 mmHg pressure increase at 15,000 rpm rotating speed, and at zero flow rate the pump can maintain a diastolic pressure over 80 mmHg at same rotating speed. For further studies the blood compatibility and the durability of the device are of most importance.

  12. Dissecting aortic aneurysm in maintenance hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Ounissi M

    2009-01-01

    Full Text Available The dissecting aortic aneurysm (DAA is a rare pathology that may result in fatal outcome. We report follow up of three cases of DAA patients undergoing maintenance hemo-dialysis who were managed conservatively.

  13. Valve selection in aortic valve endocarditis

    Science.gov (United States)

    Zubrytska, Yana

    2016-01-01

    Aortic prosthetic valve endocarditis (PVE) is a potentially life-threatening disease. Mortality and incidence of infective endocarditis have been reduced in the past 30 years. Medical treatment of aortic PVE may be successful in patients who have a prompt response after antibiotic treatment and who do not have prosthetic dysfunction. In advanced stages, antibiotic therapy alone is insufficient to control the disease, and surgical intervention is necessary. Surgical treatment may be lifesaving, but it is still associated with considerable morbidity and mortality. The aim of surgery is to perform a radical excision of all infected and necrotic tissue, reconstruction of the left ventricle outflow tract, and replacement of the aortic valve. There is no unanimous consensus on which is the optimal prosthesis to implant in this context, and several surgical techniques have been suggested. We aim to analyze the efficacy of the surgical treatment and discuss the issue of valve selection in patients with aortic valve endocarditis.

  14. Type B Aortic Dissection: Management Updates

    Directory of Open Access Journals (Sweden)

    Naghmeh Moshtaghi

    2009-12-01

    Full Text Available Acute aortic dissection (AAD is the most frequent catastrophic event of the aorta; it occurs nearly three times as frequently as the rupture of abdominal aortic aneurysm. Sixty percent of dissection cases are classified as proximal or type A and 40% as distal or type B, according to the Stanford Classification. The most frequent causes of death in acute type B dissection are aortic rupture and malperfusion syndrome.We herein review recent data suggesting different management modalities of type B aortic dissection, including medical, surgical, and endovascular treatments. Although medical therapy is still the standard approach in uncomplicated cases, there are subgroups of patients who may benefit from endovascular management. Endovascular techniques or surgery are valuable options for complicated cases. Hybrid suites, multidisciplinary approaches, and good imaging techniques can be considered as the key to success in this regard.

  15. Medical image of the week: aortic ring

    Directory of Open Access Journals (Sweden)

    Wong C

    2014-10-01

    Full Text Available No abstract available. Article truncated after 150 words. A 78 year old man presented with altered mental status and was found to have an intraventricular hemorrhage. He was intubated for airway protection. On the post-intubation chest radiograph (Figure 1, the patient was noted to have a widening of the right paratracheal stripe. A CT chest (Figure 2 was obtained to characterize this finding and revealed an aortic ring which encircles the trachea and esophagus. Vascular rings are uncommon congenital abnormalities, accounting for approximately 1% of congenital heart disease. Complete vascular rings can occur with a right aortic arch with a ligamentum arteriosum or with a double aortic arch, such as with our patient (1. This ring can cause airway compression, stridor, esophageal compression, or no symptoms at all. As the embryo develops, the left fourth pharyngeal arch normally persists to become the aortic arch while the right fourth pharyngeal arch regresses. If both fourth pharyngeal arches persist, a ...

  16. Global Strain in Severe Aortic Valve Stenosis

    DEFF Research Database (Denmark)

    Dahl, Jordi S; Videbæk, Lars; Poulsen, Mikael K

    2012-01-01

    BACKGROUND: -Global longitudinal systolic strain (GLS) is often reduced in aortic stenosis despite normal ejection fraction. The importance of reduced preoperative GLS on long-term outcome after aortic valve replacement (AVR) is unknown. METHODS AND RESULTS: -A total of 125 patients with severe...... aortic stenosis and ejection fraction >40% scheduled for AVR were evaluated preoperatively and divided into 4 groups according to GLS quartiles. Patients were followed up for 4 years. The primary endpoint was major adverse cardiac events (MACE) defined as cardiovascular mortality and cardiac......Score, history with ischemic heart disease and ejection fraction. CONCLUSIONS: -In patients with symptomatic severe aortic stenosis undergoing AVR reduced GLS provides important prognostic information beyond standard risk factors. Clinical Trial Registration-URL: http://www.clinicaltrial.gov. Unique identifier...

  17. Minimally Invasive Transcatheter Aortic Valve Replacement (TAVR)

    Medline Plus

    Full Text Available Watch a Broward Health surgeon perform a minimally invasive Transcatheter Aortic Valve Replacement (TAVR) Click Here to view the BroadcastMed, Inc. Privacy Policy and Legal Notice © 2017 BroadcastMed, Inc. ...

  18. Cusp-latitude Pc3 spectra: band-limited and power-law components

    Directory of Open Access Journals (Sweden)

    P. V. Ponomarenko

    Full Text Available This work attempts to fill a gap in comparative studies of upstream-generated Pc3–4 waves and broad band ULF noise observed at cusp latitudes. We performed a statistical analysis of the spectral properties of three years of cusp-latitude ground magnetometer data, finding that the average daytime Pc3–4 spectra are characterized by two principal components: an upstream-related band-limited enhancement (‘signal’ and a power-law background (‘noise’ with S(f a  f -4 . Based on this information we developed an algorithm allowing for the deconvolution of these two components in the spectral domain. The frequency of the signal enhancement increases linearly with IMF magnitude as f [mHz] ~ 4.4 | BIMF | [nT], and its power maximizes around IMF cone angles qxB ~ 20 and 160° and at 10:30–11:00 MLT. Both spectral components exhibit similar semiannual variations with equinoctial maxima. The back-ground noise power grows with increasing southward Bz and remains nearly constant for northward Bz . Its diurnal variation resembles that of Pc5 field-line resonance power, with a maximum near 09:00 MLT. Both the band-limited signal and broad band noise components show power-law growth with solar wind velocity a V 5.71sw and a V 4.12sw, respectively. Thus, the effective signal-to-noise ratio increases with in-creasing Vsw. The observations suggest that the noise generation is associated with reconnection processes.

    Key words. Magnetospheric physics (magnetopause, cusp, and boundary layers; MHD waves and instabilities; solar wind magnetosphere interactions

  19. Ionospheric cusp flows pulsed by solar wind Alfvén waves

    Directory of Open Access Journals (Sweden)

    P. Prikryl

    Full Text Available Pulsed ionospheric flows (PIFs in the cusp foot-print have been observed by the SuperDARN radars with periods between a few minutes and several tens of minutes. PIFs are believed to be a consequence of the interplanetary magnetic field (IMF reconnection with the magnetospheric magnetic field on the dayside magnetopause, ionospheric signatures of flux transfer events (FTEs. The quasiperiodic PIFs are correlated with Alfvénic fluctuations observed in the upstream solar wind. It is concluded that on these occasions, the FTEs were driven by Alfvén waves coupling to the day-side magnetosphere. Case studies are presented in which the dawn-dusk component of the Alfvén wave electric field modulates the reconnection rate as evidenced by the radar observations of the ionospheric cusp flows. The arrival of the IMF southward turning at the magnetopause is determined from multipoint solar wind magnetic field and/or plasma measurements, assuming plane phase fronts in solar wind. The cross-correlation lag between the solar wind data and ground magnetograms that were obtained near the cusp footprint exceeded the estimated spacecraft-to-magnetopause propagation time by up to several minutes. The difference can account for and/or exceeds the Alfvén propagation time between the magnetopause and ionosphere. For the case of short period ( < 13 min PIFs, the onset times of the flow transients appear to be further delayed by at most a few more minutes after the IMF southward turning arrived at the magnetopause. For the case of long period (30 – 40 min PIFs, the observed additional delays were 10–20 min. We interpret the excess delay in terms of an intrinsic time scale for reconnection (Russell et al., 1997 which can be explained by the surface-wave induced magnetic reconnection mechanism (Uberoi et al., 1999. Here, surface waves with wavelengths larger than the thickness of the neutral layer induce a tearing-mode instability whose rise time explains the

  20. Complete interruption of the aortic arch

    Energy Technology Data Exchange (ETDEWEB)

    Park, Sung Hak; Park, In Kyu; Lee, Won Hwa; Kim, Yong Joo; Kang, Duk Sik; Lee, Jong Tae [Kyungpook National University College of Medicine, Taegu (Korea, Republic of)

    1984-09-15

    Complete interrupture of the aortic arch is one of the least common cardiac malformation. In this condition, continuity between the ascending and descending protions of the aorta is not present, and the descending aorta is supplied through a reversing patent ductus arteriosus. In the majority of the patients a ventricular septal defect is present. Authors have experienced a case of the complete interruption of aortic arch, interruption between the left carotid and the left subclavian artery.

  1. Effect of age on aortic atherosclerosis

    Institute of Scientific and Technical Information of China (English)

    Michael A. Chen; Miwa Kawakubo; Patrick M. Colletti; Dongxiang Xu; Laurie LaBree Dustin; Robert Detrano; Stanley P Azen; Nathan D. Wong; Xue-Qiao Zhao

    2013-01-01

    Objective To examine the association of atherosclerosis burden in the survivors of an asymptomatic elderly cohort study and its relationship to other coronary risk factors (specifically, age) by evaluating aortic atherosclerotic wall burden by magnetic resonance imaging (MRI). Methods A total of 312 participants in an ongoing observational cohort study underwent cardiac and descending thoracic aorta imaging by MRI. Maximum wall thickness was measured and the mean wall thickness calculated. Wall/outer wall ratio was used as a normalized wall index (NWI) adjusted for artery size difference among participants. Percent wall volume (PWV) was calculated as NWI × 100. Results In this asymptomatic cohort (mean age: 76 years), the mean (SD) aortic wall area and wall thickness were 222 ± 45 mm2 and 2.7 ± 0.4 mm, respectively. Maximum wall thickness was 3.4 ± 0.6 mm, and PWV was 32% ± 4%. Women appeared to have smaller wall area, but after correcting for their smaller artery size, had significantly higher PWV than men (P = 0.03). Older age was associated with larger wall area (P = 0.04 for trend) with similar PWVs. However, there were no statistically significant associations between standard risk factors, Framingham global risk, or metabolic syndrome status, therapy for cholesterol or hypertension, coronary or aortic calcium score, and the aortic wall burden. Aortic calcification was associated with coronary calcification. Conclusions Asymptomatic elderly in this cohort had a greater descending thoracic aortic wall volume that correlated with age, and women had a significantly increased PWV compared to men. In these survivors, the atherosclerotic aortic wall burden was not significantly associated with traditional risk factors or with coronary or aortic calcium scores or coronary calcium progression. Results suggest that age, or as yet unidentified risk factor(s), may be responsible for the increase in atherosclerosis.

  2. Aortic coarctation repair in the adult.

    Science.gov (United States)

    Cardoso, Goncalo; Abecasis, Miguel; Anjos, Rui; Marques, Marta; Koukoulis, Giovanna; Aguiar, Carlos; Neves, José Pedro

    2014-07-01

    Aortic coarctation can be repaired surgically or percutaneously. The decision should be made according to the anatomy and location of the coarctation, age of the patient, presence of other cardiac lesions, and other anatomic determinants (extensive collaterals or aortic calcification). This article reviews the different therapeutic options available, explaining the differences between children and adults, describing different approaches to the same disease, exemplified by three cases of nonclassic surgical approach and one percutaneous treatment.

  3. Aortic Dissection Cases Presenting with Neurological Deficit

    Directory of Open Access Journals (Sweden)

    Sibel Mumcu

    2014-06-01

    Full Text Available Aortic dissection can be fatal in case of underdiagnosis, and early treatment is essential for the survival. Although acute onset of chest or back pain is most common presenting symptoms, some patients might present with atypical findings such as acute stroke, mesenteric ischaemia, renal failure or myocardial infarction. Here, we report two cases presenting emergency room with atypical findings of aortic dissection which diagnosis is made during etiologic work up for ischemic stroke.

  4. Surveillance intervals for small abdominal aortic aneurysms

    DEFF Research Database (Denmark)

    Bown, Matthew J; Sweeting, Michael J; Brown, Louise C

    2013-01-01

    Small abdominal aortic aneurysms (AAAs [3.0 cm-5.4 cm in diameter]) are monitored by ultrasound surveillance. The intervals between surveillance scans should be chosen to detect an expanding aneurysm prior to rupture.......Small abdominal aortic aneurysms (AAAs [3.0 cm-5.4 cm in diameter]) are monitored by ultrasound surveillance. The intervals between surveillance scans should be chosen to detect an expanding aneurysm prior to rupture....

  5. Cusp deflection, infraction and fracture in endodontically treated teeth filled with three temporary filling materials (in vitro

    Directory of Open Access Journals (Sweden)

    Ali Eskandarizade

    2015-12-01

    Full Text Available Aim: the aim of this study was to compare cusp deflection, infraction and fracture in teeth filled with three temporary filling materials. Materials & method: Forty five extracted human premolar teeth were chosen. After root canal therapy and mesio-occluso-distal cavity preparation, samples were randomly divided into three groups , each contained 15 teeth and filled with three temporary filling materials: Cavisol (Golchai-Iran, Coltosol F (Coltene,Swiss and Coltene (Ariadent,Iran. Teeth were kept in normal saline at room temperature and every day the intercuspal distance was measured under stereomicroscope for 20 days. Infractions as well as fractures were also noted. Data were analyzed in SPSS 17 using Repeated measurement ANOVA test to evaluate the intercuspal distance and expansion of each sample every day. Results: Intercuspal distance increased in all three groups but was significantly more in Coltosol F group. On the days 10 and 16 two teeth filled with Coltosol F had cusp fracture. Conclusion: Temporary filling materials have hygroscopic expansion and cause cusp deflection which may lead to cusp fracture, so it is recommended to use them in short period of time.

  6. Direct measurement of the plasma loss width in an optimized, high ionization fraction, magnetic multi-dipole ring cusp

    Science.gov (United States)

    Cooper, C. M.; Weisberg, D. B.; Khalzov, I.; Milhone, J.; Flanagan, K.; Peterson, E.; Wahl, C.; Forest, C. B.

    2016-10-01

    The loss width of plasma in the WiPAL multi-dipole magnetic ring cusp [Cooper et al., Phys. Plasmas 21, 13505 (2014); Forest et al., J. Plasma Phys. 81, 345810501 (2015)] has been directly measured using a novel array of probes embedded in the insulating plasma limiters. The large plasma volume ( ˜10 m3), small loss area associated with strong rare earth permanent magnets ( Bo˜2.23 kG at face), and large heating power ( ≤200 kW) produces a broad range of electron temperatures ( 2 magnetic fields, differs from previous devices: the cusp loss width is much larger than the Debye length and electron gyroradius and comparable to the collision length. Plasma parameters measured at the surface of ceramic limiter tiles covering the magnets and along radial chords in the cusp magnetic field indicate that electron density and temperature are nearly constant on magnetic field lines and that the mirror forces play little role in confining the plasma other than to constrict the loss area. Particle balance modeling is used to determine the cross field diffusion coefficient base on the measured losses to the limiters. The experimentally determined cross field diffusion coefficient (which determines the cusp loss width) is consistent with ambipolar diffusion across five orders of magnitude. The ambipolar diffusion across a given field line is set primarily by the electron-neutral collisions in the region where the magnetic field is the weakest, even though these plasmas can have ionization fractions near 1.

  7. On the contribution of thermal excitation to the total 630.0 nm emissions in the northern cusp ionosphere

    Science.gov (United States)

    Kwagala, Norah Kaggwa; Oksavik, Kjellmar; Lorentzen, Dag A.; Johnsen, Magnar G.

    2017-01-01

    Direct impact excitation by precipitating electrons is believed to be the main source of 630.0 nm emissions in the cusp ionosphere. However, this paper investigates a different source, 630.0 emissions caused by thermally excited atomic oxygen O(1D) when high electron temperature prevail in the cusp. On 22 January 2012 and 14 January 2013, the European Incoherent Scatter Scientific Association (EISCAT) radar on Svalbard measured electron temperature enhancements exceeding 3000 K near magnetic noon in the cusp ionosphere over Svalbard. The electron temperature enhancements corresponded to electron density enhancements exceeding 1011 m-3 accompanied by intense 630.0 nm emissions in a field of view common to both the EISCAT Svalbard radar and a meridian scanning photometer. This offered an excellent opportunity to investigate the role of thermally excited O(1D) 630.0 nm emissions in the cusp ionosphere. The thermal component was derived from the EISCAT Radar measurements and compared with optical data. For both events the calculated thermal component had a correlation coefficient greater than 0.8 to the total observed 630.0 nm intensity which contains both thermal and particle impact components. Despite fairly constant solar wind, the calculated thermal component intensity fluctuated possibly due to dayside transients in the aurora.

  8. Aortic events in a nationwide Marfan syndrome cohort

    DEFF Research Database (Denmark)

    Groth, Kristian A; Krag, Kirstine Stochholm; Hove, Hanne;

    2016-01-01

    BACKGROUND: Marfan syndrome is associated with morbidity and mortality due to aortic dilatation and dissection. Preventive aortic root replacement has been the standard treatment in Marfan syndrome patients with aortic dilatation. In this study, we present aortic event data from a nationwide Marfan...... syndrome cohort. METHOD: The nationwide cohort of Danish Marfan syndrome patients was established from the Danish National Patient Registry and the Cause of Death Register, where we retrieved information about aortic surgery and dissections. We associated aortic events with age, sex, and Marfan syndrome...

  9. Generic expansion of the Jastrow correlation factor in polynomials satisfying symmetry and cusp conditions

    Energy Technology Data Exchange (ETDEWEB)

    Lüchow, Arne, E-mail: luechow@rwth-aachen.de [Institute of Physical Chemistry, RWTH Aachen University, 52056 Aachen (Germany); Jülich Aachen Research Alliance (JARA-HPC), 52056 Aachen (Germany); Sturm, Alexander; Schulte, Christoph; Haghighi Mood, Kaveh [Institute of Physical Chemistry, RWTH Aachen University, 52056 Aachen (Germany)

    2015-02-28

    Jastrow correlation factors play an important role in quantum Monte Carlo calculations. Together with an orbital based antisymmetric function, they allow the construction of highly accurate correlation wave functions. In this paper, a generic expansion of the Jastrow correlation function in terms of polynomials that satisfy both the electron exchange symmetry constraint and the cusp conditions is presented. In particular, an expansion of the three-body electron-electron-nucleus contribution in terms of cuspless homogeneous symmetric polynomials is proposed. The polynomials can be expressed in fairly arbitrary scaling function allowing a generic implementation of the Jastrow factor. It is demonstrated with a few examples that the new Jastrow factor achieves 85%–90% of the total correlation energy in a variational quantum Monte Carlo calculation and more than 90% of the diffusion Monte Carlo correlation energy.

  10. New results on structure of low beta confinement Polywell cusps simulated by comsol multiphysics

    Science.gov (United States)

    Mahdavipour, B.; Salar Elahi, A.

    The Inertial electrostatic confinement (IEC) is one of the ways for fusion approaches. It is one of the various methods which can be used to confine hot fusion plasma. The advantage of IEC is that the IEC experiments could be done in smaller size facilities than ITER or NIF, costing less money and moving forward faster. In IEC fusion, we need to trap adequate electrons to confine the desired ion density which is needed for a fusion reactor. Polywell is a device which uses the magnetic cusp system and traps the required amount of electrons for fusion reactions. The purpose of this device is to create a virtual cathode in order to achieve nuclear fusion using inertial electrostatic confinement (Miley and Krupakar Murali, 2014). In this paper, we have simulated the low beta Polywell. Then, we examined the effects of coil spacing, coils current, electron injection energy on confinement time.

  11. Countering the stray magnetic field of the CUSP trap by using additional coils

    CERN Document Server

    Thole, Jelle

    2016-01-01

    The ASACUSA experiment at the Antiproton Decelerator (AD) at CERN tries to measure the Hyperfine Structure (HFS) of Antihydrogen (H ̄) using a Rabi spectroscopy set-up. In measuring this HFS it will yield a very precise test of CPT-symmetry. For this set-up to work a homogeneous magnetic field is needed in the cavity where the Hyperfine transition of H ̄ occurs. Due to the stray fields from the CUSP trap, where H ̄ is produced, additional coils are needed to counter these fields. It is found, using COMSOL simulations, that two coils are suitable for this. Leading to a relative standard deviation of the magnetic field of σB/B = 1.06%.

  12. Polar patches observed by ESR and their possible origin in the cusp region

    Directory of Open Access Journals (Sweden)

    A. M. Smith

    Full Text Available Observations by the EISCAT Svalbard radar in summer have revealed electron density enhancements in the magnetic noon sector under conditions of IMF Bz southward. The features were identified as possible candidates for polar-cap patches drifting anti-Sunward with the plasma flow. Supporting measurements by the EISCAT mainland radar, the CUTLASS radar and DMSP satellites, in a multi-instrument study, suggested that the origin of the structures lay upstream at lower latitudes, with the modulation in density being attributed to variability in soft-particle precipitation in the cusp region. It is proposed that the variations in precipitation may be linked to changes in the location of the reconnection site at the magnetopause, which in turn results in changes in the energy distribution of the precipitating particles.

    Key words: Ionosphere (ionosphere-magnetosphere interactions; plasma temperature and density; polar ionosphere

  13. Transcatheter Aortic Valve Replacement With Early- and New-Generation Devices in Bicuspid Aortic Valve Stenosis

    DEFF Research Database (Denmark)

    Yoon, Sung-Han; Lefèvre, Thierry; Ahn, Jung-Ming

    2016-01-01

    BACKGROUND: Few studies have evaluated the clinical outcomes of transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valve stenosis (AS). Particularly, limited data exist comparing the results of TAVR with new-generation devices versus early-generation devices. OBJECTIVE...

  14. Arterial elastance and heart-arterial coupling in aortic regurgitation are determined by aortic leak severity

    NARCIS (Netherlands)

    Segers, P; Morimont, P; Kolh, P; Stergiopulos, N; Westerhof, N; Verdonck, P

    2002-01-01

    Background In aortic valve regurgitation (AR), aortic leak severity modulates left ventricle (LV) arterial system interaction. The aim of this study was to assess (1) how arterial elastance (E-a), calculated as the ratio of LV end-systolic pressure and stroke volume, relates to arterial properties a

  15. Repositioning of an Intraventricular Dislocated Aortic Valve during Transcatheter Aortic Valve Implantation

    NARCIS (Netherlands)

    Natour, Ehsan; Douglas, Yvonne L.; Jainandunsing, Jayant S.; Schurer, Remco A. J.; van der Werf, Hendrik W.; van den Heuvel, Ad F. M.

    2014-01-01

    The case is presented of a 75-year-old man referred for transcatheter aortic valve implantation. During the procedure the prosthetic aortic valve became dislocated into the left ventricle shortly after expansion. The subsequent steps taken to reposition the valve using only materials at hand are des

  16. Effect of candesartan treatment on left ventricular remodeling after aortic valve replacement for aortic stenosis

    DEFF Research Database (Denmark)

    Dahl, Jordi S; Videbaek, Lars; Poulsen, Mikael K

    2010-01-01

    In hypertension, angiotensin receptor blockers can augment regression of left ventricular (LV) hypertrophy. It is not known whether this also is the case after aortic valve replacement (AVR) for severe aortic stenosis (AS). To test the hypothesis that treatment with candesartan in addition...

