Coronary and arch hybrid surgery in a patient with infrarenal aortic occlusion

2018 ◽  
Vol 26 (2) ◽  
pp. 148-150 ◽  
Author(s):  
Teng Kiat Koh ◽  
Jocelyn Zi Lin Ting ◽  
Bernard Wee ◽  
Rustem Khamitov ◽  
Kristine Teoh ◽  
...  
Keyword(s):  
Heart Surgery ◽  
Open Heart Surgery ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Type I ◽  
Hybrid Surgery ◽  
Ventricular Ejection Fraction ◽  
Hybrid Type ◽  
Triple Vessel Disease ◽  
Arch Aneurysm

A 65-year-old gentleman with claudication underwent contrast-enhanced computed tomography. The scan showed occlusion of the infrarenal abdominal aorta and a 6.0 × 3.7 cm saccular zone-3 arch aneurysm. The left ventricular ejection fraction was 35% and a coronary angiogram revealed triple-vessel disease. In view of the patient’s high risk with EuroSCORE II 20.34%, coronary artery surgery was combined with hybrid type I arch aneurysm repair. An endovascular stent was delivered in an antegrade manner. Open heart surgery and a hybrid type I arch intervention can be performed simultaneously through a midline sternotomy approach.

Abstract 3417: Unselected Human Cardiosphere-derived Cells are Functionally Superior to c-Kit- or CD90-Purified Cardiosphere-derived Cells

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Rachel Ruckdeschel Smith ◽  
Isotta Chimenti ◽  
Eduardo Marbán
Keyword(s):  
Troponin I ◽  
Therapeutic Potential ◽  
Left Ventricular ◽  
Dermal Fibroblasts ◽  
Historical Control ◽  
Border Zone ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Type I ◽  
Ventricular Ejection Fraction

Cardiosphere-derived cells (CDCs), a naturally heterogeneous mixture of cell sub-populations, were grown from percutaneous endomyocardial adult human biopsy specimens (n=6). c-Kit + and CD90 + CDCs were selected using magnetic-activated cell sorting with excellent purity as determined by flow cytometry. Immunostaining revealed that ~30% of c-Kit + CDCs expressed Nkx2.5, ~100% of CD90 + CDCs expressed procollagen type I, and ~100% of both sub-populations expressed CD105. When placed in co-culture with neonatal myocytes and fibroblasts, c-Kit + CDCs expressed cardiac troponin I, while CD90 + CDCs expressed vimentin. In order to assess the therapeutic potential of purified CDCs, acute myocardial infarcts (MIs) were created in immunodeficient mice and c-Kit + (n=16), CD90 + (n=14), or CD105 + (n=3) CDCs were injected into the border zone. Echocardiograms were performed 3 weeks post-MI to measure left ventricular ejection fraction (LVEF). CD105-injected mice were comparable to an historical control group of mixed CDC-injected mice (LVEF = 41.3±2.9% CD105 vs. 42.8±10.4% CDC [n=11], p=0.60), indicating that the sorting process did not itself impair the therapeutic potential of CDCs. c-Kit- and CD90-injected mice were indistinguishable from one another (LVEF=31.7±8.2% c-Kit vs. 32.1±11.8% CD90, p=0.92), and both groups were significantly outperformed by the CD105-injected mice (p=0.01 and p=0.03, respectively). All groups were then compared to two other historical control groups, mice treated with normal human dermal fibroblasts (NHDFs [n=7]) and mice treated with phosphate-buffered saline (PBS [n=11]). c-Kit-injected mice did significantly outperform both NHDF- (p=0.04) and PBS-injected mice (p=0.03), while more variability in the CD90-injected group resulted in nearly significant comparisons with the NHDF (p=0.08) and PBS groups (p=0.08). While the therapeutic mechanisms of action of these two distinct sub-populations are undoubtedly different, both offer similar global functional benefits in the setting of acute MI. We conclude that the spontaneously-emerging unselected CDC population serves as a therapeutic cell cocktail, and that no functional advantage is conferred by the extra step of sorting for c-Kit + or CD90 + sub-populations.

scholarly journals Procollagen propeptides and visceral obesity index in patients with myocardial infarction with preserved emission faction and various metabolic phenotype

