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1.
Stem Cells Dev ; 33(11-12): 262-275, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38717965

RESUMO

Type 2 diabetes mellitus (T2DM) is associated with endothelial dysfunction, which results in delayed wound healing. Mesenchymal stem cells (MSCs) play a vital role in supporting endothelial cells (ECs) and promoting wound healing by paracrine effects through their secretome-containing extracellular vesicles. We previously reported the impaired wound healing ability of adipose tissue-derived MSC from T2DM donors; however, whether extracellular vesicles isolated from T2DM adipose tissue-derived MSCs (dEVs) exhibit altered functions in comparison to those derived from healthy donors (nEVs) is still unclear. In this study, we found that nEVs induced EC survival and angiogenesis, whereas dEVs lost these abilities. In addition, under high glucose conditions, nEV protected ECs from endothelial-mesenchymal transition (EndMT), whereas dEV significantly induced EndMT by activating the transforming growth factor-ß/Smad3 signaling pathway, which impaired the tube formation and in vivo wound healing abilities of ECs. Interestingly, the treatment of dEV-internalized ECs with nEVs rescued the induced EndMT effects. Of note, the internalization of nEV into T2DM adipose tissue-derived MSC resulted in the production of an altered n-dEV, which inhibited EndMT and supported the survival of T2DM db/db mice from severe wounds. Taken together, our findings suggest the role of dEV in endothelial dysfunction and delayed wound healing in T2DM by the promotion of EndMT. Moreover, nEV treatment can be considered a promising candidate for cell-free therapy to protect ECs in T2DM.


Assuntos
Diabetes Mellitus Tipo 2 , Células Endoteliais , Vesículas Extracelulares , Glucose , Células-Tronco Mesenquimais , Transdução de Sinais , Proteína Smad3 , Fator de Crescimento Transformador beta , Células-Tronco Mesenquimais/metabolismo , Células-Tronco Mesenquimais/citologia , Vesículas Extracelulares/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/patologia , Humanos , Fator de Crescimento Transformador beta/metabolismo , Proteína Smad3/metabolismo , Glucose/metabolismo , Glucose/farmacologia , Animais , Camundongos , Células Endoteliais/metabolismo , Masculino , Tecido Adiposo/citologia , Tecido Adiposo/metabolismo , Transição Epitelial-Mesenquimal , Cicatrização , Feminino , Células Cultivadas , Células Endoteliais da Veia Umbilical Humana/metabolismo , Transição Endotélio-Mesênquima
2.
Front Oncol ; 14: 1346312, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38515582

RESUMO

Introduction: SARS-CoV-2 infection increases the risk of worse outcomes in cancer patients, including those with breast cancer. Our previous study reported that the SARS-CoV-2 membrane protein (M-protein) promotes the malignant transformation of triple-negative breast cancer cells (triple-negative BCC). Methods: In the present study, the effects of M-protein on the ability of extracellular vesicles (EV) derived from triple-negative BCC to regulate the functions of tissue stem cells facilitating the tumor microenvironment were examined. Results: Our results showed that EV derived from M-protein-induced triple-negative BCC (MpEV) significantly induced the paracrine effects of adipose tissue-derived mesenchymal stem cells (ATMSC) on non-aggressive BCC, promoting the migration, stemness phenotypes, and in vivo metastasis of BCC, which is related to PGE2/IL1 signaling pathways, in comparison to EV derived from normal triple-negative BCC (nEV). In addition to ATMSC, the effects of MpEV on endothelial progenitor cells (EPC), another type of tissue stem cells, were examined. Our data suggested that EPC uptaking MpEV acquired a tumor endothelial cell-like phenotype, with increasing angiogenesis and the ability to support the aggressiveness and metastasis of non-aggressive BCC. Discussion: Taken together, our findings suggest the role of SARS-CoV-2 M-protein in altering the cellular communication between cancer cells and other non-cancer cells inside the tumor microenvironment via EV. Specifically, M-proteins induced the ability of EV derived from triple-negative BCC to promote the functions of non-cancer cells, such as tissue stem cells, in tumorigenesis.

