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Introduction: In children, congenital heart defects represent the primary cause of increased serum troponin I. The elimination process of cardiac troponin I from the bloodstream and the factors influencing this process remain unknown. The objective of this study was to explore the role of troponin I as an indicator of cardiac damage in children both in serum and urine, a concept previously investigated in adults. Methods: Our prospective study involved 70 children under 24 months of age. The first group underwent ventricular septal defect repair, while the second group involved children who had undergone partial cavopulmonary anastomosis. For these groups, urine and serum troponin I were assessed on four occasions. The third group, consisting of healthy children, underwent a single measurement of urine troponin I. Results: Serum troponin I values exhibited an expected elevation in the early postoperative period, followed by a return to lower levels. Significantly higher concentrations of serum troponin I were observed in the first group of children (p < 0.05). A positive correlation was found between troponin I in the first three measurements and cardiopulmonary bypass and aortic cross-clamping time. There was no discernible increase in urine troponin I directly related to myocardial damage; troponin I couldn't be detected in most urine samples. Discussion: The inability to detect troponin I in urine remains unexplained. Potential explanatory factors may include the isoelectric point of troponin I, elevated urinary concentrations of salts and urea, variations in urine acidity (different pH levels), and a relatively low protein concentration in urine.
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Penetrating cardiac injuries are rare but are one of the most urgent emergencies because they require early intervention in order to prevent death. The mortality rate of such injuries, including pre-hospitalization deaths, goes up to 90%. The most commonly injured heart chamber is the right ventricle since it takes over half of the anterior thoracic wall. The left ventricle is injured less often, but these patients usually have worse prognoses and higher mortality rates because such injuries lead to hemodynamic instability faster. We present a unique case of a suicide attempt in which the patient stabbed himself with a knife, penetrated the left ventricle, and survived even though he transected the second diagonal branch of the left anterior descending coronary artery and pulled the knife out of his chest.
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This paper presents the development and validation of the Project Manager Skills Scale (PMSS), a novel instrument designed to quantify and evaluate the critical skills of project managers. The PMSS is anchored in a comprehensive literature review and expert feedback and identifies five key dimensions of project manager skills: Technical Skills, Managerial Competences, Communication Skills, Management Style-Leadership, and Technological and Methodological Competences. The discovery of an additional fifth dimension in this study underscores the multidimensional nature of project manager skills and deviates from the initial four-cluster expectation outlined in the project management literature. The research framework employed in this study incorporated exploratory and confirmatory factor analysis. Empirical data were gathered from 257 project managers. The criteria for respondent selection were familiarity with the concept of project management and current or past engagement in a project. The findings reveal the relative importance of each dimension and highlight the multifaceted nature of project management. The study emphasizes the need for a balanced skill set that encompasses technical expertise, managerial competences, communication skills, leadership qualities, and technological and methodological competences to achieve successful project outcomes. Despite its significant contributions, this study acknowledges its limitations in terms of geographical scope and sample diversity and suggests future research directions for the development of a universally applicable understanding of project manager skills.
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BACKGROUND: The prevalence of heart failure is constantly increasing in both children and adults. End-stage heart failure in children unresponsive to medical therapy has limited treatment options. Surgical options include heart transplantation or implantation of durable ventricular assist devices (VADs). To start the VAD program, it was necessary to train core team members, invite experienced proctors and adjust the organizational approach. METHODS: We present our first seven pediatric patients who underwent a VAD implantation with primary indication end-stage dilated cardiomyopathy. RESULTS: The median age on implant was four and a half years and the median duration of VAD support was 39 days with long term survival achieved in three patients. The causes of death were multiorgan failure, thromboembolic events, sepsis, and low cardiac output syndrome. Ischemic stroke was the reason for successful neurointervention during VAD support in two patients. CONCLUSIONS: To establish a VAD program, numerous specialties must be included with adequate training and learning for all team members.
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Insuficiencia Cardíaca , Trasplante de Corazón , Corazón Auxiliar , Accidente Cerebrovascular Isquémico , Adulto , Humanos , Niño , Insuficiencia Cardíaca/cirugía , Insuficiencia MultiorgánicaRESUMEN
Herein we present the right ventricular dissection and describe its successful management after arterial switch operation in a full-term male neonate. There are no evidence-based recommendations for the management of this rare complication. Our management included veno-arterial extracorporeal membrane oxygenation placement and delayed surgical evacuation of the dissecting haematoma with beneficial outcomes.
