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Because of the high blood flow and high pressure, the aortic arch, which sends out 3 branches including the innominate artery that separates the right common carotid artery and the right subclavian artery, the left common carotid artery, and the left subclavian artery, is an important blood vessel supplying the brain and spinal cord, so the risk of aneurysms in this area is very high. The main risk is that the rupture can cause massive bleeding; the secondary is that some aortic arch lesions can cause insufficient blood supply to the brain or spinal cord. If early diagnosis can be detected, it could be treated completely with minimally invasive or open surgery. Therefore, especially for this kind of patient, the significance of treatment is great, and better results can be obtained through treatment. Here is a 48-year-old female patient with dysplasia of the distal aortic arch, multiple aortic parietal aneurysms, and abnormal origin of the left subclavian artery, which originates from the tortuous and twisted aorta.

RESUMEN

OBJECTIVE: The purpose of this study was to explore the superior vena cava (SVC) Doppler flow changes in rabbits with acute thromboembolic pulmonary hypertension (ATEPAH) and its value in evaluating pulmonary pressure. METHODS: The systolic peak flow velocity (SPV), ventricular reverse peak flow velocity (VrPV), diastolic peak flow velocity (DPV), and atrial reverse peak flow velocity (ArPV) of the SVC were measured on end expiration with pulsed wave Doppler echocardiography in 30 rabbits with different degrees of ATEPAH. Linear regression and the Bland-Altman method were used to analyze the correlation of Doppler flow velocities of the SVC to the catheter-measured pulmonary arterial systolic pressure (PASP). RESULTS: The SPV values of all groups were significantly lower after pulmonary embolism (PE) than before PE (P < .05). The VrPV values of the mild and the moderate groups but not the severe group were significantly higher after PE than before PE. The DPV values of the severe ATEPAH group were significantly lower after PE than before PE, but they were not lower in the other 2 groups. The SPV had a significantly negative relationship with the PASP (r = -0.692; P < .0001). The VrPV/SPV ratios of all groups showed a significant positive correlation with the PASP (r = 0.698; P < .0001). The end-diastolic diameter of the SVC gradually enlarged with the rapidly increased PASP and showed a significantly positive relationship in all groups (r = 0.594; P = .002). CONCLUSIONS: Analysis of the Doppler flow SPV and VrPV, the VrPV/SPV ratio, and the diameter of the SVC might provide an alternative method for catheterization in estimating pulmonary pressure.

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RESUMEN

A rabbit model of acute thrombo-embolic pulmonary hypertension was developed by infusing self-thrombi into the right femoral vein and simultaneously measuring the pulmonary artery pressure via a right heart catheter and echocardiography. The model was used to explore the usefulness of an ultrasound-guided protocol. In the present study, acute thrombo-embolic pulmonary hypertension was produced in 25 of 30 healthy New Zealand rabbits; the success rate was 83%. A significant and positive correlation between the right ventricle-right atrial pressure gradient, an estimate of the pulmonary artery systolic pressure derived from tricuspid regurgitation and the pulmonary artery systolic pressure measured using the right heart catheter (r=0.765, P=0.002) was noted. During the process of establishing a rabbit model of acute thrombo-embolic pulmonary hypertension, it was demonstrated that echocardiography can be used to guide the right heart catheter to obtain pulmonary artery systolic pressure measurements, to quantify the tricuspid regurgitation jet to assess the pulmonary artery systolic pressure and to observe cardiac morphologic changes so as to evaluate cardiac function. Based on the present study, it is clear that echocardiography is valuable in improving the success rate of producing the animal model of acute thrombo-embolic pulmonary hypertension. This could ultimately facilitate preclinical research and clinical research in humans.

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