2020 ◽  
Vol 7 (1) ◽  
pp. 22-32
Author(s):  
A. V. Osokina ◽  
V. N. Karetnikova ◽  
O. M. Polikutina ◽  
IU. S. Slepynina ◽  
O. V. Gruzdeva ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Visceral Obesity ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Type I ◽  
Ventricular Ejection Fraction ◽  
Obesity Index

Purpose. To identify the peculiarities of the dynamics of fibrosis markers of C-terminal procollagen propeptide type I (PICP) and N-terminal collagen propeptide type III (PIIINP) in patients with ST segment elevation myocardial infarction (STEMI) and preserved myocardial contractility.Material and methods. 86 patients with STEMI and preserved left ventricular ejection fraction were examined. In addition to the standard laboratory and instrumental examinations, all the patients underwent the estimation of the concentrations of C-terminal procollagen propeptide type I (PICP) and N-terminal collagen propeptide type III (PIIINP) by enzyme-linked immunoassay using BCM Diagnostics laboratory kits (USA) on the 1st and the 12th days of disease and 1 year later.Results. The concentration of PICP was significantly reduced in all groups during the entire observation period. Significant correlations were found between PICP and visceral obesity index, age and left ventricular ejection fraction. A relationship was found between PIIINP and an increased visceral obesity index.

scholarly journals Brugada syndrome: A brand new case

2009 ◽  
Vol 66 (8) ◽  
pp. 667-670
Author(s):  
Ruzica Jurcevic ◽  
Lazar Angelkov ◽  
Dejan Vukajlovic ◽  
Velibor Ristic ◽  
Milosav Tomovic ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Ventricular Fibrillation ◽  
Brugada Syndrome ◽  
Electrophysiological Study ◽  
Structural Heart Disease ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Type I ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation

Background: Brugada syndrome (BS) is a disorder characterized by syncope or sudden death associated with one of several electrocardiographic (ECG) patterns characterized by incomplete right bundle branch block and ST elevation in the anterior precordial leads. Patients with BS are prone to develop ventricular tachyarrhythmias that may lead to syncope, cardiac arrest, or sudden cardiac death. Case report. A 58-year-old woman is the first described case of Brugada syndrome in Serbia with intermittent typical changes in basic electrocardiography (ECG): ST segment elevation in the precordial chest leads like dome or coved - major form or type I. For the last 27 years the patient had suffered of palpitations and dizziness, without syncopal events. Her sister had died suddenly during the night in sleep. During 24-hour Holter monitoring the patient had ventricular premature beats during the night with R/T phenomenon and during the recovery phase of exercise testing had rare premature ventricular beats as the consequence of parasympatethic stimulation. Late potentials were positive. Echocardiography revealed left ventricular ejection fraction of 60%. We performed coronary angiography and epicardial coronary arteries were without significant stenosis and structural heart disease was excluded. In the bigining of the electrophysiological study ECG was normal, and after administration of Propaphenon i.v. Brugada syndrome unmasked with appearance of type I ECG pattern. A programed ventricular stimulation induced non sustained ventricular tachycardia. One-chamber implantable cardioverter defibrillator was implanted and the patient was treated with a combination od amiodarone and metoprolol per os. After one-year follow-up, there were no episodes of ventricular tachycardia and ventricular fibrillation. Conclusion. Brugada syndrome is a myocardial disorder which prognosis and therapy are related to presence of ventricular fibrillation or ventricular tachycardia. Electrophysiologicaly induced malignant ventricular disorders class I are indication for implantation of cardioverter defibrilator, as also occurred in presented patient.

Abstract 3078: Myocardial Collagen Metabolism In Failing Hearts Before And During Cardiac Resynchronization Therapy

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Soban Umar ◽  
Jeroen J Bax ◽  
Margreet Klok ◽  
Marleen H Hessel ◽  
Brigit den Adel ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Collagen Synthesis ◽  
Left Ventricular ◽  
Collagen Metabolism ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Type I ◽  
Resynchronization Therapy ◽  
Ventricular Ejection Fraction ◽  
Myocardial Collagen

