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1.
Medicine (Baltimore) ; 98(38): e17250, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567993

RESUMO

RATIONALE: Central retinal artery occlusion (CRAO) due to cardiac myxoma primarily occurs in elderly individuals. Early detection and surgical resection of myxoma are extremely important because CRAO causes complete blindness in most cases. However, due to the extremely low incidence of CRAO caused by cardiac myxoma in the pediatric age group, such condition is rarely reported. PATIENT CONCERNS: A 16-year-old female patient visited our hospital due to sudden onset of vision loss in the left eye, dysarthria, and right-sided hemiplegia. DIAGNOSES: She was diagnosed with CRAO via fundoscopy. Results showed a cherry-red spot, indicating CRAO. Brain magnetic resonance imaging (MRI) revealed multifocal diffusion-restricted foci, particularly in the left frontal lobe. Echocardiography revealed a left atrial mass measuring 4.21 cm × 2.25 cm. The mass was attached to the interseptum and moved along the inflow of the mitral valve. Cardiac computed tomography (CT) revealed an enhanced mass measuring 3 cm × 2.2 cm × 3 cm and with irregular margin on the anterior wall of the left atrium and the border of the fossa ovalis. INTERVENTIONS: The patient underwent surgical excision under general anesthesia. Intraoperative finding showed a huge, jelly-like, and extremely friable mass. Pathological examination confirmed myxoma. OUTCOMES: During a follow-up of 2 years after diagnosis, she did not present with other neurological deficits and no residual mass was observed on echocardiography. However, visual impairment of the left eye persisted. LESSONS: Most patients with CRAO may present with other mild symptoms that are often be neglected before CRAO development. We recommend that patients who present with frequent syncopal attack or symptoms of transient ischemic attack should undergo echocardiography.


Assuntos
Cegueira/etiologia , Átrios do Coração , Neoplasias Cardíacas/complicações , Mixoma/complicações , Adolescente , Ecocardiografia , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/patologia , Humanos , Mixoma/diagnóstico por imagem , Mixoma/patologia , Oclusão da Artéria Retiniana/complicações , Oclusão da Artéria Retiniana/diagnóstico , Oclusão da Artéria Retiniana/etiologia , Tomografia Computadorizada por Raios X
2.
Life Sci ; 235: 116837, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31493481

RESUMO

AIMS: This study aimed to evaluate the effects of the sigma-1 receptor (S1R) on atrial fibrillation (AF) susceptibility in rats. MAIN METHODS: Rats were randomly assigned into three groups for intraperitoneal treatment with saline (CTL group), BD1047 (an antagonist of the S1R, BD group) or BD1047 plus fluvoxamine (an agonist of the S1R, BD + F group) for 4 weeks. The heart rate variability (HRV) and atrial electrophysiological parameters were measured via the PowerLab system and analyzed by LabChart 8.0 software. Atrial histology was determined with Masson staining. The protein levels of connexin (Cx) 40, Cav1.2, S1R, eNOS, p-eNOS, and p-AKT were detected by western blot assays. KEY FINDINGS: Our results showed that BD1047 significantly shortened the atrial effective refractory period (ERP) and action potential duration (APD), increased AF inducibility and duration, augmented sympathetic activity, depressed parasympathetic activity, and reduced heart rate variability (HRV) compared with the CTL group. Masson staining also showed a significant increase in atrial fibrosis in the BD group. Furthermore, the expressions of S1R, Cx40, Cav1.2, p-eNOS, and p-AKT were dramatically reduced in the BD group compared with the CTL group (all P < 0.01). However, fluvoxamine administration mitigated most of the abovementioned alterations. SIGNIFICANCE: Our findings indicated that S1R inhibition contributed to atrial electrical remodeling, cardiac autonomic remodeling and atrial fibrosis, which could be attenuated by fluvoxamine, thus providing new insights into the relationship between the S1R and AF.


Assuntos
Fibrilação Atrial/fisiopatologia , Remodelamento Atrial/fisiologia , Receptores sigma/antagonistas & inibidores , Receptores sigma/fisiologia , Potenciais de Ação , Animais , Fibrilação Atrial/patologia , Canais de Cálcio Tipo L , Conexinas/metabolismo , Etilenodiaminas/farmacologia , Fluvoxamina/farmacologia , Átrios do Coração/efeitos dos fármacos , Átrios do Coração/metabolismo , Átrios do Coração/patologia , Frequência Cardíaca/efeitos dos fármacos , Masculino , Óxido Nítrico Sintase Tipo III/metabolismo , Proteína Oncogênica v-akt/metabolismo , Ratos , Receptores sigma/agonistas , Receptores sigma/metabolismo
3.
Medicine (Baltimore) ; 98(31): e16640, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374034

