RESUMEN
Objective: Pericardial effusion after cardiac surgery remains an important cause of morbidity and mortality. We describe the risk factors of pericardial effusion after congenital heart surgery through analyzing data from a nationwide, multi-institutional registry. Methods: The Japan Congenital Cardiovascular Surgery Database, which reflects routine clinical care in Japan, was used for this retrospective cohort study. Multivariable regression analysis was done after univariable comparison of patients with pericardial effusion and no pericardial effusion. Results: The study enrolled 64,777 patients registered with the Japan Congenital Cardiovascular Surgery Database between 2008 and 2016; 909 of these had postoperative pericardial effusion (1.4%) and were analyzed along with 63,868 patients without pericardial effusion. Univariable analysis found no difference between the groups in terms of gender, early delivery, or preoperative mechanical ventilatory support. In the pericardial effusion group, cardiopulmonary bypass use was lower (58.4% vs 62.1%), whereas the cardiopulmonary bypass time (176.9 vs 139.9 minutes) and aortic crossclamp time (75.1 vs 62.2 minutes) were longer, and 30-day mortality was higher (4.1% vs 2.2%). Multivariable analysis identified trisomy 21 (odds ratio, 1.54), 22q.11 deletion (odds ratio, 2.17), first-time cardiac surgery (odds ratio, 2.01), and blood transfusion (odds ratio, 1.43) as independent risk factors of postoperative pericardial effusion. In contrast, neonates, infants, ventricular septal defect, atrial septal defect, tetralogy of Fallot repair, and arterial switch operation were correlated with a low risk of pericardial effusion development. Conclusions: The incidence of postoperative pericardial effusion in congenital cardiac surgery was 1.4%. Trisomy 21, 22q.11 deletion, first-time cardiac surgery, and blood transfusion were identified as the principal factors predicting the need for pericardial effusion drainage.
RESUMEN
Intracardiac extension of Ewing sarcoma is extremely rare. Herein, we report the case of a pediatric patient with mediastinal Ewing sarcoma which extended to right atrium via the azygos vein. Surgical resection was performed through longitudinal incision on anterior surface of the superior vena cava under cardiopulmonary bypass. Resection was feasible because the tumor was sufficiently elastic and non-adherent to the inner surface of the heart. The patient was received chemotherapy and proton beam radiation postoperatively and is doing well with no tumor recurrence for 5 years after surgery.
Asunto(s)
Neoplasias del Mediastino , Sarcoma de Ewing , Sarcoma , Niño , Atrios Cardíacos/cirugía , Humanos , Neoplasias del Mediastino/diagnóstico por imagen , Neoplasias del Mediastino/patología , Neoplasias del Mediastino/cirugía , Recurrencia Local de Neoplasia/patología , Sarcoma/patología , Sarcoma de Ewing/diagnóstico por imagen , Sarcoma de Ewing/patología , Sarcoma de Ewing/cirugía , Resultado del Tratamiento , Vena Cava Inferior/diagnóstico por imagen , Vena Cava Inferior/patología , Vena Cava Inferior/cirugía , Vena Cava Superior/diagnóstico por imagen , Vena Cava Superior/cirugíaRESUMEN
BACKGROUND: Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital coronary anomaly that results in high mortality if left untreated. Our aim was to extend our knowledge of the histological, angiographic, and clinical characteristics of ALCAPA in order to deepen our understanding of this rare entity. CASE PRESENTATION: We were involved in the assessment, treatment, and pathological evaluation of two adult ALCAPA patients who were rescued from ventricular fibrillation and then surgically treated to establish a dual coronary artery system. Histological studies indicated various chronic ischemic changes in the myocardium, patchy fibrosis, and severely thickened arteriolar walls in both ventricles. The first patient is alive and well 11.5 years after surgical correction without any implantable cardioverter defibrillator (ICD) activations. The second patient required re-do surgery 9 months after the initial operation but subsequently died. Histologically, chronic ischemic alteration of the myocardium and thickened arteriolar walls persisted even after surgical correction, and coronary angiography (CAG) showed an extremely slow flow phenomenon even after surgical correction in both patients. The average postoperative opacification rate in the first case was 7.36 + 1.12 (n = 2) in the RCA, 3.81 + 0.51 (n = 3) in the left anterior descending (LAD) artery, and 4.08 + 0.27 (n = 4) in the left circumflex (LCx) artery. The slow flow phenomenon may represent persistent high arteriolar resistance in both ventricles. CONCLUSIONS: Seldom reported or new findings in adult ALCAPA were identified in two cases. More frequent diagnosis of adult ALCAPA can be expected because of the widespread availability of resuscitation and more advanced diagnostic modalities. Accumulation of pathological and clinical findings and confirmation of the long-term follow-up results after treatment may contribute to expanding our knowledge of this rare entity and establishing optimal treatment.
