Early Estrogen Replacement Therapy Attenuates Cardiac Dysfunction Caused by Aging and Ovariectomy in Female Wistar Rats.

BACKGROUND: Cardiovascular diseases (CVDs) are the leading cause of women's mortality, linked to aging and reduced estrogen during menopause. Estrogen replacement therapy (ERT) is suggested for CVDs prevention. Yet, its timing initiation remains contentious. Thus, we aimed to evaluate the effect of early and late estrogen therapy on cardiac function and lipid metabolism in ovariectomized old female Wistar rats. METHODS: Fifty randomized female Wistar rats were included in 5 groups (n = 10, 18 months old): (1) Sham, (2) 10 weeks post ovariectomy (Ovx-10 w), (3) 10 weeks post Ovx + early estrogen replacement therapy (Ovx 10 w-early ERT), (4) 20 weeks post Ovx (Ovx-20 w) and (5) Ovx 20 w-late ERT. Three days (early ERT) or 10 weeks (late ERT) after surgery 17-ß estradiol was given (5 µg/kg/day), and 10 weeks after the start of ERT, we assessed cardiac function by echocardiography, electrocardiography, and cardiac catheterization. Estradiol, cholesterol, triglyceride (TG), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels were determined. Cardiac histology was performed with Masson's staining. RESULTS: Ovariectomy (Ovx) increases left ventricle internal systolic diameter (0.4 vs 0.3 cm, *p = 0.020) and decreases shortening fraction (40 vs 54 %, *p = 0.030) regardless of therapy. ERT prevents the increase in left ventricle mass after 10 weeks post-Ovx and the ejection fractionreduction after 20 weeks. Lower P wave amplitudes (18.8 vs 24.2 ms, *p = 0.013) were found in the Ovx-20 w group. A longer duration of the QRS complex after 20 weeks post-Ovx with and without ERT was found (32.5 and 32.1 vs 28.3 ms, *p = 0.003; *p = 0.007). Diastolic blood pressure was higher 20 weeks post-Ovx (86 vs 76 mmHg, *p = 0.047), regardless of ERT. The left ventricle (LV) -dP/dt was decreased in Ovx groups without ERT (-750 vs -1320 mmHg, *p = 0.034). An increase in LV collagen deposition was found in the Ovx 10 w group vs Sham (9.58 vs 4.54 %, *p = 0.028). Early ERT avoids the increase in body weight, cholesterol and LDL caused by Ovx. CONCLUSIONS: Ovariectomy causes time-dependent alterations in lipid metabolism, morphology, electrical activity, and heart contractile function. Early but not late ERT prevents some of these effects.

"Bronchogenic cyst impersonating a pericardial lesion": A case report.

A 32-year-old female presented with palpitations and chest discomfort. The patient had a history of pericardiotomy due to pericardial effusion. Multimodal imaging, including echocardiography, cardiac magnetic resonance (CMR), and coronary computed tomography angiography (CCTA) showed a single mass in the pericardium as the cause of the symptoms. Furthermore, its location and potential complications were accurately defined. The patient underwent a successful surgical resection of the pericardial cyst, microscopic histopathological examination was compatible with a bronchogenic cyst, a very rare congenital malformation. The article discusses the rarity of bronchogenic cysts in the pericardium and the importance of accurate diagnosis and appropriate treatment.

Prenatal Diagnosis and Outcome of Intrapericardial Teratoma: Report of Two Clinical Scenarios.

Intrapericardial teratoma is a rare tumor composed of tissue from the three germ cell layers with a rapid growth that may cause severe hemodynamic complications due to compressive effects. We present two clinical cases: the first case had severe fetal heart failure with fatal outcome, and the second underwent surgical treatment during the immediate postnatal period with a favorable evolution. Although teratomas are histologically benign tumors, rapid growth can cause serious hemodynamic complications. The importance of prenatal diagnosis is to allow appropriate monitoring of tumor growth and establish a prompt therapeutic plan. Opportune surgical treatment can prevent death and improve the prognosis of these patients.

Acute Mitral Regurgitation Due to Chordae Tendineae Rupture: A Rare Presentation of Cardiac Amyloidosis.

