Cardiovascular system
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha in Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
The thoracic aorta commences at the aortic valve and passes into the abdomen by passing through the diaphragmatic hiatus at the level of the T12 vertebral body. It is divided into the ascending aorta, aortic arch and descending aorta. Major vessels arise from the ascending aorta and arch. The right and left coronary arteries arise from the root of the ascending aorta close to the aortic valve cusps. The aortic arch gives rise to three large vessels that supply the head and neck region and the upper limbs: the brachiocephalic artery (also known as the brachiocephalic trunk or innominate artery), the left common carotid artery and the left subclavian artery. The brachiocephalic artery divides and give rise to the right common carotid and right subclavian arteries. Each common carotid artery divides into the internal and external carotid arteries. The vertebral artery arises as the first branch of the subclavian artery on each side. The subclavian artery passes laterally to continue as the axillary artery at the lateral border of the first rib. The axillary artery continues down the arm and at the inferior margin of the teres major muscle it becomes the brachial artery. At the cubital fossa the brachial artery divides into the radial and ulnar arteries, which continue down the forearm to the hand.
Anatomy of the head and neck
Helen Whitwell, Christopher Milroy, Daniel du Plessis in Forensic Neuropathology, 2021
The common carotid arteries are both branches of the brachiocephalic artery on the right and aortic arch on the left. They are enclosed within the tough protective fibrous carotid sheath that also encloses the internal jugular vein and vagus nerve to the posterior of the artery, and which lies lateral to the trachea and oesophagus. Both right and left common carotid arteries terminate at the level of the upper border of the thyroid cartilage, bifurcating to give rise to internal and external carotid arteries. A swelling at the division of the artery is the location of the carotid sinus and carotid body containing chemo- and baroreceptors.
Acute Aortic Dissection in Young Adult Patients: Clinical Characteristics, Management, and Perioperative Outcomes
Published in Journal of Investigative Surgery, 2020
Shuai Zhu, Tie Zheng, Zhi-Yu Qiao, Li Chen, Jia-Fu Ou, Wei-Gang Fang, Cheng-Nan Li, Lei Chen, Wei-Guo Ma, Jun Zheng, Yong-Min Liu, Li-Zhong Sun, Xue-Jun Sun, Jun-Ming Zhu
ECG, echocardiogram and CT data of 489 of 490 patients were retrieved from medical records for analysis (Table 2). There were totally 244 ECG cases available. Out of these data 61 cases were normal and 168 cases displayed new Q-wave, ST elevation/reduction, or bidirectional/inverted T waves. There were 210 aortic and 123 mitral regurgitation cases. In both groups of regurgitation, the majority was classified as mild (aortic regurgitation, 105/210 cases; mitral regurgitation, 107/123). For CT findings (n = 486), the number of type A and B were 310 (63.78%) and 176 (36.22%), respectively. There were totally 478 cases with findings on diagnostic imaging available. Involvement of brachiocephalic artery (n = 196), left common carotid artery (n = 176), and left subclavian artery (n = 207) could be seen. Number of aortic intramural and aortic hematoma was 87 and 79, respectively.
Current Evidence for Alternative Access Transcatheter Aortic Valve Replacement
Published in Structural Heart, 2020
J. James Edelman, Chistopher Meduri, Pradeep Yadav, Vinod H. Thourani
Transaxillary/subclavian access accounted for 34% of alternative access procedures with the S3 valve in the STS/ACC TVT Registry; this increased from 20% in 2015 to 49% in the final quarter of 2017.14 Correspondingly, there was a significant decrease in TA access in this time. In a propensity-matched analysis, mortality was lower in TAx compared with TA (5.3% vs. 8.4%, p < 0.01), but stroke was significantly higher (6.3% vs. 3.1%, p < 0.05).14 Outcomes of TAx were similar to TF access in a propensity-matched cohort of the Corevalve Pivotal and Continued Access trials, which included patients at extreme- or high-risk for aortic valve surgery.15 Mortality at 30 days was similar; an increased rate of stroke (6.5% vs. 3.5%, p = 0.165) in the TAx arm did not achieve statistical significance. Brachiocephalic artery access, either via suprasternal incision or upper hemi-sternotomy has been described in several series, with good results16–19; but has not gained widespread adoption.
S1P in the development of atherosclerosis: roles of hemodynamic wall shear stress and endothelial permeability
Published in Tissue Barriers, 2021
Christina M Warboys, Peter D Weinberg
The two earliest papers on the sphingosine analogue FTY720 and atherosclerosis82,83 showed that FTY720 inhibits development of the disease in mice. FTY720 is phosphorylated intracellularly and acts as an agonist of S1PR1, S1PR3, S1PR4 and S1PR5; it has anti-inflammatory and immunosuppressive actions. The first study used Apoe−/- mice and the second used Ldlr−/- knockout mice; in both cases, the mice were fed a lipid-enhanced diet. The effects were large: in the first paper, lesion volume in the brachiocephalic artery and aortic root was approximately halved by a dose of 1.25 mg.kg−1.d−1 and there were similar decreases in macrophage and collagen content; in the second study 0.4 mg.kg−1.d−1 reduced disease by approximately one-third and almost completely abrogated necrotic core formation. The results were attributed to interference with monocyte/macrophage82,83 and lymphocyte83 function.