  17. Aortic annulus and ascending aorta: Comparison of preoperative and periooperative measurement in patients with aortic stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Smid, Michal [Cardiology Department of Internal Medicine, School of Medicine Plzen, Charles University Prague and University Hospital Plzen, alej Svobody 80, 304 60 Plzen (Czech Republic)], E-mail: kosvin@seznam.cz; Ferda, Jiri [Department of Radiology, School of Medicine Plzen, Charles University Prague and University Hospital Plzen, alej Svobody 80, 304 60 Plzen (Czech Republic)], E-mail: ferda@fnplzen.cz; Baxa, Jan [Department of Radiology, School of Medicine Plzen, Charles University Prague and University Hospital Plzen, alej Svobody 80, 304 60 Plzen (Czech Republic)], E-mail: baxaj@fnplzen.cz; Cech, Jakub [Cardiology Department of Internal Medicine, School of Medicine Plzen, Charles University Prague and University Hospital Plzen, alej Svobody 80, 304 60 Plzen (Czech Republic)], E-mail: cechj@fnplzen.cz; Hajek, Tomas [Department of Cardiac Surgery, School of Medicine Plzen, Charles University Prague and University Hospital Plzen, alej Svobody 80, 304 60 Plzen (Czech Republic)], E-mail: hajekt@fnplzen.cz; Kreuzberg, Boris [Department of Radiology, School of Medicine Plzen, Charles University Prague and University Hospital Plzen, alej Svobody 80, 304 60 Plzen (Czech Republic)], E-mail: kreuzberg@fnplzen.cz; Rokyta, Richard [Cardiology Department of Internal Medicine, School of Medicine Plzen, Charles University Prague and University Hospital Plzen, alej Svobody 80, 304 60 Plzen (Czech Republic)], E-mail: rokyta@fnplzen.cz

    2010-04-15

    Background: Precise determination of the aortic annulus size constitutes an integral part of the preoperative evaluation prior to aortic valve replacement. It enables the estimation of the size of prosthesis to be implanted. Knowledge of the size of the ascending aorta is required in the preoperative analysis and monitoring of its dilation enables the precise timing of the operation. Our goal was to compare the precision of measurement of the aortic annulus and ascending aorta using magnetic resonance (MR), multidetector-row computed tomography (MDCT), transthoracic echocardiography (TTE), and transoesophageal echocardiography (TEE) in patients with degenerative aortic stenosis. Methods and results: A total of 15 patients scheduled to have aortic valve replacement were enrolled into this prospective study. TTE was performed in all patients and was supplemented with TEE, CT and MR in the majority of patients. The values obtained were compared with perioperative measurements. For the measurement of aortic annulus, MR was found to be the most precise technique, followed by MDCT, TTE, and TEE. For the measurement of ascending aorta, MR again was found to be the most precise technique, followed by MDCT, TEE, and TTE. Conclusion: In our study, magnetic resonance was found to be the most precise technique for the measurement of aortic annulus and ascending aorta in patients with severe degenerative aortic stenosis.

  18. General Considerations of Ruptured Abdominal Aortic Aneurysm: Ruptured Abdominal Aortic Aneurysm

    OpenAIRE

    Lee, Chung Won; Bae, Miju; Chung, Sung Woon

    2015-01-01

    Although development of surgical technique and critical care, ruptured abdominal aortic aneurysm still carries a high mortality. In order to obtain good results, various efforts have been attempted. This paper reviews initial management of ruptured abdominal aortic aneurysm and discuss the key point open surgical repair and endovascular aneurysm repair.

  19. Observations of ULF Waves at the Cusp Latitude in the two Hemispheres

    Science.gov (United States)

    Liu, Y.; Huang, D.; Liu, J.; Hu, H.; He, F.

    2015-12-01

    ULF waves are highly associated with the structure of the magnetosphere and the plasma composition in space for both their generation and propagation, and they can act as an indicator of kinds of the physical processes occurring in the outer magnetosphere particularly near the high latitude boundary and magnetopause, which usually map to the cusp region. Three fluxgate magnetometers have been respectively deployed at the cusp latitudes in the both hemispheres, Zhongshan Station (69°S 76°E in GEO, same hereafter) in Antarctica, Yellow River Station (79°N 12°E) and KHO (78°N 16°E) in the Arctic. Another fluxgate magnetometer has been set at Karholl Base (66°N 17°W) in the Iceland, which is located under the radiation belt or near the auroral zone. These magnetometer record data in three orthogonal components with sample frequency at 25 Hz. Observational data have been accumulated since February 2013. Preliminary analysis show that two types of ULF wave activities appears frequency on the observation regions, one is the broadband wave, which can occur over a frequency range 0.5-10 Hz and above, and in three components or only in the transversal components, and the other is the narrowband waves, which are generally limited within a frequency range below 0.5 Hz, and usually associated with harmonic components, in 8, 9 and 10 Hz, and basically occur on the transversal x and y components. Detailed wave properties and conjugated characteristics are under investigated and on progress.

  20. The effects of relative food item size on optimal tooth cusp sharpness during brittle food item processing.

    Science.gov (United States)

    Berthaume, Michael A; Dumont, Elizabeth R; Godfrey, Laurie R; Grosse, Ian R

    2014-12-01

    Teeth are often assumed to be optimal for their function, which allows researchers to derive dietary signatures from tooth shape. Most tooth shape analyses normalize for tooth size, potentially masking the relationship between relative food item size and tooth shape. Here, we model how relative food item size may affect optimal tooth cusp radius of curvature (RoC) during the fracture of brittle food items using a parametric finite-element (FE) model of a four-cusped molar. Morphospaces were created for four different food item sizes by altering cusp RoCs to determine whether optimal tooth shape changed as food item size changed. The morphospaces were also used to investigate whether variation in efficiency metrics (i.e. stresses, energy and optimality) changed as food item size changed. We found that optimal tooth shape changed as food item size changed, but that all optimal morphologies were similar, with one dull cusp that promoted high stresses in the food item and three cusps that acted to stabilize the food item. There were also positive relationships between food item size and the coefficients of variation for stresses in food item and optimality, and negative relationships between food item size and the coefficients of variation for stresses in the enamel and strain energy absorbed by the food item. These results suggest that relative food item size may play a role in selecting for optimal tooth shape, and the magnitude of these selective forces may change depending on food item size and which efficiency metric is being selected.

  1. Aortenklappeninsuffizienz – Operationsindikationen und Möglichkeiten der Aortenklappenrekonstruktion // Aortic Regurgitation – Aortic Valve Repair

    Directory of Open Access Journals (Sweden)

    Schachner T

    2015-01-01

    Full Text Available Aortic valve repair for aortic regurgitation has evolved at dedicated centres. It is a valuable alternative to aortic valve replacement and offers good long term results. Tricuspid, as well as bicuspid aortic valves, are suitable for repair. These techniques of aortic valve repair can be combined with reconstruction of concomitant aneurysmal disease of the ascending aorta or the sinus valsalvae. In particular, younger patients can benefit from a life without oral anticoagulation. p bKurzfassung: /bDie Aortenklappenrekonstruktion bei bestehender Aortenklappeninsuffizienz hat sich in spezialisierten Zentren zu einer guten Behandlungsalternative zum Aortenklappenersatz entwickelt. Es können sowohl bikuspide als auch trikuspide Aortenklappen rekonstruiert werden. Bei Vorliegen eines Aortenaneurysmas können Techniken der Aortenklappenrekonstruktion mit dem Ersatz von Aorta ascendens oder Sinus valsalvae kombiniert werden. In spezialisierten Zentren können gute Langzeitergebnisse erzielt werden, die vor allem jüngeren Patienten ein Leben ohne orale Antikoagulation ermöglichen.

  2. Combined surgical and catheter-based treatment of extensive thoracic aortic aneurysm and aortic valve stenosis

    DEFF Research Database (Denmark)

    De Backer, Ole; Lönn, Lars; Søndergaard, Lars

    2015-01-01

    endovascular aneurysm repair (TEVAR) has changed and extended management options in thoracic aorta disease, including in those patients deemed unfit or unsuitable for open surgery. Accordingly, transcatheter aortic valve replacement (TAVR) is increasingly used to treat patients with symptomatic severe aortic...... valve stenosis (AS) who are considered at high risk for surgical aortic valve replacement. In this report, we describe the combined surgical and catheter-based treatment of an extensive TAA and AS. To our knowledge, this is the first report of hybrid TAA repair combined with TAVR.......An extensive thoracic aortic aneurysm (TAA) is a potentially life-threatening condition and remains a technical challenge to surgeons. Over the past decade, repair of aortic arch aneurysms has been accomplished using both hybrid (open and endovascular) and totally endovascular techniques. Thoracic...

  3. Aortic root, not valve, calcification correlates with coronary artery calcification in patients with severe aortic stenosis

    DEFF Research Database (Denmark)

    Henein, Michael; Hällgren, Peter; Holmgren, Anders

    2015-01-01

    BACKGROUND: The underlying pathology in aortic stenosis (AS) and coronary artery stenosis (CAS) is similar including atherosclerosis and calcification. We hypothesize that coronary artery calcification (CAC) is likely to correlate with aortic root calcification (ARC) rather than with aortic valve...... calcification (AVC), due to tissue similarity between the two types of vessel rather than with the valve leaflet tissue. MATERIAL AND METHODS: We studied 212 consecutive patients (age 72.5 ± 7.9 years, 91 females) with AS requiring aortic valve replacement (AVR) in two Heart Centers, who underwent multidetector...... cardiac CT preoperatively. CAC, AVC and ARC were quantified using Agatston scoring. Correlations were tested by Spearman's test and Mann-Whitney U-test was used for comparing different subgroups; bicuspid (BAV) vs tricuspid (TAV) aortic valve. RESULTS: CAC was present in 92%, AVC in 100% and ARC in 82...

  4. Incidental moderate mitral regurgitation in patients undergoing aortic valve replacement for aortic stenosis: review of guidelines and current evidence.

    Science.gov (United States)

    Ramakrishna, Harish; Kohl, Benjamin A; Jassar, Arminder S; Augoustides, John G T

    2014-04-01

    Recent evidence has shown that moderate mitral regurgitation is common and clinically relevant in patients presenting for surgical and transcatheter aortic valve replacement for aortic stenosis. Prospective multicenter clinical trials are now indicated to resolve the clinical equipoise about whether or not mitral valve intervention also is indicated at the time of aortic valve intervention. Advances in three-dimensional transesophageal echocardiography, transcatheter mitral interventions, and surgical aortic valve replacement, including the advent of sutureless valves, likely will expand the therapeutic possibilities for moderate mitral regurgitation in the setting of aortic valve interventions for severe aortic stenosis.

  5. Measurement and determinants of infrarenal aortic thrombus volume

    Energy Technology Data Exchange (ETDEWEB)

    Golledge, Jonathan; Wolanski, Philippe [James Cook University, The Vascular Biology Unit, Townsville, Queensland (Australia); Townsville Hospital, Townsville, Queensland (Australia); Parr, Adam [James Cook University, The Vascular Biology Unit, Townsville, Queensland (Australia); Buttner, Petra [James Cook University, School of Public Health and Tropical Medicine, Townsville, Queensland (Australia)

    2008-09-15

    Intra-luminal thrombus has been suggested to play a role in the progression of abdominal aortic aneurysm (AAA). The aims of this study were twofold. Firstly, to assess the reproducibility of a computer tomography (CT)-based technique for measurement of aortic thrombus volume. Secondly, to examine the determinants of infrarenal aortic thrombus volume in a cohort of patients with aortic dilatation. A consecutive series of 75 patients assessed by CT angiography with maximum aortic diameter {>=}25 mm were recruited. Intra-luminal thrombus volume was measured by a semi-automated workstation protocol based on a previously defined technique to quantitate aortic calcification. Intra- and inter-observer reproducibility were assessed using correlation coefficients, coefficient of variation and Bland-Altman plots. Infrarenal aortic thrombus volume percentage was related to clinical, anatomical and blood characteristics of the patients using univariate and multivariate tests. Infrarenal aortic thrombus volume was related to the severity of aortic dilatation assessed by total aortic volume (r=0.87, P<0.0001) or maximum aortic diameter (r=0.74, P< 0.0001). We therefore examined the clinical determinates of aortic thrombus expressed as a percentage of total aortic volume. Aortic thrombus percentage was negatively correlated with serum high density lipoprotein (HDL, r=-0.31). By ordinal multiple logistic regression analysis serum HDL below median ({<=}1.2 mM) was associated with aortic thrombus percentage in the upper quartile adjusting for other risk factors (odds ratio 5.3, 95% CI 1.1-25.0). Infrarenal aortic thrombus volume can be measured reproducibly on CT. Serum HDL, which can be therapeutically raised, may play a role in discouraging aortic thrombus accumulation with implications in terms of delaying progression of AAA. (orig.)

  6. Aneurismas da aorta Aortic aneurysms

    Directory of Open Access Journals (Sweden)

    Januário M Souza

    1992-09-01

    Full Text Available Entre janeiro de 1979 e janeiro de 1992, foram realizadas 212 operações para correção de aneurismas e de dissecções da aorta. Neste trabalho serão analisados 104 procedimentos cirúrgicos (em 97 pacientes para correção de aneurismas. A idade dos pacientes variou de 14 a 79 anos (média 59,5 anos e o sexo predominante foi o masculino, com 75 pacientes. Os aneurismas localizavam-se na aorta ascendente em 46 pacientes, na croça em 8, na aorta descendente em 8, na aorta toráco-abdominal em 8, na aorta abdominal em 21, na aorta descendente e abdominal em 2, na aorta ascendente e tóraco-abdominal em 2, na aorta ascendente e descendente em 1, na aorta ascendente, croça e descendente em 1. Doenças cardiovasculares associadas estavam presentes em 39 pacientes, sendo valvopatia aórtica em 18 (excluídos os pacientes com ectasiaânulo-aórtíca, insuficiência coronária em 17, coarctação da aorta em 2, persistência do canal arterial em 1 e valvopatia mitral e aórtica em 1. A mortalidade imediata (hospitalar e/ou 30 dias foi de 14,4%, sendo de 27,7% (5/18 para pacientes com mais de 70 anos e de 11,3% (9/79 para pacientes com idade inferior a 70 anos. Os aneurismas localizados na aorta ascendente e croça foram operados como o auxílio de circulação extracorpórea. Parada circulatória e hipotermia profunda foram utilizadas em todos os pacientes com aneurisma da croça. O estudo tomográfico e angiográfico deve ser de toda a aorta, pela possibilidade de aneurismas de localizações múltiplas.Among 212 patients undergoing operation for aortic aneurysm and aortic dissection between January 1979 and January 1992, 97 were operated on for aneurysms. The aneurysms were localized in: ascending aorta in 46 patients, transverse aortic arch in 8, descending aorta in 8, thoracoabdominal aorta in 8, abdominal (infrarenal aorta in 21, descending and abdominal aorta in 2, ascending and thoracoabdominal aorta in 2, ascending and descending in 1

  7. Role of transesophageal echocardiography in percutaneous aortic valve replacement with the CoreValve Revalving system.

    Science.gov (United States)

    Berry, Colin; Oukerraj, Latifa; Asgar, Anita; Lamarche, Yoan; Marcheix, Bertrand; Denault, André Y; Laborde, Jean-Claude; Cartier, Raymond; Ducharme, Anique; Bonan, Raoul; Basmadjian, Arsène J

    2008-09-01

    Percutaneous aortic valve replacement (PAVR) is an emerging therapy for nonsurgical patients with severe aortic stenosis (AS). We examined the role of transesophageal echocardiography (TEE) in PAVR. TEE was used initially to assess the native valve and aortic root, and served as a guide during PAVR. Following prosthetic valve deployment, TEE was used to assess valve function. Eleven patients aged 82 +/- 10 years with NYHA III-IV underwent PAVR. Periprocedural TEE gave immediate information on prosthetic position and function, LV function, mitral regurgitation, pericardium, and thoracic aorta anatomy. There was excellent visual agreement between fluoroscopic and TEE images of prosthetic positioning and deployment. TEE facilitated the detection and management of procedure-related complications. Compared with pre-PAVR, AV area (0.56 +/- 0.19 cm(2) vs. 1.3 +/- 0.4 cm(2); P < 0.001) and LVEF (49 +/- 17% vs. 56 +/- 11%; P < 0.001) increased. TEE provides key anatomical and functional information, and serves as a diagnostic guide for complications, which may arise during PAVR.

  8. Vasopressor mechanisms in acute aortic coarctation hypertension

    Directory of Open Access Journals (Sweden)

    Salgado H.C.

    1997-01-01

    Full Text Available Angiotensin II (ANG II and vasopressin (AVP act together with the mechanical effect of aortic constriction in the onset of acute aortic coarctation hypertension. Blockade of ANG II and AVP V1 receptors demonstrated that ANG II acts on the prompt (5 min rise in pressure whereas AVP is responsible for the maintenance (30-45 min of the arterial pressure elevation during aortic coarctation. Hormone assays carried out on blood collected from conscious rats submitted to aortic constriction supported a role for ANG II in the early stage and a combined role for both ANG II and AVP in the maintenance of proximal hypertension. As expected, a role for catecholamines was ruled out in this model of hypertension, presumably due to the inhibitory effect of the sinoaortic baroreceptors. The lack of afferent feedback from the kidneys for AVP release from the central nervous system in rats with previous renal denervation allowed ANG II to play the major role in the onset of the hypertensive response. Median eminence-lesioned rats exhibited a prompt increase in proximal pressure followed by a progressive decline to lower hypertensive levels, revealing a significant role for the integrity of the neuroaxis in the maintenance of the aortic coarctation hypertension through the release of AVP. In conclusion, the important issue raised by this model of hypertension is the likelihood of a link between some vascular territory - probably renal - below the coarctation triggering the release of AVP, with this vasoconstrictor hormone participating with Ang II and the mechanical effect of aortic constriction in the acute aortic coarctation hypertension

  9. Atherosclerotic Aortic Plaques Detected by Transesophageal Echocardiography

    Institute of Scientific and Technical Information of China (English)

    赵云; 朱文玲; 倪超; 郭丽琳; 曾勇; 方理刚

    2002-01-01

    Objective To evaluate the predictive value of atherosclerotic aortic plaques in coronary artery disease (CAD) Methods In 50patients with suspected coronary artery disease, transesophageal echocardiography was performed to examine their thoracic aortas 2 weeks before or after coronary angiography. In the cases of coronary angiography studied, stenosis of the coronary artery ≥ 50 % was considered to be due to coronary artery disease,whereas the thickness of the intima ≥ 1.3 mm was taken to be the criteria for the presence of an atherosclerotic aortic plaque on the transesophageal echocardiographic test. Results Among the 50 patients, 37 cases were diagnosed as CAD and 13 cases were considered to be normal. The plaques of the thoracic aorta were observed in 34cases in the CAD group and 3 cases in the normal group. The sensitivity and specificity of aortic plaques for CAD were 91.9 % and 76.9%, respectively. The positive and negative predictive values of the aortic plaques for CAD were 91.9% and 76.9%, respectively. The accuracy was 88.0%. 80 percent of the patients with single- yes sel disease had thoracic aortic plaques, 92 percent of the patients with two-vessel disease and 100 percent of the patients with three-vessel disease had thoracic aortic plaques. There was a significant difference in the thickness of aortic intimas between the normal group and the CAD group. Conclusions Detectingatherosclerotic plaques in the thoracic aorta with transesophageal echocardiography may be of great value in predicting the presence and extent of coronary artery disease.

  10. [New technique of concomitant replacement of the aortic valve and the ascending aorta with enlargement of the aortic annulus for congenital bicuspid aortic valve].

    Science.gov (United States)

    Takahara, Shingo; Fukasawa, Manabu; Kawahara, Yu; Suzuki, Kotaro; Kobayashi, Yuriko

    2012-12-01

    Congenital bicuspid aortic valve (BAV) is one of the most common congenital heart diseases, with a high incidence of associated valvular lesions and aortic abnormalities including aortic stenosis( AS), aortic regurgitation, aortic dilatation, and aortic dissection. Patients with BAV and AS often have a small aortic annulus. We encountered a case of BAV in which a 51-year-old woman with severe AS having a small aortic annulus and a dilated ascending aorta required surgical intervention. We performed the surgery using new technique that involved concomitant replacement of the aortic valve and the ascending aorta with enlargement of the aortic annulus using a single uniquely-shaped graft to avoid prosthesis patient mismatch. We trimmed the proximal end of the straight graft in shape of 2 teardrops hanging on it to fit the cut annulus. It requires only a single suture line to replace the ascending aorta and enlarge the aortic annulus, which entails a decreased risk of bleeding during surgery. We believe that it could be applicable to many cases requiring concomitant surgery.

  11. MicroRNAs, fibrotic remodeling, and aortic aneurysms

    Science.gov (United States)

    Milewicz, Dianna M.

    2012-01-01

    Aortic aneurysms are a common clinical condition that can cause death due to aortic dissection or rupture. The association between aortic aneurysm pathogenesis and altered TGF-β signaling has been the subject of numerous investigations. Recently, a TGF-β–responsive microRNA (miR), miR-29, has been identified to play a role in cellular phenotypic modulation during aortic development and aging. In this issue of JCI, Maegdefessel and colleagues demonstrate that decreasing the levels of miR-29b in the aortic wall can attenuate aortic aneurysm progression in two different mouse models of abdominal aortic aneurysms. This study highlights the relevance of miR-29b in aortic disease but also raises questions about its specific role. PMID:22269322

  12. Notch signaling in descending thoracic aortic aneurysm and dissection

    NARCIS (Netherlands)

    Zou, S.; Ren, P.; Nguyen, M.; Coselli, J.S.; Shen, Y.H.; Lemaire, S.A.

    2012-01-01

    BACKGROUND: Descending thoracic aortic aneurysm and dissection (DTAAD) is characterized by progressive medial degeneration, which may result from excessive tissue destruction and insufficient repair. Resistance to tissue destruction and aortic self-repair are critical in preventing medial degenerati

  13. Rapid prototyping in aortic surgery.

    Science.gov (United States)

    Bangeas, Petros; Voulalas, Grigorios; Ktenidis, Kiriakos

    2016-04-01

    3D printing provides the sequential addition of material layers and, thus, the opportunity to print parts and components made of different materials with variable mechanical and physical properties. It helps us create 3D anatomical models for the better planning of surgical procedures when needed, since it can reveal any complex anatomical feature. Images of abdominal aortic aneurysms received by computed tomographic angiography were converted into 3D images using a Google SketchUp free software and saved in stereolithography format. Using a 3D printer (Makerbot), a model made of polylactic acid material (thermoplastic filament) was printed. A 3D model of an abdominal aorta aneurysm was created in 138 min, while the model was a precise copy of the aorta visualized in the computed tomographic images. The total cost (including the initial cost of the printer) reached 1303.00 euros. 3D imaging and modelling using different materials can be very useful in cases when anatomical difficulties are recognized through the computed tomographic images and a tactile approach is demanded preoperatively. In this way, major complications during abdominal aorta aneurysm management can be predicted and prevented. Furthermore, the model can be used as a mould; the development of new, more biocompatible, less antigenic and individualized can become a challenge in the future.

  14. Flow in an Aortic Coarctation

    Science.gov (United States)

    Loma, Luis; Miller, Paul; Hertzberg, Jean

    2009-11-01

    Coarctation of the aorta is a congenital cardiovascular defect that causes a constriction in the descending thoracic aorta. To gain a better understanding of the cause of post-surgical problems, a rigid glass and a compliant in vitro model of the aortic arch and descending aorta with a coarctation were constructed. Near-physiologic compliance was obtained using a silicone elastomer. Stereoscopic PIV was used to obtain 3D velocity maps. Results show a high speed turbulent jet formed at the exit of the coarctation. Flow in the rigid model was significantly different from in the compliant model. In the rigid model, the jet was symmetric, creating a toroidal recirculation area. In the compliant model, the jet was directed towards the medial wall, inducing flow reversal only at the lateral wall. Peak velocities and turbulence intensities were higher in the rigid model, however shear rate values in the compliant model were significantly above both the rigid model and normal in vivo values at the medial wall. In both models the reattachment region fluctuated, creating oscillatory shear.