BACKGROUND In cardiac amyloidosis (CA), misfolded proteins deposit in the extracellular space of cardiac tissue. These deposits classically cause restrictive cardiomyopathy with diastolic dysfunction. Although there are at least 30 proteins known to cause amyloid aggregates, 2 main types make up most diagnosed cases: light chain amyloidosis (AL) and transthyretin amyloidosis (ATTR). Since CA is considered a rare condition, it is often underdiagnosed or recognized in the advanced stages. Once amyloid deposits involve the heart tissue, they are associated with a worse outcome and higher mortality rates, especially in patients presenting symptoms of heart failure. CASE REPORT We report a case of a 22-year-old man presenting with acute severe mitral regurgitation, secondary to posterior mitral leaflet chordae tendineae rupture (CTR). Surgical mitral valve replacement with a mechanical prosthesis was performed, and cardiac tissue biopsy samples were obtained. After surgery, the patient improved significantly but suddenly presented with hemodynamic deterioration, until he died due to severe hemodynamic compromise and multiorgan failure. Although the etiology of the CTR was not established before surgical intervention, the histopathological analysis suggested CA. CONCLUSIONS CA diagnosis can be complex, especially in a 22-year-old-man with atypical clinical and imaging manifestations. In this patient, other differential diagnoses were considered, since CA presenting in a young patient is a rare phenomenon and acute mitral regurgitation secondary to CTR presents more frequently in other heart conditions. Furthermore, rapid postoperative deterioration resulted in the patient's death before biopsy samples were available because suspicion of amyloidosis had not been raised until that point.

Case Report: Unusual Cause of Chest Pain: A Multi-Image Assessment of a Cardiac Mass.

Myxomas represent the most common benign primary cardiac tumor, they usually grow out of the interatrial septum into the left atrium with a pedunculated base. Intracardiac masses can be found incidentally on imaging studies, but symptomatology may arise secondary to the mass effect, embolization, and valvular function impairment. We present the case of a 75-year-old woman who arrived at the emergency department with atrial fibrillation and NSTEMI segment elevation myocardial infarction (NSTEMI) secondary to a highly vascularized neoplasm visible by coronary angiography and angiotomography. Scarce reports show high quality multi-imaging assessment of significantly vascularized myxomas with such atypical presentation. High-definition imaging studies played a fundamental role in the surgeon's management of a mass with a complex neovascularization.

Histopatología y Strain auricular en pericarditis constrictiva y miocardiopatía restrictiva / Histopathology and Atrial Strain in Constrictive Pericarditis and restrictive cardiomyopathy

Resumen La pericarditis constrictiva y la miocardiopatía restrictiva son enfermedades raras caracterizadas por síntomas de insuficiencia cardíaca congestiva. El objetivo de este estudio es mostrar el diagnóstico diferencial de estas dos patologías, mediante strain auricular y establecer su correlación con la histopatología de corazones correspondientes. Se analizan 2 casos clínicos representativos de cada una de estas patologías. Se analizan sus presentaciones clínicas, los datos ecocardiograficos y en ambos casos se realizaron biopsias endomiocardicas con lo cual se presenta la correlación histológica. El strain auricular permitió evaluar la afección de las aurículas, consideramos que el strain auricular disminuido podría estar relacionado con la presencia de fibrosis.

Abstract Histopathology and Atrial Strain in Constrictive Pericarditis and restrictive cardiomyopathy Constrictive pericarditis and restrictive cardiomyopathy are rare diseases characterized by congestive heart failure symptoms. The aim of this study is to show the differential diagnosis of these two pathologies using strain and to establish their correlation with histopathology of the corresponding hearts. Two representative clinical cases of each of these pathologies are analyzed. Their clinical presentations, echocardiographic data, and endomyocardial biopsies were performed in both cases, thus presenting the histological correlation. Atrial strain allowed us to evaluate the affection of the atria, we consider that decreased atrial strain could be related to the presence of fibrosis.

Design, manufacture and initial tests of a drug-eluting coronary stent / Diseño, fabricación y pruebas iniciales de una endoprótesis coronaria liberadora de fármaco

Abstract Introduction: A drug-eluting coronary stent is being developed at the National Institute of Cardiology of Mexico for the treatment of ischemic heart disease. Objective: To establish the best animal model for the tests, to show the advances in the drug-eluting stent prototype, to assess two drugs’ antiproliferative activity and histological results. Method: Smooth muscle cell culture tests were performed in order to assess sirolimus and paclitaxel antiproliferative properties. The drugs were encapsulated inside the polymeric matrix of the stents. Rabbits and pigs were used as animal models. Results: Sirolimus and paclitaxel showed an inhibitory effect, which was higher for the latter. Infrared spectroscopy and light and optical microscopy showed that the drug/polymer layer properly adhered to the stent. At a four-week follow-up, both animal models showed satisfactory clinical evolution and adequate histological response, although the porcine model was shown to be more suitable for future protocols. Conclusions: Preliminary tests of the drug-eluting stent provided bases for the development of a study protocol with an adequate number of pigs and with clinical angiographic and histopathological three-month follow-up.

