Development of an Injectable, ECM-Derivative Embolic for the Treatment of Cerebral Saccular Aneurysms.

Cerebral aneurysms are a source of neurological morbidity and mortality, most often as a result of rupture. The most common approach for treating aneurysms involves endovascular embolization using nonbiodegradable medical devices, such as platinum coils. However, the need for retreatment due to the recanalization of coil-treated aneurysms highlights the importance of exploring alternative solutions. In this study, we propose an injectable extracellular matrix-derived embolic formed in situ by Michael addition of gelatin-thiol (Gel-SH) and hyaluronic acid vinyl sulfone (HA-VS) that may be delivered with a therapeutic agent (here, RADA-SP) to fill and remodel aneurysmal tissue without leaving behind permanent foreign bodies. The injectable embolic material demonstrated rapid gelation under physiological conditions, forming a highly porous structure and allowing for cellular infiltration. The injectable embolic exhibited thrombogenic behavior in vitro that was comparable to that of alginate injectables. Furthermore, in vivo studies in a murine carotid aneurysm model demonstrated the successful embolization of a saccular aneurysm and extensive cellular infiltration both with and without RADA-SP at 3 weeks, with some evidence of increased vascular or fibrosis markers with RADA-SP incorporation. The results indicate that the developed embolic has inherent potential for acutely filling cerebrovascular aneurysms and encouraging the cellular infiltration that would be necessary for stable, chronic remodeling.

Regression of Electrocardiographic Left Ventricular Hypertrophy After Transcatheter Aortic Valve Implantation for Aortic Stenosis.

BACKGROUND: The changes in electrocardiographic left ventricular hypertrophy (ECG-LVH) after transcatheter aortic valve implantation (TAVI) are not fully elucidated.Methods and Results:The study group included 64 patients who underwent TAVI for aortic stenosis. Their 12-lead ECGs before and at 2 days and 1, 6 and 12 months after TAVI were analyzed, and ECG-LVH was evaluated using various definitions. Values and prevalence of each ECG-LVH parameter significantly decreased between 1 and 6 months after TAVI. Values of ECG-LVH parameters decreased especially in patients with ECG-LVH at baseline. CONCLUSIONS: Regression of ECG-LVH was observed between 1 and 6 months after TAVI.

Incidental findings on computed tomography for preoperative assessment before transcatheter aortic valve implantation in Japanese patients.

Extra-cardiovascular incidental findings (IFs) on preoperative computed tomography (CT) are frequently observed in transcatheter aortic valve implantation (TAVI) candidates. However, the backgrounds of TAVI candidates and comorbidities differ based on the race and/or country, and data on IFs in a specific population are not always applicable to another. The aim of this study was to assess the prevalence, type, and clinical impact of IFs in Japanese TAVI candidates. This was a retrospective, single-center, observational study. CT reports of 257 TAVI candidates were reviewed, and IFs were classified as (a) insignificant: findings that did not require further investigation, treatment, or follow-up; (b) intermediate: findings that needed to be followed up or were considered for further investigation but did not affect the planning of TAVI; and (c) significant: findings that required further investigation immediately or affected the planning of TAVI. At least one IF was found in 254 patients (98.8%). Insignificant, intermediate, and significant IFs were found in 253 (98.4%), 153 (59.5%), and 34 (13.2%) patients, respectively. Newly indicated significant IFs were found in 19 patients (7.4%). In 2 patients (0.8%), TAVI was canceled because of significant IFs. In patients who consequently underwent TAVI, the presence of significant IFs was not associated with the duration from CT performance to TAVI [28 (19-40) days vs. 27 (19-43) days, p = 0.74] and all-cause mortality during the median follow-up period of 413 (223-805) days (p = 0.44). Almost all Japanese TAVI candidates had at least one IF, and the prevalence of significant IFs was not negligible. Although the presence of significant IFs was not associated with mid-term mortality, appropriate management of IFs was considered important.

[Successful Surgical Treatment of Primary Cardiac Lymphoma Detected with the Onset of Acute Heart Failure;Report of a Case].

A 83-year-old woman, suffering from rapidly worsening dyspnea and weight gain from a week ago, was referred for evaluation and treatment of cardiac tumor in the right atrium. Echocardiography and enhanced computed tomography revealed a large tumor, more than 6 cm, occupying the right atrium and blocking the tricuspid valve inflow. Electrocardiogram showed bradycardiac atrial fibrillation. We performed partial resection with cardiopulmonary bypass, in order to improve hemodynamics and to make a definite diagnosis. In operation, the tumor infiltrated not only the right atrium but also the right ventricle and the tricuspid annulus. The pathological examination suggested malignant lymphoma, diffuse large B-cell type. The patient was treated chemotherapy postoperatively. She is alive 1 year after the surgery without apparent recurrence.