  15. A Clinicopathological Study on Aortic Valves in Children

    Institute of Scientific and Technical Information of China (English)

    HUANG Ping; WANG Hongwei; ZHANG Zhenlu; HU Xiufen; LI Yanping; CHENG Peixuan; LIU Jianying

    2007-01-01

    In order to investigate the clinicopathological characteristics of aortic valve disease in children, all the native surgically excised aortic valves obtained between January 2003 and December 2005 were studied macroscopically and microscopically. The patients' medical records were reviewed and the clinical information was extracted. According to preoperative echocardiography, intraoperative assessment, and postoperative pathology, combined with clinical symptoms and signs, aortic valve diseases were divided into three categories: aortic stenosis (AS), aortic insufficiency (AI), and aortic stenosis with insufficiency (AS-AI). The etiology was determined according to the macroscopic, microscopic and clinical findings. The results showed that among 70 aortic valves, patient age ranged from 6 to 18 years, with a mean of 15.4 years, and there were 56 boys and 14 girts (male: female=4:1). Forty-four children only had pure aortic valve disease, and the other 26 children had aortic valve disease associated with other heart valve diseases. There were 5 cases of AS (7.14%), 60 cases of AI (85.71%) and 5 cases of AS-AI (7.14%). The causes were congenital aortic valve malformation (32 cases, 45.71%), rheumatic disease (28 cases, 40%), infective endocarditis (7 cases,10%), Marfan syndrome (2 cases, 2.86%), and undetermined (1 case, 1.43%). It was concluded that the common causes of aortic valve disease in order of frequency in children were congenital aortic valve malformation, rheumatic disease, infective endocarditis, and Marfan syndrome. AI was more common in children with aortic valve disease. Compared with adult patients, congenital bicuspid aortic valve in children was often AI. Histologically, the leaflets of congenital bicuspid aortic valve were mainly myxomatous, fibrosis and calcification less seen. AI was frequently found in rheumatic disease, mostly associated with other heart valve diseases. Macroscopic and microscopic examinations together with clinical

  16. Transcatheter aortic valve implantation: status and challenges.

    Science.gov (United States)

    Fishbein, Gregory A; Schoen, Frederick J; Fishbein, Michael C

    2014-01-01

    Calcific aortic valve disease of the elderly is the most prevalent hemodynamically-significant valvular disease, and the most common lesion requiring valve replacement in industrialized countries. Transcatheter aortic valve implantation is a less invasive alternative to classical aortic valve replacement that can provide a therapeutic option for high-risk or inoperable patients with aortic stenosis. These devices must be biocompatible, have excellent hemodynamic performance, be easy to insert, be securely anchored without sutures, and be durable, without increased risk of thrombosis or infection. To date, complications are related to the site of entry for insertion, the site of implantation (aorta, coronary ostia, base of left ventricle), and to the structure and design of the inserted device. However, as with any novel technology unanticipated complications will develop. Goals for future development will be to make the devices more effective, more durable, safer, and easier to implant, so as to further improve outcome for patients with severe aortic stenosis. The pathologist participating in research and development, and examination of excised devices will have a critical role in improving outcome for these patients.

  17. Fenestrated endovascular aortic repair for juxtarenal abdominal aortic aneurysm

    Institute of Scientific and Technical Information of China (English)

    GUO Wei; ZHANG Hong-peng; LIU Xiao-ping; JIA Xin; XIONG Jiang; MA Xiao-hui

    2013-01-01

    Background Endovascular stent-graft with fenestration can improve proximal sealing in patients with juxtarenal abdominal aortic aneurysm (JAAA).The purpose of this study was to describe our primary experience and evaluate the safety and efficacy of fenestrated device for JAAA in high-risk patients.Methods Between March 2011 and May 2012,nine male patients (mean age,(79.6±8.6) years) with asymptomatic JAAAs underwent elective deployment of the Zenith fenestrated stent-grafts at a single institution.All patients were treated in the hybrid operating room under general anesthesia.Follow-up computed tomography angiography (CTA) was routinely performed before discharge,at 3,6,and 12 months and annually thereafter.Results Procedural success was achieved in all cases.Total sixteen small fenestrations,two large fenestrations and eight scallops were used.Intra-operative complications occurred in four patients,which included one proximal type Ⅰ endoleak,two type Ⅱ endoleaks,and one renal artery dissection.The mean hospital stay was (8.9±1.4) days,mean blood loss was (360.5±46.8) ml,and mean iodinated contrast volume was (230.6±58.3) ml.The mean follow-up time was (7.6±4.2) months.The visceral graft patency was 100% until now.One patient had an increase of serum creatinine of more than 30%,but did not require dialysis.No patients died,no stent fractured,and migration were diagnosed during the follow-up.Conclusions The early results of fenestrated device for high-risk patients with complex JAAAs are satisfactory.However,long-term fenestrated graft durability and branch vessel patency remain to be determined.

  18. Successful treatment by transcatheter aortic valve implantation of severe aortic regurgitation in a patient with ascending aorta prosthesis.

    Science.gov (United States)

    Rossi, Marco Luciano; Bocchi, Roberto; Barbaro, Cristina; Pagnotta, Paolo; Mennuni, Marco; Zavalloni, Dennis; Gasparini, Gabriele; Presbitero, Patrizia

    2013-05-01

    Severe aortic regurgitation (AR), when intervention is required, is managed by surgical aortic valve replacement (SAVR). Recently, transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS) has shown non-inferiority to SAVR and superiority to medical management. TAVR could be a valid "off label" option to treat severe AR for patients unsuitable for SAVR due to their high surgical risk. Among aortic pathologies leading to severe AR, those involving the aortic root are considered as high risk procedures and thus prohibit TAVR. For these reasons TAVR is not an option for severe AR due to concomitant aortic root dilatation and degeneration. We report a successful case of TAVR for severe AR due to dilatation of degenerated tract of aortic root.

  19. Cirurgia das dissecções crónicas da aorta ascendente com insuficiência valvar Surgery of chronic aortic dissection with aortic insufficiency

    Directory of Open Access Journals (Sweden)

    Paulo M Pêgo-Fernandes

    1990-12-01

    menor índice de complicações a médio prazo do que a substituição valvar; 2 a identificação do mecanismno da insuficiência valvar é fundamental para decisão da tática operatória; 3 o uso da cola biológica facilita o manuseio da aorta e pode diminuir o sangramento intra-operatório; 4 quando é necessária a substituição valvar tem-se preferido empregar prótese mecânica dada a maior dificuldade técnica na reoperaçáo nesses pacientes; 5 a aortoplastia não deve ser utilizada devido à alta incidência de redissecção aórtica.In the period of January 1980 to December 1988, 44 patients with chronic aortic dissections and aortic insufficiency were operated on. This group of patients was analized in order to evaluate the evolution of those in which the aortic valve was preserved compared to the group of patients submitted to valvular replacement. The overall preoperative characteristics of these two groups were similar. Valvular replacement was the elected procedure in cases of valvular degeneration or of aortic annular ectasia. In cases of cusp prolapse with enlarged annulus a plastic procedure was used; in 48% of the cases it was possible to preserve the valve. In the 23 patients submitted to valve replacement, the Bentall and De Bono technique was utilized. In six patientes other surgical procedures were associated. Biological adhesives were utilized in every patient operated on from 1986 on. In 41 patients (93% the proximal aorta was substituted and in the remaining three an aortoplasty was performed. Five patients (11% had hospitalar deaths, three due to low-output syndrome, one due to bleeding and one on account of neurological complications. Late death occurred in two patients (4%. The follow-up of the 37 surviving patients varied from two to 108 months (mean: 18 months; of these, 78% were in fuctional class I, and the others in class II. Two patients that had their aortic valve preserved presented mild aortic insufficiency. Three patients with

  20. Challenging Friesian horse diseases : aortic rupture and megaesophagus

    NARCIS (Netherlands)

    Ploeg, M.

    2015-01-01

    Aortic rupture is quite rare in Warmblood horses and is best known as an acute and fatal rupture of the aortic root in older breeding stallions. It has now become clear that aortic rupture, which is diagnosed around an age of 4 years, is more frequent in the Friesian breed than in others. The high p

  1. The risk for type B aortic dissection in Marfan syndrome

    NARCIS (Netherlands)

    den Hartog, Alexander W.; Franken, Romy; Zwinderman, Aeilko H.; Timmermans, Janneke; Scholte, Arthur J.; van den Berg, Maarten P.; de Waard, Vivian; Pals, Gerard; Mulder, Barbara J. M.; Groenink, Maarten

    2015-01-01

    BACKGROUND: Aortic dissections involving the descending aorta are a major clinical problem in patients with Marfan syndrome. OBJECTIVES: The purpose of this study was to identify clinical parameters associated with type B aortic dissection and to develop a risk model to predict type B aortic dissect

  2. Outcome of pregnancy in patients after repair of aortic coarctation

    NARCIS (Netherlands)

    Vriend, JWJ; Drenthen, W; Pieper, PG; Roos-Hesselink, JW; Zwinderman, AH; van Veldhuisen, DJ; Mulder, BJM

    2005-01-01

    Aims Nowadays, most women born with aortic coarctation reach childbearing age. However, data on outcome of pregnancy in women after repair of aortic coarctation are scarce. The aim of this study was to report on maternal and neonatal outcome of pregnancy in women after aortic coarctation repair. Met

  3. Transcatheter Aortic Valve Implantation: Insights into Clinical Complications

    NARCIS (Netherlands)

    R.M.A. van der Boon (Robert)

    2014-01-01

    markdownabstract__Abstract__ Transcatheter Aortic Valve Implantation (TAVI) has emerged as a viable and safe treatment for patients with severe aortic stenosis (AS) who are considered ineligible or at prohibitive risk for Surgical Aortic Valve Replacement (SAVR)1–4. The aim of the present thesis wa

  4. Study of Coronary Artery Disease in Single Aortic Valvular Disease

    Institute of Scientific and Technical Information of China (English)

    张斌; 杨伟民; 占亚平

    2003-01-01

    Objectives To analyze the results of coronary angiographies (GAG) in patients with single aortic valvular heart disease; To study the relationship between aortic valve diseases and coronary artery disease (CAD). Methods 105 patients with single aortic valvular heart disease before surgery underwent angiography. The data of clinical characteristics and angiographies were analyzed. Results 51 patients had symptoms of angina pectoris among 105 patients with single aortic valvular heart disease. Seven of them were confirmed coronary artery disease by angiographies. Although the incidence of angina in aortic valve stenosis group was significantly higher than that in aortic valve regurgitation, the probability of combination of CAD in aortic valve stenosis group was similar to the later. However, the probability of combination of CAD in degenerative aortic valve group was significantly higher than the groups of rheumatic, congenitally bicuspid aortic valves, and other causes (p <0.01).Conclusions Angina pectoris is not sensitive for diagnosis of CAD in single aortic valve heart disease.The probability of combination of CAD in degenerative aortic valve disease is higher than that in aortic valve disease with other causes. Coronary angiography is strongly suggested for these patients.

  5. Mitral Valve Aneurysm: A Rare Complication of Aortic Valve Endocarditis

    Directory of Open Access Journals (Sweden)

    A Moaref

    2008-11-01

    Full Text Available A 20-year-old intravenous drug abuser man, refered to our hospital with dyspnea and orthopnea. Tranesophagealechocardiography revealed severe aortic regurgitation, healed vegetation of aortic valve and an aneurysm of theanterior leaflet of the mitral valve. The patient was discharged after aortic valve replacement and mitral valverepair.

  6. Interplanetary magnetic field control of Saturn's polar cusp aurora

    Directory of Open Access Journals (Sweden)

    E. J. Bunce

    2005-06-01

    Full Text Available Dayside UV emissions in Saturn's polar ionosphere have been suggested to be the first observational evidence of the kronian "cusp" (Gérard et al., 2004. The emission has two distinct states. The first is a bright arc-like feature located in the pre-noon sector, and the second is a more diffuse "spot" of aurora which lies poleward of the general location of the main auroral oval, which may be related to different upstream interplanetary magnetic field (IMF orientations. Here we take up the suggestion that these emissions correspond to the cusp. However, direct precipitation of electrons in the cusp regions is not capable of producing significant UV aurora. We have therefore investigated the possibility that the observed UV emissions are associated with reconnection occurring at the dayside magnetopause, possibly pulsed, akin to flux transfer events seen at the Earth. We devise a conceptual model of pulsed reconnection at the low-latitude dayside magnetopause for the case of northwards IMF which will give rise to pulsed twin-vortical flows in the magnetosphere and ionosphere in the vicinity of the open-closed field-line boundary, and hence to bi-polar field-aligned currents centred in the vortical flows. During intervals of high-latitude lobe reconnection for southward IMF, we also expect to have pulsed twin-vortical flows and corresponding bi-polar field-aligned currents. The vortical flows in this case, however, are displaced poleward of the open-closed field line boundary, and are reversed in sense, such that the field-aligned currents are also reversed. For both cases of northward and southward IMF we have also for the first time included the effects associated with the IMF By effect. We also include the modulation introduced by the structured nature of the solar wind and IMF at Saturn's orbit by developing "slow" and "fast" flow models corresponding to intermediate and high strength IMF respectively. We then

  7. Heritable retinoblastoma and accelerated aortic valve disease

    Science.gov (United States)

    Abeyratne, L R; Kingston, J E; Onadim, Z; Dubrey, S W

    2013-01-01

    Heritable retinoblastoma is associated with a germline mutation in the tumour suppressor gene RBI. The Rb protein (pRb) arises from the RB1 gene, which was the first demonstrated cancer susceptibility gene in humans. 1 Second primary malignancies are recognised complications of retinoblastoma. Furthermore, pRb is implicated in valve remodelling in calcific aortic valve disease. 2 3 We report a family with hereditary retinoblastoma and associated secondary primary malignancies. There are two interesting aspects to this family. The first is the concept of ‘cancer susceptibility genes’; the RBI gene being the first reported in humans. A further feature of note is that two family members also have bicuspid aortic valves. We discuss a potential association between the gene defect responsible for retinoblastoma (with its associated propensity for further malignancies) and accelerated deterioration of the bicuspid aortic valve in the proband carrying this gene defect. PMID:23595191

  8. Anesthesia Approach in Endovascular Aortic Reconstruction

    Directory of Open Access Journals (Sweden)

    Ayşin Alagöl

    2013-03-01

    Full Text Available Introduction: We have analyzed our initial results of our anesthesia techniques in our new-onset endovascular aortic reconstruction cases.Patients and Methods: The perioperative data of 15 elective and emergent endovascular aortic reconstruction cases that were operated in 2010-2011 were collected in a database. The choice of anesthesia was made by the risk factors, surgical team’s preferences, type and location of the aortic pathology and by the predicted operation duration. The data of local and general anesthesia cases were compared.Results: Thirteen (86.7% cases were male and 2 (13.3% female. Eleven patients were in ASA Class III. The demographic parameters, ASA classifications, concurrent diseases were similar in both groups. Thirteen (86.7% cases had infrarenal abdominal aortic aneurysm and 2 (13.3% had Type III aortic dissection. The diastolic arterial pressures were lower in general anesthesia group in 20th and 40th minutes’ measurements just like the mean arterial pressure measurements at the 40th, 100th minutes and during the deployment of the graft. Postoperative mortality occurred in 3 (20.0% patients and they all had general anesthesia and they were operated on emergency basis. Postoperative morbidity occurred in four patients that had general anesthesia (acute renal failure, multi-organ failure and pneumonia. The other patient had atrial fibrillation on the 1st postoperative day and was converted to sinus rhythm with amiodarone infusion.Conclusion: Edovascular aortic reconstruction procedures can safely be performed with both general and local anesthesia less invasively compared to open surgery. General anesthesia may be preferred for the better hemodynamic control.

  9. A statistical study of traveling convection vortices using the Magnetometer Array for Cusp and Cleft Studies

    Science.gov (United States)

    Zesta, E.; Hughes, W. J.; Engebretson, M. J.

    2002-10-01

    The Magnetometer Array for Cusp and Cleft Studies (MACCS) is primarily a longitudinal magnetometer array located in the eastern Canadian arctic at cusp latitudes. We present a statistical study of traveling convection vortices (TCVs) as observed by MACCS from the first year of operations, August 1992 to July 1993. For this period, data are routinely available from three stations, extending more than 2 hours in magnetic local time (MLT) and located roughly on a line of constant geomagnetic latitude at 75°. With the selection criteria used, we find an average of 38 TCV events per month. We characterize the events as "isolated" and "nonisolated". The isolated events have the typical, accepted signature of a TCV while the nonisolated ones are events that satisfy the selection criteria but occur among relatively strong magnetic activity. The diurnal distribution of these events shows a prenoon-afternoon asymmetry, but the distribution has a single peak at 10 MLT and then falls off smoothly in the afternoon hours. It does not show the previously reported minimum of event occurrence around magnetic local noon except for isolated events occurring during higher Kp values. The most likely explanation for this discrepancy is the wide longitudinal extent of MACCS. The majority of the events have propagation velocities between 3 and 11 km/s, which can be a factor of 2 larger than the events reported in previous studies. The majority of the events move away from noon, as is expected, with a small fraction moving toward noon. Most (80%) of the studied events exhibit all the characteristics of a typical TCV, while the remaining 20% show some form of irregularity. We find four different types of irregularities. The isolated and nonisolated events have many similar morphological and propagation characteristics. However, quantitative comparison of the statistical distributions of the two types of TCVs indicates that they belong to different populations. We also find that nonisolated

  10. Aortic valve replacement in octogenarians

    Directory of Open Access Journals (Sweden)

    Dark John H

    2007-07-01

    Full Text Available Abstract Background and Aims As our population ages and life expectancy increases the number of people aged over 80 and more referred for cardiac surgery is growing. This study sought to identify the outcome of aortic valve replacement (AVR in octogenarians. Methods 68 patients aged 80 years or more underwent AVR at the Freeman Hospital, between April 2001 and April 2004. A retrospective review of the notes and outcomes from the patients' GP and the NHS strategic tracking service was performed. 54% (37 underwent isolated AVR whilst 46% (31 underwent combined AVR and CABG. Results Follow up was 100% complete. The mean age was 83.1 ± s.d. 2.9 years, a mean gradient of 83 ± s.d. 31 mmHg and mean AVA of 0.56 cm2. The mean additive EuroSCORE was 8.6 ± s.d. 1.2, the logistic EuroSCORE mean 12.0 ± s.d. 5.9. In hospital 30 day mortality was 13 %. Survival was 80% at 1 year and 78% at 2 years. Median follow up was for 712 days. Stepwise logistic regression identified chronic obstructive airways disease as an independent predictor of mortality (p Conclusion Our study demonstrates that the operative mortality for AVR in the over eighties is good, whilst the mid to long term outcome is excellent There is a very low attrition rate with those undergoing the procedure living as long than their age matched population. This study confirms AVR is a safe, acceptable treatment for octogenarians with excellent mid term outcomes.

  11. Idiopathic thoracic aortic aneurysm at pediatric age.

    Science.gov (United States)

    Marín-Manzano, E; González-de-Olano, D; Haurie-Girelli, J; Herráiz-Sarachaga, J I; Bermúdez-Cañete, R; Tamariz-Martel, A; Cuesta-Gimeno, C; Pérez-de-León, J

    2009-03-01

    A 6-year-old-boy presented with epigastric pain and vomiting over 1 year. Chest X-ray and esophagogastric transit showed a mediastinal mass. A chest computerized tomography angiogram demonstrated a descending thoracic aortic aneurysm. Analytical determinations carried out were all negative. The aneurysm was surgically repaired using a Dacron patch. The anatomopathological study described atherosclerotic lesions with calcifications, compatible with an atherosclerotic aneurysm wall. Aneurysms are uncommon in the pediatric population. Usually, no pathogenesis can be determined, and thus, such cases are grouped as idiopathic. Direct repair with or without patch is a therapeutic alternative in pediatric aneurysms and can allow the growth of the aortic circumference.

  12. Infective endocarditis following transcatheter aortic valve replacement-

    DEFF Research Database (Denmark)

    Loh, Poay Huan; Bundgaard, Henning; S�ndergaard, Lars

    2013-01-01

    Transcatheter aortic valve replacement (TAVR) can improve the symptoms and prognosis of patients with severe aortic stenosis who, due to a high expected operative risk, would not have otherwise been treated surgically. If these patients develop prosthetic valve endocarditis, their presentations may...... be atypical causing a delay in the diagnosis and treatment. The management is also complicated by their comorbidities, and surgical treatment may not be feasible leading to a significant morbidity and mortality. We describe a case of an 85-year-old man with TAVI prosthetic valve endocarditis successfully...

  13. Supravalvular aortic stenosis with sudden cardiac death

    Directory of Open Access Journals (Sweden)

    Pradeep Vaideeswar

    2015-01-01

    Full Text Available Sudden cardiac death (SCD most commonly results from previously undiagnosed congenital, acquired, or hereditary cardiac diseases. Congenital aortic valvular, subvalvular, and supravalvular disease with left ventricular outflow tract obstruction is an important preventable cause of sudden death. This report documents sudden death presumably due to acute myocardial ischemia in a young male with an undiagnosed supravalvular aortic stenosis (SVAS due to a rare association of isolation of coronary sinuses of Valsalva. Congenital supravalvular pulmonary stenosis and mitral valvular dysplasia were also present.

  14. A solution to the problems of cusps and rotation curves in dark matter halos in the cosmological standard model

    CERN Document Server

    Doroshkevich, A G; Mikheeva, E V; 10.3367/UFNr.0182.201201a.0003

    2012-01-01

    We discuss various aspects of the inner structure formation in virialized dark matter (DM) halos that form as primordial density inhomogeneities evolve in the cosmological standard model. The main focus is on the study of central cusps/cores and of the profiles of DM halo rotation curves, problems that reveal disagreements among the theory, numerical simulations, and observations. A method that was developed by the authors to describe equilibrium DM systems is presented, which allows investigating these complex nonlinear structures analytically and relating density distribution profiles within a halo both to the parameters of the initial small-scale inhomogeneity field and to the nonlinear relaxation characteristics of gravitationally compressed matter. It is shown that cosmological random motions of matter `heat up' the DM particles in collapsing halos, suppressing cusp-like density profiles within developing halos, facilitating the formation of DM cores in galaxies, and providing an explanation for the diff...

  15. Cusps in the center of galaxies: a real conflict with observations or a numerical artefact of cosmological simulations?

    CERN Document Server

    Baushev, A N; Campusano, L E; Escala, A; Muñoz, R R; Palma, G A

    2016-01-01

    Galaxy observations and N-body cosmological simulations produce conflicting dark matter halo density profiles for galaxy central regions. While simulations suggest a cuspy and universal profile (UDP) of this region, the majority of observations favor variable profiles with a core in the center. In this paper, we investigate the convergency of standard N-body simulations, especially in the cusp region, following the approach proposed by (Baushev, 2015). We simulate the well known Hernquist model using the SPH code Gadget-3 and consider the full array of dynamical parameters of the particles. We find that, although the cuspy profile is stable, all integrals of motion characterizing individual particles suffer strong unphysical variations along the whole halo, revealing an effective interaction between the test bodies. This result casts doubts on the reliability of the velocity distribution function obtained in the simulations. Moreover, we find unphysical Fokker-Planck streams of particles in the cusp region. T...

  16. Diffuse Supravalvular Aortic Stenosis: Surgical Repair in Adulthood

    Directory of Open Access Journals (Sweden)

    Giovanni Ferlan

    2009-01-01

    Full Text Available We present the case of a 54-year-old woman in which a diffuse congenital supravalvular aortic stenosis (SVAS was associated with a severe aortic valve incompetence and heavy calcification of the aortic annulus. Repair consisted in resection of the ascending aorta, patch augmentation of the hypoplastic aortic root and annulus, placement of a 20 mm Dacron tubular graft (Vascutek, Renfrewshire, UK and aortic valve replacement with a mechanical prosthesis (Sorin, Turin, Italy. Follow-up echocardiography demonstrated normal prosthetic valve function and a postoperative three-dimensional computed tomographic scan showed a normal shape of the reconstructed ascending aorta.

