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1.
BMC Infect Dis ; 21(1): 460, 2021 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-34016047

RESUMO

BACKGROUND: This case report describes the clinical process of a shepherd who suffered brucellosis-related endocarditis (BE) and spondylitis (BS) and was infected with Brucella melitensis biovar 3 (B. melitensis biovar 3). CASE PRESENTATION: A 55-year-old male patient was admitted to The First Affiliated Hospital of Shihezi University on October 11, 2018, due to over 3 months of intermittent fever, back pain, and heart trouble. The Rose Bengal Plate test was positive, the standard agglutination test titer for brucellosis was 1/800, and the blood culture was positive for B. melitensis biovar 3. Three instances of transthoracic echocardiography examination at days 1, 25, and 376 after admission to the hospital and magnetic resonance imaging (MRI) and computed tomography (CT) checks at days 5 and 38 revealed that the size of the vegetation on the posterior leaflet of the mitral valve increased from 0.7 × 1.4 cm to 1.2 × 1.5 cm and that the left atrium and ventricle were enlarged. The MRI and CT results showed hyperplasia of the second and third vertebra, a cold abscess formed on both sides of the psoas major muscles, and the vertebra hyperplasia became aggravated at a later time point. The patient's situation deteriorated, and heart failure was discovered on October 22, 2019. At the moment of submission of this manuscript, the patient remains in bed at home because of severe debility caused by brucellosis. CONCLUSIONS: This is the first reported case of endocarditis combined with spondylitis caused by B. melitensis biovar 3 in a shepherd. Brucellosis infection can cause work-power losses because of misdiagnosis or a lack of proper treatment. Early diagnosis and treatment are essential for a successful outcome.


Assuntos
Brucella melitensis , Brucelose/microbiologia , Endocardite Bacteriana/microbiologia , Espondilite/microbiologia , Testes de Aglutinação , Brucelose/diagnóstico , Brucelose/patologia , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/microbiologia , Valva Mitral/patologia , Espondilite/diagnóstico
2.
Int J Mol Sci ; 22(5)2021 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-33669101

RESUMO

Mitral valve disease (MVD) is a frequent cause of heart failure and death worldwide, but its etiopathogenesis is not fully understood. Interleukin (IL)-33 regulates inflammation and thrombosis in the vascular endothelium and may play a role in the atherosclerotic process, but its role in mitral valve has not been investigated. We aim to explore IL-33 as a possible inductor of myxomatous degeneration in human mitral valves. We enrolled 103 patients suffering from severe mitral regurgitation due to myxomatous degeneration undergoing mitral valve replacement. Immunohistochemistry of the resected leaflets showed IL-33 and ST2 expression in both valve interstitial cells (VICs) and valve endothelial cells (VECs). Positive correlations were found between the levels of IL-33 and molecules implicated in the development of myxomatous MVD, such as proteoglycans, extracellular matrix remodeling enzymes (matrix metalloproteinases and their tissue inhibitors), inflammatory and fibrotic markers. Stimulation of single cell cultures of VICs and VECs with recombinant human IL-33 induced the expression of activated VIC markers, endothelial-mesenchymal transition of VECs, proteoglycan synthesis, inflammatory molecules and extracellular matrix turnover. Our findings suggest that the IL-33/ST2 system may be involved in the development of myxomatous MVD by enhancing extracellular matrix remodeling.


Assuntos
Doenças das Valvas Cardíacas/metabolismo , Proteína 1 Semelhante a Receptor de Interleucina-1/metabolismo , Interleucina-33/metabolismo , Valva Mitral/metabolismo , Idoso , Células Cultivadas , Células Endoteliais/metabolismo , Matriz Extracelular/enzimologia , Matriz Extracelular/metabolismo , Feminino , Humanos , Imuno-Histoquímica , Interleucina-33/farmacologia , Masculino , Inibidores de Metaloproteinases de Matriz/metabolismo , Metaloproteinases da Matriz/genética , Metaloproteinases da Matriz/metabolismo , Pessoa de Meia-Idade , Valva Mitral/citologia , Valva Mitral/patologia , Estudos Observacionais como Assunto , Estudos Prospectivos , Proteoglicanas/biossíntese , Proteoglicanas/genética , Proteoglicanas/metabolismo , Proteínas Recombinantes , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/genética , Análise de Célula Única
3.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33461997

