Transposition of a pericardial-derived vascular adipose flap for myocardial salvage after infarct.

AIMS: Coronary artery occlusion is associated with the risk of ventricular remodelling, heart failure, and cardiogenic shock. Novel strategies are sought to treat these ominous complications. We examined the effect of a pericardial-derived fat flap secured over an acute infarct caused by coronary occlusion. METHODS AND RESULTS: A novel intervention consisting of the pericardial isolation of a vascularized adipose flap and its transposition fully covering acute infarcted myocardium was developed in the swine model of coronary artery ligation (n= 52). Left ventricular (LV) ejection fraction and LV end-diastolic and end-systolic volumes were assessed using magnetic resonance imaging (MRI). Infarct size and gene expression analysis were performed on Day 6 and 1 month. Histological changes, collagen volume fraction (CVF), and vascular density were also evaluated on postmortem sections. One month after the intervention, a 18.8% increase in LV ejection fraction (P= 0.007), and significant reductions in LV end-systolic (P= 0.009) and LV end-diastolic volumes (P= 0.03) were found in treated animals compared with the control-MI group. At Day 6, histopathology confirmed a significant infarct size reduction (P= 0.018), the presence of vascular connections at the flap-myocardium interface, and less apoptosis in the infarct border zone compared with control animals (P< 0.001). Up-regulation of genes involved in cell cycle progression, cellular growth and proliferation, and angiogenesis were identified within the flap. CONCLUSIONS: Our results indicate that a vascular fat flap exerts beneficial effects on LV function and limits myocardial remodelling. Future studies must confirm whether these findings provide an alternative therapeutic approach for myocardial salvage after infarction.

[Complex cardiac surgery in a patient with dextrocardia and polysplenia]. / Cirugía cardíaca múltiple en un paciente con dextrocardia y poliesplenia.

Dextrocardia with polysplenia is one of a large spectrum of situs anomalies. In most cases, there are associated cardiovascular abnormalities. We report the case of a patient with dextrocardia, polysplenia, situs ambiguous, and interruption of the inferior vena cava, with an azygos vein continuation. He underwent surgery to replace the aortic valve and the ascending aorta, and to insert a double coronary artery bypass graft.

Cirugía cardíaca múltiple en un paciente con dextrocardia y poliesplenia / Complex cardiac surgery in a patient with dextrocardia and polysplenia

La dextrocardia asociada con poliesplenia forma parte de un amplio espectro de las anomalías del situs. En muchas ocasiones estas anomalías se asocian con malformaciones cardiovasculares. Se describe el caso de un paciente con dextrocardia, poliesplenia, situs ambiguo e interrupción de la vena cava inferior, con continuación por la vena ácigos, en el que se realizó una sustitución de la válvula aórtica, una sustitución de la aorta ascendente y bypass aortocoronario doble

Dextrocardia with polysplenia is one of a large spectrum of situs anomalies. In most cases, there are associated cardiovascular abnormalities. We report the case of a patient with dextrocardia, polysplenia, situs ambiguous, and interruption of the inferior vena cava, with an azygos vein continuation. He underwent surgery to replace the aortic valve and the ascending aorta, and to insert a double coronary artery bypass graft

Surgical repair of left ventricular free wall rupture.

The sutureless technique of repair of a free wall left ventricular rupture following myocardial infarction is described. The technique involves the attachment of a Teflon felt patch over the ruptured area glued to the epicardium with a synthetic biocompatible glue (cyanoacrylate). It is a simple, lifesaving procedure which can be done without the use of cardiopulmonary bypass in most of the cases.

Atrial fibrillation is associated with increased spontaneous calcium release from the sarcoplasmic reticulum in human atrial myocytes.