3.
Stem Cells Dev ; 32(19-20): 592-605, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37392019

RESUMO

Glucocorticoids are common anti-inflammatory factors; however, they have been reported to have side effects that delay the wound healing process. In a previous study, we found that mesenchymal stem cells isolated from the adipose tissue of patients with long-term glucocorticoid treatment (sAT-MSC) showed impaired wound healing ability due to the downregulation of SDF-1. In this study, we aimed to clarify the mechanisms by which SDF-1 is regulated in sAT-MSC by focusing on the roles of hypoxia-inducible factors (HIFs). Our data suggested that sAT-MSC showed impairment of HIF-1α and the upregulation of HIF-2α. Notably, HIF-2α impairment resulted in the compensatory overexpression of HIF-1α and its target gene SDF-1, which improved the wound healing ability of sAT-MSC. In addition, using knockdown/knockout heterozygous HIF-2α kd/null mice (kd/null), the functions of HIF-2α in the ischemic wound healing process were clarified. With a 50% reduction in the expression of HIF-2α, kd/null mice showed significantly induced wound healing effects, which are involved in the promotion of the inflammatory phase. Specifically, kd/null mice showed the compensatory overexpression of HIF-1α, which upregulated the expression of SDF-1 and enhanced the recruitment of inflammatory cells, such as neutrophils. Our study highlighted the novel function of HIF-2α in the inflammation phase of the wound healing process through the HIF-1α/SDF-1 axis, suggesting that the physiological state of the impaired expression of HIF-2α is a new concept for wound therapy.


Assuntos
Fatores de Transcrição Hélice-Alça-Hélice Básicos , Células-Tronco Mesenquimais , Animais , Humanos , Camundongos , Fatores de Transcrição Hélice-Alça-Hélice Básicos/genética , Fatores de Transcrição Hélice-Alça-Hélice Básicos/metabolismo , Subunidade alfa do Fator 1 Induzível por Hipóxia/genética , Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Células-Tronco Mesenquimais/metabolismo , Ativação Transcricional , Regulação para Cima , Cicatrização/genética
4.
Sci Rep ; 12(1): 13550, 2022 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-35941273

RESUMO

Triple negative breast cancer (TNBC) is associated with worse outcomes and results in high mortality; therefore, great efforts are required to find effective treatment. In the present study, we suggested a novel strategy to treat TNBC using mesenchymal stem cell (MSC)-derived extracellular vesicles (EV) to transform the behaviors and cellular communication of TNBC cells (BCC) with other non-cancer cells related to tumorigenesis and metastasis. Our data showed that, BCC after being internalized with EV derived from Wharton's Jelly MSC (WJ-EV) showed the impaired proliferation, stemness properties, tumorigenesis and metastasis under hypoxic conditions. Moreover, these inhibitory effects may be involved in the transfer of miRNA-125b from WJ-EV to BCC, which downregulated the expression of HIF1α and target genes related to proliferation, epithelial-mesenchymal transition, and angiogenesis. Of note, WJ-EV-internalized BCC (wBCC) showed transformed behaviors that attenuated the in vivo development and metastatic ability of TNBC, the angiogenic abilities of endothelial cells and endothelial progenitor cells and the generation of cancer-associated fibroblasts from MSC. Furthermore, wBCC generated a new EV with modified functions that contributed to the inhibitory effects on tumorigenesis and metastasis of TNBC. Taken together, our findings suggested that WJ-EV treatment is a promising therapy that results in the generation of wBCC to interrupt the cellular crosstalk in the tumor environment and inhibit the tumor progression in TNBC.


