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Sample records for aortic cusp guided

  1. Radiofrequency Ablation of an Atrial Tachycardia Emanating From the Non-coronary Aortic Cusp Guided by an Electroanatomic Navigation System

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    Agustin Bortone

    2010-02-01

    Full Text Available We report on an atrial tachycardia (AT, emanating from the non-coronary (NC aortic cusp, ablated with the aid of an electro-anatomical navigation system. In this setting, the electrocardiographic, electrophysiologic (EP, anatomical, and ablative considerations are discussed.Although NC aortic cusp focal ATs are an uncommon EP finding, their ablation is effective and safe, especially from an atrio-ventricular (AV conductive point of view. This origin of AT must be invoked and systematically disclosed when a peri-AV nodal AT origin is suspected, in order to avoid a potentially harmful energy application at the vicinity of the AV conductive tissue.

  2. Fibrin glue on an aortic cusp detected by transesophageal echocardiography after valve-sparing aortic valve replacement: a case report.

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    Nakahira, Junko; Ishii, Hisanari; Sawai, Toshiyuki; Minami, Toshiaki

    2015-03-07

    Fibrin glue is used commonly during cardiac surgery but can behave as an intracardiac abnormal foreign body following surgery. There have been few such cases reported, and they were typically noticed only because of the resulting catastrophic cardiac conditions, such as valvular malfunction. We report a case where, for the first time, transesophageal echocardiography was used to detected fibrin glue that was adherent to the ventricular side of a patient's aortic valve immediately after aortic declamping. A 45-year-old Japanese man with Marfan syndrome underwent an aortic valve-sparing operation to treat moderate aortic valve regurgitation resulting from enlargement of his right coronary cusp. Fibrin glue was lightly applied to the suture line between the previous and new grafts. Transesophageal echocardiography performed prior to weaning from the cardiopulmonary bypass revealed mild aortic valve regurgitation in addition to a mobile membranous structure attached to the ventricular side of his aortic valve. It was identified as fibrin glue. We resolved the regurgitation by removing the fibrin glue and repeating the aortic cusp plication. The patient had no complications during recovery. Fibrin glue can act as an intracardiac foreign body and lead to a potentially fatal embolism. We demonstrated the use of transesophageal echocardiography to detect a fibrin glue-derived intracardiac abnormal foreign body and to confirm its removal. To the best of our knowledge, this is the first case where fibrin glue adherent to the aortic valve was detected by transesophageal echocardiography. These findings demonstrate the importance of using transesophageal echocardiography during cardiac surgery that involves using biological glues.

  3. Inadvertent puncture of the aortic noncoronary cusp during postoperative left atrial tachycardia ablation

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    Dursun Aras, MD

    2015-08-01

    Full Text Available Transseptal catheterization has become part of the interventional electrophysiologist׳s technical armamentarium since the development of left atrial catheter ablation and percutaneous technologies for treating mitral and aortic valve disease. Although frequently performed, the procedure׳s most feared complication is aortic root penetration. Focal atrial tachycardia has been described as the most common late sequela of surgical valve replacements. We present a complicated case involving the inadvertent delivery of an 8 French sheath across the noncoronary cusp during radiofrequency catheter ablation for left atrial tachycardia originating from the mitral annulus in a patient with prior mitral valve replacement.

  4. [Zero-fluoroscopy catheter ablation for idiopathic premature ventricular contractions from the aortic sinus cusp].

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    Zhu, Ting-Yan; Liu, Shen-Rong; Chen, Yan-Yu; Xie, Liang-Zhen; He, Li-Wei; Meng, Su-Rong; Peng, Jian

    2016-08-20

    To compare the safety, feasibility, and efficacy of a completely nonfluoroscopic approach to radiofrequency catheter ablation (RFCA) using CARTO3 and ablation with conventional fluoroscopic guidance for treatment of idiopathic premature ventricular contractions from the aortic sinus cusp (ASC-PVCs). From April 2013 to October 2015, we prospectively enrolled 52 consecutive patients with ASC-PVCs scheduled for either CARTO3 mapping-guided zero-fluoroscopy ablation (group A, n=23) or conventional fluoroscopic ablation (group B, n=29). The success rates, rates of complications, rates of recurrences, number of radiofrequency applications, procedure time, mapping time and fluoroscopy time were compared between the 2 groups. s No significant differences were found in the success rates between the 2 groups [22/23 (96%) vs 24/29 (83%), P=0.21]. No major complications occurred during the procedures in either group. There was no significant difference with regard to the procedure time between the two groups (79.6∓8.8 vs 77.4∓7.2 min, P=0.332). The procedure was completed without any fluoroscopy use in group A, while the mean fluoroscopy time in group B was 23.1∓6.0 min. Group A showed a shorter mapping time than group B (4.3∓1.7 vs 7.8∓2.6 min, Pfluoroscopy approach can shorten the total procedure time and the ablation time with significantly reduced RF applications to eliminate ionizing radiation exposure in RFCA. RFCA guided by CARTO3 system without fluoroscopy is feasible, safe, and effective for treatment of ASC-PVCs.

  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. Doubly committed subarterial ventricular septal defect with prolapsed right coronary cusp with moderate aortic regurgitation

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    Redoy Ranjan

    2017-11-01

    Full Text Available A 4 year old girl was presented with the respiratory tract infection, breathlessness after taking meal, failure to thrive, abnormal movement of the chest on left side overlying the area of heart and systolic murmur. She developed these symptoms gradually for the last 3.5 years. Echocardiography revealed doubly committed subarterial ventricular septal defect with moderate aortic regurgitation. The size of the ventricular septal defect was 7 x 9 mm at the left ventricular outflow tract. The right coronary cusp of the aortic valve was prolapsed. Left atrium and left ventricle were dilated. The pulmonary artery systolic pressure was 35 mm Hg. The ventricular septal defect was closed with the standard surgical procedure using cardiopulmonary bypass followed by aortotomy and right atriotomy. Immediate post-operative period of this case was uneventful and the patient was discharged on 9th post-operative day. Follow-up echocardiography showed no residual ventricular septal defect or aortic regurgitation and the ventricular function was good.

  7. 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

    2015-01-01

    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. PMID:26406926

  8. 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.

  9. Facial talon cusps.

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    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.

  10. Carotid artery stenting in difficult aortic arch anatomy with or without a new dedicated guiding catheter: preliminary experience.

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    Barbiero, Giulio; Cognolato, Diego; Casarin, Andrea; Stramanà, Rudi; Galzignan, Elisa; Guarise, Alessandro

    2013-05-01

    To evaluate carotid artery stenting (CAS) procedures with or without a new dedicated guiding catheter in anatomically challenging aortic arches in our experience. We retrospectively reviewed 172 procedures of CAS performed from December 2006 to October 2011 in 159 consecutive patients (100 men, mean age 78 years): 15 patients had type III aortic arch, 13 had a bovine aortic arch, 6 had an acute angle at the origin of the left common carotid artery from the aortic arch, 2 had type III aortic arch with bovine aortic arch, and 1 had a bicarotid trunk with an aberrant right subclavian artery. In this group of difficult anatomy (37 cases), CAS was performed with (13 cases) or without (24 cases) a new dedicated guiding catheter. Mean time of fluoroscopy (16 min vs. 18 min, P guiding catheter group. The new dedicated guiding catheter may be more effective and less risky for CAS in anatomically challenging aortic arches. • Complex anatomy of the aortic arch is not rare • Endovascular carotid artery stenting (CAS) is more difficult when the anatomy is complex • A new dedicated guiding catheter may help CAS when the arch anatomy is complex • The new dedicated guiding catheter may be less risky in complex arches.

  11. JAG Tearing Technique with Radiofrequency Guide Wire for Aortic Fenestration in Thoracic Endovascular Aneurysm Repair

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    Ricci, Carmelo; Ceccherini, Claudio; Leonini, Sara; Cini, Marco; Vigni, Francesco; Neri, Eugenio; Tucci, Enrico; Benvenuti, Antonio; Tommasino, Giulio; Sassi, Carlo

    2012-01-01

    An innovative approach, the JAG tearing technique, was performed during thoracic endovascular aneurysm repair in a patient with previous surgical replacement of the ascending aorta with a residual uncomplicated type B aortic dissection who developed an aneurysm of the descending thoracic aorta with its lumen divided in two parts by an intimal flap. The proximal landing zone was suitable to place a thoracic stent graft. The distal landing zone was created by cutting the intimal flap in the distal third of the descending thoracic aorta with a radiofrequency guide wire and intravascular ultrasound catheter.

  12. Supracristal ventricular septal defect with severe right coronary cusp prolapse

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    Hussain, A.H.; Hanif, B.; Khan, G.; Hasan, K.

    2011-01-01

    The case of a 20 years old male, diagnosed as supracristal ventricular septal defect (VSD) for last 6 years is being presented. He came in emergency department with decompensated congestive cardiac failure. After initial stabilization, he underwent trans thoracic echocardiogram which showed large supracristal VSD, severely prolapsing right coronary cusp, severe aortic regurgitation and severe pulmonary hypertension. Right heart catheterization was performed which documented reversible pulmonary vascular resistance after high flow oxygen inhalation. He underwent VSD repair, right coronary cusp was excised and aortic valve was replaced by mechanical prosthesis. Post operative recovery was uneventful. He was discharged home in one week.The case of a 20 years old male, diagnosed as supracristal ventricular septal defect (VSD) for last 6 years is being presented. He came in emergency department with decompensated congestive cardiac failure. After initial stabilization, he underwent trans thoracic echocardiogram which showed large supracristal VSD, severely prolapsing right coronary cusp, severe aortic regurgitation and severe pulmonary hypertension. Right heart catheterization was performed which documented reversible pulmonary vascular resistance after high flow oxygen inhalation. He underwent VSD repair, right coronary cusp was excised and aortic valve was replaced by mechanical prosthesis. Post operative recovery was uneventful. He was discharged home in one week. (author)

  13. The novel echo-guided ProGlide technique during percutaneous transfemoral transcatheter aortic valve implantation.

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    Honda, Yohsuke; Araki, Motoharu; Yamawaki, Masahiro; Tokuda, Takahiro; Tsutumi, Masakazu; Mori, Shinsuke; Sakamoto, Yasunari; Kobayashi, Norihiro; Hirano, Keisuke; Ito, Yoshiaki

    2018-04-01

    The aim of this study was to assess clinical benefit of the Echo-guided ProGlide technique in patients undergoing percutaneous transfemoral transcatheter aortic valve implantation (TF-TAVI). The efficacy of the Echo-guided ProGlide technique during percutaneous TF-TAVI was not previously clarified. A total of 121 consecutive patients who underwent percutaneous TF-TAVI at our institution between February 2014 and July 2017 were enrolled in this study. According to the introduction of this novel technique in March 2016, patients were divided into two groups (echo-guided group who underwent TAVI from March 2016 to July 2017, n = 63; not echo-guided group who underwent TAVI from February 2014 to February 2016, n = 58). The incidence of major vascular complications, defined per the Valve Academic Research Consortium-2 criteria, and ProGlide complications including acute femoral artery stenosis or occlusion and bleeding requiring any intervention. The incidence of major vascular complication and ProGlide complication were significantly lower in the echo-guided group than in not echo-guided group (1.6% vs 17.2%, P guided ProGlide technique was independently associated with prevention of ProGlide complications (odds ratio, 0.11; 95% confidential interval, 0.01-0.76; P = 0.03). This novel Echo-guided ProGlide technique was associated with a lower rate of major vascular complications, particularly ProGlide complications during percutaneous TF-TAVI. © 2017, Wiley Periodicals, Inc.

  14. Aortic regurgitation after valve-sparing aortic root replacement: modes of failure.

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    Oka, Takanori; Okita, Yutaka; Matsumori, Masamichi; Okada, Kenji; Minami, Hitoshi; Munakata, Hiroshi; Inoue, Takeshi; Tanaka, Akiko; Sakamoto, Toshihito; Omura, Atsushi; Nomura, Takuo

    2011-11-01

    Despite the positive clinical results of valve-sparing aortic root replacement, little is known about the causes of reoperations and the modes of failure. From October 1999 to June 2010, 101 patients underwent valve-sparing aortic root replacement using the David reimplantation technique. The definition of aortic root repair failure included the following: (1) intraoperative conversion to the Bentall procedure; (2) reoperation performed because of aortic regurgitation; and (3) aortic regurgitation equal to or greater than a moderate degree at the follow-up. Sixteen patients were considered to have repair failure. Three patients required intraoperative conversion to valve replacement, 3 required reoperation within 3 months, and another 8 required reoperation during postoperative follow-up. At initial surgery 5 patients had moderate to severe aortic regurgitation, 6 patients had acute aortic dissections, 3 had Marfan syndrome, 2 had status post Ross operations, 3 had bicuspid aortic valves, and 1 had aortitis. Five patients had undergone cusp repair, including Arantius plication in 3 and plication at the commissure in 2. The causes of early failure in 6 patients included cusp perforation (3), cusp prolapse (3), and severe hemolysis (1). The causes of late failure in 10 patients included cusp prolapse (4), commissure dehiscence (3), torn cusp (2), and cusp retraction (1). Patients had valve replacements at a mean of 23 ± 20.9 months after reimplantation and survived. Causes of early failure after valve-sparing root replacement included technical failure, cusp lesions, and steep learning curve. Late failure was caused by aortic root wall degeneration due to gelatin-resorcin-formalin glue, cusp degeneration, or progression of cusp prolapse. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  15. 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

  16. 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.)

  17. 3D printed abdominal aortic aneurysm phantom for image guided surgical planning with a patient specific fenestrated endovascular graft system

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    Meess, Karen M.; Izzo, Richard L.; Dryjski, Maciej L.; Curl, Richard E.; Harris, Linda M.; Springer, Michael; Siddiqui, Adnan H.; Rudin, Stephen; Ionita, Ciprian N.

    2017-03-01

    Following new trends in precision medicine, Juxatarenal Abdominal Aortic Aneurysm (JAAA) treatment has been enabled by using patient-specific fenestrated endovascular grafts. The X-ray guided procedure requires precise orientation of multiple modular endografts within the arteries confirmed via radiopaque markers. Patient-specific 3D printed phantoms could familiarize physicians with complex procedures and new devices in a risk-free simulation environment to avoid periprocedural complications and improve training. Using the Vascular Modeling Toolkit (VMTK), 3D Data from a CTA imaging of a patient scheduled for Fenestrated EndoVascular Aortic Repair (FEVAR) was segmented to isolate the aortic lumen, thrombus, and calcifications. A stereolithographic mesh (STL) was generated and then modified in Autodesk MeshMixer for fabrication via a Stratasys Eden 260 printer in a flexible photopolymer to simulate arterial compliance. Fluoroscopic guided simulation of the patient-specific FEVAR procedure was performed by interventionists using all demonstration endografts and accessory devices. Analysis compared treatment strategy between the planned procedure, the simulation procedure, and the patient procedure using a derived scoring scheme. Results: With training on the patient-specific 3D printed AAA phantom, the clinical team optimized their procedural strategy. Anatomical landmarks and all devices were visible under x-ray during the simulation mimicking the clinical environment. The actual patient procedure went without complications. Conclusions: With advances in 3D printing, fabrication of patient specific AAA phantoms is possible. Simulation with 3D printed phantoms shows potential to inform clinical interventional procedures in addition to CTA diagnostic imaging.

  18. Factors associated with the development of aortic valve regurgitation over time after two different techniques of valve-sparing aortic root surgery.

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    Hanke, Thorsten; Charitos, Efstratios I; Stierle, Ulrich; Robinson, Derek; Gorski, Armin; Sievers, Hans-H; Misfeld, Martin

    2009-02-01

    Early results after aortic valve-sparing root reconstruction are excellent. Longer-term follow-up, especially with regard to aortic valve function, is required for further judgment of these techniques. Between July of 1993 and September of 2006, 108 consecutive patients (mean age 53.0 +/- 15.8 years) underwent the Yacoub operation (group Y) and 83 patients underwent the David operation (group D). Innovative multilevel hierarchic modeling methods were used to analyze aortic regurgitation over time. In general, aortic regurgitation increased with time in both groups. Factors associated with the development of a significant increase in aortic regurgitation were Marfan syndrome, concomitant cusp intervention, and preoperative aortic anulus dimension. In Marfan syndrome, the initial aortic regurgitation was higher in group Y versus group D (0.56 aortic regurgitation vs 0.29 aortic regurgitation, P = .049), whereas the mean annual progression rate of aortic regurgitation was marginally higher in group Y (0.132 aortic regurgitation vs 0.075 aortic regurgitation, P = .1). Concomitant cusp intervention was associated with a significant aortic regurgitation increase in both groups (P Marfan syndrome and a large preoperative aortic annulus diameter were better treated with the reimplantation technique, whereas those with a smaller diameter were better treated with the remodeling technique. Concomitant free-edge plication of prolapsing cusps was disadvantageous in both groups. Considering these factors may serve to improve the aortic valve longevity after valve-sparing aortic root surgery.

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

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    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.

  20. Determining the mechanism of cusp proton aurora.

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    Xiao, Fuliang; Zong, Qiugang; Su, Zhenpeng; Yang, Chang; He, Zhaoguo; Wang, Yongfu; Gao, Zhonglei

    2013-01-01

    Earth's cusp proton aurora occurs near the prenoon and is primarily produced by the precipitation of solar energetic (2-10 keV) protons. Cusp auroral precipitation provides a direct source of energy for the high-latitude dayside upper atmosphere, contributing to chemical composition change and global climate variability. Previous studies have indicated that magnetic reconnection allows solar energetic protons to cross the magnetopause and enter the cusp region, producing cusp auroral precipitation. However, energetic protons are easily trapped in the cusp region due to a minimum magnetic field existing there. Hence, the mechanism of cusp proton aurora has remained a significant challenge for tens of years. Based on the satellite data and calculations of diffusion equation, we demonstrate that EMIC waves can yield the trapped proton scattering that causes cusp proton aurora. This moves forward a step toward identifying the generation mechanism of cusp proton aurora.

  1. Long-term Variability of Beach Cusps

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    Pianca, C.; Holman, R. A.; Siegle, E.

    2016-02-01

    The most curious morphological features observed on beaches are the cusps. Due to their rhythmic spacing, beach cusps have attracted many observers and many, often contradictory, theories as to their form. Moreover, most of the research about beach cusps has focused on their formation. Few had available long time series to study such things as the variability of alongshore and cross-shore position and spacing on the cusp field, the presence, longevity and interactions between higher and lower sets of cusps, and the processes by which cusp fields extend, shrink or change length scale. The purpose of this work is to use long-term data sets of video images from two study sites, an intermediate (Duck, USA, 26 years) and a reflective beach (Massaguaçu, Brazil, 3 years), to investigate the temporal and spatial changes of cusps conditions. Time-evolving shoreline data were first extracted using an algorithm called ASLIM (Pianca et al 2015). Cusps were then identified based on the band-passed variability of time exposure image data about this shoreline as a function of elevation relative to MSL. The identified beaches cusps will be analyzed for cusp spacing, positions (upper or lower cusps), alongshore variability, merging events, percentage of cusp events, patterns of the events and time scales of variability. Finally, the relationship of these characteristics to environmental conditions (wave, tides, beach conditions) will be studied.

  2. 21 CFR 872.3360 - Preformed cusp.

    Science.gov (United States)

    2010-04-01

    ... DENTAL DEVICES Prosthetic Devices § 872.3360 Preformed cusp. (a) Identification. A performed cusp is a prefabricated device made of plastic or austenitic alloys or alloys containing 75 percent or greater gold and metals of the platinum group intended to be used as a temporary cusp (a projection on the chewing surface...

  3. Talon cusp on palatally erupted mesiodens

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    Ashalata Gannepalli

    2017-01-01

    Full Text Available Talon cusp is an accessory cusp-like structure or an extra cusp on an anterior tooth arising as a result of evagination on the surface of the crown before calcification has occurred. The cusp is composed of normal enamel and dentin containing varying extensions of pulp tissue. It is associated with few developmental anomalies such as peg laterals, dens invaginatus, and mesiodens. Mesiodens is a supernumerary tooth located in the premaxillary central incisor region which is supplemental or rudimentary type. Association of mesiodens with talon cusp is a rare occurrence with 25 cases reported. The presence of Talon cusp or a supernumerary tooth – mesiodens – leads to clinical implications such as poor esthetics, crowding, rotations, and also occlusal discrepancies. In this report, we present a case report of an 18-year-old male having a talon cusp on palatally erupted mesiodens.

  4. Impact of primary para-aortic lymphadenectomy on distant failure in locally advanced cervical cancer patients treated in the era of image-guided adaptive brachytherapy.

    Science.gov (United States)

    Chargari, Cyrus; Mazeron, Renaud; Dunant, Ariane; Gouy, Sébastien; Petit, Claire; Maroun, Pierre; Uzan, Catherine; Annede, Pierre; Bentivegna, Enrica; Balleyguier, Corinne; Genestie, Catherine; Pautier, Patricia; Leary, Alexandra; Lhomme, Catherine; Deutsch, Eric; Morice, Philippe; Haie-Meder, Christine

    2016-12-01

    To investigate the impact of a primary para-aortic lymphadenectomy (PAL) in locally advanced cervical cancer patients receiving definitive chemoradiation, we reviewed the clinical records of consecutive patients treated in our Institution and receiving an external beam irradiation followed with an image-guided adaptive brachytherapy for a locally advanced cervical cancer. We examined the impact of performing a primary PAL as part of primary staging for guiding irradiation fields in patients without extra-pelvic PET uptake. The outcome of patients presenting para-aortic lymph node uptake (PALNU) was also examined. 186 patients were identified. Median follow-up was 44.4 months. Patients receiving a primary PAL (PAL group) and those who received upfront pelvic chemoradiation (no-PAL group) did not significantly differ for loco-regional failures. Survival without distant failure (DFFS), including para-aortic relapses, was at 3 years 87 % (95 % CI 84-90 %) in PAL group, 67 % (95 % CI 59-85 %) in the no-PAL group and 44 % (95 % CI 32-66 %) in the PALNU group (p = 0.04 for comparison between PAL and no-PAL groups). In a multivariate model including para-aortic lymphadenectomy, pelvic nodal uptake and high-risk clinical target volume as adjustment variables, a para-aortic lymphadenectomy was significant for DFS (HR = 0.47, 95 % CI 0.26-0.84, p = 0.01). Although confounding factors could account for these retrospective results, a primary PAL with tailored irradiation fields based on para-aortic histological findings seems to be associated with a better control for distant metastases. A randomized trial is testing the benefit of this strategy.

  5. Subacute Aortic Regurgitation as a Rare Presentation of Latrogenic Aortic Valve Leaflet Perforation

    Directory of Open Access Journals (Sweden)

    Hassan Teimouri

    2009-12-01

    Full Text Available There is a paucity of literature regarding iatrogenic aortic valve perforation after cardiac operation is performed in the vicinity of the aortic valve. This report describes the clinical, echocardiographic, and angiocardiographic recognition of iatrogenic aortic valve perforation in a patient who had previously under gone membranous ventricular septal defect and pulmonary stenosis. Five days after the operation, the patient showed subacute signs and symptoms of congestive heart failure in surgical ward. Echocardiographic examination revealed free aortic regurgitation. The patient was scheduled for operation, which was performed using cardiopulmonary bypass and cardioplegic arrest. During the operation, exploration of the aortic root revealed tearing non-coronary aortic cusp at the level of the aortic ring and slightly dilated the left sinus. Despite close examination, no suture could be identified. It was reasoned that the tension created by the dacron patch pulled on the adjacent tissue and caused the separation of the non-coronary cusp from its ring and the patient was treated by aortic valve replacement with prosthetic aortic valve. We did not have the facility to use transesophaseal echocardiography for the examination of aortic valve repair and the poor condition of the patient did not permit us to repair the valve. Precise preoperative diagnosis of this lesion allows optimal surgical planning and treatment.

  6. Double cusp encounter by Cluster: double cusp or motion of the cusp?

    Czech Academy of Sciences Publication Activity Database

    Escoubet, C. P.; Berchem, J.; Trattner, K. J.; Pitout, F.; Richard, R.; Taylor, M. G. G. T.; Souček, Jan; Grison, Benjamin; Laakso, H.; Masson, A.; Dunlop, M.; Dandouras, I.; Reme, H.; Fazakerley, A.; Daly, P.

    2013-01-01

    Roč. 31, č. 4 (2013), s. 713-723 ISSN 0992-7689 R&D Projects: GA ČR(CZ) GPP209/11/P848 Institutional support: RVO:68378289 Keywords : Magnetospheric physics * Magnetopause * cusp * boundary layers Subject RIV: BL - Plasma and Gas Discharge Physics Impact factor: 1.676, year: 2013 http://www. ann -geophys.net/31/713/2013/

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

    OpenAIRE

    Kahlert, Philipp; Eggebrecht, Holger; Plicht, Bj?rn; Kraff, Oliver; McDougall, Ian; Decker, Brad; Erbel, Raimund; Ladd, Mark E; Quick, Harald H

    2010-01-01

    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...

  8. 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

  9. 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

    .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......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...... involvement. The patients received whole pelvis intensity-modulated radiation therapy (45-50 Gy/25-30 fx) to whole pelvis and two fractions of MRI pulsed-dose-rate BT. The delineated LN groups were para-aortic, inguinal, common iliac (CI), external iliac, internal iliac, obturator, and presacral. For each LN...

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  11. Aortic dissection

    Science.gov (United States)

    ... made in the chest or abdomen. Endovascular aortic repair. This surgery is done without any major surgical ... needed. If the heart arteries are involved, a coronary bypass is also performed. Outlook ... aneurysm - dissecting; Chest pain - aortic dissection; Thoracic aortic aneurysm - ...

  12. First magnetic resonance imaging-guided aortic stenting and cava filter placement using a polyetheretherketone-based magnetic resonance imaging-compatible guidewire in swine: proof of concept.

    Science.gov (United States)

    Kos, Sebastian; Huegli, Rolf; Hofmann, Eugen; Quick, Harald H; Kuehl, Hilmar; Aker, Stephanie; Kaiser, Gernot M; Borm, Paul J A; Jacob, Augustinus L; Bilecen, Deniz

    2009-05-01

    The purpose of this study was to demonstrate feasibility of percutaneous transluminal aortic stenting and cava filter placement under magnetic resonance imaging (MRI) guidance exclusively using a polyetheretherketone (PEEK)-based MRI-compatible guidewire. Percutaneous transluminal aortic stenting and cava filter placement were performed in 3 domestic swine. Procedures were performed under MRI-guidance in an open-bore 1.5-T scanner. The applied 0.035-inch guidewire has a PEEK core reinforced by fibres, floppy tip, hydrophilic coating, and paramagnetic markings for passive visualization. Through an 11F sheath, the guidewire was advanced into the abdominal (swine 1) or thoracic aorta (swine 2), and the stents were deployed. The guidewire was advanced into the inferior vena cava (swine 3), and the cava filter was deployed. Postmortem autopsy was performed. Procedural success, guidewire visibility, pushability, and stent support were qualitatively assessed by consensus. Procedure times were documented. Guidewire guidance into the abdominal and thoracic aortas and the inferior vena cava was successful. Stent deployments were successful in the abdominal (swine 1) and thoracic (swine 2) segments of the descending aorta. Cava filter positioning and deployment was successful. Autopsy documented good stent and filter positioning. Guidewire visibility through applied markers was rated acceptable for aortic stenting and good for venous filter placement. Steerability, pushability, and device support were good. The PEEK-based guidewire allows either percutaneous MRI-guided aortic stenting in the thoracic and abdominal segments of the descending aorta and filter placement in the inferior vena cava with acceptable to good device visibility and offers good steerability, pushability, and device support.

  13. First Magnetic Resonance Imaging-Guided Aortic Stenting and Cava Filter Placement Using a Polyetheretherketone-Based Magnetic Resonance Imaging-Compatible Guidewire in Swine: Proof of Concept

    International Nuclear Information System (INIS)

    Kos, Sebastian; Huegli, Rolf; Hofmann, Eugen; Quick, Harald H.; Kuehl, Hilmar; Aker, Stephanie; Kaiser, Gernot M.; Borm, Paul J. A.; Jacob, Augustinus L.; Bilecen, Deniz

    2009-01-01

    The purpose of this study was to demonstrate feasibility of percutaneous transluminal aortic stenting and cava filter placement under magnetic resonance imaging (MRI) guidance exclusively using a polyetheretherketone (PEEK)-based MRI-compatible guidewire. Percutaneous transluminal aortic stenting and cava filter placement were performed in 3 domestic swine. Procedures were performed under MRI-guidance in an open-bore 1.5-T scanner. The applied 0.035-inch guidewire has a PEEK core reinforced by fibres, floppy tip, hydrophilic coating, and paramagnetic markings for passive visualization. Through an 11F sheath, the guidewire was advanced into the abdominal (swine 1) or thoracic aorta (swine 2), and the stents were deployed. The guidewire was advanced into the inferior vena cava (swine 3), and the cava filter was deployed. Postmortem autopsy was performed. Procedural success, guidewire visibility, pushability, and stent support were qualitatively assessed by consensus. Procedure times were documented. Guidewire guidance into the abdominal and thoracic aortas and the inferior vena cava was successful. Stent deployments were successful in the abdominal (swine 1) and thoracic (swine 2) segments of the descending aorta. Cava filter positioning and deployment was successful. Autopsy documented good stent and filter positioning. Guidewire visibility through applied markers was rated acceptable for aortic stenting and good for venous filter placement. Steerability, pushability, and device support were good. The PEEK-based guidewire allows either percutaneous MRI-guided aortic stenting in the thoracic and abdominal segments of the descending aorta and filter placement in the inferior vena cava with acceptable to good device visibility and offers good steerability, pushability, and device support.

  14. Magion-4 High-Altitude Cusp Study

    Czech Academy of Sciences Publication Activity Database

    Merka, J.; Šafránková, J.; Němeček, Z.; Šimůnek, Jiří

    2005-01-01

    Roč. 26, č. 1-3 (2005), s. 57-69 ISSN 0169-3298 R&D Projects: GA ČR(CZ) GA205/02/0947 Institutional research plan: CEZ:AV0Z30420517 Keywords : cusp-like plasma * dipole tilt angle * high-altitude cusp * magnetopause * magnetopause * reconnection Subject RIV: BL - Plasma and Gas Discharge Physics Impact factor: 0.975, year: 2005

  15. Turbulence in a cusp Q device

    DEFF Research Database (Denmark)

    D'Angelo, N.; Pécseli, Hans; Petersen, P. I.

    1974-01-01

    Spectral measurements are reported of plasma turbulence in the Cs plasma of a Q device, modified to a magnetic cusp geometry. The excitation mechanism for the fluctuations appears to be the centrifugal instability discussed by Chen. A transition from an f−5 to an f−3 power spectrum is observed...... as one moves from the hot plates to the midplane of the cusp. ©1974 American Institute of Physics...

  16. Stent implantation to ductus arteriosus in a patient with interrupted aortic arch guided by CT image overlay.

    Science.gov (United States)

    Goreczny, Sebastian; Dryzek, Pawel; Moszura, Tomasz

    2017-08-01

    A 15-day-old premature patient with ventricular septal defect and interrupted aortic arch type B underwent "hybrid" initial treatment consisting of bilateral pulmonary artery banding followed by stenting of the ductus arteriosus. A pre-registered CT scan was re-purposed with a new three-dimensional image fusion software (VesselNavigator) to create a roadmap for stent delivery.

  17. Cluster observations of a structured magnetospheric cusp

    Directory of Open Access Journals (Sweden)

    N. Balan

    2006-05-01

    Full Text Available On 18 April 2002 the Cluster spacecraft crossed through the northern outer magnetospheric cusp region during 16:25-17:55 UT when the solar wind dynamic pressure was rather low (<2 nPa and IMF Bz was more negative than IMF By. The Cluster data from the FGM, CIS, PEACE, EFW, WHISPER and STAFF instruments reveal that the cusp is structured with three anti-sunward ion flow events of durations ≈1.5, 17.5 and 19.0 min, with bulk plasma flow roughly parallel to the magnetopause toward north. The ion and electron densities within the events are much greater than those outside. The zonal electric field in the ion flow events turns eastward as expected from V×B effect. The sharp inward boundaries of the ion flow events cross the four spacecraft in one time sequence, and the outward boundaries of the events cross the spacecraft in the reverse time sequence. The observations studied using magnetosphere and magnetopause models suggest that the structured cusp is a temporal feature that arises due to three inward and outward movements of the magnetopause by about 1.5RE so that Cluster, while crossing through the cusp, happened to be in the magnetosheath (ion flow event and cusp alternately. The magnetopause moved due to the changes in the solar wind dynamic pressure by up to 100%.

  18. 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.

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

    Science.gov (United States)

    Kahlert, Philipp; Eggebrecht, Holger; Plicht, Björn; Kraff, Oliver; McDougall, Ian; Decker, Brad; Erbel, Raimund; Ladd, Mark E; Quick, Harald H

    2010-10-13

    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. 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. 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. The present study shows that the Medtronic CoreValve® prosthesis is potentially suited for real-time CMR-guided placement in vivo after suggested design modifications of the delivery

  20. 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

  1. Aortic Valve Leaflet Perforation after Mitral Valve Repair

    Directory of Open Access Journals (Sweden)

    M. Aboelnasr

    2013-01-01

    Full Text Available  A 32-year-old patient with symptomatic severe aortic regurge, 6 weeks after mitral valve repair, was admitted for aortic valve surgery. No preoperative clinical data consistent with infective endocarditis could be detected. Preoperative transthoracic echocardiography showed aortic leaflet perforation affecting non coronary cusp. During operation, leaflet perforation was detected and closed completely with autologous pericardial patch. No vegetations or abscess could be seen during operation. Iatrogenic aetiology of leaflet perforation after mitral repair was suspected in  this case. Recognition of this complication will help in  avoiding it during mitral valve surgery and expecting it as a possible complication during intraoperative transesophageal echocardiography.

  2. The Magnetospheric Cusps Structure and Dynamics

    CERN Document Server

    Fritz, Theodore A

    2005-01-01

    This collection of papers will address the question "What is the Magnetospheric Cusp?" and what is its role in the coupling of the solar wind to the magnetosphere as well as its role in the processes of particle transport and energization within the magnetosphere. The cusps have traditionally been described as narrow funnel-shaped regions that provide a focus of the Chapman-Ferraro currents that flow on the magnetopause, a boundary between the cavity dominated by the geomagnetic field (i.e., the magnetosphere) and the external region of the interplanetary medium. Measurements from a number of recent satellite programs have shown that the cusp is not confined to a narrow region near local noon but appears to encompass a large portion of the dayside high-latitude magnetosphere and it appears that the cusp is a major source region for the production of energetic charged particles for the magnetosphere. Audience: This book will be of interest to space science research organizations in governments and industries, ...

  3. 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.

  4. Dynamics of Triaxial Elliptical Galaxies with Cusps

    Science.gov (United States)

    Fridman, Tema

    1997-06-01

    The gravitational potentials, orbital properties, and self-consistent equilibria of triaxial stellar systems with central density cusps are examined. Observations of the nuclei of early-type galaxies with the Hubble Space Telescope (HST) suggest that their surface brightness profiles fall into two categories: the 'cores' and the 'power laws.' We show that this dichotomy results from an optical illusion associated with projection onto the plane of the sky. Galaxies of both types have deprojected density profiles that are well-described as power-laws at small radii, with slopes 0≤γ 0.8. Regular box orbits, which depend for their existence on the stability of the long-axis orbit, do not exist in these models. The next-lowest resonance, the 2: 1 banana family, is present whenever the long-axis orbit is unstable. However the banana orbits have a very restricted range of shapes and are thicker than the model isodensity surfaces when c/a/ ~self-consistent models of triaxial galaxies with Dehnen's (1993) density law. We consider central density cusps defined by γ = 1 (weak cusp) and γ = 2 (strong cusp). These values are representative of the nuclear density profiles of bright ('core') and faint ('power-law') galaxies as observed with HST. Both mass models have short-to-long axis ratios of 1:2 and are maximally triaxial. We compute libraries of ~7000 orbits in each of the models and map them as a function of energy. A large fraction of the orbits in both model potentials are stochastic, which diffuse relatively quickly through their allowed phase-space in the strong-cusp potential (~103 dynamical times) and more slowly in the weak-cusp potential (104 dynamical times or longer). Attempts to construct self-consistent solutions using just the regular orbits failed for both mass models. Quasi-equilibrium solutions that include the stochastic orbits exist for both models; however, real galaxies constructed in this way would evolve near the center due to the continued

  5. Incidence and progression of mild aortic regurgitation after Tirone David reimplantation valve-sparing aortic root replacement.

    Science.gov (United States)

    Stephens, Elizabeth H; Liang, David H; Kvitting, John-Peder Escobar; Kari, Fabian A; Fischbein, Michael P; Mitchell, R Scott; Miller, D Craig

    2014-01-01

    The study objective was to determine whether recurrent or residual mild aortic regurgitation, which occurs after valve-sparing aortic root replacement, progresses over time. Between 2003 and 2008, 154 patients underwent Tirone David-V valve-sparing aortic root replacement; 96 patients (62%) had both 1-year (median, 12 ± 4 months) and mid-term (62 ± 22 months) transthoracic echocardiograms available for analysis. Age of patients averaged 38 ± 13 years, 71% were male, 31% had a bicuspid aortic valve, 41% had Marfan syndrome, and 51% underwent aortic valve repair, predominantly cusp free margin shortening. Forty-one patients (43%) had mild aortic regurgitation on 1-year echocardiogram. In 85% of patients (n = 35), mild aortic regurgitation remained stable on the most recent echocardiogram (median, 57 ± 20 months); progression to moderate aortic regurgitation occurred in 5 patients (12%) at a median of 28 ± 18 months and remained stable thereafter; severe aortic regurgitation developed in 1 patient, eventually requiring reoperation. Five patients (5%) had moderate aortic regurgitation at 1 year, which did not progress subsequently. Two patients (2%) had more than moderate aortic regurgitation at 1 year, and both ultimately required reoperation. Although mild aortic regurgitation occurs frequently after valve-sparing aortic root replacement, it is unlikely to progress over the next 5 years and should not be interpreted as failure of the valve-preservation concept. Further, we suggest that mild aortic regurgitation should not be considered nonstructural valve dysfunction, as the 2008 valve reporting guidelines would indicate. We need 10- to 15-year follow-up to learn the long-term clinical consequences of mild aortic regurgitation early after valve-sparing aortic root replacement. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  6. A study of extracellular matrix remodeling in aortic heart valves using a novel biaxial stretch bioreactor.

    Science.gov (United States)

    Lei, Ying; Masjedi, Shirin; Ferdous, Zannatul

    2017-11-01

    In aortic valves, biaxial cyclic stretch is known to modulate cell differentiation, extracellular matrix (ECM) synthesis and organization. We designed a novel bioreactor that can apply independent and precise stretch along radial and circumferential directions in a tissue culture environment. While this bioreactor can be used for either native or engineered tissues, this study determined matrix remodeling and strain distribution of aortic cusps after culturing under biaxial stretch for 14 days. The contents of collagen and glycosaminoglycans were determined using standard biochemical assays and compared with fresh controls. Strain fields in static cusps were more uniform than those in stretched cusps, which indicated degradation of the ECM fibers. The glycosaminoglycan content was significantly elevated in the static control as compared to fresh or stretched cusps, but no difference was observed in collagen content among the groups. The strain profile of freshly isolated fibrosa vs. ventricularis and left, right, and noncoronary cusps were also determined by Digital Image Correlation technique. Distinct strain patterns were observed under stretch on fibrosa and ventricularis sides and among the three cusps. This work highlights the critical role of the anisotropic ECM structure for proper functions of native aortic valves and the beneficial effects of biaxial stretch for maintenance of the native ECM structure. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Planar biaxial testing of heart valve cusp replacement biomaterials: Experiments, theory and material constants.

    Science.gov (United States)

    Labrosse, Michel R; Jafar, Reza; Ngu, Janet; Boodhwani, Munir

    2016-11-01

    Aortic valve (AV) repair has become an attractive option to correct aortic insufficiency. Yet, cusp reconstruction with various cusp replacement materials has been associated with greater long-term repair failures, and it is still unknown how such materials mechanically compare with native leaflets. We used planar biaxial testing to characterize six clinically relevant cusp replacement materials, along with native porcine AV leaflets, to ascertain which materials would be best suited for valve repair. We tested at least six samples of: 1) fresh autologous porcine pericardium (APP), 2) glutaraldehyde fixed porcine pericardium (GPP), 3) St Jude Medical pericardial patch (SJM), 4) CardioCel patch (CC), 5) PeriGuard (PG), 6) Supple PeriGuard (SPG) and 7) fresh porcine AV leaflets (PC). We introduced efficient displacement-controlled testing protocols and processing, as well as advanced convexity requirements on the strain energy functions used to describe the mechanical response of the materials under loading. The proposed experimental and data processing pipeline allowed for a robust in-plane characterization of all the materials tested, with constants determined for two Fung-like hyperelastic, anisotropic strain energy models. Overall, CC and SPG (respectively PG) patches ranked as the closest mechanical equivalents to young (respectively aged) AV leaflets. Because the native leaflets as well as CC, PG and SPG patches exhibit significant anisotropic behaviors, it is suggested that the fiber and cross-fiber directions of these replacement biomaterials be matched with those of the host AV leaflets. The long-term performance of cusp replacement materials would ideally be evaluated in large animal models for AV disease and cusp repair, and over several months or more. Given the unavailability and impracticality of such models, detailed information on stress-strain behavior, as studied herein, and investigations of durability and valve dynamics will be the best surrogates

  8. Tooth cusp sharpness as a dietary correlate in great apes.

    Science.gov (United States)

    Berthaume, Michael A

    2014-02-01

    Mammalian molars have undergone heavy scrutiny to determine correlates between morphology and diet. Here, the relationship between one aspect of occlusal morphology, tooth cusp radius of curvature (RoC), and two broad dietary categories, folivory and frugivory, is analyzed in apes. The author hypothesizes that there is a relationship between tooth cusp RoC and diet, and that folivores have sharper teeth than frugivores, and further test the correlation between tooth cusp RoC and tooth cusp size. Eight measures of tooth cusp RoC (two RoCs per cusp) were taken from 53 M(2) s from four species and subspecies of frugivorous apes (Pongo pygmaeus, Pan troglodytes troglodytes, Pan troglodytes schweinfurthii, and Gorilla gorilla gorilla) and two subspecies of folivorous apes (Gorilla beringei beringei, and Gorilla beringei graueri). Phylogenetically corrected ANOVAs were run on the full dataset and several subsets of the full dataset, revealing that, when buccolingual RoCs are taken into account, tooth cusp RoCs can successfully differentiate folivores and frugivores. PCAs revealed that folivores consistently had duller teeth than frugivores. In addition, a weak, statistically significant positive correlation exists between tooth cusp size and tooth cusp RoC. The author hypothesizes differences in tooth cusp RoC are correlated with wear rates, where, per vertical unit of wear, duller cusps will have a longer length of exposed enamel ridge than sharper cusps. More data need to be gathered to determine if the correlation between tooth cusp RoC and tooth cusp size holds true when small primates are considered. Copyright © 2013 Wiley Periodicals, Inc.

  9. Circumferential ascending aortic strain and aortic stenosis.

    Science.gov (United States)

    Teixeira, Rogério; Moreira, Nádia; Baptista, Rui; Barbosa, António; Martins, Rui; Castro, Graça; Providência, Luís

    2013-07-01

    Two-dimensional speckle tracking (2D-ST) echocardiography for the measurement of circumferential ascending thoracic aortic strain (CAAS) in the context of aortic stenosis (AS) is not elucidated. Purpose This study assesses the thoracic ascending aortic deformation using 2D-ST echocardiography in AS patients. Population and methods Forty-five consecutive patients with an aortic valvular area (AVA) ≤0.85 cm(2)/m(2) were included. Regarding aortic deformation, the global peak CAAS was the parameter used, and an average of six segments of arterial wall deformation was calculated. The corrected CAAS was calculated as the global CAAS/pulse pressure (PP). Aortic stiffness (β2) index was assessed according to ln(Ps/Pd)/CAAS. The sample was stratified according to the stroke volume index (SVI) as: Group A (low flow, SVI ≤35 mL/m(2); n = 19) and Group B (normal flow, SVI >35 mL/m(2); n = 26). The mean age was 76.8 ± 10.3 years, 53.3% were male, the mean indexed AVA was 0.43 ± 0.15 cm(2)/m(2), and the mean CAAS was 6.3 ± 3.0%. The CAAS was predicted by SVI (β = 0.31, P < 0.01) and by valvulo-arterial impedance (Zva). The corrected CAAS was correlated with the M-mode guided aortic stiffness index (β1) (r = -0.39, P < 0.01), and was predicted by SVI, Zva, and systemic arterial compliance (β = 0.15, P < 0.01). The β2 index was significantly higher for the low-flow patients (16.1 ± 4.8 vs. 9.8 ± 5.3, P < 0.01), and was predicted by SVI (β -0.58, P < 0.01) and PP (β = 0.17, P < 0.01). Global CAAS was more accurate to predict low flow than Zva, systolic function and systemic vascular resistance. In patients with moderate-to-severe aortic stenosis, SVI and LV afterload-related variables were the most important determinants of 2S-ST global CAAS.

  10. 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.

  11. Cost estimate for electrostatically plugged cusp reactor

    International Nuclear Information System (INIS)

    Dolan, T.J.

    1977-01-01

    A preliminary design of an electrostatically plugged cusp reactor was presented in (UCRL-52142(1976)). The capital costs of the various components of this reactor are estimated and totaled for two different blanket configurations: one having an energy multiplication factor M = 1.2, and the other having M = 1.68. The unoptimized direct capital costs for these cases are found to be about 1400 and 950 $/kWe, respectively

  12. Low pressure hugoniot cusp in polymeric materials

    Science.gov (United States)

    Sheffield, S. A.; Bloomquist, D. D.

    1982-04-01

    It has previously been shown that polymethyl methacrylate (PMMA) exhibits a cusp in the shock Hugoniot at about 2.0 GPa which corresponds with the beginning of shock-induced polarization and the beginning of an exothermic reaction measured in thermocouple and resistivity gauge temperature studies. We now report results we have recently obtained from an ongoing study which indicate that other polymers have similar behavior at about the same pressure. Quartz gauge impact experiments have been performed using polypyro-ellitimide (Vespel) and polysulfone impactors to obtain Hugoniot information and the stress history at the impact plane. In the case of Vespel a slight Hugoniot cusp was observed at about 1.8 GPa which coincides with the start of shock-induced polarization. Polysulfone does not appear to have a cusp but does show stress relaxation at the impact plane beginning at about 1.8 GPa, again coinciding with the start of shock-induced polarization. It has been suggested earlier that the abnormal behavior in PMMA is the result of a shock-induced chemical reaction. This new information suggests that a stress of about 2 GPa is a threshold for shock-induced chemical reaction in several polymers.

  13. 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.

  14. Survival and freedom from aortic valve-related reoperation after valve-sparing aortic root replacement in 1015 patients.

    Science.gov (United States)

    Kari, Fabian A; Doll, Kai-Nicolas; Hemmer, Wolfgang; Liebrich, Markus; Sievers, Hans-Hinrich; Richardt, Doreen; Reichenspurner, Hermann; Detter, Christian; Siepe, Matthias; Czerny, Martin; Beyersdorf, Friedhelm

    2016-04-01

    The aim of this study was to characterize mortality and aortic valve replacement after valve-sparing aortic root replacement (V-SARR) in a multicentre cohort. Between 1994 and 2014, 1015 patients had V-SARR with (n = 288, 28%) or without cusp/commissure repair (n = 727, 72%) at the centres of Lübeck (n = 343, 34%), Stuttgart (n = 346, 34%), Hamburg (n = 109, 11%) and Freiburg (n = 217, 21%), Germany. Comparative survival of an age- and gender-matched general population was calculated. Log-rank tests and multiple logistic regression were used to identify risk factors. The mean follow-up was 5.2 ± 3.9 years. Cumulative follow-up comprised 2933 patient-years. Early survival was 98%. NYHA status and aneurysm size were predictive of death during mid-term follow-up (P = 0.025). Freedom from aortic valve replacement was 90% at 8 years, with the type of V-SARR (root remodelling, David II) being a risk factor (P = 0.015). Bicuspid aortic valve (P = 0.26) and initial valve function (P = 0.4) did not impact reoperation. The need of additional valve repair (cusps/commissures) was not linked to reoperation: freedom from aortic valve replacement at 8 years was 84% if cusp repair was performed versus 90% if V-SARR alone was performed (P = 0.218). Marfan syndrome had no impact on survival or on aortic valve replacement. Mid-term survival of patients after V-SARR is comparable with that of a matched general population. The regurgitant bicuspid aortic valve is a favourable substrate for V-SARR. Prophylactic surgery should be performed before symptoms or large aneurysms are present to achieve optimal mid-term outcomes. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  15. Talon cusps in mandibular incisors: Report of eight rare cases

    Directory of Open Access Journals (Sweden)

    Shiu-yin Cho

    2014-01-01

    Full Text Available Talon cusps in mandibular anterior teeth are very rare. Talon cusps in mandibular anterior teeth associated with other anomalies are even rarer and that a bilateral case in the mandible has not been reported before. In this report, eight such rare cases of talon cusps in permanent mandibular incisors are presented. It includes a bilateral case that in the author′s knowledge is the first case reported in the English literatures.

  16. Mechanisms of recurrent aortic regurgitation after aortic valve repair: predictive value of intraoperative transesophageal echocardiography.

    Science.gov (United States)

    le Polain de Waroux, Jean-Benoît; Pouleur, Anne-Catherine; Robert, Annie; Pasquet, Agnès; Gerber, Bernhard L; Noirhomme, Philippe; El Khoury, Gébrine; Vanoverschelde, Jean-Louis J

    2009-08-01

    The aim of the present study was to examine the intraoperative echocardiographic features associated with recurrent severe aortic regurgitation (AR) after an aortic valve repair surgery. Surgical valve repair for AR has significant advantages over valve replacement, but little is known about the predictors and mechanisms of its failure. We blindly reviewed all clinical, pre-operative, intraoperative, and follow-up transesophageal echocardiographic data of 186 consecutive patients who underwent valve repair for AR during a 10-year period and in whom intraoperative and follow-up echo data were available. After a median follow-up duration of 18 months, 41 patients had recurrent 3+ AR, 23 patients presented with residual 1+ to 2+ AR, and 122 had no or trivial AR. In patients with recurrent 3+ AR, the cause of recurrent AR was the rupture of a pericardial patch in 3 patients, a residual cusp prolapse in 26 patients, a restrictive cusp motion in 9 patients, an aortic dissection in 2 patients, and an infective endocarditis in 1 patient. Pre-operatively, all 3 groups were similar for aortic root dimensions and prevalence of bicuspid valve (overall 37%). Patients with recurrent AR were more likely to display Marfan syndrome or type 3 dysfunction pre-operatively. At the opposite end, patients with continent AR repair at follow-up were more likely to have type 2 dysfunction pre-operatively. After cardiopulmonary bypass, a shorter coaptation length, the degree of cusp billowing, a lower level of coaptation (relative to the annulus), a larger diameter of the aortic annulus and the sino-tubular junction, the presence of a residual AR, and the width of its vena contracta were associated with the presence of AR at follow-up. Multivariate Cox analysis identified a shorter coaptation length (odds ratio [OR]: 0.8, p = 0.05), a coaptation occurring below the level of the aortic annulus (OR: 7.9, p < 0.01), a larger aortic annulus (OR: 1.2, p = 0.01), and residual aortic regurgitation

  17. Cusps enable line attractors for neural computation

    Science.gov (United States)

    Xiao, Zhuocheng; Zhang, Jiwei; Sornborger, Andrew T.; Tao, Louis

    2017-11-01

    Line attractors in neuronal networks have been suggested to be the basis of many brain functions, such as working memory, oculomotor control, head movement, locomotion, and sensory processing. In this paper, we make the connection between line attractors and pulse gating in feed-forward neuronal networks. In this context, because of their neutral stability along a one-dimensional manifold, line attractors are associated with a time-translational invariance that allows graded information to be propagated from one neuronal population to the next. To understand how pulse-gating manifests itself in a high-dimensional, nonlinear, feedforward integrate-and-fire network, we use a Fokker-Planck approach to analyze system dynamics. We make a connection between pulse-gated propagation in the Fokker-Planck and population-averaged mean-field (firing rate) models, and then identify an approximate line attractor in state space as the essential structure underlying graded information propagation. An analysis of the line attractor shows that it consists of three fixed points: a central saddle with an unstable manifold along the line and stable manifolds orthogonal to the line, which is surrounded on either side by stable fixed points. Along the manifold defined by the fixed points, slow dynamics give rise to a ghost. We show that this line attractor arises at a cusp catastrophe, where a fold bifurcation develops as a function of synaptic noise; and that the ghost dynamics near the fold of the cusp underly the robustness of the line attractor. Understanding the dynamical aspects of this cusp catastrophe allows us to show how line attractors can persist in biologically realistic neuronal networks and how the interplay of pulse gating, synaptic coupling, and neuronal stochasticity can be used to enable attracting one-dimensional manifolds and, thus, dynamically control the processing of graded information.

  18. Cusps enable line attractors for neural computation

    International Nuclear Information System (INIS)

    Xiao, Zhuocheng; Zhang, Jiwei; Sornborger, Andrew T.; Tao, Louis

    2017-01-01

    Here, line attractors in neuronal networks have been suggested to be the basis of many brain functions, such as working memory, oculomotor control, head movement, locomotion, and sensory processing. In this paper, we make the connection between line attractors and pulse gating in feed-forward neuronal networks. In this context, because of their neutral stability along a one-dimensional manifold, line attractors are associated with a time-translational invariance that allows graded information to be propagated from one neuronal population to the next. To understand how pulse-gating manifests itself in a high-dimensional, nonlinear, feedforward integrate-and-fire network, we use a Fokker-Planck approach to analyze system dynamics. We make a connection between pulse-gated propagation in the Fokker-Planck and population-averaged mean-field (firing rate) models, and then identify an approximate line attractor in state space as the essential structure underlying graded information propagation. An analysis of the line attractor shows that it consists of three fixed points: a central saddle with an unstable manifold along the line and stable manifolds orthogonal to the line, which is surrounded on either side by stable fixed points. Along the manifold defined by the fixed points, slow dynamics give rise to a ghost. We show that this line attractor arises at a cusp catastrophe, where a fold bifurcation develops as a function of synaptic noise; and that the ghost dynamics near the fold of the cusp underly the robustness of the line attractor. Understanding the dynamical aspects of this cusp catastrophe allows us to show how line attractors can persist in biologically realistic neuronal networks and how the interplay of pulse gating, synaptic coupling, and neuronal stochasticity can be used to enable attracting one-dimensional manifolds and, thus, dynamically control the processing of graded information.

  19. Characterization of Aortic Valve Closure Artifact During Outflow Tract Mapping: Correlation With Hemodynamics and Mechanical Valves.

    Science.gov (United States)

    Romero, Jorge; Ajijola, Olujimi; Shivkumar, Kalyanam; Tung, Roderick

    2017-06-01

    Premature ventricular contractions originating in the left ventricle outflow tract represent a significant subgroup of patients referred for catheter ablation. Mechanical artifacts from aortic valve leaflet motion may be observed during mapping, although the incidence and characteristics have not been reported. Twenty-eight consecutive patients with left ventricle outflow tract premature ventricular contraction were included. Electric signals recorded on the ablation catheter not coincident with atrial or ventricular depolarization were analyzed on the recording system. Correlation with invasive hemodynamic aortic pressure tracings was performed. Additionally, 4 patients with mechanical aortic valves, who underwent scar-related ventricular tachycardia ablation, were analyzed to correlate the timing of the observed artifacts with native aortic valves. Aortic valve artifact was observed while mapping within the coronary cusps in 11 patients (39%; 73% men; age, 41±25 years; left ventricular ejection fraction 49±16%) with high incidence from the left coronary cusp. This artifact was consistently observed with timing coincident with the terminal portion of the T wave. The average interval between the end of the T wave and the aortic valve artifact was 19±37 ms. The duration of the aortic valve artifact was 39±8 ms with amplitude of 0.12±0.07 mV (range, 0.06-0.36 mV). In patients referred for left ventricle outflow tract premature ventricular contraction ablation, an aortic valve closure artifact is observed in up to one third of cases during mapping within the aortic cusps. The timing of this artifact correlates with invasive hemodynamics and mechanical aortic valve artifacts. Recognition of this physiological phenomenon is useful when assigning near-field activation. © 2017 American Heart Association, Inc.

  20. A talon cusp mistaken for a mesiodens: case report.

    Science.gov (United States)

    Gosselin, Marie-Lyne; Doyle, Tracy; MacLellan, Jennifer; Anderson, Ross D; Dyment, Heather

    2012-01-01

    We present the case of an 8-year-old boy with a talon cusp associated with a permanent maxillary central incisor that was mistaken for a supernumerary tooth. The importance of early and correct diagnosis of a talon cusp is stressed. Diagnosis and treatment planning strategies are discussed.

  1. Fracture strength of cusp replacing resin composite restorations.

    NARCIS (Netherlands)

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

    2003-01-01

    PURPOSE: To assess the influence of an additional shoulder preparation on the fracture strength of a cusp-replacing direct resin composite restoration in a premolar that previously had an amalgam MOD restoration followed by fracture of a cusp. MATERIALS AND METHODS: Two preparation designs were

  2. Observations of the cusp region under northward IMF

    Directory of Open Access Journals (Sweden)

    F. Pitout

    2001-09-01

    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

  3. On the evolutionary advantage of multi-cusped teeth

    Science.gov (United States)

    Bush, Mark B.; Barani, Amir; Lawn, Brian R.