Asunto(s)
Arteria Coronaria Izquierda Anómala , Síndrome de Bland White Garland , Adulto , Arteria Coronaria Izquierda Anómala/patología , Arteria Coronaria Izquierda Anómala/cirugía , Síndrome de Bland White Garland/patología , Síndrome de Bland White Garland/cirugía , Procedimientos Quirúrgicos Cardíacos , Anomalías de los Vasos Coronarios/patología , Anomalías de los Vasos Coronarios/cirugía , Humanos , Masculino , Persona de Mediana Edad , Arteria Pulmonar/anomalíasRESUMEN
BACKGROUND: Although pulmonary artery banding (PAB) is a common palliative procedure for pediatric heart malformation, there are concerns of pressure overload and concomitant immune reactions in the right ventricle causing postsurgical complications such as pericardial effusion. At this time, no clear guidelines as to potential risk factors or procedural contraindications have been widely disseminated. Therefore, a study was undertaken to examine wide-ranging factors to find potential biomarkers for postsurgical pericardial effusion formation risk. METHODS: A retrospective study was conducted on all cardiac surgeries performed over an eight-year period, and the main inclusion criterion was pericardial effusion development after PAB that required surgical drainage. Nine cases were then analyzed against a control group of 45 cases with respect to body measurements, concomitant surgeries, genetic screens, laboratory tests results, and cardiac function parameters. RESULTS: Trisomy 21 was strongly associated with the development of severe pericardial effusion after PAB, and postoperative serum albumin levels in patients with trisomy 21 were associated with pericardial effusion development. Other parameters showed no significant correlation with pericardial effusion development. CONCLUSIONS: Our data indicate a strong association between trisomy 21 and pericardial effusion requiring drainage after PAB, which is in line with translational research findings. Pressure overload from PAB may play a role in the formation of severe pericardial effusion that is exacerbated by cardiac structural defects commonly associated with trisomy 21. Surgical teams should therefore use caution and plan to implement drainage in PAB cases, and postoperative serum albumin may serve as a useful biomarker for pericardial effusion formation.
Asunto(s)
Derrame Pericárdico/etiología , Complicaciones Posoperatorias/etiología , Arteria Pulmonar/cirugía , Procedimientos Quirúrgicos Vasculares , Estudios de Casos y Controles , Síndrome de Down/complicaciones , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Derrame Pericárdico/diagnóstico , Complicaciones Posoperatorias/diagnóstico , Estudios Retrospectivos , Factores de Riesgo , Procedimientos Quirúrgicos Vasculares/efectos adversos , Procedimientos Quirúrgicos Vasculares/métodosRESUMEN
BACKGROUND: Several proximal anastomosis devices have been developed to shorten the time required for a proximal anastomosis and to avoid aortic cross-/side-clamping during coronary artery bypass grafting. This study retrospectively examined the patency of saphenous vein grafts (SVGs) using the PAS-Port System (Cardia Inc, Redwood City, CA). METHODS: From 2004 to 2014, 451 patients underwent coronary artery bypass graft operations requiring at least 1 proximal anastomosis using a PAS-Port device. A total of 802 PAS-Port devices were used, and 95.0% (762 of 802) were implanted successfully. Among the successfully implanted anastomoses, 76.8% (585 of 762) were evaluated using coronary angiography or multidimensional computed tomography, or both. The evaluations were performed between postoperative days 4 and 3,182 (mean, 319 ± 624 days). The early (1 to 365 days) and the midterm to long-term (more than 366 days) occlusion rates were examined. A complete postoperative clinical course was recorded for 70.7% of the patients. RESULTS: Overall, 93.8% (549 of 585) of the device-dependent SVGs were patent. The patency rates of device-dependent SVGs that were 1, 2, 3, 4, 5, 6, 7, and 8 years old were 90.1% ± 1.8%, 87.1% ± 2.3%, 86.1% ± 2.5%, 82.9% ± 3.3%, 80.6% ± 3.9%, 77.2% ± 5.0%, 77.2% ± 5.0%, and 70.2% ± 8.1%, respectively. The longest follow-up period was 3,182 days (8.7 years). The occlusion rate for device-dependent SVGs tended to decrease as the number of patients accumulated. CONCLUSIONS: The PAS-Port system provided acceptable SVG patency and clinical outcome for the early and midterm to long-term. There may be a learning curve for the use of PAS-Port device that affects the device-dependent SVG patency.
