No abstract

The effect of maturation on collateral development of resistance arteries was investigated. Three to four sequential mesenteric arteries were ligated to create collateral pathways in anesthetized young (ϳ200 g) and mature (ϳ600 g) rats. Blood flow was similarly elevated in collaterals of young and mature animals. In vivo inner arterial diameter was increased only within young collaterals (33 Ϯ 7%, P Ͻ 0.001). Increases in number of intimal nuclei (57 Ϯ 10% vs. 52 Ϯ 14%) and cross-sectional medial area (33 Ϯ 13% vs. 38 Ϯ 5%) were similar between young and mature collaterals. Relative to the same animal controls, collateral endothelial nitric oxide synthase mRNA was increased as much in mature as in young rats. Proteomic analysis revealed significant differences in protein expression with maturation between control arteries as well as flow-loaded collateral vessels. The results indicate that, whereas intimal and medial remodeling events were similar in collaterals of young and mature rats, luminal expansion occurred only in young rats. Alteration in arterial protein expression with maturation and altered responses to stimuli for collateral development may contribute to this impairment. luminal expansion; resistance artery; proteomic analysis; eNOS; arterial remodeling DURING THE MATURATION OF PHYSIOLOGICAL SYSTEMS, many of the mechanisms governing various functional outcomes are altered. With increasing age, these alterations may in turn lead to functional impairments and exacerbate disease. The vascular system has been shown to follow this path with regard to a variety of functions, including blood vessel reactivity (20, 35) and vascular growth and remodeling (3,24,27). Studies from our laboratory have focused on understanding processes involved in collateral artery remodeling after chronic elevation of blood flow. Currently, little is known about how maturation and aging affect the capacity for collateral development. The clinical observation/experience is that collateral growth (32) and flow-induced luminal enlargement of arteries (8) occur in adult humans. However, flow-mediated remodeling in large conduit arteries, which has many mechanistic similarities to collateral/resistance artery remodeling, has been observed to be impaired with maturation (3, 24).Arterial remodeling occurs after chronic elevation of blood flow and is a complex process involving flow/ shear stimulus transduction and endothelial activation (5, 26). After transduction and activation, remodeling of the entire arterial wall is accomplished through changes in protein expression/activity and cell growth. Luminal dimensions are altered to normalize wall shear stress (3,24,40,46). Age-dependent alterations in any of the mechanisms involved in flow-induced arterial remodeling could influence the capacity for luminal adjustment in response to altered shear. The primary purpose of the current study was to determine whether flow-induced expansion of resistance arteries forming collateral pathways is impaired with maturation and to provide insight r...

No abstract

Although the treatment of aortic coarctation has improved significantly during the past decades, persistent hypertension after repairs at an older age and recurrent coarctation after repairs in neonates occur in all institutions. Surgeons have not agreed on the optimal approach to primary coarctation repair, and invasive cardiologists have challenged operative intervention for both recurrent and primary coarctation. This study demonstrates that surgical repair of recurrent coarctation of the aorta can be performed safely and with excellent results. We believe it is still the gold standard in the management of recurrent coarctation of the aorta.

We conclude that hepatic resection for treatment of metastatic testicular carcinoma is safe and efficacious for all patients except those with elevated marker levels after preoperative chemotherapy.

No abstract