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Operación de Switch Arterial , Oxigenación por Membrana Extracorpórea , Transposición de los Grandes Vasos , Recién Nacido , Humanos , Masculino , Operación de Switch Arterial/efectos adversos , Transposición de los Grandes Vasos/complicaciones , Ventrículos Cardíacos/cirugía , DisecciónRESUMEN
This study provides an overview of tissue banking activities at the Croatian Cardiovascular Tissue Bank (CTB) during past ten years and presents the outcomes of cryopreserved heart valve allografts (CHAs) use in different patient groups. From June 2011 until December 2021, 75 heart donations were referred to CTB: 41 recipient of heart transplant (RHT), 32 donors after brain death (DBD) and 2 donors after circulatory death (DCD) donations. Processing resulted in 103 valves of which 65 met quality requirements for clinical use. Overall tissue discard rate was 37%. The most frequent reasons for discard were inadequate morphology (12%) in RHT donations and microbiological contamination (19%) in DBD donations. Altogether, 38 CHAs were transplanted to 36 patients. Recipients were divided in three groups; infective endocarditis (IE), non-infectious heart disease and congenital heart disease group. In the IE group, the 30-day, 1-year and 3-year survival was 71%, 53% and 47%, respectively. Freedom from re-operation due to all graft-related causes was 76% and due to structural valve deterioration 88%. There were no cases of graft reinfection. In the congenital heart disease group CHAs were predominantly (94%) used for right ventricular outflow tract reconstruction and 88% of patients recovered without graft-related complications. At present, the number of demands for CHAs at CTB considerably outweighs their availability.
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Cardiopatías Congénitas , Válvulas Cardíacas , Humanos , Válvulas Cardíacas/trasplante , Trasplante Homólogo , Donantes de Tejidos , Complicaciones Posoperatorias , Aloinjertos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Despite advances in medical therapy and mechanical circulatory support (MCS), heart transplant (HT) remains the gold standard therapy for end-stage heart failure. Patients in cardiogenic shock require prompt intervention to reverse hypoperfusion and end-organ damage. When medical therapy becomes insufficient, MCS should be considered. Historically, it has been reported that critically ill patients bridged with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) directly to HT have worse outcomes. However, when the heart allocation system gives the highest priority to patients on VA-ECMO support, those patients have a higher incidence of HT and a lower incidence of death or removal from the transplant list. Moreover, patients with a short waiting time on VA-ECMO have a similar hazard of mortality to non-ECMO patients. According to the reported data, bridging with VA-ECMO directly to HT may be a solution in the selection of critically ill patients when the anticipated waiting list time is short. However, when a prolonged waiting time is expected, more durable MCS should be considered. Regardless of the favorable results of the direct bridging to HT with ECMO in selected patients, the superiority of this strategy compared to the bridge-to-bridge strategy (ECMO to durable MCS) has not been established and further studies are mandatory in order to clarify this issue.
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Procedimientos Quirúrgicos Cardiovasculares/métodos , Leiomiomatosis/cirugía , Complicaciones Posoperatorias/cirugía , Neoplasias Vasculares/cirugía , Vena Cava Inferior/cirugía , Puente Cardiopulmonar , Femenino , Atrios Cardíacos/diagnóstico por imagen , Humanos , Histerectomía , Leiomiomatosis/diagnóstico por imagen , Leiomiomatosis/patología , Imagen por Resonancia Magnética , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/patología , Neoplasias Vasculares/diagnóstico por imagen , Neoplasias Vasculares/patología , Vena Cava Inferior/diagnóstico por imagen , Vena Cava Inferior/parasitología , Vena Cava Inferior/patologíaRESUMEN
A five-month-old male with a hypoplastic left heart syndrome developed severe respiratory insufficiency due to influenza type B viral pneumonia following bidirectional Glenn. He was treated with extracorporeal membrane oxygenation and successfully weaned without neurological consequences.