Resumen Introducción: En el Instituto Nacional de Cardiología de México se desarrolla una endoprótesis (stent) coronaria liberadora de fármacos para el tratamiento de la cardiopatía isquémica. Objetivo: Establecer el mejor modelo animal para las pruebas, mostrar los avances en el prototipo del stent liberador de fármacos, evaluar la actividad antiproliferativa de dos fármacos y los resultados histológicos. Método: Se realizaron cultivos de células de músculo liso para evaluar las propiedades antiproliferativas de sirolimus y paclitaxel. Los fármacos fueron encapsulados en el interior de la matriz polimérica de los stents. Se emplearon conejos y cerdos como modelos animales. Resultados: Sirolimus y paclitaxel mostraron efecto inhibitorio, mayor en el segundo. La espectroscopia infrarroja y la microscopia óptica y electrónica mostraron que la capa del polímero con el fármaco se adhería adecuadamente al stent. A las cuatro semanas de seguimiento, ambos modelos animales mostraron evolución clínica satisfactoria y adecuada respuesta histológica, si bien el modelo porcino resultó más conveniente para protocolos futuros. Conclusiones: Las pruebas preliminares del stent liberador de fármaco brindó bases para desarrollar el protocolo con un número adecuado en cerdos y con seguimiento clínico angiográfico e histopatológico a tres meses.

DNA Vaccine Treatment in Dogs Experimentally Infected with Trypanosoma cruzi.

Chagas disease is a chronic and potentially lethal disorder caused by the parasite Trypanosoma cruzi, and an effective treatment has not been developed for chronic Chagas disease. The objective of this study was to determine the effectiveness of a therapeutic DNA vaccine containing T. cruzi genes in dogs with experimentally induced Chagas disease through clinical, pathological, and immunological analyses. Infection of Beagle dogs with the H8 T. cruzi strain was performed intraperitoneally with 3500 metacyclic trypomastigotes/kg body weight. Two weeks after infection, plasmid DNA immunotherapy was administered thrice at 15-day intervals. The clinical (physical and cabinet studies), immunological (antibody and cytokine profiles and lymphoproliferation), and macro- and microscopic pathological findings were described. A significant increase in IgG and cell proliferation was recorded after immunotherapy, and the highest stimulation index (3.02) was observed in dogs treated with the pBCSSP4 plasmid. The second treatment with both plasmids induced an increase in IL-1, and the third treatment with the pBCSSP4 plasmid induced an increase in IL-6. The pBCSP plasmid had a good Th1 response regulated by high levels of IFN-gamma and TNF-alpha, whereas the combination of the two plasmids did not have a synergistic effect. Electrocardiographic studies registered lower abnormalities and the lowest number of individuals with abnormalities in each group treated with the therapeutic vaccine. Echocardiograms showed that the pBCSSP4 plasmid immunotherapy preserved cardiac structure and function to a greater extent and prevented cardiomegaly. The two plasmids alone controlled the infection moderately by a reduction in the inflammatory infiltrates in heart tissue. The immunotherapy was able to reduce the magnitude of cardiac lesions and modulate the cellular immune response; the pBCSP treatment showed a clear Th1 response; and pBCSSP4 induced a balanced Th1/Th2 immune response that prevented severe cardiac involvement. The pBCSSP4 plasmid had a better effect on most of the parameters evaluated in this study; therefore, this plasmid can be considered an optional treatment against Chagas disease in naturally infected dogs.

Atorvastatin and Fenofibrate Exert Opposite Effects on the Vascularization and Characteristics of Visceral Adipose Tissue in New Zealand White Rabbits.

Statins may precipitate the onset of type 2 diabetes (T2D) in high-risk patients. In contrast, only the subset of individuals with insulin resistance and/or diabetes receives cardiovascular benefits with fibrates. In this context, previous observations from our laboratory suggested that atorvastatin induced an increase in visceral adipose tissue (VAT), whereas fenofibrate had the opposite effects in rabbits. Therefore, we determined the mass, morphology, and vascularization of VAT in New Zealand white rabbits (n = 6/group) that received 0.33 or 2.6 mg/kg/d of atorvastatin or fenofibrate, respectively, during 2 months. As expected, the cholesterol from the atorvastatin group was lower after treatment, while triglycerides decreased in the fenofibrate group. The mass of VAT from the fenofibrate group was 46% lower compared to the controls, meanwhile atorvastatin was associated with a larger diameter of adipocytes (+65%) than that of the control and fenofibrate groups. Fibroblast growth factor 2 (FGF2) gene expression was lower in the fenofibrate group than in the control group (-54%). By contrast, vascular endothelial growth factor A (VEGF-A) gene expression in fenofibrate-treated rabbits was 110% higher than in the control group. In agreement with the gene expression, the marker of angiogenesis platelet endothelial cell adhesion molecule 1 was slightly but significantly higher (+10%) in rabbits treated with fenofibrate than in controls, as determined by immunohistochemistry. These results suggest that fenofibrate is associated with a favorable remodeling of VAT, that is, reduced mass and increased vascularization in normolipemic rabbits; in contrast, atorvastatin induced a nonfavorable remodeling of VAT. These results may be related to the cardiovascular benefits of fenofibrate and the increased risk of T2D in high-risk patients induced by atorvastatin.