Objective Cardiac resynchronization therapy (CRT) has proven efficacy in improving left ventricular ejection fraction (LVEF), LV diastolic function, NYHA functional class and outcome in patients with congestive heart failure (CHF), although a substantial number of patients respond poorly to CRT. We investigated whether myocardial collagen metabolism of patients with CHF is implicated in good or poor response to CRT. Methods We analyzed collagen synthesis and degradation by measuring the concentrations of aminoterminal propeptides of type I and type III collagen (PINP and PIIINP, resp.) and carboxyterminal telopeptide of type I collagen (ICTP), respectively, in serum of 64 patients with CHF before and 6 months after start of CRT. Patients had NYHA class III–IV, LVEF ≤35%, and QRS duration >120 ms. Results In 46 patients, CRT resulted in >10% reduction of LV end-systolic volume (LVESV), referred to as responders, whereas in 18 patients LVESV did not change upon CRT or even increased, referred to as non-responders. Responders demonstrated an increase of serum PINP and PIIINP upon CRT, from 32.9±2.2 to 46.7±4.0 μg/L (p<0.001) and from 4.59±0.24 to 5.13±0.36 μg/L (p<0.05), respectively, whereas serum PINP and PIIINP of non-responders did not change upon CRT (from 41.8±4.3 to 43.8±6.2 μg/L and from 4.03±0.45 to 4.28±0.31 μg/L, resp.). Responders had higher serum levels of ICTP at baseline and at 6 months follow-up (from 3.38±0.54 to 3.12±0.48 μg/L) than non-responders at both time points (from 1.96±0.37 to 1.92±0.38 μg/L), although these differences were not statistically significant. Conclusion Compared to future non-responders to CRT, future responders demonstrate relatively low levels of markers of collagen synthesis and relatively high levels of markers of collagen degradation at baseline. Unlike non-responders, responders show an increase in collagen synthesis in the first 6 months of CRT.

scholarly journals Haemodynamics Support during Surgical Myocardial Revascularisation in Patients with Systolic Left Ventricular Dysfunction

2021 ◽  
Vol 11 (3) ◽  
pp. 228-234
Author(s):  
N. V. Kharitonov ◽  
V. V. Vitsukaev ◽  
N. A. Trofimov ◽  
P. D. Makalsky ◽  
V. N. Zavgorodny
Keyword(s):  
Ejection Fraction ◽  
Extracorporeal Circulation ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Treatment Standard

Coronary heart disease remains a leading cause of death worldwide, and coronary bypass surgery -- the treatment standard in haemodynamically significant multivessel and/or trunk coronary stenosis. Intraoperative haemodynamics support during coronary artery bypass grafting (CABG) in patients with reduced ejection fraction currently remains controversial. Manifold evidence favours CABG with no extracorporeal circulation in higher risk patients to avoid the system’s frequent complications of blood transfusion, renal failure, bleeding, wound infection, cerebrovascular events and humoral disturbances. On the other hand, CABG with extracorporeal circulation and heart arrest allows a bloodless operating field and complete revascularisation in most, often very complex, cases. The complication rate and outcome in beating-heart surgery are reckoned to depend directly on the relevant surgeon’s and clinic experience, which makes many relinquish the technique due to a limited history of skill. This essay overviews the current state of the art, discussions of recent systematic studies on intraoperative haemodynamics support in patients with reduced left ventricular ejection fraction and touches upon the importance of surgeon’s experience for the operation outcome.

scholarly journals Time of Anderson-Fabry Disease Detection and Cardiovascular Presentation

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
K. Selthofer-Relatic
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Fabry Disease ◽  
Ventricular Hypertrophy ◽  
Heart Surgery ◽  
Late Onset ◽  
Cardiac Pacemaker ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Family Screening

Background. Anderson-Fabry disease is an X-linked inherited disease, which manifests in a different manner depending on gender and genotype. Making a working diagnosis of Anderson-Fabry disease is difficult because of several reasons: (a) that it is a multiorgan disease with wide variety of phenotypes, (b) different timelines of presentation, (c) gender differences, and (d) possible coexistence with other comorbidities. Late-onset/cardiac type of presentation with minimal involvement of other organs can additionally make diagnosis difficult. Aim. To describe different cardiac manifestations at different time points in the course of the disease: (1) 72-year-old female (echocardiography detection), heterozygote, significant left and mild right ventricular hypertrophy; (2) 62-year-old male (echocardiography detection), hemizygote, left ventricular hypertrophy, implanted cardiac pacemaker, a performed percutaneous coronary intervention after myocardial infarction, degenerative medium degree aortic valve stenosis; (3) 45-year-old female (asymptomatic/family screening), heterozygote, thickened mitral papillary muscle, mild left ventricular hypertrophy, first degree diastolic dysfunction; and (4) 75-year-old female (symptomatic/family screening), heterozygote, cardiomyopathy with reduced left ventricular ejection fraction after heart surgery (mitral valve annuloplasty and plastic repair of the tricuspid valve). Conclusion. All patients have Anderson-Fabry disease but with different clinical presentations depending on the gender, the type of mutation, and the time of detection. All these features can make the patients’ profiles unique and delay the time of detection.

