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1.
Am J Case Rep ; 21: e926915, 2020 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-32963216

RESUMO

BACKGROUND Recent studies demonstrated evidence of coagulation dysfunction in hospitalized patients with severe coronavirus disease 2019 (COVID-19) due to excessive inflammation, hypoxia, platelet activation, endothelial dysfunction, and stasis. Effective anticoagulation therapy may play a dominant role in the management of severe COVID-19 cases. CASE REPORT A 73-year-old man with a 6-day history of fever up to 38.5°C, dyspnea, cough, and fatigue was diagnosed with COVID-19. He had a past medical history significant for hypertension and coronary artery bypass grafting. Two days after hospital admission, the patient developed acute respiratory failure, requiring intubation, mechanical ventilation, and transfer to the intensive care unit (ICU). He received treatment including antibiotics, hydroxychloroquine, tocilizumab, vasopressors, prone positioning, and anticoagulation with enoxaparin at a prophylactic dose. After a 15-day ICU stay, the patient was hemodynamically stable but still hypoxemic; a transthoracic echocardiogram at that time, followed by a transesophageal echocardiogram for better evaluation, revealed the presence of a right atrium thrombus without signs of acute right ventricular dilatation and impaired systolic function. Since the patient was hemodynamically stable, we decided to treat him with conventional anticoagulation under close monitoring for signs of hemodynamic deterioration; thus, the prophylactic dose of enoxaparin was replaced by therapeutic dosing, which was a key component of the patient's successful outcome. Over the next few days he showed significant clinical improvement. The follow-up transesophageal echocardiogram 3 weeks after effective therapeutic anticoagulation revealed no signs of right heart thrombus. CONCLUSIONS The presented COVID-19 case, one of the first reported cases with evidence of right heart thrombus by transesophageal echocardiography, highlights the central role of diagnostic imaging strategies and the importance of adequate anticoagulation therapy in the management of severe COVID-19 cases in the ICU.


Assuntos
Infecções por Coronavirus/complicações , Ecocardiografia Transesofagiana/métodos , Átrios do Coração/diagnóstico por imagem , Cardiopatias/terapia , Pneumonia Viral/complicações , Síndrome Respiratória Aguda Grave/complicações , Trombose/terapia , Idoso , Terapia Combinada , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Tosse/diagnóstico , Tosse/etiologia , Cuidados Críticos/métodos , Progressão da Doença , Serviço Hospitalar de Emergência , Febre/diagnóstico , Febre/etiologia , Seguimentos , Grécia , Átrios do Coração/patologia , Cardiopatias/diagnóstico por imagem , Cardiopatias/etiologia , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Síndrome Respiratória Aguda Grave/diagnóstico , Síndrome Respiratória Aguda Grave/terapia , Índice de Gravidade de Doença , Trombose/diagnóstico por imagem , Trombose/etiologia , Resultado do Tratamento
2.
Cardiovasc Pathol ; 49: 107265, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32745615

RESUMO

BACKGROUND: Left atrial (LA) enlargement is associated with increased risk of adverse cardiovascular outcomes. Unlike the left ventricular mass, LA mass has not been described. We sought to define the anatomic mass of the LA using anatomic specimens from autopsy. We hypothesized that LA mass could be estimated by echocardiography. METHODS AND RESULTS: Using anatomic specimens of 22 subjects who died and underwent post mortem examination as well as echocardiogram, we defined normal LA mass by weighing anatomic specimens of those with normal LA volume on echocardiogram. Using 17 subjects with normal LA volume on echocardiogram, we found their LA mass on anatomic specimens to be 25.5 ± 6.3 grams (14.4 ± 3.2 g/m2). We developed an echocardiographic measure of LA mass and validated this measurement with paired LA anatomic specimens. We found the normal LA mass on echocardiogram to be 25.4 ± 6.3 g (14.4 ± 2.8 g/m2) which correlated well with anatomic specimens (ß = 0.99; Confidence interval CI 0.6-1.4, P < .0001; Pearson correlation coefficient r = 0.83). Furthermore, we defined the normal LA volume to mass ratio as 1.38 ± 0.45. CONCLUSIONS: LA mass is an additional parameter with which may contribute to the study of LA morphology.


