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At least 19 recordsLinked to original sources
PubMed1997

A ruptured aneurysm at the distal end of the basilar artery fenestration associated with multiple fenestrations of the vertebrobasilar system: case report.

BACKGROUND: An aneurysm at the fenestrated basilar artery usually arises at the proximal end of the fenestration, with few exceptions. We failed to reveal any case of aneurysm at this site associated with multiple fenestrations of the vertebrobasilar system. CASE REPORT: This 62-year-old male was admitted to our hospital 1 day after a sudden onset of headache. CT scan showed subarachnoid hemorrhage, and angiogram revealed an aneurysm at the distal end of the fenestrated basilar artery in association with two other fenestrations of the vertebrobasilar system. The limb of the basilar artery fenestration was trapped tightly with one clip through the transcondylar approach. Postoperative course was uneventful, and postoperative angiogram showed complete disappearance of the aneurysm. CONCLUSION: An extremely rare case of an aneurysm at the distal end of the fenestrated basilar artery in association with multiple fenestrations of the vertebrobasilar system is reported. The coexistence of vertebral artery fenestration and the fenestration of the vertebrobasilar junction may give a clue to the mechanism of occurrence of basilar artery fenestration.

Aneurysm, Ruptured↗
PubMed1992

Fenestrated Fontan with delayed catheter closure. Effects of volume loading and baffle fenestration on cardiac index and oxygen delivery.

BACKGROUND. The fenestrated Fontan operation has been applied to high-risk patients with univentricular hearts, resulting in improved survival. The purpose of this study was to determine the hemodynamic factors responsible for these improved results. METHODS AND RESULTS. We performed the fenestrated Fontan operation in 17 high-risk patients with univentricular hearts (median age, 3 years; age range, 1.2-25 years). High-risk characteristics were depressed ventricular function and/or hypertrophy (n = 12), atrioventricular valve insufficiency (n = 5), pulmonary artery distortion (n = 6), elevated pulmonary vascular resistance (> 2 units/m2) (n = 4), previously failed Fontan operation (n = 2), or associated Wolff-Parkinson-White syndrome (n = 1). Intraoperative hemodynamic measurements (n = 8) included cardiac index (by aortic flow probe), peripheral arterial O2 saturations, and left and right atrial pressures during inflow occlusion, followed by volume loading with open versus closed fenestration. Mean baffle fenestration was 3.5 mm (range, 2.7-5.0 mm). Multiple regression analysis (cardiac index versus atrial pressure) revealed cardiac index was greater with open than with closed fenestration (p < 0.001) during volume loading. Oxygen delivery (cardiac index multiplied by oxygen content) was also greater with open than with closed fenestration (p < 0.001). Survival was 100% with a mean follow-up of 10.4 months; pleural drainage was high in two patients. Subsequent transcatheter fenestration closure resulted in increased O2 saturation (87 +/- 1% to 96 +/- 0.3%, p < 0.05). CONCLUSIONS. The fenestrated Fontan operation improves survival in high-risk patients by increasing cardiac index and maintaining oxygen delivery, despite mild arterial O2 desaturation. Subsequent transcatheter fenestration closure can be performed after hemodynamic assessment.

Cardiac Catheterization↗
PubMed1999

Long-term results of the fenestrated Fontan operation. Progress of patients with patent fenestrations.