    2016-01-01

    A hallmark of mammalian evolution is a progressive complexity in postcanine tooth morphology. However, the driving force for this complexity remains unclear: whether to expand the versatility in diet source, or to bolster tooth structural integrity. In this study, we take a quantitative approach to this question by examining the roles of number, position and height of multiple cusps in determining sustainable bite forces. Our approach is to use an extended finite-element methodology with due provision for step-by-step growth of an embedded crack to determine how fracture progresses with increasing occlusal load. We argue that multi-cusp postcanine teeth are well configured to withstand high bite forces provided that multiple cusps are contacted simultaneously to share the load. However, contact on a single near-wall cusp diminishes the strength. Location of the load points and cusp height, rather than cusp number or radius, are principal governing factors. Given these findings, we conclude that while complex tooth structures can enhance durability, increases in cusp number are more likely to be driven by the demands of food manipulation. Structural integrity of complex teeth is maintained when individual cusps remain sufficiently distant from the side walls and do not become excessively tall relative to tooth width. PMID:27558851

  4. 21 CFR 872.3350 - Gold or stainless steel cusp.

    Science.gov (United States)

    2010-04-01

    ...) 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 alloys containing 75 percent or greater gold and metals of the platinum group or stainless steel intended to provide...

  5. 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.

  6. Long-Term Survival on Medical Therapy Alone after Blunt-Trauma Aortic Regurgitation: Report of a New Case with Summary of 95 Others.

    Science.gov (United States)

    Tsugu, Toshimitsu; Murata, Mitsushige; Mahara, Keitaro; Iwanaga, Shiro; Fukuda, Keiichi

    2016-10-01

    Aortic regurgitation resulting from blunt chest trauma has been reported only 95 times, to our knowledge. The noncoronary and right coronary cusps are the cardiac structures most often injured. Although the aortic leaflets can appear to be undamaged after nonpenetrating trauma, they can have pathologic abnormalities and insufficient function. Some cases of posttraumatic aortic regurgitation progress slowly. Aortic valve replacement is the optimal treatment. We present the case of a then-62-year-old man who has lived more than 5 years after blunt-trauma aortic regurgitation. His is the only case of long-term survival on medical therapy alone among the 96 cases summarized in this report.

  7. Aortic valve-sparing surgery in Marfan syndrome.

    Science.gov (United States)

    Nachum, Eyal; Shinfeld, Amichay; Kogan, Alexander; Preisman, Sergey; Levin, Shany; Raanani, Ehud

    2013-08-01

    Patients with Marfan syndrome are referred for cardiac surgery due to root aneurysm with or without aortic valve regurgitation. Because these patients are young and frequently present with normal-appearing aortic cusps, valve sparing is often recommended. However, due to the genetic nature of the disease, the durability of such surgery remains uncertain. Between February 2004 and June 2012, 100 patients in our department suffering from aortic aneurysm with aortic valve regurgitation underwent elective aortic valve-sparing surgery. Of them, 30 had Marfan syndrome, were significantly younger (30 +/- 13 vs. 53 +/- 16 years), and had a higher percentage of root aneurysm, compared with ascending aorta aneurysm in their non-Marfan counterparts. We evaluated the safety, durability, clinical and echocardiographic mid-term results of these patients. While no early deaths were reported in either group, there were a few major early complications in both groups. At follow-up (reaching 8 years with a mean of 34 +/- 26 months) there were no late deaths, and few major late complications in the Marfan group. Altogether, 96% and 78% of the patients were in New York Heart Association functional class I-II in the Marfan and non-Marfan groups respectively. None of the Marfan patients needed reoperation on the aortic valve. Freedom from recurrent aortic valve regurgitation > 3+ was 94% in the Marfan patients. Aortic valve-sparing surgery in Marfan symdrome patients is safe and yields good mid-term clinical outcomes.

  8. Cusp-Shaped Elastic Creases and Furrows

    Science.gov (United States)

    Karpitschka, S.; Eggers, J.; Pandey, A.; Snoeijer, J. H.

    2017-11-01

    The surfaces of growing biological tissues, swelling gels, and compressed rubbers do not remain smooth, but frequently exhibit highly localized inward folds. We reveal the morphology of this surface folding in a novel experimental setup, which permits us to deform the surface of a soft gel in a controlled fashion. The interface first forms a sharp furrow, whose tip size decreases rapidly with deformation. Above a critical deformation, the furrow bifurcates to an inward folded crease of vanishing tip size. We show experimentally and numerically that both creases and furrows exhibit a universal cusp shape, whose width scales like y3 /2 at a distance y from the tip. We provide a similarity theory that captures the singular profiles before and after the self-folding bifurcation, and derive the length of the fold from finite deformation elasticity.

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

    Directory of Open Access Journals (Sweden)

    Jaeyoung Park

    2015-06-01

    Full Text Available 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.

  10. Microstructural alterations owing to handling of bovine pericardium to manufacture bioprosthetic heart valves: A potential risk for cusp dehiscence.

    Science.gov (United States)

    Mao, J; Wang, Y; Philippe, E; Cianciulli, T; Vesely, I; How, D; Bourget, J-M; Germain, L; Zhang, Z; Guidoin, R

    2017-06-01

    Cross-linking and anti-calcification of prosthetic heart valves have been continuously improved to prevent degeneration and calcification. However, non-calcific structural deteriorations such as cuspal dehiscences along the stent still require further analysis. Based upon the previous analysis of an explanted valve after 7 years, a fresh commercial aortic valve was embedded in poly(methyl methacrylate) (PMMA) and cut into slices to ensure the detailed observation of the assembly and material structures. A pericardial patch embossed to provide the adequate shape of the cusps was investigated after paraffin embedding and appropriate staining. The microstructural damages that occurred during manufacturing process were identified and evaluated by light microscopy, polarized microscopy, scanning electron microscopy (SEM) and transmission electron microscopy (TEM). The wavy collagen bundles, the key structure of the pericardium patch, were damaged to a great extent at suture sites along the stent and in the compressed areas around the stent post. The fixation of the embossed pericardium patch along the plots of the stent aggravated the microstructural modifications. The damages mainly appeared as the elimination of collagen bundle waviness and delamination between the bundles. Considering the modes of failure of the explant, the damages to the collagen bundles may identify the vulnerable sites that play an important role in the cusp dehiscence of heart valve implants. Such information is important to the manufacturers. Recommendations to prevent in vivo cusp dehiscence can therefore be formulated. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  11. Early identification of aortic valve sclerosis using iron oxide enhanced MRI.

    Science.gov (United States)

    Hamilton, Amanda M; Rogers, Kem A; Belisle, Andre J L; Ronald, John A; Rutt, Brian K; Weissleder, Ralph; Boughner, Derek R

    2010-01-01

    To test the ability of MION-47 enhanced MRI to identify tissue macrophage infiltration in a rabbit model of aortic valve sclerosis (AVS). The aortic valves of control and cholesterol-fed New Zealand White rabbits were imaged in vivo pre- and 48 h post-intravenous administration of MION-47 using a 1.5 Tesla (T) MR clinical scanner and a CINE fSPGR sequence. MION-47 aortic valve cusps were imaged ex vivo on a 3.0T whole-body MR system with a custom gradient insert coil and a three-dimensional (3D) FIESTA sequence and compared with aortic valve cusps from control and cholesterol-fed contrast-free rabbits. Histopathological analysis was performed to determine the site of iron oxide uptake. MION-47 enhanced the visibility of both control and cholesterol-fed rabbit valves in in vivo images. Ex vivo image analysis confirmed the presence of significant signal voids in contrast-administered aortic valves. Signal voids were not observed in contrast-free valve cusps. In MION-47 administered rabbits, histopathological analysis revealed iron staining not only in fibrosal macrophages of cholesterol-fed valves but also in myofibroblasts from control and cholesterol-fed valves. Although iron oxide labeling of macrophage infiltration in AVS has the potential to detect the disease process early, a macrophage-specific iron compound rather than passive targeting may be required. (c) 2009 Wiley-Liss, Inc.

  12. Reimplantation valve-sparing aortic root replacement with the Valsalva graft: what have we learnt after 100 cases?

    Science.gov (United States)

    Settepani, Fabrizio; Bergonzini, Marcello; Barbone, Alessandro; Citterio, Enrico; Basciu, Alessio; Ornaghi, Diego; Gallotti, Roberto; Tarelli, Giuseppe

    2009-07-01

    Reimplantation valve-sparing aortic root replacement has been increasingly performed with improving perioperative and mid-term results. The success of this operation primarily depends on preserving the highly sophisticated dynamic function of the aortic valve by recreating an anatomical three-dimensional configuration similar to the normal aortic root, thus minimizing the mechanical stress and strain on the cusps. Over the years several techniques have been proposed to reproduce the sinuses of Valsalva. We reviewed our experience with aortic valve reimplantation by means of a modified Dacron graft that incorporates sinuses of Valsalva, in a series of 100 consecutive patients. During a 60-month period, 100 patients with aortic root aneurysm underwent aortic valve reimplantation using the Gelweave Valsalva prosthesis. There were 74 males and the mean age was 60+/-12 years (range 28-83 years). Five patients had the Marfan's syndrome, 15 had a bicuspid aortic valve. Cusp repair was performed in five patients. The mean follow-up time was 28.6 months (range 1-60). Transesophageal echocardiogram was performed at the end of each procedure to assess the aortic valve in terms of competence, dynamic motion and level of coaptation within the graft. There was one hospital death and two late deaths. Overall survival at 60 months was 91.7+/-5.1%. Five patients developed severe aortic incompetence (AI) during follow-up requiring aortic valve replacement (AVR). The 60 months freedom from re-operation due to AI was 90.9+/-4.4%. One patient had moderate AI at latest echocardiographic study. The 60 months freedom from AI>2+ was 91.6+/-7.9%. Cox regression identified cusp's repair as independent risk factor (P=0.001) for late reimplantation failure (AVR or AI>2+). There were no episodes of endocarditis and the majority of the patients (88%) were in New York Heart Association functional class I. The aortic valve reimplantation with the Gelweave Valsalva prosthesis provided satisfactory

  13. 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.)

  14. Enabling Ring-Cusp Ion Thruster Technology for NASA Missions

    Data.gov (United States)

    National Aeronautics and Space Administration — ESA is flying T6 Kaufman ion thrusters on the BepiColombo Mission to Mercury in 2018. They are planning to develop a longer life, higher performing, 30-cm ring-cusp...

  15. 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...

  16. The cracked-tooth syndrome and fractured posterior cusp.

    Science.gov (United States)

    Snyder, D E

    1976-06-01

    1. Even from such a small sample as that reported in this study, it is evident that the fractured cusp and cracked-tooth syndrome are common problems. The large number of fractured cusps compared to the cracked-tooth syndrome suggests that some of the cases of fractured cusp could have been diagnosed earlier. 2. It is most important that dentists be aware of the cracked-tooth syndrome in order to relieve the patient's discomfort, prevent the possible eventual loss of the pulp or tooth, and avoid unnecessary and possibly damaging treatment for misdiagnosed facial pain. 3. Conservation of tooth structure in restorative procedures is most necessary in order to prevent the cracked-tooth syndrome or fractured posterior cusp.

  17. Aortic Dissection

    Science.gov (United States)

    ... Follow a low-salt diet with plenty of fruits, vegetables and whole grains and exercise regularly. Wear a seat belt. This reduces the risk of traumatic injury to your chest area. Work with your doctor. If you have a family history of aortic dissection, a connective tissue disorder or ...

  18. GPS scintillations associated with cusp dynamics and polar cap patches

    Directory of Open Access Journals (Sweden)

    Jin Yaqi

    2017-01-01

    Full Text Available This paper investigates the relative scintillation level associated with cusp dynamics (including precipitation, flow shears, etc. with and without the formation of polar cap patches around the cusp inflow region by the EISCAT Svalbard radar (ESR and two GPS scintillation receivers. A series of polar cap patches were observed by the ESR between 8:40 and 10:20 UT on December 3, 2011. The polar cap patches combined with the auroral dynamics were associated with a significantly higher GPS phase scintillation level (up to 0.6 rad than those observed for the other two alternatives, i.e., cusp dynamics without polar cap patches, and polar cap patches without cusp aurora. The cusp auroral dynamics without plasma patches were indeed related to GPS phase scintillations at a moderate level (up to 0.3 rad. The polar cap patches away from the active cusp were associated with sporadic and moderate GPS phase scintillations (up to 0.2 rad. The main conclusion is that the worst global navigation satellite system space weather events on the dayside occur when polar cap patches enter the polar cap and are subject to particle precipitation and flow shears, which is analogous to the nightside when polar cap patches exit the polar cap and enter the auroral oval.

  19. GPS scintillations associated with cusp dynamics and polar cap patches

    Science.gov (United States)

    Jin, Yaqi; Moen, Jøran I.; Oksavik, Kjellmar; Spicher, Andres; Clausen, Lasse B. N.; Miloch, Wojciech J.

    2017-10-01

    This paper investigates the relative scintillation level associated with cusp dynamics (including precipitation, flow shears, etc.) with and without the formation of polar cap patches around the cusp inflow region by the EISCAT Svalbard radar (ESR) and two GPS scintillation receivers. A series of polar cap patches were observed by the ESR between 8:40 and 10:20 UT on December 3, 2011. The polar cap patches combined with the auroral dynamics were associated with a significantly higher GPS phase scintillation level (up to 0.6 rad) than those observed for the other two alternatives, i.e., cusp dynamics without polar cap patches, and polar cap patches without cusp aurora. The cusp auroral dynamics without plasma patches were indeed related to GPS phase scintillations at a moderate level (up to 0.3 rad). The polar cap patches away from the active cusp were associated with sporadic and moderate GPS phase scintillations (up to 0.2 rad). The main conclusion is that the worst global navigation satellite system space weather events on the dayside occur when polar cap patches enter the polar cap and are subject to particle precipitation and flow shears, which is analogous to the nightside when polar cap patches exit the polar cap and enter the auroral oval.

  20. Aortic root surgery in Marfan syndrome.

    Science.gov (United States)

    Sheick-Yousif, Basheer; Sheinfield, Ami; Tager, Salis; Ghosh, Probal; Priesman, Sergey; Smolinsky, Aram K; Raanani, Ehud

    2008-03-01

    As the shortcomings of the Bentall operation and its variants in the Marfan syndrome have become apparent, the recent cusp-sparing techniques (remodeling or reimplantation) bear promise of better mid-term and long-term outcomes. To examine the results of aortic root surgery in patients with Marfan syndrome. During the period March 1994 to September 2007, 220 patients underwent aortic valve-sparing surgery; 20 were Marfan patients (group 1) who were compared with another 20 Marfan patients undergoing composite aortic root replacement (group 2). Fourteen patients had aortic dissection and 26 had thoracic aortic aneurysm. There were 31 males and 9 females with a mean age of 37.9 +/- 13.8 years. In group 1, reimplantation was used in 13 patients, remodeling in 4, and aortic valve repair with sinotubular junction replacement in 3. In group 2, a mechanical valve conduit was used. Mean logistic Euroscore was 12.27 +/- 14.6% for the whole group, five of whom were emergent cases Group 2 had more previous cardiac procedures compared to group 1 (9 vs. 2, P = 0.03) and shorter cross-clamp time (122 +/- 27.1 vs. 153.9 +/- 23.7 minutes, P = 0.0004). Overall mortality was 10%. Early mortality was 10% in group 2 and 5% in group 1 (NS). Mean follow-up time was 25 months for group 2 and 53 months for group 1. Three patients were reoperated; all had undergone the remodeling. Five year freedom from reoperation and death was 86% and 90% in group 2 and 70% and 95% in group 1 (P = 0.6, P = 0.6), respectively. Late survival of patients with Marfan syndrome was similar in both groups. Root reconstruction tends towards a higher incidence of late reoperations if the remodeling technique is used. We now prefer to use the reimplantation technique.

  1. Calcific Aortic Valve Disease: a Developmental Biology Perspective.

    Science.gov (United States)

    Dutta, Punashi; Lincoln, Joy

    2018-03-08

    This review aims to highlight the past and more current literature related to the multifaceted pathogenic programs that contribute to calcific aortic valve disease (CAVD) with a focus on the contribution of developmental programs. Calcification of the aortic valve is an active process characterized by calcific nodule formation on the aortic surface leading to a less supple and more stiffened cusp, thereby limiting movement and causing clinical stenosis. The mechanisms underlying these pathogenic changes are largely unknown, but emerging studies have suggested that signaling pathways common to valvulogenesis and bone development play significant roles and include Transforming Growth Factor-β (TGF-β), bone morphogenetic protein (BMP), Wnt, Notch, and Sox9. This comprehensive review of the literature highlights the complex nature of CAVD but concurrently identifies key regulators that can be targeted in the development of mechanistic-based therapies beyond surgical intervention to improve patient outcome.

  2. Transcatheter aortic valve replacement

    Science.gov (United States)

    ... gov/ency/article/007684.htm Transcatheter aortic valve replacement To use the sharing features on this page, please enable JavaScript. Transcatheter aortic valve replacement (TAVR) is surgery to replace the aortic valve. ...

  3. Aortic Valve Regurgitation

    Science.gov (United States)

    ... correct direction. These valves include the mitral valve, tricuspid valve, pulmonary valve and aortic valve. Each valve has ... Causes of aortic valve regurgitation include: Congenital heart valve disease. You may have been born with an aortic ...

  4. A computational model of aging and calcification in the aortic heart valve.

    Directory of Open Access Journals (Sweden)

    Eli J Weinberg

    Full Text Available The aortic heart valve undergoes geometric and mechanical changes over time. The cusps of a normal, healthy valve thicken and become less extensible over time. In the disease calcific aortic stenosis (CAS, calcified nodules progressively stiffen the cusps. The local mechanical changes in the cusps, due to either normal aging or pathological processes, affect overall function of the valve. In this paper, we propose a computational model for the aging aortic valve that connects local changes to overall valve function. We extend a previous model for the healthy valve to describe aging. To model normal/uncomplicated aging, leaflet thickness and extensibility are varied versus age according to experimental data. To model calcification, initial sites are defined and a simple growth law is assumed. The nodules then grow over time, so that the area of calcification increases from one model to the next model representing greater age. Overall valve function is recorded for each individual model to yield a single simulation of valve function over time. This simulation is the first theoretical tool to describe the temporal behavior of aortic valve calcification. The ability to better understand and predict disease progression will aid in design and timing of patient treatments for CAS.

  5. A quarter of a century of experience with aortic valve-sparing operations.

    Science.gov (United States)

    David, Tirone E; Feindel, Christopher M; David, Carolyn M; Manlhiot, Cedric

    2014-09-01

    To examine the late outcomes of aortic valve-sparing operations to treat patients with aortic root aneurysm with and without aortic insufficiency (AI) in a cohort of patients followed up prospectively since 1988. A total of 371 consecutive patients had undergone aortic valve-sparing surgery (mean age, 47 ± 15 years; 78% men) from 1988 through 2010. In addition to the aortic root aneurysm, 47% had moderate or severe AI, 35.5% had Marfan syndrome, 12.1% had type A aortic dissection, 9.2% had bicuspid aortic valve, 8.4% had mitral insufficiency, 16.1% had aortic arch aneurysm, and 10.2% had coronary artery disease. Reimplantation of the aortic valve was used in 296 patients and remodeling of the aortic root in 75. Cusp repair by plication of the free margin along the nodule of Arantius was used in 36.6% of patients, and reinforcement of the free margin with a double layer of fine Gore-Tex suture in 24.2%. The patients were followed up prospectively with images of the aortic root for a median follow-up of 8.9 ± 5.2 years. A total of 4 operative and 39 late deaths occurred. Survival at 18 years was 76.8% ± 4.31%, lower than that for the general population matched for age and gender. Age, type A aortic dissection, impaired ventricular function, and preoperative AI were associated with increased mortality on multivariable analysis. Reoperations on the aortic valve were performed in 8 patients for recurrent AI and in 2 for infective endocarditis. Freedom from reoperation on the aortic valve at 18 years was 94.8% ± 2.0%. No predictors of the need for reoperation were found on multivariable analysis. Eighteen patients developed AI greater than mild. Freedom from AI greater than mild at 18 years was 78.0% ± 4.8%. No predictors of recurrent AI were identified on multivariable analysis. Aortic valve-sparing operations continue to provide excellent clinical outcomes, although a slow but progressive deterioration of aortic valve function seems to occur during the first 2

  6. [Long-term outcome of aortic valve sparing procedures in connective tissue disorders].

    Science.gov (United States)

    Tanaka, Hiroshi; Ogino, H; Matsuda, H; Minatoya, K; Sasaki, N

    2009-10-01

    The aim of this study is to determine the long-term outcome of aortic valve sparing procedures for patients having connective tissue disorder. Between 1993 and 2008, the aortic valve sparing surgery was performed in 94 patients having aortic root dilatation. Eighty patients of them (37.2 +/- 13.4 years, 50 male) had cystic medial necrosis in the aortic wall, which was confirmed the pathological examination. We reviewed these patients. Sixty percent (48/80) had Marfan syndrome, 5% (4/80) had Loeyz-Dietz syndrome, 2% (2/80) had bicuspid aortic valve, and 11% (9/80) had aortic dissection. Our reimplantation procedure has been refined as followed: with a tube graft in 41, a tube graft with creation of neo-sinuses in 11, and a Valsalva graft in 14. Fourteen patients underwent the remodeling procedure. The follow-up rate was 100% with the duration of 3.7+/- 3.4 years. There were no operative death but six late deaths. Seventeen (21.3%) patients required aortic valve replacement, for recurrent aortic insufficiency in 13 and infection in 4. Freedom from reoperation was 80%, 43%, and freedom from moderate or severe aortic insufficiency was 80%, 54%, at 5 and 10 years, respectively. Pathological findings of the aortic valve obtained in the reoperations showed elongation and prolapse of the aortic valve due to myxomatous degeneration and fibrous thickening caused by aortic insufficiency. Even in connective tissue disorders, aortic valve sparing operation is associated with acceptable long-term durability, although cusp degeneration resulting in recurrent aortic insufficiency might be progressive.

  7. Steeper Stellar Cusps in Galactic Centers from Binary Disruption

    Science.gov (United States)

    Fragione, Giacomo; Sari, Re’em

    2018-01-01

    The relaxed distribution of stars around a massive black hole is known to follow a cusp profile, ρ (r)\\propto {r}-α , with a characteristic slope α =7/4. This follows from energy conservation and a scattering rate given by two-body encounters. However, we show that the injection of stars close to the black hole, i.e., a source term in the standard cusp picture, modifies this profile. In the steady-state configuration, the cusp develops a central region with a typical slope α =9/4 in which stars diffuse outward. Binary disruption by the intense tidal field of the massive black hole is among the phenomena that take place in the Galactic Center (GC). In such a disruption, one of the binary members remains bound to the black hole, thus providing a source term of stars close to the black hole. Assuming a binary fraction of 0.1 and an orbital circularization efficiency of 0.35, we show that this source is strong enough to modify the cusp profile within ≈ 0.07 pc of the GC. If the binary fraction at the influence radius is of order unity and the orbits of all captured stars are efficiently circularized, the steeper cusp extends almost as far as the radius of influence of the black hole.

  8. ``Supermassive Black-Hole Binaries in Merging Cusps''

    Science.gov (United States)

    Milosavljevic, M.; Merritt, D.

    2000-12-01

    We present N-body simulations of the formation and evolution of supermassive black-hole binaries in galactic nuclei. Initial conditions are drawn from a tree-code simulation of the merger of two spherical galaxies containing central point masses and ρ ~ r-2 central density cusps. Once the two black holes form a bound pair at the center of the merged galaxies, the evolution is continued using the Aarseth/Spurzem parallel tree code NBODY6++ at much higher resolution. Immediately following the formation of a hard black-hole binary, the density cusp of the merged galaxies is nearly homologous to the cusps in the initial galaxies. However the central density decreases rapidly as the binary black hole ejects stars which pass near to it, reducing the slope of the cusp from ~ r-2 to ~ r-1. When the distance between the black holes becomes comparable to the average stellar separation in the cusp, the binary begins to wander about the center while engaging in hard encounters with stars on radial orbits that are ejected at high speed. Ejection induces further shrinking of the binary at a decreasing rate. We discuss the dynamics of black hole binaries in the limit of large N, appropriate to real galactic nuclei, and discuss the possibility that supermassive black hole binaries can survive over cosmological times.

  9. Association of aortic valve calcification severity with the degree of aortic regurgitation after transcatheter aortic valve implantation.

    Science.gov (United States)

    Koos, Ralf; Mahnken, Andreas Horst; Dohmen, Guido; Brehmer, Kathrin; Günther, Rolf W; Autschbach, Rüdiger; Marx, Nikolaus; Hoffmann, Rainer

    2011-07-15

    This study sought to examine a possible relationship between the severity of aortic valve calcification (AVC), the distribution of AVC and the degree of aortic valve regurgitation (AR) after transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS). 57 patients (22 men, 81 ± 5 years) with symptomatic AS and with a logistic EuroSCORE of 24 ± 12 were included. 38 patients (67%) received a third (18F)-generation CoreValve® aortic valve prosthesis, in 19 patients (33%) an Edwards SAPIEN™ prosthesis was implanted. Prior to TAVI dual-source computed tomography for assessment of AVC was performed. To determine the distribution of AVC the percentage of the calcium load of the most severely calcified cusp was calculated. After TAVI the degree of AR was determined by angiography and echocardiography. The severity of AR after TAVI was related to the severity and distribution of AVC. There was no association between the distribution of AVC and the degree of paravalvular AR after TAVI as assessed by angiography (r = -0.02, p = 0.88). Agatston AVC scores were significantly higher in patients with AR grade ≥ 3 (5055 ± 1753, n = 3) than in patients with AR grade AVC scores > 3000 were associated with a relevant paravalvular AR and showed a trend for increased need for second manoeuvres. There was a significant correlation between the severity of AVC and the degree of AR after AVR (r = 0.50, p AVC have an increased risk for a relevant AR after TAVI as well as a trend for increased need for additional procedures. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  10. Aortic valve-sparing operations in aortic root aneurysms: remodeling or reimplantation?

    Science.gov (United States)

    Rahnavardi, Mohammad; Yan, Tristan D; Bannon, Paul G; Wilson, Michael K

    2011-08-01

    successful restoration of normal cusp geometry are the keys to success in aortic valve-sparing operations.

  11. 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). ...

  12. Bicuspid Aortic Valve

    Science.gov (United States)

    2006-08-01

    with tricuspid aortic valves matched for age, gender and grade of valvular disease . These studies suggest that the predisposition for aortic...enlargement in healthy patients with normally functioning BAV when compared to healthy subjects with normally functioning tricuspid aortic valves ...ascending aorta but also in the pulmonary arteries of patients with BAV, compared to that of patients with tricuspid aortic valves . These studies

  13. Valve-sparing aortic root replacement†.

    Science.gov (United States)

    Koolbergen, David R; Manshanden, Johan S J; Bouma, Berto J; Blom, Nico A; Mulder, Barbara J M; de Mol, Bas A J M; Hazekamp, Mark G

    2015-02-01

    To evaluate our results of valve-sparing aortic root replacement and associated (multiple) valve repair. From September 2003 to September 2013, 97 patients had valve-sparing aortic root replacement procedures. Patient records and preoperative, postoperative and recent echocardiograms were reviewed. Median age was 40.3 (range: 13.4-68.6) years and 67 (69.1%) were male. Seven (7.2%) patients were younger than 18 years, the youngest being 13.4 years. Fifty-four (55.7%) had Marfan syndrome, 2 (2.1%) other fibrous tissue diseases, 15 (15.5%) bicuspid aortic valve and 3 (3.1%) had earlier Fallot repair. The reimplantation technique was used in all, with a straight vascular prosthesis in 11 (26-34 mm) and the Valsalva prosthesis in 86 (26-32 mm). Concomitant aortic valve repair was performed in 43 (44.3%), mitral valve repair in 10 (10.3%), tricuspid valve repair in 5 (5.2%) and aortic arch replacement in 3 (3.1%). Mean follow-up was 4.2 ± 2.4 years. Follow-up was complete in all. One 14-year old patient died 1.3 years post-surgery presumably of ventricular arrhythmia. One patient underwent reoperation for aneurysm of the proximal right coronary artery after 4.9 years and 4 patients required aortic valve replacement, 3 of which because of endocarditis after 0.1, 0.8 and 1.3 years and 1 because of cusp prolapse after 3.8 years. No thrombo-embolic complications occurred. Mortality, root reoperation and aortic regurgitation were absent in 88.0 ± 0.5% at 5-year follow-up. Results of valve-sparing root replacement are good, even in association with a high incidence of concomitant valve repair. Valve-sparing aortic root replacement can be performed at a very young age as long as an adult size prosthesis can be implanted. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  14. Multi-point observations of intermittency in the cusp regions

    Directory of Open Access Journals (Sweden)

    M. M. Echim

    2007-08-01

    Full Text Available In this paper we investigate the statistical properties of magnetic field fluctuations measured by the four Cluster spacecraft in the cusp and close to the interface with the magnetospheric lobes, magnetopause and magnetosheath. At lower altitudes along the outbound orbit of 26 February 2001, the magnetic field fluctuations recorded by all four spacecraft are random and their Probability Distribution Functions (PDFs are Gaussian at all scales. The flatness parameter, F – related to the kurtosis of the time series, is equal to 3. At higher altitudes, in the cusp and its vicinity, closer to the interface with the magnetopause and magnetosheath, the PDFs from all Cluster satellites are non-Gaussian and show a clear intermittent behavior at scales smaller than τG≈ 61 s (or 170 km. The flatness parameter increases to values greater than 3 for scales smaller than τG. A Haar wavelet transform enables the identification of the "events" that produce sudden variations of the magnetic field and of the scales that have most of the power. The LIM parameter (i.e. normalized wavelet power indicates that events for scales below 65 s are non-uniformly distributed throughout the cusp passage. PDFs, flatness and wavelet analysis show that at coarse-grained scales larger than τG the intermittency is absent in the cusp. Fluctuations of the magnetic energy observed during the same orbit in the magnetosheath show PDFs that tend toward a Gaussian at scales smaller than τG found in the cusp. The flatness analysis confirms the decreasing of τG from cusp to magnetosheath. Our analysis reveals the turbulent cusp as a transition region from a non-intermittent turbulent state inside the magnetosphere to an intermittent turbulent state in the magnetosheath that has statistical properties resembling the solar wind turbulence. The observed turbulent fluctuations in the cusp suggests a phenomenon of nonlinear

  15. Quadricuspid Aortic Valve Combined with Moderate Ascending Aortic Dilatation

    Science.gov (United States)

    Uspenskiy, Vladimir E.; Osadchii, Alexei M.; Gordeev, Mikhail L.

    2015-01-01

    The quadricuspid aortic valve is a very uncommon malformation associated with aortic insufficiency, aortic stenosis, endocarditis, and ascending aortic dilatation. We report four cases of this aortic valve malformation. One patient with severe aortic regurgitation and moderate aortic dilatation required aortic valve replacement. Three patients had mild or moderate aortic insufficiency combined with moderate ascending aortic dilatation. These patients were referred to follow-up. The presented cases demonstrate that this aortic valve malformation may not be as rare as it appears and that attention must be paid to any quadricuspid findings during computed tomographic angiography and echocardiography. PMID:27390747

  16. Feasibility of three-dimensional magnetic resonance angiography-fluoroscopy image fusion technique in guiding complex endovascular aortic procedures in patients with renal insufficiency.

    Science.gov (United States)

    Schwein, Adeline; Chinnadurai, Ponraj; Shah, Dipan J; Lumsden, Alan B; Bechara, Carlos F; Bismuth, Jean

    2017-05-01

    Three-dimensional image fusion of preoperative computed tomography (CT) angiography with fluoroscopy using intraoperative noncontrast cone-beam CT (CBCT) has been shown to improve endovascular procedures by reducing procedure length, radiation dose, and contrast media volume. However, patients with a contraindication to CT angiography (renal insufficiency, iodinated contrast allergy) may not benefit from this image fusion technique. The primary objective of this study was to evaluate the feasibility of magnetic resonance angiography (MRA) and fluoroscopy image fusion using noncontrast CBCT as a guidance tool during complex endovascular aortic procedures, especially in patients with renal insufficiency. All endovascular aortic procedures done under MRA image fusion guidance at a single-center were retrospectively reviewed. The patients had moderate to severe renal insufficiency and underwent diagnostic contrast-enhanced magnetic resonance imaging after gadolinium or ferumoxytol injection. Relevant vascular landmarks electronically marked in MRA images were overlaid on real-time two-dimensional fluoroscopy for image guidance, after image fusion with noncontrast intraoperative CBCT. Technical success, time for image registration, procedure time, fluoroscopy time, number of digital subtraction angiography (DSA) acquisitions before stent deployment or vessel catheterization, and renal function before and after the procedure were recorded. The image fusion accuracy was qualitatively evaluated on a binary scale by three physicians after review of image data showing virtual landmarks from MRA on fluoroscopy. Between November 2012 and March 2016, 10 patients underwent endovascular procedures for aortoiliac aneurysmal disease or aortic dissection using MRA image fusion guidance. All procedures were technically successful. A paired t-test analysis showed no difference between preimaging and postoperative renal function (P = .6). The mean time required for MRA-CBCT image

  17. Pulmonary sinus cusp mapping and ablation: A new concept and approach for idiopathic right ventricular outflow tract arrhythmias.

    Science.gov (United States)

    Zhang, Jinlin; Tang, Cheng; Zhang, Yonghua; Su, Xi

    2018-01-01

    Right ventricular outflow tract (RVOT) ventricular arrhythmias (VAs) may originate from the pulmonary sinus cusps (PSCs) far more frequently than previously recognized. The purpose of this study was to assess whether mapping and ablation in PSCs might be an appropriate first-choice treatment in unselected patients with idiopathic RVOT VAs. Ninety consecutive patients with VAs of RVOT-type origin were prospectively enrolled at our institution between August 2015 and September 2016. Pulmonary valve (PV) and PSCs were precisely localized by pulmonary arteriography. Activation and pace-mapping were performed in the PSCs and RVOT region below the PV, and ablation was preferentially performed in PSCs. In 81 patients (90%), earliest activation of VAs was found in PSCs, and ablation resulted in elimination of VAs without any additional ablation in the RVOT region underneath the PV. The best pace-map was obtained at successful ablation sites in PSCs in 96.3% of patients. In the remaining 9 patients, final successful ablation sites were in the aortic coronary cusps in 5 and at the lowest and most posterior part of the RVOT in 4. During mean follow-up of 15.2 ± 9.5 months, single procedural success rate was 96.7%. In this single-center, prospective study, a strategy based on PSC mapping and ablation eliminated 90% (81/90) of unselected idiopathic RVOT-type VAs with favorable mid-term effectiveness. Copyright © 2017. Published by Elsevier Inc.

  18. Mandibular Facial Talon Cusp: A Rare Case Report | Prabhu ...

    African Journals Online (AJOL)

    Talon cusp (TC) is a relatively uncommon developmental anomaly characterized by cusp‑like projections from the cemento‑enamel junction to a variable distance toward the incisal edge of an anterior tooth. It usually presents on palatal/lingual surface of the anterior teeth. Studies have revealed that it consists of enamel, ...

  19. Elimination of cusps in dimension 4 and its applications

    NARCIS (Netherlands)

    Behrens, S.|info:eu-repo/dai/nl/380140217; Hayano, Kenta

    2016-01-01

    We study a class of homotopies between maps from 4-manifolds to surfaces which we call cusp merges. These homotopies naturally appear in the uniqueness problems for certain pictorial descriptions of 4-manifolds derived from maps to the 2-sphere (for example, broken Lefschetz fibrations, wrinkled

  20. Bicuspid Aortic Valve: Unresolved Issues and Role of Imaging Specialists

    Science.gov (United States)

    2015-01-01

    Bicuspid aortic valve (BAV) is the most common congenital heart disease with marked heterogeneity in many aspects. Fusion patterns of the aortic cusp are quite variable with different type and severity of valvular dysfunction. Moreover, non-valvular cardiovascular abnormalities are associated with BAV. Among them, aortic aneurysm/dissection is the most serious clinical condition with variable patterns of segmental aortic dilatation. Potential association between BAV phenotype and valvulopathy or aortopathy has been suggested, but needs to be tested further. A lack of long-term outcome data at this moment is responsible for unresolved debate regarding appropriate management of patients with BAV, specifically to prevent development of aortic dissection. Long-term follow-up data of a well-characterized cohort or registry based on standardized classification of BAV phenotype and aortopathy are necessary for evidence-based medical practice. Advanced imaging techniques such as computed tomography or magnetic resonance imaging offer better opportunities for accurate phenotype classification and imaging specialists should play a central role to establish a collaborative multicenter cohort or registry. PMID:25883749

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

    Directory of Open Access Journals (Sweden)

    S. K. Morley

    2003-04-01

    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

  2. Unusual Case of a Talon Cusp on a Supernumerary Tooth in Association with a Mesiodens

    Directory of Open Access Journals (Sweden)

    Prashant Babaji

    2010-06-01

    Full Text Available Talon cusp is an accessory cusp similar to a projection, extending from the cingulum or cemento-enamel junction to the incisal edge. It occurs on labial or palatal surfaces of primary or permanent anterior teeth in both arches. This accessory cusp can occur as an isolated entity or in association with other dental anomalies. Occurrence of a talon cusp on supernumerary teeth is rare and uncommon. This paper reports an unusual case of a talon cusp on a supernumerary tooth in association with mesiodens.

  3. Unusual case of a talon cusp on a supernumerary tooth in association with a mesiodens.

    Science.gov (United States)

    Babaji, Prashant; Sanadi, Firoza; Melkundi, Mahesh

    2010-01-01

    Talon cusp is an accessory cusp similar to a projection, extending from the cingulum or cemento-enamel junction to the incisal edge. It occurs on labial or palatal surfaces of primary or permanent anterior teeth in both arches. This accessory cusp can occur as an isolated entity or in association with other dental anomalies. Occurrence of a talon cusp on supernu-merary teeth is rare and uncommon. This paper reports an unusual case of a talon cusp on a supernumerary tooth in association with mesiodens.

  4. Characterization of acid and non-acid glycosphingolipids of porcine heart valve cusps as potential immune targets in biological heart valve grafts.

    Science.gov (United States)

    Barone, Angela; Benktander, John; Teneberg, Susann; Breimer, Michael E

    2014-01-01

    Although xenotransplantation of vascularized organs/cells has not yet reached the clinic, glutaraldehyde-treated bioprosthetic heart valves (BHV), derived from porcine or bovine tissues, are today used for clinical replacement of diseased heart valves. However, the durability of these valve cusps is limited partly due to the onset of immune responses to the grafts. The xenoantigen-determinant Galα3Gal- and corresponding anti-Gal antibodies have been postulated to in part contribute to BHV damage. However, the presence of other non-Gal carbohydrate antigen determinants as well as the immune response to these non-Gal antigens and the inflammatory response generated by their interaction with the immune system has not been studied. In this study, we have isolated and structurally characterized both non-acid and acid glycosphingolipids from naïve porcine aortic and pulmonary valve cusps. Total non-acid and acid glycosphingolipids were isolated from porcine aortic and pulmonalis valve cusps of 20 animals. Glycosphingolipid components were structurally characterized by thin-layer chromatography, liquid chromatography-mass spectrometry and binding of monoclonal antibodies and lectins. The non-acid glycosphingolipids were characterized as globotetraosylceramide, H-type 2 pentaosylceramide, fucosyl-gangliotetraosylceramide, and Galα3neolactotetraosylceramide. The acid glycosphingolipid fractions had both sulfatide and gangliosides (GM3, GM2, GM1, fucosyl-GM1, GD3 and GD1a), and all gangliosides contained N-acetyl-neuraminic acid. Significantly, the N-glycolyl-neuraminic acid (NeuGc) variant, a major component in many pig organs and to which humans can develop antibodies, was not detected among the gangliosides. Pig valve cusps contain several complex lipid-bound carbohydrate structures that may be targets for the human immune system. Notable, the NeuGc determinant was absent in the cusp gangliosides. This work forms a platform for further characterizing the antibody

  5. 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.)

  6. 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.

  7. The acquisition of problem behavior in individuals with developmental disabilities as a behavioral cusp.

    Science.gov (United States)

    Robertson, Rachel E

    2015-07-01

    A behavioral cusp has been defined as a behavior change that produces contact with new contingencies with important and far-reaching consequences. The concept of behavioral cusps has most frequently been used to select target skills taught to learners and to evaluate the importance of those skills; however, the concept is equally applicable to behavior changes that bring about important and far-reaching negative consequences. Although it has been acknowledged that socially undesirable behavior change can also qualify as a behavioral cusp, this area of the cusp concept has been under-examined. In this article, an undesirable behavior change, the acquisition of problem behavior in individuals with developmental disabilities, is compared with criteria for behavioral cusps previously identified in the literature. The advantages of viewing problem behavior as a behavioral cusp are outlined, and implications for practice and research from a behavioral cusp approach to problem behavior are provided. © The Author(s) 2015.

  8. Detecting atheromatous plaques in the aortic arch or supra-aortic arteries for more accurate stroke subtype classification.

    Science.gov (United States)

    Cui, Xiaoyang; Wu, Simiao; Zeng, Quantao; Xiao, Jiahe; Liu, Ming

    2015-02-01

    To investigate the correlations of atheromatous plaques in the aortic arch or supra-aortic arteries with intracranial arterial stenosis and carotid plaques in stroke patients, and to determine whether taking these plaques into account will reduce the proportion of patients in the undetermined etiology group. We prospectively enrolled 308 ischemic stroke patients, whose clinical characteristics and A-S-C-O classifications were compared with analyses of intracranial arteries, carotid arteries, aortic arch, and supra-aortic arteries. 125(40.6%) patients had plaques in the aortic arch or supra-aortic arteries, of which 106 (84.8%) had complex plaques. No correlations were observed between these plaques and carotid plaques ( p = 0.283) or intracranial arterial stenosis ( p = 0.097). After detecting the mobile thrombi in the aortic arch and supra-aortic arteries, the proportion of patients in the atherothrombosis group was increased from 33.8% to 55.5% ( p = 0.00), whereas the proportion of patients in stroke of undetermined etiology group was decreased from 19.2% to 11.0% ( p = 0.00). Examining only the carotid and intracranial arteries may not provide adequate information about large arteries in stroke patients. Therefore, it would be better to include a search for relevant plaques in the aortic arch or supra-aortic arteries in modern stroke workup, for it may lead to more accurate stroke subtype classification and guide secondary prevention.

  9. Midterm outcome of valve-sparing aortic root replacement in inherited connective tissue disorders.

    Science.gov (United States)

    Tanaka, Hiroshi; Ogino, Hitoshi; Matsuda, Hitoshi; Minatoya, Kenji; Sasaki, Hiroaki; Iba, Yutaka

    2011-11-01

    This study determined the midterm outcome of valve-sparing aortic root replacement for patients with inherited connective tissue disorders. From 1993 to 2008, 94 patients underwent valve-sparing aortic root replacement. Sixty patients (64%), average age 33 years (range, 15 to 61 years), had inherited connective tissue disorders: Marfan syndrome, 54 (92%); Loeys-Dietz syndrome, 5 (8%); and smooth muscle α-actin (ACTA2) mutation in 1. Median preoperative sinus diameter was 52 mm (range, 42 to 76 mm), and moderate/severe aortic regurgitation was present in 14 (23%). Seven (12%, 1993 to 1999) underwent remodeling procedures, and 53 had reimplantation procedures. Cusp repair was performed in 4. Median follow-up was 55 months (range, 1 to 149 months). There were 15 patients in the early term (1993 to 2000) and 45 in the late term (2001 to 2008). Four late deaths occurred (cardiac, 3; aortic, 1), with 10-year survival of 86%. Rates of freedom from aortic valve replacement at 5 and 10 years were 85% and 58% in remodeling and 96% and 58% in reimplantation. Risk factors for reoperations were postprocedure intraoperative aortic insufficiency greater than mild (p = 0.046), remodeling procedure (p = 0.016), and early term (p = 0.0002). One patient (2%) with none/trivial postprocedure aortic insufficiency required aortic valve replacement. Freedom from reoperation in patients with none/trivial postprocedure aortic insufficiency at 5 and 10 years was 100% and 67%. Meticulous control of aortic insufficiency during operation would bring favorable midterm durability in valve-sparing aortic root replacement using a reimplantation technique, even in patients with inherited connective tissue disorders. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  10. A Cusp Density Enhancement Study using CHAMP / EISCAT conjunctions

    Science.gov (United States)

    Sadler, B.; Lessard, M.; Oksavik, K.; Luhr, H.; Kervalishvili, G.; Otto, A.

    2016-12-01

    CHAMP satellite observations have identified small-scale neutral density enhancements which are localized to the high latitude polar cusp region. A number of possible drivers for this small-scale density enhancement have been proposed, including large and small-scale joule heating, soft electron precipitation, and ion-outflow related processes. We investigate this phenomenon from the perspective of EISCAT ground radar observations. Selected CHAMP cusp enhancement events are presented with corresponding EISCAT data in conjunction below. EISCAT electron and ion measurements provide additional data for determining the actual drivers of the density enhancement. Numerical simulation predictions are also discussed which relate soft electron precipitation and ion-upflow with neutral density increase.

  11. Can a stochastic cusp catastrophe model explain stock market crashes?

    Czech Academy of Sciences Publication Activity Database

    Baruník, Jozef; Vošvrda, Miloslav

    2009-01-01

    Roč. 33, č. 10 (2009), s. 1824-1836 ISSN 0165-1889 R&D Projects: GA ČR GD402/09/H045; GA ČR GA402/09/0965 Grant - others:GAUK(CZ) 46108 Institutional research plan: CEZ:AV0Z10750506 Keywords : Stochastic cusp catastrophe * Bifurcations * Singularity * Nonlinear dynamics * Stock market crash Subject RIV: AH - Economics Impact factor: 1.097, year: 2009

  12. Twin-Peak QPOs from Oscillating Torus with Cusp

    Science.gov (United States)

    Sramkova, Eva

    2017-08-01

    We propose a model of HF twin-peak quasi-periodic oscillations assuming an oscillating torus with cusp that changes location 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 rise to strong modulation of both the accretion disc radiation and the accretion rate. We illustrate that predictions of the model well match observational data for a dozen of sources.

  13. Cusp-core problem and strong gravitational lensing

    International Nuclear Information System (INIS)

    Li Nan; Chen Daming

    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 flat 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 of disk 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.

  14. UV Observations of Atomic Oxygen in the Cusp Region

    Science.gov (United States)

    Fritz, B.; Lessard, M.; Dymond, K.; Kenward, D. R.; Lynch, K. A.; Clemmons, J. H.; Hecht, J. H.; Hysell, D. L.; Crowley, G.

    2017-12-01

    The Rocket Experiment for Neutral Upwelling (RENU) 2 launched into the dayside cusp on 13 December, 2015. The sounding rocket payload carried a comprehensive suite of particle, field, and remote sensing instruments to characterize the thermosphere in a region where pockets of enhanced neutral density have been detected [Lühr et al, 2004]. An ultraviolet photomultiplier tube (UV PMT) was oriented to look along the magnetic field line and remotely detect neutral atomic oxygen (OI) above the payload. The UV PMT measured a clear enhancement as the payload descended through a poleward moving auroral form, an indicator of structure in both altitude and latitude. Context for the UV PMT measurement is provided by the Special Sensor Ultraviolet Imager (SSULI) instrument on the Defense Meteorological Space Program (DMSP) satellite, which also measured OI as it passed through the cusp. UV tomography of SSULI observations produces a two-dimensional cross-section of volumetric emission rates in the high-latitude thermosphere prior to the RENU 2 flight. The volume emission rate may then be inverted to produce a profile of neutral density in the thermosphere. A similar technique is used to interpret the UV PMT measurement and determine structure in the thermosphere as RENU 2 descended through the cusp.

  15. Preliminary results in double cusp tandem mirror MM-4U

    International Nuclear Information System (INIS)

    Ming Linzhou; Tian Zhongyu; Feng Xiaozhen

    1990-10-01

    MM-4U device and preliminary experimental results are presented. Main results are as follows: The plasma has been produced by means of the injection of strong electron current; the axial profile of the plasma potential and the plasma electron density have been obtained respectively, they had a simular form; the plasma potential in the centre of the east cusp, the west cusp and the simple mirror; V e = -180V, V w = -164V, V m -1.8V; the electron density: n e = 1.7 x 10 11 cm -3 , n w = 4.7 x 10 10 cm -3 , n m = 7.5 x 10 7 cm -3 ; the electron temperature: T e = (19.9 ± 1.6) eV, T w = (20.7 ± 1.7) eV; the plasma pressure at 8 cm on the right of the west cusp centre is about 6.76 Pa, β ≅ 1.7 x 10 -3 . The plasma instability has been observed in the simple mirror, its vibration frequency was 7∼9.2 kHz. The results are discussed. The next new task of the physical experiment are proposed

  16. Localized Models of Charged Particle Motion in Martian Crustal Magnetic Cusps

    Science.gov (United States)

    Brain, D. A.; Poppe, A. R.; Jarvinen, R.; Dong, Y.; Egan, H. L.; Fang, X.

    2017-12-01

    The induced magnetosphere of Mars is punctuated by localized but strong crustal magnetic fields that are observed to play host to a variety of phenomena typically associated with global magnetic fields, such as auroral processes and particle precipitation, field-aligned current systems, and ion outflow. Each of these phenomena occur on the night side, in small-scale magnetic `cusp' regions of vertically aligned field. Cusp regions are not yet capable of being spatially resolved in global scale models that include the ion kinetics necessary for simulating charged particle transport along cusps. Local models are therefore necessary if we are to understand how cusp processes operate at Mars. Here we present the first results of an effort to model the kinetic particle motion and electric fields in Martian cusps. We are adapting both a 1.5D Particle-in-Cell (PIC) model for lunar magnetic cusps regions to the Martian case and a hybrid model framework (used previously for the global Martian plasma interaction and for lunar magnetic anomaly regions) to cusps in 2D. By comparing the models we can asses the importance of electron kinetics in particle transport along cusp field lines. In this first stage of our study we model a moderately strong nightside cusp, with incident hot hydrogen plasma from above, and cold planetary (oxygen) plasma entering the simulation from below. We report on the spatial and temporal distribution of plasma along cusp field lines for this initial case.

  17. Radiological evaluation of ventricular septal defect with aortic insufficiency - An analysis of cineangiography in 15 cases -

    International Nuclear Information System (INIS)

    Park, Jae Hyung; Yeon, Kyung Mo; Han, Man Chung

    1981-01-01

    Fifteen cases of ventricular septal defect with aortic insufficiency were diagnosed radiographically and confirmed after operation at Seoul National University Hospital in recent two half years since 1979. Cineangiographies of ascending aorta and left ventricle were done in those cases and revealed some characteristic findings. The results of the analysis are as follow: 1. Among the 15 cases, 14 cases were male and 1 case was female. Age distribution was from 7 years to 23 years. 2. Those 15 cases were corresponded to 8% among total 193 cases of ventricular septal defect, to 11% among total 135 cases of aortic insufficiency and especially to 48% among 48 cases of aortic insufficiency below age of 20 years. 3. After operation, 11 cases were confirmed as subpulmonary type ventricular septal defect and 4 cases as subcristal type. The sizes of the ventricular septal defects were ranged between 0.6 and 2.5 cm in diameter. 4. Regurgitation of contrast media was noticed in cine aortography of all cases, and the grades of regurgitation were II-III/IV in 13 cases. 5. Various types of herniated aortic cusp through ventricular septal defect were seen. In the cases of subpulmonary ventricular septal defect characteristic saccular aneurysm was found in 7 cases. Asymmetry or mild bulging of aortic sinus was found in the cases of subcristal ventricular septal defect. 6. Infundibular stenosis was found in 3 cases with right ventriculography and those were caused by the herniated saccular aneurysm of aortic cusp. 7. It is essential for the diagnosis of ventricular septal defect with aortic insufficiency to undertake biplane cineangiography of ascending aorta and left ventricle in long axial view and right ventriculography should be done in suspicion of infundibular pulmonary stenosis

  18. Valve tissue characterization by magnetic resonance imaging in calcific aortic valve disease.

    Science.gov (United States)

    Le Ven, Florent; Tizón-Marcos, Helena; Fuchs, Christina; Mathieu, Patrick; Pibarot, Philippe; Larose, Eric

    2014-12-01

    Calcific aortic valve disease affects 10%-15% of the elderly population, causing considerable morbidity and mortality. There is no imaging technique that allows for the assessment of tissue composition of the valve in vivo. We thus investigated whether multiparametric magnetic resonance imaging (MRI) could characterize and quantify lipid, fibrous, and mineralized tissues within aortic valve (AV) cusps. AV leaflets were explanted from patients with severe aortic stenosis at the time of valve replacement surgery. Aortic cusps were imaged ex vivo using 1.5 T MRI using 3 gradient-echo sequences with T1, moderate T2, and proton density weightings (T1w, T2w, and PDw). Histopathologic analysis was performed on coregistered slices to identify and measure mineralized tissue, fibrous tissue, and lipid-rich tissue. Area and mean grey values were measured in all 3 weightings by standardized software. Four hundred ninety-two regions of interest from 30 AV leaflets were studied. Total leaflet surface and the areas of mineralized (P equation integrating the grey value data from all 3 weightings allowed multiparametric MRI to identify valve leaflet components with areas under the receiver operating characteristic curve of 0.92, 0.81, and 0.72, respectively. AV leaflet characteristics, including tissue composition, distribution, and area, may be successfully measured by multiparametric MRI with good to excellent accuracy. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  19. Aortic valve calcification as a predictor of location and severity of paravalvular regurgitation after transcatheter aortic valve implantation.

    Science.gov (United States)

    Koh, Ezra Y; Lam, Kayan Y; Bindraban, Navin R; Cocchieri, Riccardo; Planken, R Nils; Koch, Karel T; Baan, Jan; de Mol, Bas A; Marquering, Henk A

    2015-03-01

    To determine whether the location of aortic valve calcium (AVC) influences the location of paravalvular regurgitation (PR). PR is an adverse effect of transcatheter aortic valve implantation (TAVI) with a negative effect on long-term patient survival. The relationship between AVC and the occurrence of PR has been documented. However, the relationship between the distribution of AVC and the location of PR is still sparsely studied. The purpose of this study was to correlate severity and location of AVC with PR in patients treated with TAVI. Fifty-six consecutive patients who underwent transaortic or transapical TAVI and had preoperative computed tomography scans were included in this retrospective study. The volume, mass and location of AVC was determined and compared between patients with and without PR using a non-parametric t-test. Postoperative echocardiography was performed to determine the presence and location of PR, which was associated with the cusp with highest AVC using a χ(2) test. Valve deployment was successful in all 56 patients. PR was present in 38 patients (68%) after TAVI. There was a non-significantly higher volume of AVC in the PR group [214 (70-418) vs 371 (254-606) cm(3), P = 0.15]. AVC mass was significantly higher in patients with PR than in patients without PR [282 (188-421) vs 142 (48-259) mg, respectively, P = 0.043]. The location of PR was determined in 36 of these patients. Of these 36 patients, PR occurred at the cusp with the highest AVC in 20 patients (56%, χ(2) P = 0.030). In our population, PR was associated with greater AVC mass. Moreover, the location of PR was associated with the cusp with the highest amount of AVC. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  20. A Note On Signs Of Fourier Coefficients Of Two Cusp Forms

    Indian Academy of Sciences (India)

    10

    of weight k for full modular group SL2(Z) and Sk(N) denote the space of cusp forms of weight k for the congruence subgroup Γ0(N). Sign changes of Fourier coefficients of cusp forms in one or in several variables have been studied in various aspects by many authors. It is known that, if the Fourier coefficients of a cusp form ...

  1. Prevalence of cusp fractures in teeth restored with amalgam and with resin-based composite.

    Science.gov (United States)

    Wahl, Michael J; Schmitt, Margaret M; Overton, Donald A; Gordon, M Kathleen

    2004-08-01

    Complete cusp fracture in restored teeth is a common problem observed in general dental practice. Many dentists believe that teeth restored with amalgam are more likely to be associated with cusp fractures than are those restored with resin-based composite. METHODS. The authors noted the condition of 10,869 posterior teeth with amalgam or resin-based composite restorations with at least one cusp present, unrestored or missing in 1,902 consecutively seen adult patients in a private general dental practice. For each patient, the authors recorded age, type of restorations, number of surfaces of each restoration, and presence or absence of a complete cusp fracture and of caries. There was a lower percentage of cusp fractures in younger subjects than in older subjects and in teeth with a single restored surface than in those with more than one restored surface. There was no significant difference in the prevalence of cusp fracture rates in amalgam-restored teeth versus composite-restored teeth in subjects aged 18 through 54 years. In subjects aged 55 through 96 years, there was a marginally significantly greater cusp fracture rate in composite-restored teeth than in those restored with amalgam. Overall, there was no significant difference in the prevalence of cusp fracture in teeth restored with amalgam (1.88 percent) versus composite-restored teeth (2.29 percent). The prevalence of cusp fractures in amalgam-restored teeth and resin-based composite-restored teeth is not significantly different. Teeth with more than one surface restored with either resin-based composite or amalgam and teeth in older subjects were more likely to suffer a cusp fracture. Teeth restored with amalgam and with resin-based composite exhibited equally low cusp fracture prevalence. When choosing between amalgam and resin-based composite in consideration of the likelihood of a future cusp fracture, either restorative material is acceptable.