Assuntos
Ecocardiografia , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Idoso , Função do Átrio Esquerdo , Remodelamento Atrial , Autopsia , Feminino , Átrios do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos
3.
Am Heart J ; 226: 206-213, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32615358

RESUMO

INTRODUCTION: Endurance athletes are at higher risk for developing atrial fibrillation as compared to the general population. The exact mechanism to explain this observation is incompletely understood. Our study aimed to determine whether degree of left atrial fibrosis detected by late gadolinium-enhancement magnetic resonance imaging (LGE-MRI) differed between Masters athletes and non-athlete controls. METHODS: We recruited 20 endurance healthy Masters athletes and 20 healthy control subjects who underwent cardiac MRI. Healthy controls were recruited during screening colonoscopies and Masters athletes were recruited through word of mouth and at competitions. The two groups were age and gender matched. None of the participants were known to have an arrhythmia. Fibrosis, as measured by late gadolinium-enhancement, was measured in each participant by blinded readers. The degree of left atrial fibrosis was compared between the two groups. All participants were recruited from the Salt Lake City region and scanned at the University of Utah healthcare complex. RESULTS: Left ventricular function was normal in all study participants. Left atrial volumes were significantly larger in the athletes (74.2 ml ±â€¯14.4) as compared to the healthy control subjects (60.8 mL ±â€¯21.4) (P = .02). Mean left atrial fibrosis score, reported as a percentage of the LA, was 15.5% ±â€¯5.9 in the athlete cohort compared to 9.6% ±â€¯4.9 in the controls (P = .002). CONCLUSIONS: To our knowledge this is the first study that describes, characterizes and specifically quantifies fibrotic changes within the left atrium of highly trained endurance athletes. Increased atrial fibrosis seen in this population may be an early indicator for endurance athletes at risk of developing atrial arrhythmias.


Assuntos
Treino Aeróbico/efeitos adversos , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Imagem por Ressonância Magnética , Adulto , Estudos de Coortes , Meios de Contraste , Treino Aeróbico/métodos , Feminino , Fibrose/diagnóstico por imagem , Fibrose/etiologia , Gadolínio , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Esportes
4.
Clin Nucl Med ; 45(9): 709-710, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32701798

RESUMO

Rosai-Dorfman disease, or sinus histiocytosis with massive lymphadenopathy, is an uncommon histiocytic disorder, which is rare and typically occurs in lymph nodes. However, one third of the cases manifest as extranodal disease. The cardiac involvement of this disease is extremely rare. We reported here the FDG PET/CT findings of a pathologically confirmed Rosai-Dorfman disease occurring in the right atrium in a 60-year-old man.


Assuntos
Fluordesoxiglucose F18 , Átrios do Coração/diagnóstico por imagem , Histiocitose Sinusal/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Átrios do Coração/patologia , Histiocitose Sinusal/patologia , Humanos , Masculino , Pessoa de Meia-Idade
5.
Cardiol Young ; 30(9): 1358-1359, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32624054

RESUMO

A 16-year-old girl with history of treated congenital mitral valve disease and signs of respiratory infection was admitted to our paediatric cardiology department. She was tested positive for severe acute respiratory syndrome coronavirus 2. Despite her severe pre-existing cardiac conditions with pulmonary hypertension, atrial arrhythmias and mitral valve stenosis, the infection did not lead to any cardiac or pulmonary deterioration. In adults, cardiac co-morbidities are known risk factors for a severe course of coronavirus disease 2019 infections. This case illustrates that in children even severe cardiac disease is not necessarily associated with a severe course of coronavirus disease 2019.


Assuntos
Infecções por Coronavirus , Átrios do Coração , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral , Estenose da Valva Mitral , Pandemias , Pneumonia Viral , Falha de Prótese/efeitos adversos , Adolescente , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Ecocardiografia/métodos , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/fisiopatologia , Valva Mitral/patologia , Valva Mitral/fisiopatologia , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/congênito , Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/congênito , Estenose da Valva Mitral/cirurgia , Tamanho do Órgão , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Resultado do Tratamento
6.
PLoS One ; 15(6): e0234404, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32555688