RESUMO

Primary cardiac valve tumours are rare. This is a case report of a 32-year-old non-smoker man with a history of stroke 1 year prior and no other cardiovascular risk factors. The patient was admitted to our acute stroke ward for recurrent left hemiparesis, slurring of speech, facial asymmetry and central retinal artery occlusion. Initial laboratory investigations and ECG were normal. An urgent CT brain showed a large hypodense area at the right frontal, parietal, temporal, occipital region with effaced sulci and right lateral ventricle with midline shift and cerebral oedema in keeping with acute infarction. We proceeded with CT angiography of the cerebral and carotid on the following day, which revealed no evidence of thrombosis, aneurysm or arteriovenous malformation. There were no abnormal beaded vessels to suggest vasculitis. Transthoracic echocardiography revealed a large mobile mass in the left atrium. Meanwhile, MRI cardiac confirmed a large ill-defined mobile solid mass attached to the mitral valve's inferoseptal component suggestive of mitral valve myxoma. This case report highlights the significance of considering a cardiogenic source of emboli in patients with large cerebral infarcts and other cardiac embolic phenomena. Imaging modalities such as echocardiography and cardiac MRI will help detect treatable conditions, such as valvular myxoma and prevent further complications.


Assuntos
Ecocardiografia , Neoplasias Cardíacas/diagnóstico por imagem , Mixoma/diagnóstico por imagem , Oclusão da Artéria Retiniana/etiologia , Tomografia Computadorizada por Raios X , Adulto , Neoplasias Cardíacas/complicações , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia , Mixoma/complicações , Oclusão da Artéria Retiniana/diagnóstico
4.
Mol Med Rep ; 23(1)2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33179113

RESUMO

Rheumatic heart disease (RHD) is an autoimmune disease caused by rheumatic fever following group A hemolytic streptococcal infection and primarily affects the mitral valve. RHD is currently a major global health problem. However, the exact pathological mechanisms associated with RHD­induced cardiac valve damage remain to be elucidated. The endothelial­mesenchymal transition (EndMT) serves a key role in a number of diseases with an important role in cardiac fibrosis and the activin/Smad2 and 3 signaling pathway is involved in regulating the EndMT. Nevertheless, there are no studies to date, to the best of the authors' knowledge, investigating the association between RHD and EndMT. Thus, the aim of the current study was to investigate the potential role of EndMT in cardiac valve damage and assess whether activin/Smad2 and 3 signaling was activated during RHD­induced valvular injury in a rat model of RHD induced by inactivated Group A streptococci and complete Freund's adjuvant. Inflammation and fibrosis were assessed by hematoxylin and eosin and Sirius red staining. Serum cytokine and rheumatoid factor levels were measured using ELISA kits. Expression levels of activin/Smad2 and 3 signaling pathway­related factors [activin A, Smad2, Smad3, phosphorylated (p­)Smad2 and p­Smad3], EndMT­related factors [lymphoid enhancer factor­1 (LEF­1), Snail1, TWIST, zinc finger E­box­binding homeobox (ZEB)1, ZEB2, α smooth muscle actin (α­SMA) and type I collagen α 1 (COL1A1)], apoptosis­related markers (BAX and cleaved caspase­3) and valvular inflammation markers (NF­κB and p­NF­κB) were detected using reverse transcription­quantitative PCR and western blot analyses. Compared with the control group, the degree of valvular inflammation and fibrosis, serum levels of IL­6, IL­17, TNF­α and expression of apoptosis­related markers (BAX and cleaved caspase­3) and valvular inflammation marker (p­NF­κB), activin/Smad2 and 3 signaling pathway­related factors (activin A, p­Smad2 and p­Smad3), EndMT­related factors (LEF­1, Snail1, TWIST, ZEB 1, ZEB2, α­SMA and COL1A1) were significantly increased in the RHD group. These results suggested that the activin/Smad2 and 3 signaling pathway was activated during the development of valvular damage caused by RHD and that the EndMT is involved in RHD­induced cardiac valve damage.