The fenestrated Fontan operation was introduced as a modification of the "completed" Fontan operation for patients with high risk factors, and low operative mortality has frequently been reported. However, use of the umbrella device is now restricted, and this procedure should be performed without subsequent closure. In this paper, we review our clinical experience with this procedure and discuss ongoing problems. Sixteen patients (4 tricuspid atresia and 12 other cardiac anomalies including 5 cases of univentricular heart) underwent the fenestrated Fontan operation (7 atriopulmonary and 9 total cavopulmonary connection). All of them have some risk factors for a completed Fontan operation. There were three early deaths of the 16. Two experienced an anticipated thromboembolic accident, one of which involved the pulmonary aspect while the other involved the arterial aspect. Patients who survived the operation have progressed well and have a clinical status of New York Heart Association class I, with the exception of one late death due to congestive heart failure. There have been no thromboembolic accidents in this group during the late follow-up period. Spontaneous closures of the fenestrations were noted in two patients. The late mean Qp/Qs value in patients with patent fenestrations was 0.80 +/- 0.1, SaO2 was 88.8 +/- 5.6%, and right atrial pressure was 9.7 +/- 3.8 mmHg. No major problems have been encountered in patients with a patent fenestration over extended periods. A modified Fontan operation to fit a permanently open fenestration may be considered as a final surgical option for certain high-risk patients.

Adolescent↗
PubMed1983

A survey of the binding of polycationic ferritin in several fenestrated capillary beds: indication of heterogeneity in the luminal glycocalyx of fenestral diaphragms.

Polycationic ferritin (PCF) was injected into umbilical veins of 17- and 21-day-gestation rats and saphenous veins of young, male, adult Sprague-Dawley rats and allowed to circulate for 1 min or less followed by excision of tissues and immersion fixation. Fetal liver, intestine, and kidney, as well as adult liver, intestine, pancreas, kidney, adrenal cortex, bone marrow, and pituitary were examined. Nearly all fenestral diaphragms, but no subendothelial structures, were labeled with a tuft of particles in fetal intestine, adult intestine, pancreas, pituitary, and renal peritubular capillaries. A fraction of the diaphragms covering fenestrae in the thyroid, adrenal cortex, and fetal kidney glomerulus, but none in the bone marrow and fetal liver, had associated PCF. In these tissues some diaphragms appeared to be permeable to PCF, because tufts were observed immediately beneath unlabeled fenestral diaphragms either in the basal lamina (fetal kidney, adult thyroid, and adrenal cortex) or on other subendothelial structures (fetal liver, adult bone marrow). Also periodic concentrations of PCF were observed in the lamina rara interna of the adult glomerular basement membrane. PCF binding to the fenestral diaphragms and the basal lamina in the adult intestine and the renal glomerulus, respectively, have been reported by Simionescu et al. ((1981a) J. Cell. Biol. 90, 605-613) and Kanwar and Farquhar ((1979) J. Cell. Biol. 81, 137-153) as indicating accumulations of anionic material. In this study we have demonstrated not only high-specificity binding of PCF to fenestral diaphragms in capillaries of organs other than intestine and pancreas, but also considerable variation of PCF stainability of fenestral diaphragms in other organs.

Animals↗
PubMed1992

Fenestration of the middle cerebral artery and aneurysm at the site of the fenestration.

The authors report the case of a patient who presented a ruptured aneurysm of the anterior communicating artery and an unruptured aneurysm of the middle cerebral artery arising at the site of a fenestration of the MCA. The fenestration was undiagnosed on the preoperative angiogram but discovered during the surgery carried out for clipping of the aneurysms. In the literature, cases of fenestration of the MCA are sporadically reported and are incidental findings; an aneurysm may be associated on an artery other than the fenestrated MCA; an aneurysm arising at the site of the MCA fenestration is a very rare occurrence.

Aneurysm, Ruptured↗
PubMed1999

PV-1 is a component of the fenestral and stomatal diaphragms in fenestrated endothelia.

PV-1 is a novel endothelial protein shown by immunocytochemical tests to be specifically associated with the stomatal diaphragms of caveolae in lung endothelium. Although the highest expression levels of both mRNA and protein are in the lung, PV-1 also has been found to be expressed in other organs. Using a specific antibody to the extracellular domain of PV-1, we have extended the survey on the presence of this protein at light and electron microscope level in several rat organs. Here we show that by immunofluorescence the antibody recognizes with high specificity the endothelium of the fenestrated peritubular capillaries of the kidney and those of the intestinal villi, pancreas, and adrenals. By immunolocalization at electron microscope level, the antibody recognizes specifically the diaphragms of the fenestrae and the stomatal diaphragms of caveolae and transendothelial channels in the endothelia of these vascular beds. No signal was detected in the continuous endothelium of the heart, skeletal muscle, intestinal muscularis, or brain capillaries or the nondiaphragmed fenestrated endothelium of kidney glomeruli. Taken together, our findings define the only antigen to be localized thus far in fenestral diaphragms. They also show that the stomatal diaphragms of caveolae and transendothelial channels and the fenestral diaphragms might be biochemically related, in addition to being morphologically similar structures.