  2. CLUSTER encounters with the high altitude cusp: boundary structure and magnetic field depletions

    Directory of Open Access Journals (Sweden)

    P. J. Cargill

    2004-04-01

    Full Text Available Data from the four spacecraft Cluster mission during a high altitude cusp crossing on 13 February 2001 are presented. The spacecraft configuration has one leading spacecraft, with the three trailing spacecraft lying in a plane that corresponds roughly to the nominal magnetopause surface. The typical spacecraft separation is approximately 600km. The encounter occurs under conditions of strong and steady southward Interplanetary Magnetic Field (IMF. The cusp is identified as a seven-minute long depression in the magnetic field, associated with ion heating and a high abundance of He+. Cusp entry involves passage through a magnetopause boundary that has undergone very significant distortion from its nominal shape, is moving rapidly, and exhibits structure on scales of the order of the spacecraft separation or less. This boundary is associated with a rotation of the magnetic field, a normal field component, and a plasma flow into the cusp of approximately 35 km/s. However, it cannot be identified positively as a rotational discontinuity. Exit from the cusp into the lobe is through a boundary that is initially sharp, but then retreats tailward at a few km/s. As the leading spacecraft passes through this boundary, there is a plasma flow out of the cusp of approximately 30km/s, suggesting that this is not a tangential discontinuity. A few minutes after exit from the cusp, the three trailing the spacecraft see a single cusp-like signature in the magnetic field. There is an associated temperature increase at two of the three trailing spacecraft. Timing measurements indicate that this is due to cusp-like regions detaching from the rear of the cusp boundary, and moving tailward. The magnetic field in the cusp is highly disordered, with no obvious relation between the four spacecraft, indicative of structure on scales Key words. Magnetospheric physics (magnetopause, cusp and boundary layers; solar wind-magnetosphere interactions – Space plasma physics

  3. Novel Matricing Technique for Management of Fractured Cusp Conundrum – A Clinician’s Corner

    OpenAIRE

    Jadhav, Ganesh Ranganath; Mittal, Priya Ramesh

    2016-01-01

    Longitudinal tooth fracture can be classified as craze lines, fractured cusp, cracked tooth, split tooth and vertical root fracture based on extent and severity of the fracture line. The most common type of longitudinal tooth fracture is fractured cusp that poses the treatment dilemma. Retention of the fractured cusp segment temporarily with matrix band followed by permanent bonded restoration and finally removal of tooth fragment during crown preparation is a novel technique. This paper thro...

  4. Novel Matricing Technique for Management of Fractured Cusp Conundrum - A Clinician's Corner.

    Science.gov (United States)

    Jadhav, Ganesh Ranganath; Mittal, Priya Ramesh

    2016-04-01

    Longitudinal tooth fracture can be classified as craze lines, fractured cusp, cracked tooth, split tooth and vertical root fracture based on extent and severity of the fracture line. The most common type of longitudinal tooth fracture is fractured cusp that poses the treatment dilemma. Retention of the fractured cusp segment temporarily with matrix band followed by permanent bonded restoration and finally removal of tooth fragment during crown preparation is a novel technique. This paper throws light on a matricing and holding technique for the management of supra-crestally fractured palatal cusp of maxillary first premolar in a 29-year-old Asian male.

  5. Novel Matricing Technique for Management of Fractured Cusp Conundrum – A Clinician’s Corner

    Science.gov (United States)

    Mittal, Priya Ramesh

    2016-01-01

    Longitudinal tooth fracture can be classified as craze lines, fractured cusp, cracked tooth, split tooth and vertical root fracture based on extent and severity of the fracture line. The most common type of longitudinal tooth fracture is fractured cusp that poses the treatment dilemma. Retention of the fractured cusp segment temporarily with matrix band followed by permanent bonded restoration and finally removal of tooth fragment during crown preparation is a novel technique. This paper throws light on a matricing and holding technique for the management of supra-crestally fractured palatal cusp of maxillary first premolar in a 29-year-old Asian male. PMID:27190970

  6. Acute aortic syndromes: current status.

    Science.gov (United States)

    Ridge, Carole A; Litmanovich, Diana E

    2015-05-01

    The term acute aortic syndrome comprises aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer. The most recent developments in acute aortic syndromes include (1) a change in the mindset that each entity is pathologically distinct, with a shift toward considering the acute aortic syndromes as points along a spectrum of aortic disease, (2) the optimization of aortic imaging quality and radiation dose, and (3) surgical or endovascular management. This review article focuses on how these developments pertain to thoracic radiologists.

  7. Primary metastasizing aortic endothelioma.

    Science.gov (United States)

    Schmid, E; Port, S J; Carroll, R M; Friedman, N B

    1984-10-01

    An instance of malignant endothelioma, primary in the aorta, metastasizing to intestine and bone, is reported. The aortic tumor was successfully resected. The unexpected finding of a large hepatic growth at autopsy raised the possibility that the aortic neoplasm was a metastasis. Histochemical, immunologic, and ultrastructural studies supported the diagnosis of an endothelial neoplasm. Although a number of malignant aortic and large vessel tumors have been reported, only four previous instances appear to be endotheliomatous.

  8. Aortic valve replacement

    DEFF Research Database (Denmark)

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

    2008-01-01

    BACKGROUND AND AIMS OF THE STUDY: Prompted by anecdotal evidence and observations by surgeons, an investigation was undertaken into the potential differences in implanted aortic valve prosthesis sizes, during aortic valve replacement (AVR) procedures, between northern and southern European...... 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...

  9. Cusp catastrophe model for binge drinking in a college population.

    Science.gov (United States)

    Smerz, Kelly E; Guastello, Stephen J

    2008-04-01

    A cusp catastrophe model for binge drinking behavior was developed and tested with attitude toward alcohol consumption and peer influence as the two control parameters. Similar models were also developed for frequency and quantity of alcohol use. Participants were 1,247 students who completed the Long Form of the Core Alcohol and Drug Survey. The results were strongest for the binge drinking criterion (R(2) = .90), compared to a linear model (R(2) = .34) that is usually associated with the Theory of Planned Behavior or Theory of Reasoned Action. The results have numerous implications for the development of interventions and for future research.

  10. Replicating Patient-Specific Severe Aortic Valve Stenosis With Functional 3D Modeling.

    Science.gov (United States)

    Maragiannis, Dimitrios; Jackson, Matthew S; Igo, Stephen R; Schutt, Robert C; Connell, Patrick; Grande-Allen, Jane; Barker, Colin M; Chang, Su Min; Reardon, Michael J; Zoghbi, William A; Little, Stephen H

    2015-10-01

    3D stereolithographic printing can be used to convert high-resolution computed tomography images into life-size physical models. We sought to apply 3D printing technologies to develop patient-specific models of the anatomic and functional characteristics of severe aortic valve stenosis. Eight patient-specific models of severe aortic stenosis (6 tricuspid and 2 bicuspid) were created using dual-material fused 3D printing. Tissue types were identified and segmented from clinical computed tomography image data. A rigid material was used for printing calcific regions, and a rubber-like material was used for soft tissue structures of the outflow tract, aortic root, and noncalcified valve cusps. Each model was evaluated for its geometric valve orifice area, echocardiographic image quality, and aortic stenosis severity by Doppler and Gorlin methods under 7 different in vitro stroke volume conditions. Fused multimaterial 3D printed models replicated the focal calcific structures of aortic stenosis. Doppler-derived measures of peak and mean transvalvular gradient correlated well with reference standard pressure catheters across a range of flow conditions (r=0.988 and r=0.978 respectively, P3D printing, we demonstrate that patient-specific models can replicate both the anatomic and functional properties of severe degenerative aortic valve stenosis. © 2015 American Heart Association, Inc.

  11. A cusp-shaped jet observed by IRIS and SDO

    Science.gov (United States)

    Zhang, Yuzong; Zhang, Jun

    2017-04-01

    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.

  12. 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

  13. A comparison of fatigue resistance of three materials for cusp-replacing adhesive restorations.

    NARCIS (Netherlands)

    Kuijs, R.H.; Fennis, W.M.M.; Kreulen, C.M.; Roeters, F.J.M.; Verdonschot, N.J.J.; Creugers, N.H.J.

    2006-01-01

    OBJECTIVES: To investigate the fatigue resistance and failure behaviour of cusp-replacing restorations in premolars using different types of adhesive restorative materials. METHODS: A class 2 cavity was prepared and the buccal cusp was removed in an extracted sound human upper premolar. By using a

  14. Geometric Desingularization of a Cusp Singularity in Slow-Fast Systems with Applications to Zeeman's Examples

    NARCIS (Netherlands)

    Broer, Henk W.; Kaper, Tasso J.; Krupa, Martin

    2013-01-01

    The cusp singularity-a point at which two curves of fold points meet-is a prototypical example in Takens' classification of singularities in constrained equations, which also includes folds, folded saddles, folded nodes, among others. In this article, we study cusp singularities in singularly

  15. 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.

  16. Aortic valve surgery - open

    Science.gov (United States)

    ... while you are connected to this machine. This machine does the work of your heart while your heart is stopped. If your aortic valve is too damaged, you will need a new valve. This is called replacement surgery. Your surgeon will remove your aortic valve ...

  17. Imaging in aortic dissection

    International Nuclear Information System (INIS)

    Yu-Qing Liu, M.D.

    1995-01-01

    Aortic dissection (AD) is a catastrophic aortic disease. Imaging techniques play an invaluable role in the diagnostic evaluation and management of patients with AD. Major signs of AD with different imaging modalities are described in this article with a pertinent discussion on guidelines for the optimized approach of imaging study (13 refs.)

  18. Aortic arch malformations

    International Nuclear Information System (INIS)

    Kellenberger, Christian J.

    2010-01-01

    Although anomalies of the aortic arch and its branches are relatively uncommon malformations, they are often associated with congenital heart disease. Isolated lesions may be clinically significant when the airways are compromised by a vascular ring. In this article, the development and imaging appearance of the aortic arch system and its various malformations are reviewed. (orig.)

  19. [Traumatic aortic valve insufficiency].

    Science.gov (United States)

    Nascimento, J; Lemos, C; Marques, A M; Antunes, M J; Gonsalves, A

    1996-02-01

    The traumatic aortic valvular insufficiency (TAVI), through less frequent after a non-penetrating thoracic traumatism, is a serious entity with a very reserved prognosis. So it must be suspected in every patients with signs or symptoms of de novo heart failure post-traumatism. The transthoracic echocardiography and eventually transesophageal echocardiography have a fundamental role in the confirmation of the diagnosis. The clinical picture of traumatic aortic regurgitation is quickly evolutionary and the non efficacy of medical therapy has placed the valvular substitution surgery as the best succeeded treatment. With the advent of the aortic valve repairing surgery some TAVI cases has been submitted to this procedure. Nevertheless, the development of residual aortic regurgitation in these situations, usually requiring later valvular replacement surgery, make the aortic valvuloplasty a controversial surgical technique. The AA describe a recent clinical case of aortic regurgitation after a non-penetrant thoracic traumatism, discussing the aspects connected with physiopathology, diagnosis and therapy. The singularity of this case was based on the fact that the initial clinical diagnosis had been prejudiced by the context of a polytraumatism and there had been a time free of symptoms between the traumatism and the beginning of the symptomatology of left ventricular failure. Even though the identification of the problem allowed an intensive treatment of this serious situation that ended with the replacement of the aortic valve by mechanical aortic prosthesis, with the patient's total recovery.

  20. CLUSTER encounters with the high altitude cusp: boundary structure and magnetic field depletions

    Directory of Open Access Journals (Sweden)

    P. J. Cargill

    2004-04-01

    Full Text Available Data from the four spacecraft Cluster mission during a high altitude cusp crossing on 13 February 2001 are presented. The spacecraft configuration has one leading spacecraft, with the three trailing spacecraft lying in a plane that corresponds roughly to the nominal magnetopause surface. The typical spacecraft separation is approximately 600km. The encounter occurs under conditions of strong and steady southward Interplanetary Magnetic Field (IMF. The cusp is identified as a seven-minute long depression in the magnetic field, associated with ion heating and a high abundance of He+. Cusp entry involves passage through a magnetopause boundary that has undergone very significant distortion from its nominal shape, is moving rapidly, and exhibits structure on scales of the order of the spacecraft separation or less. This boundary is associated with a rotation of the magnetic field, a normal field component, and a plasma flow into the cusp of approximately 35 km/s. However, it cannot be identified positively as a rotational discontinuity. Exit from the cusp into the lobe is through a boundary that is initially sharp, but then retreats tailward at a few km/s. As the leading spacecraft passes through this boundary, there is a plasma flow out of the cusp of approximately 30km/s, suggesting that this is not a tangential discontinuity. A few minutes after exit from the cusp, the three trailing the spacecraft see a single cusp-like signature in the magnetic field. There is an associated temperature increase at two of the three trailing spacecraft. Timing measurements indicate that this is due to cusp-like regions detaching from the rear of the cusp boundary, and moving tailward. The magnetic field in the cusp is highly disordered, with no obvious relation between the four spacecraft, indicative of structure on scales <<600km. However, the plasma moments show only a gradual change over many minutes. A similar cusp crossing on 20 February 2001 also

  1. SEISM: a 60 GHz cusp electron cyclotron resonance ion source.

    Science.gov (United States)

    Latrasse, L; Marie-Jeanne, M; Lamy, T; Thuillier, T; Giraud, J; Fourel, C; Trophime, C; Debray, F; Sala, P; Dumas, J

    2010-02-01

    LPSC has been involved for several years in a challenging research and development program on the production of pulsed ions beams with high ionization efficiency primarily dedicated to radioactive ion beams. The generation of the high magnetic field requires the use of helix techniques developed at Laboratoire National des Champs Magnétiques Intenses. As a first approach, a cusp structure has been chosen. 3D simulations were used to define the geometry of the helices. The computer aided design of the mechanical parts of the magnetic structure has been performed at LPSC and was optimized to decrease the total volume of the source. The first 60 GHz magnetic structure (helices coils in their tanks, electrical, and water cooling environment) should be available before the end of 2009.

  2. Quantitative assessment of an aortic and pulmonary valve function according to valve fenestration

    International Nuclear Information System (INIS)

    Mirkhani, S.H.; Golestani, M.G.; Hosini, M.; Kazemian, A.

    1999-01-01

    There are some reasons for malfunction of aortic and pulmonary valve like fibrosis, calcification, and atheroma. Although, in some papers fenestration were known as a pathologic sign, but it is not generally accepted, while this matter is important in choosing suitable Homograft Heart Valve. In this paper fenestrations and its size, numbers and situation effect was studied. We collected 98 hearts, the donors died because of accident, we excluded valves with atheroma, calcification, fibrosis and unequal cusps, 91 aortic and 93 pulmonary valves were given further consideration. We classified valves according to situation, number and size of fenestration. Each valve was tested with 104 cm of non-nal saline column pressure which is equal to 76 mm Hg. Valve efficacy was detected by fluid flow assay. With study of 184 valves, 95 had no fenestration, 64 had less than 2 fenestration and 25 had more than 2 fenestration. Valve efficacy in condition of less than 2 fenestration was more than others (p <0.01). Malfunction effects of fenestration increased in larger valve and it will be decreased if their situation would be marginal (free margin of cusp). In the comparison of aortic and pulmonary valve we saw that malfunction effect of fenestration in pulmonary valve was more than aortic valve. Our experience in Immam Khomeini Homograft Valve Bank has shown that a great deal of valves is fenestrated. It seems that fenestration must be considered as a quality criterion in homograft valve preparation, especially in pulmonary and large aortic valves; but complementary studies is necessary

  3. Transesophageal echocardiographic guidance of transcatheter closure of the aortic valve in a patient with left ventricular assist device-related severe aortic regurgitation

    Directory of Open Access Journals (Sweden)

    Preetham R Muskala

    2017-04-01

    Full Text Available A 68-year-old man with a severe ischemic cardiomyopathy underwent left ventricular assist device (LVAD implantation (Heart Mate II device for destination therapy. He presented 49 months after LVAD implantation with worsening heart failure symptoms and new severe aortic regurgitation. Given high risk for both surgical and transcatheter aortic valve replacement, he was admitted for transcatheter closure of the aortic valve under transesophageal echocardiographic (TEE guidance. TEE imaging revealed severe aortic regurgitation (Fig. 1A and B and Videos 1 and 2. Under TEE and fluoroscopic guidance, a 25 mm Amplatzer cribriform atrial septal defect closure device was advanced across the aortic valve (Fig. 1C and D and Videos 3 and 4. Immediately after device deployment, TEE revealed a well-seated device with complete aortic valve closure and trivial aortic regurgitation (Fig. 2A, B, C and D and Videos 5, 6, 7 and 8. Subsequent transthoracic echocardiograms obtained from 74 to 172 days after the procedure revealed no residual aortic regurgitation. The patient awoke with diffuse urticaria 244 days after the procedure and died en route to the emergency department, presumably secondary to a systemic allergic reaction. De novo aortic regurgitation is increasingly recognized in patients with LVADs (1. TEE-guided transcatheter aortic valve closure is an option in these high-risk patients (2.

  4. Auroral and magnetic variations in the polar cusp and cleft. Signatures of magnetopause boundary layer dynamics

    International Nuclear Information System (INIS)

    Sandholt, P.E.; Egeland, A.

    1987-10-01

    By combining continous ground-based observations of polar cleft/cusp auroras and local magnetic variations with electromagnetic parameters obtained from satellites in polar orbit (low-altitude cleft/cusp) and in the magnetosheath/interplanetary space, different electrodynamic processes in the polar cleft/cusp have been investigated. One of the more controversial questions in this field is related to the observed shifts in latitude of cleft/cusp auroras and the relationships with the interplanetary magnetic field (IMF) orientation, local magnetic disturbances (DP2 and DPY modes) and magnetospheric substorms. A new approach which may contribute to clarifying these complicated relationships, simultaneous groundbased observations of the midday and evening-midnight sectors of the auroral oval, is illustrated. A related topic is the spatial relationship between the cleft/cusp auroras and the ionospheric convection currents. A characteristic feature of the polar cusp and cleft regions during negative IMF B z is repeated occurrence of certain short-lived auroral structures moving in accordance with the local convection pattern. Satellite measurements of particle precipitation, magnetic field and ion drift components permit detailed investigations of the electrodynamics of these cusp/cleft structures. Information on electric field components, Birkeland currents, Poynting flux, height-integrated Pedersen conductivity and Joule heat dissipation rate has been derived. These observations are discussed in relation to existing models of temporal plasma injections from the magnetosheath

  5. Influence of Cusp Inclination and Type of Retention on Fracture Load of Implant-Supported Crowns.

    Science.gov (United States)

    Rocha, Cibele Oliveira de Melo; Longhini, Diogo; Pereira, Rodrigo de Paula; Arioli, João Neudenir

    2017-01-01

    There are few informations about the influence of cusp inclination on the fracture strength of implant-supported crowns. The study aimed to evaluate the influence of cusp inclination and retention type on fracture load in implant-supported metal-ceramic single crowns. Sixty crowns were made, classified as cemented and screw-retained with screw access hole (SAH) sealed or not. Standard (33°) and reduced (20°) cusp inclinations were tested for each group (n=10). To support crowns of a mandibular second molar, analogs of external hexagon implants 5.0 were used. The fracture load was measured in a universal testing machine EMIC DL2000 (10 kN load cell; 0.5 mm/min). Two-way ANOVA (retention and cusp inclination) followed by post hoc Tukey's honest significant difference test was used for the statistical analyses (a=0.05). Crowns with reduced cusp inclination exhibited significantly higher fracture load (pcrowns with standard cusp inclination. Cemented crowns showed significantly higher fracture load (pcrowns. The interaction among these factors was not significant (p>0.05) for the fracture load. The sealing of SAH did not influence the fracture load of screw-retained crowns (p>0.05). In conclusion, fracture load of implant-supported metal-ceramic crowns was influenced by retention and cusp inclination, and there was no influence of the sealing of SAH.

  6. Statistical survey of the diamagnetic pressure in the mid-altitude cusp region: Cluster observation

    Science.gov (United States)

    Guo, Jianguang; Shi, Jiankui; Zhang, Tielong; Liu, Zhenxing

    The narrow funnel-shaped cusp stems from the interaction of the solar wind with the geomagnetic field in Earth's dayside magnetosphere. Many space missions, such as Hawkeye, IMP, HEOS and Polar, confirmed that a strong magnetic depression was a characteristic feature of the cusp. That results from the incoming magnetosheath particles, which both decrease total magnetic field as well as increase the ambient plasma density in the cusp region. Here, we present the results of a statistical study of the diamagnetic pressure as observed by Cluster in the cusp region from 4-8 Re. We identify the cusp region with Cluster magnetic field data and plasma data. The peak diamagnetic pressure is calculated by the change of magnetic pressure in the cusp, which involves calculating a boxcar average of the background field and subtracting the magnetic pressure of the background from the total pressure. The diamagnetic pressure shows strong dependence on the solar wind dynamic pressure as expected. The IMF Bz component also has influence on the value of the diamagnetic pressure. So the diamagnetic pressure of the cusp region is controlled by the fluid dynamics and electromagnetic dynamics of the solar wind.

  7. Cusp observation at Saturn's high-latitude magnetosphere by the Cassini spacecraft

    Science.gov (United States)

    Jasinski, J M; Arridge, C S; Lamy, L; Leisner, J S; Thomsen, M F; Mitchell, D G; Coates, A J; Radioti, A; Jones, G H; Roussos, E; Krupp, N; Grodent, D; Dougherty, M K; Waite, J H

    2014-01-01

    We report on the first analysis of magnetospheric cusp observations at Saturn by multiple in situ instruments onboard the Cassini spacecraft. Using this we infer the process of reconnection was occurring at Saturn's magnetopause. This agrees with remote observations that showed the associated auroral signatures of reconnection. Cassini crossed the northern cusp around noon local time along a poleward trajectory. The spacecraft observed ion energy-latitude dispersions—a characteristic signature of the terrestrial cusp. This ion dispersion is “stepped,” which shows that the reconnection is pulsed. The ion energy-pitch angle dispersions suggest that the field-aligned distance from the cusp to the reconnection site varies between ∼27 and 51 RS. An intensification of lower frequencies of the Saturn kilometric radiation emissions suggests the prior arrival of a solar wind shock front, compressing the magnetosphere and providing more favorable conditions for magnetopause reconnection. Key Points We observe evidence for reconnection in the cusp plasma at Saturn We present evidence that the reconnection process can be pulsed at Saturn Saturn's cusp shows similar characteristics to the terrestrial cusp PMID:25821276

  8. Origin of the cusp in the transverse momentum distribution for the process of strong-field ionization

    Science.gov (United States)

    Ivanov, I. A.

    2015-12-01

    We study the origin of the cusp structure in the transverse or lateral electron momentum distribution (TEMD) for the process of tunneling ionization driven by a linearly polarized laser pulse. We show that the appearance of the cusp in the TEMD can be explained as follows. Projection on the set of the Coulomb scattering states leads to the appearance of elementary cusps which have a simple structure as functions of the lateral momentum. This structure is independent of the detailed dynamics of the ionization process and can be described analytically. These elementary cusps can be used to describe the cusp structure in TEMD.

  9. Percutaneous implantation of the first repositionable aortic valve prosthesis in a patient with severe aortic stenosis.

    Science.gov (United States)

    Buellesfeld, Lutz; Gerckens, Ulrich; Grube, Eberhard

    2008-04-01

    Percutaneous aortic valve replacement is a new less-invasive alternative for high-risk surgical candidates with aortic stenosis. However, the clinical experience is still limited, and the currently available 'first-generation devices' revealed technical shortcomings, such as lack of repositionability and presence of paravalvular leakages. We report the first-in-man experience with the new self-expanding Lotus Valve prosthesis composed of a nitinol frame with implemented bovine pericardial leaflets which is designed to address these issues, being repositionable and covered by a flexible membrane to seal paravalvular gaps. We implanted this prosthesis in a 93-year old patient presenting with severe symptomatic aortic stenosis (valve area: 0.6 cm(2)). Surgical valve replacement had been declined due to comorbidities. We used a retrograde approach for insertion of the 21-French Lotus catheter loaded with the valve prosthesis via surgical cut-down to the external iliac artery. Positioning of the valve was guided by transesophageal echo and supra-aortic angiograms. The prosthesis was successfully inserted and deployed within the calcified native valve. Echocardiography immediately after device deployment showed a significant reduction of the transaortic mean pressure gradient (32 to 9 mmHg; final valve area 1.7 cm(2)) without evidence of residual aortic regurgitation. The postprocedural clinical status improved from NYHA-IV to NYHA-II. These results remained unchanged up to the 3 month follow-up. Successful percutaneous aortic valve replacement can be performed using the new self-expanding and repositionable Lotus valve for treatment of high-risk patients with aortic valve stenosis. Further studies are mandatory to assess device safety and efficacy in larger patient populations. Copyright 2008 Wiley-Liss, Inc.

  10. Computational Fluid Dynamics and Aortic Thrombus Formation Following Thoracic Endovascular Aortic Repair.

    Science.gov (United States)

    Nauta, Foeke J H; Lau, Kevin D; Arthurs, Christopher J; Eagle, Kim A; Williams, David M; Trimarchi, Santi; Patel, Himanshu J; Figueroa, Carlos A

    2017-06-01

    We present the possible utility of computational fluid dynamics in the assessment of thrombus formation and virtual surgical planning illustrated in a patient with aortic thrombus in a kinked ascending aortic graft following thoracic endovascular aortic repair. A patient-specific three-dimensional model was built from computed tomography. Additionally, we modeled 3 virtual aortic interventions to assess their effect on thrombosis potential: (1) open surgical repair, (2) conformable endografting, and (3) single-branched endografting. Flow waveforms were extracted from echocardiography and used for the simulations. We used the computational index termed platelet activation potential (PLAP) representing accumulated shear rates of fluid particles within a fluid domain to assess thrombosis potential. The baseline model revealed high PLAP in the entire arch (119.8 ± 42.5), with significantly larger PLAP at the thrombus location (125.4 ± 41.2, p fluid dynamics may assist in the prediction of aortic thrombus formation in hemodynamically complex cases and help guide repair strategies. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  11. Classical description of the electron capture to the continuum cusp formation in ion-atom collisions

    International Nuclear Information System (INIS)

    Illescas, Clara; Pons, B.; Riera, A.

    2002-01-01

    Classical calculations are used to describe the dynamics of the electron capture to the continuum (ECC) cusp formation in H + +He collisions. We illustrate the frontier character of the ECC electrons between capture and ionization, and confirm that it is a temporary capture, through projectile focusing, that is responsible for the ECC cusp. Furthermore, the cusp is not a divergence smoothed by the experiment, and is slightly shifted from the impact-velocity value because of the residual pull from the target after ionization. This shift is larger the smaller the nuclear velocity

  12. 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.

  13. Determination of polar cusp position by low-energy particle measurements made aboard AUREOLE satellite

    International Nuclear Information System (INIS)

    Gladyshev, V.A.; Jorjio, M.V.; Shuiskaya, F.K.; Crasnier, J.; Sauvaud, J.A.

    1974-01-01

    The Franco-Soviet experiment ARCAD, launched aboard the satellite AUREOLE December 27, 1971, has verified the existence of a particle penetration from the transition zone up to ionospheric altitudes across the polar cusp. The polar cusp is characterized by proton fluxes >10 7 particles/(cm 2 .s.sr.KeV) at 0.5KeV, with energy spectra similar to those in the transition zone. The position and form of the polar cusp are studied from measurements of protons in the range 0.4 to 30KeV during geomagnetically quiet periods (Kp [fr

  14. Tunable system for production of mirror and cusp configurations using chassis of permanent magnets

    Science.gov (United States)

    Hyde, Alexander; Bushmelov, Maxim; Batishchev, Oleg

    2018-03-01

    Compact arrays of permanent magnets have shown promise as replacements for electromagnets in applications requiring magnetic cusps and mirrors. An adjustable system capable of suspending and translating a pair of light, nonmagnetic chassis carrying such sources of magnetic field has been designed and constructed. Using this device to align two cylindrical chassis, strong solenoid-like domains of field, as well as classic biconic cusp and magnetic mirror topologies, are generated. Employing a pair of ring-shaped chassis instead, the superposition of their naturally-emitted cusps is demonstrated to produce sextupolar and octupolar magnetic fields.

  15. On the Casimir scaling violation in the cusp anomalous dimension at small angle

    Science.gov (United States)

    Grozin, Andrey; Henn, Johannes; Stahlhofen, Maximilian

    2017-10-01

    We compute the four-loop n f contribution proportional to the quartic Casimir of the QCD cusp anomalous dimension as an expansion for small cusp angle ϕ. This piece is gauge invariant, violates Casimir scaling, and first appears at four loops. It requires the evaluation of genuine non-planar four-loop Feynman integrals. We present results up to O({φ}^4) . One motivation for our calculation is to probe a recent conjecture on the all-order structure of the cusp anomalous dimension. As a byproduct we obtain the four-loop HQET wave function anomalous dimension for this color structure.

  16. Aortic Aneurysm Statistics

    Science.gov (United States)

    ... people with inherited connective tissue disorders, such as Marfan syndrome and Ehlers-Danlos syndrome, get thoracic aortic aneurysms. ... Smoking . Some inherited connective tissue disorders, such as Marfan syndrome and Ehlers-Danlos syndrome, can also increase your ...

  17. Aortic Valve Disease

    Science.gov (United States)

    ... It is then replaced with an artificial valve (prosthesis). There are two valve options for aortic valve ... place, the catheter will be withdrawn from your body through the original access point. Because not all ...

  18. Traumatic Aortic Injury

    Directory of Open Access Journals (Sweden)

    Brianna Miner

    2016-09-01

    Full Text Available History of present illness: A 48-year-old male with unknown past medical history presents as a trauma after being hit by a car traveling approximately 25 miles per hour. On initial presentation, the patient is confused, combative, and not answering questions appropriately. The patient is hypotensive with a blood pressure of 68/40 and a heart rate of 50 beats per minute, with oxygen saturation at 96% on room air. FAST scan is positive for fluid in Morrison’s pouch, splenorenal space, and pericardial space. Significant findings: The initial chest x-ray showed an abnormal superior mediastinal contour (blue line, suggestive of a possible aortic injury. The CT angiogram showed extensive circumferential irregularity and outpouching of the distal aortic arch (red arrows compatible with aortic transection. In addition, there was a circumferential intramural hematoma, which extended through the descending aorta to the proximal infrarenal abdominal aorta (green arrow. There was also an extensive surrounding mediastinal hematoma extending around the descending aorta and supraaortic branches (purple arrows. Discussion: Traumatic aortic injury is a life-threatening event. The incidence of blunt thoracic aortic injury is low, between 1 to 2 percent of those patients with blunt thoracic trauma.1 However, approximately 80% of patients with traumatic aortic injury die at the scene.2 Therefore it is imperative to diagnose traumatic aortic injury in a timely fashion. The diagnosis can be difficult due to the non-specific signs and symptoms and other distracting injuries. Clinical suspicion should be based on the mechanism of the injury and the hemodynamic status of the patient. In any patient with blunt or penetrating trauma to the chest that is hemodynamically unstable, traumatic aortic injury should be on the differential. Chest x-ray can be used as a screening tool. A normal chest x-ray has a negative predictive value of approximately 97%. CTA chest is the

  19. Thoracoabdominal Aortic Aneurysms

    Directory of Open Access Journals (Sweden)

    Ali Azizzadeh

    2008-09-01

    Full Text Available Over the last 50 years, significant progress has been made in the surgical repair of thoracoabdominal aortic aneurysms (TAAA.  Improvements in perioperative care and surgical techniques have resulted in reductions in complication and mortality rates. Adjunctive use of distal aortic perfusion and cerebrospinal fluid drainage has been especially helpful, reducing the incidence of neurological deficits to 2.4%. Current research is aimed at improving organ preservation. This review focuses on the current diagnosis and management of TAAA.

  20. Phase space of positron trajectories exiting a charged particle source through a magnetic field point cusp

    International Nuclear Information System (INIS)

    Kiester, A.S.; Pacheco, J.L.; Ordonez, C.A.; Weathers, D.L.

    2014-01-01

    A configuration of magnetic fields using properties of cylindrically symmetric permanent magnets is presented as a candidate to produce a high purity charged particle source or trap. Cylindrically symmetric hollow permanent magnets produce magnetic field point cusps on the axis of symmetry. A magnetic field point cusp reflects all particles that lie outside a narrow region of phase space, a region dependent on particle kinetic energies and on the magnetic field intensity. An analysis of the phase space of positron trajectories entering and exiting a magnetic field point cusp is presented and quantified with respect to magnetic field intensity and particle kinetic energy. Preliminary experimental results support the use of point cusps for ion source applications

  1. [Reliability study in the measurement of the cusp inclination angle of a chairside digital model].

    Science.gov (United States)

    Xinggang, Liu; Xiaoxian, Chen

    2018-02-01

    This study aims to evaluate the reliability of the software Picpick in the measurement of the cusp inclination angle of a digital model. Twenty-one trimmed models were used as experimental objects. The chairside digital impression was then used for the acquisition of 3D digital models, and the software Picpick was employed for the measurement of the cusp inclination of these models. The measurements were repeated three times, and the results were compared with a gold standard, which was a manually measured experimental model cusp angle. The intraclass correlation coefficient (ICC) was calculated. The paired t test value of the two measurement methods was 0.91. The ICCs between the two measurement methods and three repeated measurements were greater than 0.9. The digital model achieved a smaller coefficient of variation (9.9%). The software Picpick is reliable in measuring the cusp inclination of a digital model.

  2. Observations of collective ion acceleration by a relativistic electron beam in a magnetic cusp

    International Nuclear Information System (INIS)

    Roberson, C.W.; Eckhouse, S.; Fisher, A.; Robertson, S.; Rostoker, N.

    1976-01-01

    Ion pulses of 10 13 protons were observed by passing hollow relativistic electron beams through a magnetic cusp using drift-chamber fill pressures from 75 to 600 mTorr of H 2 . Magnetic fields of 0.8 kG suppress the mechanism responsible for acceleration without magnetic field. A different mechanism appears to begin and peak as the cusp threshold is approached. More than 10 11 protons with energies greater than 2 MeV were observed

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

    Directory of Open Access Journals (Sweden)

    P. J. Cargill

    2001-09-01

    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

  4. Neurocardiogenic Syncope and Supraventricular Tachycardia in Association with a Rare Congenital Aortic Valve Abnormality

    Directory of Open Access Journals (Sweden)

    Yashwant Agrawal

    2016-01-01

    Full Text Available We report a case of a 26-year-old woman who presented with multiple episodes of syncope over a five-months period of time. Transthoracic echocardiogram had shown a normal functioning quadricuspid aortic valve (QAV which was also confirmed on a transesophageal echocardiogram. Computed tomographic angiography of heart and coronary arteries showed the QAV with equal size of all aortic cusps and normal coronary arteries. Intermittent chest pain and palpitations warranted an exercise stress test. The stress test revealed normal aerobic exertion, with achievement of 101% of maximal peak heart rate. However, during peak stress, we noted a drop in her blood pressure significantly resulting in dizziness. No arrhythmias were noted during the stress test. With recurrent syncope episodes and palpitations, Holter monitoring was done, revealing supraventricular tachycardia (SVT. We discuss current available literature and coassociations with QAV. New association of QAV with SVT needs further analysis.

  5. X-ray emission from relativistically moving electron density cusps

    International Nuclear Information System (INIS)

    Kando, M.; Pirozhkov, A. S.; Nakamura, T.; Hayashi, Y.; Kotaki, H.; Kawase, K.; Esirkepov, T. Zh.; Fukuda, Y.; Kiriyama, H.; Okada, H.; Daito, I.; Kameshima, T.; Mori, M.; Koga, J. K.; Daido, H.; Faenov, A. Ya.; Pikuz, T.; Ma, J.; Chen, L.-M.; Ragozin, E. N.

    2012-01-01

    We report on novel methods to generate ultra-short, coherent, X-rays using a laserplasma interaction. Nonlinear interaction of intense laser pulses with plasma creates stable, specific structures such as electron cusps. For example, wake waves excited in an underdense plasma by an intense, short-pulse laser become dense and propagate along with the laser pulse. This is called a relativistic flying mirror. The flying mirror can reflect a counter-propagating laser pulse and directly convert it into high-frequency radiation, with a frequency multiplication factor of ∼ 4γ 2 and pulse shortening with the same factor. After the proof-of-principle experiments, we observed that the photon number generated in the flying mirror is close to the theoretical estimate. We present the details of the experiment in which a 9 TW laser pulse focused into a He gas jet generated the Flying Mirror, which partly reflected a 1 TW pulse, giving up to ∼ 10 10 photons, 60 nJ (1.4×10 12 photons/sr) in the XUV spectral region (12.8-22 nm).

  6. X-ray emission from relativistically moving electron density cusps

    Energy Technology Data Exchange (ETDEWEB)

    Kando, M.; Pirozhkov, A. S.; Nakamura, T.; Hayashi, Y.; Kotaki, H.; Kawase, K.; Esirkepov, T. Zh.; Fukuda, Y.; Kiriyama, H.; Okada, H.; Daito, I.; Kameshima, T.; Mori, M.; Koga, J. K.; Daido, H.; Faenov, A. Ya.; Pikuz, T.; Ma, J.; Chen, L.-M.; Ragozin, E. N. [Japan Atomic Energy Agency (Japan); Osaka University (Japan); Joint Institute for High Temperature of the Russian Academy of Science, Moscow (Russian Federation); Institute of Physics, Chinese Academy of Sciences, Beijing (China); P. N. Lebedev Physical Institute of the Russian Academy of Sciences, Leninsky prospekt 53, 119991 Moscow (Russian Federation); Japan Atomic Energy Agency and Graduate School for the Creation of New Photonics Industries (Japan); Ludwig-Maximilians-University (Germany); and others

    2012-07-11

    We report on novel methods to generate ultra-short, coherent, X-rays using a laserplasma interaction. Nonlinear interaction of intense laser pulses with plasma creates stable, specific structures such as electron cusps. For example, wake waves excited in an underdense plasma by an intense, short-pulse laser become dense and propagate along with the laser pulse. This is called a relativistic flying mirror. The flying mirror can reflect a counter-propagating laser pulse and directly convert it into high-frequency radiation, with a frequency multiplication factor of {approx} 4{gamma}{sup 2} and pulse shortening with the same factor. After the proof-of-principle experiments, we observed that the photon number generated in the flying mirror is close to the theoretical estimate. We present the details of the experiment in which a 9 TW laser pulse focused into a He gas jet generated the Flying Mirror, which partly reflected a 1 TW pulse, giving up to {approx} 10{sup 10} photons, 60 nJ (1.4 Multiplication-Sign 10{sup 12} photons/sr) in the XUV spectral region (12.8-22 nm).

  7. Pathogenetic Basis of Aortopathy and Aortic Valve Disease

    Science.gov (United States)

    2018-02-19

    Aortopathies; Thoracic Aortic Aneurysm; Aortic Valve Disease; Thoracic Aortic Disease; Thoracic Aortic Dissection; Thoracic Aortic Rupture; Ascending Aortic Disease; Descending Aortic Disease; Ascending Aortic Aneurysm; Descending Aortic Aneurysm; Marfan Syndrome; Loeys-Dietz Syndrome; Ehlers-Danlos Syndrome; Shprintzen-Goldberg Syndrome; Turner Syndrome; PHACE Syndrome; Autosomal Recessive Cutis Laxa; Congenital Contractural Arachnodactyly; Arterial Tortuosity Syndrome

  8. Aortic Valve Cyclic Stretch Causes Increased Remodeling Activity and Enhanced Serotonin Receptor Responsiveness

    Science.gov (United States)

    Balachandran, Kartik; Bakay, Marina A.; Connolly, Jeanne M.; Zhang, Xuemei; Yoganathan, Ajit P.; Levy, Robert J.

    2011-01-01

    Background Increased serotonin(5HT) receptor(5HTR) signaling has been associated with cardiac valvulopathy. Prior cell culture studies of 5HTR signaling in heart valve interstitial cells have provided mechanistic insights concerning only static conditions. We investigated the hypothesis that aortic valve biomechanics participate in the regulation of both 5HTR expression and inter-related extracellular matrix remodeling events. Methods The effects of cyclic-stretch on aortic valve 5HTR, expression, signaling and extracellular matrix remodeling were investigated using a tensile stretch bioreactor in studies which also compared the effects of adding 5HT and/or the 5HT-transporter inhibitor, Fluoxetine. Results Cyclic-stretch alone increased both proliferation and collagen in porcine aortic valve cusp samples. However, with cyclic-stretch, unlike static conditions, 5HT plus Fluoxetine caused the greatest increase in proliferation (p4.5 fold) for cyclic-stretch versus static (p<0.001), while expression of the 5HT transporter was not changed significantly. Extracellular matrix genes (eg. Collagen Types I,II,III, and proteoglycans) were also upregulated by cyclic-stretch. Conclusions Porcine aortic valve cusp samples subjected to cyclic stretch upregulate 5HTR2A and 2B, and also initiate remodeling activity characterized by increased proliferation and collagen production. Importantly, enhanced 5HTR responsiveness, due to increased 5HTR2A and 2B expression, results in a significantly greater response in remodeling endpoints (proliferation, collagen and GAG production) to 5HT in the presence of 5HT transporter blockade. PMID:21718840

  9. [Aortic arch advancement surgery as treatment for aortic coarctation with hypoplastic aortic arch in children].

    Science.gov (United States)

    Palacios-Macedo-Quenot, Alexis; Urencio, Miguel; Ponce-De-León-Rosales, Sergio; López-Terrazas, Javier; Castañuela-Sánchez, Violeta; March-Mifsut, Almudena; López-Magallón, Alejandro; Pérez-Juárez, Fabiola; Cedillo-Rendón, Irma; Tamariz-Cruz, Orlando

    2012-01-01

    Treatment of aortic coarctation with hypoplastic aortic arch is still a surgical challenge. The aortic arch advancement surgery has shown less re-coarctation frequency. To determine the re-coarctation frequency in patients who underwent aortic arch advancement technique for aortic coarctation with hypoplastic aortic arch and analyze the results. Retrospective and observational study of 38 patients who underwent aortic arch advancement in a third level Institution from 2002 to 2010. Twenty four males and 14 females all with aortic arch Z index diameter of coarctation was O%. With the previously mentioned technique the recoarctation frequency on medium and long term basis was 0%. From the anatomical and functional point of view, we believe this technique offers the best possible results.

  10. A comparative analysis of ECG-gated steady state free precession magnetic resonance imaging versus transthoracic echocardiography for evaluation of aortic root dimensions.

    Science.gov (United States)

    Hoey, Edward T D; Pakala, Vijaya; Kassamali, Rahil H; Ganeshan, Arul

    2014-10-01

    Accurate and reproducible measurement of aortic root dimensions is essential to inform clinical decision making. Transthoracic echocardiography (TTE) is the first line test for assessment of the aortic root but has potential limitations due to its limited field of view and restricted acoustic windows. Cardiac magnetic resonance imaging (MRI) is considered the "gold standard" technique for assessment of cardiac morphology and recently MRI reference ranges for aortic root dimensions have been published. The purpose of this study was to retrospectively compare aortic root measurements obtained from TTE with those derived from cardiac MRI. Sixty-eight patients (40 males, 28 females) who had undergone both cardiac MRI and TTE imaging within a 4-month interval (mean 62 days) were included. Steady-state-free precession MRI cine imaging was performed with an acquisition plane perpendicular to the aortic root and through the true cross sectional aortic valve plane. A cusp-commissure dimension from inside wall to inside wall in end-diastole was recorded and compared with standardized TTE derived Valsalva sinus measurements. Pearson correlation coefficients and a paired t-test were used for statistical analysis. Mean aortic root dimension by TTE was 3.2±0.5 cm and MRI was 3.4±0.4 cm with a Pearson correlation coefficient of >0.7. Mean difference between TTE and MRI was 0.2±0.3 (PTTE measurement was within the normal reference range. In patients with a dilated aortic root (n=19) the mean difference was 0.2±0.4 cm (PTTE and MRI derived aortic root measurements at the Valsalva sinus level. MRI consistently measures the aortic root dimension higher than TTE which may under diagnose patients with a mildly dilated aortic root. Further investigation is required to properly integrate MRI into imaging assessment algorithms.

  11. The JUPITER registry: 1-year results of transapical aortic valve implantation using a second-generation transcatheter heart valve in patients with aortic stenosis.

    Science.gov (United States)

    Silaschi, Miriam; Treede, Hendrik; Rastan, Ardawan J; Baumbach, Hardy; Beyersdorf, Friedhelm; Kappert, Utz; Eichinger, Walter; Rüter, Florian; de Kroon, Thomas L; Lange, Rüdiger; Ensminger, Stephan; Wendler, Olaf

    2016-11-01

    Transcatheter aortic valve replacement (TAVR) is an established therapy for patients with aortic stenosis (AS) at high surgical risk. The JenaValve™ is a second-generation, self-expanding transcatheter heart valve (THV), implanted through transapical access (TA). During stent deployment, a specific 'clipping-mechanism' engages native aortic valve cusps for fixation. We present 1-year outcomes of the JUPITER registry, a post-market registry of the JenaValve for TA-TAVR. The JUPITER registry is a prospective, multicentre, uncontrolled and observational European study to evaluate the long-term safety and effectiveness of the Conformité Européenne-marked JenaValve THV. A total of 180 patients with AS were enrolled between 2012 and 2014. End-points were adjudicated in accordance with the valve academic research consortium document no. 1 definitions. The mean age was 80.4 ± 5.9 years and the mean logistic European system for cardiac operative risk evaluation I 21.2 ± 14.7%. The procedure was successful in 95.0% (171/180), implantation of a second THV (valve-in-valve) was performed in 2.2% (4/180) and conversion to surgical aortic valve replacement (SAVR) was necessary in 2.8% (5/180). No annular rupture or coronary ostia obstruction occurred. Two patients required SAVR after the day of index procedure (1.1%). All-cause mortality at 30 days was 11.1% (20/180), being cardiovascular in 7.2% (13/180). A major stroke occurred in 1.1% (2/180) at 30 days, no additional major strokes were observed during 1 year. All-cause mortality after 30 days was 13.1% (21/160) and combined efficacy at 1 year was 80.8% (122/151). At 1-year follow-up, no patient presented with more than moderate paravalvular leakage, while 2 patients (3.2%) showed moderate, 12 (19.0%) mild and 49 (82.4%) trace/none paravalvular regurgitation. In a high-risk cohort of patients undergoing TA-TAVR for AS, the use of the JenaValve THV is safe and effective. In patients at higher risk for coronary ostia

  12. Risk Factors for Late Aortic Valve Dysfunction After the David V Valve-Sparing Root Replacement.

    Science.gov (United States)

    Esaki, Jiro; Leshnower, Bradley G; Binongo, Jose N; Lasanajak, Yi; McPherson, LaRonica; Guyton, Robert A; Chen, Edward P

    2017-11-01

    Valve-sparing root replacement (VSRR) is an established therapy for aortic root pathology. However, late aortic valve dysfunction requiring reoperation remains a primary concern of this procedure. This study examines risk factors for late aortic insufficiency (AI) and aortic stenosis (AS) after David V VSRR. A retrospective review from 2005 to 2015 at a US academic center identified 282 patients who underwent VSRR. Cox proportional hazards regression analysis was used to identify risk factors for late AI and AS after VSRR. The mean age was 46.4 years. Sixty-four patients (22.7%) had bicuspid valves, and 41 patients (14.5%) had Marfan syndrome. The incidence of reoperations was 27 (9.6%), and 42 cases (14.9%) presented with acute type A dissection. Operative mortality was 8 (2.8%). Seven-year survival was 90.9%. Seven-year cumulative incidence of reoperation, greater than 2+ AI and greater than moderate AS were 3.1%, 2.2%, and 0.8%, respectively. Multivariable analysis showed aortic root size 55 mm or larger (hazard ratio 3.44, 95% confidence interval: 1.27 to 9.29, p = 0.01) to be a risk factor for late AI whereas bicuspid valve (hazard ratio 16.07, 95% confidence interval: 3.12 to 82.68, p = 0.001) and cusp repair were found to be risk factors (hazard ratio 5.91, 95% confidence interval: 1.17 to 29.86, p = 0.03) for late AS. Valve-sparing root replacement can be performed with low operative risk and good overall long-term survival even in complex clinical settings. Durable valve function can be expected; however, aortic root size 55 cm or more, bicuspid valve anatomy, and cusp repair represent independent risk factors for late aortic valve dysfunction after these procedures. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  13. Talon cusps occurring concurrently with dens invaginatus on a permanent maxillary lateral incisor: a case report and literature review.

    Science.gov (United States)

    Colak, Hakan; Yilmaz, Cicek; Keklik, Hakan; Colak, Tugba

    2014-01-01

    A talon cusp is a prominent accessory horn-like structure that projects from the cingulum or cementoenamel junction of the maxillary or mandibular teeth. It can occur in primary and permanent dentition and can lead to occlusal interference, irritation of the tongue, pulpal necrosis, caries, and periodontal problems. Talon cusp has been reported to affect both sexes, and may be unilateral or bilateral. Talon cusps occur most often on the palatal surface of permanent maxillary incisors. A comprehensive literature review revealed only 6 reported cases of facial talon cusps. A talon cusp occurring simultaneously with dens invaginatus in a tooth is extremely rare; to date, only 9 case reports have been published. This article presents a unique case of concurrent dens invaginatus and palatal and facial talon cusps in the right maxillary central incisor of a 12-year-old girl.

  14. Cluster survey of the high-altitude cusp properties: a three-year statistical study

    Directory of Open Access Journals (Sweden)

    B. Lavraud

    2004-09-01

    Full Text Available The global characteristics of the high-altitude cusp and its surrounding regions are investigated using a three-year statistical survey based on data obtained by the Cluster spacecraft. The analysis involves an elaborate orbit-sampling methodology that uses a model field and takes into account the actual solar wind conditions and level of geomagnetic activity. The spatial distribution of the magnetic field and various plasma parameters in the vicinity of the low magnetic field exterior cusp are determined and it is found that: 1 The magnetic field distribution shows the presence of an intermediate region between the magnetosheath and the magnetosphere: the exterior cusp, 2 This region is characterized by the presence of dense plasma of magnetosheath origin; a comparison with the Tsyganenko (1996 magnetic field model shows that it is diamagnetic in nature, 3 The spatial distributions show that three distinct boundaries with the lobes, the dayside plasma sheet and the magnetosheath surround the exterior cusp, 4 The external boundary with the magnetosheath has a sharp bulk velocity gradient, as well as a density decrease and temperature increase as one goes from the magnetosheath to the exterior cusp, 5 While the two inner boundaries form a funnel, the external boundary shows no clear indentation, 6 The plasma and magnetic pressure distributions suggest that the exterior cusp is in equilibrium with its surroundings in a statistical sense, and 7 A preliminary analysis of the bulk flow distributions suggests that the exterior cusp is stagnant under northward IMF conditions but convective under southward IMF conditions.

  15. Model of tooth morphogenesis predicts carabelli cusp expression, size, and symmetry in humans.

    Directory of Open Access Journals (Sweden)

    John P Hunter

    Full Text Available BACKGROUND: The patterning cascade model of tooth morphogenesis accounts for shape development through the interaction of a small number of genes. In the model, gene expression both directs development and is controlled by the shape of developing teeth. Enamel knots (zones of nonproliferating epithelium mark the future sites of cusps. In order to form, a new enamel knot must escape the inhibitory fields surrounding other enamel knots before crown components become spatially fixed as morphogenesis ceases. Because cusp location on a fully formed tooth reflects enamel knot placement and tooth size is limited by the cessation of morphogenesis, the model predicts that cusp expression varies with intercusp spacing relative to tooth size. Although previous studies in humans have supported the model's implications, here we directly test the model's predictions for the expression, size, and symmetry of Carabelli cusp, a variation present in many human populations. METHODOLOGY/PRINCIPAL FINDINGS: In a dental cast sample of upper first molars (M1s (187 rights, 189 lefts, and 185 antimeric pairs, we measured tooth area and intercusp distances with a Hirox digital microscope. We assessed Carabelli expression quantitatively as an area in a subsample and qualitatively using two typological schemes in the full sample. As predicted, low relative intercusp distance is associated with Carabelli expression in both right and left samples using either qualitative or quantitative measures. Furthermore, asymmetry in Carabelli area is associated with asymmetry in relative intercusp spacing. CONCLUSIONS/SIGNIFICANCE: These findings support the model's predictions for Carabelli cusp expression both across and within individuals. By comparing right-left pairs of the same individual, our data show that small variations in developmental timing or spacing of enamel knots can influence cusp pattern independently of genotype. Our findings suggest that during evolution new cusps

  16. Model of Tooth Morphogenesis Predicts Carabelli Cusp Expression, Size, and Symmetry in Humans

    Science.gov (United States)

    Hunter, John P.; Guatelli-Steinberg, Debbie; Weston, Theresia C.; Durner, Ryan; Betsinger, Tracy K.

    2010-01-01

    Background The patterning cascade model of tooth morphogenesis accounts for shape development through the interaction of a small number of genes. In the model, gene expression both directs development and is controlled by the shape of developing teeth. Enamel knots (zones of nonproliferating epithelium) mark the future sites of cusps. In order to form, a new enamel knot must escape the inhibitory fields surrounding other enamel knots before crown components become spatially fixed as morphogenesis ceases. Because cusp location on a fully formed tooth reflects enamel knot placement and tooth size is limited by the cessation of morphogenesis, the model predicts that cusp expression varies with intercusp spacing relative to tooth size. Although previous studies in humans have supported the model's implications, here we directly test the model's predictions for the expression, size, and symmetry of Carabelli cusp, a variation present in many human populations. Methodology/Principal Findings In a dental cast sample of upper first molars (M1s) (187 rights, 189 lefts, and 185 antimeric pairs), we measured tooth area and intercusp distances with a Hirox digital microscope. We assessed Carabelli expression quantitatively as an area in a subsample and qualitatively using two typological schemes in the full sample. As predicted, low relative intercusp distance is associated with Carabelli expression in both right and left samples using either qualitative or quantitative measures. Furthermore, asymmetry in Carabelli area is associated with asymmetry in relative intercusp spacing. Conclusions/Significance These findings support the model's predictions for Carabelli cusp expression both across and within individuals. By comparing right-left pairs of the same individual, our data show that small variations in developmental timing or spacing of enamel knots can influence cusp pattern independently of genotype. Our findings suggest that during evolution new cusps may first appear as

  17. Observations of beach cusp evolution using a stationary, shore-based lidar system

    Science.gov (United States)

    O'Dea, A.; Whitesides, E. T.; Brodie, K.; Spore, N.

    2016-12-01

    Although beach cusps are common features on beaches around the world, questions still remain regarding the range of conditions in which they form, the initial forcing conditions under which they form, and the erosive or accretionary nature of cusp events. While many prior studies have focused on the formation and morphology of beach cusps, many of these are limited in the spatial extent of observations, in their spatial or temporal resolution, or in the availability of accompanying hydrodynamic data. In this study, beach cusp formation and evolution is investigated using an automated lidar system that provides hourly three-dimensional scans of subaerial beach topography with high spatial resolution ([O(1 cm)]). The stationary lidar scanner is mounted on a 4-m tower located on the crest of a shore-backing dune on an Atlantic Ocean beach near Duck, North Carolina. The device measures a 237°-framescan of the nearshore region over a 15 minute period each hour. Individual scans are coregistered to a baseline scan using an iterative closest point (ICP) algorithm and then filtered to remove noise, dune vegetation, and water. To assess the accuracy of the coregistration algorithm, the 3-dimensional location of five permanent reflectors near the device are found for each scan and compared to their measured GPS location. Precisely coregistered scans allow for an assessment of elevation change across cuspate features in addition to traditional measurements of cusp wavelength. Beach cusp events are assessed over a three month period from September through November 2015. Wave and current data from a cross-shore array of sensors deployed continuously throughout the three month period as well as from two alongshore arrays of ADV sensors deployed from October 13 through November 1 are used to determine the forcing conditions under which the cusps formed and evolved. Funded by the USACE Coastal Field Data Collection Program.

  18. The core-cusp problem: a matter of perspective

    Science.gov (United States)

    Genina, Anna; Benítez-Llambay, Alejandro; Frenk, Carlos S.; Cole, Shaun; Fattahi, Azadeh; Navarro, Julio F.; Oman, Kyle A.; Sawala, Till; Theuns, Tom

    2018-02-01

    The existence of two kinematically and chemically distinct stellar subpopulations in the Sculptor and Fornax dwarf galaxies offers the opportunity to constrain the density profile of their matter haloes by measuring the mass contained within the well-separated half-light radii of the two metallicity subpopulations. Walker and Peñarrubia have used this approach to argue that data for these galaxies are consistent with constant-density `cores' in their inner regions and rule out `cuspy' Navarro-Frenk-White (NFW) profiles with high statistical significance, particularly in the case of Sculptor. We test the validity of these claims using dwarf galaxies in the APOSTLE (A Project Of Simulating The Local Environment) Λ cold dark matter cosmological hydrodynamic simulations of analogues of the Local Group. These galaxies all have NFW dark matter density profiles and a subset of them develop two distinct metallicity subpopulations reminiscent of Sculptor and Fornax. We apply a method analogous to that of Walker and Peñarrubia to a sample of 50 simulated dwarfs and find that this procedure often leads to a statistically significant detection of a core in the profile when in reality there is a cusp. Although multiple factors contribute to these failures, the main cause is a violation of the assumption of spherical symmetry upon which the mass estimators are based. The stellar populations of the simulated dwarfs tend to be significantly elongated and, in several cases, the two metallicity populations have different asphericity and are misaligned. As a result, a wide range of slopes of the density profile are inferred depending on the angle from which the galaxy is viewed.

  19. 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.

  20. The outcome after aortic valve-sparing (David) operation in 179 patients: a single-centre experience.

    Science.gov (United States)

    Leontyev, Sergey; Trommer, Constanze; Subramanian, Sreekumar; Lehmann, Sven; Dmitrieva, Yaroslava; Misfeld, Martin; Mohr, Friedrich W; Borger, Michael A

    2012-08-01

    The David aortic valve-sparing reimplantation (AVr-D) operation is increasingly being used in patients with aortic root aneurysmal disease and pliable aortic cusps. The objective of this study was to assess our early and medium-term outcomes with the AVr-D operation. Between 2003 and 2011, a total of 179 patients underwent AVr-D procedures. The mean patient age was 49.7 ± 15.1 years, and 23.5% (n = 42) were females. Marfan syndrome was present in 17.3% of patients (n = 31), and acute Type A aortic dissection in 15.6% (n = 28). Clinical follow-up was 100% complete and was 1.8 ± 1.6 years (0 days to 7.5 years) long. Echocardiographic follow-up was performed 2.2 ± 1.5 years (0 days to 7.5 years) postoperatively and was 77% complete. Early mortality was 1.1% (n = 2), with both deaths occurring in patients with Type A dissection. Pre-discharge echocardiography revealed no patients with >2+ aortic insufficiency (AI), 19.6% of patients (n = 34) with 1+ or 2+ AI and 80.4% of patients (n = 145) with trace or no AI. Left ventricular end-diastolic diameters decreased significantly from 5.6 ± 0.9 to 5.1 ± 0.8 cm early postoperatively (P valve re-replacement during follow-up, two due to early endocarditis and two due to non-coronary leaflet prolapse in Marfan patients. Five-year freedom from aortic valve reoperation was 95.9 ± 2.0%. AVr-D is associated with a low mortality and morbidity rate, even in patients with Type A aortic dissection. Although a slightly higher rate of recurrent AI may be present in patients with Marfan syndrome, freedom from recurrent AI and reoperation remains excellent during medium-term follow-up. The David operation should be considered the gold standard for patients with proximal aortic root pathology (aneurysm or dissection) and pliable aortic cusps.

