RESUMEN
The telocyte (TC) is a new interstitial cell type described in a wide variety of organs and loose connective tissues around small vessels, but its presence in large arteries remains unexplored. TCs have small cell bodies and remarkably thin, long, moniliform processes called telopods (Tps). Using transmission electron microscopy and immunofluorescence, we identified TCs in normal human thoracic aortas and in those with aneurysm or acute dissection (TAAD). In normal aortas the TCs were distributed throughout the connective tissue of the adventitial layer, in its innermost portion and at the zone of transition with the medial layer, with their long axes oriented parallel to the external elastic lamellae, forming a three-dimensional network, without prevalence in the media layer. In contrast, TAAD TCs were present in the medial layer and in regions of neovascularization. The most important feature of the adventitia of diseased aortas was the presence of numerous contacts between TCs and stem cells, including vascular progenitor cells. Although the biologically functional correlations need to be elucidated, the morphological observations presented here provide strong evidence of the involvement of TCs in maintaining vascular homeostasis in pathological situations of tissue injury.
Asunto(s)
Aorta Torácica , Disección Aórtica , Homeostasis , Microscopía Electrónica de Transmisión , Telocitos , Humanos , Telocitos/patología , Telocitos/metabolismo , Telocitos/ultraestructura , Disección Aórtica/patología , Disección Aórtica/fisiopatología , Disección Aórtica/metabolismo , Aorta Torácica/patología , Aorta Torácica/metabolismo , Masculino , Persona de Mediana Edad , Anciano , Adventicia/patología , Adventicia/metabolismo , Aneurisma de la Aorta Torácica/patología , Aneurisma de la Aorta Torácica/metabolismo , Aneurisma de la Aorta Torácica/fisiopatología , Femenino , Telopodos/patología , Telopodos/metabolismo , Adulto , Técnica del Anticuerpo Fluorescente , Estudios de Casos y ControlesRESUMEN
Patients who have undergone organ transplantation are immunosuppressed hosts, leaving them at a higher risk of infections. SARS-COV-2 has been shown to affect heart-transplanted patients. In this case report, we present the case of a 14-year-old heart transplant recipient who developed signs and symptoms of heart failure, along with fatigue, after a COVID-19 infection. An endomyocardial biopsy was performed to diagnose rejection and to evaluate whether this was myocarditis due to SARS-COV-2. The biopsy showed intense acute cellular rejection (3R) and antibody rejection PAMR1 H+ but was negative for the SARS-CoV-2 virus. The patient received organ rejection therapy with high-dose methylprednisolone and human immunoglobulin. After treatment, her heart function recovered, with biopsy investigations showing a lower level of cellular rejection (1R).
Asunto(s)
COVID-19 , Trasplante de Corazón , Miocarditis , Humanos , Adolescente , Femenino , Miocarditis/diagnóstico , Miocarditis/patología , Rechazo de Injerto , SARS-CoV-2 , Trasplante de Corazón/efectos adversos , Biopsia , Prueba de COVID-19RESUMEN
Resumo Fundamento Alterações do substrato elétrico e anatômico do coração são fatores que originam e perpetuam a fibrilação atrial (FA), porém, os mecanismos envolvidos não foram totalmente elucidados ainda. Objetivo: Avaliar o papel do remodelamento do sistema nervoso cardíaco intrínseco (SNCI), incluindo fibras nervosas e receptores muscarínicos e β-adrenérgicos, na FA permanente humana. Métodos Foram avaliadas 4 amostras em átrios de 13 corações obtidos em necrópsias de pacientes com doença cardíaca e FA permanente, e em 13 controles com as mesmas doenças, porém, sem FA. Utilizando imunoperoxidase e histomorfometria, quantificamos a densidade das fibras do SNCI, bem como a porcentagem positiva de miocárdio para receptores β-adrenérgicos 1, 2 e 3, receptor quinase 5 acoplado à proteína G (GRK-5), e receptores muscarínicos 1 a 5. Os resultados foram comparados usando ANOVA e ANOVA hierarquizada e ajustados pelo volume do átrio esquerdo e, para avaliação da expressão de receptores β e GRK-5, pelo uso de β-bloqueadores. Adotamos como significativo α = 0,05. Resultados Houve aumento na densidade das fibras ( p <0,01), especialmente nas fibras simpáticas ( p =0,02). Quanto aos receptores muscarínicos, só houve diferença nos M1, que estavam aumentados (5,87±4,52 vs 2,85±2,40; p =0,03). Quanto aos componentes do sistema adrenérgicos analisados, houve expressão aumentada de β-3 (37,41 vs 34,18, p =0,04) e GRK-5 (51,16 vs 47,66; p<0,01). O uso de β-bloqueadores não teve impacto na expressão de receptores beta. Conclusão O aumento na inervação do SNCI e a alteração na expressão de receptores em regiões suscetíveis de desencadear FA podem ter um papel na fibrilação atrial permanente.
