Dilation of soleal vein (SV) is commonly observed in vascular ultrasound among patients with varicose veins of unknown cause. We focused on lower extremity venous incompetence and superficial venous diameter as candidates for factors related to SV dilation. A total of 25 patients with varicose veins underwent vascular ultrasound of their lower extremities while standing. Popliteal vein (Pop.V) competency (retrograde flow duration; <0.5, 0.5 to 1.0, 1.0 s or longer), and great and small saphenous vein (GSV and SSV) competencies (retrograde flow duration; <0.5, 0.5 s or longer) were verified, and maximum diameter in SV and average diameter in GSV and SSV were determined. Dilation of SV (>10 mm in maximum diameter, 13 of 50 limbs, 26%) was significantly related to Pop.V (p=0.002), but not to GSV and SSV competences. The diameter of SV was larger in limbs with intermediate than those with short retrograde flow duration in Pop.V (11.1±0.7 vs. 8.0±0.3 mm, p<0.001). The diameter of GSV was larger in limbs with SV dilation (p=0.014). Dilation of SV in patients with varicose veins was related to Pop.V competence and GSV diameter.
Objectives: Although pulmonary hypertension (PH) caused by left heart disease (PH-LHD) is more common in PH, little is known about its properties of pulmonary artery (PA) in PH-LHD. The purpose of this study was to measure pulmonary regional pulse wave velocity (PWV) and to quantify the magnitude of reflected waves in patients with PH-LHD by the analysis of the pressure-velocity loops (PV-loop). Methods: High-fidelity PA pressure (Pm) and PA velocity (Vm) were measured in 11 subjects with PH-LHD (mean Pm>25 mmHg), 1 subject with atrial septal defect (ASD) without PH and 12 control subjects, using multisensor catheters. PWV was calculated as the slope of the initial part of the PV-loop in early systole. The similarity in the shapes of the pressure and flow velocity waveforms over one PV-loop was quantified as the magnitude of reflected wave by calculating the standard error of the estimate (Sy/x) from linear regression analysis between Pm and corresponding Vm. PWV and Sy/x during a Valsalva maneuver (VM) were also assessed in nine control subjects. Results: The contour of PV-loop was so characteristic between control and PH-LHD. Max. PWV (349 cm/s) was recorded in PH-LHD and min. PWV (111 cm/s) was recorded in ASD. VM increased Pm (12[7–15] mmHg vs 50[18–110] mmHg; p=0.009) and PWV (200[148–238] cm/s vs 260[192–306] cm/s; p=0.009) significantly without significant increase of Sy/x (19.6[12.7–28.9]% vs 28.2[19.3–40.7]%; p=0.079). Although Sy/x was significantly higher in PH-LHD than in control and ASD (17.5[8.4–28.9]% vs 31.0[14.3–36.3]%; p=0.009, ASD: 18.2%), no significant difference was found in PWV between PH-LHD and control (269[159–349] cm/s vs 203[154–289] cm/s; p=0.089). Conclusions: 1) The magnitude of wave reflection was elevated in PH-LHD significantly as compared with control and ASD. 2) Despite the significant increase in PA-PWV caused by abrupt elevation in Pm during Valsalva maneuver in control, chronic elevation in Pm did not increase PA-PWV in PH-LHD significantly. It was hypothesized that the pulmonary artery constituted a self-regulating system for maintaining the arterial stiffness stable against the chronic elevation in Pm in PH-LHD by a remodeling of increasing proximal pulmonary arterial cross-sectional area gradually, which was compatible with the Moens–Korteweg equation. The PV-loop could provide a new simple and conventional method for assessing the pulmonary arterial properties, clinically.
A 50s woman was admitted to our hospital for the treatment of acute myocarditis. The patient developed acute pulmonary thromboembolism and an inferior vena cava filter was placed. It was thought that deep vein thrombi were formed due to large hysteromyomas. Retrieval of the filter was avoided because of residual thrombi in the right femoral vein and pulmonary arteries. Administration of warfarin was discontinued after a hysterectomy; subsequently, a spherical thrombus was formed on the retrieval hook of the filter. This thrombus may cause pulmonary thromboembolism in a chronic phase after inferior vena cava filter placement.