RESUMO

Myocardial energy deprivation plays a causal role in the development of heart failure. A cardiac protection blend (CPB) of nutrients including medium chain triglycerides, fish oil and other key nutrients was developed to slow the progression of canine myxomatous mitral valve disease (MMVD). A six-month dietary intervention demonstrated efficacy of CPB in slowing MMVD progression. Untargeted metabolomic analysis of serum from these dogs identified 102 differential metabolites (adjusted P < 0.05). The ratios of omega-6 to omega-3 fatty acid (FA) changed from 2.41 and 1.46 in control and CPB groups at baseline to 4.30 and 0.46 at 6 months respectively. A 2.7-fold increase of α-aminobutyrate, a myocardial modulator of glutathione homeostasis, was found in CPB dogs compared to 1.3-fold increase in control dogs. Arginine and citrulline, precursors of nitric oxide biosynthesis, were both increased 2-fold; caprate, a medium chain FA, was increased 3-fold; and deoxycarnitine, precursor of carnitine biosynthesis, was increased 2.5-fold in CPB dogs. Margarate and methylpalmitate decreased in response to CPB, a potential benefit in MMVD dogs as positive correlations were found between changes in both these FAs and left atrial diameter (r = 0.69, r = 0.87 respectively, adjusted P < 0.05). Sphingomyelins with very long chain saturated FAs associated with decreased risk of heart failure in humans were increased in MMVD dogs fed the CPB diet. Our data supports the hypothesis that CPB improves FA utilization and energetics, reduces oxidative stress and inflammation in MMVD dogs. More studies are needed to understand the roles of specific metabolites in MMVD.


Assuntos
Doenças do Cão/sangue , Doenças do Cão/dietoterapia , Metaboloma , Insuficiência da Valva Mitral/veterinária , Aminoácidos/sangue , Ração Animal/análise , Animais , Dietoterapia/veterinária , Doenças do Cão/patologia , Cães , Ácidos Graxos/sangue , Feminino , Átrios do Coração/patologia , Masculino , Metabolômica , Insuficiência da Valva Mitral/sangue , Insuficiência da Valva Mitral/dietoterapia , Fosfolipídeos/sangue
7.
J Card Surg ; 35(6): 1380-1382, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32353896

RESUMO

Intravascular tumor extension in the inferior vena cava (IVC) is known to occur with abdominal tumors, such as renal cell, hepatocellular, adrenal cell carcinoma, and Wilm's tumor. We encountered a 53-year-old male patient presenting with pulmonary embolism and a right atrial mass with imaging evidence of an adrenal tumor extending into the IVC, up to the right atrium. The patient underwent surgery for the resection of the tumor using cardiopulmonary bypass by a team of cardiothoracic surgeons and urologists. Histology identified the tumor as hepatocellular carcinoma, which developed as ectopic hepatic tissue in the right adrenal gland.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Carcinoma Hepatocelular/cirurgia , Neoplasias Cardíacas/secundário , Neoplasias Cardíacas/cirurgia , Neoplasias Vasculares/secundário , Neoplasias Vasculares/cirurgia , Veia Cava Inferior/cirurgia , Trombose Venosa/cirurgia , Neoplasias das Glândulas Suprarrenais/patologia , Carcinoma Hepatocelular/patologia , Ponte Cardiopulmonar , Átrios do Coração/patologia , Átrios do Coração/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/etiologia , Embolia Pulmonar/cirurgia , Veia Cava Inferior/patologia , Trombose Venosa/etiologia , Trombose Venosa/patologia
8.
Pediatr Cardiol ; 41(6): 1125-1134, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32367304

RESUMO

To assess the fetal cardiac function and ventricular volumes by three-dimensional (3D) ultrasound using spatio-temporal image correlation (STIC) and virtual organ computer-aided analysis (VOCAL) methods in fetuses from pre-gestational diabetic women. This was a prospective and cross-sectional study that evaluated 53 fetuses from pre-gestational diabetic women and 53 fetuses from healthy mothers between 20 and 34 weeks of gestation. Only fetuses with no structural or genetic abnormalities and singleton pregnant women were included in this study. The fetal cardiac volumes were assessed by STIC and VOCAL methods. The ejection fraction, stroke volume, and cardiac output were calculated from these measurements to evaluate fetal cardiac function. The Mann-Whitney U test was performed to compare the two groups. For calculation of intra- and interobserver reproducibility's, we used concordance correlation coefficients. The mean differences in the right atrial volumes between the diabetic and normal groups ranged from 0.05 mL to 0.1 mL (p = 0.917 and 0.355, respectively). The median of left atrium (LA) volume measurement in pre-gestational diabetic group was significantly lower than healthy mothers (LA: 0.62 vs. 0.68 mL; p < 0.001). The fetal right and left ventricular volumes were similar in both groups. No significant differences in ejection fraction, stroke volume and cardiac output were observed (p value range 0.086-0.815). The majority of fetal atrial/ventricular volumes showed good intra- and interobserver reliabilities. Conversely, the majority cardiac function parameters showed poor intra- and interobserver agreements. STIC and VOCAL methods gave reproducible quantitative results for fetal atrial and ventricular volumes. Significant differences in fetal left atrial volumes were observed between the two groups, which be related to LA atrial dysfunction and /or left ventricle (LV) compliance, reflecting earlier stages of cardiac dysfunction.