Abstract Background The primary factors that originate and perpetuate atrial fibrillation (AF) are electrical and anatomical substrate alterations. However, the central mechanisms governing AF perpetuation have not been elucidated yet, which is reflected on the modest results of the treatment in patients with long persistent AF. Objective To evaluate if human intrinsic cardiac autonomic nervous system (ICANS) remodeling, including nervous system fibers and muscarinic and β-adrenergic receptors, play a role in permanent AF. Methods Heart necropsy samples from thirteen patients with heart disease and permanent AF and thirteen controls without AF were used. By using immunoperoxidase and histomorphometry quantification, we identified the following: the density of all fibers of the ICANS, sympathetic and parasympathetic fibers; and the percentage of myocardium positive for β-adrenergic receptors 1, 2 and 3; G protein-coupled receptor kinase-5 (GRK-5); and muscarinic receptors M1 to M5. The results were compared using ANOVA and nested ANOVA and were adjusted according to the left atrium volume for all variables, and β-blocker use to evaluate the expression of β-receptors and GRK-5. Results There was an overall increase in the density of fibers of the ICANS (p=0.006), especially in atrial sympathetic nerve fibers (p=0.017). Only M1 muscarinic receptors were increased (5.87 vs 2.35, p=0.032). For adrenergic receptors, the results were positive for increased expression of β-3 (37.41 vs 34.18, p=0.039) and GRK-5 (51.16 vs 47.66; p<0.001). β-blocker use had no impact on β-receptor expression. Conclusion Increased ICANS innervation and remodeling receptor expression in regions prone to triggering AF may play a role in permanent AF.
Asunto(s)
Humanos , Fibrilación Atrial/etiología , Sistema Nervioso Autónomo , Sistema Nervioso Simpático , Atrios Cardíacos , MiocardioRESUMEN
Rheumatic heart disease (RHD) remains to be a very important health issue worldwide, mainly in underdeveloped countries. It continues to be a leading cause of morbidity and mortality throughout developing countries. RHD is a delayed non-suppurative immunologically mediated inflammatory response to the throat infection caused by a hemolytic streptococcus from the A group (Streptococcus pyogenes). RHD keeps position 1 as the most common cardiovascular disease in young people aged <25 years considering all the continents. The disease can lead to valvular cardiac lesions as well as to carditis. Rheumatic fever valvular injuries lead most commonly to the fusion and thickening of the edges of the cusps and to the fusion, thickening, and shortening of the chordae and ultimately to calcification of the valves. Valvular commissures can also be deeply compromised, leading to severe stenosis. Atrial and ventricular remodeling is also common following rheumatic infection. Mixed valvular lesions are more common than isolated valvular disorders. Echocardiography is the most relevant imaging technique not only to provide diagnostic information but also to enable prognostic data. Further, it presents a very important role for the correction of complications after surgical repair of rheumatic heart valvulopathies. Three-dimensional (3D) echocardiography provides additional anatomical and morphofunctional information of utmost importance for patients presenting rheumatic valvopathies. Accordingly, three-dimensional echocardiography is ready for routine use in patients with RHD presenting with valvular abnormalities.
RESUMEN
BACKGROUND: The primary factors that originate and perpetuate atrial fibrillation (AF) are electrical and anatomical substrate alterations. However, the central mechanisms governing AF perpetuation have not been elucidated yet, which is reflected on the modest results of the treatment in patients with long persistent AF. OBJECTIVE: To evaluate if human intrinsic cardiac autonomic nervous system (ICANS) remodeling, including nervous system fibers and muscarinic and ß-adrenergic receptors, play a role in permanent AF. METHODS: Heart necropsy samples from thirteen patients with heart disease and permanent AF and thirteen controls without AF were used. By using immunoperoxidase and histomorphometry quantification, we identified the following: the density of all fibers of the ICANS, sympathetic and parasympathetic fibers; and the percentage of myocardium positive for ß-adrenergic receptors 1, 2 and 3; G protein-coupled receptor kinase-5 (GRK-5); and muscarinic receptors M1 to M5. The results were compared using ANOVA and nested ANOVA and were adjusted according to the left atrium volume for all variables, and ß-blocker use to evaluate the expression of ß-receptors and GRK-5. RESULTS: There was an overall increase in the density of fibers of the ICANS (p=0.006), especially in atrial sympathetic nerve fibers (p=0.017). Only M1 muscarinic receptors were increased (5.87 vs 2.35, p=0.032). For adrenergic receptors, the results were positive for increased expression of ß-3 (37.41 vs 34.18, p=0.039) and GRK-5 (51.16 vs 47.66; p<0.001). ß-blocker use had no impact on ß-receptor expression. CONCLUSION: Increased ICANS innervation and remodeling receptor expression in regions prone to triggering AF may play a role in permanent AF.
