Structural assessments in decellularized extracellular matrix of porcine semilunar heart valves: Evaluation of cell niches.

Tissue-engineered heart valves aim to reproduce the biological properties of natural valves with anatomically correct structure and physiological performance. The closest alternative to creating an ideal heart valve substitute is to use decellularized porcine heart valves, due to their anatomy and availability. However, the immunological barrier and the structural maintenance limit the long-term physiological performance of decellularized porcine heart valves. This study investigated the extracellular matrix (ECM) structure of aortic and pulmonary porcine valves decellularized by a low concentration sodium dodecyl sulfate (SDS)-based method in order to determine the ECM scaffold (ECMS) conditions related to remodeling potential. To assess the structures of the leaflets and conduits of the heart valves, ECM components and their organization were evaluated by histology, biochemical analysis (BC), scanning electron microscopy, multiphoton microscopy, tensile test, immunofluorescence labeling (IF), and Raman microspectroscopy used to draw a profile of the cell niches. Histology and multiphoton imaging of decellularized aortic and pulmonary leaflets and conduits revealed a collagen and elastin histoarchitecture with rearrangement, loosening fibers, and glycosaminoglycan depletion confirmed by biochemistry quantification. The potential cytotoxicity of SDS residues was eliminated after 10 wash cycles. The mechanical properties of the structure of the valve indicated a functional resistance of decellularized ECM. The IF demonstrated the presence of basement membrane, suggesting a potential structure for host cell attachment. The RM analysis showed evidence of molecular interactions, suggesting conservation of the chemical composition, particularly among the protein molecular structures. The structural analyses performed in the semilunar porcine heart valves demonstrate that decellularized ECMS has structural properties that support physiological performance and potential host tissue integration. In fact, decellularized leaflet scaffolds were prone to cell interaction after human adipose-derived stromal cell seeding and culturing. Further analysis of biocompatibility, particularly the ECM-cell interaction, can elucidate the remodeling process, in preserved decellularized heart valve scaffold.

Multicentre, randomized, double-blind trial of intracoronary autologous mononuclear bone marrow cell injection in non-ischaemic dilated cardiomyopathy (the dilated cardiomyopathy arm of the MiHeart study).

AIMS: Pre-clinical and few clinical studies suggest that transplantation of autologous bone marrow mononuclear cells (BMNC) improves heart function in dilated cardiomyopathies. Our objective was to determine if intracoronary injection of autologous BMNC improves the left ventricular ejection fraction (LVEF) of patients with non-ischaemic dilated cardiomyopathy (NIDCM). METHODS AND RESULTS: This study was a multicentre, randomized, double-blind, placebo controlled trial with a follow-up of 12 months. Patients with NIDCM and LVEF <35% were recruited at heart failure ambulatories in specialized hospitals around Brazil. One hundred and sixty subjects were randomized to intracoronary injection of BMNC or placebo (1:1). The primary endpoint was the difference in change of LVEF between BMNC and placebo groups as determined by echocardiography. One hundred and fifteen patients completed the study. Left ventricular ejection fraction decreased from 24.0% (21.6-26.3) to 19.9% (15.4-24.4) in the BMNC group and from 24.3% (22.1-26.5) to 22.1% (17.4-26.8) in the placebo group. There were no significant differences in changes between cell and placebo groups for left ventricular systolic and diastolic volumes and ejection fraction. Mortality rate was 20.37% in placebo and 21.31% in BMNC. CONCLUSION: Intracoronary injection of autologous BMNC does not improve left ventricular function in patients with NIDCM. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00333827.

Anesthesia for pulmonary trunk aneurysmorrhaphy.

BACKGROUND AND OBJECTIVES: The aneurysm in the pulmonary trunk is a rare disease. Because of its location, a rupture can lead to right ventricular failure and sudden death. Aneurysmorraphy is the most widely used surgical treatment in these cases. The aim of this study is to report a successful balanced general anesthesia for aneurysmorraphy of pulmonary trunk. CASE REPORT: Male patient, 28 years, asymptomatic, diagnosed with an aneurysm in the pulmonary trunk. According to the location of the aneurysm and the consequent failure of the pulmonary valve, an aneurysmorraphy was indicated, with implantation of vascular-valvular prosthesis (valved tube). We opted for a balanced general anesthesia, seeking to prevent an increase in systemic and pulmonary vascular resistances, thus avoiding to cause stress on the wall of the aneurysmal vessel. CONCLUSIONS: A balanced general anesthesia, in combination with adequate ventilation to prevent elevation in pulmonary vascular pressure, was appropriate for surgical repair of an aneurysm in the pulmonary trunk.