Assuntos
Diabetes Gestacional/fisiopatologia , Ecocardiografia Tridimensional/métodos , Coração Fetal/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Adulto , Volume Cardíaco , Estudos de Casos e Controles , Estudos Transversais , Diabetes Gestacional/diagnóstico por imagem , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Humanos , Gravidez , Estudos Prospectivos , Reprodutibilidade dos Testes , Volume Sistólico , Adulto Jovem
9.
Pediatr Cardiol ; 41(6): 1153-1159, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32394061

RESUMO

We determined the prevalence and factors associated with tricuspid regurgitation (TR) in adults with repair of right ventricular (RV) outflow obstruction. A total of 256 patients (128 males) were studied at 25.7 ± 7.2 years after surgery, of whom 179 had repaired tetralogy of Fallot (TOF), 31 had pulmonary atresia with intact ventricular septum (PAIVS), and 46 had pulmonary stenosis (PS). The mitral and tricuspid annulus diameters, maximum right atrial (RA) area, RV end-systolic and end-diastolic areas, and tricuspid and pulmonary regurgitation were assessed using echocardiography. The prevalence of moderate-to-severe TR was 20.7%. Subgroup analysis revealed that prevalence was greater in patients with repaired TOF (20.7%) and PAIVS (35.5%) than PS patients (10.9%). As a group, severity of TR was found to be correlated with RA area (r = 0.35, p < 0.001), RV end-diastolic (r = 0.28, p < 0.001) and end-systolic (r = 0.22, p = 0.001) areas, and tricuspid valve annulus diameter (r = 0.15, p = 0.022). Moderate-to-severe TR was associated with development of cardiac arrhythmias with an odds ratio of 2.9 (95% CI 1.1 to 8.1, p = 0.031). Multivariate analysis revealed maximum RA area (ß = 0.36, p = 0.016) as an independent determinant of severity of TR. Moderate-to-severe TR occurs in about one-fifth of adults with repaired TOF, PAVIS, and PS and is associated with RA dilation and risk of development of cardiac arrhythmias.


Assuntos
Insuficiência da Valva Tricúspide/etiologia , Obstrução do Fluxo Ventricular Externo/cirurgia , Adolescente , Adulto , Arritmias Cardíacas/etiologia , Estudos Transversais , Ecocardiografia , Feminino , Átrios do Coração/patologia , Humanos , Masculino , Resultado do Tratamento , Obstrução do Fluxo Ventricular Externo/complicações , Adulto Jovem
10.
Transl Res ; 223: 25-39, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32438072

RESUMO

Chronic obstructive pulmonary disease (COPD) increases the risk of atrial fibrillation (AF), however, its arrhythmogenic mechanisms are unclear. This study investigated the effects of COPD on AF triggers (pulmonary veins, PVs) and substrates (atria), and their potential underlying mechanisms. Electrocardiographic, echocardiographic, and biochemical studies were conducted in control rabbits and rabbits with human leukocyte elastase (0.3 unit/kg)-induced COPD. Conventional microelectrode, Western blotting, and histological examinations were performed on PV, left atrium (LA), right atrium, and sinoatrial node (SAN) preparations from control rabbits and those with COPD. The rabbits with COPD had a higher incidence of atrial premature complexes, PV burst firing and delayed afterdepolarizations, higher sympathetic activity, larger LA, and faster PV spontaneous activity than did the control rabbits; but they exhibited a slower SAN beating rate. The LA of the rabbits with COPD had a shorter action potential duration and longer tachyarrhythmia induced by tachypacing (20 Hz) and isoproterenol (1 µM). Additionally, the rabbits with COPD had higher fibrosis in the PVs, LA, and SAN. H89 (10 µM), KN93 (1 µM), and KB-R7943 (10 µM) significantly suppressed burst firing and delayed afterdepolarizations in the PVs of the rabbits with COPD. Moreover, compared with the control rabbits, those with COPD had lower expression levels of the ß1 adrenergic receptor, Cav 1.2, and Na+/Ca2+ exchanger in the PVs; Cav 1.2 in the LA; and hyperpolarization-activated cyclic nucleotide-gated K+ channel 4 in the SAN. COPD increases atrial arrhythmogenesis by modulating the distinctive electrophysiological characteristics of the PVs, LA, and SAN.