RESUMO

RATIONALE: Tumors in the heart are rare. Myxomas, rhabdomyomas, and fibromas are the most common benign cardiac tumors. Hamartoma of mature cardiomyocytes (HMCM) is another benign cardiac tumor, are very rare and have only been reported in a few literatures. PATIENT CONCERNS: We report a case of 41-year-old male who suffered short of breath for 3 years, and lower limbs edema for 2 years. DIAGNOSES: Transthoracic echocardiogram (TTE) and cardiac magnetic resonance (CMR) showed a large amount of pericardial effusion and confirmed a mass of 18 × 14 mm on the superior vena cava near the outer edge of right atrium. The patient was first diagnosed as pleural mesothelioma. Surgery was performed to relieve the symptoms and confirm diagnoses. However, during surgery, we found the right atrium is apparently thicken with rough and uneven surface. Histology of right atrium mass indicated it as hamartoma of mature cardiomyocytes. INTERVENTION: We resected the thicken atrial wall completely, reconstructed right atrium with bovine pericardial patch, and resected the pericardium. OUTCOMES: Patient was discharged 9 days after surgery, and remained asymptomatic during 9 months follow up. LESSONS: Hamartoma of mature cardomyocytes is a rare benign cardiac tumor. There were 26 cases reported until now. The conclusive diagnosis depends on pathological sections. For patients with symptoms, surgery is an effective treatment for HMCM.


Assuntos
Hamartoma/patologia , Átrios do Coração/patologia , Cardiopatias/patologia , Miócitos Cardíacos/patologia , Adulto , Dispneia/etiologia , Ecocardiografia , Edema/etiologia , Hamartoma/complicações , Hamartoma/cirurgia , Cardiopatias/complicações , Cardiopatias/cirurgia , Humanos , Masculino
4.
Expert Rev Med Devices ; 16(9): 821-828, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31348864

RESUMO

Background: Few data are available regarding lead preferences of electrophysiologists during cardiac implantable electronic devices (CIEDs) implantation. Aim of this survey is to evaluate the leads used, and the reasons behind these choices, in a large population of implanters. Methods: A questionnaire was sent to all 314 Italian centers with experience in CIED implantation. Results: 103 operators from 100 centers (32% of centers) responded. For atrium, passive leads represented first choice for pacemakers and defibrillators (71% and 64% of physicians, respectively), mainly for safety. For right ventricle, active fixation was preferred (61% and 93% operators in pacemaker and defibrillator patients), for higher versatility in positioning and lower dislodgement risk. For left ventricular stimulation, quadripolar leads were preferred by more than 80% of respondents, for better phrenic nerve and myocardial threshold management; active-fixation leads represent a second choice, in order to prevent or manage dislodgement (78% and 17% of respondents, respectively), but 44% of operators considered them dangerous. Conclusions: The choice of leads is heterogeneous. Trends are toward active-fixation right ventricular leads and passive-fixation atrial leads (particularly in pacemaker patients, considered frailer). For left ventricular stimulation, operators' majority want to disposition all kind of leads, although quadripolar leads are the favorites.


Assuntos
Arritmias Cardíacas/terapia , Desfibriladores Implantáveis , Eletrônica Médica , Marca-Passo Artificial , Feminino , Geografia , Átrios do Coração/patologia , Ventrículos do Coração/patologia , Humanos , Itália , Inquéritos e Questionários
5.
Braz J Cardiovasc Surg ; 34(3): 372-376, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31310479

RESUMO

We are going to present a case of malignant fibrous histiocytoma in the right atrium, which is a very rare entity. The patient had a right atrial mass, which prolapsed through the tricuspid valve into the right ventricle, causing functional tricuspid valve stenosis. The tumor was completely resected and the patient had an uneventful postoperative period. Histopathological examination reported malignant fibrous histiocytoma. The patient presented to the emergency department five weeks after discharge with dyspnea and palpitation. Echocardiography and magnetic resonance imaging revealed recurrent right atrial tumor mass. His clinical status has worsened, with syncope and acute renal failure. On the repeated echocardiography, suspected tumor recurrence was observed in left atrium, which probably caused systemic embolization. Considering the aggressive nature of the tumor and systemic involvement, our Heart Council decided to provide palliative treatment by nonsurgical management. His status deteriorated for the next few days and the patient succumbed to a cardiac arrest on the 4th day.


Assuntos
Neoplasias Cardíacas/patologia , Histiocitoma Fibroso Maligno/patologia , Angiografia Coronária , Ecocardiografia , Evolução Fatal , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Neoplasias Cardíacas/diagnóstico por imagem , Histiocitoma Fibroso Maligno/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Recidiva Local de Neoplasia , Doenças Raras , Tomografia Computadorizada por Raios X , Prolapso da Valva Tricúspide/diagnóstico por imagem , Prolapso da Valva Tricúspide/patologia
6.
Pediatr Cardiol ; 40(6): 1266-1274, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31250046

