Endovascular treatment of Stanford type B aortic dissection (type B dissection) has been widely used. There will be complications such as aortic dilatation, which will lead to poor prognosis of some patients. With more in-depth researches, it was found that there was a possible correlation between the prognosis of type B dissection and tears, such as the increasing of aortic diameter would be faster with longer tears, and the location of the tear will affect the thrombosis of the false lumen. Studies on hemodynamics have also found that different characteristics of tears of aortic dissection can cause changes in the pressure, blood flow rate and blood capacity in the true and false lumens recently. The hemodynamic changes can be used to predict the prognosis of type B dissection. The main characteristics of tears included the size, position, number of tears, residual tears and stent graft induced new entry. Describing the effect of tear characteristics on the development of type B dissection, can provide the basis for the clinical treatment and further research of type B dissection.
Humans ; Aortic Dissection/surgery* ; Hemodynamics ; Prognosis ; Blood Vessel Prosthesis Implantation/adverse effects* ; Thrombosis/etiology* ; Endovascular Procedures/adverse effects* ; Aortic Aneurysm, Thoracic/surgery* ; Stents/adverse effects* ; Treatment Outcome

Objective To analyze the risk factors and build a clinical prediction model for hemodynamic depression (HD) after carotid artery stenting (CAS). Methods A total of 116 patients who received CAS in the Department of Vascular Surgery,Drum Tower Clinical College of Nanjing Medical University and the Department of Vascular Surgery,the Affiliated Suqian First People's Hospital of Nanjing Medical University from January 1,2016 to January 1,2022 were included in this study.The patients were assigned into a HD group and a non-HD group.The clinical baseline data and vascular disease characteristics of each group were collected,and multivariate Logistic regression was employed to identify the independent predictors of HD after CAS and build a clinical prediction model.The receiver operating characteristic (ROC) curve was drawn,and the area under the ROC curve (AUC) was calculated to evaluate the predictive performance of the model. Results The HD group had lower proportions of diabetes (P=0.014) and smoking (P=0.037) and higher proportions of hypertension (P=0.031),bilateral CAS (P=0.018),calcified plaque (P=0.001),eccentric plaque (P=0.003),and the distance<1 cm from the minimum lumen level to the carotid bifurcation (P=0.009) than the non-HD group.The age,sex,coronary heart disease,symptomatic carotid artery stenosis,degree of stenosis,and length of lesions had no statistically significant differences between the HD group and the non-HD group (all P>0.05).Based on the above predictive factors,a clinical prediction model was established,which showed the AUC of 0.807 and the 95% CI of 0.730-0.885 (P<0.001).The model demonstrated the sensitivity of 62.7% and the specificity of 87.7% when the best cut-off value of the model score reached 12.5 points. Conclusions Diabetes,smoking,calcified plaque,eccentric plaque,and the distance<1 cm from the minimum lumen level to the carotid bifurcation are independent predictors of HD after CAS.The clinical prediction model built based on the above factors has good performance in predicting the occurrence of HD after CAS.
Humans ; Carotid Stenosis ; Depression ; Models, Statistical ; Prognosis ; Stents ; Hemodynamics ; Plaque, Amyloid

The patient-specific aortic silicone model was established based on CTA data. The digital particle image velocimetry (DPIV) test method in the modified ViVitro pulsatile flow system was used to investigate the aortic hemodynamic performance and flow field characteristics before and after transcatheter aortic valve replacement (TAVR). The results showed that the hemodynamic parameters were consistent with the clinical data, which verified the accuracy of the model. From the comparative study of preoperative and postoperative effective orifice area (0.33 cm² and 1.78 cm²), mean pressure difference (58 mmHg and 9 mmHg), percentage of regurgitation (52% and 8%), peak flow velocity (4.60 m/s and 1.81 m/s) and flow field distribution (eccentric jet and uniform jet), the immediate efficacy after TAVR is good. From the perspective of viscous shear stress and Reynolds shear stress, the risk of hemolysis and thrombotic problems was low in preoperative and postoperative patient-specific models. This study provides a set of reliable DPIV testing methods for aortic flow field, and provides biomechanical basis for the immediate and long-term effectiveness of TAVR from the perspective of hemodynamics and flow field characteristics. It has important application value in clinical diagnosis, surgical treatment and long-term evaluation.
Humans ; Transcatheter Aortic Valve Replacement/methods* ; Aortic Valve/surgery* ; Heart Valve Prosthesis ; Hemodynamics ; Aortic Valve Stenosis/diagnosis* ; Treatment Outcome