Assuntos
Arritmias Cardíacas/complicações , Átrios do Coração/patologia , Doença Pulmonar Obstrutiva Crônica/complicações , Animais , Arritmias Cardíacas/diagnóstico por imagem , Arritmias Cardíacas/fisiopatologia , Modelos Animais de Doenças , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Frequência Cardíaca , Pulmão/fisiopatologia , Masculino , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/fisiopatologia , Coelhos , Nó Sinoatrial/diagnóstico por imagem , Nó Sinoatrial/fisiopatologia
11.
Life Sci ; 254: 117797, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32417371

RESUMO

AIMS: Atrial remodeling, including structural and electrical remodeling, is considered as the substrate in the development of atrial fibrillation (AF). Structural remodeling mainly involves atrial fibrosis, and electrical remodeling is closely related to the changes of ion channels in atrial myocytes. In this study, we aimed to investigate the changes of ion channels in atrial remodeling induced by CIH in rats, which provide the explication for the mechanisms of AF. MATERIALS AND METHODS: 80 male Sprague-Dawley rats were randomized into two groups: Control and CIH group (n = 40). CIH rats were subjected to CIH 8 h/d for 30 days. Atrial epicardial conduction velocity, conduction inhomogeneity and AF inducibility were examined. Masson's trichrome staining was used to evaluate the extent of atrial fibrosis, and the expression levels of ion channel subunits were measured by RT-qPCR, Western blot, and IHC, respectively. The remaining 40 rats were used for whole-cell patch clamp experiments. Action potential, INa, ICa-L, Ito were recorded and compared between two groups. KEY FINDINGS: CIH rats showed increased AF inducibility, atrial interstitial collagen deposition, APD, expression levels of RyR2, p-RyR2, CaMKII, p-CaMKII, and decreased atrial epicardial conduction velocity, expression levels of Nav1.5, Cav1.2, Kv1.5, Kv4.2, Kv4.3 compared to the Control rats, and the current density of INa, ICa-L, Ito were significantly decreased in CIH group. SIGNIFICANCE: We observed significant atrial remodeling induced by CIH in our rat model, which was characterized by changes in ion channels. These changes may be the mechanisms of CIH promoting AF.


Assuntos
Remodelamento Atrial/fisiologia , Hipóxia/fisiopatologia , Canais Iônicos/fisiologia , Potenciais de Ação/fisiologia , Animais , Proteína Quinase Tipo 2 Dependente de Cálcio-Calmodulina/biossíntese , Doença Crônica , Fibrose/complicações , Fibrose/patologia , Átrios do Coração/metabolismo , Átrios do Coração/patologia , Átrios do Coração/fisiopatologia , Hipóxia/complicações , Hipóxia/metabolismo , Canais Iônicos/biossíntese , Masculino , Potenciais da Membrana/fisiologia , Ratos , Canal de Liberação de Cálcio do Receptor de Rianodina/biossíntese
12.
J Card Surg ; 35(6): 1368-1370, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32333440

RESUMO

BACKGROUND AND AIM: Anterior mediastinal masses which invade the great vessels and heart are rare. We report a case of a 76-year-old male presenting with a large invasive anterior mediastinal mass following recent cardiac surgery (coronary artery bypass grafting and aortic valve replacement via sternotomy). MATERIALS AND METHODS: This is a case report study with clinical patient information retrieved from hospital electronic records. RESULTS: Computed tomography scanning revealed a large heterogeneous 6.5 × 7.2 × 7.0 cm right anterior mediastinal mass. The mass directly propagated via the left innominate vein into the superior vena cava (SVC) and proximal right atrium. The patient underwent redo sternotomy with the aid of cardiopulmonary bypass and hypothermic circulatory arrest to remove the mass. The mass was sitting in the right pleural cavity and was adherent to the right lung and pericardium. Tumor material was removed from the right atrium, SVC and left innominate vein. The mass was excised en bloc along with a portion of the upper lobe of the right lung. DISCUSSION AND CONCLUSION: Histology of the mass revealed the diagnosis of invasive type A thymoma with transvenous and transcardiac invasion. We advocate for surgeons to be aggressive in their operative resection of such tumours to ensure the best prognostic outlook for the patient.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/cirurgia , Timectomia/métodos , Timoma/patologia , Timoma/cirurgia , Neoplasias do Timo/patologia , Neoplasias do Timo/cirurgia , Idoso , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Átrios do Coração/cirurgia , Neoplasias Cardíacas/diagnóstico por imagem , Humanos , Masculino , Invasividade Neoplásica , Reoperação , Timoma/diagnóstico por imagem , Neoplasias do Timo/diagnóstico por imagem , Resultado do Tratamento
13.
Am J Cardiol ; 125(11): 1745-1748, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32284175