Assuntos
Vesículas Extracelulares , Células-Tronco Mesenquimais , MicroRNAs , Neoplasias de Mama Triplo Negativas , Geleia de Wharton , Carcinogênese/genética , Carcinogênese/metabolismo , Diferenciação Celular , Proliferação de Células , Células Cultivadas , Células Endoteliais , Humanos , Células-Tronco Mesenquimais/metabolismo , MicroRNAs/metabolismo , Transdução de Sinais , Neoplasias de Mama Triplo Negativas/genética , Neoplasias de Mama Triplo Negativas/metabolismo , Neoplasias de Mama Triplo Negativas/terapia , Geleia de Wharton/metabolismo
5.
Stem Cells Dev ; 31(21-22): 659-671, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35734905

RESUMO

Triple-negative breast cancer (TNBC) is a highly aggressive and invasive type of breast cancer. In addition, type 2 diabetes mellitus (T2DM) is recognized as a risk factor for cancer metastasis, which is associated with mortality in patients with breast cancer. Cancer-associated fibroblasts (CAFs) generated from adipose tissue-derived mesenchymal stem cells (AT-MSCs) play a vital role in the progression of TNBC. However, to date, whether T2DM affects the ability of AT-MSCs to differentiate into CAFs is still unclear. In this study, we found that in coculture with TNBC cells [breast cancer cells (BCCs)] under hypoxic conditions, AT-MSCs derived from T2DM donors (dAT-MSCs) were facilitated to differentiate into CAFs, which showed fibroblastic morphology and the induced expression of fibroblastic markers, such as fibroblast activation protein, fibroblast-specific protein, and vimentin. This was involved in the higher expression of transforming growth factor beta receptor 2 (TGFßR2) and the phosphorylation of Smad2/3. Furthermore, T2DM affected the fate and functions of CAFs derived from dAT-MSCs. While CAFs derived from AT-MSCs of healthy donors (AT-CAFs) exhibited the markers of inflammatory CAFs, those derived from dAT-MSCs (dAT-CAFs) showed the markers of myofibroblastic CAFs. Of note, in comparison with AT-CAFs, dAT-CAFs showed a higher ability to induce the proliferation and in vivo metastasis of BCCs, which was involved in the activation of the transforming growth factor beta (TGFß)-Smad2/3 signaling pathway. Collectively, our study suggests that T2DM contributes to metastasis of BCCs by inducing the myofibroblastic CAFs differentiation of dAT-MSCs. In addition, targeting the TGFß-Smad2/3 signaling pathway in dAT-MSCs may be useful in cancer therapy for TNBC patients with T2DM.


Assuntos
Neoplasias da Mama , Fibroblastos Associados a Câncer , Diabetes Mellitus Tipo 2 , Células-Tronco Mesenquimais , Neoplasias de Mama Triplo Negativas , Humanos , Feminino , Fibroblastos Associados a Câncer/metabolismo , Fibroblastos Associados a Câncer/patologia , Neoplasias de Mama Triplo Negativas/metabolismo , Neoplasias de Mama Triplo Negativas/patologia , Neoplasias da Mama/patologia , Diabetes Mellitus Tipo 2/metabolismo , Linhagem Celular Tumoral , Fibroblastos , Fator de Crescimento Transformador beta/metabolismo
6.
Gen Thorac Cardiovasc Surg ; 70(3): 292-294, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35038125

RESUMO

Reports of early and catastrophic acute structural valve deterioration (SVD) in Trifecta valve (Abbott, St Paul, MN, USA) with multiple leaflet detachment are rare. We encountered two cases of early SVD in Trifecta valve with tears on two leaflets. Both cases presented with acute heart failure because of aortic insufficiency, and underwent redo aortic valve replacement; one patient died due to multiple organ failure caused by cardiogenic shock. Durability issues with the Trifecta valves; thus, necessitates long-term vigilance in aortic replacement patients.


Assuntos
Insuficiência da Valva Aórtica , Bioprótese , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/cirurgia , Bioprótese/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Desenho de Prótese , Falha de Prótese
7.
Gen Thorac Cardiovasc Surg ; 70(4): 386-389, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34993904

RESUMO

Median sternotomy near an existing tracheostoma risks deep sternal wound infection after cardiac surgery. We present herein a case of acute type A aortic dissection in a patient with a permanent tracheostoma after laryngectomy. Total arch replacement with both frozen elephant trunk and extra-anatomical bypass for supra-aortic trunks was performed through T-shaped partial sternotomy, resulting in recovery without deep sternal wound infection.