  1. Quadricuspid Aortic Valve Combined with Moderate Ascending Aortic Dilatation: A Report of Four Cases.

    Science.gov (United States)

    Uspenskiy, Vladimir E; Osadchii, Alexei M; Gordeev, Mikhail L

    2015-12-01

    The quadricuspid aortic valve is a very uncommon malformation associated with aortic insufficiency, aortic stenosis, endocarditis, and ascending aortic dilatation. We report four cases of this aortic valve malformation. One patient with severe aortic regurgitation and moderate aortic dilatation required aortic valve replacement. Three patients had mild or moderate aortic insufficiency combined with moderate ascending aortic dilatation. These patients were referred to follow-up. The presented cases demonstrate that this aortic valve malformation may not be as rare as it appears and that attention must be paid to any quadricuspid findings during computed tomographic angiography and echocardiography.

  2. 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. No sig...

  3. Double aortic arch

    Science.gov (United States)

    Surgery can be done to fix double aortic arch. The surgeon ties off the smaller branch and separates it from the larger branch. Then the surgeon closes the ends of the aorta with stitches. This relieves pressure on the esophagus and windpipe.

  4. Bicuspid aortic valve

    Science.gov (United States)

    ... females. A BAV often exists in babies with coarctation of the aorta (narrowing of the aorta). BAV is also seen ... to view the blood vessels of the heart Treatment ... to the heart and into the narrow opening of the aortic valve. A balloon attached to the end of ...

  5. Tissue engineered aortic valve

    OpenAIRE

    Dohmen, P M

    2012-01-01

    Several prostheses are available to replace degenerative diseased aortic valves with unique advantages and disadvantages. Bioprotheses show excellent hemodynamic behavior and low risk of thromboembolic complications, but are limited by tissue deterioration. Mechanical heart valves have extended durability, but permanent anticoagulation is mandatory. Tissue engineering created a new generation heart valve, which overcome limitations of biological and mechanical heart valves due to remodelling,...

  6. ESR and EISCAT observations of the response of the cusp and cleft to IMF orientation changes

    Directory of Open Access Journals (Sweden)

    I. W. McCrea

    2000-09-01

    Full Text Available We report observations of the cusp/cleft ionosphere made on December 16th 1998 by the EISCAT (European incoherent scatter VHF radar at Tromsø and the EISCAT Svalbard radar (ESR. We compare them with observations of the dayside auroral luminosity, as seen by meridian scanning photometers at Ny Ålesund and of HF radar backscatter, as observed by the CUTLASS radar. We study the response to an interval of about one hour when the interplanetary magnetic field (IMF, monitored by the WIND and ACE spacecraft, was southward. The cusp/cleft aurora is shown to correspond to a spatially extended region of elevated electron temperatures in the VHF radar data. Initial conditions were characterised by a northward-directed IMF and cusp/cleft aurora poleward of the ESR. A strong southward turning then occurred, causing an equatorward motion of the cusp/cleft aurora. Within the equatorward expanding, southward-IMF cusp/cleft, the ESR observed structured and elevated plasma densities and ion and electron temperatures. Cleft ion fountain upflows were seen in association with elevated ion temperatures and rapid eastward convection, consistent with the magnetic curvature force on newly opened field lines for the observed negative IMF By. Subsequently, the ESR beam remained immediately poleward of the main cusp/cleft and a sequence of poleward-moving auroral transients passed over it. After the last of these, the ESR was in the polar cap and the radar observations were characterised by extremely low ionospheric densities and downward field-aligned flows. The IMF then turned northward again and the auroral oval contracted such that the ESR moved back into the cusp/cleft region. For the poleward-retreating, northward-IMF cusp/cleft, the convection flows were slower, upflows were weaker and the electron density and temperature enhancements were less structured. Following the northward turning, the bands of high electron temperature and cusp/cleft aurora bifurcated

  7. ESR and EISCAT observations of the response of the cusp and cleft to IMF orientation changes

    Directory of Open Access Journals (Sweden)

    I. W. McCrea

    Full Text Available We report observations of the cusp/cleft ionosphere made on December 16th 1998 by the EISCAT (European incoherent scatter VHF radar at Tromsø and the EISCAT Svalbard radar (ESR. We compare them with observations of the dayside auroral luminosity, as seen by meridian scanning photometers at Ny Ålesund and of HF radar backscatter, as observed by the CUTLASS radar. We study the response to an interval of about one hour when the interplanetary magnetic field (IMF, monitored by the WIND and ACE spacecraft, was southward. The cusp/cleft aurora is shown to correspond to a spatially extended region of elevated electron temperatures in the VHF radar data. Initial conditions were characterised by a northward-directed IMF and cusp/cleft aurora poleward of the ESR. A strong southward turning then occurred, causing an equatorward motion of the cusp/cleft aurora. Within the equatorward expanding, southward-IMF cusp/cleft, the ESR observed structured and elevated plasma densities and ion and electron temperatures. Cleft ion fountain upflows were seen in association with elevated ion temperatures and rapid eastward convection, consistent with the magnetic curvature force on newly opened field lines for the observed negative IMF By. Subsequently, the ESR beam remained immediately poleward of the main cusp/cleft and a sequence of poleward-moving auroral transients passed over it. After the last of these, the ESR was in the polar cap and the radar observations were characterised by extremely low ionospheric densities and downward field-aligned flows. The IMF then turned northward again and the auroral oval contracted such that the ESR moved back into the cusp/cleft region. For the poleward-retreating, northward-IMF cusp/cleft, the convection flows were slower, upflows were weaker and the electron density and temperature enhancements were less structured. Following the northward turning, the bands of high electron temperature and cusp

  8. A cusp supporting framework design can decrease critical stresses in veneered molar crowns.

    Science.gov (United States)

    Kirsten, Armin; Parkot, Daniel; Raith, Stefan; Fischer, Horst

    2014-03-01

    Veneered zirconia restorations predominately fail due to veneering fractures. It is hypothesized that a cusp-supporting framework design can prevent these catastrophic failures in all-ceramic restorations. Therefore, we investigated the influence of framework design and framework material on the stress distribution in a single tooth restoration using the numerical finite element method. A three-dimensional model of a veneered lower molar (36) crown with constant outer shape was used. The framework design was either cusp supporting or with a constant framework thickness. Zirconia, alumina, and a gold alloy were used as framework material. A glass ceramic material was used as veneering material for both cases. Two different load cases were simulated: terminal occlusion with load distributed over the occlusal surface of the tooth and a fairly extreme load case with all force concentrated on one cusp. Maximum tensile stresses in the glass ceramic veneering material concentrated in the fissure region for all models. A cusp supporting framework design decreased the maximum tensile stresses significantly up to 30.5%. The distolingual load case resulted in an approximately fourfold higher stress level compared to the terminal occlusion load case. A cusp supporting framework design can significantly decrease the maximum tensile stresses in the veneering material of single crowns. Based on the numerical results of this study it can be expected that such a design could decrease the risk of veneering failure in vivo. Copyright © 2013 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

  9. Some low-altitude cusp dependencies on the interplanetary magnetic field

    International Nuclear Information System (INIS)

    Newell, P.T.; Meng, C.; Sibeck, D.G.; Lepping, R.

    1989-01-01

    Although it has become well established that the low-altitude polar cusp moves equatorward during intervals of southward interplanetary magnetic field (IMF B z y negative (positive) in the northern (southern) hemisphere and postnoon for B y positive (negative) in the northern (southern) hemisphere. The B y induced shift is much more pronounced for southward than for northward B z , a result that appears to be consistent with elementary considerations from, for example, the antiparallel merging model. No interhemispherical latitudinal differences in cusp positions were found that could be attributed to the IMF B x component. As expected, the cusp latitudinal position correlated reasonably well (0.70) with B z when the IMF had a southward component; the previously much less investigated correlation for B z northward proved to be only 0.18, suggestive of a half-wave rectifier effect. The ratio of cusp ion number flux precipitation for B z southward to that for B z northward was 1.75±0.12. The statistical local time (full) width of the cusp proper was found to be 2.1 hours for B z northward and 2.8 hours for B z southward. copyright American Geophysical Union 1989

  10. A Collaborative Learning Network Approach to Improvement: The CUSP Learning Network.

    Science.gov (United States)

    Weaver, Sallie J; Lofthus, Jennifer; Sawyer, Melinda; Greer, Lee; Opett, Kristin; Reynolds, Catherine; Wyskiel, Rhonda; Peditto, Stephanie; Pronovost, Peter J

    2015-04-01

    Collaborative improvement networks draw on the science of collaborative organizational learning and communities of practice to facilitate peer-to-peer learning, coaching, and local adaption. Although significant improvements in patient safety and quality have been achieved through collaborative methods, insight regarding how collaborative networks are used by members is needed. Improvement Strategy: The Comprehensive Unit-based Safety Program (CUSP) Learning Network is a multi-institutional collaborative network that is designed to facilitate peer-to-peer learning and coaching specifically related to CUSP. Member organizations implement all or part of the CUSP methodology to improve organizational safety culture, patient safety, and care quality. Qualitative case studies developed by participating members examine the impact of network participation across three levels of analysis (unit, hospital, health system). In addition, results of a satisfaction survey designed to evaluate member experiences were collected to inform network development. Common themes across case studies suggest that members found value in collaborative learning and sharing strategies across organizational boundaries related to a specific improvement strategy. The CUSP Learning Network is an example of network-based collaborative learning in action. Although this learning network focuses on a particular improvement methodology-CUSP-there is clear potential for member-driven learning networks to grow around other methods or topic areas. Such collaborative learning networks may offer a way to develop an infrastructure for longer-term support of improvement efforts and to more quickly diffuse creative sustainment strategies.

  11. Impact of Aortic Insufficiency on Ascending Aortic Dilatation and Adverse Aortic Events After Isolated Aortic Valve Replacement in Patients With a Bicuspid Aortic Valve.

    Science.gov (United States)

    Wang, Yongshi; Wu, Boting; Li, Jun; Dong, Lili; Wang, Chunsheng; Shu, Xianhong

    2016-05-01

    Aberrant flow pattern and congenital fragility bestows bicuspid aortic valve (BAV) with a propensity toward ascending aorta dilatation, aneurysm, and dissection. Whether isolated aortic valve replacement (AVR) can prevent further dilatation in BAV ascending aorta and what indicates concurrent aortic intervention in the case of valve operation remain controversial. From June 2006 to January 2009, patients with a BAV who underwent isolated AVR were consecutively included and categorized into aortic insufficiency (BAV-AI, n = 84) and aortic stenosis (n = 112) groups, and another population of patients with a tricuspid aortic valve with aortic insufficiency (n = 149) was also recruited during the same period for comparison of annual aortic dilatation rate and adverse aortic events after isolated AVR. With a median follow-up period of 72 months (interquartile range, 66 to 78 months), ascending aorta dilatation rates were faster in the BAV-AI group than the BAV plus aortic stenosis and tricuspid aortic valve with aortic insufficiency groups (both p regression analysis identified aortic insufficiency (hazard ratio, 3.7; 95% confidence interval, 1.2 to 11.1; p = 0.019) as an independent risk factor for adverse aortic events among patients with BAV in general, whereas preoperative ascending aortic diameter larger than 45 mm (hazard ratio, 13.8; 95% confidence interval, 3.0 to 63.3; p = 0.001) served as a prognostic indicator in the BAV-AI group. An aggressive policy of preventive aortic interventions seemed appropriate in patients with BAV-AI during AVR, and BAV phenotype presenting as either insufficiency or stenosis should be taken into consideration when contemplating optimal surgical strategies for BAV aortopathy. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  12. Multi-lobed mesiodens with a palatal talon cusp: a rare case report.

    Science.gov (United States)

    Nagaveni, Nayaka Basavanthappa; Umashankara, Kagathur Veerbadrappa; Sreedevi; Reddy, Bokka Praveen; Radhika, Nayaka Basavanthappa; Satisha, Tirumala Suryaprakash

    2010-01-01

    Mesiodens is a midline supernumerary tooth commonly seen in the maxillary arch and the talon cusp is a rare dental developmental anomaly seen on the lingual surface of anterior teeth. This paper presents a rare clinical case of development of talon cusp in a mesiodens with multiple lobes, which interfered with both occlusion and appearance of an 11-year-old patient. During clinical interview, the patient reported difficulty on mastication. Clinical and radiographic examination revealed that a supernumerary tooth with completely formed root was causing an occlusal interference. The supernumerary tooth was diagnosed as multi-lobed mesiodens associated with a palatal talon cusp. The treatment plan consisted in the extraction of the supernumerary tooth followed by orthodontic treatment for diastema closure and tooth alignment.

  13. On the energy shift the ECC cusp. Does the shift really exist?

    International Nuclear Information System (INIS)

    Sarkadi, L.; Barrachina, R.O.

    2004-01-01

    The cusplike 'electron capture to the continuum' (ECC) peak appearing in the spectrum of the forward emitted electrons in ion-atom collisions are generally thought to be a divergence. Recently Shah et al., however, claimed that 'the ECC cusp is indeed a cusp, and not a divergence smoothed by the experiment'. These authors measured the ECC cusp for collisions of 10- and 20-keV protons with H 2 and He, and found that the peak was shifted to lower velocity than its expected position. We also carried out CTMC calculations (for the case of 20-keV protons on He) by which we demonstrated that the shift really exists but its value depends on the angular window of the electron detection. (K.A.)

  14. Studies of small-scale plasma inhomogeneities in the cusp ionosphere using sounding rocket data

    Science.gov (United States)

    Chernyshov, Alexander A.; Spicher, Andres; Ilyasov, Askar A.; Miloch, Wojciech J.; Clausen, Lasse B. N.; Saito, Yoshifumi; Jin, Yaqi; Moen, Jøran I.

    2018-04-01

    Microprocesses associated with plasma inhomogeneities are studied on the basis of data from the Investigation of Cusp Irregularities (ICI-3) sounding rocket. The ICI-3 rocket is devoted to investigating a reverse flow event in the cusp F region ionosphere. By numerical stability analysis, it is demonstrated that inhomogeneous-energy-density-driven (IEDD) instability can be a mechanism for the excitation of small-scale plasma inhomogeneities. The Local Intermittency Measure (LIM) method also applied the rocket data to analyze irregular structures of the electric field during rocket flight in the cusp. A qualitative agreement between high values of the growth rates of the IEDD instability and the regions with enhanced LIM is observed. This suggests that IEDD instability is connected to turbulent non-Gaussian processes.

  15. Achondroplasia with multiple supplemental supernumerary teeth and multiple talon cusps: A rare case report.

    Science.gov (United States)

    Raviraj, Jayam; Suman, Venkata; Suresh, Dirasantchu; Kartik, K

    2017-01-01

    Achondroplasia is the most common cause of dwarfism, which is inherited as an autosomal dominant disorder, caused by genetic mutation in fibroblast growth factor 3, leading to defective maturation of chondrocytes. It is known to be associated with various oral and dental manifestations such as delayed dental development, midfacial hypoplasia and constricted maxilla with a relatively large mandible, resulting in skeletal/dental Class III malocclusion, posterior crossbite, anterior reverse jet and anterior overbite. However, the association of achondroplasia with talon cusp and supernumerary teeth has never been reported in the literature. Wehereby reported a case of achondroplasia associated with such unusual findings. Moreover, all the three variants of talon cusp, i.e., "true talon,"semitalon" and "trace talon" are observed in the present case, which makes it a unique one. Further double talon cusps were noticed in the palatal aspect of maxillary central incisors.

  16. Residual and Progressive Aortic Regurgitation After Valve-Sparing Root Replacement: A Propensity-Matched Multi-Institutional Analysis in 764 Patients.

    Science.gov (United States)

    Kari, Fabian A; Doll, Kai-Nicolas; Hemmer, Wolfgang; Liebrich, Markus; Sievers, Hans-Hinrich; Richardt, Doreen; Reichenspurner, Hermann; Detter, Christian; Siepe, Matthias; Czerny, Martin; Beyersdorf, Friedhelm

    2016-04-01

    Residual/progressive aortic regurgitation (rAR, pAR) after valve-sparing aortic root replacement (V-SARR) can lead to reoperations. We sought to characterize risk factors of mild rAR and pAR after V-SARR in a multicenter cohort. The effect of additional cusp repair on valve function was analyzed using propensity matching. A total of 1,015 patients after V-SARR were identified with (n = 288, 28%) or without additional cusp/commissure repair (n = 727, 72%) at four cardiac units in Germany. A total of 764 patients fulfilling transthoracic echocardiography follow-up-criteria comprised the study cohort. Logistic regression was used for risk factor analysis with endpoints rAR, new onset AR, and pAR. t tests and analyses of variance were used for between-group differences. The effects of additional cusp repair on valve function were studied comparing propensity-matched quintiles. The incidence of rAR was 29%, with influencing factors aneurysm size (p = 0.07) and preoperative aortic valve function (p = 0.08). It was found more often among nonsyndromic patients (34% vs. 14%; OR, 0.4; p < 0.001). Progression of rAR was detectable in 30% after a mean of 4.3 years. The progression rate of rAR ∼ 0.3 grades per patient-year within the first 5 years. When quintiles identified by propensity score were compared, additional cusp repair was linked to new onset AR (p = 0.016) while it was not linked to rAR (p = 0.14) or pAR (p = 0.5). The incidences of rAR and pAR are considerable after V-SARR. Patients should be operated on before large aneurysms are present. New onset AR after an initially good functional result is more likely after an additional cusp repair, while rAR and pAR are not influenced by cusp repair. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  17. Transcatheter aortic valve implantation in bicuspid anatomy: procedural results with two different types of valves.

    Science.gov (United States)

    Presbitero, Patrizia; Iannetta, Loredana; Pagnotta, Paolo; Reimers, Bernhard; Rossi, Marco L; Zavalloni Parenti, Dennis; Bianchi, Giovanni; Bedogni, Francesco

    2018-04-01

    It is well known that bicuspid valve stenosis can be treated with transcatheter aortic valve implantation (TAVI) even if specific issues can cause problems: dilatation of ascending aorta, possible aorthopathy, eccentricity of the valve and calcium distribution in leaflets and in commissures. We classified Bicuspid aortic valve (BAV) in type 0 (2 cusps and no raphe), and type 1 (2 cusps and one or more raphes). The aim of the present study was to report the results of two types of valve (CoreValve from 2009 to 2016 and Lotus valve from 2014 to 2017) in a consecutive series of BAV patients treated in 2 Italian centers. A total of 30 patients with BAV underwent TAVI from September 2009 to March 2017. Mean age was 78±8 years, 54.5% were males and 7.4% had peripheral vasculopathy, 6.5% previous stroke or TIA, 15.6% previous PCI and 9.4% previous coronary artery bypass grafting. Ten patients (30.3%) had a type 1; mean aortic valvular gradient was 57.7±17.7 mmHg; aortic valvular area was 0.7±0.2 mm2, left ventricular ejection fraction was 51.4±10.0% and ascending aorta was 41.0±5.6 mm. Among these 30 patients, 16 of them (group 1) undergone CoreValve implantation and 14 (group 2) undergone Lotus valve implantation. Patients in the first group had a higher Logistic Euroscore (P<0.001) and higher AVA (P=0.026) and valve area CT (P=0.003). Device size in group1 was more often bigger than in group 2 (P<0.001) and postdilatation was never used in the last group. Group 1 had a significant more frequent aortic regurgitation ≥2 assessed with angiography (28.6% vs. 0%; P=0.05). A non-statistically significant higher rate of second valve implantation (6.2% vs. 0%; P=1.00) was also observed. New permanent pacemaker implantation (40.0% vs. 35.7%; P=0.812) was equal in both valves. Postprocedural aortic regurgitation is still an issue in BAV undergone TAVI when: 1) the annulus is big; 2) when we are using self-expandable valves; and 3) in type 0 valves. Lotus valve, with a

  18. Valve-Sparing Root Replacement Compared With Composite Valve Graft Procedures in Patients With Aortic Root Dilation.

    Science.gov (United States)

    Ouzounian, Maral; Rao, Vivek; Manlhiot, Cedric; Abraham, Nachum; David, Carolyn; Feindel, Christopher M; David, Tirone E

    2016-10-25

    Although aortic valve-sparing (AVS) operations are established alternatives to composite valve graft (CVG) procedures for patients with aortic root aneurysms, comparative long-term outcomes are lacking. This study sought to compare the results of patients undergoing AVS procedures with those undergoing CVG operations. From 1990 to 2010, a total of 616 patients age Marfan syndrome and lower rates of bicuspid aortic valve than those undergoing bio-CVG or m-CVG procedures. In-hospital mortality (0.3%) and stroke rate (1.3%) were similar among groups. After adjusting for clinical covariates, both bio-CVG and m-CVG procedures were associated with increased long-term major adverse valve-related events compared with patients undergoing AVS (hazard ratio [HR]: 3.4, p = 0.005; and HR: 5.2, p valve-related complications when compared with bio-CVG and m-CVG. AVS is the treatment of choice for young patients with aortic root aneurysm and normal or near-normal aortic cusps. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  19. Computed tomography of aortic wall calcifications in aortic dissection patients.

    Directory of Open Access Journals (Sweden)

    Pim A de Jong

    Full Text Available To investigate the frequency of aortic calcifications at the outer edge of the false lumen and the frequency of fully circular aortic calcifications in a consecutive series of patients with aortic dissection who underwent contrast-enhanced CT.The study population compromised of 69 consecutive subjects aged 60 years and older with a contrast-enhanced CT scan demonstrating an aortic dissection. All CT scans were evaluated for the frequency of aortic calcifications at the outer edge of the false lumen and the frequency of fully circular aortic calcifications by two experienced observers. Between observer reliability was evaluated by using Cohen's Kappa. Differences between groups were tested using unpaired T test and Chi-square test.Presumed media calcifications were observed in 22 (32% patients of 60 years and older and were found more frequently in chronic aortic dissection (N = 12/23, 52% than in acute aortic dissection (N = 10/46, 22%.As the intima has been torn away by the aortic dissection it is highly likely that CT scans can visualize the calcifications in the tunica media of the aorta.

  20. 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

  1. Acute Aortic Arch Perforation During Transcatheter Aortic Valve Replacement in Bicuspid Aortic Stenosis and a Gothic Aortic Arch.

    Science.gov (United States)

    Millan-Iturbe, Oscar; Sawaya, Fadi J; Bieliauskas, Gintautas; Chow, Danny H F; De Backer, Ole; Søndergaard, Lars

    2017-09-01

    Transcatheter aortic valve replacement (TAVR) has evolved from a novel technology to an established therapy for high/intermediate-risk patients with severe symptomatic aortic stenosis (AS). Although TAVR is used to treat bicuspid severe AS, the large randomized trials typically excluded bicuspid AS because of its unique anatomic features. This case report describes an acute aortic perforation during delivery of a transcatheter heart valve to treat a severe bicuspid AS with a "gothic aortic arch"; more careful evaluation of the preprocedural multislice computed tomographic scan would have unveiled a sharply angulated aortic arch. This life-threatening complication was successfully treated by thoracic endovascular aortic repair. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  2. Cusp anomalous dimension and rotating open strings in AdS/CFT

    Science.gov (United States)

    Espíndola, R.; García, J. Antonio

    2018-03-01

    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.

  3. 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 propagating parallel to the magnetic

  4. 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

  5. IMF By-Related Cusp Currents Observed from the Ørsted Satellite and from Ground

    DEFF Research Database (Denmark)

    Stauning, P.; Primdahl, Fritz; Watermann, J.

    2001-01-01

    Orsted is the first satellite to conduct high-precision magnetometer observations from low-altitude noonmidnight orbits passing through the polar cusp regions. Field-aligned currents (FAC) derived from Orsted magnetic field measurements have been combined with ionospheric current patterns inferred...... statistical analysis defines for the noon region the variations in FAC latitude with IMF B-Z. Comparisons with the statistical cusp location indicate that the more equatorward region of IMF B-gamma-while the more B related FAC is located on field lines closing at the dayside poleward FAC are on "open" field...

  6. 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

  7. PROGRESSION OF AORTIC AND VALVULAR HEART DISEASES IN PATIENTS WITH ANKYLOSING SPONDYLITIS

    Directory of Open Access Journals (Sweden)

    A. A. Godzenko

    2017-01-01

    Full Text Available Involvement of the aorta and heart valves in ankylosing spondylitis (AS is a manifestation of the systemic inflammatory process. Data on the frequency, clinical significance, and evolution of these manifestations are controversial.Objective: to estimate the time course of echocardiographic (EchoCG changes in the aorta and heart valves from the results of a prospective follow-up study of patients with AS.Subjects and methods. In 2008 to 2015, the V.A. Nasonova Research Institute of Rheumatology followed up 45 patients (35 men and 10 women with documented AS that was consistent with the modified New York criteria and the original EchoCG changes in the aorta and heart valves. All the patients underwent transthoracic echocardiography at baseline and after 1–5 years. At baseline, there was aortic root dilatation (>37 mm in 15 patients, thickening of the aortic walls and aortic valve (AV cusps in 21 and 32 patients, respectively, as well as thickening of the mitral valve (MV cusps in 15, and valve prostheses in 5 patients (2 had AV and MV prostheses. Aortic regurgitation (AR was recorded in 19 patients (grades 1–2 AR in 15 patients and grades 3–4 in 4 patients; grades 1–2 mitral regurgitation (MR was seen in 20 patients. Ten patients had subaortic pectinate thickening (SPT in the aortomitral junction area. Of the 45 patients, 16 took biological agents (BA; 29 received traditional therapy, including 14 patients who used nonsteroidal anti-inflammatory drugs, 11 and 4 patients had sulfasalazine and methotrexate, respectively.Results and discussion.Repeated examinations revealed negative changes in 27 (60% of the 45 patients. Progressive aortic dilatation (1 to 6 mm was found in 12 (80% of the 15 patients; dilatation appeared during follow-up in 2 patients. Fourteen patients were noted to have negative valve changes: the emergence of cusp thickening in the valves (that in AV and MV in 9 and 4 patients, respectively; both in 1 patient

  8. A randomized clinical trial of cusp-replacing resin composite restorations: efficiency and short-term effectiveness.

    NARCIS (Netherlands)

    Kuijs, R.H.; Fennis, W.M.M.; Kreulen, C.M.; Roeters, F.J.M.; Creugers, N.H.J.; Burgersdijk, R.C.W.

    2006-01-01

    PURPOSE: This study aimed to assess the efficacy and short-term effectiveness of the morphology and function of direct and indirect cusp-replacing resin composite restorations. MATERIALS AND METHODS: In 94 patients, 106 cusp-replacing restorations for maxillary premolars were fabricated to restore

  9. Incremental value of three-dimensional transesophageal echocardiography over two-dimensional transesophageal echocardiography in the assessment of Lambl's excrescences and nodules of Arantius on the aortic valve.

    Science.gov (United States)

    Dumaswala, Bhavin; Dumaswala, Komal; Hsiung, Ming Chon; Quiroz, Luis David Meggo; Sungur, Aylin; Escanuela, Maximilliano German Amado; Mehta, Kruti; Oz, Tugba Kemaloglu; Bhagatwala, Kunal; Karia, Nidhi M; Nanda, Navin C

    2013-09-01

    In this retrospective study, we identified 7 cases where Lambl's excrescences were identified by two-dimensional transesophageal echocardiography (2DTEE) and also had live/real time three-dimensional transesophageal echocardiography (3DTEE) studies available for comparison. We subsequently assessed them for the presence of Lambl's excrescences (LE) and nodules of Arantius (NA) on the aortic valve. After their identification, we qualitatively and quantitatively organized our findings by number, cusp location, measurements, and orientation if applicable. A greater number of LE was found by 3DTEE than 2DTEE (19 vs. 11, respectively). In all 3DTEE studies, their cusp attachment site, their x-, y-, and z-axis measurements, and orientation were clearly visualized and described. Only 3DTEE studies provided confident visualization of the cusp attachment sites. Similarly, a greater number of NA was found by 3DTEE than 2DTEE (21 vs. 5, respectively). The triad of NA was visualized in all 3DTEE studies and each was described using its x-, y-, and z- axis measurements. Only three 2DTEE studies provided reliable identification of the NA. In conclusion, we present further evidence of the incremental value of 3DTEE over 2DTEE in the qualitative and quantitative assessment of cardiac structures including LE and NA on the aortic valve. © 2013, Wiley Periodicals, Inc.

  10. 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...... ("particle cusp") and intense small-scale magnetic field variations ("current cusp"), respectively, were identical and were consistent with the statistically expected latitude of the cusp derived from a huge number of charged particle spectrograms ("statistical cusp"). The geocentric coordinates...... 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...

  11. Hypoplasia of the aortic arch

    Directory of Open Access Journals (Sweden)

    Ю. С. Синельников

    2015-10-01

    Full Text Available An aggressive surgical approach to early repair of aortic coarctation and concomitant arch hypoplasia results in considerable improvement of the long-term outcomes of surgical treatment by reducing the number of aortic re-coarctation and arterial hypertension persistence events. At present, there exist some methods of determining the degree of aortic arch hypoplasia, which allow for arch reconstruction planning. Our review focuses on the analysis of modern methods of determination of the aortic arch hypoplasia and the outcomes of surgical treatment of this disease.

  12. Orthotopic replacement of aortic heart valves with tissue-engineered grafts.

    Science.gov (United States)

    Tudorache, Igor; Calistru, Alex; Baraki, Hassina; Meyer, Tanja; Höffler, Klaus; Sarikouch, Samir; Bara, Christopher; Görler, Adelheid; Hartung, Dagmar; Hilfiker, Andres; Haverich, Axel; Cebotari, Serghei

    2013-08-01

    Heart valve tissue engineering aims to create a graft with improved durability compared to routinely used valve substitutes. This study presents the function and morphological changes of a tissue-engineered aortic valve (TEV) compared to the cryopreserved valve (CPV), aortic valve (AV) allografts in an orthotopic position in sheep. Ovine AV conduits (n=5) were decellularized with detergents. Autologous endothelial cells (ECs) were seeded onto the valve surface and cultured under physiological conditions using a high pulsatile flow. Grafts were implanted as a root with reimplantation of coronary ostia in sheep. Crystalloid cardioplegia and isogenic blood transfusions from previous sacrificed sheep were used. Only antiplatelet aggregation therapy was used postoperatively. CPVs (n=4) served as controls. The grafts were investigated for function (echocardiography, magnetic resonance investigation), morpho/histological appearance, graft rejection, and calcification at 3 months. Decellularization led to cell-free scaffolds with preserved extracellular matrices, including the basement membrane. TEVs were covered with ECs expressing typical endothelial markers. Neither dilatation, stenosis, reductions of cusp mobility nor a significant transvalvular gradient, were observed in the TEV group. Explanted valves exhibited normal morphology without signs of inflammation. An endothelial monolayer covered cusps and the valve sinus. In the CPV group, sporadic, macroscopic, calcified degeneration with mild AV insufficiency was noted. Histology revealed signs of rejection and incipient calcification of the tissue. Tissue-engineered AV based on decellularized valve allografts satisfy short-term requirements of the systemic circulation in sheep. Although results of long-term experiments are pending, the lack of degenerative traits thus far, makes these grafts a promising alternative for future aortic heart valve surgery.

  13. 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.

  14. Optimal C-arm angulation during transcatheter aortic valve replacement: Accuracy of a rotational C-arm computed tomography based three dimensional heart model.

    Science.gov (United States)

    Veulemans, Verena; Mollus, Sabine; Saalbach, Axel; Pietsch, Max; Hellhammer, Katharina; Zeus, Tobias; Westenfeld, Ralf; Weese, Jürgen; Kelm, Malte; Balzer, Jan

    2016-10-26

    To investigate the accuracy of a rotational C-arm CT-based 3D heart model to predict an optimal C-arm configuration during transcatheter aortic valve replacement (TAVR). Rotational C-arm CT (RCT) under rapid ventricular pacing was performed in 57 consecutive patients with severe aortic stenosis as part of the pre-procedural cardiac catheterization. With prototype software each RCT data set was segmented using a 3D heart model. From that the line of perpendicularity curve was obtained that generates a perpendicular view of the aortic annulus according to the right-cusp rule. To evaluate the accuracy of a model-based overlay we compared model- and expert-derived aortic root diameters. For all 57 patients in the RCT cohort diameter measurements were obtained from two independent operators and were compared to the model-based measurements. The inter-observer variability was measured to be in the range of 0°-12.96° of angular C-arm displacement for two independent operators. The model-to-operator agreement was 0°-13.82°. The model-based and expert measurements of aortic root diameters evaluated at the aortic annulus ( r = 0.79, P optimal C-arm configuration, potentially simplifying current clinical workflows before and during TAVR.

  15. Reimplantation valve-sparing aortic root replacement in Marfan syndrome using the Valsalva conduit: an intercontinental multicenter study.

    Science.gov (United States)

    Settepani, Fabrizio; Szeto, Wilson Y; Pacini, Davide; De Paulis, Ruggero; Chiariello, Luigi; Di Bartolomeo, Roberto; Gallotti, Roberto; Bavaria, Joseph E

    2007-02-01

    Introduced by DePaulis in 2000, the Gelweave Valsalva graft (Sulzer Vascutek, Refrewshire, Scotland) is a modified Dacron conduit (DuPont, Wilmington, DE), with prefashioned sinuses of Valsalva. The aim of this study was to evaluate the mid-term results of the reimplantation valve-sparing aortic root replacement using the Gelweave Valsalva prosthesis in Marfan syndrome patients. A retrospective review was performed of 35 patients with Marfan syndrome in four centers who underwent the reimplantation valve-sparing aortic root replacement using the Gelweave Valsalva prosthesis. The patients were predominantly men, with a mean age of 36.5 +/- 12.6 years (range, 14 to 62 years). Two patients presented with acute type A dissections and underwent emergent operations. Elective hemiarch reconstruction using hypothermic circulatory arrest was required in 11 patients. Aortic valve cusp repair was performed in 2 patients. There were no operative or hospital deaths, and no patients died during follow-up. The mean follow-up was 19 months (range, 1 to 60 months). Significant (>2+) aortic insufficiency (AI), requiring aortic valve replacement, developed in 3 patients during follow-up that requiring aortic valve replacement. The 5-year freedom from reoperation owing to structural valve deterioration was 88.9% +/- 8.1%. There were no episodes of clinically significant thromboembolism. Reimplantation valve-sparing aortic root replacement with the Gelweave Valsalva prosthesis in Marfan patients provides satisfactory mid-term results, thus encouraging further use of this type of repair. However, long-term results are needed in order to define the durability of this technique.

  16. 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

  17. Diamagnetic depression observations at Saturn's magnetospheric cusp by the Cassini spacecraft

    Science.gov (United States)

    Jasinski, Jamie M.; Arridge, Christopher S.; Coates, Andrew J.; Jones, Geraint H.; Sergis, Nick; Thomsen, Michelle F.; Krupp, Norbert

    2017-06-01

    The magnetospheric cusp is a region where shocked solar wind plasma can enter a planetary magnetosphere, after magnetic reconnection has occurred at the dayside magnetopause or in the lobes. The dense plasma that enters the high-latitude magnetosphere creates diamagnetic effects whereby a depression is observed in the magnetic field. We present observations of the cusp events at Saturn's magnetosphere where these diamagnetic depressions are found. The data are subtracted from a magnetic field model, and the calculated magnetic pressure deficits are compared to the particle pressures. A high plasma pressure layer in the magnetosphere adjacent to the cusp is discovered to also depress the magnetic field, outside of the cusp. This layer is observed to contain energetic He++ (up to ˜100 keV) from the solar wind as well as heavy water group ions (W+) originating from the moon Enceladus. We also find a modest correlation of diamagnetic depression strength to solar wind dynamic pressure and velocity; however, unlike at Earth, there is no correlation found with He++ counts.

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

    Energy Technology Data Exchange (ETDEWEB)

    Radics, B., E-mail: balint.radics@cern.ch [ETH Zürich, Institute for Particle Physics (Switzerland); Ishikawa, S.; Kuroda, N. [University of Tokyo, Institute of Physics, Graduate School of Arts and Sciences (Japan); Murtagh, D. J.; Nagata, Y. [RIKEN, Atomic Physics Laboratory (Japan); Tajima, M. [University of Tokyo, Institute of Physics, Graduate School of Arts and Sciences (Japan); Gorp, S. Van [RIKEN, Atomic Physics Laboratory (Japan); Abo, Y. [Hiroshima University, Graduate School of Advanced Sciences of Matter (Japan); Dupre, P. [RIKEN, Atomic Physics Laboratory (Japan); Higashi, Y. [University of Tokyo, Institute of Physics, Graduate School of Arts and Sciences (Japan); Kaga, C. [Hiroshima University, Graduate School of Advanced Sciences of Matter (Japan); Leali, M.; Mascagna, V.; Venturelli, L.; Zurlo, N. [Universita di Brescia, Dipartimento di Ingegneria dell Informazione (Italy); Breuker, H. [CERN (Switzerland); Higaki, H. [Hiroshima University, Graduate School of Advanced Sciences of Matter (Japan); Kanai, Y. [RIKEN, Atomic Physics Laboratory (Japan); Rizzini, E. Lodi [Universita di Brescia, Dipartimento di Ingegneria dell Informazione (Italy); Matsuda, Y. [University of Tokyo, Institute of Physics, Graduate School of Arts and Sciences (Japan); and others

    2016-12-15

    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.

  19. Cusp catastrophe models for cognitive workload and fatigue in a verbally cued pictorial memory task.

    Science.gov (United States)

    Guastello, Stephen J; Boeh, Henry; Schimmels, Michael; Gorin, Hillary; Huschen, Samuel; Davis, Erin; Peters, Natalie E; Fabisch, Megan; Poston, Kirsten

    2012-10-01

    The aim of this study was to evaluate two cusp catastrophe models for cognitive workload and fatigue. They share similar cubic polynomial structures but derive from different underlying processes and contain variables that contribute to flexibility with respect to load and the ability to compensate for fatigue. Cognitive workload and fatigue both have a negative impact on performance and have been difficult to separate. Extended time on task can produce fatigue, but it can also produce a positive effect from learning or automaticity. In this two-part experiment, 129 undergraduates performed tasks involving spelling, arithmetic, memory, and visual search. The fatigue cusp for the central memory task was supported with the quantity of work performed and performance on an episodic memory task acting as the control parameters. There was a strong linear effect, however. The load manipulations for the central task were competition with another participant for rewards, incentive conditions, and time pressure. Results supported the workload cusp in which trait anxiety and the incentive manipulation acted as the control parameters. The cusps are generally better than linear models for analyzing workload and fatigue phenomena; practice effects can override fatigue. Future research should investigate multitasking and task sequencing issues, physical-cognitive task combinations, and a broader range of variables that contribute to flexibility with respect to load or compensate for fatigue. The new experimental medium and analytic strategy can be generalized to virtually any real-world cognitively demanding tasks. The particular results are generalizable to tasks involving visual search.

  20. 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.

  1. 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.

  2. 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.

  3. Spectral estimates for Dirichlet Laplacians and Schrodinger operators on geometrically nontrivial cusps

    Czech Academy of Sciences Publication Activity Database

    Exner, Pavel; Barseghyan, Diana

    2013-01-01

    Roč. 3, č. 4 (2013), s. 465-484 ISSN 1664-039X R&D Projects: GA ČR GAP203/11/0701 Institutional support: RVO:61389005 Keywords : Dirichlet Laplacian * cusp-shaped region * Lieb-Thirring inequalities * bending and twisting Subject RIV: BE - Theoretical Physics

  4. Cusp anomalous dimension in maximally supersymmetric Yang-Mills theory at strong coupling.

    Science.gov (United States)

    Basso, B; Korchemsky, G P; Kotański, J

    2008-03-07

    We construct an analytical solution to the integral equation which is believed to describe logarithmic growth of the anomalous dimensions of high-spin operators in planar N=4 super Yang-Mills theory and use it to determine the strong coupling expansion of the cusp anomalous dimension.

  5. Further analysis of mandibular molar crown and cusp areas in Pliocene and early Pleistocene hominids.

    Science.gov (United States)

    Suwa, G; Wood, B A; White, T D

    1994-04-01

    Crown and cusp areas of mandibular molars were measured and analyzed on a sample of 249 specimens attributed to Australopithecus afarensis, A. africanus, A. (Paranthropus) robustus, A. (P.) boisei, and early Homo. In addition to intertaxon comparisons, we compared data that had been collected independently by two of the authors using methods that differ slightly in technique of measurement. Interobserver differences were evaluated by the t-test of paired comparisons, method error statistic, percent differences, and principal component analysis. Results suggest that between-technique error of measurement of overall crown area is small. Error estimates for individual cusp area measurements were of larger relative magnitude. However, these were not sufficient to detract from the conclusions derived from comparative analyses. Our results are in general agreement with previous assessments of early hominid dental size. Crown areas of A. africanus, however, exhibit a mosaic pattern, with M1 similar in size to that of A. afarensis and early Homo, and M2 and M3 similar in size to that of A. robustus. Intertaxon comparisons of relative cusp area were undertaken by univariate statistics and principal component analysis. These analyses revealed that while A. (P.) robustus and A. (P.) boisei both possess mandibular molars with cusp proportions significantly different from the 'non-robust' taxa, these differences are substantially greater in A. (P.) boisei.

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

    Czech Academy of Sciences Publication Activity Database

    Taylor, M. G. G. T.; Fazakerley, A. N.; Krauklis, I. C.; Owen, C.; Trávníček, Pavel; Dunlop, M. W.; Carter, P. J.; Coates, A. J.; Szita, S.; Watson, G.; Wilson, R. J.

    2001-01-01

    Roč. 19, - (2001), s. 1567-1578 ISSN 0992-7689 Grant - others:European Space Agency - Prodex(XE) IMF CS/SFe/571/2000 Institutional research plan: CEZ:AV0Z3042911 Keywords : magnetospheric physics * magnetopause * cusp and boundary layers Subject RIV: BE - Theoretical Physics Impact factor: 1.199, year: 2001

  7. On the Cusp of Cyberspace: Adolescents' Online Text Use in Conversation

    Science.gov (United States)

    Berg, Margaret A.

    2011-01-01

    This discourse analysis study examines the use of online texts in the live conversations of adolescents at and around computers in the Young Adult section of a Midwestern public library serving a diverse SES population. On the cusp of cyberspace, where online texts influence conversation and the conversation influences the creation of online…

  8. Taurodontism in association with the cusp of carabelli: a report of 2 ...

    African Journals Online (AJOL)

    The aetiology of both anomalies is not entirely clear, however, both genetic and exogenous factors have been proposed. There are recent reports that mutation of some chromosomes could be a cause of taurodontism. Taurodontism has been reported along with talon cusp, dens evaginatus and some Syndromes.

  9. Spindle-cusp confinement properties of laser-produced plasma in a low-beta regime

    Energy Technology Data Exchange (ETDEWEB)

    Yoshino, R.; Sekiguchi, T. (Tokyo Univ. (Japan). Faculty of Engineering); Sato, K.

    1981-06-01

    Behavior of a spindle-cusp plasma produced at its central null-field point from a thin wire target by laser pulse is experimentally studied, mainly in a low plasma-beta regime, by means of many different plasma diagnostics. As the results, somewhat queer confinement properties have been found, and some considerations are given for the observed results.

  10. 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.

  11. Impact of cusp inclinations on dental fractures in cracked tooth syndrome model and relevant risk evaluation.

    Science.gov (United States)

    Xie, Nina; Wang, Penglai; Wu, Cui; Song, Wenting; Wang, Wen; Liu, Zongxiang

    2017-12-01

    We explored the impact of cusp inclinations on dental fractures in cracked tooth syndrome model and formulated corresponding risk scale. Forty maxillary premolars were randomized into four groups for cusp inclination measurements by digital radiovisiography (RVG). For cracked tooth models, buccal and palatal cusp inclinations were achieved by grinding in groups I (59°-50°), II (64°-55°) and III (69°-60°), with group IV as blank control. All groups underwent compression loading test, with fracture levels recorded for statistical analysis. The fracture modes included a majority of crown root fractures and a minority of crown fractures in groups I and II, exclusive crown root fractures in group III, and exclusive crown fractures in group IV. Overall, palatal fractures were predominant versus buccal fractures, with exclusive palatal fractures in group IV, and oblique fractures were overwhelming versus the scanty vertical fractures. Fracture risk classification: grade III was prevalent in groups I and II, grade IV in group III, and grades I and II in group IV only. The fracture risk scores in groups III and IV had significant statistical differences versus groups I and II (P0.05). Cracked teeth are more vulnerable to complex fractures, with increment of cusp inclinations contributable to complex fracture modes, involving deep roots and high risk scores.

  12. Effects of cusped field thruster on the performance of drag-free control system

    Science.gov (United States)

    Cui, K.; Liu, H.; Jiang, W. J.; Sun, Q. Q.; Hu, P.; Yu, D. R.

    2018-03-01

    With increased measurement tasks of space science, more requirements for the spacecraft environment have been put forward. Those tasks (e.g. the measurement of Earth's steady state gravity field anomalies) lead to the desire for developing drag-free control. Higher requirements for the thruster performance are made due to the demand for the drag-free control system and real-time compensation for non-conservative forces. Those requirements for the propulsion system include wide continuous throttling ability, high resolution, rapid response, low noise and so on. As a promising candidate, the cusped field thruster has features such as the high working stability, the low erosion rate, a long lifetime and the simple structure, so that it is chosen as the thruster to be discussed in this paper. Firstly, the performance of a new cusped field thruster is tested and analyzed. Then a drag-free control scheme based on the cusped field thruster is designed to evaluate the performance of this thruster. Subsequently, the effects of the thrust resolution, transient response time and thrust uncertainty on the controller are calculated respectively. Finally, the performance of closed-loop system is analyzed, and the simulation results verify the feasibility of applying cusped field thruster to drag-free flight in the space science measurement tasks.

  13. Modeling transverse heating and outflow of ionospheric ions from the dayside cusp/cleft. 2 Applications

    Directory of Open Access Journals (Sweden)

    M. Bouhram

    2003-08-01

    Full Text Available In this paper, we consider major ion energization mechanisms in the dayside cusp/cleft region. This includes transverse ion heating by ion cyclotron resonance (ICR, ion energization through structures of field-aligned electric potential drops, and transverse heating by lower hybrid (LH waves. First, we present and discuss three typical cusp/cleft crossings associated with one of the first two mechanisms mentioned above. Then, we develop a procedure for finding the altitude dependence of ICR heating for any data set in the high-altitude cusp/cleft under the absence of field-aligned potential drops. This has been accomplished using a large set of numerical simulations from a two-dimensional, steady-state, Monte Carlo, trajectory-based code, as discussed in detail in the first companion paper (Bouhram et al., 2003. The procedure is applied and tested successfully for the first two events, by using patterns of ion moments along the satellite track as constraints. Then, we present a statistical study that uses 25 cusp/cleft crossings associated with steady IMF conditions, where ICR heating is expected to occur alone. It is pointed out that the ICR heating increases gradually versus geocentric distance as s 3.3 ± 1.8 . The inferred values of the wave power and the spectral index associated with the component responsible for ICR heating are lower than those characterizing the broad-band, extremely low-frequency (BBELF turbulence usually observed in the cusp/cleft. This strengthens the idea that more than one wave-mode is contained in the BBELF turbulence, and only a small fraction of the observed turbulence is responsible for ICR heating. Then, we study the occurrence versus magnetic local time (MLT of field-aligned potential drops. According to previous statistical studies, such structures are not common in the cusp and tend to be associated with the cleft region. We also discuss the effects of LH heating in the cusp on the observed ion distributions

  14. Acute Aortic Arch Perforation During Transcatheter Aortic Valve Replacement in Bicuspid Aortic Stenosis and a Gothic Aortic Arch

    DEFF Research Database (Denmark)

    Millan-Iturbe, Oscar; Sawaya, Fadi J.; Bieliauskas, Gintautas

    2017-01-01

    AS because of its unique anatomic features. This case report describes an acute aortic perforation during delivery of a transcatheter heart valve to treat a severe bicuspid AS with a “gothic aortic arch”; more careful evaluation of the preprocedural multislice computed tomographic scan would have unveiled...

  15. A general three-dimensional parametric geometry of the native aortic valve and root for biomechanical modeling.

    Science.gov (United States)

    Haj-Ali, Rami; Marom, Gil; Ben Zekry, Sagit; Rosenfeld, Moshe; Raanani, Ehud

    2012-09-21

    The complex three-dimensional (3D) geometry of the native tricuspid aortic valve (AV) is represented by select parametric curves allowing for a general construction and representation of the 3D-AV structure including the cusps, commissures and sinuses. The proposed general mathematical description is performed by using three independent parametric curves, two for the cusp and one for the sinuses. These curves are used to generate different surfaces that form the structure of the AV. Additional dependent curves are also generated and utilized in this process, such as the joint curve between the cusps and the sinuses. The model's feasibility to generate patient-specific parametric geometry is examined against 3D-transesophageal echocardiogram (3D-TEE) measurements from a non-pathological AV. Computational finite-element (FE) mesh can then be easily constructed from these surfaces. Examples are given for constructing several 3D-AV geometries by estimating the needed parameters from echocardiographic measurements. The average distance (error) between the calculated geometry and the 3D-TEE measurements was only 0.78±0.63mm. The proposed general 3D parametric method is very effective in quantitatively representing a wide range of native AV structures, with and without pathology. It can also facilitate a methodical quantitative investigation over the effect of pathology and mechanical loading on these major AV parameters. Copyright © 2012 Elsevier Ltd. All rights reserved.

  16. Low and middle altitude cusp particle signatures for general magnetopause reconnection rate variations. 1: Theory

    Science.gov (United States)

    Lockwood, M.; Smith, M. F.

    1994-01-01

    We present predictions of the signatures of magnetosheath particle precipitation (in the regions classified as open low-latitude boundary layer, cusp, mantle and polar cap) for periods when the interplanetary magnetic field has a southward component. These are made using the 'pulsating cusp' model of the effects of time-varying magnetic reconnection at the dayside magnetopause. Predictions are made for both low-altitude satellites in the topside ionosphere and for midaltitude spacecraft in the magnetosphere. Low-altitude cusp signatures, which show a continuous ion dispersion signature, reveal 'quasi-steady reconnection' (one limit of the pulsating cusp model), which persists for a period of at least 10 min. We estimate that 'quasi-steady' in this context corresponds to fluctuations in the reconnection rate of a factor of 2 or less. The other limit of the pulsating cusp model explains the instantaneous jumps in the precipitating ion spectrum that have been observed at low altitudes. Such jumps are produced by isolated pulses of reconnection: that is, they are separated by intervals when the reconnection rate is zero. These also generate convecting patches on the magnetopause in which the field lines thread the boundary via a rotational discontinuity separated by more extensive regions of tangential discontinuity. Predictions of the corresponding ion precipitation signatures seen by midaltitude spacecraft are presented. We resolve the apparent contradiction between estimates of the width of the injection region from midaltitude data and the concept of continuous entry of solar wind plasma along open field lines. In addition, we reevaluate the use of pitch angle-energy dispersion to estimate the injection distance.

  17. Under the sword of Damocles: plausible regeneration of dark matter cusps at the smallest galactic scales

    Science.gov (United States)

    Laporte, Chervin F. P.; Peñarrubia, Jorge

    2015-04-01

    We study the evolution of the dark matter (DM) halo profiles of dwarf galaxies driven by the accretion of DM substructures through controlled N-body experiments. Our initial conditions assume that early supernova feedback erases the primordial DM cusps of haloes with z = 0 masses of 109 - 1010 M⊙. The orbits and masses of the infalling substructures are borrowed from the Aquarius cosmological simulations. Our experiments show that a fraction of haloes that undergo 1:3 down to 1:30 mergers are susceptible to reform a DM cusp by z ≈ 0. Cusp regrowth is driven by the accretion of DM substructures that are dense enough to reach the central regions of the main halo before being tidally disrupted. The infall of substructures on the mean of the reported mass-concentration relation and a mass ratio above 1:6 systematically leads to cusp regrowth. Substructures with 1:6-1:8, and 1:8-1:30 only reform DM cusps if their densities are 1σ and 2σ above the mean, respectively. The merging time-scales of these dense, low-mass substructures is relatively long (5 - 11 Gyr), which may pose a time-scale problem for the longevity of DM cores in dwarfs galaxies and possibly explain the existence of dense dwarfs-like Draco. These results suggest that within cold dark matter a non-negligible level of scatter in the mass profiles of galactic haloes acted on by feedback is to be expected given the stochastic mass accretion histories of low-mass haloes and the diverse star formation histories observed in the Local Group dwarfs.

  18. 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

  19. Acute Type II Aortic Dissection with Severe Aortic Regurgitation and Chronic Descending Aortic Dissection in Pregnant Patient with Marfan Syndrome.

    Science.gov (United States)

    Lee, Seok-Soo; Jung, Tae-Eun; Lee, Dong Hyup

    2012-12-01

    Aortic dilatation and dissection are severe complications during pregnancy that can be fatal to both the mother and the fetus. The risks of these complications are especially high in pregnant patients with Marfan syndrome; however, incidents of descending aortic dissection are very rare. This case report involves a successful Bentall procedure for and recovery from a rare aortic dissection in a pregnant Marfan patient who developed acute type II aortic dissection with severe aortic regurgitation and chronic descending aortic dissection immediately after Cesarean section. Regular follow-up will be needed to monitor the descending aortic dissection.

  20. 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...... operations were completed as mini-sternotomies, 4 died later of noncardiac causes. The aortic cross-clamp and perfusion times were significantly different across all groups (P replacement...... 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...

  1. Posttraumatic abdominal aortic dissection

    International Nuclear Information System (INIS)

    Hahmann, M.; Richter, G.M.; Kauffmann, G.W.; Schuhmacher, H.; Allenberg, J.R.

    2001-01-01

    Dissections due to deceleration trauma are rarely limited to the infradiaphragmal aorta (only 2-3%) and are usually lethal. Here we report the unusual course of an abdominal aortic dissection with aneurysmatic enlargement of the false lumen. Based on diagnostic imaging, a therapeutic stent application was planed in order to close the entry and to prevent rupture. During the intervention sondation of the false lumen revealed that the left renal artery had a reentry. Due to the complexity of the entry - reentry situation of the left renal artery the intervention was not possible, and the patient had to undergo vascular surgery. (orig.) [de

  2. 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....

  3. Abdominal Aortic Emergencies.

    Science.gov (United States)

    Lech, Christie; Swaminathan, Anand

    2017-11-01

    This article discusses abdominal aortic emergencies. There is a common thread of risk factors and causes of these diseases, including age, male gender, hypertension, dyslipidemia, and connective tissue disorders. The most common presenting symptom of these disorders is pain, usually in the chest, flank, abdomen, or back. Computed tomography scan is the gold standard for diagnosis of pathologic conditions of the aorta in the hemodynamically stable patient. Treatment consists of a combination of blood pressure and heart rate control and, in many cases, emergent surgical intervention. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Valve-sparing root replacement in children with aortic root aneurysm: mid-term results.

    Science.gov (United States)

    Lange, Rüdiger; Badiu, Catalin C; Vogt, Manfred; Voss, Bernhard; Hörer, Jürgen; Prodan, Zsolt; Schreiber, Christian; Mazzitelli, Domenico

    2013-05-01

    We aimed at evaluating the results of aortic valve-sparing root replacement (AVSRR) in children with aortic root aneurysm (ARA) due to genetic disorders in terms of mortality, reoperation and recurrent aortic valve regurgitation (AVR). Thirteen patients (mean age 9.7 ± 6.5 years, 10 months-18 years) underwent AVSRR for ARA between 2002 and 2011. Six of the 13 patients had Marfan syndrome, 3 Loeys-Dietz syndrome (LDS), 2 bicuspid aortic valve syndrome and 2 an unspecified connective tissue disorder. AVR was graded as none/trace, mild and severe in 5, 7 and 1 patient, respectively. The mean pre-operative root diameter was 45 ± 10 mm (mean Z-score 10.3 ± 2.0). Remodelling of the aortic root was performed in 4 patients, reimplantation of the aortic valve in 9 and a concomitant cusp repair in 4. The diameter of the prostheses used for root replacement varied from 22 to 30 mm (mean Z-score = 2.3 ± 3). The follow-up was 100% complete with a mean follow-up time of 3.7 years. There was no operative mortality. One patient with LDS died 2.5 years after the operation due to spontaneous rupture of the descending aorta. Root re-replacement with mechanical conduit was necessary in 1 patient for severe recurrent AVR 8 days after remodelling of the aortic root. At final follow-up, AVR was graded as none/trace and mild in all patients. Eleven patients presented in New York Heart Association functional Class I and 1 in Class II. In paediatric patients with ARA, valve-sparing root replacement can be performed with low operative risk and excellent mid-term valve durability. Hence, prosthetic valve-related morbidity may be avoided. Due to the large diameters of the aortic root and the ascending aorta, the size of the implanted root prostheses will not limit later growth of the native aorta.

  5. Acute Type II Aortic Dissection with Severe Aortic Regurgitation and Chronic Descending Aortic Dissection in Pregnant Patient with Marfan Syndrome

    OpenAIRE

    Lee, Seok-Soo; Jung, Tae-Eun; Lee, Dong Hyup

    2012-01-01

    Aortic dilatation and dissection are severe complications during pregnancy that can be fatal to both the mother and the fetus. The risks of these complications are especially high in pregnant patients with Marfan syndrome; however, incidents of descending aortic dissection are very rare. This case report involves a successful Bentall procedure for and recovery from a rare aortic dissection in a pregnant Marfan patient who developed acute type II aortic dissection with severe aortic regurgitat...