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Procedimientos Quirúrgicos Cardíacos/efectos adversos , Oxigenación por Membrana Extracorpórea , Síndrome del Corazón Izquierdo Hipoplásico/complicaciones , Gripe Humana/complicaciones , Neumonía Viral/complicaciones , Puente Cardíaco Derecho , Humanos , Síndrome del Corazón Izquierdo Hipoplásico/fisiopatología , Lactante , Virus de la Influenza B , Gripe Humana/fisiopatología , Masculino , Neumonía Viral/fisiopatología , Síndrome de Dificultad RespiratoriaRESUMEN
Aortic valve stenosis is the most common cardiac valve disease, and with current trends in the population demographics, its prevalence is likely to rise, thus posing a major health and economic burden facing the worldwide societies. Over the past decade, it has become more than clear that our traditional genetic views do not sufficiently explain the well-known link between AS, proatherogenic risk factors, flow-induced mechanical forces, and disease-prone environmental influences. Recent breakthroughs in the field of epigenetics offer us a new perspective on gene regulation, which has broadened our perspective on etiology of aortic stenosis and other aortic valve diseases. Since all known epigenetic marks are potentially reversible this perspective is especially exciting given the potential for development of successful and non-invasive therapeutic intervention and reprogramming of cells at the epigenetic level even in the early stages of disease progression. This review will examine the known relationships between four major epigenetic mechanisms: DNA methylation, posttranslational histone modification, ATP-dependent chromatin remodeling, and non-coding regulatory RNAs, and initiation and progression of AS. Numerous profiling and functional studies indicate that they could contribute to endothelial dysfunctions, disease-prone activation of monocyte-macrophage and circulatory osteoprogenitor cells and activation and osteogenic transdifferentiation of aortic valve interstitial cells, thus leading to valvular inflammation, fibrosis, and calcification, and to pressure overload-induced maladaptive myocardial remodeling and left ventricular hypertrophy. This is especcialy the case for small non-coding microRNAs but was also, although in a smaller scale, convincingly demonstrated for other members of cellular epigenome landscape. Equally important, and clinically most relevant, the reported data indicate that epigenetic marks, particularly certain microRNA signatures, could represent useful non-invasive biomarkers that reflect the disease progression and patients prognosis for recovery after the valve replacement surgery.
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Estenosis de la Válvula Aórtica/genética , Epigénesis Genética , Hipertrofia Ventricular Izquierda/genética , MicroARNs/genética , Ensamble y Desensamble de Cromatina , Metilación de ADN , Progresión de la Enfermedad , Regulación de la Expresión Génica , Predisposición Genética a la Enfermedad , Humanos , Procesamiento Proteico-PostraduccionalRESUMEN
Recovery after cardiac surgery is a complex process that has to compensate for both individual variability and extensive tissue damage in the context of systemic inflammation. Protein glycosylation is essential in many steps of the inflammatory cascade, but due to technological limitations the role of individual variation in glycosylation in systemic inflammation has not been addressed until now. We analysed composition of the total plasma and IgG N-glycomes in 107 patients undergoing cardiac surgery. In nearly all individuals plasma N-glycome underwent the same pattern of changes in the first 72 h, revealing a general mechanism of glycosylation changes. To the contrary, changes in the IgG glycome were very individualized. Bi-clustering analysis revealed the existence of four distinct patterns of changes. One of them, characterized by a rapid increase in galactosylated glycoforms, was associated with nearly double mortality risk measured by EuroSCORE II. Our results indicate that individual variation in IgG glycosylation changes during acute systemic inflammation associates with increased mortality risk and indicates new avenues for the development of personalized diagnostic and therapeutic approach.
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Procedimientos Quirúrgicos Cardíacos/efectos adversos , Glicómica , Inmunoglobulina G/química , Inflamación/inmunología , Polisacáridos/química , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Secuencia de Carbohidratos , Procedimientos Quirúrgicos Cardíacos/mortalidad , Cromatografía Líquida de Alta Presión , Análisis por Conglomerados , Femenino , Glicosilación , Humanos , Interacciones Hidrofóbicas e Hidrofílicas , Inmunoglobulina G/inmunología , Inflamación/sangre , Inflamación/etiología , Inflamación/mortalidad , Masculino , Persona de Mediana Edad , Datos de Secuencia Molecular , Polisacáridos/inmunología , Factores de Riesgo , Análisis de SupervivenciaRESUMEN
Cardiac myxomas are rare benign and slowly proliferating neoplasms of uncertain histogenesis with heterogeneous histomorphology and variable and sometimes clinically quite malignant pathological manifestations. Majority of cardiac myxoma occur sporadically while a relatively small proportion of diagnosed cases develop as a part of Carney complex syndrome with established familial pattern of inheritance. Although histologically indistinguishable these two forms of cardiac myxoma exhibit distinct cytogenetic make-up and apparent pathological differences important for their clinical presentation and prognosis. Additional problem is presented with secondary lesions with more aggressive histology and significantly faster cell proliferation suggesting their successive malignant alteration. Surgical resection of cardiac myxoma is currently the only treatment of choice. However, to avoid potentially hazardous operating procedures and possible postoperative complications and to prevent recurrence of the neoplastic lesions it is necessary to develop alternative approaches and identify a possible drug targets for their successful pharmacological treatment. Due to the rarity of the disease, a small number of cases in one institution and lack of comprehensive experimental data particularly concerning the cases of metastatic dissemination and secondary lesions with malignant nature, a comprehensive multi-institutional approach is required for better understanding of their molecular pathology and illumination of key molecular, genetic as well as epigenetic markers and regulatory pathways responsible for their development. In this article we provide comprehensive pathohistological, molecular and cytogenetic overview of sporadic cardiac myxoma cases restating the major hypothesis concerning their histogenesis and emphasizing potential approaches for their further reexamination.