Assuntos
Aneurisma da Aorta Torácica , Dissecção Aórtica , Implante de Prótese Vascular , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Humanos , Stents , Esternotomia/métodos , Traqueostomia/efeitos adversos , Resultado do Tratamento
8.
Stem Cells Dev ; 30(15): 758-772, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34074129

RESUMO

Cytokine storm is recognized as one of the factors contributing to organ failures and mortality in patients with COVID-19. Due to chronic inflammation, COVID-19 patients with diabetes mellitus (DM) or renal disease (RD) have more severe symptoms and higher mortality. However, the factors that contribute to severe outcomes of COVID-19 patients with DM and RD have received little attention. In an effort to investigate potential treatments for COVID-19, recent research has focused on the immunomodulation functions of mesenchymal stem cells (MSCs). In this study, the correlation between DM and RD and the severity of COVID-19 was examined by a combined approach with a meta-analysis and experimental research. The results of a systematic review and meta-analysis suggested that the odd of mortality in patients with both DM and RD was increased in comparison to those with a single comorbidity. In addition, in the experimental research, the data showed that high glucose and uremic toxins contributed to the induction of cytokine storm in human lung adenocarcinoma epithelial cells (Calu-3 cells) in response to SARS-CoV Peptide Pools. Of note, the incorporation of Wharton's jelly MSC-derived extracellular vesicles (WJ-EVs) into SARS-CoV peptide-induced Calu-3 resulted in a significant decrease in nuclear NF-κB p65 and the downregulation of the cytokine storm under high concentrations of glucose and uremic toxins. This clearly suggests the potential for WJ-EVs to reduce cytokine storm reactions in patients with both chronic inflammation diseases and viral infection.


Assuntos
Síndrome da Liberação de Citocina/prevenção & controle , Vesículas Extracelulares/fisiologia , Células-Tronco Mesenquimais/citologia , SARS-CoV-2/fisiologia , Geleia de Wharton/citologia , Adulto , Idoso , COVID-19/sangue , COVID-19/complicações , COVID-19/metabolismo , COVID-19/terapia , Células Cultivadas , Técnicas de Cocultura , Síndrome da Liberação de Citocina/genética , Síndrome da Liberação de Citocina/metabolismo , Síndrome da Liberação de Citocina/virologia , Citocinas/genética , Citocinas/metabolismo , Complicações do Diabetes/sangue , Complicações do Diabetes/metabolismo , Complicações do Diabetes/terapia , Complicações do Diabetes/virologia , Diabetes Mellitus/sangue , Diabetes Mellitus/metabolismo , Diabetes Mellitus/terapia , Diabetes Mellitus/virologia , Relação Dose-Resposta a Droga , Feminino , Regulação da Expressão Gênica/efeitos dos fármacos , Glucose/metabolismo , Glucose/farmacologia , Humanos , Mediadores da Inflamação/metabolismo , Masculino , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/fisiologia , Gravidez , Toxinas Biológicas/metabolismo , Toxinas Biológicas/farmacologia , Cordão Umbilical/citologia , Uremia/sangue , Uremia/complicações , Uremia/metabolismo , Uremia/terapia
9.
Sci Rep ; 10(1): 17315, 2020 10 14.
Artigo em Inglês | MEDLINE | ID: mdl-33057147

RESUMO

Aging induces numerous cellular disorders, such as the elevation of reactive oxygen species (ROS), in a number type of cells, including mesenchymal stem cells (MSCs). However, the correlation of ROS and impaired healing abilities as well as whether or not the inhibition of elevating ROS results in the rejuvenation of elderly MSCs is unclear. The rejuvenation of aged MSCs has thus recently received attention in the field of regenerative medicine. Specifically, extracellular vesicles (EVs) act as a novel tool for stem cell rejuvenation due to their gene transfer ability with systemic effects and safety. In the present study, we examined the roles of aging-associated ROS in the function and rejuvenation of elderly MSCs by infant EVs. The data clearly showed that elderly MSCs exhibited the downregulation of superoxide dismutase (SOD)1 and SOD3, which resulted in the elevation of ROS and downregulation of the MEK/ERK pathways, which are involved in the impairment of the MSCs' ability to decrease necrotic area in the skin flap model. Furthermore, treatment with the antioxidant Edaravone or co-overexpression of SOD1 and SOD3 rescued elderly MSCs from the elevation of ROS and cellular senescence, thereby improving their functions. Of note, infant MSC-derived EVs rejuvenated elderly MSCs by inhibiting ROS production and the acceleration of cellular senescence and promoting the proliferation and in vivo functions in both type 1 and type 2 diabetic mice.