RESUMO

Advanced interatrial block (A-IAB) has been associated to atrial fibrillation (AF) and ischemic stroke, raising the question as to whether such patients, even when still in sinus rhythm without documented AF, could benefit from oral anticoagulation. AF and A-IAB are both markers of stroke. The anatomical substrate in both is fibrotic atrial cardiomyopathy, resulting in atrial electromechanical dyssynchrony, dysfunction, and left atrial remodelling, that favour blood stasis and hypercoagulation. Under these conditions thrombogenic cascade may be triggered, resulting in systemic embolization. Before proposing oral anticoagulation in the management of selected patients with A-IAB, as is currently recommended in patients with AF and high CHA2DS2-Vasc score, a randomized clinical trial will have to demonstrate efficacy and safety of anticoagulation in this setting. In the meantime, an individualized approach may be considered based on the recognition of those patients at a higher risk of stroke. These may be elderly patients with A-IAB and several risk factors and, thus, with a high CHA2DS2-Vasc score and the presence of environmental arrhythmias.


Assuntos
Fibrilação Atrial/epidemiologia , Bloqueio Interatrial/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/fisiopatologia , Remodelamento Atrial/fisiologia , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/patologia , Cardiomiopatias/fisiopatologia , Fibrose , Átrios do Coração/patologia , Humanos , Bloqueio Interatrial/complicações , Bloqueio Interatrial/fisiopatologia , Índice de Gravidade de Doença , Acidente Vascular Cerebral/prevenção & controle , Trombofilia/fisiopatologia
14.
J Cardiovasc Pharmacol Ther ; 25(4): 338-345, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32323557

RESUMO

BACKGROUND: Vitamin D plays an important role in immune system and in the regulation of inflammatory cytokines. Coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB) is associated with an extensive inflammatory response. The aim of this study is to examine the effect of vitamin D treatment on the apoptosis and inflammatory changes developed after CABG. METHODS: This trial was conducted on 70 patients undergoing CABG with CPB. Patients were randomly administered either in placebo or in the group of orally consuming 150 000 IU vitamin D daily for 3 consecutive days before surgery. The right atrium sample was taken to assess caspases 2, 3, and 7 activity using immunohistochemistry method. The serum level of interleukin-10 (IL-10) and insulin-like growth factor 1 (IGF-1) were compared at intervals. RESULTS: The average number of positive cells for caspases 2 and 3 were less in vitamin D group (P = .006 and P < .001, respectively). There was an increase in serum levels of IL-10 after 3 days from vitamin D treatment before surgery (vitamin D group = 4.4 ± 4.9 ng/mL and control group = 1 ± 0.5 ng/mL, P = .001). After operation, IL-10 increased in both groups, higher level in vitamin D group (P < .001). The comparison of serum IGF-1 showed significant difference after 3 days (P = .006) and remained higher in vitamin D group after CPB (P < .001). CONCLUSIONS: These findings suggest the apoptosis rate after CPB can be reduced by vitamin D. Vitamin D treatment may improve the inflammatory status before and after surgery. Further studies are needed to confirm the antiapoptotic property of vitamin D and clinical implication.


Assuntos
Apoptose/efeitos dos fármacos , Ponte Cardiopulmonar/efeitos adversos , Ponte de Artéria Coronária/efeitos adversos , Suplementos Nutricionais , Átrios do Coração/efeitos dos fármacos , Vitamina D/administração & dosagem , Idoso , Biomarcadores/sangue , Caspases/metabolismo , Suplementos Nutricionais/efeitos adversos , Método Duplo-Cego , Feminino , Átrios do Coração/metabolismo , Átrios do Coração/patologia , Humanos , Mediadores da Inflamação/sangue , Fator de Crescimento Insulin-Like I/metabolismo , Interleucina-10/sangue , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Vitamina D/efeitos adversos
16.
J Card Surg ; 35(5): 1132-1134, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32237173

