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1.
Int Heart J ; 61(1): 138-144, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-31875620

RESUMO

Exercise preconditioning may protect against cardiac injury induced by lipopolysaccharide (LPS), but the mechanism is unresolved. The aim of this study is to explore whether the general control nonderepressible 2 (GCN2) kinase gene is associated with the protective effect of exercise preconditioning. Eight-week-old male C57BL/6J (n = 40) and GCN2 knockout (KO) (n = 40) mice were divided into four groups: control, LPS (L), exercise preconditioning (E), and exercise preconditioning LPS (EL). Mice in the exercise groups performed exercise for eight weeks. After exercise, all mice were given an equal volume of LPS or saline (10 µg/g). We measured the cardiac function using echocardiography and then collected heart tissue. Exercise preconditioning improved cardiac inflammation (interleukin-6, tumor necrosis factor α) and cardiac dysfunction (ejection fraction, fraction shortening) in C57 mice induced by LPS and also decreased the expression levels of GCN2, phosphorylation of eukaryotic translation initiation factor 2α (p-eIF2α), and activating transcription factor 4 (ATF4). Moreover, GCN2 KO decreased inflammation and cardiac dysfunction induced by LPS in sedentary mice. The inflammation and cardiac dysfunction in the GCN2 KO EL group were lower than in the C57 EL group, and the expression of GCN2, p-eIF2α, and ATF4 in the GCN2 KO EL group was lower than in the C57 EL group. Exercise preconditioning alleviated cardiac injury induced by LPS. GCN2 KO also improved cardiac injury. Exercise preconditioning promoted the effect of GCN2 KO in alleviating cardiac injury, and the GCN2 and eIF2α/ATF4 pathways play an important role in the process.


Assuntos
Traumatismos Cardíacos/prevenção & controle , Lipopolissacarídeos/efeitos adversos , Condicionamento Físico Animal/métodos , Proteínas Serina-Treonina Quinases/genética , Fator 4 Ativador da Transcrição/metabolismo , Animais , Modelos Animais de Doenças , Ecocardiografia , Fator de Iniciação 2 em Eucariotos/metabolismo , Técnicas de Inativação de Genes , Traumatismos Cardíacos/induzido quimicamente , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Fosforilação , Proteínas Serina-Treonina Quinases/metabolismo
2.
J Cardiothorac Surg ; 14(1): 185, 2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31684992

RESUMO

BACKGROUND: Cardiac radiofrequency ablation is a popular treatment for arrhythmias. However, it does have some complications, some of which are severe, even fatally. And there were limited reports on cardiac internal perforation after radiofrequency catheter ablation (RFCA) that required a surgical repair. CASE PRESENTATION: A 47-year-old male was admitted to our hospital due to chest congestion for 4 months. He received a radiofrequency catheter ablation (RFCA) 9 months prior to admission. On admission, an echocardiogram showed an abnormal perforation between the left ventricle and the left atrium with moderate mitral valve regurgitation. We therefore performed a mitral valve replacement (MVR) and fixed the abnormal atrial-ventricular breakage via median sternotomy. CONCLUSIONS: Cardiac perforation is a severe complication of cardiac RFCA, operators should be extremely cautious to minimize radiofrequency associated perforations. Such a challenging and complex procedure should be deliberately considered by doctors and patients before implementation.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Traumatismos Cardíacos/diagnóstico , Ecocardiografia , Átrios do Coração/lesões , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/cirurgia , Implante de Prótese de Valva Cardíaca , Ventrículos do Coração/lesões , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral , Complicações Pós-Operatórias
3.
Vet Ital ; 55(3): 275-278, 2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31599553