Asunto(s)
Puente de Arteria Coronaria/métodos , Enfermedad de la Arteria Coronaria/cirugía , Oclusión de Injerto Vascular/fisiopatología , Monitoreo Intraoperatorio/instrumentación , Vena Safena/fisiopatología , Grado de Desobstrucción Vascular , Anciano , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/mortalidad , Diseño de Equipo , Femenino , Estudios de Seguimiento , Oclusión de Injerto Vascular/diagnóstico , Oclusión de Injerto Vascular/epidemiología , Humanos , Incidencia , Japón/epidemiología , Masculino , Tomografía Computarizada Multidetector , Estudios Retrospectivos , Factores de Riesgo , Vena Safena/diagnóstico por imagen , Vena Safena/trasplante , Tasa de Supervivencia/tendenciasRESUMEN
We experienced two adult cases of anomalous origin of the left coronary artery from the pulmonary artery, so-called Bland-White-Garland (BWG) syndrome, that presented with ventricular tachycardia (VT) and ventricular fibrillation during exertion in daily life. They presented to our hospital with syncope due to VT, and recovered following application of an automated external defibrillator with cardiopulmonary resuscitation. We diagnosed BWG syndrome by multi-detector computed tomography angiography and coronary angiography. We analyzed the mechanisms of lethal arrhythmias in relation to myocardial ischemia on exertion. Coronary flow modification and implantable cardioverter defibrillator implantation were performed in order to prevent future lethal arrhythmia due to myocardial ischemia. It is important to be aware of congenital heart disease in ordinary cases.
RESUMEN
We performed cytogenetic and molecular cytogenetic analyses of a primary cutaneous CD8-positive aggressive epidermotropic cytotoxic T-cell lymphoma, a rare type of primary cutaneous T-cell lymphoma. G-banded analysis at initial diagnosis and recurrence revealed complex karyotype and clonal evolution reflecting genomic instability that parallels the aggressive clinical course observed. Spectral karyotyping revealed numerous structural abnormalities. SNP array-based analysis of an initial diagnostic sample revealed numerous gains and losses of chromosomal material, including loss of short arm of the chromosome 17, to which TP53 is mapped. The molecular cytogenetics and array data of this case suggest genomic instability, particularly chromosomal instability and haploinsufficiency for TP53, the latter possibly giving rise to alteration of p14ARF-Mdm2-p53 tumor suppressor protein pathway, likely to be associated with unfavorable clinical course.
