CD5L, Macrophage Apoptosis Inhibitor, Was Identified in Epicardial Fat-Secretome and Regulated by Isoproterenol From Patients With Heart Failure.

OBJECTIVES: Neurohormonal dysfunction, which can regulate epicardial fat activity, is one of the main promoters of atrial fibrillation (AF) in patients with heart failure (HF). Our aim was to study the epicardial fat mediators for AF in patients with HF and its catecholaminergic regulation. METHODS: We have included 29 patients with HF who underwent cardiac surgery and were followed up for 5 years. Released proteins by epicardial adipose tissue (EAT) after isoproterenol treatment were identified by nano-high-performance liquid chromatography (HPLC) and triple time-of-flight (TOF) analysis. Common and differential identified proteins in groups of patients with AF before and after surgery were determined by the FunRich tool. Plasma and epicardial fat biopsy proteins were quantified by western blot. RESULTS: Our results identified 17 common released proteins by EAT, after isoproterenol treatment, from HF patients who suffered AF or developed new-onset AF during follow-up. Mostly, they were involved on inflammatory response and extracellular matrix. One of them was CD5L, a macrophage apoptosis inhibitor. Its secretion by isoproterenol treatment was validated on western blot. The CD5L levels on epicardial fat were also higher in the group of male patients who present or develop AF (0.44 ± 0.05 vs. 0.18 ± 0.15; p < 0.016). However, there were no differences regarding plasma levels. CONCLUSION: Our results suggest the role of epicardial fat CD5L as a mediator of AF and its possible paracrine effect by catecholaminergic activity.

Inusual endocarditis infecciosa sobre válvula protésica por Pseudomonas monteilii y Acinetobacter nosocomialis con fatal desenlace / Unusual infective prosthetic valve endocarditis due to Pseudomonas monteilii and Acinetobacter nosocomialis with a fatal result

Presentamos el caso de una endocarditis por Pseudomonas monteilii y Acinetobacter nosocomialis con un fatal desenlace. El paciente tenía una historia reciente de reemplazo valvular aórtico. La ecografía transesofágica y la tomografía computarizada confirmaron la presencia de vegetación en la válvula protésica y un seudoaneurisma aórtico con un absceso en la raíz aórtica. El cultivo de la válvula demostró P.monteilii y A.nosocomialis. El paciente fue tratado con cirugía y antibióticos, pero sufrió un deterioro y murió 44días tras la cirugía. En nuestro conocimiento este es el primer caso de endocarditis producida por P.monteilii y A.nosocomialis publicado en la literatura. Estas bacterias han sido descritas como contaminantes ambientales; sin embargo, deben ser consideradas como potenciales patógenos, en especial en pacientes con válvulas protésicas

We report a case of Pseudomonas monteilii and Acinetobacter nosocomialis endocarditis with a fatal outcome in a patient with a recent history of prosthetic aortic valve replacement. Transesophageal echocardiography and computed tomography confirmed the presence of vegetation on the prosthetic valve and aortic pseudoaneurism with an aortic root abscess. Valve cultures yielded P.monteilii and A.nosocomialis. The patient underwent surgery and received antibiotics, but his condition deteriorated and he died 44days after surgery. To our knowledge, this is the first case of P.monteilii and A.nosocomialis endocarditis reported in the literature. These organisms have been described as environmental contaminants; however, they must be considered potential pathogens, particularly in patients with prosthetic valves

Unusual infective prosthetic valve endocarditis due to Pseudomonas monteilii and Acinetobacter nosocomialis with a fatal result. / Inusual endocarditis infecciosa sobre válvula protésica por Pseudomonas monteilii y Acinetobacter nosocomialis con fatal desenlace.

We report a case of Pseudomonas monteilii and Acinetobacter nosocomialis endocarditis with a fatal outcome in a patient with a recent history of prosthetic aortic valve replacement. Transesophageal echocardiography and computed tomography confirmed the presence of vegetation on the prosthetic valve and aortic pseudoaneurism with an aortic root abscess. Valve cultures yielded P.monteilii and A.nosocomialis. The patient underwent surgery and received antibiotics, but his condition deteriorated and he died 44days after surgery. To our knowledge, this is the first case of P.monteilii and A.nosocomialis endocarditis reported in the literature. These organisms have been described as environmental contaminants; however, they must be considered potential pathogens, particularly in patients with prosthetic valves.

Double intracardiac thrombosis in a patient assisted by a venoarterial extracorporeal membrane oxygenation. / Trombosis intracardíaca doble en paciente asistido mediante membrana de oxigenación extracorpórea venoarterial.

Intracardiac thrombosis is a rare complication in patients receiving haemodynamic support with venous-arterial extracorporeal membrane oxygenation (VA-ECMO), but it has a high risk of mortality. This case report describes a patient who suffered cardiogenic shock after a ST-segment elevation myocardial infarction (STEMI) and who presented with intracardiac thrombosis during VA-ECMO support on two occasions after mitral valve replacement. The first one was after the insertion of a mechanical prosthesis, and the second, after replacing it with a biological valve.

Massive right hemothorax due to idiopathic spontaneous rupture of a phrenic artery following cardiac surgery. / Hemotórax masivo derecho por rotura espontánea idiopática de una arteria frénica tras cirugía cardiaca.

We report a case of a 35-years-old man who presented a massive haemothorax and hypovolemic shock following cardiac surgery, from spontaneous rupture of a phrenic artery. A quick diagnosis and immediate intervention is crucial to manage the patient.