[Anesthesia for pulmonary trunk aneurysmorrhaphy]. / Anestesia para aneurismorrafia de tronco de artéria pulmonar.

BACKGROUND AND OBJECTIVES: The aneurysm in the pulmonary trunk is a rare disease. Because of its location, a rupture can lead to right ventricular failure and sudden death. Aneurysmorraphy is the most widely used surgical treatment in these cases. The aim of this study is to report a successful balanced general anesthesia for aneurysmorraphy of pulmonary trunk. CASE REPORT: Male patient, 28 years, asymptomatic, diagnosed with an aneurysm in the pulmonary trunk. According to the location of the aneurysm and the consequent failure of the pulmonary valve, an aneurysmorraphy was indicated, with implantation of vascular-valvular prosthesis (valved tube). We opted for a balanced general anesthesia, seeking to prevent an increase in systemic and pulmonary vascular resistances, thus avoiding to cause stress on the wall of the aneurysmal vessel. CONCLUSIONS: A balanced general anesthesia, in combination with adequate ventilation to prevent elevation in pulmonary vascular pressure, was appropriate for surgical repair of an aneurysm in the pulmonary trunk.

[Influence of Diabetes Mellitus on immediate results of coronary stent: National Center for Cardiovascular Interventions (CENIC) data analysis]. / Influência do diabete melito nos resultados imediatos do implante de stent coronário: uma análise dos dados da Central Nacional de Intervenções Cardiovasculares (CENIC).

OBJECTIVE: This study sought to investigate the influence of Diabetes Mellitus (DM) on immediate results after coronary stenting implantation (CSI) according to clinical presentation. METHODS: Between January, 1997 and December, 2003, 11,874 diabetic patients underwent CSI, as recorded by CENIC database: 7,386 (62.3%) had chronic coronary disease (CCD); 3,142 (26.4%) acute coronary syndrome with non-ST segment elevation (ACSNST); and 1,346 (11.3%), reported acute myocardial infarction (AMI), with ST Segment elevation. Those groups were compared with 48,103 non-diabetics: 30,980 (64.5%) with CCD; 10,938 (22.7%), with non-elevated ST segments and unstable angina; and 6,185 (12.8%), with AMI. RESULTS: Diabetic patients presented worse clinical and angiographic characteristics. Diabetics with CCD showed similar incidence of MACE as compared to non-diabetics (0.98% x 0.91%, p = 0.5971); however, diabetics with ACSNST and AMI reported higher incidence of events: 2.76% x 1.46% (p < 0.0001) and 7.87% x 4.1% (p < 0.0001), respectively. Multivariate analysis showed DM to act as independent risk predictor for larger adverse events under non-elevated ST segment and unstable angina (ACSNST) (OR: 1.92 CI: 1.46-2.52 p < 0.0001) and with AMI (OR: 2.0 CI: 1.57-2.54 p < or = 0.0001) and no influence for CCD (OR: 1.08 CI: 0.83-1.42 p = 0.5470. CONCLUSION: Diabetic patients with CCD reported similar outcome as compared to the non-diabetics; however, those with ACSNST and AMI presented higher incidence of major adverse cardiac events during hospital stay.

Latin American randomized trial of balloon angioplasty vs coronary stenting for small vessels (LASMAL): immediate and long-term results.