  6. 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.

  7. Aortic mass in a newborn infant with respiratory distress

    Directory of Open Access Journals (Sweden)

    Michelle J. Vaz

    2017-10-01

    Full Text Available Thrombotic disease is rare in neonates. Many of the cases reported in literature are attributed to the placement of central catheters. We report on a case of aortic thrombosis in a newborn infant with significant respiratory distress due to meconium aspiration, necessitating intubation and placement of central catheters. Due to the location and size of the thrombus in our case, various subspecialties were involved, which ultimately guided therapy to anti-coagulate the patient.

  8. Aortic elasticity and size are associated with aortic regurgitation and left ventricular dysfunction in tetralogy of Fallot after pulmonary valve replacement

    NARCIS (Netherlands)

    Grotenhuis, H.B.; Ottenkamp, J.; de Bruijn, L.; Westenberg, J.J.M.; Vliegen, H.W.; Kroft, L.J.M.; de Roos, A.

    2009-01-01

    Background: Aortic wall pathology and concomitant aortic dilatation have been described in tetralogy of Fallot (TOF) patients, which may negatively affect aortic valve and left ventricular systolic function. Objective: To assess aortic dimensions, aortic elasticity, aortic valve competence and

  9. 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.

  10. Aortic root replacement after previous surgical intervention on the aortic valve, aortic root, or ascending aorta.

    Science.gov (United States)

    Kirsch, E W Matthias; Radu, N Costin; Mekontso-Dessap, Armand; Hillion, Marie-Line; Loisance, Daniel

    2006-03-01

    Aortic root replacement after a previous operation on the aortic valve, aortic root, or ascending aorta remains a major challenge. Records of 56 consecutive patients (44 men; mean age, 56.4 +/- 13.6 years) undergoing reoperative aortic root replacement between June 1994 and June 2005 were reviewed retrospectively. Reoperation was performed 9.4 +/- 6.7 years after the last cardiac operation. Indications for reoperation were true aneurysm (n = 14 [25%]), false aneurysm (n = 10 [18%]), dissection or redissection (n = 9 [16%]), structural or nonstructural valve dysfunction (n = 10 [18%]), prosthetic valve-graft infection (n = 12 [21%]), and miscellaneous (n = 1 [2%]). Procedures performed were aortic root replacement (n = 47 [84%]), aortic root replacement plus mitral valve procedure (n = 5 [9%]), and aortic root replacement plus arch replacement (n = 4 [7%]). In 14 (25%) patients coronary artery bypass grafting had to be performed unexpectedly during the same procedure or immediately after the procedure to re-establish coronary perfusion. Hospital mortality reached 17.9% (n = 10). Multivariate logistic regression analysis revealed the need for unplanned perioperative coronary artery bypass grafting as the sole independent risk factor for hospital death (P = .005). Actuarial survival was 83.8% +/- 4.9% at 1 month, 73.0% +/- 6.3% at 1 year, and 65.7% +/- 9.0% at 5 years after the operation. One patient had recurrence of endocarditis 6.7 months after the operation and required repeated homograft aortic root replacement. Reoperative aortic root replacement remains associated with a high postoperative mortality. The need to perform unplanned coronary artery bypass grafting during reoperative aortic root replacement is a major risk factor for hospital death. The optimal technique for coronary reconstruction in this setting remains to be debated.

  11. Aortic stenosis: An update.

    Science.gov (United States)

    Nathaniel, Sangeetha; Saligram, Shreyas; Innasimuthu, Antony Leslie

    2010-06-26

    Aortic stenosis (AS) is the most common valvular heart disease in the world. It is a disease of the elderly and as our population is getting older in both the developed and the developing world, there has been an increase in the prevalence of AS. It is impacting the mortality and morbidity of our elderly population. It is also causing a huge burden on the healthcare system. There has been tremendous progress in our understanding of AS in recent years. Lately, studies have shown that AS is not just a disease of the aortic valve but it affects the entire systemic vasculature. There are studies looking at more sophisticated measures of disease severity that might better predict the optimal timing of valve replacement. The improvement in our understanding in etiology and pathophysiology of the disease process has led to a number of trials with possible treatment options for AS. In this review, we talk about our understanding of the disease and latest developments in disease assessment and management. We look forward to a time when there will be medical treatment for AS.

  12. 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

    , respectively, with magnitudes of around 0.5 A/km(2). The geometry of the current system resembles a DPY current system [Friis-Christensen and Wilhjelm, 1975]. Using our results, we test alternative theories on cusp current origin that lead to different predictions of the relative location of the cusp current...... system with respect to the open-closed field line boundary. The location of this boundary is inferred from DMSP F10 satellite data. The center of our resulting current system is located clearly poleward of the open-closed field line boundary, thus favoring the idea of Lee et al. [1985] that the cusp FACs...... are caused by a rotational discontinuity of the magnetic field at the magnetopause. In contrast, the idea of Clauer and Banks [1986] that a mapping of the solar wind E-z component to the ionosphere is responsible for the cusp current system is not supported....

  13. Tobacco smoking and aortic aneurysm

    DEFF Research Database (Denmark)

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

    2012-01-01

    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...... aneurysm in males and females consuming above 20g tobacco daily was 3.5% and 1.3%, among those >60years with plasma cholesterol >5mmol/L and a systolic blood pressure >140mmHg. CONCLUSIONS: Tobacco smoking is the most important predictor of future aortic aneurysm outcomes in the general population...

  14. Psychological consequences of screening for abdominal aortic aneurysm and conservative treatment of small abdominal aortic aneurysms

    DEFF Research Database (Denmark)

    Lindholt, Jes Sanddal; Vammen, Sten; Fasting, H

    2000-01-01

    To describe the potential psychological consequences of screening for abdominal aortic aneurysms (AAAs).......To describe the potential psychological consequences of screening for abdominal aortic aneurysms (AAAs)....

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

    DEFF Research Database (Denmark)

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

    2011-01-01

    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...... diameters (all P SEAS study, 27% of women and 19% of men did not have aortic root geometry fulfilling current requirements for TAVI....

  16. Ruptured Abdominal Aortic Aneurysm

    Directory of Open Access Journals (Sweden)

    Jessica Andrusaitis

    2017-07-01

    Full Text Available History of present illness: A 69-year-old male with poorly controlled hypertension presented with 1 hour of severe low back pain that radiated to his abdomen. The patient was tachycardic and had an initial blood pressure of 70/40. He had a rigid and severely tender abdomen. The patient’s history of hypertension, abnormal vital signs, severity and location of his pain were suspicious for a ruptured abdominal aortic aneurysm (AAA. Therefore, a computed tomography angiogram (CTA was ordered. Significant findings: CTA demonstrated a ruptured 7.4 cm infrarenal abdominal aortic aneurysm with a large left retroperitoneal hematoma. Discussion: True abdominal aortic aneurysm is defined as at least a 3cm dilatation of all three layers of the arterial wall of the abdominal aorta.1 An estimated 15,000 people die per year in the US of this condition.2 Risk factors for AAA include males older than 65, tobacco use, and hypertension.1,3,4 There are also congenital, mechanical, traumatic, inflammatory, and infectious causes of AAA.3 Rupture is often the first manifestation of the disease. The classic triad of abdominal pain, pulsatile mass, and hypotension is seen in only 50% of ruptured AAAs.5 Pain (abdominal, groin, or back is the most common symptom. The most common misdiagnoses of ruptured AAAs are renal colic, diverticulitis, and gastrointestinal hemorrhage.6 Bedside ultrasonography is the fastest way to detect this condition and is nearly 100% sensitive.1 One study showed that bedside ultrasounds performed by emergency physicians had a sensitivity of .94 [95% CI = .86-1.0] and specificity of 1 [95% CI = .98-1.0] for detecting AAAs.7 CTA has excellent sensitivity (approximately 100% and yields the added benefit of facilitating surgical planning and management.1 Without surgical treatment, a ruptured AAA is almost uniformly fatal, and 50% of those who undergo surgery do not survive.1 Early resuscitation and coordination with vascular surgery should be

  17. The left ventricle in aortic stenosis--imaging assessment and clinical implications.

    Science.gov (United States)

    Călin, Andreea; Roşca, Monica; Beladan, Carmen Cristiana; Enache, Roxana; Mateescu, Anca Doina; Ginghină, Carmen; Popescu, Bogdan Alexandru

    2015-04-29

    Aortic stenosis has an increasing prevalence in the context of aging population. In these patients non-invasive imaging allows not only the grading of valve stenosis severity, but also the assessment of left ventricular function. These two goals play a key role in clinical decision-making. Although left ventricular ejection fraction is currently the only left ventricular function parameter that guides intervention, current imaging techniques are able to detect early changes in LV structure and function even in asymptomatic patients with significant aortic stenosis and preserved ejection fraction. Moreover, new imaging parameters emerged as predictors of disease progression in patients with aortic stenosis. Although proper standardization and confirmatory data from large prospective studies are needed, these novel parameters have the potential of becoming useful tools in guiding intervention in asymptomatic patients with aortic stenosis and stratify risk in symptomatic patients undergoing aortic valve replacement.This review focuses on the mechanisms of transition from compensatory left ventricular hypertrophy to left ventricular dysfunction and heart failure in aortic stenosis and the role of non-invasive imaging assessment of the left ventricular geometry and function in these patients.

  18. [Cine MRI of the ascending aorta in the elderly with respect to the flow signal void and aortic valve morphology].

    Science.gov (United States)

    Nakayama, M; Kyomasu, Y; Suzuki, Y; Mashima, Y; Tanno, M; Endo, K; Yamada, H

    1990-11-01

    Cine flow MRI was performed on a 1.5 Tesla system to observe signal intensity of blood flow within the ascending aorta in the elderly who had no aortic stenosis and to determine frequency of the flow signal void. Coronal and sagittal imaging planes of the ascending aorta were obtained in 27 aged patients with no known cardiac diseases (14 men and 13 women, mean age of 76) and 7 young volunteers (7 men, mean age of 24), utilizing ECG-gating. GRASS (gradient-recalled acquisition in steady state), and a flow compensation sequence. The young volunteers presented little or no signal void within the ascending aorta. In 26 (96%) of the 27 aged patients, on the other hand, signal void was demonstrated in the blood flow distal to the aortic valve during systole. The maximum length of the signal void that was measured at 318-632 msec after the R wave of ECG ranged from 33 to 97 mm. Conventional and Doppler echocardiography was used to evaluate motion and morphology of the aortic valve in 19 of the 27 aged patients. Eighteen of these 19 subjects had aortic signal void on cine MRI. Echocardiography showed sclerotic changes of the aortic valve (i.e., increased echogenicity of the cusps and/or commissure fusion) in 10 (53%) of the 19 subjects. The mean maximum length of the signal void in the 10 patients with aortic valve sclerosis was significantly greater than that in the 9 patients with echocardiographically normal valve (68 vs. 45 mm, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

  19. Reoperative Aortic Root Replacement in Patients with Previous Aortic Root or Aortic Valve Procedures

    Directory of Open Access Journals (Sweden)

    Byung Kwon Chong

    2016-08-01

    Full Text Available Background: Generalization of standardized surgical techniques to treat aortic valve (AV and aortic root diseases has benefited large numbers of patients. As a consequence of the proliferation of patients receiving aortic root surgeries, surgeons are more frequently challenged by reoperative aortic root procedures. The aim of this study was to evaluate the outcomes of redo-aortic root replacement (ARR. Methods: We retrospectively reviewed 66 patients (36 male; mean age, 44.5±9.5 years who underwent redo-ARR following AV or aortic root procedures between April 1995 and June 2015. Results: Emergency surgeries comprised 43.9% (n=29. Indications for the redo-ARR were aneurysm (n=12, pseudoaneurysm (n=1, or dissection (n=6 of the residual native aortic sinus in 19 patients (28.8%, native AV dysfunction in 8 patients (12.1%, structural dysfunction of an implanted bioprosthetic AV in 19 patients (28.8%, and infection of previously replaced AV or proximal aortic grafts in 30 patients (45.5%. There were 3 early deaths (4.5%. During follow- up (median, 54.65 months; quartile 1–3, 17.93 to 95.71 months, there were 14 late deaths (21.2%, and 9 valve-related complications including reoperation of the aortic root in 1 patient, infective endocarditis in 3 patients, and hemorrhagic events in 5 patients. Overall survival and event-free survival rates at 5 years were 81.5%±5.1% and 76.4%±5.4%, respectively. Conclusion: Despite technical challenges and a high rate of emergency conditions in patients requiring redo-ARR, early and late outcomes were acceptable in these patients.

  20. 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.

  1. Magnetization cusp in a thin AuFe spin glass film in high magnetic fields

    International Nuclear Information System (INIS)

    Fritzsche, Helmut; Root, John; Temst, Kristiaan; Haesendonck, Chris van

    2006-01-01

    We performed polarized neutron reflectometry measurements on a 78nm-thick Au 97 Fe 3 film prepared on a thermally oxidized Si wafer. The measurements were done on the C5 spectrometer at Chalk River in reflectometry mode. We determined the magnetization of the specimen in a vertical magnetic field of 6T in a temperature range from 300 to 1.5K. We observed a cusp in the magnetization at about 10K, close to the spin-glass freezing temperature of 16K of a bulk Au 97 Fe 3 alloy. From the fit to the reflectivity data we can infer a magnetic moment of 0.63μ B per Fe atom at the cusp position which is a large reduction compared to the bulk value of 1.2μ B per Fe atom

  2. The bicuspid aortic valve and its relation to aortic dilation

    Directory of Open Access Journals (Sweden)

    Shi-Min Yuan

    2010-01-01

    Full Text Available BACKGROUND: A bicuspid aortic valve (BAV is a common congenital heart disease, which affects 1-2% of the population. However, the relationship between BAVs and aortic dilation has not been sufficiently elucidated. METHODS: A total of 241 BAV patients who were referred to this hospital for cardiac surgey over a 4.75-year period were included in this study. In addition to the clinical characteristics of the included patients, the morphological features of the aortic valve and aorta, the length of the left main coronary artery, and the laboratory findings (the coagulation and hematological parameters as well as the total cholesterol concentration were determined and compared with those of the tricuspid aortic valve (TAV patients. RESULTS: The BAV patients were younger than the TAV patients for a valve surgery in the last 3 months of the study period. The BAV patients were predominantly male. Most of the BAVs that were surgically treated were stenotic, regurgitant, or combined, and only 19 (7.88% were normally functioning valves. According to echocardiography or operative records, 148 (78.31% were type A, 31 (16.40% were type B, and 10 (5.29% were type C. The left main coronary artery was much shorter in the BAV patients than it was in the TAV patients. There was no significant difference between BAV and TAV patients in the total cholesterol concentrations; whereas differences were noted between patients receiving lipid-lowering therapy and those not receiving lipid-lowering therapy. The dimensions of the aortic root, sinotubular junction, and ascending aorta were beyond normal limits, while they were significantly smaller in the BAV patients than in the TAV patients. They were also much smaller in patients receiving statin therapy than those not receiving statin therapy in both groups. Moreover, the aortic dilation in the BAV group was found to be significantly associated with patient age. CONCLUSIONS: The BAV patients developed aortic wall and

  3. Implementing the Comprehensive Unit-Based Safety Program (CUSP) to Improve Patient Safety in an Academic Primary Care Practice.

    Science.gov (United States)

    Pitts, Samantha I; Maruthur, Nisa M; Luu, Ngoc-Phuong; Curreri, Kimberly; Grimes, Renee; Nigrin, Candace; Sateia, Heather F; Sawyer, Melinda D; Pronovost, Peter J; Clark, Jeanne M; Peairs, Kimberly S

    2017-11-01

    While there is growing awareness of the risk of harm in ambulatory health care, most patient safety efforts have focused on the inpatient setting. The Comprehensive Unit-based Safety Program (CUSP) has been an integral part of highly successful safety efforts in inpatient settings. In 2014 CUSP was implemented in an academic primary care practice. As part of CUSP implementation, staff and clinicians underwent training on the science of safety and completed a two-question safety assessment survey to identify safety concerns in the practice. The concerns identified by team members were used to select two initial safety priorities. The impact of CUSP on safety climate and teamwork was assessed through a pre-post comparison of results on the validated Safety Attitudes Questionnaire. Ninety-six percent of staff completed science of safety training as part of CUSP implementation, and 100% of staff completed the two-question safety assessment. The most frequently identified safety concerns were related to medications (n = 11, 28.2), diagnostic testing (n = 9, 25), and communication (n = 5, 14). The CUSP team initially prioritized communication and infection control, which led to standardization of work flows within the practice. Six months following CUSP implementation, large but nonstatistically significant increases were found for the percentage of survey respondents who reported knowledge of the proper channels for questions about patient safety, felt encouraged to report safety concerns, and believed that the work setting made it easy to learn from the errors of others. CUSP is a promising tool to improve safety climate and to identify and address safety concerns within ambulatory health care. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

  4. Magnetic field and electric currents in the vicinity of polar cusps as inferred from Polar and Cluster data

    Directory of Open Access Journals (Sweden)

    N. A. Tsyganenko

    2009-04-01

    Full Text Available A detailed statistical study of the magnetic structure of the dayside polar cusps is presented, based on multi-year sets of magnetometer data of Polar and Cluster spacecraft, taken in 1996–2006 and 2001–2007, respectively. Thanks to the dense data coverage in both Northern and Southern Hemispheres, the analysis spanned nearly the entire length of the cusps, from low altitudes to the cusp "throat" and the magnetosheath. Subsets of data falling inside the polar cusp "funnels" were selected with the help of TS05 and IGRF magnetic field models, taking into account the dipole tilt and the solar wind/IMF conditions. The selection funnels were shifted within ±10° of SM latitude around the model cusp location, and linear regression parameters were calculated for each sliding subset, further divided into 10 bins of distance in the range 2≤R≤12 RE, with the following results. (1 Diamagnetic depression, caused by the penetrated magnetosheath plasma, becomes first visible at R~4–5 RE, rapidly deepens with growing R, peaks at R~6–9 RE, and then partially subsides and widens in latitude at the cusp's outer end. (2 The depression peak is systematically shifted poleward (by ~2° of the footpoint latitude with respect to the model cusp field line, passing through the min{|B|} point at the magnetopause. (3 At all radial distances, clear and distinct peaks of the correlation between the local By and By(IMF and of the corresponding proportionality coefficient are observed. A remarkably regular variation of that coefficient with R quantitatively confirms the field-aligned geometry of the cusp currents associated with the IMF By, found in earlier observations.

  5. Cellular Mechanisms of Aortic Valve Calcification.

    Science.gov (United States)

    Zhiduleva, E V; Irtyuga, O B; Shishkova, A A; Ignat'eva, E V; Kostina, A S; Levchuk, K A; Golovkin, A S; Rylov, A Yu; Kostareva, A A; Moiseeva, O M; Malashicheva, A B; Gordeev, M L

    2018-01-01

    Comparative in vitro study examined the osteogenic potential of interstitial cells of aortic valve obtained from the patients with aortic stenosis and from control recipients of orthotopic heart transplantation with intact aortic valve. The osteogenic inductors augmented mineralization of aortic valve interstitial cells (AVIC) in patients with aortic stenosis in comparison with the control level. Native AVIC culture of aortic stenosis patients demonstrated overexpression of osteopontin gene (OPN) and underexpression of osteoprotegerin gene (OPG) in comparison with control levels. In both groups, AVIC differentiation was associated with overexpression of RUNX2 and SPRY1 genes. In AVIC of aortic stenosis patients, expression of BMP2 gene was significantly greater than the control level. The study revealed an enhanced sensitivity of AVIC to osteogenic inductors in aortic stenosis patients, which indicates probable implication of OPN, OPG, and BMP2 genes in pathogenesis of aortic valve calcification.

  6. Imaging techniques in transcatheter aortic valve replacement

    Directory of Open Access Journals (Sweden)

    Quaife RA

    2013-11-01

    Full Text Available Robert A Quaife, Jennifer Dorosz, John C Messenger, Ernesto E Salcedo Division of Cardiology, University of Colorado, Aurora, CO, USA Abstract: Calcific aortic stenosis is now understood as a complex valvular degenerative process sharing many risk factors with atherosclerosis. Once patients develop symptomatic calcific aortic stenosis, the only effective treatment is aortic valve replacement. In the past decade, transcatheter aortic valve replacement (TAVR has been developed as an alternative to surgery to treat severe calcific aortic stenosis. Cardiac imaging plays a pivotal role in the contemporary management of patients with calcific aortic stenosis, and particularly in patients being considered for TAVR, who demand detailed imaging of the aortic valve apparatus. In this review, we highlight the role of cardiac imaging for patient selection, procedural guidance, and evaluation of results of TAVR. Keywords: aortic stenosis, cardiovascular imaging, transcutaneous aortic valve replacement

  7. 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.

  8. 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....... No significant differences in survival for patients with dissecting and nondissecting AA were detected. In all, 132 patients (78%) died and 78 (59%) of them died of rupture. Mean time to rupture was 1,300 +/- 8 days. Cumulative 5-year hazard of rupture for the dissecting AA was twice that of the nondissecting (p...... A dissections. The results suggest that type B dissections may have a more favorable course if operated on, but a prospective, randomized study is necessary to confirm this observation. We believe that older patients and those with a small aneurysm may benefit from early, elective operation....

  9. Concommitant occurance of dens invaginatus and talon cusp: A case report

    OpenAIRE

    Yadav, Monica; S.M, Meghana; Kulkarni, Sandip R.

    2011-01-01

    PURPOSE: Morphological dental anomalies of the maxillary lateral incisors are relatively common. However, their simultaneous occurrence is a relatively rare event. We report a case of dens invaginatus and talon cusp concurrently affecting maxillary lateral incisors. The etiology, pathophysiology, association with other dental anomalies, as well as various treatment modalities of these anomalies are discussed. CASE DESCRIPTION: An 18-year-old male patient reported with a complaint of crowding ...

  10. A Note On Signs Of Fourier Coefficients Of Two Cusp Forms

    Indian Academy of Sciences (India)

    10

    Abstract. Kohnen and Sengupta showed that if two Hecke eigen cusp forms of weight k1 and k2 respectively with 1 < k1 < k2 over. Γ0(N ), have totally real algebraic Fourier coefficients {a(n)} and. {b(n)} respectively for n ≥ 1 with a(1) = 1 = b(1), then there exists an element σ of the absolute Galois group Gal(Q/Q) such.

  11. A statistical survey of heat input parameters into the cusp thermosphere

    Science.gov (United States)

    Moen, J. I.; Skjaeveland, A.; Carlson, H. C.

    2017-12-01

    Based on three winters of observational data, we present those ionosphere parameters deemed most critical to realistic space weather ionosphere and thermosphere representation and prediction, in regions impacted by variability in the cusp. The CHAMP spacecraft revealed large variability in cusp thermosphere densities, measuring frequent satellite drag enhancements, up to doublings. The community recognizes a clear need for more realistic representation of plasma flows and electron densities near the cusp. Existing average-value models produce order of magnitude errors in these parameters, resulting in large under estimations of predicted drag. We fill this knowledge gap with statistics-based specification of these key parameters over their range of observed values. The EISCAT Svalbard Radar (ESR) tracks plasma flow Vi , electron density Ne, and electron, ion temperatures Te, Ti , with consecutive 2-3 minute windshield-wipe scans of 1000x500 km areas. This allows mapping the maximum Ti of a large area within or near the cusp with high temporal resolution. In magnetic field-aligned mode the radar can measure high-resolution profiles of these plasma parameters. By deriving statistics for Ne and Ti , we enable derivation of thermosphere heating deposition under background and frictional-drag-dominated magnetic reconnection conditions. We separate our Ne and Ti profiles into quiescent and enhanced states, which are not closely correlated due to the spatial structure of the reconnection foot point. Use of our data-based parameter inputs can make order of magnitude corrections to input data driving thermosphere models, enabling removal of previous two fold drag errors.

  12. His-Purkinje system-related incessant ventricular tachycardia arising from the left coronary cusp

    Directory of Open Access Journals (Sweden)

    Eiji Sato, MD

    2014-08-01

    Full Text Available We describe the case of a 23-year-old woman who had His-Purkinje system-related incessant ventricular tachycardia with a narrow QRS configuration. The ventricular tachycardia was ablated successfully in the left coronary cusp where the earliest endocardial activation had been recorded. We hypothesize that a remnant of the subaortic conducting tissue was the source of the ventricular arrhythmias.

  13. Chorus observations by the Polar spacecraft near the mid-altitude cusp

    Czech Academy of Sciences Publication Activity Database

    Menietti, J. D.; Santolík, Ondřej; Abaci, P. C.

    2009-01-01

    Roč. 57, č. 12 (2009), s. 1412-1418 ISSN 0032-0633 R&D Projects: GA AV ČR IAA301120601 Grant - others:NSF(US) ATM-04-43531; NASA (US) NNG05GM52G.; GA MŠk(CZ) ME 842 Institutional research plan: CEZ:AV0Z30420517 Keywords : chorus * mid-altitude cusp * Polar spacecraft Subject RIV: BL - Plasma and Gas Discharge Physics Impact factor: 2.067, year: 2009

  14. Two Azimuthally Separated Regions of Cusp Ion Injection Observed via Energetic Neutral Atoms

    Science.gov (United States)

    Abe, M.; Taguchi, S.; Collier, M. R.; Moore, T. E.

    2011-01-01

    The low-energy neutral atom (LENA) imager on the IMAGE spacecraft can detect energetic neutral atoms produced by ion injection into the cusp through a charge exchange with the Earth's hydrogen exosphere. We examined the occurrence of the LENA cusp signal during positive IMF B(sub z) in terms of the arrival direction and the IMF clock angle theta(sub CA). Results of statistical analyses show that the occurrence frequency is high on the postnoon side when theta(sub CA) is between approximately 20 degrees and approximately 50 degrees. This is ascribed to ion injection caused by cusp reconnection typical of positive IMF B(sub z). Our results also show that there is another situation of high occurrence frequency, which can be identified with theta(sub CA) of approximately 30 degrees to approximately 80 degrees. When theta(sub CA) is relatively large (60 degrees - 80 degrees), occurrence frequencies are high at relatively low latitudes over a wide extent spanning both prenoon and postnoon sectors. This feature suggests that the ion injection is caused by reconnection at the dayside magnetopause. Its postnoon side boundary shifts toward the prenoon as theta(sub CA) decreases. When theta(sub CA) is less than approximately 50 degrees, the high occurrence frequency exists well inside the prenoon sector, which is azimuthally separated from the postnoon region ascribed to cusp reconnection. The prenoon region, which is thought due to ion injection caused by dayside reconnection, may explain the recent report that proton aurora brightening occurs in the unanticipated prenoon sector of the northern high-latitude ionosphere for IMF B(sub y) greater than 0 and B(sub z) greater than 0.

  15. Realizing stock market crashes: stochastic cusp catastrophe model of returns under time-varying volatility

    Czech Academy of Sciences Publication Activity Database

    Baruník, Jozef; Kukačka, Jiří

    2015-01-01

    Roč. 15, č. 6 (2015), s. 959-973 ISSN 1469-7688 R&D Projects: GA ČR GA402/09/0965; GA ČR GA13-32263S EU Projects: European Commission 612955 - FINMAP Institutional support: RVO:67985556 Keywords : Stochastic cusp catastrophe model * Realized volatility * Bifurcations * Stock market crash Subject RIV: AH - Economics Impact factor: 0.794, year: 2015 http://library.utia.cas.cz/separaty/2014/E/barunik-0434202.pdf

  16. Aortic Stent-Graft Infection Following Septic Complications of a Kidney Stone

    International Nuclear Information System (INIS)

    Berg, H. Rogier van den; Leijdekkers, Vanessa J.; Vahl, Anco

    2006-01-01

    A 73-year-old man was treated because of a renal pelvis blowout of the left kidney for which he received a nephrostomy catheter without antibiotic prophylaxis. Almost a year previously this patient had undergone endovascular repair of a symptomatic infrarenal abdominal aorta aneurysm. Four weeks after the diagnosis and treatment of the ruptured renal pelvis, a new computed tomography scan and ultrasound-guided fine needle aspiration confirmed the diagnosis of infected aortic stent-graft. An extra-anatomic axillo-uniiliac bypass and graft excision was performed. Two weeks after discharge the patient returned to the hospital with an occlusion of his left renal artery and died of renal failure. This is the first time an infected aortic stent-graft after a renal pelvis blowout has been reported. Although infections of aortic stent-grafts occur rarely, one should be aware of the possibility in aortic stent-graft patients undergoing abdominal procedures without antibiotic prophylaxis

  17. Evidence for storm-time ionospheric ion precipitation in the cusp with magnetosheath energy

    Directory of Open Access Journals (Sweden)

    H. Stenuit

    2004-04-01

    Full Text Available We present evidence for a sporadic precipitation into the north polar cusp of ionospheric O+ and He+ ions accelerated up to the magnetosheath flow speed during a magnetic storm. This is deduced from data obtained on board the Interball-Auroral satellite showing that the energy/charge ratios of the H+, He++, He+ and O+ populations are similar to those of ion masses. These measurements pertain to a very disturbed magnetic period. A storm was in progress with a Dst reaching -149nT during the cusp measurements, while the AE index reached values higher than 1000nT. This result is discussed in terms of ion circulation from the magnetosphere to the magnetosheath and back to the magnetosphere. We suggest that the acceleration of O+ and He+ ions up to a magnetosheath-like velocity is directly linked to the large By component of the IMF.Key words. Magnetospheric physics (magnetopause, cusp and boundary layers; magnetosheath; storms and substorms

  18. Cusp Condition Constraints on the Thermodynamic Properties of Dense Liquid Hydrogen*

    Science.gov (United States)

    Nagao, K.; Ashcroft, N. W.

    2001-03-01

    We present a simple method for obtaining the free energy of dense liquid hydrogen by using the cusp theorem to take into account the non-linear response of electrons. The cusp condition is a rigorous requirement in hydrogen and it originates with the singular nature of the bare Coulomb interaction between electrons and protons. Our calculation has shown that response determined with the cusp condition enforced lowers the electron-proton coupling part of the free energy at low densities, which leads to an increase of the pressure (as compared with the standard linear response approach). The method currently accounts for the non-linear response around each proton but not between proton pairs, and therefore it is appropriate for the study of states in which molecules are fully dissociated but electron-proton correlations remain strong. These conditions are expected to be attained in some of recent shock-wave experiments, and comparison is made between a calculated Hugoniot and the corresponding experimental curve. * Work supported by the National Science Foundation and the Japan Society for the Promotion of Science.

  19. Results of aortic root reimplantation in patients with ascending aortic aneurysm and concomitant aortic insufficiency

    Directory of Open Access Journals (Sweden)

    А. М. Чернявский

    2016-01-01

    Full Text Available Objective. The research was designed to evaluate the results of valve-sparing operations: aortic root reimplantation versus aortic valve reimplantation when repairing an ascending aortic aneurysm with concomitant aortic insufficiency.Methods. Within a blind prospective randomized study conducted over a period from 2011 to 2015, 64 patients underwent aortic valve-sparing surgery. The inclusion criteria were the presence of an aortic aneurysm of the ascending aorta exceeding 4.5 cm and concomitant aortic insufficiency. All patients were divided into two groups: FS-group, aortic root reimplantation (modified Florida Sleeve technique (n = 32 and D-group, aortic valve reimplantation (David procedure (n = 32. The average age of patients was 57±13 (23–73 years in the FS-group and 55±11 (15–72 years in the D-group (p = 0.54. Both groups had 78% of males (p>0.99. A Marfan syndrome was identified in 6% and 9% in the FS-group and D-group respectively (p>0.99. Mean diameter of the sinuses of Valsalva was 51±7 mm and 56±10 mm (p = 0.09, aortic insufficiency 2.6±0.7 and 2.8±0.8 (p = 0.15 in the FS-group and D-group respectively. In the FS-group and D-group LVEDD amounted to 5.5±0.7 mm and 5.9±1.0 mm (p = 0.09 respectively. All patients took echocardiography in the preoperative, postoperative and follow-up periods.Results. In the long-term period, the degree of aortic regurgitation was 1.2±0.1 in the FS-group and 1.3±0.6 in the D-group (p = 0.72. LVEDD was 123±23 mm in the FS-group and 139.6±80 mm in the D-group at follow-up (p = 0.77. There were no statistically significant differences in the analysis of complications. Overall 30-day in-hospital mortality was 7.8%. There were 2 (6.3% deaths in the FS-group and 3 (9.4% in the D-group (p = 0.5.Late mortality was 6.3% in the FS-group and 3.1% in the D-group (p>0.99. Cumulative survival at 4 years was 84.3% and 84.8% in the FS-group and the D-group respectively (p = 0.94. Cumulative freedom from

  20. Influence of the cusp field on the plasma parameters of the Linac4 H- ion source

    Science.gov (United States)

    Briefi, S.; Mattei, S.; Lettry, J.; Fantz, U.

    2017-08-01

    When the H- ion source of CERN's Linac4 is operated in volume mode, a maximum of the extracted current is obtained at varying RF power. The power required for this maximum and its absolute value is strongly influenced by the cusp magnets installed at the source for electron confinement: without magnets, 15-20 mA are typically obtained at 20 kW whereas with magnets a factor of two more power is needed and 25-30 mA are achieved. In order to access the reasons behind the peaked performance with varying RF power and for determining the influence of the cusp field on the discharge, optical emission spectroscopy (OES) measurements of the atomic Balmer series and of the molecular Fulcher transition have been carried out. In all investigated cases, the gas temperature of the discharge has been virtually equal to the ambient temperature as the short discharge pulse length of 500 µs is not long enough for considerable heavy particle heating. When no cusp magnets are installed, the plasma parameters evaluated with the collisional radiative models Yacora H and Yacora H2 show a minimum in the electron temperature of 3.25 eV and a maximum in the electron density of 4×1019 m-3 and also in the vibrational excitation of the hydrogen molecule at 20 kW. Assessing the relevant production and destruction processes demonstrates that the H- yield is maximal at this point thereby explaining the optimum ion source performance. When the cusp magnets are applied, the same general trends are observed but the required RF power is a factor of two higher. The OES results indicate an optimum performance around 30 kW whereas the highest H- current is actually achieved around 40 kW. Furthermore, a higher H- yield is indicated without cusp magnets but a better ion source performance is observed with magnets. These differences can most likely be attributed to changing gradients in the plasma parameters which are not accessible by OES. Nevertheless, the obtained plasma parameters can be used as

  1. Stationary magnetospheric convection on November 24, 1981. 2. Small-scale structures in the dayside cusp/cleft

    Directory of Open Access Journals (Sweden)

    Y. I. Galperin

    Full Text Available A case study of the dayside cusp/cleft region during an interval of stationary magnetospheric convection (SMC on November, 24, 1981 is presented, based on detailed measurements made by the AUREOL-3 satellite. Layered small-scale field-aligned current sheets, or loops, superimposed to a narrow V-shaped ion dispersion structure, were observed just equatorward from the region of the "cusp proper". The equatorward sheet was accompanied by a very intense and short (less than 1 s ion intensity spike at 100 eV. No major differences were noted of the characteristics of the LLBL, or "boundary cusp", and plasma mantle precipitation during this SMC period from those typical of the cusp/cleft region for similar IMF conditions. Simultaneous NOAA-6 and NOAA-7 measurements described in Despirak et al. were used to estimate the average extent of the "cusp proper" (defined by dispersed precipitating ions with the energy flux exceeding 10-3 erg cm-2 s-1 during the SMC period, as ~0.73° ILAT width, 2.6-3.4 h in MLT, and thus the recently merged magnetic flux, 0.54-0.70 × 107 Wb. This, together with the average drift velocity across the cusp at the convection throat, ~0.5 km s-1, allowed to evaluate the cusp merging contribution to the total cross-polar cap potential difference, ~33.8-43.8 kV. It amounts to a quite significant part of the total cross-polar cap potential difference evaluated from other data. A "shutter" scenario is suggested for the ion beam injection/penetration through the stagnant plasma region in the outer cusp to explain the pulsating nature of the particle injections in the low- and medium-altitude cusp region.

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

  2. 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 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. © 2015 American Heart Association, Inc.

  3. Endoluminal treatment of aortic dissection

    Energy Technology Data Exchange (ETDEWEB)

    Chavan, Ajay; Lotz, Joachim; Galanski, Michael [Department of Diagnostic Radiology, Hannover Medical School, Carl Neuberg Strasse 1, 30625, Hannover (Germany); Oelert, Frank; Haverich, Axel; Karck, Matthias [Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Carl Neuberg Strasse 1, 30625, Hannover (Germany)

    2003-11-01

    Aortic dissection is most often a catastrophic medical emergency which, if untreated, can be potentially fatal. The intention of therapy in patients with aortic dissection is to prevent aortic rupture or aneurysm formation as well as to relieve branch vessel ischaemia. Patients with aortic dissection are often poor candidates for anaesthesia and surgery and the surgical procedure itself is challenging requiring thoracotomy, aortic cross clamping, blood transfusion as well as prolonged hospital stay in some cases. Operative mortality is especially high in patients with critical mesenteric or renal ischaemia. The past decade has experienced the emergence of a number of interventional radiological or minimally invasive techniques which have significantly improved the management of patients with aortic dissection. These include stent grafting for entry site closure to prevent aneurysmatic widening of the false lumen as well as percutaneous techniques such as balloon fenestration of the intimal flap and aortic true lumen stenting to alleviate branch vessel ischaemia. False lumen thrombosis following entry closure with stent grafts has been observed in 86-100% of patients, whereas percutaneous interventions are able to effectively relieve organ ischaemia in approximately 90% of the cases. In the years to come, it is to be expected that these endoluminal techniques will become the method of choice for treating most type-B dissections and will assist in significantly reducing the number of open surgical procedures required for type-A dissections. The intention of this article is to provide an overview of the current status of these endoluminal techniques based on our own experience as well as on a review of the relevant literature. (orig.)

  4. Endoluminal treatment of aortic dissection

    International Nuclear Information System (INIS)

    Chavan, Ajay; Lotz, Joachim; Galanski, Michael; Oelert, Frank; Haverich, Axel; Karck, Matthias

    2003-01-01

    Aortic dissection is most often a catastrophic medical emergency which, if untreated, can be potentially fatal. The intention of therapy in patients with aortic dissection is to prevent aortic rupture or aneurysm formation as well as to relieve branch vessel ischaemia. Patients with aortic dissection are often poor candidates for anaesthesia and surgery and the surgical procedure itself is challenging requiring thoracotomy, aortic cross clamping, blood transfusion as well as prolonged hospital stay in some cases. Operative mortality is especially high in patients with critical mesenteric or renal ischaemia. The past decade has experienced the emergence of a number of interventional radiological or minimally invasive techniques which have significantly improved the management of patients with aortic dissection. These include stent grafting for entry site closure to prevent aneurysmatic widening of the false lumen as well as percutaneous techniques such as balloon fenestration of the intimal flap and aortic true lumen stenting to alleviate branch vessel ischaemia. False lumen thrombosis following entry closure with stent grafts has been observed in 86-100% of patients, whereas percutaneous interventions are able to effectively relieve organ ischaemia in approximately 90% of the cases. In the years to come, it is to be expected that these endoluminal techniques will become the method of choice for treating most type-B dissections and will assist in significantly reducing the number of open surgical procedures required for type-A dissections. The intention of this article is to provide an overview of the current status of these endoluminal techniques based on our own experience as well as on a review of the relevant literature. (orig.)

  5. 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.

  6. Unruptured Aneurysm of Sinus of Valsalva Coexisting with the Large Ventricular Septal Defect and Severe Aortic Regurgitation in a Young Man

    Directory of Open Access Journals (Sweden)

    Pouya Nezafati

    2015-01-01

    Full Text Available Introduction. Unruptured sinus of valsalva aneurysm (SVA is a rare congenital anomaly, particularly, when it coexists with a ventricular septal defect (VSD and aortic regurgitation due to the prolapse of the elongated aortic cusp into the VSD. In this report, we present the case of a 19-year-old young man with VSD challenging in spite of dyspnea and lower limb edema. Presentation of Case. Its diagnosis was made on the basis of transthoracic echocardiography results. Surgical management consisted of replacing the SVA with mechanical valve prosthesis. A Gore-Tex patch repaired the VSD. Discussion. In the follow-up periods, clinical and echocardiographic tests showed that the patient was in excellent status. Conclusion. SVA requires a surgical procedure due to its high risk of mortality in unoperated patients and a good safety of surgery.

  7. Unruptured Aneurysm of Sinus of Valsalva Coexisting with the Large Ventricular Septal Defect and Severe Aortic Regurgitation in a Young Man.

    Science.gov (United States)

    Nezafati, Pouya; Nezafati, Mohammad Hassan; Hoseinikhah, Hamid

    2015-01-01

    Introduction. Unruptured sinus of valsalva aneurysm (SVA) is a rare congenital anomaly, particularly, when it coexists with a ventricular septal defect (VSD) and aortic regurgitation due to the prolapse of the elongated aortic cusp into the VSD. In this report, we present the case of a 19-year-old young man with VSD challenging in spite of dyspnea and lower limb edema. Presentation of Case. Its diagnosis was made on the basis of transthoracic echocardiography results. Surgical management consisted of replacing the SVA with mechanical valve prosthesis. A Gore-Tex patch repaired the VSD. Discussion. In the follow-up periods, clinical and echocardiographic tests showed that the patient was in excellent status. Conclusion. SVA requires a surgical procedure due to its high risk of mortality in unoperated patients and a good safety of surgery.

  8. Aortic compliance in patients with aortic regurgitation. Evaluation with magnetic resonance imaging

    International Nuclear Information System (INIS)

    Murai, Sachiko; Hamada, Seiki; Ueguchi, Takashi

    2005-01-01

    The purpose of this study was to assess by means of cine magnetic resonance imaging (MRI) aortic compliance before and after aortic valve replacement (AVR with SJM (St. Jude Medical, St paul, MN) valve) in patients with aortic regurgitation (AR). Two groups (healthy controls and patients with severe isolated AR) of 10 subjects each were included in this study. Cine MRI was performed at three locations of the aorta, and aortic compliance was calculated by dividing the maximum change in the aortic area by pulse pressure. Cine MRI is useful to assess abnormalities of aortic compliance in patients with AR. Compared with the control group, aortic compliance in the AR group was significantly less in the ascending aorta (p<0.05), decreasing in order of aortic location. After AVR, aortic compliance improved for all locations. Cine MRI enables assessment of aortic biophysical properties such as a compliance for evaluating the progression of AR and the efficacy of treatment. (author)

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

    Science.gov (United States)

    2017-04-26

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

  10. A History of Thoracic Aortic Surgery.

    Science.gov (United States)

    McFadden, Paul Michael; Wiggins, Luke M; Boys, Joshua A

    2017-08-01

    Ancient historical texts describe the presence of aortic pathology conditions, although the surgical treatment of thoracic aortic disease remained insurmountable until the 19th century. Surgical treatment of thoracic aortic disease then progressed along with advances in surgical technique, conduit production, cardiopulmonary bypass, and endovascular technology. Despite radical advances in aortic surgery, principles established by surgical pioneers of the 19th century hold firm to this day. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Abdominal aortic feminism.

    Science.gov (United States)

    Mortimer, Alice Emily

    2014-11-14

    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. 2014 BMJ Publishing Group Ltd.

  12. Observations of Pc3-4 Pulsations in the Cusp Region using Four Closely-spaced Cusp- Latitude Search-coil Magnetometers, All-sky Imagers, and the EISCAT Svalbard Radar

    Science.gov (United States)

    Lu, F.; Engebretson, M.; Lessard, M.; Kim, H.; Moen, J.; Lorentzen, D.

    2007-05-01

    A two-dimensional, closely-spaced four-station array of search-coil magnetometers was set up on the Svalbard archipelago in September, 2006, at geomagnetic latitudes ranging from 74° to 76° N. These stations can take advantage of the many other observational instruments on Svalbard, including optical instruments and the EISCAT incoherent scatter radar. We report here on observations of Pc3-4 pulsations at these sites, which are commonly thought to originate in the solar wind's ion foreshock upstream from Earth's bow shock and have long been known to be especially intense in near-cusp regions. The path or paths by which these waves travel from upstream to the near-cusp ionosphere is, however, still controversial. Data obtained during northern winter 2006-2007, when the cusp footpoint was in darkness, have shown that the Pc3-4 wave amplitude was typically but not always larger at the lower latitude station, just equatorward of the nominal cusp latitude. Further study of these data, including analysis of relative phase of the waves and comparison with optical and radar data will help determine whether the region of wave transmission to low altitudes is via the cusp, boundary layer, or slightly deeper in the magnetosphere.

  13. 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

  14. A technique for accurately determining the cusp-region polar cap boundary using SuperDARN HF radar measurements

    Directory of Open Access Journals (Sweden)

    G. Chisham

    Full Text Available Accurately measuring the location and motion of the polar cap boundary (PCB in the high-latitude ionosphere can be crucial for studies concerned with the dynamics of the polar cap, e.g. the measurement of reconnection rates. The Doppler spectral width characteristics of backscatter received by the SuperDARN HF radars have been previously used for locating and tracking the PCB in the cusp region. The boundary is generally observed in meridional beams of the SuperDARN radars and appears as a distinct change between low spectral width values observed equatorward of the cusp region, and high, but variable spectral width values observed within the cusp region. To identify the spectral width boundary (SWB between these two regions, a simple algorithm employing a spectral width threshold has often been applied to the data. However, there is not, as yet, a standard algorithm, or spectral width threshold, which is universally applied. Nor has there been any rigorous assessment of the accuracy of this method of boundary determination. This study applies a series of threshold algorithms to a simulated cusp-region spectral width data set, to assess the accuracy of different algorithms. This shows that simple threshold algorithms correctly identify the boundary location in, at the most, 50% of the cases and that the average boundary error is at least ~ 1–2 range gates (~ 1° latitude. It transpires that spatial and temporal smoothing of the spectral width data (e.g. by median filtering, before application of a threshold algorithm can increase the boundary determination accuracy to over 95% and the average boundary error to much less than a range gate. However, this is sometimes at the cost of temporal resolution in the motion of the boundary location. The algorithms are also applied to a year’s worth of spectral width data from the cusp ionosphere, measured by the Halley SuperDARN radar in Antarctica. This analysis highlights the increased accuracy of

  15. A technique for accurately determining the cusp-region polar cap boundary using SuperDARN HF radar measurements

    Directory of Open Access Journals (Sweden)

    G. Chisham

    2003-04-01

    Full Text Available Accurately measuring the location and motion of the polar cap boundary (PCB in the high-latitude ionosphere can be crucial for studies concerned with the dynamics of the polar cap, e.g. the measurement of reconnection rates. The Doppler spectral width characteristics of backscatter received by the SuperDARN HF radars have been previously used for locating and tracking the PCB in the cusp region. The boundary is generally observed in meridional beams of the SuperDARN radars and appears as a distinct change between low spectral width values observed equatorward of the cusp region, and high, but variable spectral width values observed within the cusp region. To identify the spectral width boundary (SWB between these two regions, a simple algorithm employing a spectral width threshold has often been applied to the data. However, there is not, as yet, a standard algorithm, or spectral width threshold, which is universally applied. Nor has there been any rigorous assessment of the accuracy of this method of boundary determination. This study applies a series of threshold algorithms to a simulated cusp-region spectral width data set, to assess the accuracy of different algorithms. This shows that simple threshold algorithms correctly identify the boundary location in, at the most, 50% of the cases and that the average boundary error is at least ~ 1–2 range gates (~ 1° latitude. It transpires that spatial and temporal smoothing of the spectral width data (e.g. by median filtering, before application of a threshold algorithm can increase the boundary determination accuracy to over 95% and the average boundary error to much less than a range gate. However, this is sometimes at the cost of temporal resolution in the motion of the boundary location. The algorithms are also applied to a year’s worth of spectral width data from the cusp ionosphere, measured by the Halley SuperDARN radar in Antarctica. This analysis highlights the increased accuracy of

  16. Chylothorax complicating thoracic aortic surgery.

    Science.gov (United States)

    Kanakis, Meletios A; Misthos, Panagiotis; Kokotsakis, John N; Lioulias, Achilleas G

    2011-07-01

    Chylothorax is a very rare complication of patients undergoing thoracic aortic aneurysm repair. Possible mechanisms of this condition during thoracic aorta operations and current therapeutic strategies are analyzed according to our experience and thorough search of the English literature. Current experience with chylothorax occurring during thoracic aortic surgery is analyzed in this review by collecting data retrieved from English literature research. Significant risk factors for postoperative chylothorax development after thoracic aorta surgical procedures are thoracic aortic reoperations and descending thoracic repairs. Various treatment modalities from conservative to operative intervention have been proposed. Currently, the morbidity and mortality have improved due to prompt management. Surgical intervention is needed when response to conservative treatment has failed.  © 2011 Wiley Periodicals, Inc.

  17. The Effect of Composite Thickness on the Stress Distribution Pattern of Restored Premolar Teeth with Cusp Reduction.

    Science.gov (United States)

    Panahandeh, Narges; Torabzadeh, Hassan; Ziaee, Nargess; Mahdian, Mina; Tootiaee, Bahman; Ghasemi, Amir

    2017-07-01

    Different thicknesses of restorative material can alter the stress distribution pattern in remaining tooth structure. The assumption is that a thicker composite restoration will induce a higher fracture resistance. Therefore, the present study evaluated the effect of composite thickness on stress distribution in a restored premolar with cusp reduction. A 3D solid model of a maxillary second premolar was prepared and meshed. MOD cavities were designed with different cusp reduction thicknesses (0, 0.5, 1, 1.5, 2.5 mm). Cavities were restored with Valux Plus composite. They were loaded with 200 N force on the occlusal surface in the direction of the long axis. Von Mises stresses were evaluated with Abaqus software. Stress increased from occlusal to gingival and was maximum in the cervical region. The stressed area in the palatal cusp was more than that of the buccal cusp. Increasing the thickness of composite altered the shear stress to compressive stress in the occlusal area of the teeth. The model with 2.5 mm cusp reduction exhibited the most even stress distribution. © 2015 by the American College of Prosthodontists.

  18. A density cusp of quiescent X-ray binaries in the central parsec of the Galaxy

    Science.gov (United States)

    Hailey, Charles J.; Mori, Kaya; Bauer, Franz E.; Berkowitz, Michael E.; Hong, Jaesub; Hord, Benjamin J.

    2018-04-01

    The existence of a ‘density cusp’—a localized increase in number—of stellar-mass black holes near a supermassive black hole is a fundamental prediction of galactic stellar dynamics. The best place to detect such a cusp is in the Galactic Centre, where the nearest supermassive black hole, Sagittarius A*, resides. As many as 20,000 black holes are predicted to settle into the central parsec of the Galaxy as a result of dynamical friction; however, so far no density cusp of black holes has been detected. Low-mass X-ray binary systems that contain a stellar-mass black hole are natural tracers of isolated black holes. Here we report observations of a dozen quiescent X-ray binaries in a density cusp within one parsec of Sagittarius A*. The lower-energy emission spectra that we observed in these binaries is distinct from the higher-energy spectra associated with the population of accreting white dwarfs that dominates the central eight parsecs of the Galaxy. The properties of these X-ray binaries, in particular their spatial distribution and luminosity function, suggest the existence of hundreds of binary systems in the central parsec of the Galaxy and many more isolated black holes. We cannot rule out a contribution to the observed emission from a population (of up to about one-half the number of X-ray binaries) of rotationally powered, millisecond pulsars. The spatial distribution of the binary systems is a relic of their formation history, either in the stellar disk around Sagittarius A* (ref. 7) or through in-fall from globular clusters, and constrains the number density of sources in the modelling of gravitational waves from massive stellar remnants, such as neutron stars and black holes.

  19. Magnetospheric boundary dynamics: DE 1 and DE 2 observations near the magnetopause and cusp

    Energy Technology Data Exchange (ETDEWEB)

    Maynard, N.C.; Burke, W.J. (Air Force Geophysics Lab., Hanscom AFB, MA (USA)); Aggson, T.L. (Goddard Space Flight Center, Greenbelt, MD (USA)); Basinska, E.M. (Regis College, Weston, MA (USA)); Craven, P. (Marshall Space Flight Center, Huntsville, AL (USA)); Peterson, W.K. (Lockheed Palo Alto Research Lab., CA (USA)); Sugiura, M. (Lockheed Palo Alto Research Lab., CA (USA) Tokai Univ., Tokyo (Japan)); Weimer, D.R. (Univ. of Alaska, Fairbanks (USA))

    1991-03-01

    A broad spectrum of particle and field measurements was taken near local noon by the Dynamics Explorer satellites during the magnetic storm of September 6, 1982. While at apogee, DE 1 sampled the magnetospheric boundary layer at mid southern latitudes and, due to the passage of an intense solar wind burst, briefly penetrated into the magnetosheath. In the boundary layer and the adjacent magnetosheath the plasma flow was directed toward dawn. Variance and de Hoffman-Teller analyses of electric and magnetic field data during the magnetopause crossing showed the magnetopause structure to be that of a rotational discontinuity or an intermediate shock with a substantial normal magnetic field component. This is consistent with an open magnetosphere model in which significant magnetic merging occurs at the local time of the spacecraft. The orbit of DE 2 carried it through the morning sector of the low-altitude, southern cusp. The measurements show a well-defined, cusp current system occurring on open magnetic field lines. At both cusp and subcusp latitudes the electric field was equatorward indicating a strongly eastward plasma flow. The boundary between these two regions was marked by the onset of magnetosheath precipitation and an electric field structure containing both poleward and equatorward spikes. The poleward spike has associated field-aligned currents which are closed by Pedersen currents and, from force balance considerations, is interpreted as the signature of a magnetic merging event at the magnetopause. The equatorward spike has the characteristics of a down-coming and reflected Alfven wave packet of finite dimensions. The high-altitude measurements suggest that the dayside boundary layer is made up of closed magnetic flux tubes, a large fraction of which drift to the magnetopause where merging with the IMF occurs.

  20. A Step Towards Systematic Studies of the Cusp in η → 3π0 Decay

    International Nuclear Information System (INIS)

    Kupsc, A.; Rusetsky, A.; Gullstroem, C.-O.

    2009-01-01

    A realistic estimate of the cusp effect in the η → 3π 0 decay is required for the forthcoming high precision experiments. An estimate for the size of this effect was given recently within the framework of non-relativistic effective field theory. Here we present the next step towards the systematic way of fixing the parameters of the effective non-relativistic Lagrangian and consistency tests of the existing data on η → π 0 π 0 π 0 and η → π + π - π 0 decays. (author)

  1. 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.

  2. Computerized analysis of hydrogen plasma in a compact H-cusp source

    International Nuclear Information System (INIS)

    Yuan, D.H.; Jayamanna, K.; Schmor, P.W.

    1989-11-01

    A cylindrical Langmuir probe with diam of 0.5 mm, length of 5 mm and the Laframboise theory are used to give an analysis of the plasma parameters in a H - cusp source including temperatures and densities of slow, fast electrons and positive ions in a median density plasma. The iteration technique overcomes the problems of conventional Langmuir probe analysis. A VAX based program is used to control the motion and analyze data from the probe. In this paper, we briefly describe the program and present initial results obtained from a compact H - volume multicusp source

  3. Four-Loop Nonplanar Cusp Anomalous Dimension in N=4 Supersymmetric Yang-Mills Theory.

    Science.gov (United States)

    Boels, Rutger H; Huber, Tobias; Yang, Gang

    2017-11-17

    The lightlike cusp anomalous dimension is a universal function that controls infrared divergences in quite general gauge theories. In the maximally supersymmetric Yang-Mills theory this function is fixed fully by integrability to the three-loop order. At four loops a nonplanar correction appears which we obtain for the first time from a numerical computation of the Sudakov form factor. Key ingredients are widely applicable methods to control the number-theoretic aspects of the appearing integrals. Our result shows explicitly that quadratic Casimir scaling breaks down at four loops.

  4. Flow with boiling in four-cusp channels simulating damaged core in PWR type reactors

    International Nuclear Information System (INIS)

    Esteves, M.M.

    1985-01-01

    The study of subcooled nucleate flow boiling in non-circular channels is of great importance to engineering applications in particular to Nuclear Engineering. In the present work, an experimental apparatus, consisting basically of a refrigeration system, running on refrigerant-12, has been developed. Preliminary tests were made with a circular tube. The main objective has been to analyse subcooled flow boiling in four-cusp channels simulating the flow conditions in a PWR core degraded by accident. Correlations were developed for the forced convection film coefficient for both single-phase and subcooled flow boiling. The incipience of boiling in such geometry has also been studied. (author) [pt

  5. Coulomb scatter of diamagnetic dust particles in a cusp magnetic trap under microgravity conditions

    Energy Technology Data Exchange (ETDEWEB)

    Myasnikov, M. I., E-mail: miasnikovmi@mail.ru; D’yachkov, L. G.; Petrov, O. F.; Vasiliev, M. M., E-mail: mixxy@mail.ru; Fortov, V. E. [Russian Academy of Sciences, Joint Institute for High Temperatures (Russian Federation); Savin, S. F.; Serova, E. O. [Korolev Rocket and Space Corporation Energia, ul. Lenina 4A (Russian Federation)

    2017-02-15

    The effect of a dc electric field on strongly nonideal Coulomb systems consisting of a large number (~10{sup 4}) of charged diamagnetic dust particles in a cusp magnetic trap are carried out aboard the Russian segment of the International Space Station (ISS) within the Coulomb Crystal experiment. Graphite particles of 100–400 μm in size are used in the experiments. Coulomb scatter of a dust cluster and the formation of threadlike chains of dust particles are observed experimentally. The processes observed are simulated by the molecular dynamics (MD) method.

  6. MMP-2 Isoforms in Aortic Tissue and Serum of Patients with Ascending Aortic Aneurysms and Aortic Root Aneurysms

    Science.gov (United States)

    Tscheuschler, Anke; Meffert, Philipp; Beyersdorf, Friedhelm; Heilmann, Claudia; Kocher, Nadja; Uffelmann, Xenia; Discher, Philipp; Siepe, Matthias; Kari, Fabian A.