RESUMO

BACKGROUND AND AIM: Lipomatous hypertrophy of the interatrial septum (LHIS), a fatty tumor, is usually diagnosed on both echo and CT/MRI imaging. Cases of LHIS located outside of the interatrial septum are extremely rare and rarer still are these cases large enough to cause symptoms. The clinical literature demonstrates a misunderstanding that fatty tumors outside the intra-atrial area represent lipomas. However, pathologic understanding of these fatty tumors is clear and is based on microscopic findings. METHODS: The tumor was removed by diving the base of attachment at the left ventricular apex via a median sternotomy on cardiopulmonary bypass. RESULTS: The patient made an uneventful recovery and remains well at 6 months postoperatively. CONCLUSIONS: On rare occasions, LHIS can arise from outside the interatrial septum. An LHIS can be differentiated from a lipoma by the presence of entrapped cardiac myocytes in LHIS, making it a pathological, rather than an anatomic, diagnosis.


Assuntos
Septo Interatrial/patologia , Átrios do Coração/patologia , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/patologia , Septos Cardíacos/patologia , Lipoma/diagnóstico , Lipoma/patologia , Adulto , Procedimentos Cirúrgicos Cardíacos , Ponte Cardiopulmonar , Neoplasias Cardíacas/cirurgia , Humanos , Hipertrofia , Lipoma/cirurgia , Imagem por Ressonância Magnética , Masculino , Esternotomia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
17.
Zhongguo Yi Liao Qi Xie Za Zhi ; 44(1): 20-23, 2020 Jan 08.
Artigo em Chinês | MEDLINE | ID: mdl-32343060

RESUMO

OBJECTIVE: Identifying Atrial Ventricular Hypertrophy Electrocardiogram (AVH ECG)and diagnosing the classification of theirs automatically. METHODS: The ECG data used in this experiment was collected from the First Affiliated Hospital of China Medical University. CNN are combined with conventional methods and a 10 layers of one dimensional CNN are created in this experiment to extract the features of ECG signals automatically and achieve the function of classifying. ROC, sensitivity and F1-score are used here to evaluate the effects of the model. RESULTS: In the experiment of identifying AVH ECG, the AUC of test dataset is 0.991, while in the experiment of classifying AVH ECG, the maximal F1-score can reach 0.992. CONCLUSIONS: The CNN model created in this experiment can achieve the auxiliary diagnosis of AVH ECG.


Assuntos
Eletrocardiografia , Átrios do Coração/patologia , Redes Neurais de Computação , China , Humanos , Hipertrofia
18.
Vet Radiol Ultrasound ; 61(3): 291-301, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32173960

RESUMO

Radiography is a standard diagnostic test for characterizing left heart enlargement in dogs however limited information is available on the effects of respiratory phases. This prospective and retrospective method comparison study investigated the respiratory effect on the size and shape of the left heart in dogs to determine the usefulness of expiratory radiographs to detect enlargements in the left atrium (LA) and left ventricle (LV). Thoracic radiographs taken at full inspiration and expiration were evaluated in 20 normal beagles and 100 dogs diagnosed with mitral regurgitation (MR). Vertebral heart score (VHS), vertebral left atrial size, elevation of the carina, and dorsal bulging of LA on lateral view and lateral bulging of the left auricular appendage and LV on ventrodorsal view were assessed. In normal dogs, there were no significant differences in the evaluative factors between inspiration and expiration. In dogs with MR, VHS did not change according to respiration. However, bulging of the LA, left auricular appendage, and LV had sharp margin during expiration compared with inspiration. The expiratory radiographic finding of LA bulging had a higher correlation with the LA to aorta ratio compared with LA bulging in the inspiratory radiography. Using a LA to aorta echocardiographic ratio greater than 1.5 as the gold standard, the radiographic sensitivity for LA enlargement was higher during expiration than inspiration. These findings of our study indicated that expiratory radiography can be helpful to support the detection of left heart enlargement, although it can overestimate LA enlargement in dogs with MR.