Assuntos
Vesículas Extracelulares/fisiologia , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais , Espécies Reativas de Oxigênio/metabolismo , Rejuvenescimento/fisiologia , Envelhecimento/metabolismo , Animais , Senescência Celular/fisiologia , Diabetes Mellitus Experimental/metabolismo , Humanos , Sistema de Sinalização das MAP Quinases , Células-Tronco Mesenquimais/metabolismo , Camundongos , Superóxido Dismutase/metabolismo , Superóxido Dismutase-1/metabolismo
10.
Stem Cells Dev ; 29(21): 1382-1394, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32900278

RESUMO

Cancer metastasis is the leading cause of mortality among breast cancer patients. Type 2 diabetes mellitus (T2DM) has been suggested as a risk factor of breast cancer; however, whether or not T2DM is associated with breast tumor metastasis remains unclear. In this study, we examined the involvement of T2DM with breast cancer metastasis by a combined approach of a meta-analysis and experimental research. The results of a systematic review and meta-analysis suggested that diabetes significantly increases the risk of lymph node metastasis by 1.10-fold (P < 0.01). Consistently, our data from experimental research showed that T2DM induced paracrine effects of mesenchymal stem cells (MSCs), a key contributor to cancer progression, to stimulate metastasis of breast cancer cells (BCCs) by two independent mechanisms. First, T2DM induced the excess secretion of interleukin 6 (IL6) from MSCs, which activated the JAK/STAT3 pathway in BCCs, thus promoting the metastasis of BCCs. Second, beside the EGR-1-/IL6-dependent mechanism, T2DM altered the functions of MSC-derived extracellular vesicles (EVs), which are highly associated with the metastasis of BCCs. Our present study showed that T2DM is a risk factor for breast cancer metastasis, and MSC-derived EVs might be useful for developing a novel anti-breast cancer therapy strategy.


Assuntos
Neoplasias da Mama/patologia , Diabetes Mellitus Tipo 2/patologia , Vesículas Extracelulares/metabolismo , Células-Tronco Mesenquimais/metabolismo , Comunicação Parácrina , Tecido Adiposo/patologia , Animais , Linhagem Celular Tumoral , Movimento Celular , Proteína 1 de Resposta de Crescimento Precoce/farmacologia , Vesículas Extracelulares/efeitos dos fármacos , Feminino , Humanos , Interleucina-6/farmacologia , Janus Quinases/metabolismo , Masculino , Células-Tronco Mesenquimais/efeitos dos fármacos , Camundongos Endogâmicos C57BL , Modelos Biológicos , Metástase Neoplásica , Comunicação Parácrina/efeitos dos fármacos , Fator de Transcrição STAT3/metabolismo , Transdução de Sinais/efeitos dos fármacos
11.
J Card Surg ; 34(6): 511-513, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31017327

RESUMO

A 75-year-old woman presented at a prior hospital with persistent cough and was treated conservatively for a thrombosed-type aortic dissection (Stanford A). One-year after discharge, follow-up computerized tomography revealed a DeBakey type II, chronic dissecting aortic aneurysm enlarged to 54 mm. She was referred to our hospital with slight edema in the face and extremities and chest radiography showed calcification around the heart. Computerized tomography performed at the prior hospital showed a large spherical mass in the anterior pericardium in addition to the aortic dissection. We therefore resected the mass immediately before a total aortic arch replacement. Surgery was successful and uneventful with patient discharge on postoperative day 21. The final differential diagnosis was idiopathic, localized, constrictive pericarditis.