Assuntos
Ativinas/metabolismo , Valva Mitral/patologia , Cardiopatia Reumática/patologia , Proteína Smad2/metabolismo , Proteína Smad3/metabolismo , Animais , Modelos Animais de Doenças , Feminino , Fibrose , Adjuvante de Freund/efeitos adversos , Valva Mitral/metabolismo , Ratos , Cardiopatia Reumática/etiologia , Cardiopatia Reumática/metabolismo , Transdução de Sinais , Streptococcus pyogenes/patogenicidade
5.
BMJ Case Rep ; 13(12)2020 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-33318278

RESUMO

A 66-year-old woman with a remote history of breast cancer and prior tobacco use presented to the hospital with chest pain. She was found to have an elevated troponin consistent with a diagnosis of a non-ST segment elevation myocardial infarction (NSTEMI). A left heart catheterisation revealed non-obstructive coronary disease, and subsequent transthoracic and transoesophageal echocardiograms demonstrated vegetations on both the mitral and aortic valves. Multiple blood cultures showed no growth raising suspicion for non-bacterial thrombotic endocarditis (NBTE). A CT of the chest, abdomen and pelvis was obtained that was consistent with metastatic pancreatic cancer. Her hospital course was complicated by recurrent embolic strokes leading to a rapid clinical deterioration. As a result, she was transitioned to comfort measures and passed away shortly thereafter. To our knowledge, this is the first reported case of an NSTEMI as the initial presentation of NBTE due to underlying malignancy.


Assuntos
Neoplasias da Mama/complicações , Endocardite não Infecciosa/etiologia , Infarto do Miocárdio sem Supradesnível do Segmento ST/etiologia , Neoplasias Pancreáticas/secundário , Acidente Vascular Cerebral/etiologia , Idoso , Valva Aórtica/patologia , Neoplasias da Mama/patologia , Dor no Peito/etiologia , Ecocardiografia Transesofagiana , Endocardite não Infecciosa/diagnóstico , Evolução Fatal , Feminino , Humanos , Valva Mitral/patologia , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Neoplasias Pancreáticas/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Troponina/sangue
7.
Circ Cardiovasc Imaging ; 13(12): e011396, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33317332

RESUMO

BACKGROUND: Recent animal studies have suggested that mitral valve (MV) leaflet remodeling can occur even without significant tethering force and that the postinfarct biological reaction would contribute to the histopathologic changes of the leaflet. We serially evaluated the MV remodeling in patients with anterior and inferior acute myocardial infarction (MI), by using 2- and 3-dimensional transthoracic echocardiography. Additional histopathologic examinations were performed to assess the leaflet pathology. METHODS: Sixty consecutive first-onset acute MI (anterior MI, n=30; inferior MI, n=30) patients who underwent successful primary percutaneous coronary intervention were examined (1) before primary percutaneous coronary intervention, (2) at 6-month follow-up, and (3) at follow-up 1 year or later after onset. MV complex geometry including MV leaflet area and thickness was analyzed using dedicated software. Additional histopathologic study compared 18 valves harvested during surgery for ischemic mitral regurgitation (MR). RESULTS: MV area and thickness incrementally increased during the follow-up period. MV leaflet area significantly increased (anterior MI: 5.59 [5.28-5.98] to 6.54 [6.20-7.26] cm2/m2, P<0.001; inferior MI: 5.60 [4.76-6.08] to 6.32 [5.90-6.90] cm2/m2, P<0.001), and leaflet thickness also increased (anterior MI: 1.09 [0.92-1.24] to 1.45 [1.28-1.60] mm/m2, P<0.001; inferior MI: 1.15 [1.03-1.25] to 1.44 [1.27-1.59] mm/m2, P<0.001); data represent onset versus ≥1 year. Larger annuls, larger tenting, and a reduced leaflet area/annular ratio with smaller coaptation index were observed in patients with persistent ischemic MR compared with those without significant ischemic MR. Histopathologic examinations revealed that MV thickness was significantly greater in chronic ischemic MR compared with acute ischemic MR (1432.6±490.5 versus 628.7±278.7 µm; P=0.001), with increased smooth muscle cells and fibrotic materials. CONCLUSIONS: MV leaflet remodeling progressed both in area and thickness after MI. This is the first clinical study to record the longitudinal course of MV leaflet remodeling by serial echocardiography.