RESUMO

Left heart distension during venoarterial extracorporeal membrane oxygenation (VA ECMO) often necessitates decompression to facilitate myocardial recovery and prevent life-threatening complications. The objectives of this study were to compare clinical outcomes between patients who did and did not undergo left atrial (LA) decompression, quantify decompression efficacy, and identify risk factors for development of left heart distension. This was a single-center retrospective case-control study. Pediatric VA ECMO patients who underwent LA decompression from June 2004 to March 2016 were identified, and a control cohort of VA ECMO patients who did not undergo LA decompression were matched based on diagnosis, extracorporeal cardiopulmonary resuscitation, and age. Among 194 VA ECMO cases, 21 (11%) underwent LA decompression. Compared to the control cohort, patients with decompression had longer hospital length of stay (60 ± 55 vs. 27 ± 23 days, p = 0.012), but similar in-hospital mortality (29% vs. 38%, p = 0.513). Decompression successfully decreased mean LA pressure (24 ± 11 to 14 ± 4 mmHg, p = 0.022) and LA:RA pressure gradient (10 ± 7 to 0 ± 1 mmHg, p = 0.011). No significant differences in early quantitative measures of cardiac function were observed between cases and controls to identify risk factors for left heart distension. Despite higher qualitative risk for impaired cardiac recovery, patients who underwent LA decompression had comparable outcomes to those who did not. Given that traditional quantitative measures of cardiac function are insufficient to predict development of eventual left heart distension, a combination of clinical history, radiographic findings, hemodynamic monitoring, and laboratory markers should be used during the evaluation and management of these patients.


Assuntos
Descompressão Cirúrgica/métodos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Átrios do Coração/cirurgia , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/cirurgia , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Descompressão Cirúrgica/mortalidade , Feminino , Átrios do Coração/patologia , Mortalidade Hospitalar , Humanos , Lactente , Tempo de Internação/estatística & dados numéricos , Masculino , Estudos Retrospectivos , Fatores de Risco
7.
Lipids Health Dis ; 18(1): 109, 2019 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-31077199

RESUMO

BACKGROUND: Atrial lipid metabolic remodeling is critical for the process of atrial fibrillation (AF). Abnormal Fatty acid (FA) metabolism in cardiomyocytes is involved in the pathogenesis of AF. MET (Metformin), an AMPK (AMP-activated protein kinase) activator, has been found to be associated with a decreased risk of AF in patients with type 2 diabetes. However, the specific mechanism remains unknown. METHODS: Fifteen mongrel dogs were divided into three groups: SR, ARP (pacing with 800 beats/min for 6 h), ARP plus MET (treated with MET (100 mg/kg/day) for two weeks before pacing). We assessed metabolic factors, speed limiting enzymes circulating biochemical metabolites (substrates and products), atrial electrophysiology and accumulation of lipid droplets. RESULTS: The expression of AMPK increased in the ARP group and significantly increased in the MET+ARP group comparing to the SR group. In the ARP group, the expressions of PPARα、PGC-1α and VLCAD were down-regulated, while the concentration of free fatty acid and triglyceride and the lipid deposition in LAA (left atrial appendage) increased. Moreover, AERP and AERPd have also been found abnormally in this process. Pretreatment with MET before receiving ARP reversed the alterations aforementioned. CONCLUSIONS: The FA metabolism in LAA is altered in the ARP group, mainly characterized by the abnormal expression of the rate-limiting enzyme. Metformin reduces lipid accumulation and promotes ß-oxidation of FA in AF models partially through AMPK/PPAR-α/VLCAD pathway. Our study indicates that MET may inhibit the FA lipid metabolic remodeling in AF.


Assuntos
Proteínas Quinases Ativadas por AMP/metabolismo , Acil-CoA Desidrogenase de Cadeia Longa/metabolismo , Fibrilação Atrial/metabolismo , Metabolismo dos Lipídeos/efeitos dos fármacos , Metformina/farmacologia , PPAR alfa/metabolismo , Transdução de Sinais/efeitos dos fármacos , Animais , Fibrilação Atrial/fisiopatologia , Estimulação Cardíaca Artificial , Modelos Animais de Doenças , Cães , Ácidos Graxos/metabolismo , Átrios do Coração/efeitos dos fármacos , Átrios do Coração/patologia , Masculino , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Transcrição Genética/efeitos dos fármacos
8.
BMJ Case Rep ; 12(5)2019 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-31061188

RESUMO

Primary cardiac angiosarcoma, the most common primary cardiac sarcoma has an incidence ranging from 0.001% to 0.028% in autopsy reports with around 200 cases reported in literature. Since a diagnosis of cardiac angiosarcoma portends a poor prognosis, it is vital to ascertain the precise extent of the lesions for follow-up. Imaging with positron emission tomography (PET) tracer 2-deoxy-2-[18F]-fluoro-D-glucose in cardiac angiosarcoma is challenging as myocardium takes up glucose and delineation of tumour becomes difficult. Cell proliferation rate in normal cardiac muscular tissue is low whereas cardiac tumours display a higher proliferation rate. This aspect could be exploited by use of 3'-deoxy-3'[(18)F]-fluorothymidine positron emission tomography (18F-FLT PET/CT] in cardiac tumours where the cell proliferation could be measured. Herein, we imaged an index case of cardiac angiosarcoma using 18F-FLT PET/CT and report the findings.