FUNDAMENTO: Alterações do substrato elétrico e anatômico do coração são fatores que originam e perpetuam a fibrilação atrial (FA), porém, os mecanismos envolvidos não foram totalmente elucidados ainda. Objetivo: Avaliar o papel do remodelamento do sistema nervoso cardíaco intrínseco (SNCI), incluindo fibras nervosas e receptores muscarínicos e ß-adrenérgicos, na FA permanente humana. MÉTODOS: Foram avaliadas 4 amostras em átrios de 13 corações obtidos em necrópsias de pacientes com doença cardíaca e FA permanente, e em 13 controles com as mesmas doenças, porém, sem FA. Utilizando imunoperoxidase e histomorfometria, quantificamos a densidade das fibras do SNCI, bem como a porcentagem positiva de miocárdio para receptores ß-adrenérgicos 1, 2 e 3, receptor quinase 5 acoplado à proteína G (GRK-5), e receptores muscarínicos 1 a 5. Os resultados foram comparados usando ANOVA e ANOVA hierarquizada e ajustados pelo volume do átrio esquerdo e, para avaliação da expressão de receptores ß e GRK-5, pelo uso de ß-bloqueadores. Adotamos como significativo α = 0,05. RESULTADOS: Houve aumento na densidade das fibras ( p <0,01), especialmente nas fibras simpáticas ( p =0,02). Quanto aos receptores muscarínicos, só houve diferença nos M1, que estavam aumentados (5,87±4,52 vs 2,85±2,40; p =0,03). Quanto aos componentes do sistema adrenérgicos analisados, houve expressão aumentada de ß-3 (37,41 vs 34,18, p =0,04) e GRK-5 (51,16 vs 47,66; p<0,01). O uso de ß-bloqueadores não teve impacto na expressão de receptores beta. CONCLUSÃO: O aumento na inervação do SNCI e a alteração na expressão de receptores em regiões suscetíveis de desencadear FA podem ter um papel na fibrilação atrial permanente.
Asunto(s)
Fibrilación Atrial , Fibrilación Atrial/etiología , Sistema Nervioso Autónomo , Atrios Cardíacos , Humanos , Miocardio , Sistema Nervioso SimpáticoAsunto(s)
Humanos , Femenino , Adulto , Recurrencia , Complejo de Carney/diagnóstico , Complejo de Carney/genética , Accidente Cerebrovascular Isquémico/diagnóstico , Neoplasias Cardíacas/etiología , Afasia de Broca/complicaciones , Complicaciones Posoperatorias/diagnóstico por imagen , Ecocardiografía/métodos , Espectroscopía de Resonancia Magnética/métodos , Ecocardiografía Transesofágica/métodos , Continuidad de la Atención al Paciente , Muerte Súbita , Embolia/complicaciones , Neoplasias Cardíacas/cirugíaRESUMEN
Factors causing the weakness that underlies thoracic aorta aneurysms and dissections are not well known. Based on the findings of apoptosis and ischemic-like necrosis, we hypothesized a possible role for mitochondrial disturbances in the pathogenesis of these diseases. To evaluate if mitochondria at the aortic medial layer are damaged, samples of ascending aortas with aneurysms (n = 6), acute dissections (n = 5), and hypertensive (n = 9) and normotensive controls (n = 7) were analyzed by transmission electron microscopy. Number of mitochondria, areas of cytoplasm, and areas of mitochondria were measured, and area percentage of the cytoplasm corresponding to mitochondria, their number by unit of area, and their mean area were calculated in randomly taken photographs. Data were compared using one-way analysis of variance or Kruskal-Wallis tests. Significant differences (P ≤ 0.05) were found in the number of mitochondria and their mean area, showing opposite results: the number increased and the mean area decreased from normotensive controls to hypertensive controls to acute dissections to aneurysms, although post hoc tests showed that only the differences between the aneurysms and either both controls (number of mitochondria/mm2: 10.37 in normotensive controls, 15.61 in hypertensive controls, and 43.67 in aneurysms) or normotensive controls only (mean area: 2800.15 in normotensive controls vs 894.91 µm2 in aneurysms) were significant. In conclusion, there are more, smaller mitochondria in ascending aorta aneurysms. This pattern possibly corresponds to dysfunctional mitochondria, indicating that alterations in the dynamics of these organelles may play a role in the pathogenesis of thoracic aorta aneurysms and dissections.