Assuntos
Infarto Miocárdico de Parede Anterior/terapia , Ecocardiografia Tridimensional , Infarto Miocárdico de Parede Inferior/terapia , Insuficiência da Valva Mitral/diagnóstico por imagem , Valva Mitral/diagnóstico por imagem , Intervenção Coronária Percutânea , Idoso , Idoso de 80 Anos ou mais , Infarto Miocárdico de Parede Anterior/diagnóstico por imagem , Infarto Miocárdico de Parede Anterior/fisiopatologia , Feminino , Seguimentos , Implante de Prótese de Valva Cardíaca , Hemodinâmica , Humanos , Infarto Miocárdico de Parede Inferior/diagnóstico por imagem , Infarto Miocárdico de Parede Inferior/fisiopatologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Valva Mitral/patologia , Valva Mitral/fisiopatologia , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/cirurgia , Valor Preditivo dos Testes , Estudos Prospectivos , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda
8.
Asian Cardiovasc Thorac Ann ; 28(7): 381-383, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33023307
10.
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
11.
BMC Infect Dis ; 20(1): 476, 2020 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-32631238

RESUMO

BACKGROUND: Blood culture-negative endocarditis (BCNE) is diagnosed in 2-7% of patients with infective endocarditis (IE) and recent antibiotic use is a known risk factor. Altered mental status may be a presenting symptom. Besides empiric antibiotics, intravenous anticoagulation using heparin may have a role in the management of such patients. CASE PRESENTATION: A 23-year-old male patient was referred to our center with fever, altered mental status and abnormal gait. Neurologic examination revealed Wernicke's aphasia. Cardiac auscultation revealed systolic murmur at the left sternal border. ECG (electrocardiogram) was unremarkable. Brain MRI showed multiple cerebellar lesions. Transthoracic echocardiography (TTE) demonstrated three large masses on the right ventricle (RV), tricuspid valve (TV), and anterior mitral valve (MV) leaflet. Blood cultures (three sets) were negative. Intravenous heparin therapy was administered. After 48 h, the second TTE demonstrated that one valvular lesion disappeared and the other two lesions showed a significant decrease in size. The patient's neurological symptoms resolved gradually. Further workup for collagen vascular disorders did not show any abnormality. CONCLUSION: BCNE should be considered in patients with fever and neurologic manifestations. TTE should be performed to detect valvular abnormalities. Intravenous heparin could be used in such patients when TTE demonstrate valvular vegetations.


Assuntos
Anticoagulantes/uso terapêutico , Afasia de Wernicke/tratamento farmacológico , Hemocultura , Ecocardiografia , Endocardite Bacteriana/diagnóstico por imagem , Heparina/uso terapêutico , Administração Intravenosa , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Anticoagulantes/administração & dosagem , Afasia de Wernicke/microbiologia , Endocardite Bacteriana/sangue , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Heparina/administração & dosagem , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/patologia , Adulto Jovem
12.
J Card Surg ; 35(5): 1145-1147, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32293048

RESUMO

Caseous calcification of the mitral annulus (CCMA) is a very rare form of mitral annular calcification (MAC). CCMA accounts for 0.63% of all cases and 0.06-0.07% of the total population and usually seen in elderly and female patients. It mostly affects the posterior leaflet of the mitral valve. The pathogenesis of CCMA remains unclear. Hypercholesterolemia and the dissolution of lipid-laden macrophages may be implicated in liquefaction necrosis. CCMA is composed of a mixture of calcium, fatty acid, and cholesterol. The name "caseous" comes from the cheese-like or toothpaste-like consistency of the mass. Cardiac magnetic resonance imaging may help in differentiating MAC from CCMA and should perform. The first treatment option should be conservative treatment because of surgical complications of the procedure. We presented a case report which is about CCMA with preoperative and intraoperative robotic images.