  17. Infected abdominal aortic aneurysm due to Morganella morganii: CT findings.

    Science.gov (United States)

    Kwon, Oh Young; Lee, Jong Seok; Choi, Han Sung; Hong, Hoon Pyo; Ko, Young Gwan

    2011-02-01

    An infected aortic aneurysm, or mycotic aneurysm, is a rare arterial dilatation due to destruction of the infected vessel wall. Common pathogens resulting in an infected aortic aneurysm are Salmonella and Clostridium species, as well as Staphylococcus aureus; Morganella morganii, on the other hand, is very rare. An infected abdominal aortic aneurysm has tendencies to grow rapidly and to rupture. The mortality rate is high in patients undergoing emergent surgical intervention. We report the case of a 65-year-old man who presented with an infected abdominal aortic aneurysm caused by M. morganii. A high index of suspicion and imaging tests are necessary in order to diagnose an infected aortic aneurysm.

  18. Treatment of infrarenal abdominal aortic dissection concomitant with an aneurysm

    Institute of Scientific and Technical Information of China (English)

    WANG Li-xin; ZHU Ting; FU Wei-guo; WANG Yu-qi; XI Xun; GUO Da-qiao; CHEN Bin; JIANG Jun-hao; YANG Ju; SHI Zhen-yu

    2007-01-01

    @@ Aortic dissection occurs when layers of the aortic walls are separated by the blood flow through an intimal tear. Dissection of the aorta most frequently originates in the ascending aorta (70%), followed by the descending aorta (22%), the aortic arch (7%) and the abdominal aorta (1/%).1 The dissection limited to the abdominal aorta is rare.2 An isolated abdominal aortic dissection (IAAD) concomitant with an abdominal aortic aneurysm (AAA) is uncommon. We present here one patient with IAAD and AAA treated by endovascular therapy.

  19. A solution to the problems of cusps and rotation curves in dark matter halos in the cosmological standard model

    OpenAIRE

    Doroshkevich, A. G.; Lukash, V. N.; Mikheeva, E. V.

    2012-01-01

    We discuss various aspects of the inner structure formation in virialized dark matter (DM) halos that form as primordial density inhomogeneities evolve in the cosmological standard model. The main focus is on the study of central cusps/cores and of the profiles of DM halo rotation curves, problems that reveal disagreements among the theory, numerical simulations, and observations. A method that was developed by the authors to describe equilibrium DM systems is presented, which allows investig...

  20. Generation of high charge state metal ion beams by electron cyclotron resonance heating of vacuum arc plasma in cusp trap.

    Science.gov (United States)

    Nikolaev, A G; Savkin, K P; Oks, E M; Vizir, A V; Yushkov, G Yu; Vodopyanov, A V; Izotov, I V; Mansfeld, D A

    2012-02-01

    A method for generating high charge state heavy metal ion beams based on high power microwave heating of vacuum arc plasma confined in a magnetic trap under electron cyclotron resonance conditions has been developed. A feature of the work described here is the use of a cusp magnetic field with inherent "minimum-B" structure as the confinement geometry, as opposed to a simple mirror device as we have reported on previously. The cusp configuration has been successfully used for microwave heating of gas discharge plasma and extraction from the plasma of highly charged, high current, gaseous ion beams. Now we use the trap for heavy metal ion beam generation. Two different approaches were used for injecting the vacuum arc metal plasma into the trap--axial injection from a miniature arc source located on-axis near the microwave window, and radial injection from sources mounted radially at the midplane of the trap. Here, we describe preliminary results of heating vacuum arc plasma in a cusp magnetic trap by pulsed (400 μs) high power (up to 100 kW) microwave radiation at 37.5 GHz for the generation of highly charged heavy metal ion beams.

  1. Analysis of the effect of symmetric/asymmetric CUSP magnetic fields on melt/crystal interface during Czochralski silicon growth

    Science.gov (United States)

    Daggolu, Parthiv; Ryu, Jae Woo; Galyukov, Alex; Kondratyev, Alexey

    2016-10-01

    With the use of 300 mm silicon wafers for industrial semiconductor device manufacturing, the Czochralski (Cz) crystal growth process has to be optimized to achieve higher quality and productivity. Numerical studies based on 2D global thermal models combined with 3D simulation of melt convection are widely used today to save time and money in the process development. Melt convection in large scale Cz Si growth is controlled by a CUSP or transversal magnetic field (MF) to suppress the melt turbulence. MF can be optimized to meet necessary characteristics of the growing crystal, in terms of point defects, as MF affects the melt/crystal interface geometry and allows adjustment of the pulling rate. Among the different knobs associated with the CUSP magnetic field, the nature of its configuration, going from symmetric to asymmetric, is also reported to be an important tool for the control of crystallization front. Using a 3D unsteady model of the CGSim software, we have studied these effects and compared with several experimental results. In addition, physical mechanisms behind these observations are explored through a detailed modeling analysis of the effect of an asymmetric CUSP MF on convection features governing the heat transport in the silicon melt.

  2. Overlapping ion structures in the mid-altitude cusp under northward IMF: signature of dual lobe reconnection?

    Directory of Open Access Journals (Sweden)

    F. Pitout

    2012-03-01

    Full Text Available On some rare occasions, data from the Cluster Ion Spectrometer (CIS in the mid-altitude cusp reveal overlapping ion populations under northward interplanetary magnetic field (IMF. While the poleward part of the cusp exhibits the expected reverse dispersion due to lobe reconnection, its equatorward part shows a second ion population at higher-energy that coexists with the low energy tail of the dispersion. This second population is either dispersionless or slightly dispersed with energies increasing with increasing latitudes, indicative of lobe reconnection as well. Our analysis of a case that occurred 3 September 2002 when the IMF stayed northward for more than two hours suggests that the second population comes from the opposite hemisphere and is very likely on newly-closed field lines. We interpret this overlap of cusp populations as a clear mid-altitude signature of re-closed magnetic field lines by double lobe reconnection (reconnection in both hemispheres under northward IMF. This interpretation is supported by modelling performed with the Cooling model and an MHD model.

  3. Particle-In-Cell Simulations of the Solar Wind Interaction with Lunar Crustal Magnetic Anomalies: Magnetic Cusp Regions

    Science.gov (United States)

    Poppe, A. R.; Halekas, J. S.; Delory, G. T.; Farrell, W. M.

    2012-01-01

    As the solar wind is incident upon the lunar surface, it will occasionally encounter lunar crustal remanent magnetic fields. These magnetic fields are small-scale, highly non-dipolar, have strengths up to hundreds of nanotesla, and typically interact with the solar wind in a kinetic fashion. Simulations, theoretical analyses, and spacecraft observations have shown that crustal fields can reflect solar wind protons via a combination of magnetic and electrostatic reflection; however, analyses of surface properties have suggested that protons may still access the lunar surface in the cusp regions of crustal magnetic fields. In this first report from a planned series of studies, we use a 1 1/2-dimensional, electrostatic particle-in-cell code to model the self-consistent interaction between the solar wind, the cusp regions of lunar crustal remanent magnetic fields, and the lunar surface. We describe the self-consistent electrostatic environment within crustal cusp regions and discuss the implications of this work for the role that crustal fields may play regulating space weathering of the lunar surface via proton bombardment.

  4. Aortic root and proximal aortic arch replacement (performed by a left-handed surgeon).

    Science.gov (United States)

    Carrel, Thierry

    2017-01-01

    We present our standard technique of composite graft replacement performed by a left-handed surgeon. This procedure is performed with a 30-day mortality comparable to that of elective isolated aortic valve replacement.

  5. The role of balloon aortic valvuloplasty in the era of transcatheter aortic valve implantation

    Science.gov (United States)

    Wilczek, Krzysztof; Pres, Damian; Krajewski, Adam; Poloński, Lech; Zembala, Marian; Gąsior, Mariusz

    2015-01-01

    Balloon aortic valvuloplasty is recommended in patients not suitable for transcatheter aortic valve implantation/aortic valve replacement (TAVI/AVR) or when such interventions are temporarily contraindicated. The number of performed balloon aortic valvuloplasty (BAV) procedures has been increasing in recent years. Valvuloplasty enables the selection of individuals with severe left ventricular dysfunction or with symptoms of uncertain origin resulting from concomitant disorders (including chronic obstructive pulmonary disease [COPD]) who can benefit from destination therapy (AVR/TAVI). Thanks to improved equipment, the number of adverse effects is now lower than it was in the first years after the advent of BAV. Valvuloplasty can be safely performed even in unstable patients, but long-term results remain poor. In view of the limited availability of TAVI in Poland, it is reasonable to qualify patients for BAV more often, as it is a relatively safe procedure improving the clinical condition of patients awaiting AVR/TAVI. PMID:26336471

  6. CUSP9* treatment protocol for recurrent glioblastoma: aprepitant, artesunate, auranofin, captopril, celecoxib, disulfiram, itraconazole, ritonavir, sertraline augmenting continuous low dose temozolomide.

    Science.gov (United States)

    Kast, Richard E; Karpel-Massler, Georg; Halatsch, Marc-Eric

    2014-09-30

    CUSP9 treatment protocol for recurrent glioblastoma was published one year ago. We now present a slight modification, designated CUSP9*. CUSP9* drugs--aprepitant, artesunate, auranofin, captopril, celecoxib, disulfiram, itraconazole, sertraline, ritonavir, are all widely approved by regulatory authorities, marketed for non-cancer indications. Each drug inhibits one or more important growth-enhancing pathways used by glioblastoma. By blocking survival paths, the aim is to render temozolomide, the current standard cytotoxic drug used in primary glioblastoma treatment, more effective. Although esthetically unpleasing to use so many drugs at once, the closely similar drugs of the original CUSP9 used together have been well-tolerated when given on a compassionate-use basis in the cases that have come to our attention so far. We expect similarly good tolerability for CUSP9*. The combined action of this suite of drugs blocks signaling at, or the activity of, AKT phosphorylation, aldehyde dehydrogenase, angiotensin converting enzyme, carbonic anhydrase -2,- 9, -12, cyclooxygenase-1 and -2, cathepsin B, Hedgehog, interleukin-6, 5-lipoxygenase, matrix metalloproteinase -2 and -9, mammalian target of rapamycin, neurokinin-1, p-gp efflux pump, thioredoxin reductase, tissue factor, 20 kDa translationally controlled tumor protein, and vascular endothelial growth factor. We believe that given the current prognosis after a glioblastoma has recurred, a trial of CUSP9* is warranted.

  7. Congenital quadricuspid aortic valve: analysis of 11 surgical cases

    Institute of Scientific and Technical Information of China (English)

    TANG Yang-feng; XU Ji-bin; HAN Lin; LU Fang-lin; LANG Xi-long; SONG Zhi-gang; XU Zhi-yun

    2011-01-01

    Background Congenital quadricuspid aortic valve is rarely seen during aortic valve replacement (AVR).The diagnosis and treatment of the disease were reported in 11 cases.Methods Eleven patients (nine men and two women,mean age 33.4 years) with quadricuspid aortic valve were retrospectively evaluated.Medical records,echocardiograms and surgical treatment were reviewed.Results In accordance with the Hurwitz and Roberts classification,the patients were classified as type A (n=2),type B (n=7),type F (n=1) and type G (n=1).Three patients were associated with other heart diseases,including infective endocarditis and mitral prolaps,left superior vena cava,aortic aneurysm.All had aortic regurgitation (AR) except two with aortic stenosis (AS),detected by color-flow Doppler echocardiography.The congenital quadricuspid aortic valve deformity in seven patients was diagnosed by echocardiography.All patients underwent successful aortic valve replacement.Conclusion Quadricuspid aortic valve is a rare cause of aortic insufficiency,while echocardiography plays an important role in diagnosing the disease.Aortic valve replacement is the major therapy for the disease.

  8. Experimental study on aortic remodeling in sinoaortic denervated rats

    Institute of Scientific and Technical Information of China (English)

    MIAO Chao-yu; TAO Xia; GUAN Yun-feng; YANG You-cai; CHU Zheng-xu; SU Ding-feng

    2001-01-01

    Objective: To study the aortic remodeling produced by chronic sinoaortic denervation (SAD) and its time course, and to study the role of humoral factor in the SAD-induced aortic remodeling. Methods: In rats with chronic SAD or sham operation, the aortic structure was measured by computer-assisted image analysis, the aortic function by isolated artery preparation, and angiotensin Ⅱ concentration by radioimmunoassay. Results and Conclusion: The aortic structural remodeling developed progressively at 4, 8, 16 and 32 weeks after SAD. Aortic structural remodeling after SAD expressed mainly as aortic hypertrophy due to SMC growth and collagen accumulation. The aortic contraction elicited by norepinephrine (NE) was progressively increased 8, 16 and 32 weeks after SAD. The aortic relaxation elicited by acetylcholine (ACh) was depressed 8, 16 and 32 weeks after SAD. In addition, in 32-week SAD rats the NE-induced contraction was not increased by endothelial denudation. These indicated that the increased contraction and depressed relaxation after SAD were related to the change of endothelium and/or the change of interaction between endothelium and SMC. In 10-week SAD rats, plasma angiotensin Ⅱ concentration remained unchanged, whereas aortic angiotensin Ⅱ concentration was significantly increased, suggesting that activation of tissue renin-angiotensin system may be involved in SAD-induced aortic remodeling.

  9. Study and observation of the great solar event in July 2000 at cusp latitude

    Institute of Scientific and Technical Information of China (English)

    刘勇华; 刘瑞源; 胡红桥; 徐中华

    2001-01-01

    A series of solar flare and coronal mass ejection (CME) event occurred in July 2000, particularly the largest flare (X5.7/3B) with CME on 14th of July since 1989, which stimulated a great geomagnetic storm with Dst index reaching -300 nT. A number of data have been obtained from the Chinese Antarctic Zhongshan Station (ZHS, INT Lat. 74.5°, L≈14), which is located at cusp latitude, and from the ACE satellite. After analyzing these data we have got the results as follows: a lot of solar high energy particles penetrated into the polar ionosphere and ionized it, which significantly increased the cosmic noise absorption (CNA) and blanked the DPS-4 data for more than two days. The magnetic pulsation in Pc 3/5 frequency band on the ground has a high relation with the fluctuation of interplanetary magnetic field (IMF) Bz, which shows the contribution of interplanetary magnetohydrodynamical (MHD) waves to the Pc 3/5 pulsation on the ground. The Pc 3/5 pulsation was intensified much during the great magnetic storm. The H component of the magnetic field at ZHS varied with the southern value of IMF Bz but lagged behind for about 8 10 h. While Dst index responded to the variation of the IMF Bz very quickly, which suggested that the magnetic storm occurred at low latitude firstly and then effected the ionospheric current at high latitude.

  10. The Cusp/Core problem: supernovae feedback versus the baryonic clumps and dynamical friction model

    CERN Document Server

    Del Popolo, A

    2015-01-01

    In the present paper, we compare the predictions of two well known mechanisms considered able to solve the cusp/core problem (a. supernova feedback; b. baryonic clumps-DM interaction) by comparing their theoretical predictions to recent observations of the inner slopes of galaxies with masses ranging from dSphs to normal spirals. We compare the $\\alpha$-$V_{\\rm rot}$ and the $\\alpha$-$M_{\\ast}$ relationships, predicted by the two models with high resolution data coming from \\cite{Adams2014}, \\cite{Simon2005}, LITTLE THINGS \\citep{Oh2014}, THINGS dwarves \\citep{Oh2011a,Oh2011b}, THINGS spirals \\citep{Oh2014}, Sculptor, Fornax and the Milky Way. The comparison of the theoretical predictions with the complete set of data shows that the two models perform similarly, while when we restrict the analysis to a smaller subsample of higher quality, we show that the method presented in this paper (baryonic clumps-DM interaction) performs better than the one based on supernova feedback. We also show that, contrarily to t...

  11. Wave particle interactions in the high-altitude polar cusp: a Cluster case study

    Directory of Open Access Journals (Sweden)

    B. Grison

    2005-12-01

    Full Text Available On 23 March 2002, the four Cluster spacecraft crossed in close configuration (~100 km separation the high-altitude (10 RE cusp region. During a large part of the crossing, the STAFF and EFW instruments have detected strong electromagnetic wave activity at low frequencies, especially when intense field-aligned proton fluxes were detected by the CIS/HIA instrument. In all likelihood, such fluxes correspond to newly-reconnected field lines. A focus on one of these ion injection periods highlights the interaction between waves and protons. The wave activity has been investigated using the k-filtering technique. Experimental dispersion relations have been built in the plasma frame for the two most energetic wave modes. Results show that kinetic Alfvén waves dominate the electromagnetic wave spectrum up to 1 Hz (in the spacecraft frame. Above 0.8 Hz, intense Bernstein waves are also observed. The close simultaneity observed between the wave and particle events is discussed as an evidence for local wave generation. A mechanism based on current instabilities is consistent with the observations of the kinetic Alfvén waves. A weak ion heating along the recently-opened field lines is also suggested from the examination of the ion distribution functions. During an injection event, a large plasma convection motion, indicative of a reconnection site location, is shown to be consistent with the velocity perturbation induced by the large-scale Alfvén wave simultaneously detected.

  12. Twin peak quasi-periodic oscillations as signature of oscillating cusp torus

    CERN Document Server

    Török, Gabriel; Horák, Jiří; Šrámková, Eva; Urbanec, Martin; Pecháček, Tomáš; Bakala, Pavel

    2015-01-01

    Serious theoretical effort has been devoted to explain the observed frequencies of twin-peak quasi-periodic oscillations (HF QPOs) observed in low-mass X-ray neutron star binaries. Here we propose a new model of HF QPOs. Within its framework we consider an oscillating torus with cusp that changes location $r_0$ of its centre around radii very close to innermost stable circular orbit. The observed variability is assigned to global modes of accreted fluid motion that may give strong modulation of both accretion disc radiation and the accretion rate. For a given spacetime geometry, the model predicts that QPO frequencies are function of single parameter $r_0$. We illustrate that the model can provide fits of data comparable to those reached by other models, or even better. In particular it is compared to relativistic precession model. Moreover, we also illustrate that the model consideration is compatible with consideration of models of a rotating neutron star in the atoll source 4U~1636-53.

  13. Propagation and source of Pc5 frequency range pulsation at cusp latitude

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    Two induction magnetometers have been installed at Chinese Zhongshan Station and Australia Davis Station, Antarctica respectively. We adopt the cross-spectral analysis technique to analyze the data of the two induction magnetometers, in June, September, December 1996 and March 1997, and to investigate Pc5 frequency range pulsation (150 600 s) occurrence and propagation in cusp latitude. The results are summarized as follows: At Zhongshan-Davis Station, the magnetic pulsations in Pc5 frequency band can occurs over a wide time, but more frequently at pre local magnetic noon and pre local magnetic midnight. The Pc5 pulsations have no significant seasonal variation in the amplitude, occurrence and propagation. The amplitude has a small peak at pre local magnetic noon and large value sometimes at pre local magnetic midnight. In daytime, the Pc5 pulsations propagate westward in morning and eastward in afternoon, and reversal at local magnetic noon. In nighttime, the Pc5 pulsations propagate westward before 20:00 MLT and eastward after 20:00 MLT. Near dusk time, the Pc5 pulsations propagate irregularly. These characteristics indicate that the Pc5 pulsations have different source at different local magnetic time.

  14. Cluster observations of high-frequency waves in the exterior cusp

    Directory of Open Access Journals (Sweden)

    Y. Khotyaintsev

    2004-07-01

    Full Text Available We study wave emissions, in the frequency range from above the lower hybrid frequency up to the plasma frequency, observed during one of the Cluster crossings of a high-beta exterior cusp region on 4 March 2003. Waves are localized near narrow current sheets with a thickness a few times the ion inertial length; currents are strong, of the order of 0.1-0.5μA/m2 (0.1-0.5mA/m2 when mapped to ionosphere. The high frequency part of the waves, frequencies above the electron-cyclotron frequency, is analyzed in more detail. These high frequency waves can be broad-band, can have spectral peaks at the plasma frequency or spectral peaks at frequencies below the plasma frequency. The strongest wave emissions usually have a spectral peak near the plasma frequency. The wave emission intensity and spectral character change on a very short time scale, of the order of 1s. The wave emissions with strong spectral peaks near the plasma frequency are usually seen on the edges of the narrow current sheets. The most probable generation mechanism of high frequency waves are electron beams via bump-on-tail or electron two-stream instability. Buneman and ion-acoustic instability can be excluded as a possible generation mechanism of waves. We suggest that high frequency waves are generated by electron beams propagating along the separatrices of the reconnection region.

  15. Simulation of RF power and multi-cusp magnetic field requirement for H- ion sources

    Science.gov (United States)

    Pathak, Manish; Senecha, V. K.; Kumar, Rajnish; Ghodke, Dharmraj. V.

    2016-12-01

    A computer simulation study for multi-cusp RF based H- ion source has been carried out using energy and particle balance equation for inductively coupled uniformly dense plasma considering sheath formation near the boundary wall of the plasma chamber for RF ion source used as high current injector for 1 Gev H- Linac project for SNS applications. The average reaction rates for different reactions responsible for H- ion production and destruction have been considered in the simulation model. The RF power requirement for the caesium free H- ion source for a maximum possible H- ion beam current has been derived by evaluating the required current and RF voltage fed to the coil antenna using transformer model for Inductively Coupled Plasma (ICP). Different parameters of RF based H- ion source like excited hydrogen molecular density, H- ion density, RF voltage and current of RF antenna have been calculated through simulations in the presence and absence of multicusp magnetic field to distinctly observe the effect of multicusp field. The RF power evaluated for different H- ion current values have been compared with the experimental reported results showing reasonably good agreement considering the fact that some RF power will be reflected from the plasma medium. The results obtained have helped in understanding the optimum field strength and field free regions suitable for volume emission based H- ion sources. The compact RF ion source exhibits nearly 6 times better efficiency compare to large diameter ion source.

  16. Magnetic Field Effects on the Plume of a Diverging Cusped-Field Thruster

    KAUST Repository

    Matlock, Taylor

    2010-07-25

    The Diverging Cusped-Field Thruster (DCFT) uses three permanent ring magnets of alternating polarity to create a unique magnetic topology intended to reduce plasma losses to the discharge chamber surfaces. The magnetic field strength within the DCFT discharge chamber (up to 4 kG on axis) is much higher than in thrusters of similar geometry, which is believed to be a driving factor in the high measured anode efficiencies. The field strength in the near plume region is large as well, which may bear on the high beam divergences measured, with peaks in ion current found at angles of around 30-35 from the thruster axis. Characterization of the DCFT has heretofore involved only one magnetic topology. It is then the purpose of this study to investigate changes to the near-field plume caused by altering the shape and strength of the magnetic field. A thick magnetic collar, encircling the thruster body, is used to lower the field strength outside of the discharge chamber and thus lessen any effects caused by the external field. Changes in the thruster plume with field topology are monitored by the use of normal Langmuir and emissive probes interrogating the near-field plasma. Results are related to other observations that suggest a unified conceptual framework for the important near-exit region of the thruster.

  17. Polar spacecraft observations of the turbulent outer cusp/magnetopause boundary layer of Earth

    Directory of Open Access Journals (Sweden)

    J. S. Pickett

    1999-01-01

    Full Text Available The orbit of the Polar spacecraft has been ideally suited for studying the turbulent region of the cusp that is located near or just outside the magnetopause current sheet at 7-9 RE. The wave data obtained in this region show that electromagnetic turbulence is dominant in the frequency range 1-10 Hz. The waves responsible for this turbulence usually propagate perpendicular to the local magnetic field and have an index of refraction that generally falls between the estimated cold plasma theoretical values of the electromagnetic lower hybrid and whistler modes and may be composed of both modes in concert with kinetic Alfvén waves and/or fast magnetosonic waves. Fourier spectra of the higher frequency wave data also show the electromagnetic turbulence at frequencies up to and near the electron cyclotron frequency. This higher frequency electromagnetic turbulence is most likely associated with whistler mode waves. The lower hybrid drift and current gradient instabilities are suggested as possible mechanisms for producing the turbulence. The plasma and field environment of this turbulent region is examined and found to be extremely complex. Some of the wave activity is associated with processes occurring locally, such as changes in the DC magnetic field, while others are associated with solar wind and interplanetary magnetic field changes.