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Neoplasias Cardíacas/patología , Técnicas de Diagnóstico Molecular , Mixoma/patología , Diagnóstico Diferencial , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/etiología , Humanos , Análisis por Micromatrices , Mixoma/diagnóstico , Mixoma/etiología , Recurrencia Local de NeoplasiaAsunto(s)
Lesiones Cardíacas/fisiopatología , Heridas Punzantes/fisiopatología , Electrocardiografía , Lesiones Cardíacas/diagnóstico por imagen , Lesiones Cardíacas/cirugía , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Intento de Suicidio , Tomografía Computarizada por Rayos X , Heridas Punzantes/diagnóstico por imagen , Heridas Punzantes/cirugíaRESUMEN
BACKGROUND: Although cardiac resynchronization therapy (CRT) is well established as an adjunctive heart failure treatment, a 30% rate of nonresponders poses a challenge to improve the detection of potential responders prior to device implantation. A previously proposed mechanism-based approach to patient selection suggests in part that the septal flash is a sign of intraventricular dyssynchrony, which is predictive of CRT responsiveness. METHODS: In this pilot study, data from 5 consecutive patients (2 women and 3 men; mean + or - SD age, 62 + or - 9 years) referred for CRT device implantation via a minithoracotomy were analyzed. Intraoperative transthoracic and/or transesophageal echocardiography data, as well as Doppler myocardial imaging data, were acquired before and after CRT device activation. The septal flash was defined as an early ventricular inward and outward septal motion within the isovolumic contraction period and was imaged with grayscale imaging or tissue Doppler color M-mode. Reverse remodeling was defined as a reduction in the left ventricular end-systolic volume (LVESV) of > or =10%. The right atrial and right ventricular leads were placed transvenously, and the LV screw-in lead was positioned epicardially on the lateral wall. RESULTS: The septal flash was detected preoperatively in all patients and resolved immediately after the onset of biventricular pacing. Immediately following pacemaker activation, we measured a significant reduction in the LVESV (248 + or - 99 mL versus 190 + or - 100 mL, P = .01) and an increase in the ejection fraction (19% + or - 5% versus 28% + or - 5%, P = .01) in all patients. Likewise, a significant increase in the postactivation dP/dt (rate of LV pressure change) measured noninvasively from the mitral regurgitation trace was noted in all patients (298.6 + or - 58.0 mm Hg/s versus 601.7 + or - 111.2 mm Hg/s, P = .001). CONCLUSION: The preoperative presence of the septal flash is a valid predictor of the response to CRT. Immediately after CRT device activation, the septal flash disappears, and LV reverse remodeling and an increase in contractility are observed.
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Estimulación Cardíaca Artificial/métodos , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/prevención & control , Tabiques Cardíacos/diagnóstico por imagen , Implantación de Prótesis/métodos , Toracotomía/métodos , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/prevención & control , Femenino , Insuficiencia Cardíaca/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Proyectos Piloto , Pronóstico , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Resultado del Tratamiento , Ultrasonografía , Disfunción Ventricular Izquierda/etiología , Remodelación VentricularRESUMEN
AIM: To determine the in-hospital outcome of patients undergoing off-pump coronary artery bypass grafting. METHODS: The study included 212 consecutive patients (147 men and 65 women) undergoing off-pump coronary artery bypass grafting between March 2000 and March 2002. Mean +/- SD age of the patients was 60 +/- 8 years. We analyzed in-hospital mortality and perioperative and postoperative course of treatment of our patients. RESULTS: The mean +/- SD number of grafts was 2.9 +/- 0.9 per patient. More than 75% of patients were extubated within the first 6 h after surgery, and 6% received no blood transfusions. The mortality rate was 2.8% and there were no intraoperative deaths. CONCLUSION: Off-pump coronary artery bypass procedure seems a safe alternative to standard on-pump revascularization procedures and can also be safely suggested to elderly population.