INTRODUCTION: Umbilical cord milking (UCM) is a method that allows for postnatal placental transfusion. The benefits of UCM have been demonstrated in some studies, but knowledge about its haemodynamic effects in term infants is limited. The aim of this study was to evaluate the haemodynamic effects of UCM in term infants. METHODS: In this prospective, randomised controlled study, 149 healthy term infants with a birth week of ≥37 weeks were randomly assigned to either the UCM or immediate cord clamping (ICC) group. Blinded echocardiographic evaluations were performed in all the neonates in the first 2-6 h. RESULTS: Superior vena cava (SVC) flow measurements were higher in the UCM group compared to the ICC group (132.47 ± 37.0 vs. 126.62 ± 34.3 mL/kg/min), but this difference was not statistically significant. Left atrial diameter (12.23 ± 1.99 vs. 11.43 ± 1.78 mm) and left atrium-to-aorta diastolic diameter ratio (1.62 ± 0.24 vs. 1.51 ± 0.22) were significantly higher in the UCM group. There were no significant differences in other echocardiographic parameters between the two groups. CONCLUSION We found no significant difference in the SVC flow measurements in term infants who underwent UCM versus those who underwent ICC. This lack of significant difference in SVC flow may be explained by the mature cerebral autoregulation mechanism in term neonates.
Infant, Newborn ; Infant ; Humans ; Pregnancy ; Female ; Infant, Premature/physiology* ; Umbilical Cord Clamping ; Prospective Studies ; Vena Cava, Superior/diagnostic imaging* ; Placenta ; Umbilical Cord/physiology* ; Constriction ; Hemodynamics/physiology*

Objective Dexmedetomidine is a highly selective alpha-2 adrenergic receptor agonist with sedative and analgesic properties but without respiratory depression effect and has been widely used in perioperative anesthesia. Here we performed a systematic review and meta-analysis to evaluate the effect of dexmedetomidine on maintaining perioperative hemodynamic stability in elderly patients.Methods PubMed, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang Data were searched for randomized-controlled trials (RCTs) on the application of dexmedetomidine in maintaining perioperative hemodynamic stability in elderly patients from their inception to September, 2021. The standardized mean differences (SMD) with 95% confidence interval (CI) were employed to analyze the data. The random-effect model was used for the potential clinical inconsistency.Results A total of 12 RCTs with 833 elderly patients (dexmedetomidine group, 546 patients; control group, 287 patients) were included. There was no significant increase in perioperative heart rate (HR), mean arterial pressure (MAP), and diastolic blood pressure (DBP) in the dexmedetomidine group before and during the operation. In addition, the variations of hemodynamic indexes including HR, MAP, SBP (systolic blood pressure), and DBP were significantly lower in the dexmedetomidine group compared with the control group (HR: SMD = -0.87, 95% CI: -1.13 to -0.62; MAP: SMD = -1.12, 95% CI: -1.60 to -0.63; SBP: SMD = -1.27, 95% CI: -2.26 to -0.27; DBP: SMD = -0.96, 95% CI: -1.33 to -0.59). Subgroup analysis found that with the prolongation of 1.0 μg/kg dexmedetomidine infusion, the patient's heart rate declined in a time-dependent way.Conclusion Dexmedetomidine provides more stable hemodynamics during perioperative period in elderly patients. However, further well-conducted trials are required to assess the effective and safer doses of dexmedetomidine in elderly patients.
Humans ; Aged ; Dexmedetomidine/adverse effects* ; Hemodynamics ; Hypnotics and Sedatives/pharmacology* ; Blood Pressure ; Heart Rate

Introduction: Laparoscopic Cholecystectomy uses carbon dioxide (CO2) which affects the respiratory, cardiovascular and renal system. The residual CO2 induces phrenic nerve irritation, manifesting as shoulder and abdominal pain. Recruitment maneuvers opens the lungs and helps expelling this residual carbon dioxide. However, there are limited studies on its role to hemodynamics especially in patients undergoing abdominal laparoscopic procedures. Methods: Sixty patients (51 15.1) scheduled for laparoscopic cholecystectomy under General Endotracheal Anesthesia were randomly allocated to two groups. The control group (Group C) underwent standard laparoscopic cholecystectomy procedures. The experimental group (Group R) was placed in a Trendelenburg and was given 4-5 manual pulmonary inflations at a pressure of 40cmH20. The blood pressure, heart rate, respiratory rate and oxygen saturation, as well as the post operative site pain and shoulder pain were measured using the Numerical Pain Scale (NPS) were monitored at 0, 1 and 2 hours post operatively. Results: The demographics and preoperative vital signs were comparable. The mean systolic blood pressure [119.5 vs 131.5; p=0.002], mean arterial pressure [91.8 vs 95.3; p=0.049], heart rate [74.9 vs 87.5; p <0.001] and respiratory rate [15.7 vs 16.2; p=0.02] were all differrent only during the immediate post operative period. The mean shoulder pain was lower in Group R immediately [1.9 ± 1.2; p=0.01] and 1 hour after surgery [0.7 ± 0.8; p=0.01]. Conclusion Recruitment maneuver significantly reduces the shoulder pain scores after laparoscopic cholecystectomy. It causes a decrease in blood pressure, heart rate and mean arterial pressure in the immediate post operative period.
Cholecystectomy, Laparoscopic ; Shoulder Pain ; Hemodynamics ; Carbon Dioxide