  18. Factors influencing long-term survival after aortic valve replacement.

    Directory of Open Access Journals (Sweden)

    Shigenobu,Masaharu

    1980-06-01

    Full Text Available In the aortic stenosis group, the left ventricular (LV muscle mass index was a good parameter for predicting the prognosis. Associated mitral valve disease had no influence on long term survival after aortic valve replacement. In the aortic insufficiency group, associated mitral valve disease had a marked influence on the results of aortic valve replacement. In general, the aortic insufficiency group had less clinical improvement postoperatively than the aortic stenosis group. In the annuloaortic ectasia group, left ventricular enddiastolic pressure (LVEDP might be the predictor to the prognosis. This group had the worst prognosis, of the three groups. Early operation should be considered for patients who have no, or only mild symptoms of, aortic valve disease.

  19. Aortic Remodeling Following Transverse Aortic Constriction in Mice is Attenuated with AT1 Receptor Blockade

    Science.gov (United States)

    Kuang, Shao-Qing; Geng, Liang; Prakash, Siddharth K.; Cao, Jiu-Mei; Guo, Steven; Villamizar, Carlos; Kwartler, Callie S.; Ju, Xiaoxi; Brasier, Allan R.; Milewicz, Dianna M.

    2016-01-01

    Objective Although hypertension is the most common risk factor for thoracic aortic diseases, it is not understood how increased pressures on the ascending aorta lead to aortic aneurysms. We investigated the role of Ang II type 1 (AT1) receptor activation in ascending aortic remodeling in response to increased biomechanical forces using a transverse aortic constriction (TAC) mouse model. Approach and Results Two weeks after TAC, the increased biomechanical pressures led to ascending aortic dilatation, aortic wall thickening and medial hypertrophy. Significant adventitial hyperplasia and inflammatory responses in TAC ascending aortas were accompanied by increased adventitial collagen, elevated inflammatory and proliferative markers, and increased cell density due to accumulation of myofibroblasts and macrophages. Treatment with losartan significantly blocked TAC induced vascular inflammation and macrophage accumulation. However, losartan only partially prevented TAC induced adventitial hyperplasia, collagen accumulation and ascending aortic dilatation. Increased Tgfb2 expression and phosphorylated-Smad2 staining in the medial layer of TAC ascending aortas was effectively blocked with losartan. In contrast, the increased Tgfb1 expression and adventitial phospho-Smad2 staining were only partially attenuated by losartan. In addition, losartan significantly blocked Erk activation and ROS production in the TAC ascending aorta. Conclusions Inhibition of the AT1 receptor using losartan significantly attenuated the vascular remodeling associated with TAC but did not completely block the increased TGF- β1 expression, adventitial Smad2 signaling and collagen accumulation. These results help to delineate the aortic TGF-β signaling that is dependent and independent of the AT1 receptor after TAC. PMID:23868934

  20. [Evaluation of aortic valve replacement involving small severely calcified aortic annulus in elderly patients].

    Science.gov (United States)

    Iwahashi, M; Nishimura, Y; Hiramatsu, K; Komori, S; Shibata, M; Yuzaki, M; Okamura, Y

    2006-04-01

    We performed aortic valve replacement in 24 patients aged over 70 with small calcified valves. The surgical management of such patients remains controversial as the extensive calcification compromises implantation. Hence, we used an ultrasonic debridement instrument to remove calcium and selected a small prosthesis with the largest possible orifice without enlargement of the aortic annulus. Echocardiography showed significant reductions in left ventricular mass index compared with preoperative values. Early and mid-term prognosis has been relatively good.

  1. Minimally invasive aortic valve replacement – pros and cons of keyhole aortic surgery

    OpenAIRE

    Kaczmarczyk, Marcin; Szałański, Przemysław; Zembala, Michał; Filipiak, Krzysztof; Karolak, Wojciech; Wojarski, Jacek; Garbacz, Marcin; Kaczmarczyk, Aleksandra; Kwiecień, Anna; Zembala, Marian

    2015-01-01

    Over the last twenty years, minimally invasive aortic valve replacement (MIAVR) has evolved into a safe, well-tolerated and efficient surgical treatment option for aortic valve disease. It has been shown to reduce postoperative morbidity, providing faster recovery and rehabilitation, shorter hospital stay and better cosmetic results compared with conventional surgery. A variety of minimally invasive accesses have been developed and utilized to date. This concise review demonstrates and discus...

  2. Effect of transcatheter aortic valve implantation on QT dispersion in patients with aortic stenosis

    Institute of Scientific and Technical Information of China (English)

    Hakan Erkan; kr elik; Engin Hatem; Mustafa Tark Aa; Levent Korkmaz; Teyyar Gkdeniz; Ahmet arAykan; Ezgi Kalaycolu; Faruk Boyac; mer Faruk rakolu

    2014-01-01

    Background QT dispersion (QTd) is a predictor of ventricular arrhythmia. Ventricular arrhythmia is an important factor influencing morbidity and mortality in patients with aortic stenosis. Surgical aortic valve replacement reduced the QTd in this patients group. However, the effect of transcatheter aortic valve implantation (TAVI) on QTd in patients with aortic stenosis is unknown. The aim of this study was to investigate the effect of TAVI on QTd in patients with aortic stenosis. Methods Patients with severe aortic stenosis, who were not candi-dates for surgical aortic valve replacement due to contraindications or high surgical risk, were included in the study. All patients underwent electrocardiographic and echocardiographic evaluation before, and at the 6th month after TAVI, computed QTd and left ventricular mass index (LVMI). Results A total 30 patients were admitted to the study (mean age 83.2 ± 1.0 years, female 21 and male 9, mean valve area 0.7 ± 3 mm2). Edwards SAPIEN heart valves, 23 mm (21 patients) and 26 mm (9 patients), by the transfemoral approach were used in the TAVI procedures. All TAVI procedures were successful. Both QTd and LVMI at the 6th month after TAVI were significantly reduced com-pared with baseline values of QTd and LVMI before TAVI (73.8 ± 4 ms vs. 68 ± 2 ms, P=0.001 and 198 ± 51 g/m² vs. 184 ± 40 g/m², P=0.04, respectively). There was a significant correlation between QTd and LVMI (r=0.646, P<0.001). Conclusions QTd, which malign ventricular arrhythmia marker, and LVMI were significantly reduced after TAVI procedure. TAVI may decrease the possibility of ventricu-lar arrhythmia in patients with aortic stenosis.

  3. Aortic valve leaflet replacement with bovine pericardium to preserve native dynamic capabilities of the aortic annulus.

    Science.gov (United States)

    Kim, Kyung Hwa; Choi, Jong Bum; Kim, Min Ho; Kim, Won Ho; Lee, Mi Kyung; Lee, Sam Youn

    2014-02-01

    Valve replacement is typically the most appropriate option for treating aortic valve stenotic insufficiency. However, neither mechanical nor bioprosthetic replacement components preserve the circumferential expansion and contraction of a native aortic annulus during the cardiac cycle, because the prosthetic ring is affixed to the annulus. A 64-year-old man presented with a bicuspid and stenotic aortic valve, and the native annulus was too small to accommodate a porcine replacement valve. We fashioned new aortic leaflets from bovine pericardium with use of a template, and we affixed the sinotubular junction with use of inner and outer stabilization rings. Postoperative echocardiograms revealed coaptation of the 3 new leaflets with no regurgitation. At the patient's 5.5-year follow-up examination, echocardiograms showed flexible leaflet movement with a coaptation height of 7 mm, and expansion and contraction of the aortic annulus similar to that of a normal native annulus. The transvalvular pressure gradient was insignificant. If long-term durability of the new leaflets is confirmed, this method of leaflet replacement and fixation of the sinotubular junction might serve as an acceptable alternative to valve replacement in the treatment of aortic valve stenosis. We describe the patient's case and present our methods and observations.

  4. Aortic root aneurysm in an adult patient with aortic coarctation: a single-stage approach.

    Science.gov (United States)

    Ananiadou, Olga G; Koutsogiannidis, Charilaos; Ampatzidou, Fotini; Drossos, George E

    2012-09-01

    Coarctation of the aorta is a common congenital defect that may be undiagnosed until adulthood. Moreover, coarctation is associated with congenital and acquired cardiac pathology that may require surgical intervention. The management of an adult patient with aortic coarctation and an associated cardiac defect poses a great technical challenge since there are no standard guidelines for the therapy of such a complex pathology. Several extra-anatomic bypass grafting techniques have been described, including methods in which distal anastomosis is performed on the descending thoracic aorta, allowing simultaneous intracardiac repair. We report here a 37-year old man who was diagnosed with an aortic root aneurysm and aortic coarctation. The patient was treated electively with a single-stage approach through a median sternotomy that consisted of valve-sparing replacement of the aortic root and ascending-to-descending extra-anatomic aortic bypass, using a 18-mm Dacron graft. Firstly, the aortic root was replaced with the Yacoub remodelling procedure, and then the distal anastomosis was performed to the descending aorta, behind the heart, with the posterior pericardial approach. The extra-anatomic bypass graft was brought laterally from the right atrium and implanted in the ascending graft. Postoperative recovery was uneventful and a control computed tomographic angiogram 1 month after complete repair showed good results.

  5. Medtronic Freestyle Aortic Root Bioprosthesis Implantation for the Infective Endocarditis on Aortic Root

    Directory of Open Access Journals (Sweden)

    Zekeriya Arslan

    2013-10-01

    Full Text Available    Infective endocarditis and periannular abscess formation are serious problems in cardiac valve surgery, requiring extensive surgical debridement and reconstruction of the aortic annulus. We aimed to report two cases which were successfully treated with bioprosthetic valve implantation for infective endocarditis. Transosephageal echocardiography were performed for the diagnosis of one prosthetic and one native destructive aortic valve endocarditis in association with congestive heart failure (NYHA class-VI and abscess formation. Medtronic Freestyle stentless aortic root bioprosthesis was implanted into the left ventricular outflow tract after surgical radical aortic root debridement for each patient followed with medical treatment, which was extended to six weeks. Neither early nor late mortality was detected. One patient required prolonged ventilatory support (two days and permanent DDD-R pacing. Echocardiography showed no signs of valve dysfunction or recurrent endocarditis for both patients in 10 months follow up.Medtronic Freestyle stentless aortic root bioprosthesis may be a good alternative way of treatment to aortic valve and root endocarditis instead of homograft.

  6. COMPARISON OF PREOPERATIVE NONINVASIVE AND INTRAOPERATIVE MEASUREMENTS OF AORTIC ANNULUS

    Directory of Open Access Journals (Sweden)

    Manish Hinduja

    2016-10-01

    Full Text Available BACKGROUND Precise preoperative assessment of aortic annulus diameter is essential for sizing of aortic valve especially in patients planned for transcatheter aortic valve replacement. Computed Tomographic (CT and echocardiographic measurements of the aortic annulus vary because of elliptical shape of aortic annulus. This study was undertaken to compare the measurement of aortic annulus intraoperatively with preoperative noninvasive methods in patients undergoing aortic valve replacement. MATERIALS AND METHODS Aortic annulus diameter was measured with cardiac CT and Transesophageal Echocardiography (TEE prior to open aortic valve replacement in 30 patients with aortic valve stenosis. In CT, aortic annulus dimensions were measured in coronal plane, sagittal oblique plane and by planimetry. Both 2-dimensional and 3-dimensional TEE were used. These were compared with intraoperative measurements done by valve sizers and Hegar dilators. Pearson analysis was applied to test for degree of correlation. RESULTS CT in coronal and sagittal oblique plane tends to overestimate the diameter of aortic annulus when compared with intraoperative measurements (coefficient of relation, r = 0.798 and 0.749, respectively. CT measurements in single oblique plane showed a weaker correlation with intraoperative measurements than 3D TEE and 2D TEE (r = 0.917 and 0.898, respectively. However, CT measurements by planimetry method were most correlating with the intraoperative measurements (r = 0.951. CONCLUSION Noninvasive investigations with 3-dimensional views (CT-based measurement employing calculated average diameter assessment by planimetry and 3-dimensional TEE showed better correlation with intraoperative measurement of aortic annulus. CT-based aortic annulus measurement by planimetry seems to provide adequate dimensions most similar to operative measurements.

  7. Conservative aortic valve surgery in adults

    NARCIS (Netherlands)

    Casselman, F.P.A.

    2001-01-01

    118 Chapter 1 reviews the current knowledge of the aortic valve. The normal anatomy and possible variations are described. The different pathological conditions are explained as wel as their natural history and the indications for intervention. The various surgical options with regard to the patholo

  8. The future of transcatheter aortic valve implantation.

    Science.gov (United States)

    Hamm, Christian W; Arsalan, Mani; Mack, Michael J

    2016-03-01

    Since the introduction of transcatheter aortic valve implantation (TAVI) into clinical practice, the treatment of aortic stenosis has changed dramatically. In the past, medical therapy with or without balloon aortic valvuloplasty was the only option for inoperable patients. More recently, TAVI has become the treatment of choice for these patients and the preferred alternative for high-risk operable patients. Surgical aortic valve replacement (SAVR) currently remains the gold standard for patients at low or intermediate operative risk. As randomized trials have demonstrated comparable results between TAVI and SAVR in the high-risk population, there is now a clear trend towards performing TAVI even in intermediate-risk patients while awaiting the results of randomized trials in that population. Nevertheless, there are still questions regarding TAVI involving paravalvular leak (PVL), stroke, pacemaker requirements, and durability that remain to be more definitively answered before TAVI can routinely be performed in a broader, lower risk population. Improvements in patient selection, imaging, and second and third generation devices have decreased the incidence of PVLs and vascular complications that followed the earliest TAVI procedures, but the rates of perioperative stroke and permanent pacemaker implantation must still be addressed. Furthermore, the long-term durability of TAVI devices and a role for post-procedure antithrombotic management remain unanswered. Until these questions are more clearly answered, it is the Heart Team's task to determine the optimal treatment for each patient based on risk scores, frailty metrics, comorbidities, patient preference, and potential for improvement in quality of life.

  9. Painless aortic dissection presenting as paraplegia.

    Science.gov (United States)

    Colak, Necmettin; Nazli, Yunus; Alpay, Mehmet Fatih; Akkaya, Ismail Olgun; Cakir, Omer

    2012-01-01

    Acute dissection of the aorta can be life-threatening. As a presenting manifestation of aortic dissection, neurologic complications such as paraplegia are rare. Herein, we report the case of a 51-year-old man who presented with sudden-onset paraplegia and ischemia of the legs, with no chest or back pain. His medical history included coronary artery bypass grafting. Physical examination revealed pulseless lower extremities, and computed tomography showed aortic dissection from the ascending aorta to the common iliac arteries bilaterally. A lumbar catheter was inserted for cerebrospinal fluid drainage, and axillary arterial cannulation was established. With the use of cardiopulmonary bypass, the aortic dissection was corrected, and the previous coronary artery grafts were reattached. The surgery restored spinal and lower-extremity perfusion, and the patient walked unaided from the hospital upon his discharge 5 days later. Although acute aortic dissection presenting as paraplegia is rare, it should be considered in patients who have pulseless femoral arteries bilaterally and sudden-onset paraplegia, despite no pain in the chest or back. Prompt diagnosis and intervention can prevent morbidity and death.

  10. [Albert Einstein and his abdominal aortic aneurysm].

    Science.gov (United States)

    Cervantes Castro, Jorge

    2011-01-01

    The interesting case of Albert Einstein's abdominal aortic aneurysm is presented. He was operated on at age 69 and, finding that the large aneurysm could not be removed, the surgeon elected to wrap it with cellophane to prevent its growth. However, seven years later the aneurysm ruptured and caused the death of the famous scientist.

  11. Fatal Saccharomyces Cerevisiae Aortic Graft Infection

    Science.gov (United States)

    Meyer, Michael (Technical Monitor); Smith, Davey; Metzgar, David; Wills, Christopher; Fierer, Joshua

    2002-01-01

    Saccharomyces cerevisiae is a yeast commonly used in baking and a frequent colonizer of human mucosal surfaces. It is considered relatively nonpathogenic in immunocompetent adults. We present a case of S. cerevisiae fungemia and aortic graft infection in an immunocompetent adult. This is the first reported case of S. cerevisiue fungemia where the identity of the pathogen was confirmed by rRNA sequencing.

  12. Aortic thrombus formation during a Seldinger aortography

    Energy Technology Data Exchange (ETDEWEB)

    Kiermayer, H.

    1984-12-01

    Acute aortic thrombosis is a rarely described complication of angiography with the technique of arterial catheterization. In the presented case record, a sudden therapy-resistant rise in blood pressure was accompanied by paraplegia of the lower limbs. The activation of the coagulation system caused by the heterogeneous material brought into the aorta, combined with severe arteriosclerosis, is discussed as a possible cause.

  13. Severe aortic valve stenosis and nosebleed

    NARCIS (Netherlands)

    Schoedel, Johannes; Obergfell, Achim; Maass, Alexander H.; Schodel, Johannes

    2007-01-01

    Aortic valve stenosis is known to be associated with loss of high molecular von Willebrand multimers. This can lead to gastrointestinal bleeding in patients with gastrointestinal angiodysplasia, the Heyde syndrome. Here we present a case of anaemia and severe epistaxis associated with acquired von W

  14. Noncardiac surgery in patients with aortic stenosis

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Jørgensen, Mads Emil; Martinsson, Andreas

    2014-01-01

    BACKGROUND: Past research has identified aortic stenosis (AS) as a major risk factor for adverse outcomes in noncardiac surgery; however, more contemporary studies have questioned the grave prognosis. To further our understanding of this, the risks of a 30-day major adverse cardiovascular event...

  15. Systolic time intervals in congenital aortic stenosis.

    NARCIS (Netherlands)

    Moene, Rudolf Johannens

    1974-01-01

    Obstruction to left ventricular outflow may occur at the valvular, subvalvular and Supravalvular level. The most common congenital forms are valvular aortic stenosis and membranous subaortic stenosis, representing about 75 and l0 percent of all cases respectively. ... Zie: Chapter 1

  16. 57. Aortic valve replacement with sutureless valve and mitral valve repair in patient with infected aortic homograft

    Directory of Open Access Journals (Sweden)

    A. attia

    2016-07-01

    Full Text Available The approach of implanting aortic sutureless valve inside the calcific homograft is suitable in redo surgery especially if associated with mitral valve surgery. Aortic valve replacement in patients who have undergone previous aortic root replacement with an aortic homograft remains a technical challenge because of homograft degeneration and the need for a redo Bentall operation. We report a case of redo aortic valve replacement (valve in valve with a sutureless valve and mitral valve repair by miniband annuloplasty in a female patient aged 64 years old who underwent aortic valve replacement with homograft 14 years ago and presented by sever aortic valve regurge and sever mitral valve regurge because of infective endocarditis. This technique allows rapid aortic valve replacement in a heavily calcified aortic root. It also avoids aortic valve size affection after mitral valve repair by ordinary methods especially in patients with small aortic annulus. This technique is particularly suitable in redo procedures for homograft degeneration, it avoids performing a redo Bentall operation with its known problems as well as to avoid patient prosthesis mismatch.

  17. Cluster observations of the high-latitude magnetopause and cusp: initial results from the CIS ion instruments

    Directory of Open Access Journals (Sweden)

    J. M. Bosqued

    Full Text Available Launched on an elliptical high inclination orbit (apogee: 19.6 RE since January 2001 the Cluster satellites have been conducting the first detailed three-dimensional studies of the high-latitude dayside magnetosphere, including the exterior cusp, neighbouring boundary layers and magnetopause regions. Cluster satellites carry the CIS ion spectrometers that provide high-precision, 3D distributions of low-energy (<35 keV/e ions every 4 s. This paper presents the first two observations of the cusp and/or magnetopause behaviour made under different interplanetary magnetic field (IMF conditions. Flow directions, 3D distribution functions, density profiles and ion composition profiles are analyzed to demonstrate the high variability of high-latitude regions. In the first crossing analyzed (26 January 2001, dusk side, IMF-BZ < 0, multiple, isolated boundary layer, magnetopause and magnetosheath encounters clearly occurred on a quasi-steady basis for ~ 2 hours. CIS ion instruments show systematic accelerated flows in the current layer and adjacent boundary layers on the Earthward side of the magnetopause. Multi-point analysis of the magnetopause, combining magnetic and plasma data from the four Cluster spacecraft, demonstrates that oscillatory outward-inward motions occur with a normal speed of the order of ± 40 km/s; the thickness of the high-latitude current layer is evaluated to be of the order of 900–1000 km. Alfvénic accelerated flows and D-shaped distributions are convincing signatures of a magnetic reconnection occurring equatorward of the Cluster satellites. Moreover, the internal magnetic and plasma structure of a flux transfer event (FTE is analyzed in detail; its size along the magnetopause surface is ~ 12 000 km and it convects with a velocity of ~ 200 km/s. The second event analyzed (2 February 2001 corresponds to the first Cluster pass within the cusp when the IMF-BZ component was northward directed. The analysis of

  18. Surgical management of a hypoplastic distal aortic arch and coarctation of aorta in a patient with Klippel-Feil syndrome, ascending aortic aneurysm and bicuspid aortic valve.

    Science.gov (United States)

    Sabol, Frantisek; Kolesar, Adrián; Toporcer, Tomás; Bajmoczi, Milan

    2014-10-01

    Klippel-Feil syndrome has been associated with cardiovascular malformations, but only 3 cases have been reported to be associated with aortic coarctation and surgical management is not defined. A 51-year old woman with Klippel-Feil syndrome associated with an aneurysm of the ascending aorta, hypoplastic aortic arch and aortic coarctation at the level of the left subclavian artery presented with shortness of breath 2 years after diagnosis. Imaging identified interim development of a 7.2-cm aneurysm at the level of the aortic coarctation. She underwent surgical repair with a Dacron interposition graft under hypothermic circulatory arrest. She continues to do well 18 months following repair.