PURPOSE: To assess the potential role of coronary stent to improved acute success and reduce late restenosis in lesions with reference diameter <2.9 mm using a bare metal stent specifically designed for small coronary vessels. There is controversy on the results among previous studies comparing bare metal stent implantation with conventional balloon percutaneous transluminal coronary angioplasty (PTCA). Differences in baseline characteristics, inclusion and exclusion criteria, and stent design may account for these discrepancies. METHODS: The population of this multicenter, multinational randomized study (LASMAL) consisted of 246 patients undergoing percutaneous coronary intervention of small vessel reference diameter. They were randomized into 2 strategies of percutaneous revascularization: elective primary stent (n = 124) or conventional balloon PTCA with provisional stenting (n = 122) in the presence of acute, threatened closure or flow-limiting dissections. RESULTS: The clinical success rate was significantly better for the stent group (98.3% vs 91.8%; P = 0.038). At 30 days follow-up, requirements of target vessel revascularization (TVR) (6.6% vs 0.8%; P = 0.018) and incidence of major adverse cardiac and cerebrovascular events (MACCE) (9.8% vs 2.4%; P = 0.01) was significantly lower in the stent strategy. Postpercutaneous coronary intervention minimal luminal diameter (MLD) was significantly larger in the stent group (2.3 +/- 0.2 mm vs 2.2 +/- 0.2 mm; P = 0.003). At follow-up, MLD in the stent group was larger than with PTCA (1.7 +/- 0.7 mm vs 1.5 +/- 0.7 mm, respectively; P = 0.035). Net gain was also significantly better with stent strategy (1.1 +/- 0.7 mm vs 0.8 +/- 0.7 mm, respectively; P = 0.002). Stenting resulted in a significant lower angiographic binary restenosis (20% vs 31%; P = 0.02) than PTCA. Furthermore, patients treated with stent were more frequently free from MACCE at 9-month follow-up (death, acute myocardial infarction [AMI], stroke, repeat revascularization procedures) than those treated initially with PTCA (82.2% vs 72% of PTCA, P = 0.046). CONCLUSIONS: The use of a specifically designed bare metal coronary phosphoril choline-coated stent as primary device during percutaneous interventions in small coronary arteries was associated with high procedural success and low in-hospital and 30-day follow-up complications. At long-term follow-up, patients initially treated with stents had lower angiographic restenosis rate and were more frequently free from major adverse cardiac events.

Mitral stenosis and percutaneous mitral valvuloplasty (part 1).

Although the incidence and severity of rheumatic mitral stenosis have declined in developed countries, the disease is still highly prevalent in many of the poorer and most densely populated areas of the globe, remaining a major public health issue and reflecting the socioeconomic status of the region. In the last 30 years, mitral stenosis therapy has undergone a reorientation with the introduction of percutaneous mitral valvuloplasty. This manuscript is an updated review of percutaneous dilation of mitral stenosis in its different aspects, encompassing traditional techniques, technical innovations, the most significant case loads worldwide, an analysis of the procedure as well as immediate and late outcomes.

Oxidative Damage in the Aging Heart: an Experimental Rat Model.

INTRODUCTION: Several theories have been proposed to explain the cause of 'aging'; however, the factors that affect this complex process are still poorly understood. Of these theories, the accumulation of oxidative damage over time is among the most accepted. Particularly, the heart is one of the most affected organs by oxidative stress. The current study, therefore, aimed to investigate oxidative stress markers in myocardial tissue of rats at different ages. METHODS: Seventy-two rats were distributed into 6 groups of 12 animals each and maintained for 3, 6, 9, 12, 18 and 24 months. After euthanasia, the heart was removed and the levels of non-protein thiols, lipid peroxidation, and protein carbonylation, as well as superoxide dismutase and catalase activities were determined. RESULTS: Superoxide dismutase, catalase activity and lipid peroxidation were reduced in the older groups of animals, when compared with the younger group. However, protein carbonylation showed an increase in the 12-month group followed by a decrease in the older groups. In addition, the levels of non-protein thiols were increased in the 12-month group and not detected in the older groups. CONCLUSION: Our data showed that oxidative stress is not associated with aging in the heart. However, an increase in non-protein thiols may be an important factor that compensates for the decrease of superoxide dismutase and catalase activity in the oldest rats, to maintain appropriate antioxidant defenses against oxidative insults.

Effects of hypertonic saline-dextran solution in cardiac valve surgery with cardiopulmonary bypass.

BACKGROUND: Hypertonic saline-dextran (HSD) solution may be beneficial in patients undergoing coronary artery surgery with cardiopulmonary bypass. Valvular dysfunction is associated with high pulmonary wedge pressure, pulmonary hypertension, and ventricular dysfunction. Fluid overload or transient left ventricular failure may occur with HSD infusion in such patients. This study evaluates the cardiorespiratory effects and tolerance of HSD solution infusion in patients undergoing cardiac valve surgery. METHODS: This prospective, randomized, double-blind study compared clinical, laboratory, hemodynamic, and respiratory measurements, and fluid balance in 50 patients over a 48-hour period after cardiopulmonary bypass for cardiac valve surgery. Twenty-five patients received 4 mL/kg of HSD during 20 minutes before cardiopulmonary bypass (HSD group). The control group received the same volume of Ringer's solution (Ringer group). RESULTS: Hospital mortality was zero. The HSD patients had a near zero fluid balance (6.5 +/- 13.5 mL/Kg/48 hours), and the control patients had a positive balance (91.0 +/- 33.7 mL/Kg/48 hours). Hemoglobin was similar in both groups, but more blood transfusions were necessary in the Ringer group (1.21 +/- 1.28 vs 0.48 +/- 0.59 units per patients). The HSD solution induced a higher cardiac index and left ventricular systolic work index postoperatively, and a lower systemic vascular resistance index until 6, 24, and 48 hours. Right ventricular systolic work index increased and pulmonary vascular resistance index decreased after HSD infusion. A better Pao(2)/Fio(2) relation was observed at 1 and 6 hours postoperatively in the HSD group and was associated with a shorter extubation time (432.0 +/- 123.6 vs 520.8 +/- 130.2 minutes). Increased oxygen delivery index occurred in the HSD group. The HSD infusion was well tolerated as none of the patients experienced fluid overload or had left ventricular failure develop. No other complication attributable to the use of HSD solution was observed. CONCLUSIONS: The HSD solution infusion in patients during cardiac valve surgery with cardiopulmonary bypass was well tolerated. Hemodynamic and respiratory functions improved and fluid balance was near zero during the first 48 hours as compared with a large positive balance in the control group. We conclude that HSD infusion is advantageous for patients undergoing cardiac valve surgery.