Asunto(s)
Antígenos CD8 , Análisis Citogenético , Linfoma Cutáneo de Células T/genética , Niño , Cromosomas Humanos Par 17/genética , Femenino , Inestabilidad Genómica , Humanos , Polimorfismo de Nucleótido Simple , Cariotipificación Espectral , Proteína p53 Supresora de Tumor/genéticaRESUMEN
BACKGROUND: Which graft material is the optimal graft material for the treatment of infected aortic aneurysms and aortic graft infections is still a matter of controversy. Orthotopic aortic reconstruction with intraoperatively prepared xenopericardial roll grafts without omentopexy was performed as the "initial" operation to treat aortic infection or as a "rescue" operation to treat graft infection. Mid-term outcomes were evaluated. METHODS: Between 2009 and 2013, orthotopic xenopericardial roll graft replacement was performed to treat eight patients (male/female: 6/2; mean age: 69.5 [55-80] yr). Graft material: equine/bovine pericardium: 2/6; type of operation: initial 4/rescue 4; omentopexy 0. Additional operation: esophagectomy 2. Mean follow-up period: 2.6 ± 1.6 (1.1-5.1) years. RESULTS: Replacement: ascending 3, arch 1 (reconstruction of neck vessels with small xenopericardial roll grafts), descending 3, and thoracoabdominal 1. Pathogens: MRSA 2, MSSA 1, Candida 1, E. coli 1, oral bacillus 1, and culture negative 2. Postoperative local recurrence of infection: 0. Graft-related complications: stenosis 0, calcification 0, non-infectious pseudoaneurysm of anastomosis 2 (surgical repair: 1/TEVAR 1). In-hospital mortality: 2 (MOF: initial 1/rescue 1); Survival rate exclusive of in-hospital deaths (~3 y): 100 %, but one patient died of lung cancer (3.6 yr). CONCLUSIONS: Because xenopericardial roll grafts are not composed of synthetic material, the replacement procedure is simpler and less invasive than the standard procedure. Based on the favorable results obtained, this procedure may have the possibility to serve as an option for the treatment of aortic infections and aortic graft infections not only as a "rescue" treatment but as an "initial" treatment as well.
Asunto(s)
Aneurisma Falso/cirugía , Aneurisma de la Aorta/cirugía , Implantación de Prótesis Vascular/métodos , Infecciones Cardiovasculares/cirugía , Infección de la Herida Quirúrgica/cirugía , Anciano , Anciano de 80 o más Años , Animales , Aorta/cirugía , Aorta Torácica/cirugía , Implantación de Prótesis Vascular/efectos adversos , Bovinos , Femenino , Xenoinjertos , Caballos , Humanos , Masculino , Persona de Mediana Edad , Pericardio/trasplante , Análisis de SupervivenciaRESUMEN
BACKGROUND: Retropharyngeal hematoma is a rare form of pharyngeal pathology and can present as acute airway obstruction. Among the many causes of retropharyngeal hematoma, thoracic aortic rupture is extremely rare. METHODS AND RESULTS: A 78-year-old female with airway obstruction by a retropharyngeal hematoma secondary to thoracic aortic aneurysm rupture was successfully treated by total aortic arch replacement and open stent-graft insertion. CONCLUSION: Rupture of the thoracic aorta should be considered as a rare but important cause of retropharyngeal hematoma and airway obstruction.
Asunto(s)
Obstrucción de las Vías Aéreas/cirugía , Aneurisma de la Aorta Torácica/cirugía , Rotura de la Aorta/cirugía , Hematoma/cirugía , Enfermedades del Mediastino/cirugía , Anciano , Obstrucción de las Vías Aéreas/etiología , Aneurisma de la Aorta Torácica/complicaciones , Rotura de la Aorta/complicaciones , Dolor de Espalda/etiología , Femenino , Hematoma/complicaciones , Humanos , Laringoscopía , Enfermedades del Mediastino/complicaciones , StentsRESUMEN
The standard procedure for treating infected aortic aneurysms is to resect the infected aorta, debridement of the surrounding tissue, in situ graft replacement, and omentopexy. However, the question of which graft material is optimal is still a matter of controversy. We recently treated a patient with an infected ascending aortic aneurysm. Because of previous abdominal surgery, the omentum was unavailable. The ascending aorta was replaced in situ with equine pericardial roll grafts. The patient is alive and well 29 months after the operation.
Asunto(s)
Aneurisma Falso/cirugía , Aorta/cirugía , Implantación de Prótesis Vascular , Prótesis Vascular , Infecciones Cardiovasculares/cirugía , Anciano , Animales , Aneurisma de la Aorta/cirugía , Materiales Biocompatibles , Implantación de Prótesis Vascular/instrumentación , Implantación de Prótesis Vascular/métodos , Caballos , Humanos , Masculino , Pericardio/cirugía , Trasplante HeterólogoRESUMEN
Resection of the infected aorta, debridement of the surrounding tissue, in situ graft replacement, and omentopexy is the standard procedure for treating infected aortic aneurysms, but the question of which graft material is optimal is still a matter of controversy. We recently treated a patient with an infected thoracic aortic aneurysm. The aneurysm was located in the proximal aortic arch. Because the patients had previously undergone abdominal surgery, the aortic arch were replaced in situ with a branched equine pericardial roll grafts. The patient is alive and well 23 months after the operation.