RESUMO

An adult male Eurasian otter, found dead on the roadside, was submitted for post-mortem examination in April 2014 at the Veterinary Pathology Unit of the Faculty of Veterinary Medicine of Teramo, as part of the RECAL [RECovery and post mortem Analysis of Eurasian otters (Lutra lutra) in the National Park of Cilento, Vallo di Diano and Alburni (Salerno, Italy), and surrounding areas] project. Necropsy revealed an abundant hemothorax associated with multifocal, bilateral pulmonary contusions and lacerations, and a severe hemopericardium characterised by the presence of a wide blood clot in the intact pericardial sac. Two small laceration wounds of the left auricle were found at the base, along the atrioventricular groove, and on the outer free wall. Since myocardial and endocardial tissues showed no other gross and histopathological abnormalities, a left atrial appendage rupture resulting from a blunt chest trauma was diagnosed. Blunt traumatic cardiac rupture is a rarely reported, life-threatening condition in humans. To the best of our knowledge, this is the first report on a left atrial appendage rupture due to blunt chest trauma in veterinary literature. The possible occurrence of a cardiac rupture following a blunt thoracic injury should be taken into consideration in veterinary emergency care.


Assuntos
Apêndice Atrial/patologia , Traumatismos Cardíacos/veterinária , Lontras , Traumatismos Torácicos/veterinária , Ferimentos não Penetrantes/veterinária , Animais , Evolução Fatal , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/patologia , Itália , Masculino , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/patologia , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/patologia
4.
Rev Bras Ter Intensiva ; 31(2): 262-265, 2019 May 30.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31166560

RESUMO

Cardiac trauma often occurs in motor vehicle accidents. A 50-year-old female driver was transported to our hospital with multiple trauma after a high-speed car accident. After admission to the intensive care unit, cardiac ultrasound examination revealed traumatic tricuspid valve papillary muscle rupture and patent foramen ovale, while Lancisi's sign was noted on physical examination. Surgical treatment was performed with valve annuloplasty and closure of the patent foramen ovale and a covert right atrial defect that was detected intraoperatively.


Assuntos
Forame Oval Patente/etiologia , Átrios do Coração/cirurgia , Músculos Papilares/lesões , Valva Tricúspide/lesões , Acidentes de Trânsito , Anuloplastia da Valva Cardíaca/métodos , Feminino , Forame Oval Patente/diagnóstico , Forame Oval Patente/cirurgia , Átrios do Coração/lesões , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/cirurgia , Humanos , Pessoa de Meia-Idade , Músculos Papilares/cirurgia , Valva Tricúspide/cirurgia
7.
BMJ Case Rep ; 12(2)2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30824470

RESUMO

Postcardiac injury syndrome (PCIS) is a rare condition that is considered to have a trauma-induced autoimmune mechanism triggered by damage to pericardial and/or pleural tissues. We report a case of PCIS accompanied by systemic oedema after thymectomy. A 73-year-old woman was referred to our hospital for dyspnoea and oedema, 9 months after thymectomy. Evaluation revealed the presence of pericardial effusion, pleural effusion and systemic oedema. Differential diagnosis included constrictive pericarditis (secondary to tuberculosis), serositis caused by collagen disease and malignancy. Detailed investigations led to the diagnosis of PCIS, which was successfully treated with prednisolone. This report focuses on the diagnostic approach to PCIS. Since it took time to make a final diagnosis in our patient, we analysed several past case reports and series to determine the cause of the delay in diagnosis.


Assuntos
Traumatismos Cardíacos/complicações , Traumatismos Cardíacos/diagnóstico , Timectomia/efeitos adversos , Idoso , Anti-Inflamatórios/uso terapêutico , Aspirina/uso terapêutico , Colchicina/uso terapêutico , Diagnóstico Tardio , Diagnóstico Diferencial , Ecocardiografia , Feminino , Traumatismos Cardíacos/tratamento farmacológico , Traumatismos Cardíacos/etiologia , Humanos , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/tratamento farmacológico , Derrame Pericárdico/etiologia , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/tratamento farmacológico , Derrame Pleural/etiologia , Prednisolona/uso terapêutico , Síndrome , Tomografia Computadorizada por Raios X , Moduladores de Tubulina/uso terapêutico
9.
J Cardiothorac Surg ; 14(1): 28, 2019 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-30717747