BACKGROUND: Spontaneous Ca2+ release from the sarcoplasmic reticulum (SR) can generate afterdepolarizations, and these have the potential to initiate arrhythmias. Therefore, an association may exist between spontaneous SR Ca2+ release and initiation of atrial fibrillation (AF), but this has not yet been reported. METHODS AND RESULTS: Spontaneous Ca2+ release from the SR, manifested as Ca2+ sparks and Ca2+ waves, was recorded with confocal microscopy in atrial myocytes isolated from patients with and those without AF. In addition, the spontaneous inward current associated with Ca2+ waves was measured with the use of the perforated patch-clamp technique. The Ca2+ spark frequency was higher in 8 patients with AF than in 16 patients without (6.0+/-1.2 versus 2.8+/-0.8 sparks/mm per second, P<0.05). Similarly, the spontaneous Ca2+ wave frequency was greater in patients with AF (2.8+/-0.5 versus 1.1+/-0.3 waves/mm per second, P<0.01). The spontaneous inward current frequency was also higher in 10 patients with AF than in 13 patients without this arrhythmia (0.101+/-0.028 versus 0.031+/-0.007 per second, P<0.05, at a clamped potential of -80 mV). In contrast, both the Ca2+ released from the SR and the Na+-Ca2+ exchange rate induced by a rapid caffeine application were comparable in patients with and without AF. CONCLUSIONS: The observed increase in spontaneous Ca2+ release in patients with AF probably is due to an upregulation of the SR Ca2+ release channel activity, which may contribute to the development of AF.

Tricuspid valve replacement in the presence of an endocardial pacemaker electrode.

A technique is described to implant a mechanical tricuspid prosthesis in a patient with a previously implanted endocardial pacemaker lead. The lead was allowed to pass between two pledgeted sutures placed in the area of the septal leaflet. The patient remains asymptomatic, with a functioning pacemaker system at one year following the procedure.

Necrotizing vasculitis: a cause of aortic insufficiency and conduction system disturbance.

Cardiac involvement in vasculitis syndromes is uncommon. We describe a 50-year-old male who presented with progressive dyspnea and myalgies. Echocardiogram revealed significant thickening of aortic root, aortic cusps, and anterior mitral valve leaflet, with severe aortic regurgitation that required aortic valve replacement. Furthermore, this patient suffered progressive atrioventricular block that needed implantation of a pacemaker. The study performed disclosed the presence of necrotizing vasculitis positive for perinuclear antineutrophil cytoplasmic antibody.

Preservación aparato subvalvular mitral con prótesis de disco / Mitral valve preservation with tilting-disc prosthesis

No disponible

Rotura traumática de la válvula tricúspide: presentación de tres casos / Traumatic rupture of the tricuspid valve: report of three cases

Las lesiones tricuspídeas secundarias a traumatismos cerrados del tórax son raras y difíciles de diagnosticar. No obstante, han sido descritos más de 100 casos de insuficiencia tricuspídea postraumática en los últimos 35 años. Presentamos tres casos diagnosticados e intervenidos en nuestro centro en los últimos 8 años (AU)

Intraaortic administration of protamine: Method for heparin neutralization after cardiopulmonary bypass.

In neutralizing heparin with intravenous protamine sulfate, hypotension may be prevented by administering the drug intraarterially. Forty patients underwent cardiac surgery with extracorporeal circulation in our hospital; each received a rapid injection of nondiluted protamine sulfate in the aortic root to reverse the effects of heparin. To maintain the blood volume at a constant level, volume expanders and inotropic drugs were avoided. The intraaortic injections ranged in duration from 0.2 min to 2.8 min, with a mean of 1.1 min. The mean systolic pressure only dropped from 92 mm Hg (SD +/- 21) before protamine injection to 85 mm Hg (SD +/- 23) after injection (p < 0.0001). In seven patients (18%), no hypotension was evident; in the remaining patients, the systolic pressure returned to preinjection values within a mean of 2.2 min. Coagulation was observed within 3 to 4 min (mean = 2.2 min) after the initiation of injection. This study indicates that intraaortic administration of protamine is a rapid and safe technique for heparin reversal after cardiopulmonary bypass.