    2016-01-01

    Objective The need for biological markers of aortic wall stress and risk of rupture or dissection of ascending aortic aneurysms is obvious. To date, wall stress cannot be related to a certain biological marker. We analyzed aortic tissue and serum for the presence of different MMP-2 isoforms to find a connection between serum and tissue MMP-2 and to evaluate the potential of different MMP-2 isoforms as markers of high wall stress. Methods Serum and aortic tissue from n = 24 patients and serum from n = 19 healthy controls was analyzed by ELISA and gelatin zymography. 24 patients had ascending aortic aneurysms, 10 of them also had aortic root aneurysms. Three patients had normally functioning valves, 12 had regurgitation alone, eight had regurgitation and stenosis and one had only stenosis. Patients had bicuspid and tricuspid aortic valves (9/15). Serum samples were taken preoperatively, and the aortic wall specimen collected during surgical aortic repair. Results Pro-MMP-2 was identified in all serum and tissue samples. Pro-MMP-2 was detected in all tissue and serum samples from patients with ascending aortic/aortic root aneurysms, irrespective of valve morphology or other clinical parameters and in serum from healthy controls. We also identified active MMP-2 in all tissue samples from patients with ascending aortic/aortic root aneurysms. None of the analyzed serum samples revealed signals relatable to active MMP-2. No correlation between aortic tissue total MMP-2 or tissue pro-MMP-2 or tissue active MMP-2 and serum MMP-2 was found and tissue MMP-2/pro-MMP-2/active MMP-2 did not correlate with aortic diameter. This evidence shows that pro-MMP-2 is the predominant MMP-2 species in serum of patients and healthy individuals and in aneurysmatic aortic tissue, irrespective of aortic valve configuration. Active MMP-2 species are either not released into systemic circulation or not detectable in serum. There is no reliable connection between aortic tissue—and serum MMP-2

  7. Finding the ideal biomaterial for aortic valve repair with ex vivo porcine left heart simulator and finite element modeling.

    Science.gov (United States)

    Toeg, Hadi Daood; Abessi, Ovais; Al-Atassi, Talal; de Kerchove, Laurent; El-Khoury, Gebrine; Labrosse, Michel; Boodhwani, Munir

    2014-10-01

    Aortic valve (AV) repair (AVr) has become an attractive alternative to AV replacement for the correction of aortic insufficiency; however, little clinical evidence exists in determining which biomaterial at AVr would be optimal. Cusp replacement in AVr has been associated with increased long-term AVr failure. We measured the hemodynamic and biomaterial properties using an ex vivo porcine AVr model with clinically relevant biomaterials and generated a finite element model to ascertain which materials would be best suited for valve repair. Porcine aortic roots with intact AVs were placed in a left heart simulator mounted with a high-speed camera for baseline valve assessment. The noncoronary cusp was excised and replaced with autologous porcine pericardium, glutaraldehyde-fixed bovine pericardial patch (Synovis), extracelluar matrix scaffold (CorMatrix), or collagen-impregnated Dacron (Hemashield). The hemodynamic parameters were measured for a range of cardiac outputs (2.5-6.5 L/min) after repair. The biomaterial properties and St Jude Medical pericardial patch were determined using pressurization experiments. Finite element models of the AV and root complex were constructed to determine the hemodynamic characteristics and leaflet stresses. The geometric orifice areas after repair were significantly reduced in the Hemashield (Pbiomaterial groups. Finite element modeling of the biomaterials displayed differences in the percentage of changes in total Von Mises stress for both replaced (noncoronary cusp) and nonreplaced left and right cusps with the St Jude Medical pericardial patch (+4%, +24%) and autologous porcine pericardium (+5, +26%), with a lower percentage of changes than for the bovine pericardial patch (+12%, +27%), Hemashield (+30%, +9%), and CorMatrix (+13%, +32%). The present study has shown that postrepair left ventricular work did not increase despite a decrease in geometric orifice areas in the Hemashield and CorMatrix groups. The autologous porcine

  8. Transcatheter Aortic Valve Replacement for Perceval Sutureless Aortic Valve Failure.

    Science.gov (United States)

    Kalra, Ankur; Reyes, Manuel; Yang, Eric Y; Little, Stephen H; Nabi, Faisal; Barker, Colin M; Ramchandani, Mahesh; Reul, Ross M; Reardon, Michael J; Kleiman, Neal S

    2017-06-01

    As experience with Perceval aortic prosthesis and valve-in-valve TAVR grows, it will be crucial to meticulously document short- and long-term follow-up for establishment of real-world safety and durability of these new technologies.

  9. Augmented Reality System for Ultrasound Guidance of Transcatheter Aortic Valve Implantation.

    Science.gov (United States)

    Currie, Maria E; McLeod, A Jonathan; Moore, John T; Chu, Michael W A; Patel, Rajni; Kiaii, Bob; Peters, Terry M

    2016-01-01

    Transcatheter aortic valve implantation (TAVI) relies on fluoroscopy and nephrotoxic contrast medium for valve deployment. We propose an alternative guidance system using augmented reality (AR) and transesophageal echocardiography (TEE) to guide TAVI deployment. The goals of this study were to determine how consistently the aortic valve annulus is defined from TEE using different aortic valve landmarks and to compare AR guidance with fluoroscopic guidance of TAVI deployment in an aortic root model. Magnetic tracking sensors were integrated into the TAVI catheter and TEE probe, allowing these tools to be displayed in an AR environment. Variability in identifying aortic valve commissures and cuspal nadirs was assessed using TEE aortic root images. To compare AR guidance of TAVI deployment with fluoroscopic guidance, a TAVI stent was deployed 10 times in the aortic root model using each of the two guidance systems. Commissures and nadirs were both investigated as features for defining the valve annulus in the AR guidance system. The commissures were identified more consistently than the nadirs, with intraobserver variability of 2.2 and 3.8 mm, respectively, and interobserver variability of 3.3 and 4.7 mm, respectively. The precision of TAVI deployment using fluoroscopic guidance was 3.4 mm, whereas the precision of AR guidance was 2.9 mm, and its overall accuracy was 3.4 mm. This indicates that both have similar performance. Aortic valve commissures can be identified more reliably than cuspal nadirs from TEE. The AR guidance system achieved similar deployment accuracy to that of fluoroscopy while eliminating the use and consequences of nephrotoxic contrast and radiation.

  10. 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.

  11. Observations of a transverse magnetic field perturbation at two altitudes on the equatorward edge of the magnetospheric cusp

    Science.gov (United States)

    Peterson, W. K.; Abe, T.; Andre, M.; Engebretson, M. J.; Fukunishi, H.; Hayakawa, H.; Matsuoka, A.; Mukai, T.; Persoon, A. M.; Retterer, J. M.

    1993-01-01

    On January 28, 1990, the Dynamic Explorer 1 (DE-1) and Akebono satellites crossed a magnetic field structure at the equatorward edge of the polar cusp at altitudes od 22,000 and 5000 km, respectively, within 6 min of each other. Locally measured plasma particles and fields and magnetometer data from a ground station near the foot of the magnetic field line are more consistent with an interpretation of the structure as that of a standing Alfven wave than that of a quasi-steady field-aligned current sheet. We discuss the observations supporting this conclusion and other related observations of field-aligned currents, Alfven waves, and ion energization near the equatorward edge of the cusp. These observations suggest that Alfven waves are commonly present near the equatorward edge of the cusp.

  12. Type III talon cusp and Type III B dens invaginatus occurring simultaneously in a mandibular lateral incisor.

    Science.gov (United States)

    Dharmani, Umesh; Rajput, Akhil; Chaudhary, Sarika; Talwar, Sangeeta; Verma, Mahesh

    2014-01-01

    Talon cusp and dens invaginatus are developmental anomalies of the human dentition. They not only affect the esthetic appearance of teeth but also may create difficulties during dental treatment and lead to a number of dental problems. Both anomalies are observed most commonly in the lateral maxillary incisor and rarely in the mandibular dentition. The simultaneous occurrence of talon cusp and dens invaginatus in a single tooth is very rare in the mandibular dentition and, to the authors' knowledge, has not yet been reported in a mandibular lateral incisor. This article presents a rare case of dens invaginatus and talon cusp occurring concurrently in a mandibular lateral incisor. Three-dimensional imaging modality was used to describe the complex internal anatomy.

  13. Valve-sparing aortic root repair in acute type A dissection: how many sinuses have to be repaired for curative surgery?

    Science.gov (United States)

    Urbanski, Paul P; Hijazi, Husam; Dinstak, Witold; Diegeler, Anno

    2013-09-01

    The aim of the study was to evaluate operative and long-term results of valve-sparing aortic root surgery in acute type A dissection. The repair consisted of selective replacement of all dissected and pathological sinuses. Forty-six patients (mean age 62 ± 14; range 29-88 years, 3 with Marfan syndrome), operated on between August 2001 and July 2011 due to acute type A aortic dissection, underwent valve-sparing root repair, resulting in a valve preservation rate of 56% in acute aortic dissection surgery involving the aortic root. Insufficiency grades of 0/1+, 2+, 3+ and 4+ were presented in 16, 17, 12 and 1 patients, respectively. Root repair with resection of the whole of the pathological aortic wall without the use of any glue was performed in all patients. Replacement of 1, 2 or 3 sinuses of Valsalva was performed in 29, 12 and 5 patients, respectively. Concomitant cusp repair was necessary in 7 patients. All perioperative data were collected prospectively and an intention-to-treat analysis was performed. A total of 6 patients (median age 76, range 63-81 years) died, on average 10 months (range 0.9-44) after surgery resulting in an overall survival of 87% at the mean follow-up of 54 ± 37, range 0.9-132 months. The linearized death rate was 2.9%/year, and the actuarial survival rate at 8 years was 85.5 ± 5.6%. No death was related to the aortic valve or aortic root. There were no valve-related events and no patient required reoperation on the proximal aorta/aortic valve during the follow-up. At the last echocardiography (47.8 ± 35.6 months after surgery), 33 patients showed no and 13 patients slight (1+) aortic insufficiency. Curative repair with replacement of all pathological sinuses of Valsalva leads to an excellent long-term outcome. Selected sinus repair is a simple and effective method of curative, valve-sparing root repair in acute aortic dissection because replacement of all sinuses is seldom necessary.

  14. 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

    Transcatheter aortic valve implantation (TAVI) in severe aortic stenosis has proven to be a feasible and effective treatment modality for inoperable patients. Until now, neither aortic regurgitation nor degenerated bioprostheses has been an indication for TAVI. However, this article reports...... 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...

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

    International Nuclear Information System (INIS)

    Bangard, Christopher; Franke, Mareike; Maintz, David; Chang, De-Hua; Pfister, Roman; Deppe, Antje-Christin; Matoussevitch, Vladimir

    2014-01-01

    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.)

  16. Automatic measurement of cusps in 2.5D dental images

    Science.gov (United States)

    Wolf, Mattias; Paulus, Dietrich W.; Niemann, Heinrich

    1996-01-01

    Automatic reconstruction of occlusal surfaces of teeth is an application which might become more and more urgent due to the toxicity of amalgam. Modern dental chairside equipment is currently restricted to the production of inlays. The automatic reconstruction of the occlusal surface is presently not possible. For manufacturing an occlusal surface it is required to extract features from which it is possible to reconstruct destroyed teeth. In this paper, we demonstrate how intact upper molars can be automatically extracted in dental range and intensity images. After normalization of the 3D location, the sizes of the cusps are detected and the distances between them are calculated. In the presented approach, the detection of the upper molar is based on a knowledge-based segmentation which includes anatomic knowledge. After the segmentation of the interesting tooth the central fossa is calculated. The normalization of the spatial location is archieved by aligning the detected fossa with a reference axis. After searching the cusp tips in the range image the image is resized. The methods have been successfully tested on 60 images. The results have been compared with the results of a dentist's evaluation on a sample of 20 images. The results will be further used for automatic production of tooth inlays.

  17. 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 ...

  18. Origin of the turbulent spectra in the high-altitude cusp: Cluster spacecraft observations

    Directory of Open Access Journals (Sweden)

    K. Nykyri

    2006-05-01

    Full Text Available High-resolution magnetic field data from Cluster Flux Gate Magnetometer (FGM and the Spatio-Temporal Analysis of Field Fluctuations (STAFF instruments are used to study turbulent magnetic field fluctuations during the high-altitude cusp crossing on 17 March 2001. Despite the quiet solar wind conditions, the cusp was filled with magnetic field turbulence whose power correlates with the field-aligned ion plasma flux. The magnetic field wave spectra shows power law behavior with both double and single slopes with break in the spectra usually occurring in the vicinity of the local ion cyclotron frequency. Strong peaks in the wave power close to local ion cyclotron frequency were sometimes observed, with secondary peaks at higher harmonics indicative of resonant processes between protons and the waves. We show that the observed spectral break point may be caused partly by damping of obliquely propagating kinetic Alfvén (KAW waves and partly by cyclotron damping of ion cyclotron waves.

  19. 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.

  20. MHC molecules in health and disease: At the cusp of a paradigm shift.

    Science.gov (United States)

    de Almeida, Denise E; Holoshitz, Joseph

    2011-01-01

    Half a century after the major histocompatibility complex (MHC) was discovered, its functional roles in health and disease remain poorly understood. Many hallmarks of the MHC, including its unusual evolution, structurefunction properties of its gene products and allele-specific associations with dozens of diseases and health traits cannot be convincingly explained by the tenets of existing paradigms. It is therefore becoming increasingly apparent that in order to better understand MHC-health/disease association-a phenomenon that impacts the health of millions-heterodox ideas are critically needed. Here we propose a testable, novel theory concerning the functional role of MHC molecules in health and disease. At the focus of this theory is an evolutionarily-conserved, tri-dimensional cusp-like prominence ('kink'), found in the midst of one of the two α helices that form the perimeter of the groove of all MHC molecules. Based on structural, functional and evolutionary considerations, as well as our recent experimental data, it is proposed here that the MHC cusp region is enriched in allele-specific signal transduction ligands that interact with non-MHC cell surface receptors and trigger signaling events. Aberrations in these pathways could lead to disease development, or affect the severity of such diseases.

  1. 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...

  2. Statins for aortic valve stenosis.

    Science.gov (United States)

    Thiago, Luciana; Tsuji, Selma Rumiko; Nyong, Jonathan; Puga, Maria Eduarda Dos Santos; Góis, Aécio Flávio Teixeira de; Macedo, Cristiane Rufino; Valente, Orsine; Atallah, Álvaro Nagib

    2016-01-01

    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. To evaluate the effectiveness and safety of statins in aortic valve stenosis. 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. 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), and aortic jet velocity (MD -0.06, 95% CI -0.26 to 0

  3. Transfer coefficients in a four-cusp duct simulating a typical nuclear reactor channel degraded by accident

    International Nuclear Information System (INIS)

    Souza Dutra, A. de.

    1985-01-01

    An experimental study on forced convection in a four-cusp duct simulating a typical nuclear reactor channel degraded by accident is presented. Transfer coefficients were obtained by using the analogy between heat and mass tranfer, with the naphtalene sublimation technique. The experiment consisted in forcing air past a four-cusp naphthalene moulded duct. Mass transfer coefficients were determined in nondimensional form as Sherwood number. Experimental curves correlating the Sherwood number with a nondimensional length, x + , were obtained for Reynolds number varying from 891 to 30.374. This range covers typical flow rates that are expected to exist in a degraded nuclear reactor core. (Author) [pt

  4. A Rare Bilateral Presentation of Multiple Dens Invaginatus, Shovel-Shaped Incisor and Talon Cusp With Mesiodens.

    Science.gov (United States)

    Hegde, S; Jain, M; Shubha, A B

    2014-01-01

    The aim of this paper is to describe a unique and unusual case of concomitant appearance of morphological dental anomalies in the maxillary anterior region, along with its management in a patient with no systemic abnormality. This case report describes the clinical and radiographic features of talon cusp, dens invaginatus, shovel-shaped incisors and a supernumerary tooth occurring in a single patient, which is a rare presentation. All 4 permanent maxillary incisors had dens invaginatus, the permanent maxillary canines showed the presence of talon cusps, the permanent maxillary central incisors were shovel-shaped and an erupted mesiodens was also observed. Treatment included restorative, surgical and orthodontic approaches.

  5. Coexistence of true talon cusp and double dens invaginatus in a single tooth: a rare case report and review of the literature.

    Science.gov (United States)

    Nu Nu Lwin, Hnin; Phyo Kyaw, Pyae; Wai Yan Myint Thu, Sai

    2017-12-01

    Co-occurrence of a talon cusp and double dens invaginatus is an extremely rare developmental dental anomaly. This case report represents a talon cusp with two dens invaginatus on a maxillary right lateral incisor. Early identification is needed for prevention of potential problems on the affected or opposing tooth.

  6. HIV infection and aortic stiffness.

    Science.gov (United States)

    Leite, Luisa Helena Maia; Cohen, Ariel; Boccara, Franck

    People living with human immunodeficiency virus (HIV) infection and receiving antiretroviral therapy now have the same life expectancy as the general population. However, they have a higher risk of atherosclerotic cardiovascular events because of a complex and polyfactorial vasculopathy, combining the effects of antiretroviral therapy, the HIV virus itself, immune activation, chronic inflammation and metabolic disturbances. Whether people living with HIV infection experience increased vascular aging compared with the general population remains controversial. To summarize current knowledge of the association between HIV infection and aortic stiffness as a marker of vascular aging. This review included 18 clinical studies in adult populations, published between 2009 and 2016, and identified on PubMed/MEDLINE or other databases. Search terms were aortic stiffness, arterial stiffness, vascular aging, pulse wave velocity and HIV. All 18 studies were observational, and compared groups infected (HIV+) and not infected (HIV-) with HIV. Ten studies (55%) reported no significant differences in aortic stiffness between HIV+ groups and age-matched HIV- control groups. The main reported determinants of aortic stiffness were age, blood pressure, smoking, metabolic syndrome and HIV-related variables, including CD4/CD8 ratio, current T-CD4 count CD4+ count < 200/mm 3 . We found discordant results regarding whether HIV+ patients had increased aortic stiffness compared with HIV- controls. However, HIV-related conditions were associated with vascular health. This association has been confirmed in recent prospective studies. There is emerging evidence that HIV itself and immune activity affect vascular health and the large arteries. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  7. [Thymic carcinoma involving aortic arch; report of a case].

    Science.gov (United States)

    Noriyuki, Toshio; Hamamoto, M; Takazawa, Y; Katoh, K; Hashimoto, M; Kuranishi, F; Nakahara, M; Fukuda, T; Ishizaki, Y; Okuda, H; Akimoto, E; Yonehara, S

    2009-05-01

    Adenocarcinoma of the thymus is a very rare malignant tumor. The standard treatment for advanced thymic carcinoma has not yet been established, and the prognosis is poor. We report a case of thymic carcinoma that involving the aortic arch and the innominate vein. A 78-year-old woman was admitted to our hospital complaining of hoarseness in April 2007. The computed tomography (CT) scan showed an anterior mediastinal tumor contiguous to the aortic arch and the innominate vein with swelling lymphnodes. Microspcopic examinations of specimens obtained by CT-guided needle biopsy revealed poorly differenciated adenocarcinoma. The carcinoembryonic antigen (CEA) level of serum elevated at 54.9 ng/ml. Thymic carcinoma was diagnosed. The chemoradiotherapy [concurrent, carboplatin (CBDCA) + paclitaxel(TXL)-->vinorelbine (NVB), 60 Gy] was performed, but the effect of the therapy was limited. The resection of the tumor with a part of aortic arch and other peripheral tissues was performed in Augast 2007. The postoperative course was uneventful and the CEA level of serum lowered to the normal. She was discharged 30 days after surgery.

  8. Aortic intramural hematoma : assessment of clinical and radiological features in comparison to acute aortic dissection

    International Nuclear Information System (INIS)

    Yoon, Kwon Ha; Hwang, Jae Cheol; Lee, Jin Seong; Kang, Duk Hyun; Song, Jae Kwan; Song, Koun Sik; Lim, Tae Hwan

    1996-01-01

    To compare the clinical and radiological features of aortic intramural hematoma(IMH) to those of acute aortic dissection(AD). We analyzed the clinical and radiological features of 12 patients with aortic IMH and 43 patients with acute AD. In aortic IMH, the diagnoses were made by means of both CT and transesophageal echocardiography(TEE) and included two surgically proven cases. In acute AD, the diagnoses were made by means of CT and TEE and included 21 surgically proven cases. We compared patients ages, etiologies, the extent of the disease, the presence or absence of aortic branch involvement, complications, and outcomes. Aortic IMH tended to develop in older patients (67.8±7.9 vs. 50.4±13.4, P .05). In aortic IMH, there was no involvement of aortic branches, whereas in acute AD, 14(33%) patients showed involvement of one or more aortic branches. Complications of aortic IMH included pericardial effusion (n=2) and pleural effusion (n=4);in acute AD, pericardial effusion (n=7), pleural effusion (n=4), aortic insufficiency (n=8), cerebral infarction (n=3), renal infarction (n=4) and spinal infarction (n=1) were seen. There was one (8%) death due to aortic IMH and ten (23%) deaths due to acute AD (p<.01). Aortic IMH is characterized by its occurrence in older patients with hypertension, a less frequent incidence of complications, and a more favorable outcome than acute AD

  9. One stage surgical treatment of aortic valve disease and aortic coarctation with aortic bypass grafting through the diaphragm and aortic valve replacement.

    Science.gov (United States)

    Yu, Zipu; Wu, Shengjun; Li, Chengchen; Zou, Yu; Ma, Liang

    2015-11-10

    To validate ascending aorta-lower abdominal aorta bypass grafting treatment for patients with descending aortic coarctation and an aortic valve disease. The three patients in whom a descending atypical aortic coarctation was associated with an aortic valve disease were treated with one stage surgical treatment with aortic bypass grafting through the diaphragm and aortic valve replacement in our heart center. Operative technique consisted of performing ascending aorta-lower abdominal aorta bypass grafting through diaphragm muscle and implementing aortic valve replacement. The mean time for extracorporeal circulation and occluding clamp of aorta was recorded. Blood pressure data for pre- and post-operation was measured in the limbs. Computer-enhanced transvenous angiograms of pre- and post-operation were applied for detection of aortic stenosis. The other adverse events were noticed in outpatient service during a follow-up period. The mean extracorporeal circulation time was 54 ± 11 min. The mean time for occluding clamp of aorta was 34 ± 6 min. An arterial pressure gradient was totally corrected after surgical treatment. Post-operation computer-enhanced transvenous angiograms showed the grafts to be open with a fluent flow. The patients had no gastrointestinal tract complications. No adverse event was noticed during a follow-up period in outpatient service. Treatment of ascending aorta-lower abdominal aorta bypass is advisable for patients with descending aortic coarctation and an aortic valve disease.

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

    NARCIS (Netherlands)

    van Wachem, Pauline B.; Brouwer, Linda A.; Zeeman, R.; Dijkstra, Pieter J.; Feijen, Jan; Hendriks, Marc; Cahalan, Patrick T.; van Luyn, Marja J.A.

    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

  11. 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

    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

  12. Abdominal aortic aneurysms.

    Science.gov (United States)

    Lindholt, Jes Sanddal

    2010-12-01

    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 surgery of symptomfree AAA. In order to fulfil all WHO, European, and Danish criteria for screening, a randomised hospitalbased screening trial of 12,639 65-73 year old men in Viborg County (Denmark) was initiated in 1994. It seemed that US screening is a valid, suitable and acceptable method of screening. 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 intervals. Two large RCTs have given clear indications of operation. Survivors of surgery enjoy the same quality of life as the background population, and only 2-5% of patients refuse an offer of surgery. Early detection seems relevant since the cardiovascular mortality is more than 4 times higher in AAA patients without previous hospital discharge diagnoses due to cardiovascular disease than among similar men without AAA. The absolute risk difference after 5 years was 16%. So, they will benefit from general cardiovascular preventive action as smoking cessation, statins and low-dose aspirin, which could inhibit further AAA progression. All 4 existing RCTs point in the same direction, viz. in favour of screening of men aged 65 and above. We found that screening significantly reduced AAA-related mortality by 67% within the first five years (NNT = 352). Restriction of screening to men with previous cardiovascular or pulmonary hospital discharge diagnoses would request only 27% of the relevant male population study to be invited, but would only have prevented 46.7% of the

  13. Aorto-aortic intrathoracic bypass in surgical treatment of aortic

    International Nuclear Information System (INIS)

    Gutierrez Perez, F.; Duran Reyes, A.; Bigalli, D.; Filgueira Berobide, J.

    1998-01-01

    The prevalence of coarctation of the aorta is 6.5 percent of all congenital heart defects, according to national and international data. There is a restenosis rate of patients after surgery. Factors that influence this evolution depends on the age at which patients underwent surgery for the first time the anatomy of the aortic arch and type of surgical technique. Several procedures can be used to correct the coarctation, which include surgery and balloon catheter dilation. We present here a case of a patient of 22 years old, with a recurrent coarctation of the aorta studied by echocardiography and magnetic resonance imaging. The patient underwent surgery a third time. We used an anterior approach (median sternotomy) and performed an aortic bypass graft, intrathoracic, under cardiopulmonary bypass. Evolved favorably and was discharged on the sixth day of post operative day (Author) [es

  14. 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...

  15. Large aortic root pseudoaneurysm occurring late after aortic root repair and valve replacement for endocarditis

    Directory of Open Access Journals (Sweden)

    Prashanth Panduranga

    2013-01-01

    Full Text Available A 68-year-old male presented with Group B Streptococcus aortic valve (AV endocarditis with aortic root abscess and refractory sepsis. An emergency cardiac surgery was performed with root abscess drainage, excision and debridement of necrotic tissue, reconstruction of annulus, and AV replacement. Fifteen months later he presented with a huge aortic root pseudoaneurysm (PA. This case illustrates late occurrence of aortic root PA following AV surgery for endocarditis.

  16. Ionospheric cusp flows pulsed by solar wind Alfvén waves

    Directory of Open Access Journals (Sweden)

    P. Prikryl

    2002-02-01

    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

  17. 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

  18. Studies of small scale irregularities in the cusp ionosphere using sounding rockets: recent results

    Science.gov (United States)

    Spicher, A.; Ilyasov, A. A.; Miloch, W. J.; Chernyshov, A. A.; Moen, J.; Clausen, L. B. N.; Saito, Y.

    2017-12-01

    Plasma irregularities occurring over many scale sizes are common in the ionosphere. Understanding and characterizing the phenomena responsible for these irregularities is not only important from a theoretical point of view, but also in the context of space weather, as the irregularities can disturb HF communication and Global Navigation Satellite Systems signals. Overall, research about the small-scale turbulence has not progressed as fast for polar regions as for the equatorial ones, and for the high latitude ionosphere there is still no agreement nor detailed explanation regarding the formation of irregularities. To investigate plasma structuring at small scales in the cusp ionosphere, we use high resolution measurements from the Investigation of Cusp Irregularities (ICI) sounding rockets, and investigate a region associated with density enhancements and a region characterized by flow shears. Using the ICI-2 electron density data, we give further evidence of the importance of the gradient drift instability for plasma structuring inside the polar cap. In particular, using higher-order statistics, we provide new insights into the nature of the resulting plasma structures and show that they are characterized by intermittency. Using the ICI-3 data, we show that the entire region associated with a reversed flow event (RFE), with the presence of meter-scale irregularities, several flow shears and particle precipitation, is highly structured. By performing a numerical stability analysis, we show that the inhomogeneous-energy-density-driven instability (IEDDI) may be active in relation to RFEs at the rocket's altitude. In particular, we show that the presence of particle precipitation decreases the growth rates of IEDDI and, using a Local Intermittency Measure, we observe a correlation between IEDDI growth rates and electric field fluctuations over several scales. These findings support the view that large-scale inhomogeneities may provide a background for the

  19. Influence of occlusal contact area on cusp defection and stress distribution.

    Science.gov (United States)

    Costa, Anna Karina Figueiredo; Xavier, Thaty Aparecida; Paes-Junior, Tarcisio José Arruda; Andreatta-Filho, Oswaldo Daniel; Borges, Alexandre Luiz Souto

    2014-11-01

    The purpose of this study was to evaluate the effect of occlusal contact area for loading on the cuspal defection and stress distribution in a first premolar restored with a high elastic modulus restorative material. The Rhinoceros 4.0 software was used for modeling the three-dimensional geometries of dental and periodontal structures and the inlay restoration. Thus, two different models, intact and restored teeth with three occlusal contact areas, 0.1, 0.5 and 0.75 mm(2), on enamel at the occlusal surface of buccal and lingual cusps. Finite element analysis (FEA) was performed with the program ANSYS (Workbench 13.0), which generated a mesh with tetrahedral elements with greater refinement in the regions of interest, and was constrained at the bases of cortical and trabecular bone in all axis and loaded with 100 N normal to each contact area. To analysis of maximum principal stress, the smaller occlusal contact area showed greater compressive stress in region of load application for both the intact and inlay restored tooth. However, tensile stresses at the occlusal isthmus were similar for all three tested occlusal contact areas (60 MPa). To displacement of the cusps was higher for teeth with inlay (0.46-0.48 mm). For intact teeth, the smaller contact area showed greater displacement (0.10 mm). For teeth with inlays, the displacement of the cusps were similar in all types of occlusal area. Cuspal displacement was higher in the restored tooth when compared to the intact tooth, but there were no significant variations even with changes in the occlusal contact area. RELEVANCE CLINICAL: Occlusal contacts have a great influence on the positioning of teeth being able to maintain the position and stability of the mandible. Axial loads would be able to generate more uniform stress at the root presenting a greater concentration of load application in the point and the occlusal surface. Thus, is necessary to analyze the relationship between these occlusal contacts as dental

  20. 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.

  1. Efficient Word Reading: Automaticity of Print-Related Skills Indexed by Rapid Automatized Naming through Cusp-Catastrophe Modeling

    Science.gov (United States)

    Sideridis, Georgios D.; Simos, Panagiotis; Mouzaki, Angeliki; Stamovlasis, Dimitrios

    2016-01-01

    The study explored the moderating role of rapid automatized naming (RAN) in reading achievement through a cusp-catastrophe model grounded on nonlinear dynamic systems theory. Data were obtained from a community sample of 496 second through fourth graders who were followed longitudinally over 2 years and split into 2 random subsamples (validation…

  2. Four-loop photon quark form factor and cusp anomalous dimension in the large-Nc limit of QCD

    International Nuclear Information System (INIS)

    Henn, Johannes; Lee, Roman N.; Smirnov, Alexander V.; Smirnov, Vladimir A.; Steinhauser, Matthias

    2017-01-01

    We compute the four-loop QCD corrections to the massless quark-anti-quark-photon form factor F q in the large-N c limit. From the pole part we extract analytic expressions for the corresponding cusp and collinear anomalous dimensions.

  3. Cusps in the center of galaxies: a real conflict with observations or a numerical artefact of cosmological simulations?

    Energy Technology Data Exchange (ETDEWEB)

    Baushev, A.N.; Valle, L. del; Campusano, L.E.; Escala, A.; Muñoz, R.R. [Departamento de Astronomía, Universidad de Chile, Casilla 36-D, Correo Central, Santiago (Chile); Palma, G.A., E-mail: baushev@gmail.com, E-mail: ldelvalleb@gmail.com, E-mail: luis@das.uchile.cl, E-mail: aescala@das.uchile.cl, E-mail: rmunoz@das.uchile.cl, E-mail: gpalmaquilod@ing.uchile.cl [Departamento de Física, FCFM, Universidad de Chile, Blanco Encalada 2008, Santiago (Chile)

    2017-05-01

    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 density 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 [1]. 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. The same streams should appear in cosmological N-body simulations, being strong enough to change the shape of the cusp or even to create it. Our analysis, based on the Hernquist model and the standard SPH code, strongly suggests that the UDPs generally found by the cosmological N-body simulations may be a consequence of numerical effects. A much better understanding of the N-body simulation convergency is necessary before a 'core-cusp problem' can properly be used to question the validity of the CDM model.

  4. 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

  5. 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...

  6. Cervical aortic arch and a new type of double aortic arch. Report of a case.

    Science.gov (United States)

    Cornali, M; Reginato, E; Azzolina, G

    1976-09-01

    A case of cervical aortic arch is reported. To the best of our knowledge, it is the first to be associated with a serious intracardiac anomaly. In addition, it is part of a new type of double aortic arch, caused by failure of reabsorption of both dorsal aortic roots and persistence of the fourth right and second (or third) left branchial arches.

  7. Ascending aortic diameters in congenital aortic stenosis: cardiac magnetic resonance versus transthoracic echocardiography

    NARCIS (Netherlands)

    Linde, D. van der; Rossi, A. de; Yap, S.C.; McGhie, J.S.; Bosch, A.E. van den; Kirschbaum, S.W.; Russo, B.; Dijk, A.P.J. van; Moelker, A.; Krestin, G.P.; Geuns, R.J. van; Roos-Hesselink, J.W.

    2013-01-01

    OBJECTIVES/BACKGROUND: Congenital aortic stenosis (AS) is the most common obstructive left heart lesion in the young adult population and often complicated by aortic dilatation. Our objective was to evaluate accuracy of aortic imaging with transthoracic echocardiography (TTE) compared with cardiac

  8. 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)

  9. Hybrid treatment of penetrating aortic ulcer

    International Nuclear Information System (INIS)

    Lara, Juan Antonio Herrero; Martins-Romeo, Daniela de Araujo; Escudero, Carlos Caparros; Falcon, Maria del Carmen Prieto; Batista, Vinicius Bianchi; Vazquez, Rosa Maria Lepe

    2015-01-01

    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)

  10. 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....

  11. 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.

  12. Quantum Spectral Curve for a cusped Wilson line in N=4 SYM

    Energy Technology Data Exchange (ETDEWEB)

    Gromov, Nikolay [King’s College London, Department of Mathematics, The Strand, London WC2R 2LS (United Kingdom); St. Petersburg INP,Gatchina, 188 300, St.Petersburg (Russian Federation); Levkovich-Maslyuk, Fedor [King’s College London, Department of Mathematics, The Strand, London WC2R 2LS (United Kingdom)

    2016-04-20

    We show that the Quantum Spectral Curve (QSC) formalism, initially formulated for the spectrum of anomalous dimensions of all local single trace operators in N=4 SYM, can be extended to the generalized cusp anomalous dimension for all values of the parameters. We find that the large spectral parameter asymptotics and some analyticity properties have to be modified, but the functional relations are unchanged. As a demonstration, we find an all-loop analytic expression for the first two nontrivial terms in the small |ϕ±θ| expansion. We also present nonperturbative numerical results at generic angles which match perfectly 4-loop perturbation theory and the classical string prediction. The reformulation of the problem in terms of the QSC opens the possibility to explore many open questions. We attach to this paper several Mathematica notebooks which should facilitate future studies.

  13. 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%.

  14. Atypical presentation of bilateral supplemental maxillary central incisors with unusual talon cusp

    Directory of Open Access Journals (Sweden)

    Sivakumar Nuvvula

    2011-01-01

    Full Text Available Delayed eruption of maxillary permanent central incisors in a child poses a distressing esthetic quandary to parents, by virtue of its location in the dental architecture. Well-aligned anterior teeth add confidence to smile and have enhanced self-esteem, which is critical even in early life. Impaction of the maxillary central incisors compared to third molars or the canines is less reported; bilateral supplemental maxillary central incisors related to impacted permanent maxillary central incisors are rare and one of the supplemental central incisors showing unusual talon is still infrequent. A case of impacted maxillary permanent central incisors related to supplemental maxillary central incisors, with one of them showing an unusual talon cusp, is presented.

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

    Science.gov (United States)

    Lüchow, Arne; Sturm, Alexander; Schulte, Christoph; Haghighi Mood, Kaveh

    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.

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

    Directory of Open Access Journals (Sweden)

    B. Mahdavipour

    Full Text Available 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. Keywords: Low beta confinement, Polywell, IEC, Comsol multiphysics

  17. 3D printing based on cardiac CT assists anatomic visualization prior to transcatheter aortic valve replacement.

    Science.gov (United States)

    Ripley, Beth; Kelil, Tatiana; Cheezum, Michael K; Goncalves, Alexandra; Di Carli, Marcelo F; Rybicki, Frank J; Steigner, Mike; Mitsouras, Dimitrios; Blankstein, Ron

    2016-01-01

    3D printing is a promising technique that may have applications in medicine, and there is expanding interest in the use of patient-specific 3D models to guide surgical interventions. To determine the feasibility of using cardiac CT to print individual models of the aortic root complex for transcatheter aortic valve replacement (TAVR) planning as well as to determine the ability to predict paravalvular aortic regurgitation (PAR). This retrospective study included 16 patients (9 with PAR identified on blinded interpretation of post-procedure trans-thoracic echocardiography and 7 age, sex, and valve size-matched controls with no PAR). 3D printed models of the aortic root were created from pre-TAVR cardiac computed tomography data. These models were fitted with printed valves and predictions regarding post-implant PAR were made using a light transmission test. Aortic root 3D models were highly accurate, with excellent agreement between annulus measurements made on 3D models and those made on corresponding 2D data (mean difference of -0.34 mm, 95% limits of agreement: ± 1.3 mm). The 3D printed valve models were within 0.1 mm of their designed dimensions. Examination of the fit of valves within patient-specific aortic root models correctly predicted PAR in 6 of 9 patients (6 true positive, 3 false negative) and absence of PAR in 5 of 7 patients (5 true negative, 2 false positive). Pre-TAVR 3D-printing based on cardiac CT provides a unique patient-specific method to assess the physical interplay of the aortic root and implanted valves. With additional optimization, 3D models may complement traditional techniques used for predicting which patients are more likely to develop PAR. Copyright © 2016 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  18. Surgery for acute Type I aortic dissection without resection of supra-aortic entry sites leads to unfavourable aortic remodelling.

    Science.gov (United States)

    Heo, Woon; Song, Suk-Won; Lee, Kwang-Hun; Lee, Shin-Young; Kim, Tae-Hoon; Baek, Min-Young; Yoo, Kyung-Jong

    2018-01-29

    This study aimed to evaluate the impact of remnant re-entries in arch branches on postoperative change in the aortic arch and descending aortic diameters and the rate of major adverse aortic events. Between January 2010 and December 2016, 249 patients underwent surgery for acute Type I aortic dissection. Patients who underwent total arch replacement, had Marfan syndrome or had intramural haematoma were excluded. Seventy-two patients with predischarge and follow-up computed tomography scans were enrolled. Patients with and without re-entries in the arch branches after surgery were assigned to the supra-aortic entry (SAE, n = 21) and no supra-aortic entry (n = 51) groups, respectively. Diameters were measured at 7 levels: the innominate artery, left common carotid artery, left subclavian artery, 20 mm distal to the left subclavian artery, pulmonary artery bifurcation, coeliac axis and maximal diameter of the descending thoracic aorta. Growth rates at the levels of the pulmonary artery bifurcation and 20 mm distal to the left subclavian artery were significantly higher in the SAE group than in the no supra-aortic entry group. The rate of freedom from major adverse aortic events (annual growth >5 mm or maximal diameter of the descending thoracic aorta >50 mm) at 5 years was significantly higher in the no supra-aortic entry group than in the SAE group. Remnant SAE leads to unfavourable aortic remodelling after acute Type I aortic dissection repair. © The Author(s) 2018. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  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. In-situ Measurement of Reversed Flow Event in the Cusp Ionosphere

    Science.gov (United States)

    Jin, Y.; Moen, J.; Miloch, W. J.; Spicher, A.; Clausen, L. B. N.

    2017-12-01

    The Reversed Flow Events (RFEs) are a new category of flow channel that frequently occur in the cusp ionosphere. The RFEs are 100-200 km wide and east-west elongated flow channels, in which plasma flow opposes to the background convection direction. The RFEs are thought to be an important source for the rapid development of the ionospheric irregularities. We present an overview of the ionospheric conditions during the launch of the Investigation of Cusp Irregularities 3 (ICI-3) sounding rockets. The ICI-3 was launched from Ny-Ålesund, Svalbard at 7:21.31 UT on December 3, 2011. The objective of the ICI-3 was to target a RFE. The IMF was characterized by strongly negative Bz and weakly negative By during the time period of interest. The EISCAT Svalbard Radar (ESR) 32m beam was operating in a fast azimuth sweep mode between 180° (south) and 300° (northwest) at an elevation angle of 30°. The ESR observed a series of RFEs as westward flow channels opposing to the eastward normal plasma flow in the prenoon sector. The ICI-3 was shot to cross the first observed RFE in the ESR field of view. The ICI-3 observed flow structures that were consistent with the ESR. Furthermore, the ICI-3 reveals fine-scale of the flow structures inside the RFE observed by the ESR. The high resolution electron density data show intense fluctuations at all scales throughout the RFE region. The GPS TEC and scintillation data inside the same RFE region are used to compare with the in-situ measurements.

  1. Maintaining and sustaining the On the CUSP: stop BSI model in Hawaii.

    Science.gov (United States)

    Lin, Della M; Weeks, Kristina; Holzmueller, Christine G; Pronovost, Peter J; Pham, Julius Cuong

    2013-02-01

    Hawaii joined the On the CUSP: Stop BSI national effort in the United States in 2009 (CUSP stands for Comprehensive Unit-based Safety Program). In the initial 18-month study evaluation, adult ICUs decreased central line-associated bloodstream infection (CLABSI) rates by 61%. The impact of a series of novel strategies/tools in reducing infections and sustaining the collaborative in ICUs and non-ICUs in Hawaii was assessed. This cohort collaborative consisted of 20 adult ICUs and 18 nonadult ICUs in 16 hospitals. Hawaii developed and implemented six tools between July 2010 and August 2011: a tool to investigate CLABSIs, a video to address cultural barriers, a standardized dressing change kit, a map of the cohort's journey, a 12-strategies leadership dashboard, and a geometric plot of consecutive infection-free days. The primary outcome measure was overall CLABSI rates (mean infections per 1,000 catheter-days). A comparison of baseline data from 28 ICUs with 12-quarter (36-month) postimplementation data indicated that the CLABSI rate decreased across the entire state: overall, 1.57 to 0.29 infections/1,000 catheter-days; adult ICUs, 1.49 to 0.25 infections/1,000 catheter-days; nonadult ICUs, 2.54 to 0.33 infections/1,000 catheter-days, non-ICUs (N= 14), 4.52 to 0.25 infections/1,000 catheter-days, and PICU/NICU (N = 4), 2.05 to 0.53 infections/1,000 catheter-days. Days between CLABSIs in the adult ICUs statewide increased from a median of 5 days in 2009 to 70 days in 2011. Hawaii successfully spread the program beyond adult ICUs and implemented a series of tools for maintenance and sustainment. Use of the tools shaped a culture around the continued belief that CLABSIs can be eradicated, and infections further reduced.

  2. Meridian-scanning photometer, coherent HF radar, and magnetometer observations of the cusp: a case study

    Directory of Open Access Journals (Sweden)

    S. E. Milan

    1999-02-01

    Full Text Available The dynamics of the cusp region and post-noon sector for an interval of predominantly IMF By, Bz < 0 nT are studied with the CUTLASS Finland coherent HF radar, a meridian-scanning photometer located at Ny Ålesund, Svalbard, and a meridional network of magnetometers. The scanning mode of the radar is such that one beam is sampled every 14 s, and a 30° azimuthal sweep is completed every 2 minutes, all at 15 km range resolution. Both the radar backscatter and red line (630 nm optical observations are closely co-located, especially at their equatorward boundary. The optical and radar aurora reveal three different behaviours which can interchange on the scale of minutes, and which are believed to be related to the dynamic nature of energy and momentum transfer from the solar wind to the magnetosphere through transient dayside reconnection. Two interpretations of the observations are presented, based upon the assumed location of the open/closed field line boundary (OCFLB. In the first, the OCFLB is co-located with equatorward boundary of the optical and radar aurora, placing most of the observations on open field lines. In the second, the observed aurora are interpreted as the ionospheric footprint of the region 1 current system, and the OCFLB is placed near the poleward edge of the radar backscatter and visible aurora; in this interpretation, most of the observations are placed on closed field lines, though transient brightenings of the optical aurora occur on open field lines. The observations reveal several transient features, including poleward and equatorward steps in the observed boundaries, "braiding" of the backscatter power, and 2 minute quasi-periodic enhancements of the plasma drift and optical intensity, predominantly on closed field lines.Key words. Ionosphere (auroral ionosphere; plasma convection · Magnetospheric physics (magnetopause · cusp · and boundary layers

  3. Plasma and magnetic field characteristics of the distant polar cusp near local noon: The entry layer

    International Nuclear Information System (INIS)

    Paschmann, G.; Haerendel, G.; Sckopke, N.; Rosenbauer, H.; Hedgecock, P.C.

    1976-01-01

    Heos 2 plasma and magnetic field measurements in the distant polar cusp region reveal the existence of a plasma layer on day side field lines just inside the magnetopause. Density and temperature in this layer are nearly the same as they are in the adjacent magnetosheath, but the flow lacks the order existing both in the magnetosheath and in the plasma mantle. Flow directions toward and away from the sun but, in general, parallel to the field lines have been found. The magnetopause (as defined by a sudden rotation of the magnetic field vector) mostly coincides with the transition to ordered magnetosheath flow. The inner boundary of the layer is located just within the outer boundary of the hot ring current plasma. In the region of overlap the hot electrons have the signature of trapped particles, though often at reduced intensity. The magnetic field is strongly fluctuating in magnitude, while its orientation is more stable, consistent with a connection to the earth, but is systematically distorted out of the meridian plane. The layer is thought to be a consequence of the entry of magnetosheath plasma, which does not appear to be unobstructed, as has been claimed in the concept of a magnetospheric cleft. The magnetopause has a cusplike indentation which is elongated in local time. The existence of field-aligned currents (total strength approx. =10 6 A) and their location of flow in the inner part of the entry layer (into the ionosphere before noon and out of it after noon) are inferred from the systematic bending of field lines. It is proposed that the dynamo of the related current system is provided by the transfer of perpendicular momentum resulting from the plasma entry into the layer. The essential features of the entry layer might be compatible with the model of plasma flow through the magnetopause of Levy et al. (1964) if a 'dam' effect caused by the cusp geometry were added

  4. The primary enamel knot determines the position of the first buccal cusp in developing mice molars.

    Science.gov (United States)

    Cho, Sung-Won; Lee, Hyun-A; Cai, Jinglei; Lee, Min-Jung; Kim, Jae-Young; Ohshima, Hayato; Jung, Han-Sung

    2007-06-01

    The enamel knot (EK), which is located in the center of bud and cap stage tooth germs, is a transitory cluster of non-dividing epithelial cells. The EK acts as a signaling center that provides positional information for tooth morphogenesis and regulates the growth of tooth cusps by inducing secondary EKs. The morphological, cellular, and molecular events leading to the relationship between the primary and secondary EKs have not been described clearly. This study investigated the relationship between the primary and secondary EKs in the maxillary and mandibular first molars of mice. The location of the primary EK and secondary EKs was investigated by chasing Fgf4 expression patterns in tooth germ at some intervals of in vitro culture, and the relationship between the primary EK and secondary EK was examined by tracing the primary EK cells in the E13.5 tooth germs which were frontally half sliced to expose the primary EK. After 48 hr, the primary EK cells in the sliced tooth germs were located on the buccal secondary EKs, which correspond to the future paracone in maxilla and protoconid in mandible. The Bmp4 expression in buccal part of the dental mesenchyme might be related with the lower growth in buccal epithelium than in lingual epithelium, and the Msx2 expressing area in epithelium was overlapped with the enamel cord (or septum) and cell dense area. The enamel cord might connect the primary EK with enamel navel to fix the location of the primary EK in the buccal side during the cap to bell stages. Overall, these results suggest that primary EK cells strictly contribute to form the paracone or protoconid, which are the main cusps of the tooth in the maxilla or mandible.

  5. Aortic dilatation in patients with prosthetic aortic valve: comparison of MRI and echocardiography.

    Science.gov (United States)

    von Knobelsdorff-Brenkenhoff, Florian; Rudolph, André; Wassmuth, Ralf; Abdel-Aty, Hassan; Schulz-Menger, Jeanette

    2010-05-01

    Patients with prosthetic aortic valve have an increased risk for aortic dissection, which rises further with growing aortic diameters. Thus, accurate aortic monitoring is required. As transthoracic echocardiography (TTE), the current clinical standard, is frequently restricted to the proximal ascending aorta, the use of two-dimensional cardiovascular magnetic resonance (2D-CMR) in transverse orientation was investigated as a screening tool to assess ascending aortic dimensions. Fast, non-contrast-enhanced, non-breath-hold, steady-state free-precession (SSFP) sequences (1.5 Tesla, slice thickness 7 mm, gap 1.8 mm, scan time 10-15 s) were applied to image the thorax in transverse planes. To test the accuracy of aortic dimensions obtained in this way, comparison was made to contrast-enhanced three-dimensional MR angiography (3D-MRA) as the 'gold standard' in 30 patients with aortic or aortic valve disease. After validation, transverse 2D-CMR was used to assess ascending aortic dimensions in 65 patients with aortic bioprostheses, and the results were compared to those acquired with TTE. Data acquired with both 2D-CMR and 3D-MRA agreed well when assessing ascending aortic diameters (r = 0.99; p 2.1 cm/m2) was present in 38.5% of 2D-CMR cases and in 11.5% of TTE cases. The intra- and inter-observer variabilities to assess aortic dimensions by 2D-CMR were 2.1 +/- 1.9% and 4.3 +/- 3.7%, respectively. Imaging of the complete thorax in transverse orientation using fast, non-contrast-enhanced SSFP images provided an accurate and reliable approach to screen for aortic dilatation. In patients with aortic bioprostheses, 2D-CMR revealed a high prevalence of aortic dilatation, which was considerably underestimated by TTE.

  6. Early results of valve-sparing ascending aortic replacement in type A aortic dissection and aortic insufficiency

    Directory of Open Access Journals (Sweden)

    М. Л. Гордеев

    2016-08-01

    Full Text Available Aim: The study was designed to investigate predictors of effective valve-sparing ascending aortic replacement in patients with Stanford type A aortic dissection combined with aortic insufficiency and to analyze efficacy and safety of this kind of surgery.Methods: From January 2010 to December 2015, 49 patients with Stanford type A aortic dissection combined with aortic insufficiency underwent ascending aortic replacement. All patients were divided into 3 groups: valve-sparing procedures (group 1, n = 11, combined aortic valve and supracoronary ascending aortic replacement (group 2, n = 12, and Bentall procedure (group 3, n = 26. We assessed the initial status of patients, incidence of complications and efficacy of valve-sparing ascending aortic replacement.Results: The hospital mortality rate was 8.2% (4/49 patients. The amount of surgical correction correlated with the initial diameter of the aorta at the level of the sinuses of Valsalva. During the hospital period, none of patients from group 1 developed aortic insufficiency exceeding Grade 2 and the vast majority of patients had trivial aortic regurgitation. The parameters of cardiopulmonary bypass, cross-clamp time and circulatory arrest time did not correlate with the initial size of the ascending aorta and aortic valve blood flow impairment, neither did they influence significantly the incidence and severity of neurological complications. The baseline size of the ascending aorta and degree of aortic regurgitation did not impact the course of the early hospital period.Conclusions: Supracoronary ascending aortic replacement combined with aortic valve repair in ascending aortic dissection and aortic regurgitation is effective and safe. The initial size of the ascending aorta and aortic arch do not influence immediate results. The diameter of the aorta at the level of the sinuses of Valsalva and the condition of aortic valve leaflets could be considered as the limiting factors. Further long

  7. 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......: Trials comparing TAVI vs. SAVR were identified through Medline, Embase, and Cochrane databases. The primary outcome was death from any cause at 2 years. We performed random-effects meta-analyses to combine the available evidence and to evaluate the effect in different subgroups. This systematic review...... and meta-analysis is registered with PROSPERO (CRD42016037273). We identified four eligible trials including 3806 participants, who were randomly assigned to undergo TAVI (n = 1898) or SAVR (n = 1908). For the primary outcome of death from any cause, TAVI when compared with SAVR was associated...

  8. [Metabolic syndrome and aortic stiffness].

    Science.gov (United States)

    Simková, A; Bulas, J; Murín, J; Kozlíková, K; Janiga, I

    2010-09-01

    The metabolic syndrome (MS) is a cluster of risk factors that move the patient into higher level of risk category of cardiovascular disease and the probability of type 2 diabetes mellitus manifestation. Definition of MS is s based on the presence of selected risk factors as: abdominal obesity (lager waist circumpherence), atherogenic dyslipidemia (low value of HDL-cholesterol and increased level of triglycerides), increased fasting blood glucose (or type 2 DM diagnosis), higher blood pressure or antihypertensive therapy. In 2009 there were created harmonizing criteria for MS definition; the condition for assignment of MS is the presence of any 3 criteria of 5 mentioned above. The underlying disorder of MS is an insulin resistance or prediabetes. The patients with MS more frequently have subclinical (preclinical) target organ disease (TOD) which is the early sings of atherosclerosis. Increased aortic stiffness is one of the preclinical diseases and is defined by pathologically increased carotidofemoral pulse wave velocity in aorta (PWV Ao). With the aim to assess the influence of MS on aortic stiffness we examined the group of women with arterial hypertension and MS and compare them with the group of women without MS. The aortic stiffness was examined by Arteriograph--Tensiomed, the equipment working on the oscillometric principle in detection of pulsations of brachial artery. This method determines the global aortic stiffness based on the analysis of the shape of pulse curve of brachial artery. From the cohort of 49 pts 31 had MS, the subgroups did not differ in age or blood pressure level. The mean number of risk factors per person in MS was 3.7 comparing with 1.7 in those without MS. In the MS group there was more frequently abdominal obesity present (87% vs 44%), increased fasting blood glucose (81% vs 22%) and low HDL-cholesterol level. The pulse wave velocity in aorta, PWV Ao, was significantly higher in patients with MS (mean value 10,19 m/s vs 8,96 m

  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. Safety considerations during transapical aortic valve implantation.

    Science.gov (United States)

    Drews, Thorsten; Pasic, Miralem; Juran, Ralf; Unbehaun, Axel; Dreysse, Stephan; Kukucka, Marian; Mladenow, Alexander; Hetzer, Roland; Buz, Semih

    2014-05-01

    Transcatheter aortic valve implantation (TAVI) is a new method for the treatment of very high-risk patients with aortic valve stenosis. The radiation dose to which the patient and each member of the heart team are exposed during this new fluoroscopically guided intervention is unknown. Between April 2008 and August 2013, 1177 consecutive patients underwent transapical TAVI (TA-TAVI). In 22 consecutive patients undergoing TA-TAVI, the radiation doses to the cardiothoracic surgeon, cardiologist, anaesthesiologist (performing echocardiography examination), surgical assistant and nurse were measured. The radiation dose measurements were performed during TAVI using thermoluminescence and film dosimeters positioned on seven parts of the body: (i) chest above the lead apron, (ii) pelvic area below the apron, (iii) chest below the apron, (iv) thyroid gland above the apron, (v) near eyes, (vi) hands (using rings) and (vii) the feet. The results were compared with the values given in the international literature on recommended radiation dose limits for workers. The mean radiation time was 6.1 min and the mean dose-area product for the patients was 8.661 µGy · m(2). Analysis of the dosimeters and the calculation of the effective dose showed a per intervention dose of 0.03 mSv for the surgeon, 0.05 mSv for the assistant, 0.02 mSv for the cardiologist and the anaesthesiologist and 0.001 mSv for the nurse. The maximum ionizing radiation per intervention was 0.5 mSv at the right hand of the surgeon (holding the introducer sheet) and 0.7 mSv at the left hand of the surgical assistant. Additionally, the analysis of the body dose shows a maximum dose to the lower leg of the surgeon (0.3 mSv) and the genital area of the assistant (0.06 mSv). During a TA-TAVI procedure, the patients receive a higher X-ray dose than during coronary angiography with intervention. After 100 TAVI procedures, the members of the heart team sustain a comparable dose of ionizing radiation to the annual dose

  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. Intermittent mechanical and clinical intravalvar regurgitation aortic ...

    African Journals Online (AJOL)

    due to intravalvar occlusion caused by thrombosis and/or tissue ingrowth or to periprosthetic regurgitation. .... position). A. The tilting disc of the prosthetic aortic valve is in the normal closed position during diastole. B. The disc is 'stuck' in the open position during diastole. Intermittent AR in patients with aortic prosthetic ...

  13. Valve-sparing aortic root replacement†

    NARCIS (Netherlands)

    Koolbergen, David R.; Manshanden, Johan S. J.; Bouma, Berto J.; Blom, Nico A.; Mulder, Barbara J. M.; de Mol, Bas A. J. M.; Hazekamp, Mark G.

    2015-01-01

    To evaluate our results of valve-sparing aortic root replacement and associated (multiple) valve repair. From September 2003 to September 2013, 97 patients had valve-sparing aortic root replacement procedures. Patient records and preoperative, postoperative and recent echocardiograms were reviewed.

  14. 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

  15. Graft infections after surgical aortic reconstructions

    NARCIS (Netherlands)

    Berger, P.