Misdiagnosis for right atrial mass: a case report.

INTRODUCTION: Patients with chronic kidney disease undergoing haemodialysis (HD) therapy have high morbidity and mortality, the main causes are cardiovascular events followed by infectious disease. Infectious problems originate from the vascular access, especially when such access is through a central venous catheter. CASE PRESENTATION: We described a 72-year-old man with end-stage renal disease, requiring HD, with fever and purulent discharge at the catheter insertion site. Transthoracic echocardiography revealed a 39 × 27 mm mobile mass in the right atrium. Magnetic resonance imaging showed a 53 × 45 × 36 mm mass suggesting myxoma. The patient underwent surgery and a mass of approximately 5 × 6 cm was found attached to the floor of the right atrium, next to the inferior vena cava outlet, without affecting the tricuspid valve or the interatrial septum. Histopathology reported infected thrombus. This case confirms that sometimes it is difficult to perform a differential diagnosis between intracardiac masses. The patient showed full clinical recovery during this period and was discharged. Currently, he is in good clinical condition and attends follow-up clinic of nephrology, regularly. DISCUSSION: In HD patients, a high index of suspicion is very important in the early recognition and management of infective endocarditis. Imaging studies are very useful for the diagnosis of intracardiac masses, but sometimes it is difficult to differentiate one mass from another. In our case, despite the multimodal approach, the histopathological study was the one that gave us the definitive diagnosis.

Immunohistochemical Diagnosis of Primary Cardiac Leiomyosarcoma in a Latin American Patient.

Primary cardiac malignancies are rare entities. Although sarcomas enclosed the main group of malignant heart neoplasms, primary cardiac leiomyosarcomas are extremely rare and constitutes less than 8% of cardiac tumors. Leiomyosarcoma usually originates from the pulmonary veins and have a worm-like shaped structure. In this article, we present a case of a 40-year-old Hispanic man diagnosed with a cardiac tumor who underwent surgical resection, during pathological examination the tissue samples were consistent with a malignancy of mesenchymal origin that contained irregular bundles of spindle cells. Subsequent immunohistochemical study categorized the mass as a primary heart leiomyosarcoma with positive smooth muscle actin and muscle specific actin. As usual in this type of malignancy, patient's clinical status declined overtime, recurrence was diagnosed two months after surgery, and four months after the procedure the patient was discharge for palliative care.

Participation of oleic acid in the formation of the aortic aneurysm in Marfan syndrome patients.

Marfan syndrome (MFS) is associated with progressive aortic dilatation and endothelial dysfunction that lead to early acute dissection and rupture of the aorta and sudden death. Alteration in fatty acid (FA) metabolism can stimulate nitric oxide (NO) overproduction which increases the activity of the inducible form of NO synthase (iNOS) that is involved in endothelial dysfunction. We evaluated the participation of FA in the formation of thoracic aneurysms in MFS and its relation to the iNOS. Oleic acid (OA), iNOS, citrulline, nitrates and nitrites, TGF-ß1, TNF-α, monounsaturated FA and NO synthase activity were significantly increased (p<0.05) in tissue from the aortas of MFS. Saturated FA, eNOS and HDL were significantly decreased (p<0.05). Arachidonic acid, delta-9 desaturase tended to increase and histological examination showed an increase in cystic necrosis, elastic fibers and collagen in MFS. The increase in OA contributes to the altered pathway of iNOS, which favors endothelial dysfunction and formation of the aortic aneurysms in MFS.