RESUMO

BACKGROUND: Isolated right atrial rupture (IRAR) from blunt chest trauma is rare. There are no physical exam findings and non-invasive testing specific to the condition, which result in diagnostic delays and poor outcomes. We present a case of IRAR along with a systematic review of similar cases in the literature. CASE REPORT: A 23-year-old male presented following a motor vehicle accident (MVA). He was bradycardic and hypotensive during transportation; and required intubation. There were contusions along the right chest wall with clear breath sounds, and no jugular venous distension, muffled heart sounds. Hemodynamic status progressively worsened, ultimately leading to his death. However, no external sources of bleeding or evidence of cardiac tamponade was found. METHODS: A search of PubMed, Ovid, and the Cochrane Library using: (Blunt OR Blunt trauma) AND (Laceration OR Rupture OR Tear) AND (Right Atrium OR Right Atrial). Articles were included if they were original articles describing cases of IRAR. RESULTS: Forty-five reports comprising seventy-five (n = 75) cases of IRAR. CONCLUSION: IRAR most commonly occurs following MVAs as the result of blunt chest trauma. Rupture occurs at four distinct sites and is most commonly at the right atrial appendage. IRAR is a diagnostic challenge and requires a high index of suspicion, as patients' hemodynamics can rapidly deteriorate. The presentations vary depending on multiple factors including rupture size, pericardial integrity, and concomitant injuries. Cardiac tamponade may have a protective effect by prompting the search for a bleeding source. A pericardial window can be diagnostic and therapeutic in IRAR. Outcomes are favourable with timely recognition and prompt surgical intervention.


Assuntos
Apêndice Atrial/lesões , Traumatismos Cardíacos/diagnóstico , Ferimentos não Penetrantes/complicações , Acidentes de Trânsito , Evolução Fatal , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/fisiopatologia , Hemodinâmica , Humanos , Masculino , Adulto Jovem
10.
Interact Cardiovasc Thorac Surg ; 28(6): 999-1000, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30508174

RESUMO

The isolated coronary sinus (CS) rupture causing cardiac tamponade following blunt chest trauma is a very rare and very unique traumatic form of cardiac tamponade. Prompt recognition of this injury is crucial for patient survival. CS injuries are frequently difficult to repair and are potentially lethal. A meticulous repair carried out on an arrested, empty and well-protected heart is recommended to achieve secure haemostasis and CS patency. To our knowledge, this is the first report on the successful repair of isolated CS rupture following blunt chest trauma.


Assuntos
Tamponamento Cardíaco/etiologia , Seio Coronário/lesões , Traumatismos Cardíacos/complicações , Traumatismos Torácicos/complicações , Ferimentos não Penetrantes/complicações , Acidentes de Trânsito , Idoso , Procedimentos Cirúrgicos Cardíacos/métodos , Tamponamento Cardíaco/diagnóstico , Tamponamento Cardíaco/cirurgia , Seio Coronário/diagnóstico por imagem , Seio Coronário/cirurgia , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/cirurgia , Humanos , Imagem Tridimensional , Masculino , Tomografia Computadorizada Multidetectores , Ruptura , Traumatismos Torácicos/diagnóstico , Ferimentos não Penetrantes/diagnóstico
11.
Clin Res Cardiol ; 108(5): 465-467, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30259106

RESUMO

Late perforation of the atrial wall after pacemaker implantation frequently remains asymptomatic but may cause chest pain, dyspnea or syncope. Perforation can also lead to rarer complications such as hemoptysis and pneumopericardium. We present the case of a patient who developed progressive hemoptysis 3 years after a dual-chamber pacemaker implantation. Pacemaker interrogation showed stable impedance of the right atrial lead and stable pacing threshold values. CT revealed perforation of the right atrial wall by the RA-lead with consecutive pneumopericardium and diffuse lung bleeding of the right middle lobe. The patient was hemodynamically stable at all times. The right atrial lead was transvenously extracted and replaced without any further complications.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Remoção de Dispositivo/métodos , Átrios do Coração/lesões , Traumatismos Cardíacos/complicações , Hemoptise/etiologia , Marca-Passo Artificial/efeitos adversos , Pneumopericárdio/etiologia , Idoso de 80 Anos ou mais , Bloqueio Atrioventricular/terapia , Ecocardiografia , Feminino , Seguimentos , Átrios do Coração/diagnóstico por imagem , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/cirurgia , Hemoptise/diagnóstico , Humanos , Pneumopericárdio/diagnóstico , Fatores de Tempo , Tomografia Computadorizada por Raios X
15.
J Invasive Cardiol ; 30(11): E126-E127, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30373956