Assuntos
Aorta Torácica/cirurgia , Aneurisma Aórtico/cirurgia , Dissecção Aórtica/cirurgia , Implante de Prótese Vascular/métodos , Calcinose/cirurgia , Cardiomiopatias/cirurgia , Pericardite Constritiva/complicações , Pericardite Constritiva/cirurgia , Pericárdio/cirurgia , Idoso , Dissecção Aórtica/complicações , Dissecção Aórtica/diagnóstico por imagem , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Calcinose/etiologia , Calcinose/patologia , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/etiologia , Cardiomiopatias/patologia , Doença Crônica , Feminino , Humanos , Pericardite Constritiva/patologia , Pericárdio/diagnóstico por imagem , Pericárdio/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
Ann Vasc Dis ; 11(2): 248-251, 2018 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-30116421

RESUMO

Two-dimensional perfusion angiography (2DPA) is utilized in hybrid operating rooms. 2DPA produces color map images and functional parameters to provide more robust visual and quantitative evaluations than conventional angiography. Its efficacy was suggested in five patients following bypass surgery; unexpected results were obtained in one patient, leading to a decision to perform surgical re-anastomosis. Furthermore, we found that the general anesthesia eliminates body movements that tend to disrupt 2DPA results. 2DPA was more useful during surgical revascularization than conventional angiography and provided more detailed information.

13.
Gen Thorac Cardiovasc Surg ; 65(11): 646-649, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28150060

RESUMO

A 49-year-old man was transferred to our hospital by ambulance due to blunt chest trauma sustained in a car accident. Echocardiography and enhanced computed tomography showed hemopericardium without other vital organ damage. Emergent surgery was performed under strong suspicion of traumatic cardiac rupture. Careful inspection showed a rupture of the right upper pulmonary vein at the junction of the left atrium, a laceration of the inferior vena cava, and a left-side pericardium rupture, and they were repaired with running 4-0 polypropylene suture. Postoperative hemodynamics were stable. The patient was discharged ambulatory on postoperative day 15.


Assuntos
Átrios do Coração/lesões , Veias Pulmonares/lesões , Traumatismos Torácicos/complicações , Lesões do Sistema Vascular/etiologia , Ferimentos não Penetrantes/complicações , Procedimentos Cirúrgicos Cardíacos/métodos , Ecocardiografia , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/fisiopatologia , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Ruptura , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/fisiopatologia , Tomografia Computadorizada por Raios X , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/cirurgia , Ferimentos não Penetrantes/fisiopatologia , Ferimentos não Penetrantes/cirurgia
14.
Ann Vasc Surg ; 39: 290.e17-290.e20, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27908813

RESUMO

We report a coil embolization-assisted thoracic endovascular aortic repair technique successfully applied to multiple saccular descending aortic aneurysms in a 74-year-old man. Because of the most distal aneurysm being located at the celiac trunk level and the distance between the superior mesenteric artery and the aneurysm being only 10 mm, a coil embolization of the distal saccular aneurysm was performed before stent delivery to secure a sufficient landing zone. Postoperative computed tomography showed an appropriate positioning of the endovascular devices without endoleak. This coil embolization-assisted technique may extend the indication of the endovascular aortic repair when a saccular aneurysm has an insufficient landing zone.


Assuntos
Aneurisma da Aorta Torácica/terapia , Implante de Prótese Vascular , Embolização Terapêutica , Procedimentos Endovasculares , Idoso , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aortografia/métodos , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Tomografia Computadorizada Multidetectores , Stents , Resultado do Tratamento
15.
Ann Thorac Cardiovasc Surg ; 22(6): 340-347, 2016 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-27725352