A comparison of rescue and primary percutaneous coronary interventions for acute myocardial infarction: a multicenter registry report of 9,371 patients.

OBJECTIVE: To perform a comparative analysis of in-hospital results obtained from AMI patients who underwent rescue or primary PTCA. METHODS: From the Brazilian Interventional National Registry (CENIC), we selected all consecutive patients who underwent a percutaneous coronary intervention for myocardial infarction (< 24 hours), between 1997 and 2000, analyzing those undergoing a rescue (n=840) or a primary (n=8,531) procedure, and comparing their in-hospital results. RESULTS: Rescue patients were significantly younger males with anterior wall infarctions, associated with left ventricular dysfunction, but had less multivessel disease, compared with those treated with primary intervention. Coronary stents were implanted in at similar rates (56.9% vs. 54.9%; P=0.283). Procedural success were lower for rescue cases (88.1% vs. 91.2%; P<0.001), with higher mortality (7.4% vs. 5.6%; P=0.034), compared with the primary intervention group; target vessel revascularization (< or =0.5%), emergency bypass surgery (< or =0.3%) and reinfarction (< or =2.6%) rates were similar for both strategies. Multivariate analysis identified the rescue procedure as a predictor of in-hospital death [OR(CI=95%) = 1.60 (1.17-2.19); P=0.003]. CONCLUSION: Patients who underwent a rescue coronary intervention had higher in-hospital death rates compared with those who underwent a primary coronary intervention.

Dual anterior descending coronary artery associated with coronary artery disease.

The patient is a male with risk factors for coronary artery disease, who was referred for cardiac catheterization after acute myocardial infarction in the inferior wall. The patient underwent transluminal coronary angioplasty in the right coronary artery with successful stent implantation.

Intravenous clonidine administration and its ability to reduce pulmonary arterial pressure in patients undergoing heart surgery.

OBJECTIVE: Evaluate the ability of clonidine to reduce pulmonary arterial pressure in patients with pulmonary hypertension undergoing heart surgery, either by reducing the pressure values from the direct measurement of pulmonary arterial pressure or by reducing or eliminating the need for intraoperative dobutamine and nitroprusside. METHOD: Randomized, double-blind, placebo-controlled, comparative study conducted in 30 patients with pulmonary arterial hypertension type 2 undergoing cardiac surgery. Mean pulmonary arterial pressure and dosage of dobutamine and sodium nitroprusside were assessed four times: before intravenous administration of clonidine (2 µg/kg) or placebo (T0), 30 min after tested treatment and before cardiopulmonary bypass (T1), immediately after CPB (T2), 10 min after protamine injection (T3). RESULTS: There were no significant differences regarding mean pulmonary arterial pressure at any time of evaluation. There was no significant difference between groups regarding other variables, such as mean systemic arterial pressure, heart rate, total dose of dobutamine, total dose of sodium nitroprusside, and need for fentanyl. CONCLUSION: Data analysis from patients included in this study allows us to conclude that intravenous clonidine (2 µg/kg) was not able to reduce the mean pulmonary arterial pressure in patients with pulmonary hypertension in group 2 (pulmonary venous hypertension), undergoing heart surgery, or reduce or eliminate the need for intraoperative administration of dobutamine and sodium nitroprusside.

Autologous transplantation of bone marrow adult stem cells for the treatment of idiopathic dilated cardiomyopathy.