scholarly journals Comparative study between the use of St. Thomas' II cardioplegia and del Nido cardioplegia in patients who underwent open-heart surgery

2020 ◽  
Vol 17 (1) ◽  
pp. 23-27
Author(s):  
Satish Vaidya ◽  
Asit Baran Adhikari ◽  
Robin Karmacharya ◽  
Karan Rai
Keyword(s):  
Single Dose ◽  
Myocardial Protection ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Open Heart ◽  
Cardioplegic Solution ◽  
Aortic Cross Clamp ◽  
Ischemic Time

Background and Aims: Cardioplegia is used to arrest the heart after the application of an aortic cross-clamp that interrupts the coronary circulation. Commonly used St. Thomas’II cardioplegic solution has to be repeated at short intervals, which may cause additional myocardial injury. So, this study is done to determine whether del Nido (DN) cardioplegia, which has a longer duration of arrest with a single dose, provides equivalent or better myocardial protection as compared to St. Thomas’ II Cardioplegia. Methods: A prospective observational study was done among 100 patients who underwent open-heart surgery with myocardial protection, between September 2016 to August 2018 in Bangabandhu Sheikh Mujib Medical University, Bangladesh. Patients were divided into two groups, group A (n=50) for del Nido cardioplegic and group B (n=50) for St. Thomas’ II cardioplegia. We compared the amount of cardioplegic solution, Aortic cross-clamp time, cardiopulmonary bypass (CPB) time, ischemic time, arrhythmia, spontaneous sinus rhythm after declamping, intraoperative DC shock requirement, postoperative left ventricular ejection fraction, serum potassium level, low cardiac output, cardiac Troponin level I and CK-MB release after 12 hours and 24 hours, presence of myocardial infarction and death. Results: The per-operative variable suggested spontaneous activity during a cardiac arrest was 2% in del Nido and 14% in St. Thomas’ II group (p=0.044). Similarly, during intraoperative phase spontaneous restoration of cardiac activity after the procedure in del Nido was 2.90 ± 1.16 minutes and in St. Thomas’ II was 1.8 ± 0.615 minutes (p=0.001). However total bypass time and ischemic time were not significant. During the postoperative period, Troponin I and CKMB were measured at 12 hours and 24 hours which were not statistically different in two groups. Postoperatively, low output syndrome was seen among 3 patients in del Nido Group and 4 patients in St. Thomas’ II group (p-value=0.341). Conclusion: This study showed with the use of del Nido cardioplegia provides equivalent myocardial protection to St. Thomas’ II cardioplegia, with the use of only single-dose cardioplegia.

Abstract 13347: Injectable Collagen-based Hydrogel Matrix Modulates Micro-RNA Expression and Prevents Cardiac Deterioration Post-myocardial Infarction

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Nick J Blackburn ◽  
Brian McNeill ◽  
Helene Chiarella-Redfern ◽  
Tanja Sofrenovic ◽  
Drew Kuraitis ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricular ◽  
Post Treatment ◽  
Left Ventricular Ejection ◽  
Type I ◽  
Injectable Hydrogel ◽  
Ventricular Ejection Fraction ◽  
Hydrogel Matrix ◽  
The Matrix