RESUMO

Left atrial appendage (LAA) perforation is a possible complication not only after release of the closure device, but also during the diagnostic phase due to sheath positioning in the LAA. We present an 83-year-old woman with permanent atrial fibrillation and high thromboembolic and bleeding risk who was admitted for elective percutaneous LAA closure. During angiographic study, she suddenly became hypotensive. Heart perforation with leakage of contrast in the pericardial space was evident and imaging confirmed cardiac tamponade. Rapid release of the closure device and pericardial evacuation allowed the operators to successfully manage the cardiac tamponade and avoid a surgical option.


Assuntos
Apêndice Atrial/lesões , Fibrilação Atrial/cirurgia , Cateterismo Cardíaco/efeitos adversos , Tamponamento Cardíaco/etiologia , Traumatismos Cardíacos/etiologia , Dispositivo para Oclusão Septal/efeitos adversos , Idoso de 80 Anos ou mais , Angiografia , Apêndice Atrial/diagnóstico por imagem , Fibrilação Atrial/diagnóstico , Transfusão de Sangue Autóloga/métodos , Tamponamento Cardíaco/diagnóstico , Tamponamento Cardíaco/terapia , Ecocardiografia Transesofagiana , Feminino , Traumatismos Cardíacos/complicações , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/terapia , Humanos , Pericardiocentese , Fatores de Tempo
16.
J Invasive Cardiol ; 30(11): E128, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30373957

RESUMO

Left atrial dissection is an exceedingly rare complication of cardiac surgery, with an incidence of 0.16%-0.84%. We report the first case of interatrial dissection and hematoma in association with the MitraClip procedure. Hemodynamically stable patients can be managed conservatively, with echocardiographic imaging, often with resolution of the dissection over the course of weeks. Our patient remained hemodynamically stable and asymptomatic post operation; at 1-month follow-up, echocardiogram showed resolution of the interatrial septal dissection.


Assuntos
Septo Interatrial/lesões , Cateterismo Cardíaco/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Traumatismos Cardíacos/etiologia , Comunicação Interatrial/etiologia , Insuficiência da Valva Mitral/cirurgia , Idoso , Septo Interatrial/diagnóstico por imagem , Ecocardiografia Transesofagiana , Feminino , Traumatismos Cardíacos/diagnóstico , Comunicação Interatrial/diagnóstico , Humanos , Insuficiência da Valva Mitral/diagnóstico
17.
Int Heart J ; 59(6): 1296-1302, 2018 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-30369574

RESUMO

Our aim was to assess the clinical effects of myocardial injury after transcatheter aortic-valve implantation (TAVI). Between October 2013 and July 2016, 157 patients underwent TAVI with Sapien XT, Sapien 3, or CoreValve prostheses at our institute. Of these, 130 patients for whom the transapical approach was not used were included in this study. Myocardial injury was defined as a peak troponin I level of ≥1.5 ng/mL within 48 hours after TAVI. We evaluated the predictors of myocardial injury and compared the clinical outcomes of 82 patients classified as the myocardial injury group and 44 patients classified as the non-myocardial injury group. The patients were aged 85 ± 6 years. Myocardial injury occurred in 82 patients (65.1%). Age (per 1 increase) (odds ratio [OR]: 1.11, 95% confidence interval [CI]: 1.01-1.22, P = 0.041), female sex (OR: 3.88, 95% CI: 1.23-12.22, P = 0.021), valve type (Sapien XT; OR: 4.22, 95% CI: 1.15-15.47, P = 0.03, Core valve; OR: 18.12, 95% CI: 2.86-114.59, P = 0.002), balloon aortic valvuloplasty as a bridge therapy (OR: 0.10, 95% CI: 0.02-0.42, P = 0.002), and left ventricular end-diastolic volume (LVEDV) (per 1 increase) (OR: 0.97, 95% CI: 0.95-0.99, P = 0.003) were associated with myocardial injury in a multivariate model. The myocardial injury group did not have a higher rate of midterm (365-day) mortality (log-rank test P = 0.57) than the non-myocardial injury group on Kaplan-Meier analysis. Myocardial injury after TAVI was not associated with midterm mortality.