Assuntos
Fibrilação Atrial/etiologia , Fluordesoxiglucose F18 , Átrios do Coração/patologia , Neoplasias Cardíacas/patologia , Hemangiossarcoma/patologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Angioplastia , Fibrilação Atrial/diagnóstico por imagem , Proliferação de Células , Tratamento Farmacológico/métodos , Dispneia , Ecocardiografia , Átrios do Coração/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Hemangiossarcoma/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
9.
J Forensic Leg Med ; 65: 45-47, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31100653

RESUMO

The histological findings in the heart in cases of fatal sepsis can show myocytolysis, interstitial fibrosis, necrotic contraction band, mononuclear infiltrates, and interstitial edema, which can be used in post mortem diagnosis of sepsis. Septic myocardial calcification is a very rare condition, and only a few cases have been reported in the literature. In general, the pathogenesis of the myocardial calcification has not been well clarified, but two pathogenic mechanisms have been universally recognized: metastatic or dystrophic. We present a rare case of sepsis-related myocardial calcification. Here we report a case involving a 72-year-old white male who was admitted to a hospital for a polytrauma caused by a motorbike accident. On the 110th day of hospitalization, the patient was diagnosed with a septic process and a subsequent transesophageal echocardiogram revealed the presence of a calcification on the right atrial wall. According to the medical history of the patient there were no systemic factors predisposing to calcium crystals deposition in tissues. Patient died due to multi-organ failure in the course of multimicrobial septic shock during the 149th day. The autopsy revealed both the presence of a greenish-brown formation and a greater consistency of the right atrial wall. The histological investigation of the right atrium wall showed a wide calcification area localized at subendocardial level, which contained fibrin deposition and was surrounded by fibrotic tissue.


Assuntos
Calcinose/patologia , Átrios do Coração/patologia , Sepse/complicações , Idoso , Evolução Fatal , Fibrina/metabolismo , Fibrose/patologia , Átrios do Coração/metabolismo , Humanos , Masculino , Insuficiência de Múltiplos Órgãos , Choque Séptico/etiologia
10.
Blood Press Monit ; 24(3): 110-113, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30969227

RESUMO

Both regular physical activity and hypertension may be related to increased myocardial thickness, but the interplay between these two factors in causing cardiac remodeling in athletes is still a matter of debate. The aim of this study was to analyze the relation between resting and peak exercise blood pressure (BP) and myocardial hypertrophy in healthy middle-aged amateur endurance athletes. The study included 30 male, long-term athletes (mean age 40.9±6.6 years) who underwent resting BP assessment, cardiopulmonary exercise testing with peak exercise BP measurement, and cardiac magnetic resonance. We found that interventricular septal diameter is increased in athletes with high-normal resting BP (n=11, 37%) - median 13 mm (interquartile range: 12-13.75 mm), but not in those with optimal or normal BP (n=19) - median 10 mm (10-11.75 mm), P=0.001. This finding is accompanied by significantly higher left and right ventricular mass index and larger left atrial area in the first group. These differences are even more pronounced in athletes in whom high-normal BP is accompanied by exaggerated blood pressure response (EBPR) to exercise, whereas isolated EBPR to exercise does not lead to hypertrophy or further left atrial enlargement. Prehypertension, isolated or combined with EBPR to exercise, affects cardiac remodeling in athletes. Identification of increased myocardial thickness in pure endurance middle-aged athletes should merit further investigation on masked hypertension.


Assuntos
Atletas , Hipertrofia Ventricular Esquerda/etiologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Resistência Física , Remodelação Ventricular , Adulto , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial , Exercício/fisiologia , Teste de Esforço , Átrios do Coração/patologia , Átrios do Coração/fisiopatologia , Ventrículos do Coração/fisiopatologia , Humanos , Hipertensão/fisiopatologia , Hipertrofia Ventricular Esquerda/patologia , Masculino , Hipertensão Mascarada/complicações , Hipertensão Mascarada/fisiopatologia , Pessoa de Meia-Idade , Descanso , Função Ventricular Esquerda
11.
Nat Commun ; 10(1): 1929, 2019 04 26.
Artigo em Inglês | MEDLINE | ID: mdl-31028265

RESUMO

Genetically modified mice have advanced our understanding of valve development and disease. Yet, human pathophysiological valvulogenesis remains poorly understood. Here we report that, by combining single cell sequencing and in vivo approaches, a population of human pre-valvular endocardial cells (HPVCs) can be derived from pluripotent stem cells. HPVCs express gene patterns conforming to the E9.0 mouse atrio-ventricular canal (AVC) endocardium signature. HPVCs treated with BMP2, cultured on mouse AVC cushions, or transplanted into the AVC of embryonic mouse hearts, undergo endothelial-to-mesenchymal transition and express markers of valve interstitial cells of different valvular layers, demonstrating cell specificity. Extending this model to patient-specific induced pluripotent stem cells recapitulates features of mitral valve prolapse and identified dysregulation of the SHH pathway. Concurrently increased ECM secretion can be rescued by SHH inhibition, thus providing a putative therapeutic target. In summary, we report a human cell model of valvulogenesis that faithfully recapitulates valve disease in a dish.