Asunto(s)
Aneurisma de la Aorta Torácica/cirugía , Infecciones Cardiovasculares/cirugía , Pericardio/trasplante , Injerto Vascular , Anciano , Animales , Aorta Torácica/patología , Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/patología , Rotura de la Aorta/patología , Rotura de la Aorta/cirugía , Materiales Biocompatibles , Infecciones Cardiovasculares/patología , Caballos , Humanos , Masculino , Tomografía Computarizada por Rayos X , Trasplante Heterólogo/instrumentación , Trasplante Heterólogo/métodosRESUMEN
BACKGROUND: A malpositioned heart with apicocaval juxtaposition may complicate the management of patients with functional single ventricles when total cavopulmonary connection is performed. We reviewed our experience with extracardiac total cavopulmonary connection in patients with apicocaval juxtaposition with a special focus on route selection and outcomes. METHODS: Of 68 patients who underwent extracardiac total cavopulmonary connection at our hospitals, 10 patients with apicocaval juxtaposition were included in this study. The mean follow-up was 40 ± 28 months. Patient demographics were compared with data on patients without apicocaval juxtaposition. RESULTS: The age at operation was 8 ± 7 years. We carefully chose conduit routes to create satisfactory fluid dynamics. The conduit was placed between the inferior vena cava and the ipsilateral pulmonary artery in 2 patients, and the conduit crossed midline in 8 patients. The mean postoperative pulmonary artery pressure was 13 ± 2 mm Hg. The surgical and postoperative data were not significantly different when compared with the patients without apicocaval juxtaposition. There were no conduit-related early or late complications except for 1 patient who had poor ventricular function. CONCLUSIONS: Extracardiac total cavopulmonary connection in apicocaval juxtaposition can be carried out with favorable midterm outcomes. The route between the inferior vena cava and the contralateral pulmonary artery should be the primary choice when the relevant pulmonary artery is in good shape. Care must be taken in regard to critical conduit oppression by the ventricle in cases with large ventricular volume or poor ventricular function.
Asunto(s)
Puente Cardíaco Derecho/métodos , Cardiopatías Congénitas/cirugía , Ventrículos Cardíacos/anomalías , Adolescente , Adulto , Niño , Preescolar , Humanos , Arteria Pulmonar/cirugía , Estudios Retrospectivos , Vena Cava Inferior/cirugíaRESUMEN
BACKGROUND: Infarct expansion after myocardial infarction (MI) is an important phenomenon that initiates and sustains adverse left ventricular (LV) remodeling. We tested the hypothesis that infarct modification by material-induced infarct stiffening and thickening limits infarct expansion and LV remodeling. METHODS: Anteroapical infarction was induced in 21 sheep. Sheep were randomized to injection of saline (2.6 mL) or tissue filler material (2.6 mL) into the infarct within 3 hours of MI. Animals were monitored for 8 weeks with echocardiography to assess infarct expansion and global LV remodeling. Morphometric measurements were performed of excised hearts to quantify infarct thickness. Regional blood flow was assessed with colored microspheres. Infarct material properties were measured using biaxial tensile testing. RESULTS: Compared with controls at 8 weeks, treatment animals had less infarct expansion, reduced LV dilatation (LV systolic volumes: 60.8±4.3 vs 80.3±6.9 mL; p<0.05), greater ejection fraction (0.310±0.026 vs 0.276±0.013; p<0.05), thicker infarcts (5.5±0.2 vs 2.2±0.3 mm; p<0.05), and greater infarct blood flow (0.22±0.04 vs 0.11±0.03 mL/min/g; p<0.05). The longitudinal peak strain in the treatment group was less (0.05014±0.0141) than the control group (0.1024±0.0101), indicating increased stiffness of the treated infarcts. CONCLUSIONS: Durable infarct thickening and stiffening can be achieved by infarct biomaterial injection, resulting in the amelioration of infarct expansion and global LV remodeling. Further material optimization will allow for clinical translation of this novel treatment paradigm.