Assuntos
Cardiomegalia/veterinária , Doenças do Cão/diagnóstico por imagem , Átrios do Coração/diagnóstico por imagem , Insuficiência da Valva Mitral/veterinária , Radiografia/veterinária , Animais , Aorta/diagnóstico por imagem , Cardiomegalia/diagnóstico por imagem , Cardiomegalia/patologia , Doenças do Cão/patologia , Cães , Ecocardiografia/veterinária , Feminino , Átrios do Coração/patologia , Masculino , Insuficiência da Valva Mitral/diagnóstico por imagem , Estudos Prospectivos , Radiografia/métodos , Estudos Retrospectivos
19.
Proc Natl Acad Sci U S A ; 117(14): 7990-8000, 2020 04 07.
Artigo em Inglês | MEDLINE | ID: mdl-32198206

RESUMO

Atrial fibrillation (AF) is prevalent in diabetes mellitus (DM); however, the basis for this is unknown. This study investigated AF susceptibility and atrial electrophysiology in type 1 diabetic Akita mice using in vivo intracardiac electrophysiology, high-resolution optical mapping in atrial preparations, and patch clamping in isolated atrial myocytes. qPCR and western blotting were used to assess ion channel expression. Akita mice were highly susceptible to AF in association with increased P-wave duration and slowed atrial conduction velocity. In a second model of type 1 DM, mice treated with streptozotocin (STZ) showed a similar increase in susceptibility to AF. Chronic insulin treatment reduced susceptibility and duration of AF and shortened P-wave duration in Akita mice. Atrial action potential (AP) morphology was altered in Akita mice due to a reduction in upstroke velocity and increases in AP duration. In Akita mice, atrial Na+ current (INa) and repolarizing K+ current (IK) carried by voltage gated K+ (Kv1.5) channels were reduced. The reduction in INa occurred in association with reduced expression of SCN5a and voltage gated Na+ (NaV1.5) channels as well as a shift in INa activation kinetics. Insulin potently and selectively increased INa in Akita mice without affecting IK Chronic insulin treatment increased INa in association with increased expression of NaV1.5. Acute insulin also increased INa, although to a smaller extent, due to enhanced insulin signaling via phosphatidylinositol 3,4,5-triphosphate (PIP3). Our study reveals a critical, selective role for insulin in regulating atrial INa, which impacts susceptibility to AF in type 1 DM.


Assuntos
Fibrilação Atrial/metabolismo , Remodelamento Atrial/fisiologia , Diabetes Mellitus Experimental/complicações , Diabetes Mellitus Tipo 1/complicações , Insulina/metabolismo , Potenciais de Ação/efeitos dos fármacos , Potenciais de Ação/fisiologia , Animais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/etiologia , Fibrilação Atrial/fisiopatologia , Remodelamento Atrial/imunologia , Células Cultivadas , Diabetes Mellitus Experimental/induzido quimicamente , Diabetes Mellitus Experimental/metabolismo , Diabetes Mellitus Tipo 1/genética , Diabetes Mellitus Tipo 1/metabolismo , Modelos Animais de Doenças , Ecocardiografia , Eletrocardiografia , Átrios do Coração/citologia , Átrios do Coração/metabolismo , Átrios do Coração/patologia , Átrios do Coração/fisiopatologia , Humanos , Insulina/administração & dosagem , Insulina/genética , Canal de Potássio Kv1.5/metabolismo , Masculino , Camundongos , Camundongos Transgênicos , Miócitos Cardíacos/efeitos dos fármacos , Miócitos Cardíacos/patologia , Miócitos Cardíacos/fisiologia , Canal de Sódio Disparado por Voltagem NAV1.5/metabolismo , Técnicas de Patch-Clamp , Potássio/metabolismo , Cultura Primária de Células , Sódio/metabolismo , Estreptozocina/toxicidade
20.
Pediatr Blood Cancer ; 67(6): e28197, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32207557

RESUMO

Fibrin sheath formation around long-term indwelling central venous catheters is common and usually benign. Fibrin sheath can persist after catheter removal and rarely leads to complications. This is a report of three pediatric oncology patients that required cardiac surgery for cardiac embolization of a "ghost" catheter several years after catheter removal. One case required tricuspid valve replacement for complete tricuspid valve destruction and two had erosion through the atrial wall. The severity of these rare complications mandates follow-up of "ghost" catheters in pediatric oncology patients.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Procedimentos Cirúrgicos Cardíacos/métodos , Cateteres de Demora/efeitos adversos , Embolia/cirurgia , Átrios do Coração/cirurgia , Linfoma não Hodgkin/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Adolescente , Criança , Embolia/etiologia , Embolia/patologia , Átrios do Coração/patologia , Humanos , Linfoma não Hodgkin/patologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/patologia , Prognóstico
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