La cardiología en la obra anatomopatológica de G.B. Morgagni / Cardiology in the Morgagni's anatomo pathological work

En el siglo XVIII, bajo el influjo del <

In the XVIII century, under the influence of the <

About the specialized myocardial conducting tissue / Acerca del tejido miocárdico especializado de excitoconducción

The chronological succession of discoveries on the location and structure of the atrio-ventricular conducting system are described. The starting point of this system is located in the sinus atrial node, identified by the English scientists A. Keith and M. W. Flack in 1907. The atrioventricular conducting system was pointed out by the Swiss physician Wilhelm His Jr. in 1893. The atrioventricular node (AV) was first identified by the Japanese pathologist Sumao Tawara and his German professor Ludwig Aschoff in 1906. Likewise the structure and routes of the three internodal bundles are described. These bundles include: Bachmann's bundle (1916) connecting the right with the left atrium and the AV node; the middle Wenckebach's bundle (1910) and the posterior or Thorel's bundle (1910), extending from the region of the sinus atrial node towards the posterior margin of the AV node. Lastly, the ventricular left and right conduction systems are detailed. These include the main trunk and their peripheral subdivisions with respective networks. Regarding the controversial existence of the left middle subdivision, it can exist in animal and human hearts. Nevertheless, an intermediate left septal network of specialized fibers seems to act as a functional equivalent of this subdivision.

Se describe, en orden cronológico, la sucesión del descubrimiento de la localización y la estructura de los componentes del sistema de conducción auriculoventricular. El haz de conducción AV fue descrito por el médico suizo Wilhelm His Jr. en 1893. El punto de origen de dicho sistema se halla en el nodo sinoauricular, identificado por los ingleses A. Keith y M.W. Flack en 1907. El nodo auriculoventricular (AV) fue identificado por el patólogo japonés Sunao Tawara y su maestro, el alemán Ludwig Aschoff, en 1906. Asimismo se relatan la estructura y los recorridos de los 3 haces internodales: el anterior o de Bachmann (1916), que conecta la aurícula derecha con la izquierda y el nodo AV; el medio o haz de Wenckebach (1910) y el posterior o haz de Thórel (1910), que se dirige desde la región del nodo sinoauricular hacia la aurícula izquierda y el margen de atrás del nodo AV. Se presentan asimismo, de forma esquemática, los sistemas de conducción ventricular izquierdo y derecho, que comprenden el tronco principal y las subdivisiones periféricas con sus respectivas redes de Purkinje. Respecto a la controvertida existencia de un fascículo izquierdo medio, éste sí puede existir en corazones humanos y de animales. Pero la red septal intermedia de fibras especializadas parece ser un equivalente funcional de dicho fascículo.

Orígenes del conocimiento de la estructura y función del sistema cardiovascular / Gradual knowledge of the structure and function of the cardiovascular system

El léxico anatómico más antiguo se estableció por los sacerdotes egipcios, quienes ofrecían de forma ritual a los dioses todas las partes del cuerpo del difunto. Hacia el año 500 a. c. se iniciaron estudios de anatomía comparada por el médico Alcmeón de Crotona, autor del texto que, según Laín Entralgo, inicia formalmente la historia universal de la patología científica. Solamente en el siglo III a. C. en el Egipto tolemaico comenzaron a efectuarse disecciones en cadáveres humanos. En la época romana y en la Alta Edad Media, los médicos realizaban estudios anatómicos en humanos para descartar o confirmar sospechas de envenenamiento y en animales (monos, cerdos, etcétera) para extrapolar sus hallazgos al hombre. Pero en la Baja Edad Media (siglo XIV), se volvió al estudio directo del cuerpo humano. Dicho estudio alcanzó un gran auge en el siglo XVI, lo que llevó al descubrimiento de la circulación menor y, más tarde, de la circulación mayor de la sangre. En el siglo XVII llegó el estudio de la anatomía microscópica y, en el siglo XVIII, la sistematización de la anatomía patológica. En el siglo siguiente se impuso el cotejo anatomoclínico y, actualmente, se impone el auxilio de procedimientos tecnológicos de gabinete.

The first anatomical lexicon was established in old Egypt, Alexandria by the priests who ritually offered all the parts of the human corpses to their gods. About 500 years b. C. studies of comparative anatomy began due to the physician Alcmeon of Croton, author of the text seriously starting the history of scientific pathology according to Laín Entralgo. It was only during the III century b. C. that dissections of human corpses began at the famous Alexandrian School of Medicine in Ptolemaic Egypt. During the Roman era and in high Middle Ages, physicians carried out anatomical studies in humans in order to dismiss or confirm poisoning suspicions or to extrapolate their flindings in animals (monkeys, pigs, etc) to humans. However, in low Middle Ages (XIV century), direct studies in human corpses were performed once again. These studies reached their pinnacle in the XVI century allowing the discovery of the lesser blood circulation and later of the greater blood circulation. The XVII century saw the coming of microscopic anatomy and the XVIII century witnessed the zenith of pathological anatomy. These studies developed during the following century into clinical-anatomical comparison. Today the help of technological studies is mandatory.