ABSTRACT
A 79-year-old woman was referred to undergo surgery for a type A dissection. The patient had a history of previous coronary artery bypass. She was in shock and had a hematoma surrounding the ascending aorta and the heart. In this case, a coronary sinus cardioplegia cannula was placed under a short period of circulatory arrest via a small atriotomy, and the atriotomy was closed immediately to establish selective cerebral perfusion.
Subject(s)
Aortic Dissection/surgery , Aortic Rupture/surgery , Blood Vessel Prosthesis Implantation , Coronary Artery Bypass , Coronary Sinus/physiopathology , Heart Arrest, Induced/methods , Aged , Aortic Dissection/complications , Aortic Dissection/diagnostic imaging , Aortic Dissection/physiopathology , Aortic Rupture/diagnostic imaging , Aortic Rupture/etiology , Aortic Rupture/physiopathology , Aortography/methods , Cardiopulmonary Bypass , Catheters , Cerebrovascular Circulation , Female , Heart Arrest, Induced/instrumentation , Hematoma/etiology , Hematoma/surgery , Humans , Saphenous Vein/transplantation , Sternotomy , Time Factors , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
For myocardial regeneration therapy, the low differentiation capability of functional cardiomyocytes sufficient to replace the damaged myocardial tissue is one of the major difficulties. Using Nkx2.5-GFP knock-in ES cells, we show a new efficient method to obtain cardiomyocytes from embryonic stem (ES) cells. The proportion of GFP-positive cells was significantly increased when ES cells were cultured with a conditioned medium from aortic endothelial cells (ECs), accompanied by upregulation of cardiac-specific genes as well as other mesodermal genes. The promotion was more prominent when EC-conditioned medium was added at an early stage of ES cell differentiation culture (Day 0-3). Inhibitors of bone morphogenic protein (BMP), cyclooxygenase (COX), and nitric oxide synthetase (NO) prevented the promotion of cardiomyogenesis by EC-conditioned medium. These results suggest that supplementation of EC-conditioned medium enables cardiomyocytes to be obtained efficiently through promotion of mesoderm induction, which is regulated by BMP, COX, and NOS.
Subject(s)
Cell Culture Techniques , Cell Differentiation , Embryonic Stem Cells/cytology , Endothelium, Vascular/cytology , Endothelium, Vascular/metabolism , Myocytes, Cardiac/cytology , Angiotensin II Type 1 Receptor Blockers/pharmacology , Animals , Aorta/cytology , Bone Morphogenetic Proteins/antagonists & inhibitors , Cell Differentiation/drug effects , Culture Media, Conditioned/metabolism , Culture Media, Conditioned/pharmacology , Cyclooxygenase Inhibitors/pharmacology , Embryonic Stem Cells/drug effects , Endothelin-1/antagonists & inhibitors , Endothelium, Vascular/drug effects , Gene Knock-In Techniques , Green Fluorescent Proteins/genetics , Homeobox Protein Nkx-2.5 , Homeodomain Proteins/genetics , Mice , Myocytes, Cardiac/drug effects , Nitric Oxide Synthase/antagonists & inhibitors , Prostaglandin-Endoperoxide Synthases/drug effects , Receptor, Angiotensin, Type 1/drug effects , Transcription Factors/geneticsABSTRACT
Atresia of the coronary sinus orifice is rare. We describe the surgical treatment of coronary orifice atresia in an infant with a persistent left superior vena cava after total cavo-pulmonary connection for hypoplastic left heart syndrome. The diagnosis was made by cardiac catheterization after total cavo-pulmonary connection at 8 months of age. After surgery, cardiac performance deteriorated. At reoperation, the coronary sinus was fenestrated to the left atrium. The patient survived surgical treatment of coronary sinus ostial atresia unroofed to the left atrium, guiding the placement of the fenestration with a probe placed through the open cardiac end of left superior vena cava.