Assuntos
Células Endoteliais/patologia , Proteínas Hedgehog/genética , Prolapso da Valva Mitral/patologia , Valva Mitral/patologia , Células-Tronco Pluripotentes/patologia , Animais , Antígenos CD/genética , Antígenos CD/metabolismo , Biomarcadores/metabolismo , Proteína Morfogenética Óssea 2/farmacologia , Caderinas/genética , Caderinas/metabolismo , Diferenciação Celular/efeitos dos fármacos , Embrião de Mamíferos , Endocárdio/metabolismo , Endocárdio/patologia , Células Endoteliais/efeitos dos fármacos , Células Endoteliais/metabolismo , Células Endoteliais/transplante , Transição Epitelial-Mesenquimal/efeitos dos fármacos , Fator de Transcrição GATA5/genética , Fator de Transcrição GATA5/metabolismo , Perfilação da Expressão Gênica , Regulação da Expressão Gênica , Átrios do Coração/metabolismo , Átrios do Coração/patologia , Proteínas Hedgehog/metabolismo , Humanos , Camundongos , Valva Mitral/metabolismo , Prolapso da Valva Mitral/genética , Prolapso da Valva Mitral/metabolismo , Prolapso da Valva Mitral/terapia , Modelos Biológicos , Células-Tronco Pluripotentes/efeitos dos fármacos , Células-Tronco Pluripotentes/metabolismo , Cultura Primária de Células , Proteínas com Domínio T/genética , Proteínas com Domínio T/metabolismo , Proteína Wnt3A/farmacologia
12.
Zhonghua Bing Li Xue Za Zhi ; 48(4): 293-297, 2019 Apr 08.
Artigo em Chinês | MEDLINE | ID: mdl-30955265

RESUMO

Objective: To study the clinicopathological characteristics of cardiac neoplasms. Methods: A total of 689 cases of cardiac neoplasms from January 1st 1992 to December 31th 2017 at Guangdong Provincial People's Hospital were collected. The clinical data and histologic features were analyzed along with a review of literature. The pathological diagnosis and classification were based on the criteria of WHO 4th edition(2015). Results: Among 689 cases of cardiac neoplasms, 259 were male and 430 were female patients, with age from 0 to 84 years (mean of 48 years). The peak incidence was between the fourth and sixth decade. Among patients younger than 20 years, there were 24 males and 12 females. 674 cases(674/689,97.8%)were primary cardiac tumors and 15 cases were secondary tumors (15/689,2.2%). Amongst the primary cardiac neoplasms, 625 cases were benign(625/674,92.7%), 7 cases were borderline (7/674, 1.0%), and 42 cases were malignant (42/674, 6.2%). The incidences of benign, borderline and malignancy heart tumors among patients below 20 years old were lower than those of patients over 20 years of age (4.8% vs. 95.2%; 3/9 vs. 6/9; 5.5% vs. 94.5%, respectively). Of the benign tumors, 406 cases were female and 219 cases were male. More male than female patients were seen in borderline and malignancy cardiac tumor categories (6∶3; 34∶21). Of 625 benign tumors, 577 cases were myxoma(85.6%), which mainly occurred in patients over 20 years of age(85.9% vs. 14.1%) with a female predominance. Non-myxomas mainly occurred in children and adolescent patients compared to adult (55.6% vs. 44.4%, P<0.01) with a male predominance. Overall, 524 tumors originated from the left atrium, 84 cases from the right atrium, 26 cases from the pericardium, 23 cases from the right ventricular, and 11 cases from the left ventricle. However, 21 cases were multicentric or involving cardiac valves. Benign tumors mainly involved left heart(76.3%) vs. right heart(81/625, 12.6%). The mostly common location of borderline tumors was right heart(5/9). Malignant tumors tended to involve the right heart(22/55,40.0%) and pericardium(18/55, 32.7%). Conclusions: Although the incidence of cardiac neoplasms is low,various tumor types can occur, most of which are myxoma with a female predominance. Non-myxomas mainly occur in children and adolescents with a male predominance.


Assuntos
Neoplasias Cardíacas/patologia , Mixoma/patologia , Adolescente , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , China/epidemiologia , Feminino , Átrios do Coração/patologia , Neoplasias Cardíacas/epidemiologia , Ventrículos do Coração , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Mixoma/epidemiologia , Distribuição por Sexo , Adulto Jovem
13.
Heart Surg Forum ; 22(2): E162-E164, 2019 04 12.
Artigo em Inglês | MEDLINE | ID: mdl-31013229

RESUMO

Primary cardiac neoplasms are extremely rare and often overlooked as differential diagnosis. Angiosarcomas are the most common primary malignant neoplasms of the heart often with nonspecific symptoms. We present a 43-year-old woman admitted to our hospital with chest pain and inferoposterolateral myocardial infarction. Coronary angiography indicated the distal occlusion of the left circumflex artery. Transthoracic and transoesophagic echocardiography revealed a mass in the left atrium with probable myocardial infiltration and vascularisation. The mass in the left atrium was removed by surgical resection, and histopathology confirmed angiosarcoma. We emphasize the pivotal role of transthoracic and transoesophageal echocardiography in evaluating even rare differential diagnosis of acute coronary syndrome as cardiac neoplasms.