  19. Endovascular treatment of thoracic aortic diseases

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    Davidović Lazar

    2013-01-01

    Full Text Available Bacground/Aim. Endovascular treatment of thoracic aortic diseases is an adequate alternative to open surgery. This method was firstly performed in Serbia in 2004, while routine usage started in 2007. Aim of this study was to analyse initial experience in endovacular treatment of thoracic aortic diseses of three main vascular hospitals in Belgrade - Clinic for Vascular and Endovascular Surgery of the Clinical Center of Serbia, Clinic for Vascular Surgery of the Military Medical Academy, and Clinic for Vascular Surgery of the Institute for Cardiovascular Diseases “Dedinje”. Methods. Between March 2004. and November 2010. 41 patients were treated in these three hospitals due to different diseases of the thoracic aorta. A total of 21 patients had degenerative atherosclerotic aneurysm, 6 patients had penetrating aortic ulcer, 6 had posttraumatic aneurysm, 4 patients had ruptured thoracic aortic aneurysm, 1 had false anastomotic aneurysm after open repair, and 3 patients had dissected thoracic aneurysm of the thoracoabdominal aorta. In 15 cases the endovascular procedure was performed as a part of the hybrid procedure, after carotidsubclavian bypass in 4 patients and subclavian artery transposition in 1 patient due to the short aneurysmatic neck; in 2 patients iliac conduit was used due to hypoplastic or stenotic iliac artery; in 5 patients previous reconstruction of abdominal aorta was performed; in 1 patient complete debranching of the aortic arch, and in 2 patients visceral abdominal debranching were performed. Results. The intrahospital mortality rate (30 days was 7.26% (3 patients with ruptured thoracic aneurysms died. Endoleak type II in the first control exam was revealed in 3 patients (7. 26%. The patients were followed up in a period of 1-72 months, on average 29 months. The most devastating complication during a followup period was aortoesofageal fistula in 1 patient a year after the treatment of posttraumatic aneurysm. Conversion was

  20. Intramural aortic hematomas; Intramurale Haematome der Aorta

    Energy Technology Data Exchange (ETDEWEB)

    Raab, B.W.; Vosshenrich, R.; Fischer, U.; Funke, M.; Grabbe, E. [Goettingen Univ. (Germany). Abt. fuer Roentgendiagnostik

    2001-08-01

    Intramural hematomas (IMH) are regarded as a hemorrhage into the aortic wall. In general a traumatic form can be differentiated from a spontaneous non-traumatic. There is a predisposition of IMH with arterial hypertension and mesoectodermal dysplastic syndromes. The diagnosis is established with the clinical presentation in combination with the findings of different imaging modalities. Acute and subacute discomfort associated with a tendency of collaps are considered as typical presenting complaints. A semicircular or concentric thickening of the aortic wall with the absence of blood flow or a dissection membran are typical findings in transesophageal echocardiography, computed tomography and magnetic resonance tomography. From a differential diagnostic point of view a distinction from atherosclerotic wall changes, intraluminal thrombi and inflammatory aortic diseases is essential. The IMH is considered as an early presentation of aortic dissection, put into and treated according to the Stanford classification. In the course of natural history an IMH can disappear, rupture or progress into a classic aortic dissection. (orig.) [German] Das intramurale Haematom (IMH) ist eine Einblutung in die Aortenwand. Grundsaetzlich kann zwischen traumatischer Genese und einer atraumatischen spontanen Form unterschieden werden. Praedisponierend sind arterielle Hypertension und mesoektodermale Dysplasiesyndrome. Die Diagnose ergibt sich aus der Klinik und den Befunden in den bildgebenden Verfahren. Zu den klinischen Symptomen zaehlen akut oder subakut auftretende Schmerzen, assoziiert mit einer Kollapsneigung. Typische Befunde in der transoesophagealen Echokardiographie, der Computer- oder der Magnetresonanztomographie sind eine halbmondfoermige oder konzentrische Wandverdickung der Aorta ohne Nachweis von Blutfluss oder einer Dissektionsmembran mit Dichtewerten bzw. Signalintensitaeten in Abhaengigkeit vom Alter der Einblutung. Differenzialdiagnostisch ist eine Abgrenzung

  1. Correlative magnetic resonance imaging in the evaluation of aortic and pulmonary artery abnormalities

    Energy Technology Data Exchange (ETDEWEB)

    Risius, B.; O' Donnell, J.K.; Geisinger, M.A.; Zelch, M.G.; George, C.R.; Graor, R.A.; Moodie, D.S.

    1985-05-01

    Magnetic resonance imaging (MRI) yields excellent quality images of the cardiovascular system utilizing the inherent natural contrast between flowing blood and the surrounding anatomic structures. To evaluate the clinical usefulness of MRI in the noninvasive diagnosis of large vessel disorders, the authors have performed MRI on 40 pts with either aortic or pulmonary artery abnormalities (18 thoracic or abdominal aortic aneurysms, 8 aorto-occlusive disease, 6 dissecting aneurysms, 4 Marfan's syndrome, 2 pulmonary artery aneurysms 1 pulmonary artery occlusion, 1 aortic coarctation). Images were obtained in the transverse, coronal and sagital body planes utilizing a 0.6T superconductive magnet. Cardiac and/or respiratory gating was employed in most cases. Correlation was made for all studies with conventional or digital subtraction angiography, computed tomography, and/or ultrasound. The diagnostic information obtained by MRI equaled or exceeded that obtained by other imaging techniques except for the few cases where cardiac arrhythmias precluded adequate gated acquisition. All aneurysms and their relationships to adjacent structures were readily demonstrated as were the presence or absence of mural thrombi and dissecting intimal flaps. Angiographically demonstrated atherosclerotic plaques and luminal stenoses were seen by MRI in all patients without arrhythmias. The authors concluded that MRI is a powerful noninvasive diagnostic aid in the delineation of large vessel disorders, especially where knowledge of anatomic interrelationships can guide surgical or other interventional planning.

  2. An incidentally discovered asymptomatic para-aortic paraganglioma with Peutz-Jeghers syndrome

    Directory of Open Access Journals (Sweden)

    Nazish Butt

    2012-01-01

    Full Text Available Peutz-Jeghers syndrome (PJS is an autosomal dominant inherited disorder characterized by mucocutaneous melanin pigmentation and gastrointestinal (GI tract hamartomatous polyps and an increased risk of malignancy. In addition to polyposis, previous studies have reported increased risk of GI and extraGI malignancies in PJS patients, compared with that of the general population. The most common extraintestinal malignancies reported in previous studies are pancreatic, breast, ovarian and testicular cancers.We report the case of a 17-year-old boy who presented with generalized weakness, recurrent sharp abdominal pain and melena, had exploratory laparotomy and ileal resection for ileo-ileal intussusception. Pigmentation of the buccal mucosa was noted. An abdominal computed tomography scan (CT revealed multiple polyps in small bowel loops. Gastroscopy revealed multiple dimunitive polyps in stomach and pedunculated polyp in duodenum. Colonoscopy revealed multiple colonic polyps. Pathological examination of the polyps confirmed hamartomas with smooth muscle arborization, compatible with Peutz-Jeghers polyps. CT scan guided left para-aortic lymph node biopsy revealed the characteristic features of extra-adrenal para-aortic paraganglioma. Although cases of various GI and extra GI malignancies in PJS patients has been reported, the present case appears to be the first in literature in which the PJS syndrome was associated with asymptomatic extraadrenal para-aortic paraganglioma. Patients with PJS should be treated by endoscopic or surgical resection and need whole-body screening.

  3. The registry of anomalous aortic origin of the coronary artery of the Congenital Heart Surgeons' Society.

    Science.gov (United States)

    Brothers, Julie A; Gaynor, J William; Jacobs, Jeffrey P; Caldarone, Christopher; Jegatheeswaran, Anusha; Jacobs, Marshall L

    2010-12-01

    The anomalous aortic origin of a coronary artery from the wrong sinus of Valsalva with interarterial, intramural, and/or intraconal course is a rare congenital anomaly that is associated with a high risk of sudden death in children. The Congenital Heart Surgeons' Society established the Registry of Anomalous Aortic Origin of the Coronary Artery to help determine the outcome of children and young adults managed with surgical intervention versus observation and to test the hypothesis that subsets of patients with anomalous aortic origin of a coronary artery can be identified in whom the risk of intervention is less than the risk of observation. All institutional members of the Congenital Heart Surgeons' Society were recruited for participation. The registry consists of a retrospective cohort of patients diagnosed between 1 January, 1998 and 20 January, 2009 and a prospective, population-based cohort of patients newly diagnosed from 21 January, 2009 onwards. Baseline demographics, diagnoses, and results of tests will be obtained through a review of the medical records. Annual follow-up data will be collected. Data will be analysed for different factors of risk at diagnosis, different strategies of treatment, and the impact of both on the outcomes of the patients. As of June 2010, 28 institutions had applied for approval from their institutional review board and 16 institutions had received approval from their institutional review board. Seventy-four patients have enrolled to date. We hope to use the established Pediatric Cardiomyopathy Registry as a guide to successful implementation, with a cooperative effort between institutions. The overall purpose of the Registry of Anomalous Aortic Origin of the Coronary Artery is to determine the outcome of surgical intervention versus observation in children and young adults with anomalous aortic origin of a coronary artery, and to describe the natural and "unnatural" history of these patients over the course of their lifetime

  4. Relation of thoracic aortic and aortic valve calcium to coronary artery calcium and risk assessment.

    Science.gov (United States)

    Wong, Nathan D; Sciammarella, Maria; Arad, Yadon; Miranda-Peats, Romalisa; Polk, Donna; Hachamovich, Rory; Friedman, John; Hayes, Sean; Daniell, Anthony; Berman, Daniel S

    2003-10-15

    Aortic calcium, aortic valve calcium (AVC), and coronary artery calcium (CAC) have been associated with cardiovascular event risk. We examined the prevalence of thoracic aortic calcium (TAC) and AVC in relation to the presence and extent of CAC, cardiovascular risk factors, and estimated risk of coronary heart disease (CHD). In 2,740 persons without known CHD aged 20 to 79 years, CAC was assessed by electron beam- or multidetector-computed tomography. We determined the prevalence of TAC and AVC in relation to CAC, CHD risk factors, and predicted 10-year risk of CHD. A close correspondence of TAC and AVC was observed with CAC. TAC and AVC increased with age; by the eighth decade of life, the prevalence of TAC was similar to that of CAC (>80%), and 36% of men and 24% of women had AVC. Age, male gender, and low-density lipoprotein cholesterol were directly related to the likelihood of CAC, TAC, and AVC; higher diastolic blood pressure and cigarette smoking additionally predicted CAC. Body mass index and higher systolic and lower diastolic blood pressures were also related to TAC, and higher body mass index and lower diastolic blood pressure were related to AVC. Calculated risk of CHD increased with the presence of AVC and TAC across levels of CAC. TAC and AVC provided incremental value over CAC in association with the 10-year calculated risk of CHD. If longitudinal studies show an incremental value of aortic and aortic valve calcium over that of CAC for prediction of cardiovascular events, future guidelines for risk assessment incorporating CAC assessment may additionally incorporate the measurement of aortic and/or aortic valve calcium.

  5. Plasma convection across the polar cap, plasma mantle and cusp: Cluster EDI observations

    Directory of Open Access Journals (Sweden)

    H. Vaith

    2004-07-01

    Full Text Available In this paper we report measurements of the convection obtained with the Electron Drift Instrument (EDI on Cluster. We use 20 passes that cross the between its dayside and nightside boundaries (or vice versa at geocentric distances ranging from about 5 to about 13RE, and at interspacecraft separations (transverse to the ambient magnetic field between a few km and almost 10000km. We first illustrate the nature of the data by presenting four passes in detail. They demonstrate that the sense of convection (anti-sunward vs. sunward essentially agrees with the expectations based on magnetic reconnection occurring on the dayside or poleward of the cusp. The most striking feature in the EDI data is the occurrence of large-amplitude fluctuations that are superimposed on the average velocities. One type of fluctuation appears to grow when approaching the dayside boundary. The examples also show that there is a variable degree of inter-spacecraft correlation, ranging from excellent to poor. We then present statistical results on all 20 passes. Plotting 10-min averages of the convection velocities vs. IMF Bz one recovers the expected dependence, albeit with large scatter. Looking at the variances computed over the same 10-min intervals, one confirms that there is indeed one type of contribution that grows towards the dayside boundary, but that variances can be high anywhere. Finally, computing the inter-spacecraft correlations as a function of their separation distance transverse to the magnetic field shows that the average correlation drops with increasing distance, but that even at distances as large as 5000km the correlation can be very good. To put those scales into context, the separation distances have also been scaled to ionospheric altitudes where they range between a few hundred meters and 600km.

  6. Deep venous thrombosis: The valve cusp hypoxia thesis and its incompatibility with modern orthodoxy.

    Science.gov (United States)

    Malone, P Colm; Agutter, Paul S

    2016-01-01

    The valve cusp hypoxia thesis (VCHT) of the aetiology of deep venous thrombosis (DVT) was adumbrated in this journal in 1977 and fully articulated in 2008, the original hypothesis having been strongly corroborated by experiments published in 1981 and 1984. It presents a unitary account of the pathogenesis of venous thrombosis and embolism that is rooted in the pathophysiological tradition of Hunter, Virchow, Lister, Welch and Aschoff, a tradition traceable back to Harvey. In this paper we summarise the thesis in its mature form, consider its compatibility with recent advances in the DVT field, and ask why it has not yet been assimilated into the mainstream literature, which during the past half century has been dominated by a haematology-orientated 'consensus model'. We identify and discuss seven ways in which the VCHT is incompatible with these mainstream beliefs about the aetiology of venous thrombosis, drawing attention to: (1) the spurious nature of 'Virchow's triad'; (2) the crucial differences between 'venous thrombus' and 'clot'; the facts that (3) venous thrombi form in the valve pockets (VVPs), (4) DVT is not a primarily haematological condition, (5) the so-called 'thrombophilias' are not thrombogenic per se; (6) the conflict between the single unitary aetiology of DVT and the tacit assumption that the condition is 'multicausal'; (7) the inability of anticoagulants to prevent the initiation of venous thrombogenesis, though they do prevent the growth of thrombi to clinically significant size. In discussing point (7), we show that the VCHT indicates new approaches to mechanical prophylaxis against DVT. These approaches are then formulated as experimentally testable hypotheses, and we suggest methods for testing them preclinically using animal trials.

  7. Valve Replacement with a Sutureless Aortic Prosthesis in a Patient with Concomitant Mitral Valve Disease and Severe Aortic Root Calcification.

    Science.gov (United States)

    Lio, Antonio; Scafuri, Antonio; Nicolò, Francesca; Chiariello, Luigi

    2016-04-01

    Aortic valve replacement with concomitant mitral valve surgery in the presence of severe aortic root calcification is technically difficult, with long cardiopulmonary bypass and aortic cross-clamp times. We performed sutureless aortic valve replacement and mitral valve annuloplasty in a 68-year-old man who had severe aortic stenosis and moderate-to-severe mitral regurgitation. Intraoperatively, we found severe calcification of the aortic root. We approached the aortic valve through a transverse aortotomy, performed in a higher position than usual, and we replaced the valve with a Sorin Perceval S sutureless prosthesis. In addition, we performed mitral annuloplasty with use of an open rigid ring. The aortic cross-clamp time was 63 minutes, and the cardiopulmonary bypass time was 83 minutes. No paravalvular leakage of the aortic prosthesis was detected 30 days postoperatively. Our case shows that the Perceval S sutureless bioprosthesis can be safely implanted in patients with aortic root calcification, even when mitral valve disease needs surgical correction.

  8. Aortic Blood Flow Reversal Determines Renal Function: Potential Explanation for Renal Dysfunction Caused by Aortic Stiffening in Hypertension.

    Science.gov (United States)

    Hashimoto, Junichiro; Ito, Sadayoshi

    2015-07-01

    Aortic stiffness determines the glomerular filtration rate (GFR) and predicts the progressive decline of the GFR. However, the underlying pathophysiological mechanism remains obscure. Recent evidence has shown a close link between aortic stiffness and the bidirectional (systolic forward and early diastolic reverse) flow characteristics. We hypothesized that the aortic stiffening-induced renal dysfunction is attributable to altered central flow dynamics. In 222 patients with hypertension, Doppler velocity waveforms were recorded at the proximal descending aorta to calculate the reverse/forward flow ratio. Tonometric waveforms were recorded to measure the carotid-femoral (aortic) and carotid-radial (peripheral) pulse wave velocities, to estimate the aortic pressure from the radial waveforms, and to compute the aortic characteristic impedance. In addition, renal hemodynamics was evaluated by duplex ultrasound. The estimated GFR was inversely correlated with the aortic pulse wave velocity, reverse/forward flow ratio, pulse pressure, and characteristic impedance, whereas it was not correlated with the peripheral pulse wave velocity or mean arterial pressure. The association between aortic pulse wave velocity and estimated GFR was independent of age, diabetes mellitus, hypercholesterolemia, and antihypertensive medication. However, further adjustment for the aortic reverse/forward flow ratio and pulse pressure substantially weakened this association, and instead, the reverse/forward flow ratio emerged as the strongest determinant of estimated GFR (P=0.001). A higher aortic reverse/forward flow ratio was also associated with lower intrarenal forward flow velocities. These results suggest that an increase in aortic flow reversal (ie, retrograde flow from the descending thoracic aorta toward the aortic arch), caused by aortic stiffening and impedance mismatch, reduces antegrade flow into the kidney and thereby deteriorates renal function.

  9. Decellularized aortic conduits: could their cryopreservation affect post-implantation outcomes? A morpho-functional study on porcine homografts.

    Science.gov (United States)

    Gallo, Michele; Bonetti, Antonella; Poser, Helen; Naso, Filippo; Bottio, Tomaso; Bianco, Roberto; Paolin, Adolfo; Franci, Paolo; Busetto, Roberto; Frigo, Anna Chiara; Buratto, Edward; Spina, Michele; Marchini, Maurizio; Ortolani, Fulvia; Iop, Laura; Gerosa, Gino

    2016-11-01

    Decellularized porcine aortic valve conduits (AVCs) implanted in a Vietnamese Pig (VP) experimental animal model were matched against decellularized and then cryopreserved AVCs to assess the effect of cryopreservation on graft hemodynamic performance and propensity to in vivo repopulation by host's cells. VPs (n = 12) underwent right ventricular outflow tract substitution using AVC allografts and were studied for 15-month follow-up. VPs were randomized into two groups, receiving AVCs treated with decellularization alone (D; n = 6) or decellularization/cryopreservation (DC; n = 6), respectively. Serial echocardiography was carried out to follow up hemodynamic function. All explanted AVCs were processed for light and electron microscopy. No signs of dilatation, progressive stenosis, regurgitation, and macroscopic calcification were echocardiographically observed in both D and DC groups. Explanted D grafts exhibited near-normal features, whereas the presence of calcification, inflammatory infiltrates, and disarray of elastic lamellae occurred in some DC grafts. In the unaltered regions of AVCs from both groups, almost complete re-endothelialization was observed for both valve cusps and aorta walls. In addition, side-by-side repopulation by recipient's fibroblasts, myofibroblasts, and smooth muscle cells was paralleled by ongoing tissue remodeling, as revealed by the ultrastructural identification of typical canals of collagen fibrillogenesis and elastogenesis-related features. Incipient neo-vascularization and re-innervation of medial and adventitial tunicae of grafted aortic walls were also detected for both D and DC groups. Cryopreservation did not affect post-implantation AVC hemodynamic behavior and was topically propensive to cell repopulation and tissue renewal, although graft deterioration including calcification was present in several areas. Thus, these preliminary data provide essential information on feasibility of decellularization and

  10. Aortic tear and dissection related to connective tissues abnormalities resembling Marfan syndrome in a Great Dane.

    Science.gov (United States)

    Lenz, Jennifer A; Bach, Jonathan F; Bell, Cynthia M; Stepien, Rebecca L

    2015-06-01

    Aortic tears and acute aortic dissection are rarely reported in dogs. This report describes a case of aortic dissection and probable sinus of Valsalva rupture in a young Great Dane with associated histopathologic findings suggestive of a connective tissue abnormality.

  11. Acute aortic occlusion as an unusual embolic complication of cardiac myxoma

    Institute of Scientific and Technical Information of China (English)

    ZHANG Jian; DUAN Zhi-quan; WANG Chuan-jiang; SONG Qing-bin; LUO Ying-wei; XIN Shi-jie

    2006-01-01

    @@ Acute aortic occlusion is an infrequent but dangerous vascular emergency with a mortality rate of 50%,1 resulting from aortic saddle embolus, thrombosis of an atherosclerotic abdominal aorta, or sudden thrombosis of a small abdominal aortic aneurysm.

  12. Enlargement of the aortic annulus during aortic valve replacement: a review.

    Science.gov (United States)

    Bortolotti, Uberto; Celiento, Michele; Milano, Aldo D

    2014-01-01

    The main goal of aortic valve replacement (AVR) is to obtain relief from the fixed left ventricular (LV) obstruction by replacing the aortic valve with a prosthesis, either mechanical or biological, of adequate size. Most currently available prostheses provide satisfactory hemodynamic performance, but small-sized prostheses may be associated with high transvalvular gradients and suboptimal effective orifice area that result in prosthesis-patient mismatch (PPM), and thus are far from ideal for use in young, active patients. The avoidance of PPM is advisable as it has been repeatedly associated with increased mortality, decreased exercise tolerance and an impaired regression of LV hypertrophy after AVR for severe aortic stenosis. Enlargement of the aortic annulus (EAA) has proved to be a valuable method to prevent PPM in the presence of a diminutive aortic root. This review outlines the various techniques described for EAA, presenting technical details, long-term results and major procedure-related complications, and discussing the current role of EAA in patients requiring AVR.

  13. Endovascular treatment of late thoracic aortic aneurysms after surgical repair of congenital aortic coarctation in childhood.

    Directory of Open Access Journals (Sweden)

    Robert Juszkat

    Full Text Available BACKGROUND: In some patients, local surgery-related complications are diagnosed many years after surgery for aortic coarctation. The purposes of this study were: (1 to systematically evaluate asymptomatic adults after Dacron patch repair in childhood, (2 to estimate the formation rate of secondary thoracic aortic aneurysms (TAAs and (3 to assess outcomes after intravascular treatment for TAAs. METHODS: This study involved 37 asymptomatic patients (26 female and 11 male who underwent surgical repair of aortic coarctation in the childhood. After they had reached adolescence, patients with secondary TAAs were referred to endovascular repair. RESULTS: Follow-up studies revealed TAA in seven cases (19% (including six with the gothic type of the aortic arch and mild recoarctation in other six (16%. Six of the TAA patients were treated with stentgrafts, but one refused to undergo an endovascular procedure. In three cases, stengrafts covered the left subclavian artery (LSA, in another the graft was implanted distally to the LSA. In two individuals, elective hybrid procedures were performed with surgical bypass to the supraaortic arteries followed by stengraft implantation. All subjects survived the secondary procedures. One patient developed type Ia endoleak after stentgraft implantation that was eventually treated with a debranching procedure. CONCLUSIONS: The long-term course of clinically asymptomatic patients after coarctation patch repair is not uncommonly complicated by formation of TAAs (particularly in individuals with the gothic pattern of the aortic arch that can be treated effectively with stentgrafts. However, in some patients hybrid procedures may be necessary.

  14. Catalase overexpression in aortic smooth muscle prevents pathological mechanical changes underlying abdominal aortic aneurysm formation.

    Science.gov (United States)

    Maiellaro-Rafferty, Kathryn; Weiss, Daiana; Joseph, Giji; Wan, William; Gleason, Rudolph L; Taylor, W Robert

    2011-08-01

    The causality of the associations between cellular and mechanical mechanisms of abdominal aortic aneurysm (AAA) formation has not been completely defined. Because reactive oxygen species are established mediators of AAA growth and remodeling, our objective was to investigate oxidative stress-induced alterations in aortic biomechanics and microstructure during subclinical AAA development. We investigated the mechanisms of AAA in an angiotensin II (ANG II) infusion model of AAA in apolipoprotein E-deficient (apoE(-/-)) mice that overexpress catalase in vascular smooth muscle cells (apoE(-/-)xTg(SMC-Cat)). At baseline, aortas from apoE(-/-)xTg(SMC-Cat) exhibited increased stiffness and the microstructure was characterized by 50% more collagen content and less elastin fragmentation. ANG II treatment for 7 days in apoE(-/-) mice altered the transmural distribution of suprarenal aortic circumferential strain (quantified by opening angle, which increased from 130 ± 1° at baseline to 198 ± 8° after 7 days of ANG II treatment) without obvious changes in the aortic microstructure. No differences in aortic mechanical behavior or suprarenal opening angle were observed in apoE(-/-)xTg(SMC-Cat) after 7 days of ANG II treatment. These data suggest that at the earliest stages of AAA development H(2)O(2) is functionally important and is involved in the control of local variations in remodeling across the vessel wall. They further suggest that reduced elastin integrity at baseline may predispose the abdominal aorta to aneurysmal mechanical remodeling.

  15. Fluid dynamics of aortic root dilation in Marfan syndrome

    CERN Document Server

    Querzoli, Giorgio; Espa, Stefania; Costantini, Martina; Sorgini, Francesca

    2014-01-01

    Aortic root dilation and propensity to dissection are typical manifestations of the Marfan Syndrome (MS), a genetic defect leading to the degeneration of the elastic fibres. Dilation affects the structure of the flow and, in turn, altered flow may play a role in vessel dilation, generation of aneurysms, and dissection. The aim of the present work is the investigation in-vitro of the fluid dynamic modifications occurring as a consequence of the morphological changes typically induced in the aortic root by MS. A mock-loop reproducing the left ventricle outflow tract and the aortic root was used to measure time resolved velocity maps on a longitudinal symmetry plane of the aortic root. Two dilated model aortas, designed to resemble morphological characteristics typically observed in MS patients, have been compared to a reference, healthy geometry. The aortic model was designed to quantitatively reproduce the change of aortic distensibility caused by MS. Results demonstrate that vorticity released from the valve ...