Asunto(s)
Aorta Torácica/ultraestructura , Aneurisma de la Aorta Torácica/patología , Disección Aórtica/patología , Mitocondrias/ultraestructura , Apoptosis , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Microscopía Electrónica de Transmisión , Persona de Mediana Edad , Dinámicas MitocondrialesAsunto(s)
Complicaciones de la Diabetes/patología , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/patología , Infarto del Miocardio sin Elevación del ST/complicaciones , Infarto del Miocardio sin Elevación del ST/patología , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/patología , Diabetes Mellitus/patología , Electrocardiografía , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Radiografía TorácicaAsunto(s)
Prótesis Valvulares Cardíacas/efectos adversos , Válvula Mitral , Complicaciones Cardiovasculares del Embarazo/patología , Insuficiencia Respiratoria/patología , Choque Cardiogénico/patología , Trombosis/patología , Adulto , Resultado Fatal , Femenino , Humanos , Embarazo , Complicaciones Cardiovasculares del Embarazo/etiología , Primer Trimestre del Embarazo , Falla de Prótesis , Edema Pulmonar/patología , Insuficiencia Respiratoria/etiología , Choque Cardiogénico/etiología , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Síndrome de Respuesta Inflamatoria Sistémica/patología , Trombosis/etiologíaAsunto(s)
Humanos , Femenino , Embarazo , Adulto , Complicaciones Cardiovasculares del Embarazo/patología , Insuficiencia Respiratoria/patología , Choque Cardiogénico/patología , Trombosis/patología , Prótesis Valvulares Cardíacas/efectos adversos , Válvula Mitral , Complicaciones Cardiovasculares del Embarazo/etiología , Primer Trimestre del Embarazo , Edema Pulmonar/patología , Insuficiencia Respiratoria/etiología , Choque Cardiogénico/etiología , Trombosis/etiología , Falla de Prótesis , Resultado Fatal , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Síndrome de Respuesta Inflamatoria Sistémica/patologíaAsunto(s)
Neoplasias Cardíacas/patología , Neoplasias Cardíacas/cirugía , Trasplante de Corazón , Paraganglioma Extraadrenal/patología , Paraganglioma Extraadrenal/cirugía , Biomarcadores de Tumor/análisis , Biopsia , Diagnóstico Diferencial , Neoplasias Cardíacas/química , Humanos , Inmunohistoquímica , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Paraganglioma Extraadrenal/química , Valor Predictivo de las PruebasAsunto(s)
Hipertensión Pulmonar/patología , Embolia Pulmonar/patología , Adulto , Enfermedad Crónica , Resultado Fatal , Femenino , Humanos , Hipertensión Pulmonar/complicaciones , Hipertensión Pulmonar/diagnóstico por imagen , Embolia Pulmonar/complicaciones , Embolia Pulmonar/diagnóstico por imagenAsunto(s)
Humanos , Femenino , Adulto , Embolia Pulmonar/patología , Hipertensión Pulmonar/patología , Embolia Pulmonar/complicaciones , Embolia Pulmonar/diagnóstico por imagen , Enfermedad Crónica , Resultado Fatal , Hipertensión Pulmonar/complicaciones , Hipertensión Pulmonar/diagnóstico por imagenRESUMEN
OBJECTIVE:: To present the results of a new experimental device developed to facilitate the transapical access in endovascular treatment of structural heart diseases. It aims to reduce the risk of bleeding and complications in this type of access and demonstrate the device as a safe, fast and effective alternative. METHODS:: CorPoint is composed of three parts: introducer, base with coiled spring, and closing capsule. By rotating movements, the spring is introduced into the myocardium and progressively approaches the base to the surface of the heart. Guidewires and catheters are inserted through the hollow central part and, at the end of the procedure, the capsule is screwed over the base, therefore stopping any bleeding. RESULTS:: The device was implanted in 15 pigs, weighing 60 kg each, through an anterolateral thoracotomy, while catheters were introduced and guided by fluoroscopy. All animals had minimal bleeding; introducers with diameter up to 22 Fr were used and various catheters and guidewires were easily handled. After finishing the procedure, the closing capsule was attached and no bleeding was observed at the site. CONCLUSION:: This new device has proved effective, fast and secure for the transapical access. This shows great potential for use, especially by ensuring an easier and direct access to the mitral and aortic valves; the shortest distance to be traveled by catheters; access to the ascending and descending aorta; decreased bleeding complications; decreased surgical time; and the possibility of allowing the technique to evolve and become totally percutaneous.