Asunto(s)
Materiales Biocompatibles , Modelos Animales de Enfermedad , Durapatita , Ecocardiografía Tridimensional , Ecocardiografía , Infarto del Miocardio/fisiopatología , Remodelación Ventricular/fisiología , Animales , Fenómenos Biomecánicos , Colágeno/metabolismo , Circulación Coronaria/fisiología , Fibroblastos/patología , Fibroblastos/fisiología , Análisis de Elementos Finitos , Hemodinámica/fisiología , Inyecciones , Microesferas , Contracción Miocárdica/fisiología , Infarto del Miocardio/patología , Miocardio/patología , Ovinos , Estrés Mecánico , Resistencia a la Tracción , Disfunción Ventricular Izquierda/patología , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
BACKGROUND: Apoptosis is thought to play a role in infarction induced ventricular remodeling. Apoptosis repressor with caspase recruitment domain (ARC) has been shown to limit cardiomyocytes apoptosis; however, its role in the pathogenesis of heart failure is not established. This study examines the regional and temporal relationships of apoptosis, ARC, and remodeling. METHODS: Myocardium was harvested from the infarct borderzone and remote regions of the left ventricle (LV) at 2 (n=8), 8 (n=6), and 32 (n=5) wk after MI. Activated ARC was compared with myocardial apoptosis in each region at each time. Both were then compared with the progression of remodeling. RESULTS: LV systolic volume increased by a factor 1.56±0.06 and 2.09±0.07 at 2 and 8 wk, respectively then stabilized by 32 wk (2.08±0.18). Activated ARC was elevated at 2 wk, diminished at 8 wk, and increased again at 32 wk in both regions. Apoptosis was elevated at 2 wk, and further increased at 8 wk. By 32 wk, apoptosis had diminished significantly. CONCLUSIONS: In a large animal infarction model, remodeling varied directly with the degree of apoptosis and inversely with ARC activation, suggesting that ARC acts as a natural regulatory phenomenon that limits apoptosis induced ventricular remodeling.
Asunto(s)
Apoptosis/fisiología , Caspasas/metabolismo , Infarto del Miocardio/metabolismo , Infarto del Miocardio/patología , Remodelación Ventricular/fisiología , Animales , Cardiomiopatías/diagnóstico por imagen , Cardiomiopatías/metabolismo , Cardiomiopatías/patología , Caspasas/química , Modelos Animales de Enfermedad , Ecocardiografía , Etiquetado Corte-Fin in Situ , Microscopía Electrónica , Infarto del Miocardio/diagnóstico por imagen , Miocitos Cardíacos/metabolismo , Miocitos Cardíacos/patología , Miocitos Cardíacos/ultraestructura , Estructura Terciaria de Proteína , Ovinos , Sístole/fisiología , Proteína X Asociada a bcl-2/metabolismoRESUMEN
BACKGROUND: The efficacy of annuloplasty for ischemic mitral regurgitation (IMR) has been difficult to establish. Using an established ovine model of IMR, we tested the ability of ring annuloplasty to durably relieve IMR and reverse or limit progression of left ventricular (LV) remodeling during a clinically relevant follow-up period. METHODS: A posterolateral infarction known to result in chronic IMR was initiated in 33 sheep. Echocardiography was used to assess LV end diastolic and systolic volumes and IMR (0 to 4 scale) before and 8 weeks after infarction. Eight weeks after infarction, 20 surviving animals with > or = 2+ IMR were randomized (1:1) to no treatment or undersized, semi-rigid, complete ring annuloplasty placement. LV remodeling and IMR were assessed at 4 and 6 months after infarction. RESULTS: All animals had similarly sized LV volumes at baseline (end systolic, 27.8 +/- 4.6 mL; end diastolic, 53.5 +/- 6.4 mL). The 20 randomized animals survived to complete the study. The degree of IMR before randomization was similar in treatment (2.6 +/- 0.4) and control (2.8 +/- 0.3) groups. At the 6-month follow-up, the degree of IMR was significantly less in the annuloplasty group (0.3 +/- 0.1 vs 3.4 +/- 0.6); however, LV volumes in the treatment group were not significantly different from the control group (end systolic, 82.1 +/- 15.6 vs 81.1 +/- 8.6 mL; end diastolic, 110.4 +/- 22.1 vs 111.1 +/- 16.5 mL). CONCLUSIONS: In a clinically relevant ovine model of IMR, annuloplasty provides durable relief from IMR during an extended follow-up period but does not significantly influence LV remodeling.
