[Unilateral Pulmonary Edema during Aortic Valve Replacement through Median Sternotomy].

Unilateral pulmonary edema (UPE) has been reported as a re-expansion pulmonary edema that occurs following rapid re-expansion of a collapsed lung in a patient with pneumothorax or large volume of pleural fluid. Recently, UPE after minimally invasive cardiac surgery through right-sided thoracotomy has received considerable attention because of its increasing morbidity and mortality. However, development of UPE in patients undergoing cardiac surgery through median sternotomy has not generally been recognized. Herein, we present our experience of UPE of the right lung after aortic valve replacement through median sternotomy. UPE may reflect ventilation-induced lung injury in concomitant systemic inflammation by cardiopulmonary bypass. Heterogeneity of lung collapse and wide pleural opening, which induced lung overdistension during recruitement, were considered to be associated with the occurrence of UPE in this case. Preventive measures should be considered for patients with multiple risk factors, and a meticulous recruitment maneuver is required for lung re-expansion during cardiac surgery.

[Adult Cor Triatriatum Found by Chance at the Onset of Myocardial Infarction].

Cor triatriatum sinister is a rare congenital heart disease in which the left atrium is divided into 2 chambers by a membrane, causing resistance to the blood flow to the left ventricle. The onset of symptoms depends upon the effective size of the orifice in the membrane and the associated heart disease. Our case is a 67-year-old woman with cor triatriatum found by chance at the onset of myocardial infarction. Coronary artery bypass surgery and excision of the membrane were successfully performed. Preoperative left ventricular dysfunction was improved after surgery. Imaging examinations such as enhanced computed tomography(CT) and magnetic resonance imaging(MRI) were useful for selecting surgical approach.

Usefulness of serum cardiac troponins T and I to predict cardiac molecular changes and cardiac damage in patients with hypertrophic cardiomyopathy.

Cardiac troponins provide diagnostic and prognostic information on ischemic heart disease, but their roles in hypertrophic cardiomyopathy (HCM) are unclear. We sought to investigate the associations between elevated serum cardiac troponins T (cTnT) and I (cTnI) levels and cardiac injury in patients with HCM. We measured serum cTnT and cTnI in a peripheral vein of 73 consecutive HCM patients in stable condition. In addition, to examine the transcardiac release of cTnT and that of cTnI, we measured them in the aortic root and coronary sinus. Mitochondrial- and Ca(2+)-handling-related gene expression assays were analyzed by endomyocardial biopsy specimens. Based on the median value of serum cTnT, we divided the patients into two groups [group A: cTnT < 0.008 ng/mL, (n = 35), group B: cTnT group ≥ 0.008 ng/mL, (n = 38)]. Left ventricular (LV) mass index was significantly higher, while LV ejection fraction was significantly lower, in group B than in group A. Meanwhile, there was a significantly positive correlation between the transcardiac gradient of serum cTnT or cTnI, and the mRNA level of troponin I3 (r = 0.473, r = 0.516, respectively). The mRNA level of troponin T2 significantly correlated with mRNA levels of sarco-endoplasmic reticulum Ca(2+)-ATPase 2, cytochrome c oxidase subunit 5B, and troponin I3 (r = 0.486, r = 0.957, r = 0.633, respectively). These findings indicate that both elevated serum cTnT and cTnI might be associated with cardiac dysfunction in patients with HCM, resulting from the impairment of mitochondrial function and Ca(2+)-handling protein.

Relationship of myocardial fibrosis to left ventricular and mitochondrial function in nonischemic dilated cardiomyopathy--a comparison of focal and interstitial fibrosis.

BACKGROUND: Mitochondrial damage is associated with histologic myocardial fibrosis. Late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) can be used to identify focal fibrosis. We examined whether myocardial fibrosis on CMR and collagen volume fraction (CVF) from biopsies correlated with left ventricular (LV) and mitochondrial function in patients with nonischemic dilated cardiomyopathy (DCM). METHODS AND RESULTS: Fifty-nine DCM patients underwent CMR, cardiac catheterization, and endomyocardial biopsy. Minimum first derivative of LV pressure (LVdP/dt(min)) was measured as an index of LV relaxation. Mitochondrial RNA expression was also analyzed. For quantitative analysis of myocardial fibrosis, percentage LGE (%LGE) and CVF were calculated. Patients were divided into 2 groups on the basis of the presence (LGE group; n = 27) or absence (non-LGE group; n = 32) of LGE. Mean CVF and absolute value of LVdP/dt(min) were significantly higher and lower, respectively, in the LGE group than in the non-LGE group. Multivariate analysis revealed that %LGE was an independent determinant of LVdP/dt(min). The abundance of mitochondrial enzyme mRNA was significantly lower in the LGE group. CONCLUSIONS: Noninvasive CMR imaging is more useful in predicting diastolic dysfunction than invasive histologic assessments. In addition, it might indicate mitochondrial dysfunction in DCM.