Assuntos
Átrios do Coração/cirurgia , Neoplasias Cardíacas/cirurgia , Hemangiossarcoma/cirurgia , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/cirurgia , Adulto , Biomarcadores/sangue , Angiografia Coronária , Ecocardiografia , Eletrocardiografia , Feminino , Átrios do Coração/patologia , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/patologia , Hemangiossarcoma/diagnóstico , Hemangiossarcoma/patologia , Humanos , Esternotomia , Tomografia Computadorizada por Raios X
14.
J Cancer Res Ther ; 15(2): 305-311, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30964102

RESUMO

Background: Hepatocellular carcinoma (HCC) with tumor thrombus extending to the inferior vena cava (IVC) and right atrium (RA) is rare, which is generally associated with serial syndromes and poor prognosis. The results of earlier observations revealed that the median survival was 1-5 months after diagnosis for untreated patients. The prognosis was poor with surgery, radiotherapy, transarterial chemoembolization (TACE), and chemotherapy. Methods: A total of 1850 patients received TACE for advanced HCC at our institution from October 2011 to September 2016. Among them, 18 cases presented tumor thrombus extended from hepatic vein to IVC and RA. TACE was performed to deal with the tumor thrombus inside the RA, and angiography was performed for characterizing. The successful rate, survival, safety, and clinical adverse events were retrospectively studied. Results: A total of 56 interventional procedures were conducted for the 18 cases of tumor thrombus extending to IVC and RA. TACE were successfully performed in all patients without significant complications. One case died of pneumonia, and no severe adverse effect was observed in the other 17 cases. The 1- and 3-year overall survival rates were 50% and 16.7%, respectively. The average survival from diagnosis of right atrial tumor thrombus (RATT) was 15.2 months. The blood supply was rich for all RATT. There were seven cases with single-feeding artery and 11 cases with two or three feeding arteries that originated from intra- or extra-hepatic arteries. The extrahepatic artery played a critical role in the blood supply of RATT, including right inferior phrenic artery (8/18), left inferior phrenic artery (1/18), and the left gastric artery (2/18). Conclusion: For HCC with tumor thrombus in the IVC and RA, TACE could safely improve the prognosis of these patients. Searching for multiple feeding arteries are essential for ensuring efficacy. In addition, careful examination and appropriate embolization technique are essential for safety and efficacy. Lipiodol was a safe and ideal agent for the embolization in RATT.


Assuntos
Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica , Átrios do Coração/patologia , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/terapia , Tromboembolia/diagnóstico , Tromboembolia/etiologia , Adulto , Idoso , Angiografia/métodos , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/mortalidade , Quimioembolização Terapêutica/métodos , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Tromboembolia/mortalidade , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
15.
Transl Res ; 208: 30-46, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30857762

RESUMO

B-type natriuretic peptide (BNP) was approved by the US Food and Drug Administration in 2001 for the treatment of heart failure. However, the effects of BNP in clinical applications are controversial and uncertain. Recently, study indicated that high BNP levels are associated with an increased risk of developing atrial fibrillation. In this study, we investigated the direct effects of BNP on TNF-α-induced atrial fibrosis mice, as well as its effects on human atrial myofibroblasts. We found that injecting TNF-α-induced mice with recombinant human BNP enhanced atrial fibrosis via matrix metalloproteinase-2 (MMP-2) expression and collagen accumulation. Furthermore, we found that BNP stimulated MMP-2 expression in human atrial myofibroblasts. Treatment of human atrial myofibroblasts with cycloheximide had no effect on this outcome; however, treatment of cells with MG132 enhanced BNP-induced MMP-2 expression, indicating that protein stability and inhibition of proteasome-mediated protein degradation pathways are potentially involved. Inhibition of SIRT1 significantly decreased BNP-induced MMP-2 expression. Additionally, confocal and coimmunoprecipitation data indicated that BNP-regulated MMP-2 expression are likely to be mediated through direct interaction with SIRT1, which is thought to deacetylate MMP-2 and to increase its protein stability in human atrial myofibroblasts. Finally, we confirmed that SIRT1 is expressed and cytoplasmically redistributed as well as colocalized with MMP-2 in mouse fibrotic atrial tissue. We suggest a possible fibrosis-promoting role of BNP in the atrium, although the antifibrotic properties of BNP in the ventricle have been reported in previous studies, and that the coordination between MMP-2 and SIRT1 in BNP-induced atrial myofibroblasts participates in atrial fibrosis.


Assuntos
Átrios do Coração/enzimologia , Metaloproteinase 2 da Matriz/metabolismo , Miofibroblastos/metabolismo , Peptídeo Natriurético Encefálico/fisiologia , Acetilação , Animais , Fibrose , Átrios do Coração/patologia , Humanos , Técnicas In Vitro , Camundongos , Miofibroblastos/enzimologia , Sirtuína 1/metabolismo
16.
J Forensic Leg Med ; 63: 48-51, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30861473

RESUMO

Percutaneous vertebroplasty consists of percutaneous injection of polymethylmethacrylate (PMMA) via a transpedicular approach for the treatment of collapsed osteoporotic or metastatic vertebrae. Even if percutaneous vertebroplasty is considered to be minimally invasive, threatening complications can occur. Cement leakage is the most common complication of percutaneous vertebroplasty. Rigorous patient selection and individual therapeutic strategy may reduce the occurrence of leakage, in particular the risk of cement entry into the venous system and the spinal canal is the potent major hazard of this technique. Cement pulmonary and cardiac embolism are reported in literature as a cause of unexpected death after percutaneous vertebroplasty. Authors report a fatal case of pulmonary cement embolization occurred after vertebroplasty with haemopericardium, due to the perforation of the right atrium wall from a cement solidified fragment. A complete post mortem examination documented the presence of multiple cement fragments in the pulmonary arteries and transmural perforation of the wall of the right atrium by a whitish needle-like foreign body. Pulmonary microembolization was observed under polarized light.