    2015-01-01

    Prosthetic vascular grafts are frequently used to reconstruct (part) of the aorta. Every surgical procedure caries a certain risk for infection and when a prosthetic aortic graft is implanted, this may lead to an aortic graft infection (AGI). Endovascular techniques have gradually replaced open

  16. Development of the Plasma Thruster Particle-in-Cell Simulator to Complement Empirical Studies of a Low-Power Cusped-Field Thruster

    Science.gov (United States)

    Gildea, Stephen Robert

    conical jet of fast ions in the near plume region. The influences guiding the formation of the simulated beam in low-current mode are described in detail. A module for predicting erosion rates on dielectric surfaces has also been incorporated into PTpic and applied to simulations of both DCFT operational modes. Two data sets from high---current mode simulations successfully reproduce elevated erosion profiles in each of the three magnetic ring-cusps present in the DCFT. Discrepancies between the simulated and experimental data do exist, however, and are once again attributable to the misplacement of the primary acceleration region of the thruster. Having successfully captured the most significant erosion profile features observed in high-current mode, a simulation of erosion in low-current mode indicates substantially reduced erosion in comparison to the more oscillatory mode. These findings further motivate the completion of low-current mode erosion measurements, and continued numerical studies of the DCFT. Additionally, PTpic has proven to be a useful simulation tool for this project, and has been developed with adaptability in mind to facilitate its application to a variety of thruster designs---including Hall thrusters. (Copies available exclusively from MIT Libraries, libraries.mit.edu/docs - docs mit.edu)

  17. Multi-instrument mapping of the small-scale flow dynamics related to a cusp auroral transient

    Directory of Open Access Journals (Sweden)

    K. Oksavik

    2005-10-01

    Full Text Available In this paper we focus on flux transfer events (FTEs and poleward moving auroral forms (PMAFs in the cusp region, combining data from the EISCAT Svalbard radar, SuperDARN HF radars, ground-based optics, and three low-altitude polar-orbiting spacecraft. During an interval of southward interplanetary magnetic field the EISCAT Svalbard radar tracked a train of narrow flow channels drifting into the polar cap. One 30-60 km wide flow channel surrounded by flow running in the opposite direction is studied in great detail from when it formed equatorward of the cusp aurora, near magnetic noon, until it left the field-of-view and disappeared into the polar cap. Satellite data shows that the flow channel was on open field lines. The flow pattern is consistent with field-aligned currents on the sides of the flow channel; with a downward current on the equatorward side, and an upward current on the poleward side. The poleward edge of the flow channel was coincident with a PMAF that separated from the background cusp aurora and drifted into the polar cap. A passage of the DMSP F13 spacecraft confirms that the FTE flow channel was still discernable over 15 minutes after it formed, as the spacecraft revealed a 30–40 km wide region of sunward flow within the anti-sunward background convection. From the dimensions of the flow channel we estimate that the magnetic flux contained in the event was at least 1 MWb. This data set also shows that Birkeland current filaments often seen by low-altitude spacecraft in the cusp/mantle are really associated with individual FTE events or a train of FTEs in progress. As the region 0 or cusp/mantle current represents the statistical average consistent with the large-scale flow pattern, we therefore introduce a new term – FTE currents – to denote the unique pair of Birkeland current sheets that are associated with individual meso-scale FTE flow disturbances. The poleward moving auroral forms (PMAFs, often referred to in

  18. Origin of energetic ions in the polar cusp inferred from ion composition measurements by the Viking satellite

    Directory of Open Access Journals (Sweden)

    G. Kremser

    Full Text Available The magnetospheric ion composition spectrometer MICS on the Swedish Viking satellite provided measurements of the ion composition in the energy range 10.1 keV/eleqE/Qleq326.0 keV/e. Data obtained during orbit 842 were used to investigate the ion distribution in the northern polar cusp and its vicinity. The satellite traversed the outer ring current, boundary region, cusp proper and plasma mantle during its poleward movement. H+ and He++ ions were encountered in all of these regions. He+ ions were present only in the ring current. The number of O+ and O++ ions was very small. Heavy high-charge state ions typical for the solar wind were observed for the first time, most of them in the poleward part of the boundary region and in the cusp proper. The H+ ions exhibited two periods with high intensities. One of them, called the BR/CP event, appeared at energies up to 50 keV. It started at the equatorward limit of the boundary region and continued into the cusp proper. Energy spectra indicate a ring current origin for the BR/CP event. Pitch angle distributions show downward streaming of H+ ions at its equatorward limit and upward streaming on the poleward side. This event is interpreted as the result of pitch angle scattering of ring current ions by fluctuations in the magnetopause current layer in combination with poleward convection. The other of the two periods with high H+ ion intensities, called the accelerated ion event, was superimposed on the BR/CP event. It was restricted to energies leq15 keV and occurred in the poleward part of the boundary region. This event is regarded as the high-energy tail of magnetosheath ions that were accelerated while penetrating into the magnetosphere. The cusp region thus contains ions of magnetospheric as well as of magnetosheath origin. The appearance of the ions depends, in addition to the ion source, on the

  19. Multi-instrument mapping of the small-scale flow dynamics related to a cusp auroral transient

    Directory of Open Access Journals (Sweden)

    K. Oksavik

    2005-10-01

    Full Text Available In this paper we focus on flux transfer events (FTEs and poleward moving auroral forms (PMAFs in the cusp region, combining data from the EISCAT Svalbard radar, SuperDARN HF radars, ground-based optics, and three low-altitude polar-orbiting spacecraft. During an interval of southward interplanetary magnetic field the EISCAT Svalbard radar tracked a train of narrow flow channels drifting into the polar cap. One 30-60 km wide flow channel surrounded by flow running in the opposite direction is studied in great detail from when it formed equatorward of the cusp aurora, near magnetic noon, until it left the field-of-view and disappeared into the polar cap. Satellite data shows that the flow channel was on open field lines. The flow pattern is consistent with field-aligned currents on the sides of the flow channel; with a downward current on the equatorward side, and an upward current on the poleward side. The poleward edge of the flow channel was coincident with a PMAF that separated from the background cusp aurora and drifted into the polar cap. A passage of the DMSP F13 spacecraft confirms that the FTE flow channel was still discernable over 15 minutes after it formed, as the spacecraft revealed a 30–40 km wide region of sunward flow within the anti-sunward background convection. From the dimensions of the flow channel we estimate that the magnetic flux contained in the event was at least 1 MWb. This data set also shows that Birkeland current filaments often seen by low-altitude spacecraft in the cusp/mantle are really associated with individual FTE events or a train of FTEs in progress. As the region 0 or cusp/mantle current represents the statistical average consistent with the large-scale flow pattern, we therefore introduce a new term – FTE currents – to denote the unique pair of Birkeland current sheets that are associated with individual meso-scale FTE flow disturbances. The poleward moving auroral forms (PMAFs, often referred to in

  20. [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.

  1. Imaging techniques in aortic valve and root surgery

    NARCIS (Netherlands)

    Regeer, M.V.

    2017-01-01

    Aortic valve sparing surgery for aortic regurgitation and/or aortopathy serves as an alternative to aortic valve and root replacement. One of the advantages of aortic valve sparing surgery over conventional replacement is that there is no need for life-long anticoagulation, which is particularly

  2. Leaking mycotic abdominal aortic aneurysm

    International Nuclear Information System (INIS)

    Sing, T.M.Y.; Young, N.; O'Rourke, I.C.; Tomlinson, P.

    1994-01-01

    A case of leaking mycotic abdominal aortic aneurysm is reported, with a brief review of the literature. A 58 year old female presented with shoulder and abdominal pain associated with diarrhea, vomiting and fever with leucocytosis. Computed tomography of the abdomen showed pooling of contrast in the retroperitoneum anterior to a non-dilated abdominal aorta. There was considerable retroperitoneal blood accumulating in a mass-like lesion in the right lower abdomen and pelvis obstructing the right renal collecting system. Laparotomy revealed a 4 cm diameter saccular aneurysm of the abdominal aorta, with a 1 cm diameter neck. Culture of the thrombus grew Streptococcus pyogens. 11 refs., 2 figs

  3. FELINE AORTIC THROMBOEMBOLISM: CASE REPORT

    OpenAIRE

    Figueroa A., Lizbeth; Facultad de Medicina Veterinaria, Universidad Nacional Mayor de San Marcos, Lima, Perú.; Paz M., Ricardo; Facultad de Medicina Veterinaria, Universidad Nacional Mayor de San Marcos, Lima, Perú.; Díaz C., Diego; Facultad de Medicina Veterinaria, Universidad Nacional Mayor de San Marcos, Lima, Perú.; Dávila F., Roberto; Facultad de Medicina Veterinaria, Universidad Nacional Mayor de San Marcos, Lima, Perú.

    2014-01-01

    Se presenta el caso de un felino Siamés de 13 años con tromboembolismo aórtico. Esta es una complicación asociada a una cardiomiopatía hipertrófica (CMH), enfermedad cardiaca más común del gato y que se caracteriza por la hipertrofia concéntrica ventricular izquierda. A case of a 13 year old Siamese cat whit feline aortic thromboembolism is presented. This is a devastating complication associated to hypertrophic cardiomyopathy (HCM), one of the most common heart disease in cats characteriz...

  4. Aortic root surgery in Marfan syndrome: Comparison of aortic valve-sparing reimplantation versus composite grafting.

    Science.gov (United States)

    Karck, Matthias; Kallenbach, Klaus; Hagl, Christian; Rhein, Christine; Leyh, Rainer; Haverich, Axel

    2004-02-01

    The objective of this study was to compare the results of aortic valve-sparing reimplantation and aortic root replacement with mechanical valve conduits in patients with Marfan syndrome undergoing operation for aortic root aneurysms. Patients and methods Between March 1979 and April 2002, 119 patients with clinical evidence of Marfan syndrome underwent composite graft replacement with mechanical valve conduits (n = 74) or aortic valve-sparing reimplantation according to David (n = 45). The underlying causes were aortic dissection type A (43 patients) and aneurysms (76 patients). Patients undergoing aortic valve reimplantation were younger compared with patients undergoing composite grafting (28 vs 35 years, P =.002) and had longer intraoperative aortic crossclamp times (125 vs 78 minutes, P valve reimplantation (P =.15). Mean follow-up was 30 months for patients undergoing aortic valve reimplantation and 114 months for patients undergoing composite grafting. Freedom from reoperation and death after 5 years postoperatively was 92% and 89% in patients undergoing composite grafting and 84% and 96% in patients undergoing aortic valve reimplantation (P =.31; P =.54), respectively. Thromboembolic complications or late postoperative bleeding occurred in 17 patients undergoing composite grafting, and an early postoperative event occurred in 1 patient undergoing aortic valve reimplantation. The results of aortic valve reimplantation and composite grafting of the aortic valve and ascending aorta with mechanical valve conduits are similar with regard to early and mid-term postoperative mortality and to the incidence of late reoperations in patients with Marfan syndrome. The low risk of thromboembolic or bleeding complications favors aortic valve reimplantation in these patients.

  5. Repetitive complications after prosthetic graft for inflammatory aortic aneurysm

    Directory of Open Access Journals (Sweden)

    Yoshihiro Takeda

    2013-11-01

    Full Text Available The presence of retroperitoneal fibrosis after an aortic graft replacement is a marker of poor prognosis following aortic graft replacement. Herein we report the case of a 39-year-old man with retroperitoneal fibrosis that had been causing ureteral obstruction. The man had undergone repeated aortic graft replacement due to bacteremia and aortic graft–small intestinal fistula that occurred 4 years after initial aortic grafting for an inflammatory aortic aneurysm. The patient was discharged after 4 weeks of intravenous antibiotic therapy following the latest aortic graft replacement.

  6. Flameballs, cells and cusps in ultra-lean hythane-air mixtures

    Energy Technology Data Exchange (ETDEWEB)

    Shoshin, Y.; Bastiaans, R.; De Goey, P.; Hernandez Perez, F.; Van Oijen, J. [Eindhoven University of Technology TUE, Eindhoven (Netherlands)

    2012-06-07

    There is a growing interest in using hydrogen-containing gas fuel blends for practical combustion applications. The addition of hydrogen to natural gas (the main constituent of which is methane) allows for leaner operation of premixed combustion at lower temperatures, which leads to reduced NOx, CO, and CO2 emissions, and to higher efficiencies of engines and turbines. While hydrogen is often seen as the main energy carrier of the future, the transition to a global hydrogen economy may take decades. In this period, mixtures of hydrogen with natural gas and other hydrogen-containing blends, such as syngas or biofuels, are expected to become dominant fuels. Hydrogen-containing blends exhibit a very specific combustion behavior. Due to the high diffusivity of hydrogen, flames are strongly affected by so-called preferential diffusion effects. Even in the absence of turbulence, these effects lead to flame instability and to the formation of characteristic non-uniform cellular structures. In turbulent flames, the local flame structure still exhibits characteristic features of laminar cellular flames. Non-uniform reaction layers strongly affect the total rate of pollutant generation, overall combustion rate, and the lean limit of operation of combustion devices. Test simulations show that ignoring preferential diffusion effects in hydrogen-containing mixtures may lead to a more than twofold underestimation of the combustion rate. The goal of the proposed research is to acquire deep knowledge on the mentioned effects. To meet this goal a detailed experimental study using (ultra) lean two-dimensional laminar stationary flames of hydrogen-methane air mixtures will be carried out. The experiments will be setup to model all key structural elements of cellular flames: (1) Flame cells; (2) Flame cusps separating the cells; (3) Flame balls (in ultra-lean mixtures). To model flame cusps a flame formed at the tip of a laminar 2-D Bunsen flame will be used, for the flame balls and

  7. Evolution of ionosphere-thermosphere (IT) parameters in the cusp region related to ion upflow events

    Science.gov (United States)

    Kervalishvili, Guram; Lühr, Hermann

    2017-04-01

    In this study we investigate the relationships of various IT parameters with the intensity of vertical ion flow. Our study area is the ionospheric cusp region in the northern hemisphere. The approach uses superposed epoch analysis (SEA) method, centered alternately on peaks of the three different variables: neutral density enhancement, vertical plasma flow, and electron temperature. Further parameters included are large-scale field-aligned currents (LSFACs) and thermospheric zonal wind velocity profiles over magnetic latitude (MLat), which are centered at the event time and location. The dependence on the interplanetary magnetic field (IMF) By component orientation and the local (Lloyd) season is of particular interest. Our investigations are based on CHAMP and DMSP (F13 and F15) satellite observations and the OMNI online database collected during the years 2002-2007. The three Lloyd seasons of 130 days each are defined as follows: local winter (1 January ± 65 days), combined equinoxes (1 April and 1 October ± 32 days), and local summer (1 July ± 65 days). A period of 130 days corresponds to the time needed by CHAMP to sample all local times. The SEA MLat profiles with respect to neutral density enhancement and vertical plasma flow peaks show no significant but only slight (decreasing towards local summer) seasonal variations for both IMF By orientations. The latitude profiles of median LSFACs show a clear dependence on the IMF By orientation. As expected, the maximum and minimum values of LSFAC amplitudes are increasing towards local summer for both IMF By signs. With respect to zero epoch latitude, FAC peaks appear equatorward (negative MLat) related to Region 1 (R1) and poleward (positive MLat) to Region 0 (R0) FACs. However, there is an imbalance between the amplitudes of LSFACs, depending on the current latitude. R1 currents are systematically stronger than R0 FACs. A somewhat different distribution of density enhancements and large-scale FACs emerges when

  8. A cusp catastrophe model of mid-long-term landslide evolution over low latitude highlands of China

    Science.gov (United States)

    Tao, Yun; Cao, Jie; Hu, Jinming; Dai, Zhicheng

    2013-04-01

    Based on a model describing a certain landslide case and catastrophe theory, we derived a cusp catastrophe model and corresponding inversion method to study mid-long-term landslide evolution. According to data of landslides, precipitation, and socioeconomic development from 1976 to 2008, the cusp catastrophe model describing this landslide evolution across a low-latitude highland area in China is obtained with the least squares method. Results of the model indicate that human activity determines landslide intensity. Local precipitation also impacts yearly landslide intensity to some extent, and controls the time when a strong and abrupt change in landslides occurs. During the period 1976-2008, there was an abrupt decrease of landslide intensity during 1994-1995, and an abrupt increase during 1995-1996. Since then, there have been frequent landslides in the low-latitude highland, with greater intensity. All these factors provide a scientific basis for formulating a contingency plan regarding landslide disasters.

  9. 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...

  10. Factors Affecting Optimal Aortic Remodeling After Thoracic Endovascular Aortic Repair of Type B (IIIb) Aortic Dissection

    Energy Technology Data Exchange (ETDEWEB)

    Chen, I-Ming [National Yang Ming University, Institute of Clinical Medicine, School of Medicine (China); Chen, Po-Lin; Huang, Chun-Yang [National Yang Ming University, Department of Medicine, School of Medicine (China); Weng, Shih-Hsien; Chen, Wei-Yuan; Shih, Chun-Che, E-mail: ccshih@vghtpe.gov.tw [National Yang Ming University, Institute of Clinical Medicine, School of Medicine (China)

    2017-05-15

    PurposeThe purpose of this study was to determine factors associated with entire aortic remodeling after thoracic endovascular aortic repair (TEVAR) in patients with type B dissection.Materials and MethodsThe patients with type B (IIIb) dissections who underwent TEVAR from 2006 to 2013 with minimum of 2 years of follow-up computed tomography data were retrospectively reviewed. Based on the status of false lumen remodeling of entire aorta, patients were divided into three groups: complete regression, total thrombosis, and inadequate regression with patent abdominal false lumen.ResultsA total of 90 patients (72 males, 18 females; mean age 56.6 ± 16.4 years) were included and divided into the complete regression (n = 22), total thrombosis (n = 18), and inadequate regression (n = 50) groups. Multivariate logistic regression analysis indicated that dissection extension to iliac arteries, increased preoperative number of dissection tear over abdominal aorta, and decreased preoperative abdominal aorta bifurcation true lumen ratio, as compared between the inadequate and complete regression groups, were associated with a persistent false lumen (odds ratio = 33.33, 2.304, and 0.021; all, p ≤ 0.012). Comparison of 6, 12, and 24 months postoperative data revealed no significant differences at any level, suggesting that the true lumen area ratio might not change after 6 months postoperatively.ConclusionsIncreased preoperative numbers of dissection tear around the abdominal visceral branches, dissection extension to the iliac arteries, and decreased preoperative true lumen area ratio of abdominal aorta are predictive of entire aortic remodeling after TEVAR in patients with type B dissection.Level of EvidenceIII.

  11. Influence of cusp inclination and curvature on the in vitro failure and fracture resistance of veneered zirconia crowns.

    Science.gov (United States)

    Preis, Verena; Dowerk, Thomas; Behr, Michael; Kolbeck, Carola; Rosentritt, Martin

    2014-04-01

    The aim was to investigate the influence of cusp inclinations and curvatures on the failure behaviour and fracture resistance of veneered zirconia crowns. Five groups (n = 8/group) of zirconia-based molar crowns were fabricated by modifying cusp inclination (S, steep = 45°; M, medium = 30°; F, flat = 10°) and curvature (P, pointed; R, round; O, round-oblate). Combinations MP, MR, SP, SR and FO were investigated. All crowns were fixed on polymethylmethacrylate teeth, thermally cycled and mechanically loaded. Failures were monitored and fracture resistance was determined after ageing. Crowns were fractographically analysed with scanning electron microscopy. Chipping during thermal cycling and mechanical loading (TCML) was observed in groups MR (1×), SP (6×) and SR (3×). Defect sizes varied between 0.12 mm(2) (MR) and 17.28 mm(2) (SP). Failures started from occlusal contacts. Mean fracture varied significantly between 1,354.2 ± 360.0 N (SR) and 3,155.8 ± 444.4 N (FO). Cusp inclination and curvature influenced failures during TCML and fracture loads. Crowns with medium cusp inclination and pointed or round curvature are recommended for clinical application as they revealed high resistance to chipping. Steep inclination, especially in combination with pointed curvature, was shown to increase chipping rates and areas and to decrease fracture force. The results show the necessity of considering design parameters of the veneer in order to reduce failures of zirconia-based crowns.

  12. Aortography following subdiaphragmal aortic biopsy

    International Nuclear Information System (INIS)

    Schimmler, J.

    1982-01-01

    A juxtaposition of the subdiaphragmal and infrarenal translumbar aortic biopsy sites showed decisive advantages in favour of the higher site: a more stable position because of better anatomic fixation and rarer incidence of vascular alterations, a wider vascular lumen. Disadvantages lie in the fact that the large visceral arteries (especially Tr. coeliacus) branch off nearly and in the close anatomic relationship to large abdominal organs and the thoracal region. Evaluation of the radiographical image of the vascular tree after subdiaphragmal aortic biopsy showed an average 82% of the vessels to the area of the Knees to be assessable (renal arteries approximately 93%, popliteal arteries approximately 70%). Beyong, the method proved unsatisfactory: 52% of the vessels could not, or not safety, be evaluated. A relatively broad spectrum of indications by comparison with transfemoral catheter aortography had no influence on the rate of complications with reference to either method. A comparison of the topographic conditions shows the need for even more scrupulons observation of the technique in subdiaphragmal biopsy than in the infrarenal one. To sum up the results obtained, subdiaphregmal translumbar aortography is to be preferred to the infrarenal one where transfemoral catheter aortography is contra-indicated, within the limits mentioned. (orig.) [de

  13. 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.

  14. Ascending aortic injuries following blunt trauma.

    Science.gov (United States)

    Sun, Xiumei; Hong, Jenny; Lowery, Robert; Goldstein, Steven; Wang, Zuyue; Lindsay, Joseph; Hill, Peter C; Corso, Paul J

    2013-11-01

    The diagnosis and the management of traumatic thoracic aortic injuries have undergone significant changes due to new technology and improved prehospital care. Most of the discussions have focused on descending aortic injuries. In this review, we discuss the recent management of ascending aortic injuries. We found 5 cohort studies on traumatic aortic injuries and 11 case reports describing ascending aortic injuries between 1998 to the present through Medline research. Among case reports, 78.9% of cases were caused by motor vehicle accidents (MVA). 42.1% of patients underwent emergent open repair and the operative mortality was 12.5%. 36.8% underwent delayed repair. Associated injuries occurred in 84.2% of patients. Aortic valve injury was concurrent in 26.3% of patients. The incidence of ascending aortic injury ranged 1.9-20% in cohort studies. Traumatic injuries to the ascending aorta are relatively uncommon among survivors following blunt trauma. Aortography has been replaced by computed tomography and echocardiography as a diagnostic tool. Open repair, either emergent or delayed, remains the treatment of choice. © 2013 Wiley Periodicals, Inc.

  15. The bicuspid aortic valve and related disorders

    Directory of Open Access Journals (Sweden)

    Shi-Min Yuan

    Full Text Available Bicuspid aortic valve (BAV is the most common congenital cardiac malformation, affecting 1-2% of the population, with strong male predominance. Individuals may have a normally functioning BAV, and may be unaware of its presence and the potential risk of complications. However, they may easily develop aortic valve disorders: either stenotic or regurgitant, or both. Today, BAV is recognized as a syndrome incorporating aortic valve disorders and aortic wall abnormalities, including aortic dilation, dissection or rupture. Congenital or hereditary diseases such as ventricular septal defect, patent ductus arteriosus, coarctation of the aorta, Turner's syndrome, Marfan's syndrome etc., may frequently be associated with BAV. Infective endocarditis and occasionally thrombus formation may develop during the lives of BAV patients. Elevated cholesterol or C-reactive protein may be seen in laboratory findings of these patients. Beta-blockers and statins are the possibilities for medical treatment, and aortic valve repair/replacement and ascending aorta replacement are indicated for patients with a severely diseased aortic valve and aorta. Rigorous follow-up throughout life is mandatory after BAV has been diagnosed. The aim of the present article was to describe the implications of BAV and its associated disorders, and to discuss diagnostic and treatment strategies.

  16. 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.

  17. 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

    2014-01-01

    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. PMID:25211298

  18. Mechanical interactions of cuspal-coverage designs and cement thickness in a cusp-replacing ceramic premolar restoration: a finite element study.

    Science.gov (United States)

    Chang, Yen-Hsiang; Lin, Wen-Hsueng; Kuo, Wen-Chieh; Chang, Chia-Yu; Lin, Chun-Li

    2009-04-01

    The aim of this study was to investigate the biomechanical interactions between cuspal preparation designs and cement thickness in a cusp-replacing ceramic premolar restoration. The cavity was designed in a typical MODP (mesial-occlusal-distal- palatal) restoration failure shape when the palatal cusp has been lost. Twelve 3D finite element (FE) models with four cavity preparations (without coverage and with buccal cuspal coverage in 1.0, 1.5 and 2.0 mm reducing in cuspal height) and three cement thicknesses (50, 100 and 150 microm) were constructed to perform the simulations. The results indicated that enamel and cement stresses in designs with no buccal cusp replacement or a 1.0 mm thick buccal cusp replacement were higher than the designs with 1.5 and 2.0 mm thick replacement. No apparent differences were found in the dentin, enamel, and cement stresses based on cement thicknesses of 50, 100, or 150 microm. This study concluded that when cusp replacement is indicated, reduction of the buccal cusp by 1.5 mm at least could reduce stress.

  19. 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.

  20. 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.

  1. Muscle activity and masticatory efficiency with bilateral extension base removable partial dentures with different cusp angles.

    Science.gov (United States)

    Al-Omiri, Mahmoud K

    2018-03-01

    Whether masticatory efficiency and electromyographic activity are influenced by type of artificial teeth and food is unclear. The purpose of this clinical study was to evaluate the influence of extension base removable partial dentures (RPDs) with different cusp angles: anatomic (33 degrees), semianatomic (20 degrees), and nonanatomic (0 degrees) teeth on masticatory efficiency and muscle activity during the mastication of test foods with different textures. Twelve participants with RPDs were selected to perform masticatory efficiency and electromyographic tests. Surface electromyograms (EMGs) were used to record the activities of the masseter and temporalis muscles during the mastication of different types of test foods. The maximal voltage and duration were measured on the integrated EMG signal in each muscle during food mastication, and the mean reading of both sides was then recorded. Analysis of variance and the Tukey post hoc test were used to perform statistical analyses (α=.05). The masticatory efficiency of RPDs with nonanatomic teeth was significantly inferior to that of RPDs with anatomic and semianatomic teeth (P.05). Also, muscle activity (according to EMG) with RPDs with NA teeth was significantly higher than that with anatomic and semianatomic teeth (P<.05). RPDs with NA teeth were associated with higher EMG muscle activity and reduced masticatory efficiency than anatomic or semianatomic teeth. Copyright © 2017 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

  2. Climatology of the Ionospheric Scintillations over the Auroral and Cusp European Regions

    Science.gov (United States)

    Spogli, L.; Alfonsi, L.; de Franceschi, G.; Romano, V.; Aquino, M.; Dodson, A.

    2009-04-01

    Under perturbed conditions coming from the outer space, the ionosphere may become highly turbulent and small scale (from centimeters to meters) irregularities, typically enhancements or depletions of the electron density embedded in the ambient ionosphere, can form causing diffraction effects on the satellites signals passing through them. Such effect can abruptly corrupt the performance of the positioning systems affecting, in turn, the awareness and safety of the modern devices. In this paper we analyze data of ionospheric scintillation in the latitudinal range 57°- 88° N during the period October, November and December 2003 as a first step to develop a "scintillation climatology" over the Northern Europe. The behavior of the scintillation occurrence as function of the magnetic local time and of the corrected magnetic latitude is investigated to characterize the scintillation conditions. The Istituto Nazionale di Geofisica e Vulcanologia (INGV) and the Institute of Engineering Surveying and Space Geodesy (IESSG) of the University of Nottingham manage the same kind of GISTM (GPS Ionospheric Scintillation and TEC monitor) receivers over the European middle and high latitude regions. The results here shown and obtained merging observations from three GISTM, highlight also the possibility to investigate the dynamics of irregularities causing scintillation by combining the information coming from auroral to cusp latitudes. The findings, even if at a very preliminary stage, are here presented also in the frame of possible Space Weather implications.

  3. High Fidelity Multi-Objective Design Optimization of a Downscaled Cusped Field Thruster

    Directory of Open Access Journals (Sweden)

    Thomas Fahey

    2017-11-01

    Full Text Available The Cusped Field Thruster (CFT concept has demonstrated significantly improved performance over the Hall Effect Thruster and the Gridded Ion Thruster; however, little is understood about the complexities of the interactions and interdependencies of the geometrical, magnetic and ion beam properties of the thruster. This study applies an advanced design methodology combining a modified power distribution calculation and evolutionary algorithms assisted by surrogate modeling to a multi-objective design optimization for the performance optimization and characterization of the CFT. Optimization is performed for maximization of performance defined by five design parameters (i.e., anode voltage, anode current, mass flow rate, and magnet radii, simultaneously aiming to maximize three objectives; that is, thrust, efficiency and specific impulse. Statistical methods based on global sensitivity analysis are employed to assess the optimization results in conjunction with surrogate models to identify key design factors with respect to the three design objectives and additional performance measures. The research indicates that the anode current and the Outer Magnet Radius have the greatest effect on the performance parameters. An optimal value for the anode current is determined, and a trend towards maximizing anode potential and mass flow rate is observed.

  4. Polar Spacecraft Observations of the Turbulent Outer Cusp/Magnetopause Boundary Layer of Earth

    Science.gov (United States)

    Pickett, J. S.; Menietti, J. D.; Dowell, J. H.; Gurnett, D. A.; Scudder, J. D.

    1999-01-01

    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 R(sub E). 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 Alfven 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.

  5. Stability of endodontically treated teeth with differently invasive restorations: Adhesive vs. non-adhesive cusp stabilization.

    Science.gov (United States)

    Frankenberger, Roland; Zeilinger, Inka; Krech, Michael; Mörig, Gernot; Naumann, Michael; Braun, Andreas; Krämer, Norbert; Roggendorf, Matthias J

    2015-11-01

    Aim of the present study was to evaluate fracture strength of endodontically treated molars with different preparations/restorations after thermomechanical loading in vitro. 264 extracted human third molars were used. Beside the control group, 256 teeth in 32 test groups (n=8) received root canal treatment (MTwo #40/.6) and root canal obturation with AH Plus and Guttapercha. After postendodontic sealing and build-up (Syntac, SDR), specimens were additionally prepared MO or MOD. Postendodontic restorations were: Direct restorations (Tetric EvoCeram Bulk Fill bonded with Syntac; as filling or direct partial crown (PC) after reducing the cusps 3mm; amalgam as filling or direct pin-retained partial crown (PC)), vs. indirect adhesive restorations (I: Inlay vs. PC; IPS Empress I/PC; Celtra Duo I/PC; e.max CAD I/PC; Lava Ultimate I/PC; Enamic I/PC - all inserted with Syntac/Variolink) vs. cemented cast gold I/PC. After 300,000 thermocycles (5/55°C) and 1.2 Mio. 100N load cycles, specimens were loaded until fracture. Whereas IPS Empress showed no difference between I and PC (p>0.05), in all other groups PC were significantly more stable than fillings/inlays (pgold PC exhibited the highest fracture strengths (pAmalgam fillings showed the worst outcome (pgold PC remain the ultimate stabilization tool for ETT in terms of fracture resistance. Copyright © 2015 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

  6. Stability of interbed for salt cavern gas storage in solution mining considering cusp displacement catastrophe theory

    Directory of Open Access Journals (Sweden)

    Le Yu

    2015-03-01

    Full Text Available Cusp displacement catastrophe theory can be introduced to propose a new method about instability failure of the interbed for gas storage cavern in bedded salt in solution mining. We can calculate initial fracture drawing pace of this interbed to obtain 2D and 3D gas storage shapes at this time. Moreover, Stability evaluation of strength reduction finite element method (FEM based on this catastrophe theory can used to evaluate this interbed stability after initial fracture. A specific example is simulated to obtain the influence of the interbed depth, cavern internal pressure, and cavern building time on stability safety factor (SSF. The results indicate: the value of SSF will be lower with the increase of cavern building time in solution mining and the increase of interbed depth and also this value remains a rise with the increase of cavern internal pressure Especially, we can conclude that the second-fracture of the interbed may take place when this pressure is lower than 6 MPa or after 6 days later of the interbed after initial fracture. According to above analysis, some effective measures, namely elevating the tube up to the top of the interbed, or changing the circulation of in-and-out lines, can be introduced to avoid the negative effects when the second-fracture of the interbed may occur.

  7. Deformation of the Galactic Centre stellar cusp due to the gravity of a growing gas disc

    Science.gov (United States)

    Kaur, Karamveer; Sridhar, S.

    2018-03-01

    The nuclear star cluster surrounding the massive black hole at the Galactic Centre consists of young and old stars, with most of the stellar mass in an extended, cuspy distribution of old stars. The compact cluster of young stars was probably born in situ in a massive accretion disc around the black hole. We investigate the effect of the growing gravity of the disc on the orbits of the old stars, using an integrable model of the deformation of a spherical star cluster with anisotropic velocity dispersions. A formula for the perturbed phase space distribution function is derived using linear theory, and new density and surface density profiles are computed. The cusp undergoes a spheroidal deformation with the flattening increasing strongly at smaller distances from the black hole; the intrinsic axis ratio ˜0.8 at ˜0.15 pc. Stellar orbits are deformed such that they spend more time near the disc plane and sample the dense inner parts of the disc; this could result in enhanced stripping of the envelopes of red giant stars. Linear theory accounts only for orbits whose apsides circulate. The non-linear theory of adiabatic capture into resonance is needed to understand orbits whose apsides librate. The mechanism is a generic dynamical process, and it may be common in galactic nuclei.

  8. 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.

  9. 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.

  10. Determination of Local Magnetic Dipole Moment of the Plasma at the PUPR Cusp-Mirror Machine

    International Nuclear Information System (INIS)

    Leal-Quiros, Edbertho; Prelas, Mark

    2006-01-01

    A novel diagnostic that allows measurement of the magnetic moment μ has been designed. The μ-Analyzer consists of a Directional Energy Analyzer and a Magnetic Hall Probe in the same detector miniature case. The Directional Energy Analyzer measures the ion temperature in the perpendicular direction to the magnetic field. On the other side, the Hall Probe measures the magnetic field. The μ-Analyzer is a miniature analyzer to avoid plasma perturbation. This allows the measurement of the ion temperature and the local magnetic field at the same point at the same time, therefore μ, the first adiabatic invariant is found. From the above parameters, the local Larmor radius also will be calculated. From the analysis of the data simultaneously in time and space, the μ of the Local Plasma has been determined. This result is a very important quantity, among other properties that permit one to know the stability of the magnetic confinement device using the MHD Stability Criterium, and also very important in Space Plasma Research. In addition to the above, a direct measurement of the Larmor radius of each position is also possible. The experiments have been made in a Cusp/Mirror Plasma Machine where plasma parameters such as Density and Temperature are relatively easy to change in a very wide range

  11. Black Holes and Galactic Density Cusps III From Black Hole to Bulge

    CERN Document Server

    Henriksen, Richard N; Macmillan, Joseph D

    2011-01-01

    Aims. In this paper we continue our study of density cusps that may contain central black holes. Methods. We recall our attempts to use distribution functions with a memory of self-similar relaxation, but mostly they apply only in restricted regions of the global system. We are forced to consider related distribution functions that are steady but not self-similar. Results. One remarkably simple distribution function that has a filled loss cone describes a bulge that transits from a near black hole domain to an outer 'zero flux' regime where$\\rho\\propto r^{-7/4}$. The transition passes from an initial inverse square profile through a region having a 1/r density profile. The structure is likely to be developed at an early stage in the growth of a galaxy. A central black hole is shown to grow exponentially in this background with an e-folding time of a few million years. Conclusions. We derive our results from first principles, using only the angular momentum integral in spherical symmetry. The initial relaxatio...

  12. N-Body Growth of a Bahcall-Wolf Cusp around a Black Hole

    Science.gov (United States)

    Preto, Miguel; Merritt, David; Spurzem, Rainer

    2004-10-01

    We present a clear N-body realization of the growth of a Bahcall-Wolf f~E1/4 (ρ~r-7/4) density cusp around a massive object (``black hole'') at the center of a stellar system. Our N-body algorithm incorporates a novel implementation of the Mikkola-Aarseth chain regularization to handle close interactions between star and black hole particles. Forces outside the chain were integrated on a GRAPE-6A/8 special-purpose computer with particle numbers up to N=0.25×106. We compare our N-body results with predictions of the isotropic Fokker-Planck equation and verify that the time dependence of the density (both configuration and phase-space) predicted by the Fokker-Planck equation is well reproduced by the N-body algorithm. Our results highlight the usefulness of direct N-body techniques for simulating the dynamical evolution of galactic nuclei containing supermassive black holes.

  13. Cusping, transport and variance of solutions to generalized Fokker-Planck equations

    Science.gov (United States)

    Carnaffan, Sean; Kawai, Reiichiro

    2017-06-01

    We study properties of solutions to generalized Fokker-Planck equations through the lens of the probability density functions of anomalous diffusion processes. In particular, we examine solutions in terms of their cusping, travelling wave behaviours, and variance, within the framework of stochastic representations of generalized Fokker-Planck equations. We give our analysis in the cases of anomalous diffusion driven by the inverses of the stable, tempered stable and gamma subordinators, demonstrating the impact of changing the distribution of waiting times in the underlying anomalous diffusion model. We also analyse the cases where the underlying anomalous diffusion contains a Lévy jump component in the parent process, and when a diffusion process is time changed by an uninverted Lévy subordinator. On the whole, we present a combination of four criteria which serve as a theoretical basis for model selection, statistical inference and predictions for physical experiments on anomalously diffusing systems. We discuss possible applications in physical experiments, including, with reference to specific examples, the potential for model misclassification and how combinations of our four criteria may be used to overcome this issue.

  14. Combined Repair of Ascending Aortic Pseudoaneurysm and Abdominal Aortic Aneurysm in a Patient with Marfan Syndrome

    OpenAIRE

    Kokotsakis, John N.; Lioulias, Achilleas G.; Foroulis, Christophoros N.; Skouteli, Eleni Anna T.; Milonakis, Michael K.; Bastounis, Elias A.; Boulafendis, Dimitrios G.

    2003-01-01

    Pseudoaneurysms of the ascending aorta after the original inclusion/wrap technique of the Bentall procedure present a difficult surgical management problem and are associated with substantial morbidity and mortality. Patients with Marfan syndrome frequently develop aneurysms and dissections that involve multiple aortic segments. We present the case of a Marfan patient who successfully underwent repair of a giant ascending aortic pseudoaneurysm and concomitant repair of an abdominal aortic ane...

  15. Altered aortic shape in bicuspid aortic valve relatives influences blood flow patterns.

    Science.gov (United States)

    Schnell, Susanne; Smith, Danielle A; Barker, Alex J; Entezari, Pegah; Honarmand, Amir R; Carr, Maria L; Malaisrie, S Chris; McCarthy, Patrick M; Collins, Jeremy; Carr, James C; Markl, Michael

    2016-11-01

    Bicuspid aortic valve (BAV) is known to exhibit familial inheritance and is associated with aortopathy and altered aortic haemodynamics. However, it remains unclear whether BAV-related aortopathy can be inherited independently of valve morphology. Four-dimensional flow magnetic resonance imaging for the in vivo assessment of thoracic aortic 3D blood flow was performed in 24 BAV relatives with trileaflet aortic valves (age = 40 ± 14 years) and 15 healthy controls (age = 37 ± 10 years). Data analysis included aortic dimensions, shape (round/gothic/cubic), and 3D blood flow characteristics (semi-quantitative vortex/helix grading and peak velocities). Cubic and gothic aortic shapes were markedly more prevalent in BAV relatives compared with controls (38 vs. 7%). Ascending aorta (AAo) vortex flow in BAV relatives was significantly increased compared with controls (grading = 1.5 ± 1.0 vs. 0.6 ± 0.9, P = 0.015). Aortic haemodynamics were influenced by aortic shape: peak velocities were reduced for gothic aortas vs. round aortas (P = 0.003); vortex flow was increased for cubic aortas in the AAo (P gothic aortas in the AAo and descending aorta (P = 0.003, P = 0.029). Logistic regression demonstrated significant associations of shape with severity of vortex flow in AAo (P < 0.001) and aortic arch (P = 0.016) in BAV relatives. BAV relatives expressed altered aortic shape and increased vortex flow despite the absence of valvular disease or aortic dilatation. These data suggest a heritable component of BAV-related aortopathy affecting aortic shape and aberrant blood flow, independent of valve morphology. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  16. Surgical anatomy of the aortic root: Implication for valve-sparing reimplantation and aortic valve annuloplasty

    OpenAIRE

    de Kerchove, Laurent; Jashari, Ramadan; Boodhwani, Munir; Duy, Khanh Tran; Lengelé, Benoit; Gianello, Pierre; Nezhad, Zahra Mozala; Astarci, Parla; Noirhomme, Philippe; El Khoury, Gebrine

    2015-01-01

    BACKGROUND: To enhance the reproducibility of aortic valve-sparing reimplantation and annuloplasty, we analyzed the topographic relationship between the ventriculoaortic junction (VAJ), basal ring (BR), and sinotubular junction (STJ). The root base thickness is also quantified. METHOD: Fifty-eight fresh human aortic valves were analyzed. The root was dissected to the limit where the aortic wall terminates into the cardiac structures (VAJ). Root height was measured externally from the STJ t...

  17. Predictive Value of Aortic Valve Calcification for Periprocedural Myocardial Injury in Patients Undergoing Percutaneous Coronary Intervention.

    Science.gov (United States)

    Shibata, Yohei; Ishii, Hideki; Suzuki, Susumu; Tanaka, Akihito; Tatami, Yosuke; Harata, Shingo; Ota, Tomoyuki; Shimbo, Yusaku; Takayama, Yohei; Kunimura, Ayako; Hirayama, Kenshi; Harada, Kazuhiro; Osugi, Naohiro; Murohara, Toyoaki

    2017-05-01

    Previous studies have shown that aortic valve calcification (AVC) was associated with cardiovascular events and mortality. On the other hand, periprocedural myocardial injury (PMI) in percutaneous coronary intervention (PCI) is a well-known predictor of subsequent mortality and poor clinical outcomes. The purpose of the study was to assess the hypothesis that the presence of AVC could predict PMI in PCI. This study included 370 patients treated with PCI for stable angina pectoris. AVC was defined as bright echoes >1 mm on one or more cusps of the aortic valve on ultrasound cardiography (UCG). PMI was defined as an increase in high-sensitivity troponin T level of >5 times the upper normal limit (>0.070 ng/ml) at 24 hours after PCI. AVC was detected in 45.9% of the patients (n=170). The incidence of PMI was significantly higher in the patients with AVC than in those without AVC (43.5% vs 21.0%, p<0.001). The presence of AVC independently predicted PMI after adjusting for other significant variables (odds ratio 2.26, 95% confidence interval 1.37-3.74, p=0.002). Other predictors were male sex, age, estimated glomerular filtration rate, and total stent length. Furthermore to predict PMI, adding AVC to the established risk factors significantly improved the area under the receiver operating characteristic curves, from 0.68 to 0.72, of the PMI prediction model (p=0.025). The presence of AVC detected in UCG could predict the incidence of PMI.

  18. 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.

  19. 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...

  20. Aortic root reimplantation procedure: a new milestone in aortic valve-sparing operations

    Directory of Open Access Journals (Sweden)

    А. М. Чернявский

    2016-08-01

    Full Text Available Aim: Emphasis in this study was placed on clinical and functional assessment of a modified "Florida Sleeve" procedure during surgical correction of ascending aorta aneurysms with concomitant aortic insufficiency.Methods: 32 patients with an aneurysm of the ascending aorta and aortic insufficiency underwent a modified "Florida Sleeve" procedure. The average follow-up was 17 (0-60 months. The average age of patients was 57±13 (23-73 years 56±13 years.Results: The expected 4-year cumulative survival rate was 84.3%. Overall freedom from aortic insufficiency in the late period was 88.9%. Median aortic regurgitation was 1+ (1; 2. Long-term follow-up revealed no valve-associated complications.Conclusion: The aortic root reimplantation procedure enables optimal correction of the existing lesions of the aortic root without performing aortic valve replacement and demonstrates stable clinical and functional outcomes in the long-term period.Key words: aortic aneurysm; aortic valve; valve-sparing operations.FundingThe study had no sponsorship.Conflict of interestThe authors declare no conflict of interest.

  1. Circulating matrix metalloproteinase patterns in association with aortic dilatation in bicuspid aortic valve patients with isolated severe aortic stenosis.

    Science.gov (United States)

    Wang, Yongshi; Wu, Boting; Dong, Lili; Wang, Chunsheng; Wang, Xiaolin; Shu, Xianhong

    2016-02-01

    Bicuspid aortic valve (BAV) exhibits a clinical incline toward aortopathy, in which aberrant tensile and shear stress generated by BAV can induce differential expression of matrix metalloproteinases (MMPs) and their endogenous tissue inhibitors (TIMPs). Whether stenotic BAV, which exhibits additional eccentric high-velocity flow jet upon ascending aorta and further worsens circumferential systolic wall shear stress than BAV with echocardiographically normal aortic valve, can lead to unique plasma MMP/TIMP patterns is still unknown. According to their valvulopathy and aortic dilatation status, 93 BAV patients were included in the present study. Group A (n = 37) and B (n = 28) comprised severely stenotic patients with or without ascending aorta dilatation; Group C (n = 12) and D (n = 16) comprised echocardiographically normal BAV patients with or without ascending aorta dilatation. Plasma MMP/TIMP levels (MMP-1, -2, -3, -8, -9, -10, -13 and TIMP-1, -2, -4) were determined via a multiplex ELISA detection system in a single procedure. Among patients with isolated severe aortic stenosis, plasma levels of MMP-2 and -9 were significantly elevated when ascending aortic dilatation was present (p = 0.001 and p = 0.002, respectively). MMP-2, however, remained as the single elevated plasma component among echocardiographically normal BAV patients with dilated ascending aorta (p = 0.027). Multivariate analysis revealed that MMP-2 and MMP-9 could both serve as independent risk factor for aortic dilatation in the case of isolated severe stenosis (p = 0.003 and p = 0.001, respectively), and MMP-2 in echocardiographically normal patients (p = 0.002). In conclusion, BAV patients with isolated severe aortic stenosis demonstrated a distinct plasma MMP/TIMP pattern, which might be utilized as circulating biomarkers for early detection of aortic dilatation.

  2. Energetic particle fluxes in the exterior cusp and the high-latitude dayside magnetosphere: statistical results from the Cluster/RAPID instrument

    Directory of Open Access Journals (Sweden)

    T. Asikainen

    2005-09-01

    Full Text Available In this paper we study the fluxes of energetic protons (30–4000 keV and electrons (20–400 keV in the exterior cusp and in the adjacent high-latitude dayside plasma sheet (HLPS with the Cluster/RAPID instrument. Using two sample orbits we demonstrate that the Cluster observations at high latitudes can be dramatically different because the satellite orbit traverses different plasma regions for different external conditions. We make a statistical study of energetic particles in the exterior cusp and HLPS by analysing all outbound Cluster dayside passes in February and March, 2002 and 2003. The average particle fluxes in HLPS are roughly three (protons or ten (electrons times larger than in the exterior cusp. This is also true on those Cluster orbits where both regions are visited within a short time interval. Moreover, the total electron fluxes, as well as proton fluxes above some 100 keV, in these two regions correlate with each other. This is true even for fluxes in every energy channel when considered separately. The spectral indices of electron and proton fluxes are the same in the two regions. We also examine the possible dependence of particle fluxes at different energies on the external (solar wind and IMF and internal (geomagnetic conditions. The energetic proton fluxes (but not electron fluxes in the cusp behave differently at low and high energies. At low energies (<70 keV, the fluxes increase strongly with the magnitude of IMF By. Instead, at higher energies the proton fluxes in the cusp depend on substorm/geomagnetic activity. In HLPS proton fluxes, irrespective of energy, depend strongly on the Kp and AE indices. The electron fluxes in HLPS depend both on the cusp the electron fluxes mainly depend on the solar wind speed, and are higher for northward than southward IMF. These results give strong evidence in favour of the idea that the high-latitude dayside plasma sheet is the main source

  3. Aortic stiffness and the balance between cardiac oxygen supply and demand: the Rotterdam Study

    NARCIS (Netherlands)

    Guelen, Ilja; Mattace-Raso, Francesco U. S.; van Popele, Nicole M.; Westerhof, Berend E.; Hofman, Albert; Witteman, Jacqueline C. M.; Bos, Willem Jan W.

    2008-01-01

    OBJECTIVES: Aortic stiffness is an independent predictor of cardiovascular morbidity and mortality. We investigated whether aortic stiffness, estimated as aortic pulse wave velocity, is associated with decreased perfusion pressure estimated as the cardiac oxygen supply potential. METHODS: Aortic

  4. [Aortic valve-sparing root reconstruction in Marfan syndrome].

    Science.gov (United States)

    Ogino, H; Sasaki, H; Hanafusa, Y; Hirata, M; Numata, S; Ando, M; Yagihara, T; Kitamura, S

    2002-07-01

    The outcome of aortic valve-sparing root reconstruction in Marfan syndrome was reviewed. Thirteen patients with Marfan syndrome underwent aortic valve-sparing root reconstruction for annuloaortic ectasia or aortic root dissection between 1994 and 1999. The grade of preoperative aortic regurgitation was I in 4, II in 2, III in 5, IV in 2 patients. The procedures of aortic valve-sparing were reimplantation in 7 and remodeling in 5 patients. There was no hospital and late death. Recurrence of aortic regurgitation greater than moderate grade developed in 1 patient immediately after the surgery and in the other 4 patients in the late stage. One patient of them required aortic valve replacement for it. Aortic valve-sparing root reconstruction is applicable in Marfan patients, although the indication should be cautious. Close observation is needed for recurrence of aortic regurgitation.

  5. Aortic aneurysm secondary to umbilical artery catheterization

    Energy Technology Data Exchange (ETDEWEB)

    Brill, P.W.; Winchester, P.; Griffith, A.Y.; Kazam, E.; Zirinsky, K.; Levin, A.R.

    1985-02-01

    A 14-month-girl presented with an asymptomatic posterior mediastinal mass. She had a history of prematurity, umbilical artery catheterization, and sepsis. The diagnosis of aortic aneurysm was made by dynamic computed tomography. The aneurysm was successfully resected.

  6. Successful Thrombolysis of Aortic Prosthetic Valve Thrombosis ...

    African Journals Online (AJOL)

    Arun Kumar Agnihotri

    threatening. Standard surgical treatment using cardiopulmonary bypass carries high maternal and fetal complications. Here we report a case of an antenatal female in first trimester with aortic prosthetic valve thrombosis (PVT), who was successfully ...

  7. Lipedema is associated with increased aortic stiffness.

    Science.gov (United States)

    Szolnoky, G; Nemes, A; Gavallér, H; Forster, T; Kemény, L

    2012-06-01

    Lipedema is a disproportional obesity due to unknown pathomechanism. Its major hallmark is frequent hematoma formation related to increased capillary fragility and reduced venoarterial reflex. Beyond microangiopathy, both venous and lymphatic dysfunction have also been documented. However, arterial circulation in lipedema has not been examined, and therefore we explored aortic elastic properties by echocardiography. Fourteen women with and 14 without lipedema were included in the study. Each subject consented to blood pressure measurement, physical examination, and transthoracic echocardiography. Aortic stiffness index (beta), distensibility, and strain were evaluated from aortic diameter and blood pressure data. Mean systolic (30.0 +/- 3.2 vs. 25.5 +/- 3.6, P lipedema is characterized with increased aortic stiffness.

  8. Telomere Biology and Thoracic Aortic Aneurysm

    Directory of Open Access Journals (Sweden)

    Thomas Aschacher

    2017-12-01

    Full Text Available Ascending aortic aneurysms are mostly asymptomatic and present a great risk of aortic dissection or perforation. Consequently, ascending aortic aneurysms are a source of lethality with increased age. Biological aging results in progressive attrition of telomeres, which are the repetitive DNA sequences at the end of chromosomes. These telomeres play an important role in protection of genomic DNA from end-to-end fusions. Telomere maintenance and telomere attrition-associated senescence of endothelial and smooth muscle cells have been indicated to be part of the pathogenesis of degenerative vascular diseases. This systematic review provides an overview of telomeres, telomere-associated proteins and telomerase to the formation and progression of aneurysms of the thoracic ascending aorta. A better understanding of telomere regulation in the vascular pathology might provide new therapeutic approaches. Measurements of telomere length and telomerase activity could be potential prognostic biomarkers for increased risk of death in elderly patients suffering from an aortic aneurysm.

  9. 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.

  10. Incidental Finding of a Large Mobile Aortic Arch Mass during Conventional Angiography

    Directory of Open Access Journals (Sweden)

    Hassan Aghajani

    2018-02-01

    Full Text Available Thromboembolism occurs commonly in general practice and leads to significant health burden. Apart from cardiac sources, aortic atherosclerotic plaques contribute considerably to thromboembolism. A 63-year-old diabetic hypertensive woman referred to our center due to exertional chest pain unresponsive to optimal medical therapy and underwent coronary angiography. Owing to resistance during guide-wire advancement, an aortography was performed. Aortic arch injection demonstrated a large suspended mass distal to the left subclavian artery with free movement in the descending thoracic aorta. Echocardiography revealed widespread atherosclerotic changes in the aortic arch with a large hypermobile mass. Dual-source multi-slice (2 × 128:256 computed tomography angiography of the whole aorta revealed a large floating mass (in favor of a thrombus in the distal portion of the arch. The patient underwent coronary artery bypass grafting due to severe coronary artery disease. The intra-aortic mass, which was actually a large atherosclerotic plaque, was resected at the same session. She was discharged uneventfully and during a 1-year follow-up, she had no embolic events.

  11. Comparison of ascending aortic cohesion between patients with bicuspid aortic valve stenosis and regurgitation.

    Science.gov (United States)

    Benedik, Jaroslav; Dohle, Daniel S; Wendt, Daniel; Pilarczyk, Kevin; Price, Vivien; Mourad, Fanar; Zykina, Elizaveta; Stebner, Ferdinand; Tsagakis, Konstantinos; Jakob, Heinz

    2014-12-01

    A bicuspid aortic valve (BAV) is commonly associated with aortic wall abnormalities, including dilatation of the ascending aorta and increased potential for aortic dissection. We compared the mechanical properties of the aortic wall of BAV patients with aortic valve stenosis (AS) and regurgitation (AR) using a dissectometer, a device mimicking transverse aortic wall shear stress. Between March 2010 and February 2013, 85 consecutive patients with bicuspid aortic valve undergoing open aortic valve replacement at our institution were prospectively enrolled, presenting either with stenosis (Group 1, n = 58) or regurgitation (Group 2, n = 27). Aortic wall cohesion measured by the dissectometer (Parameters P7, P8 and P9), aortic diameters measured by transoesophageal echocardiography (TOE) and thickness of the wall were compared. One patient presenting with the Marfan syndrome was excluded from the study. Patients with aortic regurgitation were significantly younger (48.2 ± 15.8 vs 64.7 ± 10.7, P group (27.3 ± 3.6 vs 25.5 ± 2.4, P = 0.008; 41.1 ± 7.7 vs 36.7 ± 8.0, P = 0.011; 37.6 ± 9.7 vs 33.8 ± 9.1, P = 0.049). The ascending aortic diameter did not differ (43.2 ± 10.6 vs 40.3 ± 9.1, P = 0.292). Patients with AR had significantly worse aortic cohesion, as measured by shear stress testing (P7: 97.2 ± 45.0 vs 145.5 ± 84.9, P = 0.015; P8: 2.00 ± 0.65 vs 3.82 ± 1.56, P cohesion, a thicker aortic wall and a larger aortic root in patients presenting with bicuspid AR compared with patients with AS. These results suggest that bicuspid AR represents a different disease process with possible involvement of the ascending aorta, as demonstrated by dissectometer examination. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  12. CT diagnosis of acute aortic dissection

    International Nuclear Information System (INIS)

    Ogawa, Noriko; Kobayashi, Takeshi

    1989-01-01

    Sixteen (47.5%) of 35 patients with acute aortic dissection showed a non-opacified crescent in the aorta on an initial contrast CT. Seven of these 16 patients underwent cineangiography soon after the initial CT, and in all 7 patients, neither an intimal tear nor an intimal flap was obtained. All but one of above 16 patients were followed by CT. Mean duration of follow-up was 9.6 months. In 10 of 15 patients with non-opacified false lumen, the false lumen remained non-opacified until the last examination. Moreover, in 6 of these 10 patients, the false lumen shrunk, and in the other 3, it disappeared completely on follow-up CT. On the other hand, in remaining 5 of these 15 patients who were initially diagnosed to have non-opacified false lumen, the false lumen became opacified and enlarged in size on follow-up CT performed in the first 14 weeks. Moreover, in 4 of these 5 patients, the false lumen became opacified in the only first 6 weeks. No matter how intensive care should be paid at least for the first 6 weeks, it seems that patients with aortic dissection which have non-opacified false lumen had good prognosis in comparison to patients with ordinary aortic dissections which have opacified false lumen. We believe aortic dissection with non-opacified false lumen may consist of two type of aortic dissection, one has no intimal tear, the other has some intimal tears and a thrombosed false lumen. In conclusion, CT is the most useful modality in diagnosing acute aortic dissection. The reasons are the incidence of acute aortic dissection with non-opacified false lumen was high, patients with non-opacified false lumen had good prognosis, and it was difficult to diagnose aortic dissection with non-opacified false lumen by conventional cineangiography and/or DSA. (author)

  13. 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....

  14. Graft infections after surgical aortic reconstructions

    OpenAIRE

    Berger, P.

    2015-01-01

    Prosthetic vascular grafts are frequently used to reconstruct (part) of the aorta. Every surgical procedure caries a certain risk for infection and when a prosthetic aortic graft is implanted, this may lead to an aortic graft infection (AGI). Endovascular techniques have gradually replaced open surgical reconstructions as first line of treatment for aorto-iliac diseases. Nowadays, open reconstructions are primarily reserved for patients unsuitable for endovascular reconstructions or for redo ...

  15. Aortic dissection. Basic aspects and endovascular management

    International Nuclear Information System (INIS)

    Jaramillo, Nicolas I; Alviar, Carlos I

    2005-01-01

    Treatment of thoracic aortic pathology is complicated by the morbidity associated to the surgical procedure and to the frailty of an elderly and difficult population. Surgical operation in this kind of population frequently bears a significant incidence of death and long-term disability. In an effort to reduce the incidence of negative outcomes, minimally invasive techniques in the form of endovascular stenting have been introduced during the past decade. The technology, originally described by Parodi, and initially designed for its use in abdominal aortic aneurysms, has been adapted for the treatment of thoracic aortic aneurysms. Furthermore, an improved understanding of the pathophysiology and the natural history of thoracic aortic disease as well as the analysis of the outcomes have facilitated our treatment decisions in terms of the timing for an appropriate intervention. Treatment of thoracic aortic dissection using endovascular Stent is one of the more recent advances in this condition and is receiving increasing attention, as it is a less invasive alternative to an open surgical repair. Although this technology is still innovative, significant improvements have been made lately in the design and deployment of the endovascular Stent-grafts. These prostheses have been increasingly used to treat aneurysms, dissections and traumatic ruptures, as well as giant penetrating ulcers and intramural hematomas of the descending thoracic aorta with good early and mid-term outcomes. The rareness, complexity and severity of the pathology and the theoretically high risk of complications should render the surgeon extremely cautious especially with young patients. Conceptually, the endo luminal treatment in the acute phase seems to be the solution and will probably become a preferred therapy while technical refinement is under way. Worldwide experience is growing and with this a better understanding of the indications and limitations of this innovative therapy will be

  16. RADIOLOGICAL TIPS CT-guided biopsy of suspected malignancy: A ...

    African Journals Online (AJOL)

    A 70-year-old woman was referred for computed tomography (CT)-guided biopsy of an incidentally detected partially necrotic 35 mm para-aortic mass in the left infrarenal area (Figs 1 and 2). Immediately post procedure, she developed severe central chest pain. Anterolateral myocardial infarction was confirmed on ECG.