BACKGROUND: Morbimortality in patients with dilated idiopathic cardiomyopathy is high, even under optimal medical treatment. Autologous infusion of bone marrow adult stem cells has shown promising preliminary results in these patients. OBJECTIVE: Determine the effectiveness of autologous transplantation of bone marrow adult stem cells on systolic and diastolic left ventricular function, and on the degree of mitral regurgitation in patients with dilated idiopathic cardiomyopathy in functional classes NYHA II and III. METHODS: We administered 4,54 x 10(8) ± 0,89 x 10(8) bone marrow adult stem cells into the coronary arteries of 24 patients with dilated idiopathic cardiomyopathy in functional classes NYHA II and III. Changes in functional class, systolic and diastolic left ventricular function and degree of mitral regurgitation were assessed after 3 months, 6 months and 1 year. RESULTS: During follow-up, six patients (25%) improved functional class and eight (33.3%) kept stable. Left ventricular ejection fraction improved 8.9%, 9.7% e 13.6%, after 3, 6 and 12 months (p = 0.024; 0.017 and 0.018), respectively. There were no significant changes neither in diastolic left ventricular function nor in mitral regurgitation degree. A combined cardiac resynchronization and implantable cardioversion defibrillation was implanted in two patients (8.3%). Four patients (16.6%) had sudden death and four patients died due to terminal cardiac failure. Average survival of these eight patients was 2.6 years. CONCLUSION: Intracoronary infusion of bone marrow adult stem cells was associated with an improvement or stabilization of functional class and an improvement in left ventricular ejection fraction, suggesting the efficacy of this intervention. There were no significant changes neither in left ventricular diastolic function nor in the degree of mitral regurgitation.

Anesthesia for pulmonary trunk aneurysmorrhaphy / Anestesia para aneurismorrafia de tronco de artéria pulmonar

Abstract Background and objectives: The aneurysm in the pulmonary trunk is a rare disease. Because of its location, a rupture can lead to right ventricular failure and sudden death. Aneurysmorraphy is the most widely used surgical treatment in these cases. The aim of this study is to report a successful balanced general anesthesia for aneurysmorraphy of pulmonary trunk. Case report: Male patient, 28 years, asymptomatic, diagnosed with an aneurysm in the pulmonary trunk. According to the location of the aneurysm and the consequent failure of the pulmonary valve, an aneurysmorraphy was indicated, with implantation of vascular-valvular prosthesis (valved tube). We opted for a balanced general anesthesia, seeking to prevent an increase in systemic and pulmonary vascular resistances, thus avoiding to cause stress on the wall of the aneurysmal vessel. Conclusions: A balanced general anesthesia, in combination with adequate ventilation to prevent elevation in pulmonary vascular pressure, was appropriate for surgical repair of an aneurysm in the pulmonary trunk.

Resumo Justificativa e objetivos: O aneurisma de tronco de artéria pulmonar é uma doença rara. Por sua localização, uma ruptura pode conduzir à falência do ventrículo direito e à morte súbita. A aneurismorrafia é o tratamento cirúrgico mais usado nesses casos. O objetivo foi relatar uma anestesia geral balanceada para aneurismorrafia de tronco de artéria pulmonar feita com sucesso. Relato do caso: Paciente do sexo masculino, 28 anos, assintomático, diagnosticado com aneurisma de tronco de artéria pulmonar. De acordo com a localização do aneurisma e a consequente insuficiência da válvula pulmonar, foi indicada a aneurismorrafia com implante de prótese vascular e valvular (tubo valvado). Optou-se pela anestesia geral balanceada, para impedir um aumento nas resistências vasculares sistêmicas e pulmonar e evitar-se, dessa maneira, um estresse sobre a parede do vaso aneurismático. Conclusões: A anestesia geral balanceada, em associação com uma ventilação adequada para evitar elevação na pressão vascular pulmonar, foi apropriada para correção cirúrgica de um aneurisma em tronco pulmonar.

Checklist para acompanhamento de cateterismo cardíaco: estratégia para o gerenciamento de enfermagem / Checklist for monitoring of heart catheterization: a strategy for nursing management / Checklist para monitoreo de cateterismo cardíaco: una estrategia para la gestión de enfermería