Assuntos
Cimentos para Ossos/efeitos adversos , Morte Súbita/etiologia , Extravasamento de Materiais Terapêuticos e Diagnósticos/complicações , Átrios do Coração/lesões , Embolia Pulmonar/patologia , Vertebroplastia/efeitos adversos , Idoso , Feminino , Corpos Estranhos/patologia , Patologia Legal , Fraturas por Compressão/cirurgia , Átrios do Coração/patologia , Humanos , Fraturas por Osteoporose/cirurgia , Polimetil Metacrilato/efeitos adversos , Fraturas da Coluna Vertebral/cirurgia
17.
Cardiovasc Pathol ; 40: 32-40, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30836303

RESUMO

BACKGROUND: The mechanism by which atrial fibrosis leads to the production and maintenance of atrial fibrillation (AF) is unclear. Myocardial biopsies, which have often been used in previous studies, are taken from a single site and do not always reflect the overall condition of atrial fibrosis. AIMS: The aim of this study was to investigate the location of fibrosis in the atria induced by mitral regurgitation (MR) and its effect on atrial electrophysiology and vulnerability to AF. METHODS: Nineteen pigs were divided into three groups. The control group (n=6) underwent a sham operation, and the experimental groups underwent an MR induction operation and were observed for 3 (n=7) or 6 (n=6) months. All the animals were tested for vulnerability to AF. Then, the atria were divided into 12 regions: 6 in the left atrium (LA) and 6 in the right atrium (RA). The conduction velocities (CVs) and effective refractory periods (ERPs) in different regions were examined by electroanatomic mapping, and fibrosis in different regions was examined by Masson staining. RESULTS: With the duration of MR, fibrosis (3.11% ±â€¯0.08% in the control group, 5.85% ±â€¯0.42% in the 3-month group and 8.17% ±â€¯0.23% in the 6-month group, P<.001), vulnerability to AF (0/6 in the control group, 2/7 in the 3-month group and 5/6 in the 6-month group, P<.05) and the effective refractory period (220.1±1.1 ms in the control group, 244.4±1.4 ms in the 3-month group and 289.0±8.9 ms in the 6-month group, P<.001) were increased, while the conduction velocity (1.39±0.16 m/s in the control group, 1.04±0.05 m/s in the 3-month group and 0.89±0.02 m/s in the 6-month group, P<.001) was reduced. These pathophysiological changes were not uniform in different regions of the atria (3.83% ±â€¯0.25% in right atrial fibrosis vs 8.22% ±â€¯0.83% in left atrial fibrosis, P<.001; 5.09% ±â€¯0.34% in the right atrium vs 11.76% ±â€¯0.52% in the left atrium, P<.001). A negative correlation was identified between fibrosis and conduction velocity (P<.001 in the 3-month and 6-month groups), but no correlation was found between fibrosis and the effective refractory period (P=.829 in the 3-month group and P=.093 in the 6-month group). Susceptibility to AF was associated with the dispersion of atrial fibrosis (P=.023). CONCLUSIONS: With the duration of MR, atrial fibrosis increased, and the degree of increase was not uniform among different areas of the atria. The dispersion of atrial fibrosis may contribute to increased susceptibility to AF by influencing the conduction velocity rather than the effective refractory period.


Assuntos
Potenciais de Ação , Fibrilação Atrial/etiologia , Remodelamento Atrial , Átrios do Coração/fisiopatologia , Frequência Cardíaca , Insuficiência da Valva Mitral/complicações , Animais , Fibrilação Atrial/patologia , Fibrilação Atrial/fisiopatologia , Modelos Animais de Doenças , Fibrose , Átrios do Coração/patologia , Masculino , Insuficiência da Valva Mitral/patologia , Insuficiência da Valva Mitral/fisiopatologia , Período Refratário Eletrofisiológico , Fatores de Risco , Suínos , Porco Miniatura , Fatores de Tempo
18.
Mol Med ; 25(1): 7, 2019 03 20.
Artigo em Inglês | MEDLINE | ID: mdl-30894138

RESUMO

BACKGROUND: Long non-coding RNAs (lncRNA) plasmacytoma variant translocation 1 (PVT1) has been shown to be associated with liver fibrosis. Nevertheless, the role of PVT1 in atrial fibrosis remains undefined. This study aims to elucidate the pathophysiological role of lncRNA PVT1 in the regulation of atrial fibrosis and to explore the underlying mechanism. METHODS: Expression of PVT1, miR-128-sp, and Sp1 were examined in human atrial muscle tissues and angiotensin-II (Ang-II)-induced human atrial fibroblasts. Furthermore, the role of PVT1 in regulating atrial fibrosis in Ang-II-treated human atrial fibroblasts and Ang-II-induced atrial fibrosis in mice was investigated. Moreover, the interaction among PVT1, miR-128-3p, and Sp1 were examined using bioinformatics, expression correlation analysis, gain- or loss-of-function assays, RIP assays, and luciferase reporter assays. The involvement of transforming growth factor beta 1 (TGF-ß1)/Smad pathway in this process was also explored. RESULTS: PVT1 was increased in atrial muscle tissues from AF patients and positively with collagen I and collagen III. In vitro assay revealed that PVT1 overexpression facilitated the Ang-II-induced atrial fibroblasts proliferation, collagen production, and TGF-ß1/Smad signaling activation, whereas PVT1 knockdown caused the opposite effect. In vivo assay further confirmed that PVT1 knockdown attenuated the Ang-II-induced mouse atrial fibrosis. Mechanically, PVT1 acted as a sponge for miR-128-3p to facilitate Sp1 expression, thereby activating the TGF-ß1/Smad signaling pathway. CONCLUSION: LncRNA PVT1 promotes atrial fibrosis via miR-128-3p-SP1-TGF-ß1-Smad axis in atrial fibrillation.