Objective Although goal-directed fluid therapy (GDFT) has been proven to be effective in reducing the incidence of postoperative complications, the underlying mechanisms remain unknown. The aim of this study was to examine the mediating role of intraoperative hemodynamic lability in the association between GDFT and the incidence of postoperative complications. We further tested the role of this mediation effect using mean arterial pressure, a hemodynamic indicator. Methods This secondary analysis used the dataset of a completed nonrandomized controlled study to investigate the effect of GDFT on the incidence of postoperative complications in patients undergoing posterior spine arthrodesis. We used a simple mediation model to test whether there was a mediation effect of average real variability between the association of GDFT and postoperative complications. We conducted mediation analysis using the mediation package in R (version 3.1.2), based on 5,000 bootstrapped samples, adjusting for covariates. Results Among the 300 patients in the study, 40% (120/300) developed postoperative complications within 30 days. GDFT was associated with fewer 30-day postoperative complications after adjustment for confounders (odds ratio: 0.460, 95% CI: 0.278, 0.761; P = 0.003). The total effect of GDFT on postoperative complications was -0.18 (95% CI: -0.28, -0.07; P < 0.01). The average causal mediation effect was -0.08 (95% CI: -0.15, -0.04; P < 0.01). The average direct effect was -0.09 (95% CI: -0.20, 0.03; P = 0.17). The proportion mediated was 49.9% (95% CI: 18.3%, 140.0%). Conclusions The intraoperative blood pressure lability mediates the relationship between GDFT and the incidence of postoperative complications. Future research is needed to clarify whether actively reducing intraoperative blood pressure lability can prevent postoperative complications.
Humans ; Blood Pressure ; Goals ; Postoperative Complications/epidemiology* ; Hemodynamics ; Fluid Therapy/methods*

Microcirculatory dysfunction is an important pathophysiological change of shock. In the last decade, many researches on the mechanism of microcirculatory dysfunction have been involved in areas such as the glycocalyx damage of vascular endothelial cells, macrocirculation- microcirculation discoupling, vascular hyporeactivity, and microcirculation monitoring. Accordingly, this paper discussed how these research findings can be applied to burn patients, with the aim of alerting the clinicians to improving microcirculation, and maintaining hemodynamic coordination during the treatment of burn shock and burn septic shock. In addition, with the development of accurate and reliable microcirculation monitoring techniques, it is necessary to carry out multi-center clinical trials to reveal the clinical significance of target-oriented shock resuscitation protocol combining macrocirculatory and microcirculatory parameters.
Burns/therapy* ; Endothelial Cells ; Hemodynamics/physiology* ; Humans ; Microcirculation/physiology* ; Resuscitation ; Shock ; Shock, Septic/therapy*