Assuntos
Calcinose/diagnóstico por imagem , Calcinose/cirurgia , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Imagem Multimodal , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Calcinose/patologia , Evolução Fatal , Feminino , Doenças das Valvas Cardíacas/patologia , Humanos , Período Intraoperatório , Valva Mitral/patologia
13.
Am J Cardiol ; 125(11): 1700-1709, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32278461

RESUMO

Clinical spectrum of hypertrophic cardiomyopathy (HC) has been expanded to include patients with mild or no thickening of the left ventricle (LV), who nevertheless have outflow tract obstruction at rest or after exercise, due to systolic anterior motion (SAM) and ventricular septal contact, with mitral valve elongation and papillary muscles anomalies. Apical ballooning mimicking a takotsubo syndrome (TS) wall motion pattern can occur in HC with mild septal thickening when latent obstruction becomes unrelenting. To define the prevalence of anatomic abnormalities characteristic of HC in patients diagnosed with TS, we analyzed echocardiograms of 44 unselected TS patients, age 67±12 years, 95% women including studies performed before the event (n = 11, median 515 days) and after recovery of left ventricular function (n = 33, median 92 days, interquartile range = 29 to 327) and compared the findings to 60 age and sexed matched controls. Analysis of echocardiograms was blinded to event timing, and patient vs. control status. During the ballooning event, 13 patients (30%) had SAM including 9 with LV outflow obstruction, peak gradients 71±40 mmHg, as well as: ventricular septal thickening (16 ± 4 mm), elongated anterior leaflets (30 ± 3mm), and increased mitral coaptation to posterior wall distance (17 ± 5 mm), consistent with diagnosis of the HC phenotype. Compared to 31 TS patients without SAM, study patients with SAM had longer anterior leaflets (30 ± 3 vs 26 ± 4 mm, p = 0.006), thicker septum (16 ± 4 vs 12 ± 3 mm), increased coaptation to posterior wall distance (17 ± 5 vs 14 ± 4 mm, p < 0.04) and reduced distance from coaptation to septum (19 ± 5 vs 27 ± 5, p < 0.001). In the 13 patients with SAM, morphologic characteristics of HC persisted after normalization of LV function. In conclusion, a subset of patients experiencing TS events demonstrates a constellation of morphologic abnormalities characteristic of HC that persist after recovery of LV wall motion. These findings suggest that dynamic outflow obstruction may cause apical ballooning in susceptible patients.


Assuntos
Cardiomiopatia Hipertrófica/diagnóstico por imagem , Valva Mitral/diagnóstico por imagem , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Septo Interventricular/diagnóstico por imagem , Idoso , Estudos de Casos e Controles , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/patologia , Tamanho do Órgão , Recuperação de Função Fisiológica , Cardiomiopatia de Takotsubo/fisiopatologia , Obstrução do Fluxo Ventricular Externo/fisiopatologia , Septo Interventricular/patologia
14.
J Infect Public Health ; 13(5): 821-823, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32241725

RESUMO

Q fever prosthetic valve endocarditis in association with antiphospholipid antibody syndrome (APS) in systemic lupus erythematosus (SLE) has not been previously reported. Here, we report a 22-year-old Saudi female diagnosed with SLE and APS. She had mitral valve replacement with bio-prosthesis five years earlier for Libman-Sack endocarditis. She presented with two months' history of fever, cough, palpitations, and progressive shortness of breath. A transthoracic echocardiogram showed a degenerative mitral valve prosthesis with a large mass causing severe obstruction. Open heart surgery revealed multiple masses on the mitral valve. PCR from the resected tissues was positive for Coxiella burnetii DNA. Q fever serology showed phase two IgG 1:2048, phase one IgG 1:512, and IgM 1:1024. The valve was replaced with a bio-prosthesis. She was well at 12 months of follow-up.


Assuntos
Síndrome Antifosfolipídica/complicações , Bioprótese/efeitos adversos , Endocardite Bacteriana/diagnóstico , Próteses Valvulares Cardíacas/efeitos adversos , Lúpus Eritematoso Sistêmico/complicações , Febre Q/diagnóstico , Procedimentos Cirúrgicos Cardíacos , Coxiella burnetii/isolamento & purificação , DNA Bacteriano/isolamento & purificação , Ecocardiografia , Endocardite Bacteriana/cirurgia , Feminino , Implante de Prótese de Valva Cardíaca , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/cirurgia , Reação em Cadeia da Polimerase , Febre Q/cirurgia , Resultado do Tratamento , Adulto Jovem
16.
J Card Surg ; 35(4): 916-919, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32073685