Assuntos
Fibrilação Atrial , Átrios do Coração/patologia , MicroRNAs/metabolismo , RNA Longo não Codificante/metabolismo , Proteínas Smad/metabolismo , Fator de Transcrição Sp1/metabolismo , Fator de Crescimento Transformador beta1/metabolismo , Adulto , Angiotensina II/farmacologia , Animais , Fibrilação Atrial/metabolismo , Fibrilação Atrial/patologia , Fibrilação Atrial/fisiopatologia , Proliferação de Células/efeitos dos fármacos , Colágeno Tipo I/metabolismo , Colágeno Tipo II/metabolismo , Feminino , Fibroblastos/metabolismo , Fibrose , Átrios do Coração/metabolismo , Átrios do Coração/fisiopatologia , Humanos , Masculino , Camundongos Endogâmicos C57BL , Pessoa de Meia-Idade
19.
J Med Case Rep ; 13(1): 75, 2019 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-30894202

RESUMO

BACKGROUND: Hypertrophic cardiomyopathy is one of the most common causes of sudden cardiac death in young athletes. Performing, comparing, and monitoring serial electrocardiograms over time can help to detect potential cardiovascular diseases and to prevent malignant cardiac events in these populations. CASE PRESENTATION: A young Han Chinese male football player had abnormal electrocardiograms for 8 years without any subjective discomfort. Electrocardiograms revealed that T-wave inversions increased from 1 mm to a maximum of 5 mm on lead I and fluctuated around 5 mm on lead avL. Q-wave duration ranged from 40 ms to 60 ms, its depth increased to a maximum of 8 mm and was much greater than 40% of the R waves in depth in II, III, and avF leads. Echocardiography showed increasingly thickened interventricular septum from 10 mm to 13 mm, enlarged left atrium and ventricle, and reduced left ventricular ejection fraction. Coronary angiography showed no distinct stenosis. Emission computed tomography revealed mild myocardial ischemia of the left ventricular inferior wall. These unusual electrocardiogram manifestations were initially regarded as benign alterations of a highly trained athlete. Upon reviewing the clinical information and the newest criteria for electrocardiographic interpretation in athletes, hypertrophic cardiomyopathy was identified. The misreading of electrocardiograms is not uncommon, thus predisposing such patients to high susceptibility to exercise-induced sudden cardiac death. CONCLUSIONS: We propose that abnormal electrocardiogram findings reveal the initial expression of underlying cardiac diseases such as hypertrophic cardiomyopathy, preceding the symptoms and signs by many years. Accordingly, early detection and continuous surveillance are important for athletes with such electrocardiogram patterns, and improvement of physicians' expertise is crucial.


Assuntos
Cardiomiopatia Hipertrófica/diagnóstico , Adulto , Atletas , Ecocardiografia , Eletrocardiografia , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Septos Cardíacos/diagnóstico por imagem , Septos Cardíacos/patologia , Humanos , Masculino , Cooperação do Paciente , Função Ventricular Esquerda
20.
Mol Cell Biochem ; 457(1-2): 169-177, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30895498

RESUMO

The aim of this study was to explore the role of NRON in the atrial fibrosis. The expression of NRON in atrial tissue was detected using qRT-PCR. The protein levels of collagen I, collagen III, NFATc3 and p-NFATc3 were determined by western blot. Immunohistochemistry assay were performed to observe expression and distribution of collagen I in atrial tissues. The atrial fibroblasts were authenticated by vimentin/troponin immunofluorescence staining. Fibroblast proliferation was detected by CCK-8 assay. The morphological changes of cardiac tissue were observed by HE staining. Myocardial fibrosis was detected by masson staining. NRON expression was significantly downregulated in atrial tissues of AF. NRON suppressed fibroblast proliferation; expression of collagen I and collagen III; activation of NFATc3 and nucleu import. NRON promoted p-NFATc3 expression and alleviated atrial fibrosis in vivo. Our data indicated that NRON alleviates atrial fibrosis via promoting NFATc3 phosphorylation.


Assuntos
Fibroblastos/metabolismo , Miocárdio/metabolismo , Fatores de Transcrição NFATC/metabolismo , RNA Longo não Codificante/metabolismo , Adulto , Animais , Colágeno Tipo I/biossíntese , Colágeno Tipo III/biossíntese , Feminino , Fibroblastos/patologia , Fibrose , Átrios do Coração/metabolismo , Átrios do Coração/patologia , Humanos , Masculino , Camundongos , Pessoa de Meia-Idade , Miocárdio/patologia , Fosforilação
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