  16. Small aortic valve annulus in children with fixed subaortic stenosis.

    Science.gov (United States)

    Thilenius, O G; Campbell, D; Bharati, S; Lev, M; Arcilla, R A

    1989-01-01

    Twenty-one hearts with fixed subaortic stenosis (FSAS) were examined pathologically. Thirty children with no hemodynamically significant heart disease, 31 children with valvar aortic stenosis, and 25 children with FSAS were studied by echo- and angiocardiography. The following conclusions were drawn: (1) Patients with FSAS often have abnormal aortic valve leaflets as well as small aortic valve annulus. (2) A small aortic annulus/descending aorta ratio is probably present at birth, and may decrease with increasing age. (3) In some patients with FSAS the aortic valve annulus is too small for simple resection of the fibroelastic tissue. A Konno operation is needed for these patients. (4) M-mode echocardiography has not been useful in identifying abnormally small aortic valve annulus in FSAS patients.

  17. Aortic valve replacement in familial hypercholesterolemia: not an ordinary procedure.

    Science.gov (United States)

    Muretti, Mirko; Massi, Francesco; Coradduzza, Enrico; Portoghese, Michele

    2015-04-28

    Familial hypercholesterolemia is an inherited disorder with incidences of approximately 1:500 and 1:1,000,000 in heterozygous and homozygous form respectively. Affected patients usually show early coronary artery disease and severe aortic root calcification, despite optimization of therapy. We report a case of a 64-year-old woman affected by heterozygous familial hypercholesterolemia which presented dyspnea and anginal symptoms due to a severely calcified aortic root causing valve stenosis and narrowed sinotubular junction. Aortic valve replacement and aortic root enlargement were performed using the Manougian procedure. Even for experiences surgeons, this surgery could prove challenging for this group of patients due to aggressive degenerative tissue calcification of the aortic root, which often presents an extremely calcified aortic valve with a small annulus associated to a narrowed sinotubular junction.

  18. Implantation of the CoreValve percutaneous aortic valve.

    Science.gov (United States)

    Lamarche, Yoan; Cartier, Raymond; Denault, André Y; Basmadjian, Arsène; Berry, Colin; Laborde, Jean-Claude; Bonan, Raoul

    2007-01-01

    Surgical aortic valve replacement is the only recommended treatment for significant aortic valve stenosis. Percutaneous aortic valve replacement appears to be a novel option for high-risk patients. We report the implantation of the ReValving system (CoreValve, Paris, France) in a 64-year-old woman who was refused aortic valve replacement surgery for critical aortic stenosis and left ventricular dysfunction because of severe pulmonary fibrosis. After anesthesia, the patient was put on femorofemoral cardiopulmonary bypass, and underwent a balloon valvuloplasty with subsequent retrograde aortic valve replacement by the ReValving system. Transesophageal echocardiographic monitoring of the patient's hemodynamics showed immediate improvements of the valvular area and left ventricular ejection fraction and only traces of paravalvular leaks. The patient was easily weaned from ventilation and resumed activity soon after the surgery. A multidisciplinary approach is presently necessary to offer a reliable and safe procedure.

  19. Adjusting parameters of aortic valve stenosis severity by body size

    DEFF Research Database (Denmark)

    Minners, Jan; Gohlke-Baerwolf, Christa; Kaufmann, Beat A

    2014-01-01

    BACKGROUND: Adjustment of cardiac dimensions by measures of body size appears intuitively convincing and in patients with aortic stenosis, aortic valve area (AVA) is commonly adjusted by body surface area (BSA). However, there is little evidence to support such an approach. OBJECTIVE: To identify...... the adequate measure of body size for the adjustment of aortic stenosis severity. METHODS: Parameters of aortic stenosis severity (jet velocity, mean pressure gradient (MPG) and AVA) and measures of body size (height, weight, BSA and body mass index (BMI)) were analysed in 2843 consecutive patients with aortic...... stenosis (jet velocity ≥2.5 m/s) and related to outcomes in a second cohort of 1525 patients from the Simvastatin/Ezetimibe in Aortic Stenosis (SEAS) study. RESULTS: Whereas jet velocity and MPG were independent of body size, AVA was significantly correlated with height, weight, BSA and BMI (Pearson...

  20. Steam-deformed Judkins-left guiding catheter with use of the GuideLiner® catheter to deliver stents for anomalous right coronary artery

    Directory of Open Access Journals (Sweden)

    Toshiki Kuno

    2015-10-01

    Full Text Available Objective: Percutaneous coronary intervention for anomalous right coronary artery (RCA originating from the left coronary cusp is challenging because of our current inability to coaxially engage the guiding catheter. Methods: We report a case of an 88-year-old woman with non-ST segment elevation myocardial infarction, with an anomalous RCA origin. Using either the Judkins-Left catheter or Amplatz-Left catheter was difficult because of RCA ostium tortuosity. Thus, we used steam to deform the Judkins-Left catheter, but back-up support was insufficient to deliver the stent. Results: We used GuideLiner®, a novel pediatric catheter with rapid exchange/monorail systems, to enhance back-up support. Conclusions: We were able to successfully stent with both the deformed Judkins-Left guiding catheter and GuideLiner® for an anomalous RCA origin.

  1. Aortic arch blunt injury in front-seat passenger.

    Science.gov (United States)

    Türkmen, Nursel; Eren, Bülent; Aydin, Şule Akköse

    2013-10-01

    Aortic arch blunt injury has highly lethal nature. Because the physical examination findings are subtle, immediate medical evaluation is very important. The case was a 72-year-old woman. Massive haemorrhage in the left haemotorax, contusion area in the left lung and a traumatic transection of the distal aortic arch was observed during autopsy. We described intersting autopsy case of aortic arch blunt injury.

  2. Apicoaortic conduit for severe hemolytic anemia after aortic valve replacement.

    Science.gov (United States)

    Hatori, Kyohei; Ohki, Satoshi; Obayashi, Tamiyuki; Koyano, Tetsuya; Yasuhara, Kiyomitsu; Hirai, Hanako

    2015-06-01

    We describe the case of an 82-year-old woman who had undergone aortic mechanical valve replacement for aortic stenosis with a small annulus, and coronary artery bypass grafting. Four years after the operation, she began to experience hemolysis. Prosthetic valve obstruction was observed but there was no paravalvular leakage or aortic regurgitation through the mechanical valve. We elected to perform apicoaortic bypass in this patient with severe hemolytic anemia secondary to a mechanical valve malfunction.

  3. Transcatheter aortic valve replacement: techniques, complications, and bailout strategies.

    Science.gov (United States)

    Singh, Vikas; Macon, Conrad J; Scot Shaw, Eric; Londoño, Juan C; Martinez, Claudia A

    2013-09-01

    Transcatheter aortic valve replacement has emerged as an alternative option for inoperable or very high-risk patients with severe aortic stenosis-however, there are serious complications associated with the procedure, such as patient mortality, stroke, conduction disturbances, paravalvular regurgitation, and vascular concerns. Our review focuses on the most common complications related to transcatheter aortic valve replacement procedures and potential bailout strategies and techniques.

  4. Transcatheter aortic valve prosthesis surgically replaced 4 months after implantation

    DEFF Research Database (Denmark)

    Thyregod, Hans Gustav; Lund, Jens Teglgaard; Engstrøm, Thomas;

    2010-01-01

    Transcatheter aortic valve implantation is a new and rapidly evolving treatment option for high-risk surgical patients with degenerative aortic valve stenosis. Long-term results with these new valve prostheses are lacking, and potential valve dysfunction and failure would require valve replacement....... We report the first case of surgical valve replacement in a patient with a dysfunctional transcatheter-implanted aortic valve prosthesis 4 months after implantation....

  5. Acute aortic syndromes: Role of multi-detector row CT

    Energy Technology Data Exchange (ETDEWEB)

    Salvolini, Luca; Renda, Pietro [Department of Radiology, University ' Politecnica delle Marche' , Ancona (Italy); Fiore, Davide [Department of Radiology, University of Padova, Padova (Italy); Scaglione, Mariano [Emergency and Trauma CT Section, Department of Radiology, Cardarelli Hospital, Naples (Italy); Piccoli, GianPiero [Cardiosurgery Division, Ospedali Riuniti ' Torrette-Lancisi-Salesi' , Ancona (Italy); Giovagnoni, Andrea [Department of Radiology, University ' Politecnica delle Marche' , Ancona (Italy)], E-mail: a.giovagnoni@univpm.it

    2008-03-15

    Acute thoracic aortic syndromes encompass a spectrum of emergencies including aortic dissection, intramural haematoma, penetrating atherosclerotic ulcer and aneurysm rupture. All these life-threatening conditions require prompt diagnosis and appropriate management. To date multi-detector row Computed Tomography represents a valuable diagnostic tool especially in the emergency setting. This paper focus on the use of multi-detector row Computed Tomography in the evaluation of acute thoracic aortic syndromes and illustrates the key imaging findings related to each disease.

  6. Acute aortic and mitral valve regurgitation following blunt chest trauma.

    Science.gov (United States)

    Bernabeu, Eduardo; Mestres, Carlos A; Loma-Osorio, Pablo; Josa, Miguel

    2004-03-01

    Traumatic rupture of intracardiac structures is an uncommon phenomenon although there are a number of reports with regards to rupture of the tricuspid, mitral and aortic valves. We report the case of a 25-year-old patient who presented with acute aortic and mitral valve regurgitation of traumatic origin. Both lesions were seen separated by 2 weeks. Pathophysiology is reviewed. The combination of both aortic and mitral lesions following blunt chest trauma is almost exceptional.

  7. Technical tips for abdominal aortic endografting.

    Science.gov (United States)

    Murphy, Erin H; Arko, Frank R

    2008-03-01

    Favorable clinical results combined with increased patient demand for minimally invasive surgery has resulted in an increased application of endovascular aortic aneurysm repair (EVAR), and this treatment modality is now being extended to younger, healthier patients. While it seems that EVAR is becoming a desirable option for many patients, it is essential to realize that the feasibility of the procedure may be limited at times by patient anatomy and technical difficulties. Specific anatomical difficulties can be imposed by difficult access, short tortuous and calcified aortic and iliac landing zones, and presence of coincident complex iliac aneurysms. Renal failure has also presented a concern for patients being considered for treatment with EVAR, as the contrast loads required for the procedure, as well as for continued postoperative surveillance, may place the patient at risk. We will discuss technical maneuvers and considerations when encountering difficult anatomy and challenging surgical procedures.

  8. Glucose Suppresses Biological Ferroelectricity in Aortic Elastin

    Science.gov (United States)

    Liu, Yuanming; Wang, Yunjie; Chow, Ming-Jay; Chen, Nataly Q.; Ma, Feiyue; Zhang, Yanhang; Li, Jiangyu

    2013-04-01

    Elastin is an intriguing extracellular matrix protein present in all connective tissues of vertebrates, rendering essential elasticity to connective tissues subjected to repeated physiological stresses. Using piezoresponse force microscopy, we show that the polarity of aortic elastin is switchable by an electrical field, which may be associated with the recently discovered biological ferroelectricity in the aorta. More interestingly, it is discovered that the switching in aortic elastin is largely suppressed by glucose treatment, which appears to freeze the internal asymmetric polar structures of elastin, making it much harder to switch, or suppressing the switching completely. Such loss of ferroelectricity could have important physiological and pathological implications from aging to arteriosclerosis that are closely related to glycation of elastin.

  9. Multislice CT angiography of interrupted aortic arch

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Dong Hyun; Goo, Hyun Woo [Asan Medical Center, Department of Radiology and Research Institute of Radiology, Seoul (Korea); Seo, Dong-Man; Yun, Tae-Jin; Park, Jeong-Jun [Asan Medical Center, University of Ulsan College of Medicine, Department of Paediatric Cardiac Surgery, Seoul (Korea); Park, In-Sook; Ko, Jae Kon; Kim, Young Hwee [Asan Medical Center, University of Ulsan College of Medicine, Department of Paediatric Cardiology, Seoul (Korea)

    2008-01-15

    Interrupted aortic arch (IAA) is defined as complete luminal and anatomic discontinuity between the ascending and descending aorta. Because almost all patients with IAA become critically ill during the neonatal period, they should undergo urgent corrective surgery. This clinical urgency necessitates a fast and accurate noninvasive diagnostic method. Although echocardiography remains the primary imaging tool for this purpose, it is not always sufficient for planning surgical correction of IAA, principally due to a limited acoustic window and the inexperience of imagers. In this context, multislice CT angiography is regarded as an appropriate imaging technique complementary to echocardiography because it is fast, accurate, and objective for the diagnosis of IAA. In this article we describe what cardiac radiologists should know about IAA in their clinical practice, including clinicopathological features, CT features with contemporary surgical methods and postoperative complications, and differentiation from coarctation of the aorta and aortic arch atresia. (orig.)

  10. Glucose Suppresses Biological Ferroelectricity in Aortic Elastin

    Science.gov (United States)

    Liu, Yuanming; Wang, Yunjie; Chow, Ming-Jay; Chen, Nataly Q.; Ma, Feiyue; Zhang, Yanhang; Li, Jiangyu

    2013-01-01

    Elastin is an intriguing extracellular matrix protein present in all connective tissues of vertebrates, rendering essential elasticity to connective tissues subjected to repeated physiological stresses. Using piezoresponse force microscopy, we show that the polarity of aortic elastin is switchable by an electrical field, which may be associated with the recently discovered biological ferroelectricity in the aorta. More interestingly, it is discovered that the switching in aortic elastin is largely suppressed by glucose treatment, which appears to freeze the internal asymmetric polar structures of elastin, making it much harder to switch, or suppressing the switching completely. Such loss of ferroelectricity could have important physiological and pathological implications from aging to arteriosclerosis that are closely related to glycation of elastin. PMID:23679639

  11. 超声心动图在经皮主动脉瓣置入术中应用进展%Application Development of Echocardiography in Percutaneous Aortic Valve Replacement

    Institute of Scientific and Technical Information of China (English)

    许进; 李治安

    2011-01-01

    Percutaneous aortic valve implantation is an emerging technique that has the potential to revolutionize the treatment of aortic valve stenosis disease. Echocardiography has been used in guiding percutaneous aortic valve replacement successfully, it plays an important role in case selection, in guiding device placement, and in detecting complications of percutaneous aortic valve implantation. We demonstrate the superiority of echocardiography in guiding percutaneous aortic valve replacement and recently application development.%经皮主动脉瓣置入术是近年来出现的有效治疗主动脉瓣狭窄的新技术,能够明显改善患者预后,增加生存率.超声心动图在术前临床病例选择、术中监测、术后疗效评价及随访中均发挥着重要的作用,手术成功与否与其密切相关.本文就超声心动图在经皮主动脉瓣置换术中的优势及进展进行介绍.

  12. The Four-Loop Planar Amplitude and Cusp Anomalous Dimension in Maximally Supersymmetric Yang-Mills Theory

    Energy Technology Data Exchange (ETDEWEB)

    Bern, Zvi; Czakon, Michael; Dixon, Lance J.; Kosower, David A.; Smirnov, Vladimir A.

    2006-11-15

    We present an expression for the leading-color (planar) four-loop four-point amplitude of N = 4 supersymmetric Yang-Mills theory in 4-2{epsilon} dimensions, in terms of eight separate integrals. The expression is based on consistency of unitarity cuts and infrared divergences. We expand the integrals around {epsilon} = 0, and obtain analytic expressions for the poles from 1/{epsilon}{sup 8} through 1/{epsilon}{sup 4}. We give numerical results for the coefficients of the 1/{epsilon}{sup 3} and 1/e{sup 2} poles. These results all match the known exponentiated structure of the infrared divergences, at four separate kinematic points. The value of the 1/{epsilon}{sup 2} coefficient allows us to test a conjecture of Eden and Staudacher for the four-loop cusp (soft) anomalous dimension. We find that the conjecture is incorrect, although our numerical results suggest that a simple modification of the expression, flipping the sign of the term containing {zeta}{sub 3}{sup 2}, may yield the correct answer. Our numerical value can be used, in a scheme proposed by Kotikov, Lipatov and Velizhanin, to estimate the two constants in the strong-coupling expansion of the cusp anomalous dimension that are known from string theory. The estimate works to 2.6% and 5% accuracy, providing non-trivial evidence in support of the AdS/CFT correspondence. We also use the known constants in the strong-coupling expansion as additional input to provide approximations to the cusp anomalous dimension which should be accurate to under one percent for all values of the coupling. When the evaluations of the integrals are completed through the finite terms, it will be possible to test the iterative, exponentiated structure of the finite terms in the four-loop four-point amplitude, which was uncovered earlier at two and three loops.

  13. Apyrexic Brucella melitensis aortic valve endocarditis.

    Science.gov (United States)

    al-Mudallal, D S; Mousa, A R; Marafie, A A

    1989-10-01

    The case of a young shepherd with Brucella melitensis aortic valve endocarditis is presented. His illness ran an afebrile course and was also complicated by disseminated intravascular coagulation (DIC), nephritis, hepatitis and peritonitis, all of which responded well to supportive measures and a combination of tetracycline, trimethoprim-sulphamethoxazole and amikacin sulphate. The fact that even the most severe case of brucellosis can present without fever is stressed.

  14. Mast Cells in Abdominal Aortic Aneurysms

    DEFF Research Database (Denmark)

    Shi, Guo-Ping; Lindholt, Jes Sanddal

    2013-01-01

    Mast cells (MCs) are proinflammatory cells that play important roles in allergic responses, tumor growth, obesity, diabetes, atherosclerosis, and abdominal aortic aneurysm (AAA). Although the presence and function of MCs in atherosclerotic lesions have been thoroughly studied in human specimens...... neighboring cells, degrade extracellular matrix proteins, process latent bioactive molecules, promote angiogenesis, recruit additional inflammatory cells, and stimulate vascular cell apoptosis. These activities associate closely with medial elastica breakdown, medial smooth-muscle cell loss and thinning...

  15. Evaluation of regional aortic distensibility using color kinesis.

    Science.gov (United States)

    Kato, Yoshimasa; Kotoh, Keiju; Yamashita, Akio; Furuta, Hidetoshi; Shimazu, Chikasi; Misaki, Takurou

    2003-01-01

    Regional aortic stiffness cannot be evaluated by conventional methods. Regional aortic wall velocity during systole in the descending aorta was evaluated by using transesophageal echocardiography with color kinesis. The authors defined regional aortic distensibility (RAD) by considering pulse pressure, with RAD (microm/s/mm Hg) = (regional aortic wall velocity)/(pulse pressure). RAD was evaluated in 38 patients who had coronary artery disease (CAD) and 10 who did not. RAD decreased depending on aging (partial regression coefficient was -5.39 x 10(-1), pkinesis provides information on characteristic difference between calcified and noncalcified plaque.

  16. MicroRNAs, fibrotic remodeling, and aortic aneurysms

    OpenAIRE

    Milewicz, Dianna M.

    2012-01-01

    Aortic aneurysms are a common clinical condition that can cause death due to aortic dissection or rupture. The association between aortic aneurysm pathogenesis and altered TGF-β signaling has been the subject of numerous investigations. Recently, a TGF-β–responsive microRNA (miR), miR-29, has been identified to play a role in cellular phenotypic modulation during aortic development and aging. In this issue of JCI, Maegdefessel and colleagues demonstrate that decreasing the levels of miR-29b i...

  17. FOXE3 mutations predispose to thoracic aortic aneurysms and dissections.

    Science.gov (United States)

    Kuang, Shao-Qing; Medina-Martinez, Olga; Guo, Dong-Chuan; Gong, Limin; Regalado, Ellen S; Reynolds, Corey L; Boileau, Catherine; Jondeau, Guillaume; Prakash, Siddharth K; Kwartler, Callie S; Zhu, Lawrence Yang; Peters, Andrew M; Duan, Xue-Yan; Bamshad, Michael J; Shendure, Jay; Nickerson, Debbie A; Santos-Cortez, Regie L; Dong, Xiurong; Leal, Suzanne M; Majesky, Mark W; Swindell, Eric C; Jamrich, Milan; Milewicz, Dianna M

    2016-03-01

    The ascending thoracic aorta is designed to withstand biomechanical forces from pulsatile blood. Thoracic aortic aneurysms and acute aortic dissections (TAADs) occur as a result of genetically triggered defects in aortic structure and a dysfunctional response to these forces. Here, we describe mutations in the forkhead transcription factor FOXE3 that predispose mutation-bearing individuals to TAAD. We performed exome sequencing of a large family with multiple members with TAADs and identified a rare variant in FOXE3 with an altered amino acid in the DNA-binding domain (p.Asp153His) that segregated with disease in this family. Additional pathogenic FOXE3 variants were identified in unrelated TAAD families. In mice, Foxe3 deficiency reduced smooth muscle cell (SMC) density and impaired SMC differentiation in the ascending aorta. Foxe3 expression was induced in aortic SMCs after transverse aortic constriction, and Foxe3 deficiency increased SMC apoptosis and ascending aortic rupture with increased aortic pressure. These phenotypes were rescued by inhibiting p53 activity, either by administration of a p53 inhibitor (pifithrin-α), or by crossing Foxe3-/- mice with p53-/- mice. Our data demonstrate that FOXE3 mutations lead to a reduced number of aortic SMCs during development and increased SMC apoptosis in the ascending aorta in response to increased biomechanical forces, thus defining an additional molecular pathway that leads to familial thoracic aortic disease.

  18. Transcatheter Aortic Valve Replacement: Comprehensive Review and Present Status

    Science.gov (United States)

    Misenheimer, Jacob A.; Ramaraj, Radhakrishnan

    2017-01-01

    Aortic stenosis is the most common valvular heart disease in the developed world. About 7% of the population over age 65 years suffers from degenerative aortic stenosis. The prognosis of patients with symptomatic severe aortic stenosis is dismal without valve replacement. Even though the American College of Cardiology recommends aortic valve replacement to treat this condition as a class I recommendation, approximately one third of these patients over the age of 75 years are not referred for surgery. Typically, this is from concern about prohibitive surgical risk associated with patient frailty, comorbidities, age, and severe left ventricular dysfunction. The advent in France of transcatheter aortic valve replacement has raised the hope in the United States for an alternative, less invasive treatment for aortic stenosis. Two recent trials—the Placement of AoRTic TraNscathetER Valve Trial Edwards SAPIEN Transcatheter Heart Valve (Partner) and the CoreValve US Pivotal—have established transcatheter aortic valve replacement as the preferred approach in patients who are at high or prohibitive surgical risk. The more recently published Partner 2 trial has shown the feasibility of transcatheter aortic valve replacement in intermediate-surgical-risk patients as well. With a profile that promises easier use and better valve performance and delivery, newer-generation valves have shown their potential for further improvement in safety profile and overall outcomes. We review the history and status of this topic. PMID:28265210

  19. Right aortic arch with coarctation in Chinese children

    Energy Technology Data Exchange (ETDEWEB)

    Ming, Zhu; Aimin, Sun [Shanghai Children' s Medical Center, Department of Radiology, Shanghai (China)

    2008-05-15

    Because of the rarity of right aortic arch coarctation there are few reports of large groups of patients. To characterize the frequency and type of right aortic arch coarctation in a large group of pediatric patients. From June 1997 through May 2007, 11,276 consecutive children with congenital heart disease underwent multidetector CT (MDCT), MRI or angiocardiography examination. All children with a right aortic arch or coarctation were reviewed. Right aortic arch coarctation was found in 11 children representing 0.1% of the total group of 11,276 children, 1.7% of 658 children with native coarctations and 2.3% of 473 children with a right aortic arch. Among the 11 patients, 6 had long-segment narrowing and 7 had an aberrant left subclavian artery. MDCT, MRI and angiocardiography are reliable imaging techniques for the diagnosis of right aortic arch and coarctation. Our findings showed that the pattern of right aortic arch coarctation was different from that of left aortic arch coarctation, suggesting that they are different etiological entities. The pivotal role possibly played by flow dynamics in the development of right aortic arch coarctation is discussed. (orig.)