Asunto(s)
Insuficiencia de la Válvula Mitral/cirugía , Remodelación Ventricular , Animales , Modelos Animales de Enfermedad , Masculino , Insuficiencia de la Válvula Mitral/etiología , Infarto del Miocardio , Isquemia Miocárdica/complicaciones , Ovinos , Factores de TiempoRESUMEN
BACKGROUND: Cyclosporine A (CsA) limits myocardial reperfusion injury and preserves mitochondrial integrity, but its influence on mitochondrial function has not been described in vivo. Auto-fluorescence of mitochondrial nicotinamide adenine dinucleotide and flavin adenine dinucleotide correlate with mitochondrial dysfunction. We hypothesized that CsA limits mitochondrial dysfunction and that fluorometry can quantify this influence. METHODS: Seventeen rabbits were studied: untreated (UnT, n = 7), CsA preinfarction (CsAp, n = 6), and CsA on reperfusion (CsAr, n = 4). Animals underwent 30 minutes of myocardial ischemia and 3 hours reperfusion. Infarct size was determined by staining. Nicotinamide adenine dinucleotide and flavin adenine dinucleotide fluorescence was continually measured in the risk area. The redox ratio was calculated [flavin adenine dinucleotide(f)/(flavin adenine dinucleotide(f) + nicotinamide adenine dinucleotide(f))]. Electron microscopy evaluated mitochondria morphology. RESULTS: The infarct size by group was 39.1% +/- 1.7% in CsAp, 39.1% +/- 1.7% in CsAr, and 53.4% +/- 1.9% in UnT (p < 0.001). During ischemia, the CsAp group demonstrated less hypoxic reduction, with the redox ratio decreasing to 75.6% +/- 4.1% of baseline. The UnT and CsAr groups deceased to 67.1% +/- 4.0% and 67.2% +/- 3.6%, respectively (p < 0.005). During reperfusion the UnT group redox ratio increased to 1.59 +/- 0.04 times baseline. This increase was blunted in the CsAp (1.17 +/- 0.04, p = 0.026) and CsAr (1.35 +/- 0.02, p = 0.056) groups. Electron microscopy revealed reduced mitochondrial disruption in CsAp (19.7% +/- 7.6%) and CsAr (18.1% +/- 7.1%) rabbits compared with UnT (53.3% +/- 12.5%). CONCLUSIONS: Fluorometric spectroscopy can be used in vivo to quantitatively assess the time course of CsA's influence on the mitochondrial dysfunction associated with myocardial ischemia and reperfusion.
Asunto(s)
Ciclosporina/farmacología , Mitocondrias Cardíacas/efectos de los fármacos , Infarto del Miocardio/prevención & control , Isquemia Miocárdica/terapia , Daño por Reperfusión Miocárdica/prevención & control , Espectrometría de Fluorescencia , Animales , Modelos Animales de Enfermedad , Inmunohistoquímica , Precondicionamiento Isquémico Miocárdico , Mitocondrias Cardíacas/fisiología , Infarto del Miocardio/patología , Isquemia Miocárdica/patología , Reperfusión Miocárdica/métodos , Daño por Reperfusión Miocárdica/patología , Conejos , Distribución Aleatoria , Valores de Referencia , Medición de RiesgoRESUMEN
We report a Kawashima procedure (total cavopulmonary shunt) successfully carried out for asplenia syndrome, pulmonary atresia, and major aortopulmonary collateral arteries. At the age of 8, the patient underwent staged bilateral unifocalizations using confluent central pulmonary arteries concomitant with bilateral modified Blalock-Taussig shunts. As the result of an interrupted inferior vena cava with azygous continuation, the patient required a Kawashima procedure with augmentation of the central pulmonary arteries for definitive palliation 1 year later. Cyanosis, respiratory distress, and ventricular function improved.