RESUMO

BACKGROUND AND AIM: Second-order chord tethering of the anterior leaflet is a risk factor for failure of posterior leaflet prolapse repair. MATERIALS AND METHODS: We describe two cases of second-order chord tethering of the anterior leaflet associated with severe mitral regurgitation due to prolapse or chordal rupture of the anterior leaflet, causing early and late failure of repair. RESULTS: We described two cases where this phenomenon happened. CONCLUSIONS: Our cases demonstrate that the second-order chords of the prolapsing AL can be tethered and that this aspect should be carefully evaluated before surgery, as it can progress over time, affecting the results of surgical repair.


Assuntos
Implante de Prótese de Valva Cardíaca/métodos , Anuloplastia da Valva Mitral/métodos , Insuficiência da Valva Mitral/cirurgia , Prolapso da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Falha de Tratamento , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/etiologia , Prolapso da Valva Mitral/complicações , Prolapso da Valva Mitral/diagnóstico por imagem , Recidiva , Fatores de Risco , Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/cirurgia , Fatores de Tempo , Resultado do Tratamento
17.
Cardiology ; 145(3): 155-160, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32018250

RESUMO

INTRODUCTION: There is no consensus regarding the natural history of rheumatic mitral stenosis (MS) among adults presenting with nonsevere disease. This study aims to describe the progression of stenosis among adult rheumatic MS patients, to identify predictive factors for progression, and to assess the incidence of complications. METHODS: A retrospective cohort analysis was performed among patients with rheumatic MS treated at a single center. Eighty-five patients were included with mild to moderate MS, ≥30 years old on initial echocardiography. Demographics, medical history, echocardiographic reports over at least 10 years, and related complications were obtained from a computerized database. RESULTS: Over a period of 13.1 ± 2.38 years, 75 patients (88%) had no significant progression in stenosis severity. The final echocardiographic assessment demonstrated 2 groups with a significant difference between them regarding the mitral valve area (1.58 ± 0.44 vs. 1.1 ± 0.26 cm2, p = 0.001) and mean valvular pressure gradient (6.27 ± 2.52 vs. 8.5 ± 2.69 mm Hg, p = 0.01). Patients with indolent MS (group A) were compared to patients with progressive disease (group B), and a higher percent of Bedouin patients were found in group B (OR 8.036, p = 0.015). No significant differences were found in other parameters. Complications including atrial fibrillation, cerebral ischemic events, and impaired right ventricle function, although frequent, were not statistically different between the groups. CONCLUSIONS: An indolent natural progression of rheumatic MS was observed in our study. Despite this finding, it still has potentially deleterious effects. Bedouin patients have a higher risk for progressive disease.


Assuntos
Ecocardiografia , Estenose da Valva Mitral/diagnóstico por imagem , Valva Mitral/diagnóstico por imagem , Fibrilação Atrial/etiologia , Isquemia Encefálica/etiologia , Progressão da Doença , Feminino , Seguimentos , Humanos , Israel , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Valva Mitral/patologia , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/patologia , Estudos Retrospectivos , Cardiopatia Reumática/complicações , Cardiopatia Reumática/diagnóstico por imagem , Cardiopatia Reumática/patologia , Disfunção Ventricular Direita/etiologia
18.
Mol Biol Rep ; 47(3): 1809-1820, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32002794