  20. Asendan Desendan Aortic Bypass: Atan Kalpte Mediyan Sternotomi Yoluyla Onarim

    Directory of Open Access Journals (Sweden)

    Muhammet Akyuz

    2013-10-01

    Full Text Available We report the case of a 9-month-old patient presenting for redo aortic arch surgery because of recoarctation. In present case, ascending-to-descending aortic bypass via median sternotomy was performed without cardiopulmonary bypass with good result. In spite of the fact that the different surgical and intervention treatment options of aortic coarctation are quite satisfactory, a certain group of patients need reoperation because of recoarctation. The recoarctation repair of the aorta with the extra-anatomic aortic bypass is considered a low-risk procedure with high success rate.

  1. The Effects of Fetuin-A Levels on Aortic Stenosis

    Directory of Open Access Journals (Sweden)

    Ahmet Tutuncu

    2014-12-01

    Full Text Available Aim: We aimed to investigate the relation between fetuin-A and calcific aortic stenosis in non diabetic patients whose renal function were normal. Material and Method: 26 patients followed for aortic stenosis by our cardiology clinic for outpatients and 25 voluntary healthy subjects were included in the study. The fetuin%u2013A levels were measured from the venous blood samples of the study population. All patients underwent transthorasic echocardiography, the aortic valvular area and left ventricular parameters of the patients were measured. Results: The average age of the patients in degenerative aortic stenosis group was significantly higher than the control group. The parameters related to aortic valve were naturally higher in patients with dejenerative aortic valve. There was no siginificant difference between two groups about fetuin-A levels. Further more there was no significant relation between fetuin-a levels and aortic stenosis severity. Discussion: In conclusion fetuin-A is a multifunctional glycoprotein that plays important role in systemic calcification inhibition and valvular calcification. Finally aortic stenosis is an active process and larger studies that investigate the relation between fetuin-a and the progression and prognosis of aortic stenosis are needed.

  2. Minimally Invasive Transaortic Mitral Decalcification During Aortic Valve Replacement.

    Science.gov (United States)

    Totsugawa, Toshinori; Sakaguchi, Taichi; Hiraoka, Arudo; Matsushita, Hiroshi; Hirai, Yuki; Yoshitaka, Hidenori

    2015-01-01

    Mitral annular calcification accompanied by aortic stenosis is hazardous for both double-valve replacement and transcatheter aortic valve implantation. Less invasive mitral procedure is required in this condition, and minimally invasive approach may further reduce the operative risk in high-risk patients. Here, we report minimally invasive transaortic mitral decalcification during aortic valve replacement through minithoracotomy. We believe that this option is feasible in patients who are at prohibitive risk for double-valve replacement or transcatheter aortic valve implantation because of severe mitral annular calcification.

  3. A CUSP CATASTROPHE, PRECURSORS PATTERN ANDEVOLUTION PROCESS OF ROCKBUST OF COAL PILLARUNDER A HARD ROCK SUBJECT TO ELASTIC SUPPORT

    Institute of Scientific and Technical Information of China (English)

    徐曾和; 徐小荷

    1996-01-01

    The rockburst of the coal pillar under a thick hard roof stratum is modelled as the instability failure problem of coal pillars under strata subject to elastic support. The instability mechanism of rockburst is studied by applying cusp catastrophic theory. The effects of the stiffness ratio of the system and loads imposed on the system on the rockburst are explicated.The factors affecting rockbursts are discussed. Based on them, the "evolution process, the forewarning regularity and forewarning sings of rockbursts are studied. It is indicated that the subsidence velocity of roof stratum, which increases quickly and tends to infinity, is the forewarning measurable signs of the rockbursts of coal pillar.

  4. The Wigner cusp revisited: The Strutinskij-smoothing of the RPA part of the isovector pair correlation energy

    CERN Document Server

    Neergård, K

    2016-01-01

    Previously published expressions for a smooth counterterm in the sense of the Strutinskij theory to the correction to the Bardeen-Cooper-Schrieffer isovector pair correlation energy obtained in the Random Phase Approximation (RPA) are derived in detail and extended. In particular the counterterm to the neutron-proton pair correlation energy, whose variation contributes to the so-called Wigner cusp in plots of masses along isobaric chains, is analyzed rigorously and found to be less attenuated at large excesses of neutrons or protons than suggested by the previous estimate.

  5. Effects of magnetic field strength in the discharge channel on the performance of a multi-cusped field thruster

    Directory of Open Access Journals (Sweden)

    Peng Hu

    2016-09-01

    Full Text Available The performance characteristics of a Multi-cusped Field Thruster depending on the magnetic field strength in the discharge channel were investigated. Four thrusters with different outer diameters of the magnet rings were designed to change the magnetic field strength in the discharge channel. It is found that increasing the magnetic field strength could restrain the radial cross-field electron current and decrease the radial width of main ionization region, which gives rise to the reduction of propellant utilization and thruster performance. The test results in different anode voltage conditions indicate that both the thrust and anode efficiency are higher for the weaker magnetic field in the discharge channel.

  6. Therapeutics Targeting Drivers of Thoracic Aortic Aneurysms and Acute Aortic Dissections: Insights from Predisposing Genes and Mouse Models.

    Science.gov (United States)

    Milewicz, Dianna M; Prakash, Siddharth K; Ramirez, Francesco

    2017-01-14

    Thoracic aortic diseases, including aneurysms and dissections of the thoracic aorta, are a major cause of morbidity and mortality. Risk factors for thoracic aortic disease include increased hemodynamic forces on the ascending aorta, typically due to poorly controlled hypertension, and heritable genetic variants. The altered genes predisposing to thoracic aortic disease either disrupt smooth muscle cell (SMC) contraction or adherence to an impaired extracellular matrix, or decrease canonical transforming growth factor beta (TGF-β) signaling. Paradoxically, TGF-β hyperactivity has been postulated to be the primary driver for the disease. More recently, it has been proposed that the response of aortic SMCs to the hemodynamic load on a structurally defective aorta is the primary driver of thoracic aortic disease, and that TGF-β overactivity in diseased aortas is a secondary, unproductive response to restore tissue function. The engineering of mouse models of inherited aortopathies has identified potential therapeutic agents to prevent thoracic aortic disease.

  7. Aortic aneurysm disease vs. aortic occlusive disease - differences in outcome and intensive care resource utilisation after elective surgery

    DEFF Research Database (Denmark)

    Bisgaard, Jannie; Gilsaa, Torben; Rønholm, Ebbe;

    2013-01-01

    clamping is more pronounced in patients with aortic aneurysm disease, which may affect outcome. OBJECTIVES: The aim of this observational cohort study was to evaluate outcome after open elective abdominal aortic surgery, hypothesising a higher 30-day mortality, a higher incidence of postoperative organ...... dysfunction and a longer length of stay in patients with aortic aneurysm compared with aortic occlusive disease. DESIGN: Cohort observational study based on prospective registrations from national databases. SETTING: Eight Danish hospitals, including four university and four non-university centres, from 1...... or inotropes, ICU stay more than 24 h, hospital length of stay and mortality. RESULTS: Compared with aortic occlusive disease, more patients with aortic aneurysm disease had ICU stays more than 24 h (62 vs. 45%, P ...

  8. Aortic valve replacement with concomitant annular enlargement for small aortic annulus of less than 19 mm.

    Science.gov (United States)

    Takakura, H; Sasaki, T; Hashimoto, K; Hachiya, T; Onoguchi, K; Oshiumi, M; Takeuchi, S

    2000-06-01

    Three female patients with aortic stenosis associated with a severely small annulus underwent aortic valve replacement. In intraoperative measurements, a 19-mm obtulator could not pass through the aortic annulus in each case. We therefore concluded that it would be difficult to implant an appropriate-sized prosthesis in a routine fashion, so we performed an annular enlargement in a modified Nicks procedure. By using a wide teardrop-shaped patch for enlargement and slightly tilting insertion of a prosthesis, a 21 mm bileaflet mechanical prosthesis could be inserted into the enlarged annulus. Despite being a simpler method than other enlarging procedures, a two- or three-sizes larger prosthesis than the native annulus can be inserted with relative ease. Thus, the use of a 19 mm mechanical prosthesis may be avoidable in most adult cases.

  9. Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Severe Aortic Valve Stenosis

    DEFF Research Database (Denmark)

    Thyregod, Hans Gustav; Steinbrüchel, Daniel Andreas; Ihlemann, Nikolaj

    2015-01-01

    outcome was the composite rate of death from any cause, stroke, or myocardial infarction (MI) at 1 year. RESULTS: A total of 280 patients were randomized at 3 Nordic centers. Mean age was 79.1 years, and 81.8% were considered low-risk patients. In the intention-to-treat population, no significant...... difference in the primary endpoint was found (13.1% vs. 16.3%; p = 0.43 for superiority). The result did not change in the as-treated population. No difference in the rate of cardiovascular death or prosthesis reintervention was found. Compared with SAVR-treated patients, TAVR-treated patients had more......BACKGROUND: Transcatheter aortic valve replacement (TAVR) is an option in certain high-risk surgical patients with severe aortic valve stenosis. It is unknown whether TAVR can be safely introduced to lower-risk patients. OBJECTIVES: The NOTION (Nordic Aortic Valve Intervention Trial) randomized...

  10. Recurrent Pneumonia due to Double Aortic Arch

    Directory of Open Access Journals (Sweden)

    I. Sedighi

    2012-04-01

    Full Text Available Introduction: Pneumonia is one of the most common infections during childhood. In children with recurrent bacterial pneumonia complete evaluation for underlying factors is necessary. The most common underlying diseases include: antibody deficiencies , cystic fibrosis , tracheoesophageal fistula and increased pulmonary blood flow. Vascular ring and its pressure effect is a less common cause of stridor and recurrent pneumonia. Congenital abnormalities in aortic arch and main branches which form vascular ring around esophagus and trachea with variable pressure effect cause respiratory symptoms such as stridor , wheezing and recurrent pneumoniaCase Report: A 2 year old boy was admitted in our hospital with respiratory distress and cough . Chest x-Ray demonstrated right lobar pneumonia. He had history of stridor and wheezing from neonatal period and hospitalization due to pneumonia for four times. The patient received appropriate antibiotics. Despite fever and respiratory distress improvement, wheezing continued. Review of his medical documents showed fixed pressure effect on posterior aspect of esophagus in barium swallow. In CT angiography we confirmed double aortic arch.Conclusion: Double aortic arch is one of the causes of persistant respiratory symptom and recurrent pneumonia in children for which fluoroscopic barium swallow is the first non-invasive diagnostic method.(Sci J Hamadan Univ Med Sci 2012;19(1:70-74

  11. Acute aortic dissection: be aware of misdiagnosis

    Directory of Open Access Journals (Sweden)

    Asteri Theodora

    2009-02-01

    Full Text Available Abstract Background Acute aortic dissection (AAD is a life-threatening condition requiring immediate assessment and therapy. A patient suffering from AAD often presents with an insignificant or irrelevant medical history, giving rise to possible misdiagnosis. The aim of this retrospective study is to address the problem of misdiagnosing AD and the different imaging studies used. Methods From January 2000 to December 2004, 49 patients (41 men and 8 women, aged from 18–75 years old presented to the Emergency Department of our hospital for different reasons and finally diagnosed with AAD. Fifteen of those patients suffered from arterial hypertension, one from giant cell arteritis and another patient from Marfan's syndrome. The diagnosis of AAD was made by chest X-ray, contrast enhanced computed tomography (CT, transthoracic echocardiography (TTE and coronary angiography. Results Initial misdiagnosis occurred in fifteen patients (31% later found to be suffering from AAD. The misdiagnosis was myocardial infarction in 12 patients and cerebral infarction in another three patients. Conclusion Aortic dissection may present with a variety of clinical manifestations, like syncope, chest pain, anuria, pulse deficits, abdominal pain, back pain, or acute congestive heart failure. Nearly a third of the patients found to be suffering from AD, were initially otherwise diagnosed. Key in the management of acute aortic dissection is to maintain a high level of suspicion for this diagnosis.

  12. Hemodynamic predictors of aortic dilatation in bicuspid aortic valve by velocity-encoded cardiovascular magnetic resonance

    Directory of Open Access Journals (Sweden)

    Ramamurthy Senthil

    2010-01-01

    Full Text Available Abstract Background Congenital Bicuspid Aortic Valve (BAV is a significant risk factor for serious complications including valve dysfunction, aortic dilatation, dissection, and sudden death. Clinical tools for identification and monitoring of BAV patients at high risk for development of aortic dilatation, an early complication, are not available. Methods This paper reports an investigation in 18 pediatric BAV patients and 10 normal controls of links between abnormal blood flow patterns in the ascending aorta and aortic dilatation using velocity-encoded cardiovascular magnetic resonance. Blood flow patterns were quantitatively expressed in the angle between systolic left ventricular outflow and the aortic root channel axis, and also correlated with known biochemical markers of vessel wall disease. Results The data confirm larger ascending aortas in BAV patients than in controls, and show more angled LV outflow in BAV (17.54 ± 0.87 degrees than controls (10.01 ± 1.29 (p = 0.01. Significant correlation of systolic LV outflow jet angles with dilatation was found at different levels of the aorta in BAV patients STJ: r = 0.386 (N = 18, p = 0.048, AAO: r = 0.536 (N = 18, p = 0.022, and stronger correlation was found with patients and controls combined into one population: SOV: r = 0.405 (N = 28, p = 0.033, STJ: r = 0.562 (N = 28, p = 0.002, and AAO r = 0.645 (N = 28, p Conclusions The results of this study provide new insights into the pathophysiological processes underlying aortic dilatation in BAV patients. These results show a possible path towards the development of clinical risk stratification protocols in order to reduce morbidity and mortality for this common congenital heart defect.

  13. Aortic annulus eccentricity before and after transcatheter aortic valve implantation: Comparison of balloon-expandable and self-expanding prostheses

    Energy Technology Data Exchange (ETDEWEB)

    Schuhbaeck, Annika, E-mail: annika.schuhbaeck@uk-erlangen.de [Department of Cardiology, University of Erlangen, Erlangen (Germany); Weingartner, Christina [Department of Cardiology, University of Gießen, Giessen (Germany); Arnold, Martin; Schmid, Jasmin; Pflederer, Tobias; Marwan, Mohamed [Department of Cardiology, University of Erlangen, Erlangen (Germany); Rixe, Johannes; Nef, Holger [Department of Cardiology, University of Gießen, Giessen (Germany); Schneider, Christian [Department of Radiology, University of Gießen, Giessen (Germany); Lell, Michael; Uder, Michael [Department of Radiology, University of Erlangen, Erlangen (Germany); Ensminger, Stephan [Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen (Germany); Feyrer, Richard; Weyand, Michael [Department of Cardiothoracic Surgery, University of Erlangen, Erlangen (Germany); Achenbach, Stephan [Department of Cardiology, University of Erlangen, Erlangen (Germany)

    2015-07-15

    Highlights: • Post-implant geometry of catheter-based aortic valve prostheses is influenced by aortic valve calcification. • Balloon-expandable prostheses are more circular as compared to self-expanding prostheses. • The impact of post-implant geometry on valve function needs to be investigated. - Abstract: Introduction: The geometry of the aortic annulus and implanted transcatheter aortic valve prosthesis might influence valve function. We investigated the influence of valve type and aortic valve calcification on post-implant geometry of catheter-based aortic valve prostheses. Methods: Eighty consecutive patients with severe aortic valve stenosis (mean age 82 ± 6 years) underwent computed tomography before and after TAVI. Aortic annulus diameters were determined. Influence of prosthesis type and degree of aortic valve calcification on post-implant eccentricity were analysed. Results: Aortic annulus eccentricity was reduced in patients after TAVI (0.21 ± 0.06 vs. 0.08 ± 0.06, p < 0.0001). Post-TAVI eccentricity was significantly lower in 65 patients following implantation of a balloon-expandable prosthesis as compared to 15 patients who received a self-expanding prosthesis (0.06 ± 0.05 vs. 0.15 ± 0.07, p < 0.0001), even though the extent of aortic valve calcification was not different. After TAVI, patients with a higher calcium amount retained a significantly higher eccentricity compared to patients with lower amounts of calcium. Conclusions: Patients undergoing TAVI with a balloon-expandable prosthesis show a more circular shape of the implanted prosthesis as compared to patients with a self-expanding prosthesis. Eccentricity of the deployed prosthesis is affected by the extent of aortic valve calcification.

  14. The role of cardiovascular magnetic resonance in the assessment of severe aortic stenosis and in post-procedural evaluation following transcatheter aortic valve implantation and surgical aortic valve replacement.

    Science.gov (United States)

    Musa, Tarique Al; Plein, Sven; Greenwood, John P

    2016-06-01

    Degenerative aortic stenosis (AS) is the most common valvular disease in the western world with a prevalence expected to double within the next 50 years. International guidelines advocate the use of cardiovascular magnetic resonance (CMR) as an investigative tool, both to guide diagnosis and to direct optimal treatment. CMR is the reference standard for quantifying both left and right ventricular volumes and mass, which is essential to assess the impact of AS upon global cardiac function. Given the ability to image any structure in any plane, CMR offers many other diagnostic strengths including full visualisation of valvular morphology, direct planimetry of orifice area, the quantification of stenotic jets and in particular, accurate quantification of valvular regurgitation. In addition, CMR permits reliable and accurate measurements of the aortic root and arch which can be fundamental to appropriate patient management. There is a growing evidence base to indicate tissue characterisation using CMR provides prognostic information, both in asymptomatic AS patients and those undergoing intervention. Furthermore, a number of current clinical trials will likely raise the importance of CMR in routine patient management. This article will focus on the incremental value of CMR in the assessment of severe AS and the insights it offers following valve replacement.

  15. Long-term Computed Tomography Follow-up After Open Surgical Repair of Abdominal Aortic Aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Mantoni, M.; Neergaard, K.; Christoffersen, J. K.; Lambine, T.L.; Baekgaard, N. [Gentofte Univ. Hospital (Denmark). Depts. of Radiology and Vascular Surgery

    2006-07-15

    Purpose: To describe the findings on computed tomography (CT) of the aortic sac (AS) in patients operated on for abdominal aortic aneurysm (AAA) with insertion of a coated Dacron prosthesis. Material and Methods: A prospective study of 36 consecutive patients operated on for AAA over 2 years and followed longitudinally with CT for up to 10 years. Results: All patients had a fluid-filled AS on CT 7-10 days postoperatively. At 6 months, the AS had decreased in most patients, mainly in the antero-posterior diameter, and in two had disappeared completely. In five patients with complications, the AS increased in size. The AS disappeared completely at 10 years' follow-up in 13 patients. When present, a retroperitoneal hematoma always disappeared after 6 months. Conclusion: These data indicate that the AS after graft implantation will diminish gradually but will persist for at least 6 months. Usually the transverse diameter is bigger than the antero-posterior diameter. If the AS enlarges and becomes rounded and distended with an inhomogeneous interior, it might be a sign of graft infection. In these cases an ultrasound-guided or CT-guided puncture is recommended.

  16. Observations of Multi - Component Ion Beams in the High-Altitude Cusp/Cleft Region

    Science.gov (United States)

    Koleva, R.; Semkova, J.; Smirnov, V.; Fedorov, A.

    Both Solar wind and the Earth ionosphere serve as sources of magnetospheric plasma. Having entered (SW ions) or being ejected (ionospheric ions) into the magnetosphere, ions are involved in the magnetospheric circulation. The common idea is that ions, convected to the lobe region, due to the ExB drift, enter the region of the plasma sheet and get energized by different processes. Magnetospheric plasma flows have been widely investigated, using mainly energy-per-charge measurements. While this method successfully differentiates ion species, which have near - equal flow speed and low thermal velocities [e.g. Seki et al., J. Geophys. Res., 1998], the ionic composition of hot magnetospheric flows could only be revealed in mass or mass-per-charge measurements. Recent plasma flows studies based on ion composition measurements [Lennartson, J. Geophys. Res., 2001] showed a great deal of similarity between the tailward drifts of the different ions, especially in the transition region between the central plasma sheet and the tail lobes, and evoked the idea of near-Earth mixing of the Solar wind and ionospheric ions. We present some experimental evidence on near-Earth mixing of magnetospheric ions of different origin. Used are data from the Low Energy Plasma Composition Experiment (AMEI-2) onboard the high-apogee INTERBALL-1 satellite. We present and discuss several cases of ion beams with energies above 3 keV, registered in the cusp/cleft region at distances from 5 to 9 Re, in which both He++ and O+ are present. The beams are observed on filed lines connected with different magnetospheric regions: the LLBL, the plasma mantle and the lobe. The energy/pitch angle behaviour of both He++ (Solar wind origin) and O+ (ionospheric origin) reveals great similarity, as if they are from one and the same source. Only the wider distributions of the He++ fluxes and the narrow ones of the O+ ions indicate their different origin. The distributions bare the signatures of various acceleration

  17. Guided labworks

    DEFF Research Database (Denmark)

    Jacobsen, Lærke Bang

    For the last 40 years physics education research has shown poor learning outcomes of guided labs. Still this is found to be a very used teaching method in the upper secodary schools. This study explains the teacher's choice of guided labs throught the concept of redesign as obstacle dislodgement...

  18. Minimally invasive aortic valve replacement - pros and cons of keyhole aortic surgery.

    Science.gov (United States)

    Kaczmarczyk, Marcin; Szałański, Przemysław; Zembala, Michał; Filipiak, Krzysztof; Karolak, Wojciech; Wojarski, Jacek; Garbacz, Marcin; Kaczmarczyk, Aleksandra; Kwiecień, Anna; Zembala, Marian

    2015-06-01

    Over the last twenty years, minimally invasive aortic valve replacement (MIAVR) has evolved into a safe, well-tolerated and efficient surgical treatment option for aortic valve disease. It has been shown to reduce postoperative morbidity, providing faster recovery and rehabilitation, shorter hospital stay and better cosmetic results compared with conventional surgery. A variety of minimally invasive accesses have been developed and utilized to date. This concise review demonstrates and discusses surgical techniques used in contemporary approaches to MIAVR and presents the most important results of MIAVR procedures.

  19. Minimally invasive aortic valve replacement – pros and cons of keyhole aortic surgery

    Science.gov (United States)

    Szałański, Przemysław; Zembala, Michał; Filipiak, Krzysztof; Karolak, Wojciech; Wojarski, Jacek; Garbacz, Marcin; Kaczmarczyk, Aleksandra; Kwiecień, Anna; Zembala, Marian

    2015-01-01

    Over the last twenty years, minimally invasive aortic valve replacement (MIAVR) has evolved into a safe, well-tolerated and efficient surgical treatment option for aortic valve disease. It has been shown to reduce postoperative morbidity, providing faster recovery and rehabilitation, shorter hospital stay and better cosmetic results compared with conventional surgery. A variety of minimally invasive accesses have been developed and utilized to date. This concise review demonstrates and discusses surgical techniques used in contemporary approaches to MIAVR and presents the most important results of MIAVR procedures. PMID:26336491

  20. Endovascular Repair of Acute Uncomplicated Aortic Type B Dissection Promotes Aortic Remodelling

    DEFF Research Database (Denmark)

    Brunkwall, J; Kasprzak, P; Verhoeven, E

    2014-01-01

    treatment (BMT) with BMT and Gore TAG stent graft in patients with uncomplicated AD. The primary endpoint was a combination of incomplete/no false lumen thrombosis, aortic dilatation, or aortic rupture at 1 year. METHODS: The AD history had to be less than 14 days, and exclusion criteria were rupture......, impending rupture, malperfusion. Of the 61 patients randomised, 80% were DeBakey type IIIB. RESULTS: Thirty-one patients were randomised to the BMT group and 30 to the BMT+TAG group. Mean age was 63 years for both groups. The left subclavian artery was completely covered in 47% and in part in 17...