Asunto(s)
Procedimientos Quirúrgicos Cardiovasculares , Circulación Colateral , Puente Cardíaco Derecho , Cardiopatías Congénitas/cirugía , Arteria Pulmonar/cirugía , Atresia Pulmonar/cirugía , Circulación Pulmonar , Bazo/anomalías , Aorta Torácica/anomalías , Procedimientos Quirúrgicos Cardiovasculares/métodos , Niño , Femenino , HumanosRESUMEN
The female sex has been associated with improved myocardial salvage after ischemia and reperfusion (I/R). Estrogen, specifically 17beta-estradiol, has been demonstrated to mediate this phenomenon by limiting cardiomyocyte apoptosis. We sought to quantitatively assess the effect of sex, ovarian hormone loss, and I/R on myocardial Bax, Bcl-2, and apoptosis repressor with caspase recruitment domain (ARC) expression. Male (n = 48), female (n = 26), and oophorectomized female (n = 20) rabbits underwent 30 min of regional ischemia and 3 h of reperfusion. The myocardial area at risk and infarct size were determined using a double-staining technique and planimetry. In situ oligo ligation was used to assess apoptotic cell death. Western blot analysis was used to determine proapoptotic (Bax) and antiapoptotic (Bcl-2 and ARC) protein levels in all three ischemic groups and, additionally, in three nonischemic groups. Infarct size (43.7 +/- 3.2%) and apoptotic cell death (0.51 +/- 0.10%) were significantly attenuated in females compared with males (56.4 +/- 1.6%, P < 0.01, and 4.29 +/- 0.95%, P < 0.01) and oophorectomized females (55.7 +/- 3.4%, P < 0.05, and 4.36 +/- 0.51%, P < 0.01). Females expressed significantly higher baseline ARC levels (3.62 +/- 0.29) compared with males (1.78 +/- 0.18, P < 0.01) and oophorectomized females (1.08 +/- 0.26, P < 0.01). Males expressed a significantly higher baseline Bax-to-Bcl-2 ratio (4.32 +/- 0.99) compared with females (0.65 +/- 0.13, P < 0.01) and oophorectomized females (0.42 +/- 0.10, P < 0.01). I/R significantly reduced Bax-to-Bcl-2 ratios in males. In all other groups, ARC levels and Bax-to-Bcl-2 ratios did not significantly change. These results support the conclusion that in females, endogenous estrogen limits I/R-induced cardiomyocyte apoptosis by producing a baseline antiapoptotic profile, which is associated with estrogen-dependent high constitutive myocardial ARC expression.
Asunto(s)
Proteínas Adaptadoras de Señalización CARD/biosíntesis , Proteínas Adaptadoras de Señalización CARD/genética , Daño por Reperfusión Miocárdica/patología , Animales , Apoptosis/fisiología , Análisis de los Gases de la Sangre , Western Blotting , Temperatura Corporal/fisiología , Separación Celular , Electrocardiografía , Estradiol/sangre , Estrógenos/fisiología , Femenino , Hemodinámica/fisiología , Masculino , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/patología , Daño por Reperfusión Miocárdica/diagnóstico por imagen , Miocitos Cardíacos/fisiología , Ovariectomía , Proteínas Proto-Oncogénicas c-bcl-2/biosíntesis , Conejos , Caracteres Sexuales , Ultrasonografía , Proteína X Asociada a bcl-2/biosíntesisRESUMEN
BACKGROUND: Surgical repair for hypoplastic aortic arch in neonates carries a substantial risk of recurrent obstruction. Simple arch anastomosis is not always a solution in cases of extended arch hypoplasia. We present our modified technique of extended aortic arch anastomosis augmented with subclavian flap aortoplasty. METHOD: We describe two neonates: interrupted aortic arch and transverse arch hypoplasia associated with aortic coarctation, who underwent a modification of extended aortic arch anastomosis augmented with subclavian flap aortoplasty. RESULTS: The patients recovered without any pressure gradient at the anastomotic site. Postoperative aortography showed no arch obstruction and they successfully underwent second stage repair. CONCLUSION: Our technique provides extensive augmentation of the aortic arch with a tension-free, wide and non-circumferential suture line which preserves potential for growth. The technique described may avoid persistent or repeat arch obstruction.