Objetivo:aplicar um checklist para acompanhar procedimento de cateterismo cardíaco diagnóstico e terapêutico como estratégia para o gerenciamento do cuidado de enfermagem. Método:durante seis meses foram monitorados os procedimentos por meio de um formulário tipo CheckList, em um serviço de hemodinâmica de um hospital deensino. Foram incluídos procedimentos agendados de pacientes internados no hospital e ambulatoriais, e excluídos procedimentos de urgência/emergência.O estudo teve aprovado o projeto de pesquisa pelo Comitê de Ética em Pesquisa, CAAE 0283.0.208.000-11. Resultados: o formulário utilizado foi útil na monitorização de complicações pós-cateterismo cardíaco e forneceu subsídios necessários para o gerenciamento do cuidado de enfermagem ao paciente atendido nesse contexto. Conclusão:a aplicação de uma ferramenta administrativa permitiu detalhar os procedimentos, tornando-se medida eficaz para controle e conhecimento dos eventos adversos e riscos envolvidos. Os resultados deste estudo podem fornecer subsídios para modificações pontuais nos laboratórios de hemodinâmica, onde a prioridade deve ser dada, sobretudo aos grupos de risco.(AU)

Objective:applying a checklist to monitor diagnostic and therapeutic cardiac catheterization procedure as a strategy for the management of nursing care. Method:for six months there were monitored procedures through a CheckList form, in a hemodynamics service of a teaching hospital. There were included scheduled procedures of patients admitted to the hospital and outpatient, and excluded urgency/emergency procedures. The study had the research project approved by the Research Ethics Committee, CAAE 0283.0.208.000-11. Results:the form applied was useful in monitoring complications after cardiac catheterization and provided necessary support for nursing care management to patient seen in this context. Conclusion:the application of an administrative tool allowed detailing the procedures, becoming an effective measure for control and knowledge ofadverse events and risks involved. The results of this study may provide grants for changes in hemodynamic laboratories, where the priority should be given, especially to groups at risk.(AU)

Objetivo:aplicar un checklist para monitoreo el procedimiento de cateterismo cardíaco diagnóstico y terapéutico como estrategia para la gestión de los cuidados de enfermería. Método:durante seis meses fueron monitoreados procedimientos a través de un formulario CheckList, en un servicio de hemodinámica de un hospital universitario. Se incluyeron los procedimientos programados de los pacientes ingresados en el hospital y ambulatoriales, y excluidos los procedimientos de urgencia/ emergencia. El estudio tuvo el proyecto de investigación aprobado por el Comité de Ética en la Investigación, CAAE 0283.0.208.000-11. Resultados:el formulario utilizado era útil en el monitoreo de complicaciones después de la cateterización cardíaca y proporcionó apoyo necesario para la gestión de los cuidados de enfermería al paciente asistido en este contexto. Conclusión:la aplicación de una herramienta administrativa permitió detallar los procedimientos, por lo que se volvió como medida eficaz para el control y el conocimiento de los eventos adversos y los riesgos involucrados. Los resultados de este estudio pueden proporcionar subvenciones para cambios específicos en laboratorios de hemodinámica, donde se debe dar la prioridad, sobre todo, a los grupos deriesgo.(AU)

Evaluation of the efficacy and safety of a stent covered with biosynthetic cellulose in a rabbit iliac artery model.

OBJECTIVES: We sought to test the efficacy and safety of the implantation of a stent covered with biosynthetic cellulose compared to a conventional bare-metal stent (BMS) in a rabbit iliac artery model. BACKGROUND: Biosynthetic cellulose is a biocompatible film used in several fields of medicine. Stents covered with biosynthetic cellulose are devices with the potential of achieving total lesion coverage, acting as a physical barrier to the migration of smooth muscle cells from the artery wall to the arterial lumen, and capturing circulating endothelial progenitor cells that may form a functional endothelial layer. METHODS AND RESULTS: Seven BMS and 7 stents covered with biosynthetic cellulose were implanted in the iliac arteries of 7 rabbits. Angiographic restudy and morphometric analysis of the specimens were performed after 4 weeks. No intrastent angiographic restenosis was observed, either with BMS or with stents covered with biosynthetic cellulose. There was also no acute or late vessel occlusion caused by stent thrombosis in either group. In the BMS and biosynthetic cellulose stented groups, respectively, mean neointimal thicknesses were 0.18 +/- 0.02 mm and 0.35 +/- 0.02 mm*; lumen area, 4.6 +/- 0.43 mm2 and 4.04 +/- 0.42 mm2; neointimal area, 0.58 +/- 0.09 mm2 and 2.13 +/- 0.11 mm(2)*; % lumen, 79.09 +/- 1.6% and 58.44 +/- 3.26%*; % stenosis, 10.97 +/- 1.23% and 35.55 +/- 3.39%* (*p < 0.05 vs. bare-metal). CONCLUSIONS: Implantation of stents covered with biosynthetic cellulose was safe, with no acute or late vessel occlusion caused by stent thrombosis, although it resulted in a more pronounced absolute neointimal thickness when compared to BMS.

