Circulating matrix metalloproteinase 3 due to myocardial ischemia.

BACKGROUND: Experimental data suggest that matrix metalloproteinases (MMPs) such as MMP-3 have a central role in the remodeling period after a myocardial infarction (MI). The aim of this study was to use an experimental small-animal model to investigate the fluctuation in MMP-3 levels occurring in vivo after an acute MI. METHODS: We studied 13 New Zealand white rabbits weighing between 3 and 4 kg. After anesthetizing the animals, we performed a tracheotomy and induced an acute MI in 10 of the animals by occluding the left anterior descending coronary artery for 45 minutes. The remaining 3 rabbits constituted the control group. Three hours after reperfusion, blood samples were taken for biomedical analyses. RESULTS: Three hours after the artificially induced acute MI, serum MMP-3 levels were decreased by almost 50%. Cardiac troponin I (cTnI) concentrations were increased greatly (90-fold) after MI, further validating the efficiency of our experimental in vivo model of acute MI. CONCLUSION: Combining the data, we demonstrated that acute MI caused an early reduction in MMP-3 levels. The range of MMP-3 reduction is limited compared with other factors predicting MI, such as cTnI, which increases its usefulness. We demonstrated, however, that plasma fluctuation in MMP-3 levels could be used as a supplementary independent predictor of cardiovascular events in patients with stable coronary artery disease. This acute MI model used in our controlled setting proved to be a reliable and safe method for conducting in vivo studies.

Multiple cerebral mycotic aneurysms due to left atrial myxoma: are there any pitfalls for the cardiac surgeon?

Acute cerebral embolism or cerebral aneurysm formation as a consequence of left atrial myxomas has been well documented, but the formation of multiple cerebral aneurysms resulting from atrial myxoma is a very rare neurological complication. We present the case of a 72-year-old-woman with a cardiac myxoma who suffered multiple cerebral mycotic aneurysms. After experiencing both vertigo and a sudden collapse accompanied by loss of consciousness, she underwent cerebral computed tomography (CT) and magnetic resonance imaging (MRI) examinations, which revealed multiple cerebral mycotic aneurysms of various dimensions and a large cyst, as a result of a previous haemorrhage. Embolisation was performed in large aneurysms of the circle of Willis but not in the one located in the periphery, and re-examination for a cardiac intervention a month later was indicated. The risk of cerebral haemorrhage was considered high; thus she was not operated on. Conservative treatment followed. Two years after the first diagnosis the patient remains healthy, suggesting that in such cases we should also consider conservative treatment. According to the literature, the risk is high when aneurysms are large, multiple and intractable. We propose that cerebral CT or MRI scan should be performed before operation in all patients with a cardiac myxoma, especially in those with left cardiac chamber localisation.

Congenital hypopituitarism: monitoring after coronary artery bypass grafting.

Cardiovascular disease in patients with congenital hypopituitarism is not rare; however, there is a lack of reports referring to cardiac interventions in such patients. We present a 76-year-old man with complete pituitary hormone deficiency, who presented with recurrent events of unstable angina. He had a significant stenosis of the left anterior descending artery and he underwent off-pump coronary artery bypass. Our aim is to present the successful management of this patient with congenital hypopituitarism who underwent cardiac surgery and to review the relevant literature.

Is there any difference in carotid stenosis between male and female patients undergoing coronary artery bypass grafting?

Cardiovascular diseases are among the leading causes of death in women. Significant gender differences have been reported among patients with symptomatic carotid artery disease. The aim of this study is to examine if the female sex is a predisposing factor for carotid stenosis in coronary artery bypass grafting (CABG) patients. We studied 965 CABG patients, 796 males and 169 females. We combined the gender with risk factors predicting carotid disease as a history of cerebrovascular accident (CVA), peripheral vascular disease (PVD), left main (LM) disease and advanced age. We compared the incidence of carotid disease for each gender against known risk factors, which are history of CVA, PVD, LM and advanced age. In our study, there was not a statistically significant difference for the presence of carotid disease between males and females undergoing CABG. However, patients with a history of CVA, with PVD and older age were at greater risk for carotid stenosis. We conclude that the female sex is not a predictive factor for carotid stenosis in CABG patients.