Background: Injectable hydrogel biomaterials have emerged as promising therapies for treating myocardial infarction (MI). We developed a collagen type I based injectable hydrogel matrix that can prevent the deterioration of cardiac function when delivered soon post-MI and found that the effects may be mediated through a microRNA (miRNA) mechanism. Methods/Results: C57BL/6J mice underwent LAD ligation to induce MI. Mice then received myocardial injections of PBS or matrix delivered at 3hours post-MI. Analyses were performed at 2 days, 1 and 3 months post-treatment. At one month post-treatment, mice that received the matrix had superior left ventricular ejection fraction (LVEF; 45.1±2.3%) compared to the PBS group (29.6±2.4%; p< 0.001). LVEF was maintained in matrix-treated mice at 3 months (42.9±3.8%). Matrix treatment was also associated with reduced infarct sizes and improved ventricular volumes. Matrix-treated mice had more angiogenesis, mitigated apoptosis and reduced inflammation in the infarcted myocardium at both 2 and 28 days post-treatment. To better understand the mechanisms, we performed miRNA microarrays on infarct and peri-infarct tissue. Matrix treatment resulted in 120 miRNAs with differential expression within +/- 0.3 log2 fold change. In particular, we found matrix treatment down-regulated miR-92a ( p< 0.0005), an anti-angiogenic miRNA. Integrins α5 (Itgα5) and αV (ItgαV), involved in angiogenesis and cell-matrix interactions, were identified as putative miR-92a targets and pursued further in vitro using circulating angiogenic cells (CACs). CACs cultured on the matrix had increased Itgα5 and ItgαV expression after 4 days (12.4-fold and 13.9-fold, respectively vs. fibronectin; p< 0.01). When applied in an in vitro angiogenesis assay, the number of CACs that incorporated into capillary-like structures was greater (by 4.2-fold) for cells derived from matrix culture ( p <0.005). Conclusion: We demonstrate pronounced benefits associated with our hydrogel matrix when delivered at 3h post-MI. The matrix effects may be mediated, at least in part, through its ability to regulate miR-92a and integrin-mechanisms. Overall, the matrix may provide a promising therapeutic approach for protecting the myocardium post-MI.

Abstract 1707: Analysis Of Extracellular Matrix Remodeling On Endomyocardial Biopsies From Patients With Inflammatory Cardiomyopathy

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Olga Lettau ◽  
Susanne Rutschow ◽  
Sebastian Jaeger ◽  
Uwe Kuehl ◽  
Kerstin Puhl ◽  
...  
Keyword(s):  
Extracellular Matrix ◽  
Collagen Type ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Myocardial Inflammation ◽  
Extracellular Matrix Remodeling ◽  
Type I ◽  
Matrix Remodeling ◽  
Inflammatory Cardiomyopathy ◽  
Ventricular Ejection Fraction

Introduction: The biopsy based analyse, with histological, immunohistological and molecular biological analysis of myocardial tissues, represents the only possible tool to investigate the basement of inflammatory cardiomyopathy. Since development of this disease assume involvement of extracellular matrix remodelling, the analyze of this process were aimed in this article. Methods and results: Endomyocardial biopsies from patient with inflammatory cardiomyopathy (n=170) were analysed by RT-PCR, Furthermore, histological, immunohistological and biochemical methods (ELISA) were used to estimate the matrix proteins amount in myocardial tissues (n=36). All results were obtained by comparison of patient groups regarding to left ventricular ejection fraction (LVEF), EF>60 versus EF<30. EF<30 group featured significaly increased inflammation cells per surface area: CD3 (p<0.001), CD11a (p<0.02), CD45 (p<0.02), Mac1 (p<0.02) and HLA (p<0.01). The gene expression revealed an increased transcripts number of IL-2 (p<0.01), IL-5 (p<0.01), IL-6 (p<0.02), INF beta (p<0.039), Collagen type I (p<0.001), III (p<0.0014) and IV (p<0.0004) as well Laminin (p<0.001). On the protein level ICTP (p<0.04), MMP9 (p<0.04) and TIMP I (p<0.01) were significaly increased in this group in comparison with EF>60 group. The escalating number of active CD3 cells correlated positively with BNP (ρ=0.624, p<0.0091), adhesion cell number ICAM (ρ=0.682, p<0.01) and VCAM (ρ=0.475, p<0.01) and with uPA (ρ =0.265, p<0.013), as well as with increased quantity of collagen type III per section area (ρ=0.632, p<0.01). The expanded abundance of type I collagen products was clearly dependent of the expression of collagen I gene (ρ=0.575, p<0.002) and uPA (ρ=0.544, p<0.004). Precise correlation between the amount of MMP 9 protein and downward EV values (ρ=− 0.4133, p<0.0073) was also observed in the patient group with EF<30. Conclusion: Myocardial inflammation lead to an imbalance in the MMP/TIMP system with development of myocardial fibrosis with significant correlation to LV-dysfunction. Extracellular matrix remodeling with an imbalance in the MMP/TIMP system plays an important role in the development of left ventricular dysfunction in inflammatory heart disease

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