Staphylococcus Aureus Infective Endocarditis: JACC Patient Pathways.

A 19-year-old female patient presented with Staphylococcus aureus infective endocarditis, with suspected subdural brain hemorrhage, disseminated intravascular coagulopathy, and septic renal as well as spleen infarcts. The patient had extensive vegetations on the mitral and tricuspid valves and underwent urgent mitral and tricuspid repair. This paper discusses the clinical case and current evidence regarding the management and treatment of Staphylococcus aureus endocarditis.

Staphylococcus Aureus Infective Endocarditis: JACC Patient Pathways.

A 19-year-old female patient presented with Staphylococcus aureus infective endocarditis, with suspected subdural brain hemorrhage, disseminated intravascular coagulopathy, and septic renal as well as spleen infarcts. The patient had extensive vegetations on the mitral and tricuspid valves and underwent urgent mitral and tricuspid repair. This paper discusses the clinical case and current evidence regarding the management and treatment of Staphylococcus aureus endocarditis.

Hypoxia-induced microRNA-424 expression in human endothelial cells regulates HIF-α isoforms and promotes angiogenesis.

Adaptive changes to oxygen availability are critical for cell survival and tissue homeostasis. Prolonged oxygen deprivation due to reduced blood flow to cardiac or peripheral tissues can lead to myocardial infarction and peripheral vascular disease, respectively. Mammalian cells respond to hypoxia by modulating oxygen-sensing transducers that stabilize the transcription factor hypoxia-inducible factor 1α (HIF-1α), which transactivates genes governing angiogenesis and metabolic pathways. Oxygen-dependent changes in HIF-1α levels are regulated by proline hydroxylation and proteasomal degradation. Here we provide evidence for what we believe is a novel mechanism regulating HIF-1α levels in isolated human ECs during hypoxia. Hypoxia differentially increased microRNA-424 (miR-424) levels in ECs. miR-424 targeted cullin 2 (CUL2), a scaffolding protein critical to the assembly of the ubiquitin ligase system, thereby stabilizing HIF-α isoforms. Hypoxia-induced miR-424 was regulated by PU.1-dependent transactivation. PU.1 levels were increased in hypoxic endothelium by RUNX-1 and C/EBPα. Furthermore, miR-424 promoted angiogenesis in vitro and in mice, which was blocked by a specific morpholino. The rodent homolog of human miR-424, mu-miR-322, was significantly upregulated in parallel with HIF-1α in experimental models of ischemia. These results suggest that miR-322/424 plays an important physiological role in post-ischemic vascular remodeling and angiogenesis.

Balloon atrial septostomy in infants with transposition of the great arteries (d-TGA): PGIMER experience.

Experience in use of Balloon Atrial Septostomy (BAS) in the palliation of infants with TGA is scanty from developing countries. We report 53 infants of d-TGA palliated with BAS in the period 1972 - 88 (mean age 2.03 +/- 1.32 months, mean weight 3.44 +/- 0.58 kg). 44 infants had an intact ventricular septum. The mean pre-BAS systemic oxygen saturation was 37.29 +/- 8.41% which rose to 53 +/- 13.6% after a successful septostomy. The procedure was successful in 83% of the infants and caused 3 deaths (5.7%) all part of our early experience. Balloon deflation failure (1) was encountered only in the earlier years. Follow up is available in 30 infants upto 2.8 years. Cynosis and congestive failure improved uniformly post procedure. The improvement was maintained at an average of 5 months. 5 deaths (16%) occurred at an average of 7.6 months. 5 patients underwent definitive repair. We conclude that BAS is safe and effective in palliation of infants with d-TGA and that the gain with BAS is at best a temporary measure before definitive surgery.