RESUMO

Fetuin-A (AHSG) is a multifunctional secretory protein and acts as an ectopic valve and artery calcification inhibitor. We assessed the correlation between serum levels of Fetuin-A and both exon 6 (248 C/T) and exon 7 (256 C/G) mutations in patients with coronary artery calcification (CAC), mitral annular calcification (MAC), and aortic valve calcification (AVC). 184 patients and 184 healthy individuals as control group were included. The genetic variants of rs4917 and rs4918 for the AHSG gene were determined by PCR-RFLP and T-ARMS PCR techniques. Fetuin-A levels, fasting blood sugar (FBS), urea, creatinine, calcium phosphorus, and lipid profile were measured. Fetuin-A levels were remarkedly lower in individuals with AVC, MAC, and CAC comparing to the control group (p < 0.001). The CT + TT genotypes and the T allele (AHSG Thr248Met) were associated with the risk of calcification of heart valves and coronary artery by 1.31 and 1.27 times in the patient group, respectively. The frequency of CT genotype and T allele was considerably higher in the patient group comparing to the control group. Patients with T allele (CT + TT) had higher levels of FBS, urea, low-density lipoproteins (LDL)-C, phosphorus, systolic blood pressure (SBP), diastolic blood pressure (DBP) while decreased levels of triglyceride, high-density lipoproteins (HDL)-C, calcium and fetuin-A in comparison to control group. Additionally, there was a positive correlation between serum FBS, urea, creatinine, HDL-C, calcium with fetuin-A, and a negative correlation between phosphorous level, SBP, and DBP with fetuin-A. T allele in rs4917 Single nucleotide polymorphism (SNP) is the risk allele of calcification of heart valves and coronary arteries and fetuin-A levels correlates negatively with the occurrence of the disease.


Assuntos
Calcinose/genética , Polimorfismo de Nucleotídeo Único , alfa-2-Glicoproteína-HS/genética , alfa-2-Glicoproteína-HS/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/metabolismo , Valva Aórtica/patologia , Estenose da Valva Aórtica/genética , Estenose da Valva Aórtica/metabolismo , Estenose da Valva Aórtica/patologia , Calcinose/metabolismo , Calcinose/patologia , Estudos de Casos e Controles , Vasos Coronários/metabolismo , Vasos Coronários/patologia , Feminino , Estudos de Associação Genética , Genótipo , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Valva Mitral/patologia , Calcificação Vascular/genética , Calcificação Vascular/metabolismo , Calcificação Vascular/patologia
19.
Cardiovasc Pathol ; 46: 107196, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32006823

RESUMO

Myxomatous mitral valve degeneration (MMVD) is a leading cause of valve repair or replacement secondary to the production of mitral regurgitation, cardiac enlargement, systolic dysfunction, and heart failure. The pathophysiology of myxomatous mitral valve degeneration is complex and incompletely understood, but key features include activation and transformation of mitral valve (MV) valvular interstitial cells (VICs) into an active phenotype leading to remodeling of the extracellular matrix and compromise of the structural components of the mitral valve leaflets. Uncovering the mechanisms behind these events offers the potential for therapies to prevent, delay, or reverse myxomatous mitral valve degeneration. One such mechanism involves the neurotransmitter serotonin (5HT), which has been linked to development of valvulopathy in a variety of settings, including valvulopathy induced by serotonergic drugs, Serotonin-producing carcinoid tumors, and development of valvulopathy in laboratory animals exposed to high levels of serotonin. Similar to humans, the domestic dog also experiences naturally occurring myxomatous mitral valve degeneration, and in some breeds of dogs, the lifetime prevalence of myxomatous mitral valve degeneration reaches 100%. In dogs, myxomatous mitral valve degeneration has been associated with high serum serotonin, increased expression of serotonin-receptors, autocrine production of serotonin within the mitral valve leaflets, and downregulation of serotonin clearance mechanisms. One pathway closely associated with serotonin involves transforming growth factor beta (TGF-ß) and the two pathways share a common ability to activate mitral valve valvular interstitial cells in both humans and dogs. Understanding the role of serotonin and transforming growth factor beta in myxomatous mitral valve degeneration gives rise to potential therapies, such as 5HT receptor (5HT-R) antagonists. The main purposes of this review are to highlight the commonalities between myxomatous mitral valve degeneration in humans and dogs, with specific regards to serotonin and transforming growth factor beta, and to champion the dog as a relevant and particularly valuable model of human disease that can accelerate development of novel therapies.


Assuntos
Doenças do Cão/metabolismo , Insuficiência da Valva Mitral/veterinária , Prolapso da Valva Mitral/metabolismo , Valva Mitral/metabolismo , Serotonina/metabolismo , Fator de Crescimento Transformador beta/metabolismo , Animais , Doenças do Cão/patologia , Cães , Humanos , Valva Mitral/patologia , Insuficiência da Valva Mitral/metabolismo , Insuficiência da Valva Mitral/patologia , Prolapso da Valva Mitral/patologia , Transdução de Sinais , Especificidade da Espécie
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