[Aortic Valve Replacement and Mitral Valve Plasty in a Patient with Left Ventricular Noncompaction Associated with Aortic Regurgitation and Mitral Regurgitation;Report of a Case].

Left ventricular noncompaction (LVNC) is believed to represent an arrest in the normal process of myocardial compaction, resulting in persistence of both hyper-trabeculation and intra-trabecular recess within the left ventricle. The clinical features of this disease are left ventricular dilatation and systolic dysfunction, which carry a high mortality. Most patients die in infancy, but some cases of LVNC in adults have been reported. To the best of our knowledge, only 4 cases of LVNC with valvular heart disease in adults have recently been operated. We describe a 51-year-old man with LVNC and severe aortic regurgitation and mild mitral regurgitation, who was successfully operated upon with aortic valve replacement using a tissue valve, and mitral valve plasty with bilateral papillary muscle relocation.

[Aortic Valve Regurgitation with Dove-coo Murmur: Report of Two Cases].

We performed aortic valve replacement in 2 patients with aortic regurgitation (AR) in whom a "dovecoo" murmur was heard. Here we discuss the valve shape and the origin of the heart murmur. In the 1st patient, echocardiography revealed prolapse of the right coronary valve cusp toward the left ventricular outflow tract during the diastolic phase and fibrillation of the valve leaflet due to the AR jet. In the 2nd patient, surgical findings revealed thickening of the middle part of the leaflet of the right coronary cusp, which caused prolapse of the right coronary valve cusp toward the left ventricle. We hereby report 2 rare cases of "dove-coo" murmur in which the cause of the murmur was morphologically confirmed by echocardiography in one case and by surgical findings in the other case.

Administration of an antibody against apoptosis inhibitor of macrophage prevents aortic aneurysm progression in mice.

Apoptosis inhibitor of macrophage (AIM) is known to induce apoptosis resistance in macrophages and to exacerbate chronic inflammation, leading to arteriosclerosis. The role of AIM in aortic aneurysm (AA) remains unknown. This study examined the effects of an anti-AIM antibody in preventing AA formation and progression. In apolipoprotein E-deficient mice, AA was induced by subcutaneous angiotensin II infusion. Mice were randomly divided into two groups: (i) AIM group; weekly anti-murine AIM monoclonal antibody injection (n = 10), and (ii) IgG group; anti-murine IgG antibody injection as control (n = 14). The AIM group, compared with the IgG group, exhibited reduced AA enlargement (aortic diameter at 4 weeks: 2.1 vs. 2.7 mm, respectively, p = 0.012); decreased loss of elastic lamellae construction; reduced expression levels of IL-6, TNF-α, and MCP-1; decreased numbers of AIM-positive cells and inflammatory M1 macrophages (AIM: 1.4 vs. 8.0%, respectively, p = 0.004; M1 macrophages: 24.5 vs. 55.7%, respectively, p = 0.017); and higher expression of caspase-3 in the aortic wall (22.8 vs. 10.5%, respectively, p = 0.019). Our results suggest that administration of an anti-AIM antibody mitigated AA progression by alleviating inflammation and promoting M1 macrophage apoptosis.

[A surgical technique of tricuspid valve repair for infective endocarditis using an autologous pericardium].

We report a surgically treated case of tricuspid valve endocarditis. A 33-year-old man was diagnosed with ventricular septal defect (VSD) and active infective endocarditis associated with severe tricuspid regurgitation. Ultrasonic echocardiography (UCG) showed vegetations attached to the tricuspid valve. His blood culture was positive for Streptococcus oralis. Although intravenous antibiotics therapy was effective, chest computed tomography( CT) revealed multiple septic pulmonary enboli in right lung and UCG showed severe tricuspid valve regurgitation. So we performed tricuspid valve repair by reconstructing septal leaflet using an autologous pericardium, expanded polytetrafluoroethylene( ePTFE) artificial chordae and annuloplasty ring. The postoperative course was uneventful, without tricuspid regurgitation or stenosis. He has been free from any complication for over 8 months. This surgical technique of tricuspid valve repair with an autologous pericardium and ePTFE artificial chordae for infective endocarditis might be useful choice of procedure for patients with leaflet destruction, in particular for young patients because of less recurrence of infection, less chance of anticoagulant therapy and expected long uneventful course.

