RESUMO
A 79-year-old woman was referred to undergo surgery for a type A dissection. The patient had a history of previous coronary artery bypass. She was in shock and had a hematoma surrounding the ascending aorta and the heart. In this case, a coronary sinus cardioplegia cannula was placed under a short period of circulatory arrest via a small atriotomy, and the atriotomy was closed immediately to establish selective cerebral perfusion.
Assuntos
Dissecção Aórtica/cirurgia , Ruptura Aórtica/cirurgia , Implante de Prótese Vascular , Ponte de Artéria Coronária , Seio Coronário/fisiopatologia , Parada Cardíaca Induzida/métodos , Idoso , Dissecção Aórtica/complicações , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/fisiopatologia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/etiologia , Ruptura Aórtica/fisiopatologia , Aortografia/métodos , Ponte Cardiopulmonar , Catéteres , Circulação Cerebrovascular , Feminino , Parada Cardíaca Induzida/instrumentação , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Veia Safena/transplante , Esternotomia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
For myocardial regeneration therapy, the low differentiation capability of functional cardiomyocytes sufficient to replace the damaged myocardial tissue is one of the major difficulties. Using Nkx2.5-GFP knock-in ES cells, we show a new efficient method to obtain cardiomyocytes from embryonic stem (ES) cells. The proportion of GFP-positive cells was significantly increased when ES cells were cultured with a conditioned medium from aortic endothelial cells (ECs), accompanied by upregulation of cardiac-specific genes as well as other mesodermal genes. The promotion was more prominent when EC-conditioned medium was added at an early stage of ES cell differentiation culture (Day 0-3). Inhibitors of bone morphogenic protein (BMP), cyclooxygenase (COX), and nitric oxide synthetase (NO) prevented the promotion of cardiomyogenesis by EC-conditioned medium. These results suggest that supplementation of EC-conditioned medium enables cardiomyocytes to be obtained efficiently through promotion of mesoderm induction, which is regulated by BMP, COX, and NOS.
Assuntos
Técnicas de Cultura de Células , Diferenciação Celular , Células-Tronco Embrionárias/citologia , Endotélio Vascular/citologia , Endotélio Vascular/metabolismo , Miócitos Cardíacos/citologia , Bloqueadores do Receptor Tipo 1 de Angiotensina II/farmacologia , Animais , Aorta/citologia , Proteínas Morfogenéticas Ósseas/antagonistas & inibidores , Diferenciação Celular/efeitos dos fármacos , Meios de Cultivo Condicionados/metabolismo , Meios de Cultivo Condicionados/farmacologia , Inibidores de Ciclo-Oxigenase/farmacologia , Células-Tronco Embrionárias/efeitos dos fármacos , Endotelina-1/antagonistas & inibidores , Endotélio Vascular/efeitos dos fármacos , Técnicas de Introdução de Genes , Proteínas de Fluorescência Verde/genética , Proteína Homeobox Nkx-2.5 , Proteínas de Homeodomínio/genética , Camundongos , Miócitos Cardíacos/efeitos dos fármacos , Óxido Nítrico Sintase/antagonistas & inibidores , Prostaglandina-Endoperóxido Sintases/efeitos dos fármacos , Receptor Tipo 1 de Angiotensina/efeitos dos fármacos , Fatores de Transcrição/genéticaRESUMO
Atresia of the coronary sinus orifice is rare. We describe the surgical treatment of coronary orifice atresia in an infant with a persistent left superior vena cava after total cavo-pulmonary connection for hypoplastic left heart syndrome. The diagnosis was made by cardiac catheterization after total cavo-pulmonary connection at 8 months of age. After surgery, cardiac performance deteriorated. At reoperation, the coronary sinus was fenestrated to the left atrium. The patient survived surgical treatment of coronary sinus ostial atresia unroofed to the left atrium, guiding the placement of the fenestration with a probe placed through the open cardiac end of left superior vena cava.