Cardiac Neural Crest Cells: Their Rhombomeric Specification, Migration, and Association with Heart and Great Vessel Anomalies.

Outflow tract abnormalities are the most frequent congenital heart defects. These are due to the absence or dysfunction of the two main cell types, i.e., neural crest cells and secondary heart field cells that migrate in opposite directions at the same stage of development. These cells directly govern aortic arch patterning and development, ascending aorta dilatation, semi-valvular and coronary artery development, aortopulmonary septation abnormalities, persistence of the ductus arteriosus, trunk and proximal pulmonary arteries, sub-valvular conal ventricular septal/rotational defects, and non-compaction of the left ventricle. In some cases, depending on the functional defects of these cells, additional malformations are found in the expected spatial migratory area of the cells, namely in the pharyngeal arch derivatives and cervico-facial structures. Associated non-cardiovascular anomalies are often underestimated, since the multipotency and functional alteration of these cells can result in the modification of multiple neural, epidermal, and cervical structures at different levels. In most cases, patients do not display the full phenotype of abnormalities, but congenital cardiac defects involving the ventricular outflow tract, ascending aorta, aortic arch and supra-aortic trunks should be considered as markers for possible impaired function of these cells. Neural crest cells should not be considered as a unique cell population but on the basis of their cervical rhombomere origins R3-R5 or R6-R7-R8 and specific migration patterns: R3-R4 towards arch II, R5-R6 arch III and R7-R8 arch IV and VI. A better understanding of their development may lead to the discovery of unknown associated abnormalities, thereby enabling potential improvements to be made to the therapeutic approach.

Surgical Treatment of Constrictive Pericarditis.

Constrictive pericarditis is the final stage of a chronic inflammatory process characterized by fibrous thickening and calcification of the pericardium that impairs diastolic filling, reduces cardiac output, and ultimately leads to heart failure. Transthoracic echocardiography, computed tomography, and cardiac magnetic resonance imaging each can reveal severe diastolic dysfunction and increased pericardial thickness. Cardiac catheterization can help to confirm a diagnosis of diastolic dysfunction secondary to pericardial constriction, and to exclude restrictive cardiomyopathy. Early pericardiectomy with complete decortication (if technically feasible) provides good symptomatic relief and is the treatment of choice for constrictive pericarditis, before severe constriction and myocardial atrophy occur. We describe our surgical approach to constrictive pericarditis, summarize our results in 93 patients, and provide a brief overview of the literature.

Embolization of a Large Rapidly Growing Aortic Pseudo-Aneurysm Not Amenable to Open or Endovascular Repair.

BACKGROUND: To report the case of a rapidly growing aortic false aneurysm because of Q fever infection that was managed by embolization. CASE REPORT: An 80-year-old man was admitted to our unit for an aortic false aneurysm from a chronic Q fever infection. During his stay, the aneurysm showed rapid progression necessitating urgent treatment. The patient was unfit for surgical repair; moreover, the location of the aneurysm at the level of the superior mesenteric artery prohibited the use of an endovascular graft. He was managed by coiling of the aneurysmal cavity with multiple detachable coils after positioning of a bare aortic stent to lock the coils and prevent their migration into the aortic lumen. The false aneurysm was successfully thrombosed with no complications. The patient was then put on doxycycline and hydroxychloroquine to target Coxiella burnetii. CONCLUSIONS: Aortic false aneurysm coiling is feasible in cases where an endograft is not possible or an open repair is contraindicated. The use of a bare metal stent may help as a barrier to prevent the coils from migrating into the aneurysm and thus avoiding embolization into the systemic circulation.

External Saphenous Vein Support Mesh Does Not Interfere With Transit-Time Flow Measurement on Venous Coronary Bypass Conduit: Clinical Confirmation.

A 65-year-old patient underwent double coronary artery bypass grafting using the left internal thoracic artery on the left anterior descending coronary artery and nitinol alloy mesh [external Saphenous Vein Support (eSVS)]-covered saphenous vein graft to the right posterior descending coronary artery. Transit-time flow measurements (TTFMs) were obtained on meshed and bare parts of the vein graft. There was no difference in TTFM parameters (flow, pulsatility index, and diastolic fraction values) obtained from the eSVS mesh-covered and the uncovered parts of the venous graft. This observation confirms that eSVS mesh does not interfere with TTFM on venous coronary bypass conduits.