Albuminuria predicts worsening renal function after transcatheter aortic valve replacement.

BACKGROUND: The impact of albuminuria on worsening renal function (WRF) and clinical outcomes after transcatheter aortic valve replacement (TAVR) is unknown. METHODS: Overall, 142 patients who underwent TAVR for severe aortic stenosis were divided into two groups based on the preoperative urinary albumin-to-creatinine ratio (ACR): high (ACR ≥30 mg/g) and low (ACR <30 mg/g). The incidence of WRF (an absolute increase in serum creatinine level of ≥0.3 mg/dL or ≥1.5-fold from baseline or dialysis initiation) at 6 months after TAVR and the incidence of all-cause death and heart failure readmission during follow-up were investigated. RESULTS: Half of the examined patients [n=71/142 (50.0%)] had a high ACR. Patients with a high ACR more frequently had WRF at 6 months than those with a low ACR (17.6% vs. 2.9%, p=0.004). Multivariate analysis showed a high ACR was independently associated with WRF (odds ratio, 7.76; 95% confidence interval, 1.62-37.30; p=0.01), whereas baseline estimated glomerular filtration rate <60 mL/min/1.73m² was not (odds ratio, 0.34; 95% confidence interval, 0.08-1.50; p=0.15). Patients with a high ACR had a higher risk of composite outcomes of all-cause death and heart failure readmission (p=0.002). CONCLUSIONS: Preoperative albuminuria (ACR ≥30 mg/g) was independently associated with WRF at 6 months after TAVR. Furthermore, patients with an ACR ≥30 mg/g had higher risks of all-cause death and heart failure readmission than those with an ACR <30 mg/g.

Multiple giant coronary artery aneurysms with extended coronary ectasia emerging 12 years after previous coronary artery bypass grafting.

A 73-year-old man presented with multiple giant coronary artery aneurysms. Twelve years prior to the presentation, he had undergone coronary artery bypass grafting. At that time, he exhibited small aneurysms (16 mm diameter) in the right coronary artery and a single aneurysm (10 mm diameter) in the left circumflex artery. During follow-up, the aneurysms gradually increased in size (to 45 and 30 mm, respectively, at 12 years after surgery). We resected all of the aneurysms and performed coronary artery bypass grafting of the left circumflex artery through re-sternotomy.

Aggregatibacter aphrophilus infective endocarditis confirmed by broad-range PCR diagnosis: A case report.

INTRODUCTION: Aggregatibacter aphrophilus is a rare cause of infective endocarditis. This pathogen is difficult to identify with common culture methods, which can lead to incorrect diagnosis and treatment. PRESENTATION OF CASE: A 72-year-old woman was admitted to a community hospital with a persistent high fever and deteriorating renal function. Based on negative blood culture and positive serum proteinase 3 anti-neutrophil cytoplasmic antibody (PR3-ANCA), acute renal failure associated with ANCA-rerated vasculitis was initially suspected. However, the patient developed heart failure soon afterward; echocardiography showed mitral insufficiency with mobile vegetation attached to the mitral valve, indicating infective endocarditis. After transfer to our hospital, the patient underwent mitral valve repair. Broad-range polymerase chain reaction (br-PCR) and sequencing identified Aggregatibacter aphrophilus in the excised vegetation. The patient had a good postoperative course, with recovery of renal function. CONCLUSION: A rare disease, Aggregatibacter aphrophilus infective endocarditis was successfully treated with surgical repair and appropriate antibiotic therapy. To avoid misdiagnosis, br-PCR testing should be performed in patients with blood culture-negative endocarditis.

Mitral valve repair for traumatic mitral regurgitation.

Mitral valve injury after blunt chest trauma is a rare clinical condition. We describe a case of mitral valve repair for severe mitral regurgitation due to blunt chest trauma 5 years previously. A 22-year-old man was referred to our hospital for surgical correction of severe mitral regurgitation. Echocardiography demonstrated a partial tear of the anterolateral papillary muscle which lacerated to the apex. The entire anterolateral part of the mitral valve including the anterior commissure and posterior leaflets had prolapsed. Reimplantation of the papillary muscle to the posterior left ventricular wall and ring annuloplasty were successfully performed without residual regurgitation.