RESUMO

PURPOSE: There is less certainty regarding the best strategy for treating neonates with functional single ventricle (SV) and hypoplastic aortic arch. We have applied a modified extended aortic arch anastomosis (EAAA) and main pulmonary artery banding (PAB) as an initial palliation in neonates with transverse arch hypoplasia and assessed the mid-term outcomes. METHODS: In total, 10 neonates with functional SV and extensive hypoplasia or interruption of the arch underwent a modified EAAA (extended arch anastomosis with a subclavian flap) concomitant with main PAB through a thoracotomy without cardiopulmonary bypass. Patient age and weight ranged from 4 to 14 days and 2.3 to 3.8 kg, respectively. RESULTS: There were no hospital deaths although there were two late deaths. Gradients across the arch were 0 to 7 mmHg at postoperative day 1 and no arch reoperations were required. Two patients required balloon aortoplasty. Nine underwent bidirectional cavopulmonary shunt and two of them needed concomitant Damus-Kaye-Stansel (DKS) anastomosis. Six have completed Fontan. CONCLUSION: Our modification of EAAA with main PAB for SV neonates may benefit a certain population with transverse arch hypoplasia as an option to be considered. Patients with the potential for developing outflow obstruction may be best managed with an initial DKS-type palliation.


Assuntos
Anormalidades Múltiplas , Aorta Torácica/cirurgia , Cardiopatias Congênitas/cirurgia , Ventrículos do Coração/cirurgia , Artéria Pulmonar/cirurgia , Anastomose Cirúrgica , Aorta Torácica/anormalidades , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Aortografia/métodos , Técnica de Fontan , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/fisiopatologia , Ventrículos do Coração/anormalidades , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Recém-Nascido , Cuidados Paliativos , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/fisiopatologia , Estudos Retrospectivos , Artéria Subclávia/cirurgia , Retalhos Cirúrgicos , Toracotomia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
16.
Kyobu Geka ; 69(9): 787-91, 2016 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-27476570

RESUMO

We report a case of successful aortic valve replacement and relief of right and left ventricular outflow tract obstruction 8 years after an arterial switch operation for double outlet right ventricle. Since the surgical access to the ascending aorta was limited because of the anatomical feature and the adhesion after the arterial switch operation, arterial infusion site for cardiopulmonary bypass was secured at the right common carotid artery ahead of the sternal re-entry. After cardiopulmonary bypass was established, the right pulmonary artery was divided and then dissection of the ascending aorta was completed to secure the space for aortic valve replacement. A discrete membrane of the left ventricular outflow and muscle bands of the right ventricular outflow were completely resected. The right pulmonary artery was reconstructed by interpose of a prosthetic graft. Our experience would provide a technical option how to handle complex late complications after the arterial switch operation.


Assuntos
Obstrução do Fluxo Ventricular Externo/cirurgia , Valva Aórtica/cirurgia , Transposição das Grandes Artérias , Criança , Comunicação Interventricular/cirurgia , Próteses Valvulares Cardíacas , Humanos , Masculino , Resultado do Tratamento
17.
Gen Thorac Cardiovasc Surg ; 64(10): 597-603, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27393332

RESUMO

OBJECTIVES: Pulmonary arterial hypertension (PAH) is a progressive disease which causes increased vascular resistance. In this study, our purpose was to quantify the micro-vascular remodeling in monocrotaline-induced PAH rats using synchrotron radiation pulmonary micro-angiography (SRPA), a method we have previously established in an in vivo rat model. To determine the relationship between endothelial function and vascular remodeling, the local expression of endothelin-1 (ET-1), endothelial nitric oxide synthase (eNOS) and vascular endothelial growth factor (VEGF) was evaluated using immunohistochemical staining. METHODS: Monocrotaline-induced PAH rats were created by subcutaneous injection of monocrotaline. After 2 weeks, SRPA was performed at the Photon Factory of the High Energy Accelerator Research Organization. The internal diameters of pulmonary arterioles were measured using SRPA images. Semi-quantified analyses of ET-1, eNOS and VEGF expression in pulmonary arterioles were performed by immunohistochemical staining. RESULTS: Micro-vascular density and the internal diameters of pulmonary arterioles were significantly decreased in PAH. ET-1 expression was significantly increased in PAH compared with the control (1.53 ± 0.45 vs. 0.80 ± 0.14) and eNOS expression was significantly decreased in PAH compared with the control (1.12 ± 0.59 vs. 1.91 ± 0.66), although VEGF expression did not differ between the groups. CONCLUSIONS: SRPA can be effectively used for visualizing the decreased pulmonary micro-vasculature associated with PAH. Increased ET-1 expression and decreased eNOS expression may contribute to the proliferation and vasospasm of pulmonary arterioles induced by endothelial dysfunction due to PAH. This SRPA technology may help to identify a correlation between endothelial function and micro-vasculature remodeling in PAH.