Administracao de clonidina intravenosa e sua capacidade de reduzir a pressao da arteria pulmonar em pacientes submetidos a cirurgia cardiaca / Intravenous clonidine administration and its ability to reduce pulmonary arterial pressure in patients undergoing heart surgery / Administracion de la clonidina intravenosa y su capacidad de reducir la presion de la arteria pulmonar en pacientes sometidos a cirugia cardiaca

Objetivo: Avaliar a capacidade da clonidina de reduzir a pressão arterial pulmonar de pacientes com hipertensão pulmonar, submetidos a cirurgia cardíaca, seja pela diminuição dos valores pressóricos a partir da aferição direta da pressão de artéria pulmonar, seja pela redução ouabolição da necessidade de dobutamina e nitroprussiato de sódio no intraoperatório. Método: Trata-se de estudo controlado, comparativo, randomizado e duplamente encoberto feito com 30 pacientes portadores de hipertensão arterial pulmonar tipo 2, submetidos a cirurgia cardíaca. Avaliaram-se a pressão média de artéria pulmonar e a posologia de dobutaminae nitroprussiato de sódio em quatro momentos: (M0) antes da administração de 2 µg/kg declonidina intravenosa ou placebo; (M1) decorridos 30 minutos do tratamento testado e antes da circulação extracorpórea; (M2) imediatamente após a circulação extracorpórea; e (M3)10 minutos após a injeção de protamina. Resultados: Não houve diferenças significativas em relação à pressão média de artéria pulmonarem nenhum dos momentos estudados. Entre os grupos não houve também diferença significativa entre as demais variáveis estudadas, como pressão arterial sistêmica média, frequência cardíaca, dosagem total de dobutamina, dosagem total de nitroprussiato de sódio e necessidade do hipnoanalgésico fentanil. Conclusão: A análise dos dados obtidos dos pacientes incluídos neste estudo permite concluir que a clonidina, na dose de 2 µg/kg administrada via intravenosa, não foi capaz de reduzir a pressão média de artéria pulmonar de pacientes com hipertensão pulmonar do grupo 2 (hipertensão venosa pulmonar), ...

Objective: Evaluate the ability of clonidine to reduce pulmonary arterial pressure in patients with pulmonary hypertension undergoing heart surgery, either by reducing the pressure values from the direct measurement of pulmonary arterial pressure or by reducing or eliminating the need for intraoperative dobutamine and nitroprusside. Method: Randomized, double-blind, placebo-controlled, comparative study conducted in 30 patients with pulmonary arterial hypertension type 2 undergoing cardiac surgery. Mean pulmonary arterial pressure and dosage of dobutamine and sodium nitroprusside were assessed four times: before intravenous administration of clonidine (2 µg/kg) or placebo (T0), 30 min after tested treatment and before cardiopulmonary bypass (T1), immediately after CPB (T2), 10 min after protamine injection (T3). Results: There were no significant differences regarding mean pulmonary arterial pressure at any time of evaluation. There was no significant difference between groups regarding other variables, such as mean systemic arterial pressure, heart rate, total dose of dobutamine, total dose of sodium nitroprusside, and need for fentanyl. Conclusion: Data analysis from patients included in this study allows us to conclude that intra-venous clonidine (2 µg/kg) was not able to reduce the mean pulmonary arterial pressure inpatients with pulmonary hypertension in group 2 (pulmonary venous hypertension), undergoing heart surgery, or reduce or eliminate the need for intraoperative administration of dobutamineand sodium nitroprusside. .

Objetivo: Evaluar la capacidad de la clonidina de reducir la presión arterial pulmonar de pacientes con hipertensión pulmonar sometidos a cirugía cardíaca, sea por la disminución de los valores tensionales a partir de la comprobación directa de la presión de la arteria pulmonar, o por la reducción o supresión de la necesidad de dobutamina y nitroprusiato de sodio en el intraoperatorio. Método: Se trata de un estudio controlado, comparativo, aleatorizado y doble ciego hecho con 30 pacientes con hipertensión arterial pulmonar tipo 2, sometidos a cirugía cardíaca. Fueron evaluados la presión promedio de la arteria pulmonar y la posología de dobutamina y nitroprusiato de sodio en 4 momentos: (M0) antes de la administración de 2 µg/kg de clonidina intravenosa o placebo; (M1) transcurridos 30 min del tratamiento testado y antes de la circulación extracorpórea; (M2) inmediatamente después de la circulación extracorpórea; y (M3) 10 min después de la inyección de protamina. Resultados: No fueron verificadas diferencias significativas con relación a la presión promedio de la arteria pulmonar en ninguno de los momentos estudiados. Entre los grupos tampoco hubo diferencia significativa entre las demás variables estudiadas, como presión arterial sistémica promedio, frecuencia cardíaca, dosificación total de dobutamina, dosificación total de nitroprusiato de sodio y la necesidad del hipnoanalgésico fentanilo. Conclusiones: El análisis de los datos obtenidos de los pacientes incluidos en este estudio permite concluir que la clonidina en una dosis de 2 µg/kg administrada por vía intravenosa no fue capaz de reducir la presión promedio de la arteria pulmonar de pacientes con hipertensión pulmonar del grupo 2 (hipertensión venosa pulmonar), sometidos ...