Objective: To compare the impact of bicuspid aortic valve (BAV) or tricuspid aortic valve (TAV) on hemodynamics and left ventricular reverse remodeling after transcatheter aortic valve replacement (TAVR). Methods: We retrospectively analyzed the clinical data of patients who underwent TAVR in our hospital from January 2019 to March 2021. Patients were divided into BAV group and TAV group according to aortic contrast-enhanced CT. Each patient was followed up by N-terminal pro B-type natriuretic peptide (NT-proBNP) and echocardiography at four time points, namely before TAVR, 24 hours, 1 month and 6 months after TAVR. Echocardiographic data, including mean pressure gradient (MPG), aortic valve area (AVA), left ventricular ejection fraction (LVEF), left ventricle mass (LVM) and LV mass index (LVMi) were evaluated. Results: A total of 41 patients were included. The age was (75.0±8.6) years, and male patients accounted for 53.7%. There were 19 BAV patients and 22 TAV patients in this cohort. All patients undergoing TAVR using a self-expandable prosthesis Venus-A valve. MPG was (54.16±21.22) mmHg(1 mmHg=0.133 kPa) before TAVR, (21.11±9.04) mmHg at 24 hours after TAVR, (18.84±7.37) mmHg at 1 month after TAVR, (17.68±6.04) mmHg at 6 months after TAVR in BAV group. LVEF was (50.42±13.30)% before TAVR, (53.84±10.59)% at 24 hours after TAVR, (55.68±8.71)% at 1 month after TAVR and (57.42±7.78)% at 6 months after TAVR in BAV group. MPG and LVEF substantially improved at each time point after operation, and the difference was statistically significant (all P<0.05) in BAV group. MPG in TAV group improved at each time point after operation, and the difference was statistically significant (all P<0.05). LVMi was (164.13±49.53), (156.37±39.11), (146.65±38.84) and (134.13±39.83) g/m² at the 4 time points and the value was significantly reduced at 1 and 6 months post TAVR compared to preoperative level(both P<0.05). LVEF in the TAV group remained unchanged at 24 hours after operation, but it was improved at 1 month and 6 months after operation, and the difference was statistically significant (all P<0.05). LVMi in TAV group substantially improved at each time point after operation, and the difference was statistically significant (all P<0.05). NT-proBNP in both two groups improved after operation, at 1 month and 6 months after operation, and the difference was statistically significant (all P<0.05). MPG in TAV group improved better than in BAV group during the postoperative follow-up (24 hours after TAVR: (11.68±5.09) mmHg vs. (21.11±9.04) mmHg, P<0.001, 1 month after TAVR: (10.82±3.71) mmHg vs. (18.84±7.37) mmHg, P<0.001, 6 months after TAVR: (12.36±4.42) mmHg vs. (17.68±6.04) mmHg, P=0.003). There was no significant difference in NT-proBNP between BAV group and TAV group at each time point after operation (all P>0.05). There was no significant difference in paravalvular regurgitation and second prosthesis implantation between the two groups (all P>0.05). Conclusions: AS patients with BAV or TAV experience hemodynamic improvement and obvious left ventricular reverse remodeling after TAVR, and the therapeutic effects of TAVR are similar between BAV and TAV AS patients in the short-term post TAVR.
Humans ; Male ; Aged ; Aged, 80 and over ; Transcatheter Aortic Valve Replacement ; Aortic Valve/surgery* ; Bicuspid Aortic Valve Disease/surgery* ; Aortic Valve Stenosis/surgery* ; Retrospective Studies ; Stroke Volume ; Heart Valve Diseases ; Ventricular Function, Left ; Treatment Outcome ; Ventricular Remodeling ; Hemodynamics

BACKGROUND: It is still unclear what the minimal infusion volume is to effectively predict fluid responsiveness. This study was designed to explore the minimal infusion volume to effectively predict fluid responsiveness in septic shock patients. Hemodynamic effects of fluid administration on arterial load were observed and added values of effective arterial elastance (Ea) in fluid resuscitation were assessed. METHODS: Intensive care unit septic shock patients with indwelling pulmonary artery catheter (PAC) received five sequential intravenous boluses of 100 mL 4% gelatin. Cardiac output (CO) was measured with PAC before and after each bolus. Fluid responsiveness was defined as an increase in CO >10% after 500 mL fluid infusion. RESULTS: Forty-seven patients were included and 35 (74.5%) patients were fluid responders. CO increasing >5.2% after a 200 mL fluid challenge (FC) provided an improved detection of fluid responsiveness, with a specificity of 80.0% and a sensitivity of 91.7%. The area under the ROC curve (AUC) was 0.93 (95% CI: 0.84-1.00, P  < 0.001). Fluid administration induced a decrease in Ea from 2.23 (1.46-2.78) mmHg/mL to 1.83 (1.34-2.44) mmHg/mL (P = 0.002), especially for fluid responders in whom arterial pressure did not increase. Notably, the baseline Ea was able to detect the fluid responsiveness with an AUC of 0.74 (95% CI: 0.59-0.86, P < 0.001), whereas Ea failed to predict the pressure response to FC with an AUC of 0.50 (95% CI: 0.33-0.67, P = 0.086). CONCLUSION: In septic shock patients, a minimal volume of 200 mL 4% gelatin could reliably detect fluid responders. Fluid administration reduced Ea even when CO increased. The loss of arterial load might be the reason for patients who increased their CO without pressure responsiveness. Moreover, a high level of Ea before FC was able to predict fluid responsiveness rather than to detect the pressure responsiveness. TRIAL REGISTRATION ClinicalTrials.gov, NCT04515511.
Cardiac Output/physiology* ; Fluid Therapy ; Gelatin/therapeutic use* ; Hemodynamics ; Humans ; Shock, Septic/therapy*