Assuntos
Endotélio Vascular/fisiopatologia , Hipertensão Pulmonar/fisiopatologia , Remodelação Vascular/fisiologia , Angiografia/métodos , Animais , Pressão Arterial/fisiologia , Arteríolas/diagnóstico por imagem , Arteríolas/patologia , Endotélio Vascular/diagnóstico por imagem , Hipertensão Pulmonar/induzido quimicamente , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/diagnóstico por imagem , Hipertrofia , Pulmão/irrigação sanguínea , Masculino , Monocrotalina , Óxido Nítrico Sintase Tipo III , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/fisiopatologia , Ratos , Ratos Sprague-Dawley , Síncrotrons , Trombose/etiologia , Fator A de Crescimento do Endotélio Vascular
18.
Gen Thorac Cardiovasc Surg ; 57(1): 33-6, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19160009

RESUMO

We report herein a case of subdural hematoma following aortic root and subtotal aortic arch replacement with selective cerebral perfusion in a 78-year-old woman. Her level of consciousness gradually deteriorated on postoperative day (POD) 2. Subdural hematoma, including fresh bleeding in bilateral frontal and parietal regions, was detected on brain computed tomography (CT) on POD 3. No head injury had been sustained previously. As the brain was not under pressure and disturbance of consciousness improved the next day, she was observed conservatively with follow-up brain CT. The subdural hematoma disappeared within about 2 months. The patient recovered completely and was discharged without sequelae.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Hematoma Subdural/etiologia , Idoso , Aneurisma da Aorta Torácica/fisiopatologia , Ponte Cardiopulmonar , Circulação Cerebrovascular , Feminino , Hematoma Subdural/diagnóstico por imagem , Hematoma Subdural/terapia , Humanos , Perfusão , Tomografia Computadorizada por Raios X
19.
Surg Today ; 36(6): 534-7, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16715424

RESUMO

We report a case of invasive thymoma with intracardiac extension, resulting from the progression of intracaval growth, in a 56-year-old woman. Initially, the patient received two courses of chemotherapy, but the tumor showed only a modest response; however, subsequent radiotherapy reduced the tumor size further and the intracardiac lesion disappeared, making it possible to excise the tumor without cardiopulmonary bypass. Thus, when a thymoma does not respond well, we recommend radiotherapy as another treatment option, because its effects may allow for less invasive and more complete tumor excision.


Assuntos
Átrios do Coração/patologia , Timoma/patologia , Timoma/terapia , Neoplasias do Timo/patologia , Neoplasias do Timo/terapia , Terapia Combinada , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica
20.
Free Radic Res ; 40(2): 127-33, 2006 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-16390821

RESUMO

We measured the hydroxyl radical (.OH) generation in fourteen patients undergoing coronary artery bypass grafting (CABG), of whom seven patients underwent on-pump CABG with cardiopulmonary bypass (CPB) and seven patients underwent off-pump CABG without CPB. To detect .OH generation, we measured the urinary excretion of .OH products of creatinine (Cr), creatol (CTL; 5-hydroxycreatinine) and methylguanidine (MG) with HPLC using the one point sampling and collected urine during and after the operation. The urinary CTL value corrected urinary Cr value of on-pump CABG significantly increased about 3-5 times from the beginning of CPB to 4 h after operation compared to the baseline value before CPB in both the collected urine and the one point sampling urine. The urinary MG/Cr value in both groups did not change significantly. Significantly increased .OH generation was found during and soon after on-pump CABG.


Assuntos
Ponte Cardiopulmonar , Ponte de Artéria Coronária , Radical Hidroxila/metabolismo , Idoso , Cromatografia Líquida de Alta Pressão , Creatinina/análogos & derivados , Creatinina/urina , Feminino , Humanos , Masculino , Metilguanidina/urina
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