Assuntos
Estenose da Valva Aórtica/cirurgia , Traumatismos Cardíacos/etiologia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/mortalidade , Feminino , Seguimentos , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/epidemiologia , Traumatismos Cardíacos/terapia , Humanos , Incidência , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
18.
JCI Insight ; 3(20)2018 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-30333303

RESUMO

BACKGROUND: Because injury is universal in organ transplantation, heart transplant endomyocardial biopsies present an opportunity to explore response to injury in heart parenchyma. Histology has limited ability to assess injury, potentially confusing it with rejection, whereas molecular changes have potential to distinguish injury from rejection. Building on previous studies of transcripts associated with T cell-mediated rejection (TCMR) and antibody-mediated rejection (ABMR), we explored transcripts reflecting injury. METHODS: Microarray data from 889 prospectively collected endomyocardial biopsies from 454 transplant recipients at 14 centers were subjected to unsupervised principal component analysis and archetypal analysis to detect variation not explained by rejection. The resulting principal component and archetype scores were then examined for their transcript, transcript set, and pathway associations and compared to the histology diagnoses and left ventricular function. RESULTS: Rejection was reflected by principal components PC1 and PC2, and by archetype scores S2TCMR, and S3ABMR, with S1normal indicating normalness. PC3 and a new archetype score, S4injury, identified unexplained variation correlating with expression of transcripts inducible in injury models, many expressed in macrophages and associated with inflammation in pathway analysis. S4injury scores were high in recent transplants, reflecting donation-implantation injury, and both S4injury and S2TCMR were associated with reduced left ventricular ejection fraction. CONCLUSION: Assessment of injury is necessary for accurate estimates of rejection and for understanding heart transplant phenotypes. Biopsies with molecular injury but no molecular rejection were often misdiagnosed rejection by histology.TRAIL REGISTRATION. ClinicalTrials.gov NCT02670408FUNDING. Roche Organ Transplant Research Foundation, the University of Alberta Hospital Foundation, and Alberta Health Services.


Assuntos
Endocárdio/patologia , Rejeição de Enxerto/etiologia , Traumatismos Cardíacos/diagnóstico , Transplante de Coração/efeitos adversos , Miocárdio/patologia , Adolescente , Adulto , Idoso , Biópsia , Criança , Pré-Escolar , Endocárdio/lesões , Feminino , Perfilação da Expressão Gênica , Traumatismos Cardíacos/etiologia , Traumatismos Cardíacos/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Análise Serial de Tecidos , Transplantados , Adulto Jovem
20.
Heart Surg Forum ; 21(4): E254-E256, 2018 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-30084774

RESUMO

Traumatic pericardial rupture is a rare event with high mortality. We present the case of a 15-year-old boy who sustained thoracic and abdominal trauma secondary to motor vehicle collision, with a delayed diagnosis of traumatic pericardial rupture with cardiac herniation. Out of concern for torsion and hemodynamic collapse, surgical repair was advised. We have developed a novel surgical approach to this rare condition, utilizing a combination of thoracoscopic and open surgical techniques. The guiding principles of our repair include the utilization of fenestrated pieces of bovine pericardium to create a tension free repair, minimizing the likelihood of pericardial effusion, and returning the cardiac mass to normal anatomic position.


Assuntos
Traumatismos Abdominais/diagnóstico , Procedimentos Cirúrgicos Cardíacos/métodos , Traumatismos Cardíacos/diagnóstico , Traumatismo Múltiplo , Pericárdio/lesões , Ferimentos não Penetrantes/diagnóstico , Traumatismos Abdominais/cirurgia , Acidentes de Trânsito , Adolescente , Ecocardiografia , Traumatismos Cardíacos/cirurgia , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Pericárdio/diagnóstico por imagem , Pericárdio/cirurgia , Ruptura , Ferimentos não Penetrantes/cirurgia
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