  17. Retrograde ascending aortic dissection during or after thoracic aortic stent graft placement: insight from the European registry on endovascular aortic repair complications

    DEFF Research Database (Denmark)

    Eggebrecht, Holger; Thompson, Matt; Rousseau, Hervé

    2009-01-01

    BACKGROUND: Single-center reports have identified retrograde ascending aortic dissection (rAAD) as a potentially lethal complication of thoracic endovascular aortic repair (TEVAR). METHODS AND RESULTS: Between 1995 and 2008, 28 centers participating in the European Registry on Endovascular Aortic...

  18. Aortic Dissection Type A in Alpine Skiers

    Directory of Open Access Journals (Sweden)

    Thomas Schachner

    2013-01-01

    Full Text Available Patients and Methods. 140 patients with aortic dissection type A were admitted for cardiac surgery. Seventy-seven patients experienced their dissection in the winter season (from November to April. We analyzed cases of ascending aortic dissection associated with alpine skiing. Results. In 17 patients we found skiing-related aortic dissections. Skiers were taller (180 (172–200 cm versus 175 (157–191 cm, and heavier (90 (68–125 kg versus 80 (45–110 kg, than nonskiers. An extension of aortic dissection into the aortic arch, the descending thoracic aorta, and the abdominal aorta was found in 91%, 74%, and 69%, respectively, with no significant difference between skiers and nonskiers. Skiers experienced RCA ostium dissection requiring CABG in 17.6% while this was true for 5% of nonskiers (. Hospital mortality of skiers was 6% versus 13% in nonskiers (. The skiers live at an altitude of 170 (0–853 m.a.s.l. and experience their dissection at 1602 (1185–3105; m.a.s.l. In 82% symptom start was during recreational skiing without any trauma. Conclusion. Skiing associated aortic dissection type A is usually nontraumatic. The persons affected live at low altitudes and practice an outdoor sport at unusual high altitude at cold temperatures. Postoperative outcome is good.

  19. Aortic Dissection Type A in Alpine Skiers

    Science.gov (United States)

    Schachner, Thomas; Fischler, Nikolaus; Dumfarth, Julia; Bonaros, Nikolaos; Krapf, Christoph; Schobersberger, Wolfgang; Grimm, Michael

    2013-01-01

    Patients and Methods. 140 patients with aortic dissection type A were admitted for cardiac surgery. Seventy-seven patients experienced their dissection in the winter season (from November to April). We analyzed cases of ascending aortic dissection associated with alpine skiing. Results. In 17 patients we found skiing-related aortic dissections. Skiers were taller (180 (172–200) cm versus 175 (157–191) cm, P = 0.008) and heavier (90 (68–125) kg versus 80 (45–110) kg, P = 0.002) than nonskiers. An extension of aortic dissection into the aortic arch, the descending thoracic aorta, and the abdominal aorta was found in 91%, 74%, and 69%, respectively, with no significant difference between skiers and nonskiers. Skiers experienced RCA ostium dissection requiring CABG in 17.6% while this was true for 5% of nonskiers (P = 0.086). Hospital mortality of skiers was 6% versus 13% in nonskiers (P = 0.399). The skiers live at an altitude of 170 (0–853) m.a.s.l. and experience their dissection at 1602 (1185–3105; P < 0.001) m.a.s.l. In 82% symptom start was during recreational skiing without any trauma. Conclusion. Skiing associated aortic dissection type A is usually nontraumatic. The persons affected live at low altitudes and practice an outdoor sport at unusual high altitude at cold temperatures. Postoperative outcome is good. PMID:23971024

  20. Long-Term Risk for Aortic Complications After Aortic Valve Replacement in Patients With Bicuspid Aortic Valve Versus Marfan Syndrome.

    Science.gov (United States)

    Itagaki, Shinobu; Chikwe, Joanna P; Chiang, Yuting P; Egorova, Natalia N; Adams, David H

    2015-06-09

    Bicuspid aortic valves are associated with valve dysfunction, ascending aortic aneurysm and dissection. Management of the ascending aorta at the time of aortic valve replacement (AVR) in these patients is controversial and has been extrapolated from experience with Marfan syndrome, despite the absence of comparative long-term outcome data. This study sought to assess whether the natural history of thoracic aortopathy after AVR in patients with bicuspid aortic valve disease is substantially different from that seen in patients with Marfan syndrome. In this retrospective comparison, outcomes of 13,205 adults (2,079 with bicuspid aortic valves, 73 with Marfan syndrome, and 11,053 control patients with acquired aortic valve disease) who underwent primary AVR without replacement of the ascending aorta in New York State between 1995 and 2010 were compared. The median follow-up time was 6.6 years. The long-term incidence of thoracic aortic dissection was significantly higher in patients with Marfan syndrome (5.5 ± 2.7%) compared with those with bicuspid valves (0.55 ± 0.21%) and control group patients (0.41 ± 0.08%, p Marfan syndrome (10.8 ± 4.4%) compared with those with bicuspid valves (4.8 ± 0.8%) and control group patients (1.4 ± 0.2%) (p Marfan syndrome were significantly more likely to undergo thoracic aortic surgery in late follow-up (10.4 ± 4.3%) compared with those with bicuspid valves (2.5 ± 0.6%) and control group patients (0.50 ± 0.09%) (p Marfan syndrome compared with those with bicuspid aortic valves confirm that operative management of patients with bicuspid aortic valves should not be extrapolated from Marfan syndrome and support discrete treatment algorithms for these different clinical entities. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  1. 3D printing guiding stent graft fenestration: A novel technique for fenestration in endovascular aneurysm repair.

    Science.gov (United States)

    Huang, Jianhua; Li, Gan; Wang, Wei; Wu, Keming; Le, Tianming

    2017-08-01

    Objective To describe a novel approach, 3D printing guiding stent graft fenestration, for fenestration during endovascular aneurysm repair for juxtarenal abdominal aortic aneurysm. Methods A 69-year-old male with juxtarenal abdominal aortic aneurysm underwent endovascular aneurysm repair with "off the label" fenestrated stent graft. To precisely locate the fenestration position, we reconstructed a 3D digital abdominal aortic aneurysm model and created a skin template covering this abdominal aortic aneurysm model. Then the skin template was physically printed and the position of the visceral vessel was hollowed out, thereby helping in locating the fenestration on stent graft. Results and conclusions With the help of this 3D printed skin template, we fenestrated the stent graft accurately and rebuilt the bilateral renal artery successfully. This is the first clinical case that used 3D printing guiding stent graft fenestration, which is a novel approach for precise fenestration on stent graft on the table during endovascular aneurysm repair.

  2. Geometric Deformations of the Thoracic Aorta and Supra-Aortic Arch Branch Vessels Following Thoracic Endovascular Aortic Repair.

    Science.gov (United States)

    Ullery, Brant W; Suh, Ga-Young; Hirotsu, Kelsey; Zhu, David; Lee, Jason T; Dake, Michael D; Fleischmann, Dominik; Cheng, Christopher P

    2018-04-01

    To utilize 3-D modeling techniques to better characterize geometric deformations of the supra-aortic arch branch vessels and descending thoracic aorta after thoracic endovascular aortic repair. Eighteen patients underwent endovascular repair of either type B aortic dissection (n = 10) or thoracic aortic aneurysm (n = 8). Computed tomography angiography was obtained pre- and postprocedure, and 3-D geometric models of the aorta and supra-aortic branch vessels were constructed. Branch angle of the supra-aortic branch vessels and curvature metrics of the ascending aorta, aortic arch, and stented thoracic aortic lumen were calculated both at pre- and postintervention. The left common carotid artery branch angle was lower than the left subclavian artery angles preintervention ( P Supra-aortic branch vessel angulation remains relatively static when proximal landing zones are distal to the left common carotid artery.

  3. 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. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Aortic events in a nationwide Marfan syndrome cohort

    DEFF Research Database (Denmark)

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

    2017-01-01

    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...

  5. Infantile Aortic Coarctation in an Adult with Heart Failure.

    Science.gov (United States)

    Rumiz, Eva; Valero, Ernesto; Vilar, Juan Vicente; Santas, Enrique; Haba, Javier

    2017-01-01

    The aim of this case report is to highlight the importance of excluding aortic coarctation in a patient with a bicuspid aortic valve. A 56-year-old woman with hypertension was admitted complaining of progressive dyspnea. Transthoracic echocardiography showed a calcified, bicuspid aortic valve with severe stenosis. Aortography revealed the presence of severe narrowing of the aorta between the carotid and subclavian arteries. The patient was referred for cardiovascular surgery in which successful aortic valve replacement and aortic correction were performed. This case report shows an uncommon finding of infantile aortic coarctation in an adult patient admitted with heart failure. © 2016 S. Karger AG, Basel.

  6. Systematic review of the outcome of aortic valve replacement in patients with aortic stenosis

    NARCIS (Netherlands)

    Sharma, Umesh C.; Barenbrug, Paul; Pokharel, Saraswati; Dassen, Willem R. M.; Pinto, Yigal M.; Maessen, Jos G.

    2004-01-01

    BACKGROUND: After the establishment of aortic valve replacement procedure for aortic stenosis, there are heterogeneous studies and varying reports on outcome. An analysis that compares individual studies to summarize the overall effect is still lacking. This study systematically analyzes the change

  7. 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...

  8. 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.

  9. 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...

  10. Outcomes in Transcatheter Aortic Valve Replacement for Bicuspid Versus Tricuspid Aortic Valve Stenosis

    DEFF Research Database (Denmark)

    Yoon, Sung-Han; Bleiziffer, Sabine; De Backer, Ole

    2017-01-01

    BACKGROUND: Transcatheter aortic valve replacement (TAVR) is being increasingly performed in patients with bicuspid aortic valve stenosis (AS). OBJECTIVES: This study sought to compare the procedural and clinical outcomes in patients with bicuspid versus tricuspid AS from the Bicuspid AS TAVR mul...

  11. Aortic stiffness and diameter predict progressive aortic dilatation in patients with Marfan syndrome

    NARCIS (Netherlands)

    Nollen, Gijs J.; Groenink, Maarten; Tijssen, Jan G. P.; van der Wall, Ernst E.; Mulder, Barbara J. M.

    2004-01-01

    Aim Patients with Marfan syndrome may develop dissection due to progressive dilatation in the entire aorta, which is not always predictable by mere anatomic assessment of the aortic diameter, especially of the descending aorta. The aim of this study was to identify the predictive value of aortic

  12. Aortic valve regurgitation and the congenitally bicuspid aortic valve: a clinico-pathological correlation

    NARCIS (Netherlands)

    Sadee, A. S.; Becker, A. E.; Verheul, H. A.; Bouma, B.; Hoedemaker, G.

    1992-01-01

    To investigate the morphology of congenitally bicuspid aortic valves causing pure valve regurgitation. A case series collected over five years. An academic hospital. One hundred and forty eight excised congenitally bicuspid aortic valves. The morphological findings were correlated with sex, age,

  13. [Comparison of aortic annular diameter defined by different measurement mordalities before transcatheter aortic valve implantation].

    Science.gov (United States)

    Qi, R X; You, X D; Pu, Z X; Yang, Q; Huang, Z X; Zhou, L M; Huang, P T

    2017-05-24

    Objective: To compare aortic annular diameter measured by transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and multislice computed tomography (MSCT) in patients with severe aortic stenosis, and to evaluate the impact on selection of prosthetic valve type in transcatheter aortic valve implantation (TAVI). Methods: Clinical data of 138 patients with severe aortic stenosis referred for TAVI between January 2014 and June 2016 in our hospital were retrospectively analyzed.The difference of aortic annular diameter measured by TTE, TEE, and MSCT were compared.TTE was performed after TAVI to evaluate the accuracy of measurement before TAVI. Results: (1) Aortic annular diameter was (23.37±2.22) mm by TTE and (23.52±1.70) mm by TEE ( P =0.12). Pearson correlation analysis showed that aortic annular diameter measured by TTE was correlated to that measured by TEE ( r =0.87, P TTE and TTE (all P TTE and TEE measurements are smaller than that from MSCT.In the absence of a gold standard, selection of prosthetic valve type in TAVI procedure should rely on comprehensive considerations, which is of importance to get good clinical results for severe aortic stenosis patients underwent TAVI.

  14. Abdominal Aortic Diameter Is Increased in Males with a Family History of Abdominal Aortic Aneurysms

    DEFF Research Database (Denmark)

    Mejnert Jørgensen, Trine; Houlind, K; Green, A

    2014-01-01

    OBJECTIVE: To investigate, at a population level, whether a family history of abdominal aortic aneurysm (AAA) is independently related to increased aortic diameter and prevalence of AAA in men, and to elucidate whether the mean aortic diameter and the prevalence of AAA are different between...... participants with male and female relatives with AAA. DESIGN: Observational population-based cross-sectional study. MATERIALS: 18,614 male participants screened for AAA in the VIVA-trial 2008-2011 with information on both family history of AAA and maximal aortic diameter. METHODS: Standardized ultrasound scan...... measurement of maximum antero-posterior aortic diameter. Family history obtained by questionnaire. Multivariate regression analysis was used to test for confounders: age, sex, smoking, comorbidity and medication. RESULTS: From the screened cohort, 569 participants had at least one first degree relative...

  15. Segmentation of the Aortic Valve Apparatus in 3D Echocardiographic Images: Deformable Modeling of a Branching Medial Structure.

    Science.gov (United States)

    Pouch, Alison M; Tian, Sijie; Takabe, Manabu; Wang, Hongzhi; Yuan, Jiefu; Cheung, Albert T; Jackson, Benjamin M; Gorman, Joseph H; Gorman, Robert C; Yushkevich, Paul A

    2015-01-01

    3D echocardiographic (3DE) imaging is a useful tool for assessing the complex geometry of the aortic valve apparatus. Segmentation of this structure in 3DE images is a challenging task that benefits from shape-guided deformable modeling methods, which enable inter-subject statistical shape comparison. Prior work demonstrates the efficacy of using continuous medial representation (cm-rep) as a shape descriptor for valve leaflets. However, its application to the entire aortic valve apparatus is limited since the structure has a branching medial geometry that cannot be explicitly parameterized in the original cm-rep framework. In this work, we show that the aortic valve apparatus can be accurately segmented using a new branching medial modeling paradigm. The segmentation method achieves a mean boundary displacement of 0.6 ± 0.1 mm (approximately one voxel) relative to manual segmentation on 11 3DE images of normal open aortic valves. This study demonstrates a promising approach for quantitative 3DE analysis of aortic valve morphology.

  16. The dynamic cusp at low altitudes: A case study utilizing Viking, DMSP-F7 and Sondrestrom incoherent scatter radar observations

    Science.gov (United States)

    Watermann, J.; De La Beaujardiere, O.; Lummerzheim, D.; Woch, J.; Newell, P. T.; Potemra, T. A.; Rich, F. J.; Shapshak, M.

    1994-01-01

    Coincident multi-instrument magnetospheric and ionospheric observations have made it possible to determine the position of the ionospheric footprint of the magnetospheric cusp and to monitor its evolution over time. The data used include charged particle and magnetic field measurements from the Earth-orbiting Viking and DMSP-F7 satellites, electric field measurements from Viking, interplanetary magnetic field and plasma data from IMP-8, and Sondrestrom incoherent scatter radar observations of the ionospheric plasma density, temperature, and convection. Viking detected cusp precipitation poleward of 75.5 deg invariant latitude. The ionospheric response to the observed electron precipitation was simulated using an auroral model. It predicts enhanced plasma density and elevated electron temperature in the upper E- and F- regions. Sondrestrom radar observations are in agreement with the predictions. The radar detected a cusp signature on each of five consecutive antenna elevation scans covering 1.2h local time. The cusp appeared to be about 2 deg invariant latitude wide, and its ionospheric footprint shifted equatorward by nearly 2 deg during this time, possibly influenced by an overall decrease in the interplanetary magnetic field (IMF) B(sub z) component. The radar plasma drift data and the Viking magnetic and electric field data suggest that the cusp was associated with a continuous, rather than a patchy, merging between the IMF and the geomagnetic field.

  17. A model based method for obtaining the open/closed field line boundary from the cusp auroral 6300 Å[OI] red line

    Science.gov (United States)

    Johnsen, M. G.; Lorentzen, D. A.; Holmes, J. M.; Løvhaug, U. P.

    2012-03-01

    Ground based optical instruments are invaluable tools for studies of processes associated with the cusps and auroral morphology. In this work we present a method for obtaining the magnetic latitude of the open/closed field line boundary (OCB) from the cusp 6300 Å[OI] auroral red line using a meridian scanning photometer. The method which is based on a pre-defined reference cusp aurora produced by the GLOW model is examined with respect to uncertainties, and we describe how a set of equations describing the error is constructed. The method is applicable to data from optical instruments located at high latitude observation sites such as Svalbard and Antarctica. Equations describing both errors and the mapping altitude for transforming the OCB from instrument centered coordinates to magnetic latitude for instrumentation located in Svalbard (Longyearbyen) are presented. Further, by applying the GLOW model we present results illustrating the great variability in the altitude profile of the atomic oxygen 6300 Å[OI] red line emission in the cusp. A simple calculation showing how a poleward neutral wind will change the latitudinal shape of the cusp aurora is also performed.

  18. Excitation of transient lobe cell convection and auroral arc at the cusp poleward boundary during a transition of the interplanetary magnetic field from south to north

    Directory of Open Access Journals (Sweden)

    P. E. Sandholt

    2001-05-01

    Full Text Available We document the activation of transient polar arcs emanating from the cusp within a 15 min long intermediate phase during the transition from a standard two-cell convection pattern, representative of a strongly southward interplanetary magnetic field (IMF, to a "reverse" two-cell pattern, representative of strongly northward IMF conditions. During the 2–3 min lifetime of the arc, its base in the cusp, appearing as a bright spot, moved eastward toward noon by ~ 300 km. As the arc moved, it left in its "wake" enhanced cusp precipitation. The polar arc is a tracer of the activation of a lobe convection cell with clockwise vorticity, intruding into the previously established large-scale distorted two-cell pattern, due to an episode of localized lobe reconnection. The lobe cell gives rise to strong flow shear (converging electric field and an associated sheet of outflowing field-aligned current, which is manifested by the polar arc. The enhanced cusp precipitation represents, in our view, the ionospheric footprint of the lobe reconnection process.Key words. Magnetospheric physics (auroral phenomena; magnetopause, cusp, and boundary layers; plasma convection

  19. The Four-Loop Planar Amplitude and Cusp Anomalous Dimension in Maximally Supersymmetric Yang-Mills Theory

    International Nuclear Information System (INIS)

    Bern, Zvi; Czakon, Michael; Dixon, Lance J.; Kosower, David A.; Smirnov, Vladimir A.

    2006-01-01

    We present an expression for the leading-color (planar) four-loop four-point amplitude of N = 4 supersymmetric Yang-Mills theory in 4-2ε dimensions, in terms of eight separate integrals. The expression is based on consistency of unitarity cuts and infrared divergences. We expand the integrals around ε = 0, and obtain analytic expressions for the poles from 1/ε 8 through 1/ε 4 . We give numerical results for the coefficients of the 1/ε 3 and 1/e 2 poles. These results all match the known exponentiated structure of the infrared divergences, at four separate kinematic points. The value of the 1/ε 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 ζ 3 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

  20. 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

  1. Qureshi-5 Catheter for Complex Supra- and Abdominal-Aortic Catheterization.

    Science.gov (United States)

    Qureshi, Adnan I; Xiao, WeiGang; Liu, HongLiang

    2015-10-01

    The use of previously described catheter technique was expanded to complex supra- and abdominal- aortic catheterizations. A new (Qureshi 5) catheter with curved shape at the distal end that has two lumens was used. One of lumens can accommodate a 0.035-inch guide wire and the second lumen can accommodate a 0.018-inch guide wire and terminates at the beginning of the distal curve of the first lumen. The manipulation and engagement of the curved distal end catheter was facilitated by rotation and movement of the J-shaped 0.018-inch guide wire extended coaxial and beyond the distal end of catheter. Subsequently, either contrast was injected or a 0.035-inch guide wire advanced into the target artery. The catheters were used in one patient to perform diagnostic cerebral and abdominal angiography through a 6F introducer sheath placed in the right common femoral artery. The catheterization was complex because of severe tortuosity of arch and descending aorta secondary to kyphosis. The left and right internal carotid arteries and left and right vertebral arteries, left renal artery, and superior mesenteric artery were catheterized in patient (fluoroscopy time 19:46 min). No complications were observed in the patient. The Qureshi-5 catheter was successful in complex supra- and abdominal-aortic catheterizations.

  2. Pre-Procedural Hemodynamic Status Improves the Discriminatory Value of the Aortic Regurgitation Index in Patients Undergoing Transcatheter Aortic Valve Replacement.

    Science.gov (United States)

    Sinning, Jan-Malte; Stundl, Anja; Pingel, Simon; Weber, Marcel; Sedaghat, Alexander; Hammerstingl, Christoph; Vasa-Nicotera, Mariuca; Mellert, Fritz; Schiller, Wolfgang; Kovac, Jan; Welz, Armin; Grube, Eberhard; Werner, Nikos; Nickenig, Georg

    2016-04-11

    The aims of this study were to increase the discriminatory value of the aortic regurgitation index (ARI) for the assessment of paravalvular regurgitation (PVR) and to further elucidate the association between aortic regurgitation severity and mortality after transcatheter aortic valve replacement (TAVR). Hemodynamic parameters such as the ARI complement predominantly angiographically guided TAVR. However, the ARI depends on several baseline and periprocedural characteristics. The ARI was prospectively calculated before and after TAVR in 600 patients. The severity of PVR was assessed in all patients by angiography and echocardiography according to a 3-class scheme. To account for pre-procedural hemodynamic status, the ARI ratio was calculated as post- over pre-procedural ARI. Apart from the degree of PVR (β = -0.396, p procedural hemodynamic status in the form of the ARI before TAVR (β = 0.227, p procedural ARI in multivariate regression analysis. The ARI ratio increased the specificity of post-procedural ARI alone for the prediction of both more than mild PVR and 1-year mortality from 75.1% to 93.2% and from 75.0% to 93.3%, respectively. Patients with post-procedural ARI values procedural hemodynamic status increases the discriminatory value of post-procedural ARI. The ARI ratio, which reflects acute hemodynamic changes after TAVR, is useful to identify patients with negative outcomes. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  3. Artificial aortic valves: an overview.

    Science.gov (United States)

    Morsi, Y S; Birchall, I E; Rosenfeldt, F L

    2004-06-01

    This review discusses strategies that may address some of the limitations associated with replacing diseased or dysfunctional aortic valves with mechanical or tissue valves. These limitations range from structural failure and thromboembolic complications associated with mechanical valves to a limited durability and calcification with tissue valves. In pediatric patients there is an issue with the inability of substitutes to grow with the recipient. The emerging science of tissue engineering potentially provides an attractive alternative by creating viable tissue structures based on a resorbable scaffold. Morphometrically precise, biodegradable polymer scaffolds may be fabricated from data obtained from scans of natural valves by rapid prototyping technologies such as fused deposition modelling. The scaffold provides a mechanical profile until seeded cells produce their own extra cellular matrix. The microstructure of the forming tissue may be aligned into predetermined spatial orientations via fluid transduction in a bioreactor. Although there are many technical obstacles that must be overcome before tissue engineered heart valves are introduced into routine surgical practice these valves have the potential to overcome many of the shortcomings of current heart valve substitutes.

  4. 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. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  5. The hexagonal lattice marks in the muroids rodent explain molar-cusp enamel line

    Directory of Open Access Journals (Sweden)

    Ruiz Bustos, A.

    2011-12-01

    Full Text Available The crown enamel line of muroids rodent has geometric traces that coincide exactly with an equilateral triangular lattice. This finding helps to explain the muroids dental pattern from a novel perspective in molar morphology that it is based on hexagonal structures. The adult traces imply that the morphology of the teeth mammals is consequence of a morphogenetic process. This is the study of the hexagonal lattice marks observed in the enamel line, and therefore called odontohexasymmetry. The particular dental pattern, which it is passed down from parents to offspring, it start with a genetic algorithm coded in DNA. This includes a system of intelligent self-control, which during the morphogenesis coordinates the morphology of the all teeth of a specimen to get the best occlusion. The hypothesis of mitosis area loop-development (Ruiz Bustos, 2004a, 2005, 2006 and 2007 explains that in early morphogenesis stage, the initial mass-cell (basal mitosis area, it is repeated in a loop, thereby forming all other mitosis areas of the tooth. At the end of the morphogenesis, the biomineralization processes transform the mitosis areas in the cusps crown.

    La línea de esmalte observada en la corona de los roedores muroideos tiene formas geométricas que coinciden exactamente con una red plana triangular equilateral. Esta conclusión ayuda a explicar el modelo dental de los muroideos con una nueva perspectiva denominada odontohexasimetria, fundamentada en las formas hexagonales observadas en la línea de esmalte. La morfología de la corona del diente de los mamíferos es heredada de padres a hijos. Esto infiere la existencia en cada espécimen de un autocontrol inteligente codificado en el genoma, que coordina la morfología de los dientes durante el desarrollo embriológico y su oclusión. La hipótesis del desarrollo el bucle de las áreas de mitosis (Ruiz Bustos, 2004a, 2005, 2006 y 2007 propone, que en los momentos iniciales de la morfog

  6. Research of Customized Aortic Stent Graft Manufacture

    Science.gov (United States)

    Zhang, Lei; Chen, Xin; Liu, Muhan

    2017-03-01

    Thoracic descending aorta diseases include aortic dissection and aortic aneurysm, of which the natural mortality rate is extremely high. At present, endovascular aneurysm repair (EVAR) has been widely used as an effective means for the treatment of descending aortic disease. Most of the existing coating stents are standard design, which are unable to meet the size or structure of different patients. As a result, failure of treatment would be caused by dimensional discrepancy between stent and vessels, which could lead to internal leakage or rupture of blood vessels. Therefore, based on rapid prototyping sacrificial core - coating forming (RPSC-CF), a customized aortic stent graft manufactured technique has been proposed in this study. The aortic stent graft consists of film and metallic stent, so polyether polyurethane (PU) and nickel-titanium (NiTi) shape memory alloy with good biocompatibility were chosen. To minimum film thickness without degrading performance, effect of different dip coating conditions on the thickness of film were studied. To make the NiTi alloy exhibit super-elasticity at body temperature (37°C), influence of different heat treatment conditions on austenite transformation temperature (Af) and mechanical properties were studied. The results show that the customized stent grafts could meet the demand of personalized therapy, and have good performance in blasting pressure and radial support force, laying the foundation for further animal experiment and clinical experiment.

  7. Impact of bicuspid aortic valve on complications and death in infective endocarditis of native aortic valves.

    Science.gov (United States)

    Kahveci, Gokhan; Bayrak, Fatih; Pala, Selcuk; Mutlu, Bulent

    2009-01-01

    We retrospectively investigated the impact of bicuspid aortic valve on the prognosis of patients who had definite infective endocarditis of the native aortic valve.Of 51 patients, a bicuspid aortic valve was present in 22 (43%); the other 29 had tricuspid aortic valves. On average, the patients who had bicuspid valves were younger than those who had tricuspid valves. Patients with a tricuspid valve had larger left atrial diameters and were more likely to have severe mitral regurgitation.Periannular complications, which we detected in 19 patients (37%), were much more common in the patients who had a bicuspid valve (64% vs 17%, P = 0.001). The presence of a bicuspid valve was the only significant independent predictor of periannular complications. The in-hospital mortality rate in the bicuspid group was lower than that in the tricuspid group; however, this figure did not reach statistical significance (9% vs 24%, P = 0.15). In multivariate analysis, left atrial diameter was the only independent predictor associated with an increased risk of death (hazard ratio, 2.19; 95% confidence interval, 1.1-4.5; P = 0.031).In our study, patients with infective endocarditis in a bicuspid aortic valve were younger and had a higher incidence of periannular complications. Although a worse prognosis has been reported previously, we found that infective endocarditis in a native bicuspid aortic valve is not likely to increase the risk of death in comparison with infective endocarditis in native tricuspid aortic valves.

  8. 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

  9. Total Endovascular Aortic Repair in a Patient with Marfan Syndrome.

    Science.gov (United States)

    Amako, Mau; Spear, Rafaëlle; Clough, Rachel E; Hertault, Adrien; Azzaoui, Richard; Martin-Gonzalez, Teresa; Sobocinski, Jonathan; Haulon, Stéphan

    2017-02-01

    The aim of this study is to describe a total endovascular aortic repair with branched and fenestrated endografts in a young patient with Marfan syndrome and a chronic aortic dissection. Open surgery is the gold standard to treat aortic dissections in patients with aortic disease and Marfan syndrome. In 2000, a 38-year-old man with Marfan syndrome underwent open ascending aorta repair for an acute type A aortic dissection. One year later, a redo sternotomy was performed for aortic valve replacement. In 2013, the patient presented with endocarditis and pulmonary infection, which necessitated tracheostomy and temporary dialysis. In 2014, the first stage of the endovascular repair was performed using an inner branched endograft to exclude a 77-mm distal arch and descending thoracic aortic aneurysm. In 2015, a 63-mm thoracoabdominal aortic aneurysm was excluded by implantation of a 4-fenestrated endograft. Follow-up after both endovascular repairs was uneventful. Total aortic endovascular repair was successfully performed to treat a patient with arch and thoraco-abdominal aortic aneurysm associated with chronic aortic dissection and Marfan syndrome. The postoperative images confirmed patency of the endograft and its branches, and complete exclusion of the aortic false lumen. Endovascular repair is a treatment option in patients with connective tissue disease who are not candidates for open surgery. Long-term follow-up is required to confirm these favorable early outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. 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.

  11. Acute Abdominal Mobile Aortic Thrombus Post Chemotherapy: Two Cases Reports

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Woo Chul; Kim, Jun Ho; Lee, Kyung Hee; Cho, Soon Gu; Jeon, Yong Sun [Dept. of Radiology, Inha University School of Medicine, Incheon (Korea, Republic of)

    2011-08-15

    An acute abdominal mobile aortic thrombus is a very unusual finding, and this is a potential source of arterial embolism. Mobile aortic thrombus mostly occurs in a diffuse atherosclerotic and aneurysmal aorta. Chemotherapy agents have been documented as a possible rare cause of acute arterial thrombus. We report acute abdominal mobile aortic thrombus post-chemotherapy for pancreatic and stomach cancer.

  12. Local repair of distal thoracal aortic dissections (Locus minoris resistencia).

    Science.gov (United States)

    Belov, Iu V; Komarov, R N; Stepanenko, A B; Gens, A P; Charchian, E R

    2007-01-01

    The paper presents the method of local repair of distal aortic dissections. Local aortic grafting for surgical correction of type B dissecting aortic aneurysms helped to decrease hospital mortality up to 15.4%, the rate of paraparesis and multiorgan failure - up to 11.5%.

  13. Neutron guide

    Science.gov (United States)

    Greene, Geoffrey L.

    1999-01-01

    A neutron guide in which lengths of cylindrical glass tubing have rectangular glass plates properly dimensioned to allow insertion into the cylindrical glass tubing so that a sealed geometrically precise polygonal cross-section is formed in the cylindrical glass tubing. The neutron guide provides easier alignment between adjacent sections than do the neutron guides of the prior art.

  14. In situ total aortic arch replacement for infected distal aortic arch aneurysms with penetrating atherosclerotic ulcer.

    Science.gov (United States)

    Okada, Kenji; Yamanaka, Katsuhiro; Sakamoto, Toshihito; Inoue, Takeshi; Matsumori, Masamichi; Kawakami, Fumi; Okita, Yutaka

    2014-11-01

    We present a series of patients who underwent in situ total aortic arch replacement for infected distal aortic arch aneurysms. Between 2002 and 2013, 9 patients with infected distal aortic arch aneurysms underwent total aortic arch replacement using antegrade selective cerebral perfusion. There were 4 male and 5 female patients with a mean age of 72.7±9.0 years. All patients had penetrating atherosclerotic ulcer in the distal aortic arch, which formed saccular aneurysms. Four patients had preoperative hoarseness. Maximum preoperative white blood cell count was 10,211±4375/μL, and mean serum C-reactive protein concentration was 12.7±7.2 mg/dL. Causative microorganisms were identified by blood culture or aortic wall culture and were as follows: Candida albicans, Pseudomonas aeruginosa, Edwardsiella tarda, Streptococcus dysgalactiae, Listeria monocytogenes, Staphylococcus aureus (2 cases), and unknown (2 cases). Radical debridement with in situ total aortic arch replacement was performed in all patients, followed by the omental flap grafting in 7 patients. All surgery was performed on an urgent or emergency basis. Average cardiopulmonary bypass time and lower body circulatory arrest time were 199.7±50.7 minutes and 66.6±13.8 minutes, respectively. There was no in-hospital mortality, but 1 patient died of asphyxia 5 months after hospital discharge. Freedom from recurrence of infection was 100%. Surgical treatment with the combination of radical debridement with in situ total aortic arch replacement using antegrade selective cerebral perfusion and omental flap grafting was a reliable procedure for the treatment of infected distal aortic arch aneurysms. Copyright © 2014. Published by Elsevier Inc.

  15. Blunt traumatic aortic injuries of the ascending aorta and aortic arch: a clinical multicentre study.

    Science.gov (United States)

    Mosquera, Victor X; Marini, Milagros; Muñiz, Javier; Gulias, Daniel; Asorey-Veiga, Vanesa; Adrio-Nazar, Belen; Herrera, José M; Pradas-Montilla, Gonzalo; Cuenca, José J

    2013-09-01

    To report the clinical and radiological characteristics, management and outcomes of traumatic ascending aorta and aortic arch injuries. Historic cohort multicentre study including 17 major trauma patients with traumatic aortic injury from January 2000 to January 2011. The most common mechanism of blunt trauma was motor-vehicle crash (47%) followed by motorcycle crash (41%). Patients sustaining traumatic ascending aorta or aortic arch injuries presented a high proportion of myocardial contusion (41%); moderate or greater aortic valve regurgitation (12%); haemopericardium (35%); severe head injuries (65%) and spinal cord injury (23%). The 58.8% of the patients presented a high degree aortic injury (types III and IV). Expected in-hospital mortality was over 50% as defined by mean TRISS 59.7 (SD 38.6) and mean ISS 48.2 (SD 21.6) on admission. Observed in-hospital mortality was 53%. The cause of death was directly related to the ATAI in 45% of cases, head and abdominal injuries being the cause of death in the remaining 55% cases. Long-term survival was 46% at 1 year, 39% at 5 years, and 19% at 10 years. Traumatic aortic injuries of the ascending aorta/arch should be considered in any major thoracic trauma patient presenting cardiac tamponade, aortic valve regurgitation and/or myocardial contusion. These aortic injuries are also associated with a high incidence of neurological injuries, which can be just as lethal as the aortic injury, so treatment priorities should be modulated on an individual basis. Copyright © 2012 Elsevier Ltd. All rights reserved.

  16. Aortic Dissection and Aortic Aneurysms Associated with Fluoroquinolones: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Singh, Sonal; Nautiyal, Amit

    2017-12-01

    Our objective was to evaluate the association between fluoroquinolone use and aortic dissection or aortic aneurysm in a systematic review and meta-analysis. We searched Medline, Embase, and Scopus from inception to February 15, 2017. We selected controlled studies for inclusion if they reported data on aortic dissection and aortic aneurysm associated with fluoroquinolones exposure versus no exposure. Data were extracted by 2 independent reviewers, with disagreements resolved through further discussion. We assessed the quality of studies using the Newcastle-Ottawa Scale for observational studies and the strength of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach. The odds ratios (ORs) from observational studies were pooled using the fixed-effect inverse variance method, and statistical heterogeneity was assessed using the I 2 statistic. After a review of 714 citations, we included 2 observational studies in the meta-analysis. Current use of fluoroquinolones was associated with a statistically significantly increased risk of aortic dissection (OR, 2.79; 95% confidence interval [CI], 2.31-3.37; I 2  = 0%) and aortic aneurysm (OR, 2.25; 95% CI, 2.03-2.49; I 2  = 0%) in a fixed-effects meta-analysis. The unadjusted OR estimates and sensitivity analysis using a random-effects model showed similar results. We rated the strength of evidence to be of moderate quality. The number needed to treat to harm for aortic aneurysm for elderly patients aged more than 65 years who were current users of fluoroquinolones was estimated to be 618 (95% CI, 518-749). Evidence from a small number of studies suggests that exposure to fluoroquinolones is consistently associated with a small but significantly increased risk of aortic dissection and aortic aneurysm. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Electric Field Observations of Plasma Convection, Shear, Alfven Waves, and other Phenomena Observed on Sounding Rockets in the Cusp and Boundary Layer

    Science.gov (United States)

    Pfaff, R. F.

    2009-01-01

    On December 14,2002, a NASA Black Brant X sounding rocket was launched equatorward from Ny Alesund, Spitzbergen (79 N) into the dayside cusp and subsequently cut across the open/closed field line boundary, reaching an apogee of771 km. The launch occurred during Bz negative conditions with strong By negative that was changing during the flight. SuperDarn (CUTLASS) radar and subsequent model patterns reveal a strong westward/poleward convection, indicating that the rocket traversed a rotational reversal in the afternoon merging cell. The payload returned DC electric and magnetic fields, plasma waves, energetic particle, suprathermal electron and ion, and thermal plasma data. We provide an overview of the main observations and focus on the DC electric field results, comparing the measured E x B plasma drifts in detail with the CUTLASS radar observations of plasma drifts gathered simultaneously in the same volume. The in situ DC electric fields reveal steady poleward flows within the cusp with strong shears at the interface of the closed/open field lines and within the boundary layer. We use the observations to discuss ionospheric signatures of the open/closed character of the cusp/low latitude boundary layer as a function of the IMF. The electric field and plasma density data also reveal the presence of very strong plasma irregularities with a large range of scales (10 m to 10 km) that exist within the open field line cusp region yet disappear when the payload was equatorward of the cusp on closed field lines. These intense low frequency wave observations are consistent with strong scintillations observed on the ground at Ny Alesund during the flight. We present detailed wave characteristics and discuss them in terms of Alfven waves and static irregularities that pervade the cusp region at all altitudes.

  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...... (NOAF) is 31%-64% and 4%-32%, respectively. NOAF is independently associated with adverse events such as stroke, death, and increased length of hospital stay. Increasing the knowledge of predisposing factors, optimal postprocedural monitoring, and prophylactic antiarrhythmic and antithrombotic therapy...

  19. 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...... (NOAF) is 31%-64% and 4%-32%, respectively. NOAF is independently associated with adverse events such as stroke, death, and increased length of hospital stay. Increasing the knowledge of predisposing factors, optimal postprocedural monitoring, and prophylactic antiarrhythmic and antithrombotic therapy...

  20. Combined Repair of Ascending Aortic Pseudoaneurysm and Abdominal Aortic Aneurysm in a Patient with Marfan Syndrome

    Science.gov (United States)

    Kokotsakis, John N.; Lioulias, Achilleas G.; Foroulis, Christophoros N.; Skouteli, Eleni Anna T.; Milonakis, Michael K.; Bastounis, Elias A.; Boulafendis, Dimitrios G.

    2003-01-01

    Pseudoaneurysms of the ascending aorta after the original inclusion/wrap technique of the Bentall procedure present a difficult surgical management problem and are associated with substantial morbidity and mortality. Patients with Marfan syndrome frequently develop aneurysms and dissections that involve multiple aortic segments. We present the case of a Marfan patient who successfully underwent repair of a giant ascending aortic pseudoaneurysm and concomitant repair of an abdominal aortic aneurysm. An aggressive surgical strategy followed by life-long cardiovascular monitoring is warranted in order to prolong the survival of these patients. (Tex Heart Inst J 2003;30:233–5) PMID:12959210

  1. Tailored endovascular repair of traumatic aortic disruptions with "stacked" abdominal aortic extension cuffs.

    Science.gov (United States)

    Allen, Keith B; Borkon, A Michael; Laster, Steven B; Aggarwal, Sanjeev; Davis, John R; Pak, Alexander F; Stewart, James R; Stuart, R Scott

    2012-01-01

    The management paradigm for traumatic aortic disruptions has evolved from open to endovascular repair. Thoracic stent grafts designed to treat aneurysmal disease, however, have disadvantages, including size mismatch in younger trauma patients and current standard lengths, which may needlessly necessitate coverage of at least 10 cm of thoracic aorta, increasing the risk of spinal cord ischemia. The "off-label" use of abdominal aortic extension cuffs to treat traumatic aortic disruptions may provide an advantage in this regard by better size matching for the younger trauma patient, reduced thoracic aortic coverage, and less cost to the institution. From 2008 to 2011, a total of 16 traumatic aortic disruptions were evaluated and managed with endovascular techniques. The last six were treated with abdominal aortic extensions cuffs (Excluder Extension Cuffs; W.L. Gore & Associates, Flagstaff, AZ) rather than traditional thoracic stent grafts. In addition to demographics and trauma-related data, additional endpoints evaluated in this retrospective review included operative time, number of cuffs used, stent cost data, procedural complications, and follow-up. All six patients (five men/one woman) with traumatic aortic disruption were successfully treated with complete exclusion of the disruption using abdominal aortic cuffs. There were no complications including death or spinal cord ischemia. The average age was 27 years (range, 18-44 years). The average number of cuffs used to cover the traumatic tear was 2.6 per patient (range, 2-3 cuffs per patient), covering an average of 5.3 cm of thoracic aorta (range, 4-6 cm). Mean procedure time was 70 minutes. Hospital cost for each cuff was $2200 (average total stent cost per patient, $5720). For comparison, a single 10-cm conformable thoracic aortic graft (CTAG) (Gore) costs $14,500. Average follow-up of all six patients for up to 3 years demonstrates no complications or migration of the stent grafts. Traumatic aortic

  2. Combined repair of ascending aortic pseudoaneurysm and abdominal aortic aneurysm: in a patient with Marfan syndrome.

    Science.gov (United States)

    Kokotsakis, John N; Lioulias, Achilleas G; Foroulis, Christophoros N; Skouteli, Eleni Anna T; Milonakis, Michael K; Bastounis, Elias A; Boulafendis, Dimitrios G

    2003-01-01

    Pseudoaneurysms of the ascending aorta after the original inclusion/wrap technique of the Bentall procedure present a difficult surgical management problem and are associated with substantial morbidity and mortality. Patients with Marfan syndrome frequently develop aneurysms and dissections that involve multiple aortic segments. We present the case of a Marfan patient who successfully underwent repair of a giant ascending aortic pseudoaneurysm and concomitant repair of an abdominal aortic aneurysm. An aggressive surgical strategy followed by life-long cardiovascular monitoring is warranted in order to prolong the survival of these patients.

  3. Refractory pulmonary edema secondary to severe aortic valvular stenosis - aortic valvuloplasty as bridge therapy to surgery

    International Nuclear Information System (INIS)

    Santiago, Salazar; Hanna, Franklin; Capasso, Aminta

    2009-01-01

    Aortic valve stenosis is a progressive disease; when it is severe and symptomatic has a bleak prognosis that affects adversely the patient survival. In these cases, the treatment of choice is valve replacement surgery that under certain circumstances can bear a huge risk that forces the physician to consider less aggressive management alternatives to solve the problem. The case of a 65 years old male with severe aortic valve stenosis is reported. He developed pulmonary edema refractory to medical treatment that was solved by aortic valvuloplasty as bridge therapy to surgery.

  4. Digital substraction angiography in aortic dissection

    International Nuclear Information System (INIS)

    Khadzhidekov, V.; Mircheva, M.; Genov, P.

    1993-01-01

    Regardless of the technical progress in new noninvasive methods, aortography is still regarded as a method providing the necessary information for cases of aortic dissection, especially those requiring emergency operative management. Twenty-four DS-aortographies of patients suspected for aortic dissection are reviewed. Intraarterial DSA is less hazardous owing to the reduced flow rate and quantity of contrast medium required. The relative share of inadequate images is rather high, and conventional cineaortography cannot be invariably replaced by the digital subtracted one. However, angiographic examination in cases suspected for aortic dissection may start with intraarterial digital substraction, and provided the latter proves inconclusive, conventional cineaortography may be resorted to. 6 refs., 3 figs. (orig.)

  5. From the sun's corona to the polar cusp aurora above Svalbard. Interplanetary and terrestrial effects of a coronal transient

    International Nuclear Information System (INIS)

    Sandholt, P.E.

    1986-08-01

    The report presents a study of the flare-related coronal transient of Nov. 27, 1979, with the resulting interplanetary (IP) shock, and the associated auroral and magnetic effects that were observed from the ground 72 hours after the initial coronal brightening. The observed disturbance of the interplanetary magnetic field (IMF) resulting from the coronal mass ejection is discussed in relation to a model discription of flare-related perturbations of the solar current sheet. The power transfer from the solar wind to the magnetosphere did not rise above the treshold value for magnetospheric strom triggering in this case. thus, the IP shock was not followed by a major storm. However, distinct signatures related to the IP disturbance were observed in the polar cusp aurorae above Svaldbard and in the local magnetic field. The dynamical behaviour of the cusp aurora is discussed in relation to different models of plasma transfer across the dayside magnetopause, from the shocked solar wind to the magnetosphere. A detailed analysis of the available information from interplanetary space and the ground indicates that the main auroral dynamics observed in this case are related to localized, impulsive plasma injections associated with flux transfer events

  6. Relationship of upflowing ion beams and conics around the dayside cusp/cleft region to the interplanetary conditions

    Directory of Open Access Journals (Sweden)

    W. Miyake

    2002-04-01

    Full Text Available The dayside cusp/cleft region is known as a major source of upflowing ionospheric ions to the magnetosphere. Since the ions are supposed to be energized by an input of energy from the dayside magnetospheric boundary region, we examined the possible influence of the interplanetary conditions on dayside ion beams and conics observed by the polar-orbiting Exos-D (Akebono satellite. We found that both the solar wind velocity and density, as well as IMF By and Bz , affect the occurrence frequency of ion conics. The energy of ion conics also depends on the solar wind velocity, IMF By and Bz . The ion beams around the local noon are not significantly controlled by the interplanetary conditions. The results reveal that ion convection, as well as the energy source, is important to understand the production of dayside ion conics while that of ion beams basically reflects the intensity of local field-aligned currents.Key words. Ionosphere (particle acceleration – magnetospheric physics (magnetopause, cusp, and boundary layers; magnetosphere ionosphere interaction

  7. An Immature Type II Dens Invaginatus in a Mandibular Lateral Incisor with Talon's Cusp: A Clinical Dilemma to Confront.

    Science.gov (United States)

    Gangwar, Anshul; Singal, Deepa; Giri, K Y; Agarwal, Anshita; Keerthi, S Sruthi

    2014-01-01

    Dens invaginatus (DI) is a malformation of teeth probably resulting from an infolding of the dental papilla during tooth development. DI is classified as type I, II, and III by Oehlers depending on the severity of malformation. The maxillary lateral incisor is the most commonly affected tooth. Structural defects do exist in the depth of the invagination pits, and as a consequence, the early development of caries and the subsequent necrosis of the dental pulp, as well as abscess and cyst formation are clinical implications associated with DI. Occasionally, we can see more than one developmental anomaly occurring in a single tooth. In such cases it becomes important to identify the anomalies and initiate a proper treatment plan for good prognosis. In this paper, an unusual case of DI which clinically presented as a huge talons cusp affecting a mandibular lateral incisor tooth is described. This case report illustrates grinding of the talons cusp followed by nonsurgical endodontic management of dens invaginatus type II with an immature apex and periapical lesions, in which Mineral Trioxide Aggregate (MTA) shows a complete periapical healing with bone formation at the site of the lesions.

  8. Bentall Procedure Using Cryopreserved Valved Aortic Homografts

    Science.gov (United States)

    Christenson, Jan T.; Sierra, Jorge; Trindade, Pedro T.; Didier, Dominique; Kalangos, Afksendiyos

    2004-01-01

    The Bentall procedure is the standard operation for patients who have lesions of the ascending aorta associated with aortic valve disease. In many cases, however, mechanical prosthetic conduits are not suitable. There are few reports in the English-language medical literature concerning the mid- to long-term outcome of Bentall operations with cryopreserved homografts. Therefore, we reviewed our experience with this procedure and valved homografts. From January 1997 through December 2002, 21 patients underwent a Bentall operation with cryopreserved homografts at our institution. There were 14 males and 7 females; the mean age was 36 ± 21 years (range, 15–74 years). Eleven patients had undergone previous aortic valve surgery. All patients had aortic dilatation or aneurysms involving the ascending aorta. Indications for surgery included aortic valve stenosis or insufficiency, and aortic valve endocarditis (native valve or prosthetic). One patient had Takayasu's arteritis and 3 had Marfan syndrome. There was 1 hospital death (due to sepsis), but no other major postoperative complications. The mean hospital stay was 14 ± 7 days. Follow-up echocardiographic and computed tomographic scans were performed yearly. The mean follow-up was 34 months (6–72 months). Follow-up imaging revealed no calcifications or degenerative processes related to the homograft. Four patients had minimal valve regurgitation. Two patients died during follow-up. The 3-year actuarial survival rate was 85.7%. Our data suggest that the Bentall procedure with a valved homograft conduit is a safe procedure with excellent mid- to long-term results, comparable to results reported with aortic valve replacement with a homograft. PMID:15745290

  9. Diagnostic imaging of acute aortic dissection

    International Nuclear Information System (INIS)

    Ohya, Tohru; Kumazaki, Tatsuo

    1991-01-01

    One hundred and nineteen patients with aortic dissection who underwent diagnostic imaging were reviewed and angiographic findings as well as those of CT were analysed. Thirty eight cases (43.1%) had non-contrast opacified false lumen, the type of which we call 'thrombosed type aortic dissection'. A comparative study of the thrombosed type with the patent type of false lumens was made particularly from the stand point of the characteristic diagnostic imagings (CT and angiography). At the same time, the pitfalls of these imagings in thrombosed type aortic dissection were studied. At the onset the average age of thrombosed type was 62.3 years old, while that of the patent type was 57.3. A statistical significance between the two groups was p<0.05. Thrombosed type in all cases was caused by atherosclerosis, whereas patent type was caused by the Marfan's syndrome in 11 cases. Other clinical findings, such as initial symptoms and blood pressure revealed no significant differences between the two groups. Pre-contrast CT in acute thrombosed type aortic dissection showed 'hyperdense crescent sign' in 89.4%. However, in 3 cases with thrombosed type in which the pre-contrast CT showed 'hyperdense crescent sign' contrast-enhanced CT detected no clear evidence of aortic dissection in the same site. This was due to obscurity induced by contrast medium. Angiographic findings of thrombosed type were classified into 3 groups: normal type, stenosed true lumen type and ulcer-like projection type. The incidence of normal type was estimated to be 48.4%, whereas stenosed true lumen type was 24.2% and ulcer-like projection was 27.7%. The present study concluded that thrombosed type is not rare in acute aortic dissection and contrast-enhanced CT as well as pre-contrast CT, is of great value in diagnosing thrombosed type. 'Hyperdense crescent sign' in pre-contrast CT is characteristic of intramural hematoma. (author)

  10. Transcatheter Aortic Valve Replacement: A Review Article

    Directory of Open Access Journals (Sweden)

    Juan A Siordia

    2016-06-01

    Full Text Available Transcatheter aortic valve replacement (TAVR is a novel therapeutic intervention for the replacement of severely stenotic aortic valves in high-risk patients for standard surgical procedures. Since the initial PARTNER trial results, use of TAVR has been on the rise each year. New delivery methods and different valves have been developed and modified in order to promote the minimally invasive procedure and reduce common complications, such as stroke. This review article focuses on the current data on the indications, risks, benefits, and future directions of TAVR. Recently, TAVR has been considered as a standard-of-care procedure. While this technique is used frequently in high-risk surgical candidates, studies have been focusing on the application of this method for younger patients with lower surgical risk. Moreover, several studies have proposed promising results regarding the use of valve-in-valve technique or the procedure in which the valve is placed within a previously implemented bioprosthetic valve. However, ischemic strokes and paravalvular leak remain a matter of debate in these surgeries. New methods and devices have been developed to reduce the incidence of post-procedural stroke. While the third generation of TAVR valves (i.e., Edwards Sapien 3 and Medtronic Evolut R addresses the issue of paravalvular leak structurally, results on their efficacy in reducing the risk of paravalvular leak are yet to be obtained. Furthermore, TAVR enters the field of hybrid methods in the treatment of cardiac issues via both surgical and catheter-based approaches. Finally, while TAVR is primarily performed on cases with aortic stenosis, new valves and methods have been proposed regarding the application of this technique in aortic regurgitation, as well as other aortic pathologies. TAVR is a suitable therapeutic approach for the treatment of aortic stenosis in high-risk patients. Considering the promising results in the current patient population

  11. 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.

  12. Preventative Valve-Sparing Aortic Root Replacement and Pregnancy Outcome in Marfan Syndrome

    OpenAIRE

    Sokol, Vesna; Zlopaša, Gordan; Herman, Mislav; Planinić, Pavao; Micevska, Ana

    2012-01-01

    In Marfan syndrome, with dilatation of the aortic root secondary to an underlying connective tissue defect, pregnancy can cause hemodynamic stress leading to the development of an aortic aneurysm and even a fatal aortic dissection. In the presence of existing aortic root enlargement and a family history of aortic dissection, preventative elective surgery is suggested. Aortic root replacement with or without a valve-sparing procedure is superior to total aortic root replacement with ...

  13. 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.

  14. 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...... quartile 49% (n=15), p=0.04. Patients with increased age, left ventricular hypertrophy and left atrial dilatation were at increased risk. In Cox regression analysis after correcting for standard risk factors and ejection fraction, GLS was found to be significantly associated with cardiac morbidity...

  15. 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.

  16. Flow measurement at the aortic root

    DEFF Research Database (Denmark)

    Bertelsen, Litten; Svendsen, Jesper Hastrup; Køber, Lars

    2016-01-01

    BACKGROUND: Cardiovascular magnetic resonance (CMR) is considered the gold standard of cardiac volumetric measurements. Flow in the aortic root is often measured at the sinotubular junction, even though placing the slice just above valve level may be more precise. It is unknown how much flow...... measurements vary at different levels in the aortic root and which level corresponds best to left ventricle volumetry. METHODS: All patients were older than 70 years presenting with at least one of the following diagnoses: diabetes, hypertension, prior stroke and/or heart failure. Patients with arrhythmias...

  17. Steam-deformed Judkins-left guiding catheter with use of the GuideLiner® catheter to deliver stents for anomalous right coronary artery

    Science.gov (United States)

    Kuno, Toshiki; Fujisawa, Taishi; Yamazaki, Hiroyuki; Motoda, Hiroyuki; Kodaira, Masaki; Numasawa, Yohei

    2015-01-01

    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. PMID:27489700

  18. A Novel Fluoroscopy-free, Resuscitative Endovascular Aortic Balloon Occlusion System in a Model of Hemorrhagic Shock

    Science.gov (United States)

    2013-07-01

    A novel fluoroscopy -free, resuscitative endovascular aortic balloon occlusion system in a model of hemorrhagic shock Daniel J. Scott, MD, Jonathan L...hemorrhagic shock. However, emergent use of REBOA is limited by existing technology, which requires large sheath arterial access and fluoroscopy - guided...balloon positioning. The objectives of this study were to describe a new, fluoroscopy -free REBOA system and to compare its efficacy to existing technology

  19. First transcatheter aortic valve implantation for severe pure aortic regurgitation in Asia

    Science.gov (United States)

    Chiam, Paul Toon-Lim; Ewe, See Hooi; Chua, Yeow Leng; Lim, Yean Teng

    2014-01-01

    Transcatheter aortic valve implantation (TAVI) has become the standard of care for inoperable patients with symptomatic severe aortic stenosis (AS), and an alternative to open aortic valve replacement for patients at high surgical risk. TAVI has also been performed in several groups of patients with off-label indications such as severe bicuspid AS, and as a valve-in-valve therapy for a degenerated surgical bioprosthesis. Although TAVI with CoreValve® prosthesis is technically challenging, and global experience in the procedure is limited, the procedure could be a treatment option for well-selected patients with severe pure aortic regurgitation (AR). Herein, we report Asia's first case of TAVI for severe pure AR in a patient who was at extreme surgical risk, with good clinical outcome at six months. PMID:24570320

  20. Hybrid aortic repair with antegrade supra-aortic and renovisceral debranching from ascending aorta.

    Science.gov (United States)

    Del Castro-Madrazo, José Antonio; Rivas-Domínguez, Margarita; Fernández-Prendes, Carlota; Zanabili Al-Sibbai, Amer; Llaneza-Coto, José Manuel; Alonso-Pérez, Manuel

    2017-05-01

    Aortic dissection is a life threatening condition. Hybrid repair has been described for the treatment of complex aortic pathology such as thoracoabdominal aortic aneurysms (TAAA) and type A and B dissections, although open and total endovascular repair are also possible. Open surgery is still associated with substantial perioperative morbi-mortality rates, thus less invasive techniques such as endovascular repair and hybrid procedures can achieve good results in centers with experience. We present the case of a patient with a chronic type B dissection and TAAA degeneration that was treated in a single stage hybrid procedure with antegrade supra-aortic and renovisceral debranching from the ascending aorta and TEVAR. At three-year follow up, the patient is free of intervention-related complications.