Autologous Transplantation of Bone Marrow Adult Stem Cells for the Treatment of Idiopathic Dilated Cardiomyopathy / Transplante Autólogo de Células-Tronco Adultas para Tratamento da Cardiomiopatia Dilatada Idiopática

Background: Morbimortality in patients with dilated idiopathic cardiomyopathy is high, even under optimal medical treatment. Autologous infusion of bone marrow adult stem cells has shown promising preliminary results in these patients. Objective: Determine the effectiveness of autologous transplantation of bone marrow adult stem cells on systolic and diastolic left ventricular function, and on the degree of mitral regurgitation in patients with dilated idiopathic cardiomyopathy in functional classes NYHA II and III. Methods: We administered 4,54 x 108 ± 0,89 x 108 bone marrow adult stem cells into the coronary arteries of 24 patients with dilated idiopathic cardiomyopathy in functional classes NYHA II and III. Changes in functional class, systolic and diastolic left ventricular function and degree of mitral regurgitation were assessed after 3 months, 6 months and 1 year. Results: During follow-up, six patients (25%) improved functional class and eight (33.3%) kept stable. Left ventricular ejection fraction improved 8.9%, 9.7% e 13.6%, after 3, 6 and 12 months (p = 0.024; 0.017 and 0.018), respectively. There were no significant changes neither in diastolic left ventricular function nor in mitral regurgitation degree. A combined cardiac resynchronization and implantable cardioversion defibrillation was implanted in two patients (8.3%). Four patients (16.6%) had sudden death and four patients died due to terminal cardiac failure. Average survival of these eight patients was 2.6 years. Conclusion: Intracoronary infusion of bone marrow adult stem cells was associated with an improvement or stabilization of functional class and an improvement in left ventricular ejection fraction, suggesting the efficacy of this intervention. There were no significant changes neither in left ventricular diastolic function nor in the degree of mitral regurgitation. .

Fundamento: Pacientes portadores de cardiomiopatia dilatada idiopática apresentam alta morbimortalidade, mesmo em tratamento clínico otimizado. A infusão autóloga de células-tronco adultas da medula óssea mostrou resultados clínicos preliminares promissores nesses pacientes. Objetivo: Determinar a eficácia do transplante autólogo de células-tronco adultas da medula óssea sobre as funções sistólica e diastólica, e o grau de insuficiência mitral em pacientes portadores de cardiomiopatia dilatada idiopática em classes funcionais NYHA II e III. Métodos: Infundiram-se 4,54 x 108 ± 0,89 x 108 células-tronco adultas da medula óssea nas artérias coronárias de 24 pacientes com cardiomiopatia dilatada idiopática em classes funcionais NYHA II e III. Após 3 meses, 6 meses e 1 ano, avaliaram-se as mudanças de classe funcional, das funções ventricular esquerda sistólica e diastólica, e do grau da insuficiência mitral. Resultados: No seguimento, seis (25%) pacientes melhoraram sua classe funcional e oito (33,3%) mantiveram sua classe funcional inicial. A fração de ejeção ventricular esquerda aumentou 8,9%, 9,7% e 13,6%, após 3 e 6 meses e 1 ano (p = 0,024; p = 0,017 e p = 0,018), respectivamente. A função diastólica ventricular esquerda e o grau de insuficiência mitral não demonstraram mudanças significativas. Dois pacientes (8,3%) receberam cardioversor e ressincronizador implantável. Ocorreram quatro (16,6%) mortes súbitas e quatro (16,6%) mortes por insuficiência cardíaca terminal. A sobrevida média desses oitos pacientes foi de 2,6 anos. Conclusão: A infusão intracoronariana de células-tronco adultas da medula óssea em pacientes com cardiomiopatia dilatada idiopática promoveu melhora ...