Adrenal Glands↗
PubMed1997

Revaluation on the types and pattern of distribution of sinusoidal fenestrations in the lobule of normal rat liver.

BACKGROUND: There is a need to identify the existence of large fenestrations and to evaluate the type and pattern of the distribution of sinusoidal fenestrations in the hepatic lobule. METHODS: The sinusoidal fenestrations in the rat liver lobule were investigated by scanning electron microscopy of perfusion-fixed specimens and by transmission electron microscopy of freeze-fracture replicas from immersion-fixed specimens. Ringer solution used for precleaning was equilibrated with 84%/16% O2/CO2 at 37 degrees C, and the perfusion pressure was maintained at 5-10 mmHg in the portal vein. RESULTS: The fenestrations were recognized on the luminal surface of sinusoids on the basis of regional difference in size and distribution within the lobule and divided into three types: small, medium-sized, and large. The small fenestrations were numerous in each region. The number of medium-sized fenestrations was large in the pericentral and intermediate regions, while that of large fenestrations was predominant in the intermediate region. Based on the occurrence of fenestrations, the sinusoids were also divided into three types. The type I sinusoid mainly showed small fenestrations and was predominant in the periportal region. The type II sinusoid showed small and medium-sized fenestrations and was predominant in the pericentral region. The type III sinusoid showed all the types of fenestrations including large ones and was predominant in the intermediate region. The images showing dumbbell-shaped or irregularly shaped margins were observed between small or medium-sized fenestrations on the freeze-fracture replica. CONCLUSIONS: 1) The fenestrations are divided into three types according to the size and pattern of distribution within the lobule. 2) The sinusoids are also divided into three types based on the distribution pattern of each type of fenestrations. 3) The small fenestrations are evenly distributed throughout the entire lobule, while the medium-sized and large fenestrations show the regional difference within the lobule. 4) The large fenestrations exist as real structures of the endothelial lining cells of sinusoids and may result from the fusion of contiguous smaller ones.

Animals↗
PubMed1992

[On the fenestration of the vertebral and basilar arteries].

The fenestration of the vertebral and basilar arteries was investigated macroscopically in 370 human cases. Altogether 43 fenestrations were found in 32 (8.6%) out of 370 cases. The fenestrations could be divided in three groups according to the position where the fenestration appeared. Group I was the fenestration observed along the vertebral artery (Fig. 1), and 7 such fenestrations were found in 6 (1.6%) out of 370 cases; 3 fenestrations among them were located on the right side, 2 were located on the left side and 1 was found on the bilateral vertebral arteries. In 4 out of 7 fenestrations in this group, the hypoglossal nerve was found passing through the fenestration. Group II was the fenestration observed along the basilar artery (Fig. 2), and 26 fenestrations of this type were found in 20 (5.4%) out of 370 cases: 23 fenestrations (88.5%) were located at the caudal half, 3 (11.5%) were located on the rostral half of the basilar artery (Fig. 5). A close relation was indicated between the side on which the fenestration appeared in the basilar artery and the largeness in caliber of the vertebral artery of either side. Group III was the fenestration observed at the lateral area of the vertebral and basilar arteries (Fig. 3), and 10 fenestrations of this type were found in 9 (2.4%) out of 370 cases; all the fenestrations were located on the right side. In this group, the hypoglossal nerve was observed passing through the fenestratin in 4 out of the 10 fenestrations.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