Wireless Interrogation During Cardiac Surgery For a Patient With Aveir Leadless Pacemaker: A Case Report.

Intraoperative wireless interrogation is a useful monitoring method for the leadless pacemaker (LP); however, there are few reports on this technique. A 60-year-old woman underwent cardiac surgery 24 days after Aveir LP implantation. Considering the risk of intraoperative device dislodgment and pacemaker malfunction due to electromagnetic interference, the LP was monitored by wireless interrogation via body-surface electrodes, and no device dislodgement or pacemaker malfunction was observed during surgery. Our findings suggest that wireless interrogation using body-surface electrodes on the chest is a practical and valuable monitoring technique in open-heart surgery, which lends additional safety to anesthetic management.

Pathway analysis with genome-wide association study (GWAS) data detected the association of atrial fibrillation with the mTOR signaling pathway.

BACKGROUND: Genome-wide association studies (GWAS) have identified numerous loci associated with diseases and traits. However, the elucidation of disease mechanisms followed by drug development has remained a challenge owing to complex gene interactions. We performed pathway analysis with MAGENTA (Meta-Analysis Geneset Enrichment of variaNT Associations) to clarify the pathways in genetic background of AF. METHODS: The existing GWAS data were analyzed using MAGENTA. A microarray analysis was then performed for the identified pathways with human atrial tissues, followed by Gene-Set Enrichment Analysis (GSEA). RESULTS: MAGENTA identified two novel candidate pathways for AF pathogenesis, the CTCF (CCCTC-binding factor, p = 1.00 × 10-4, FDR q = 1.64 × 10-2) and mTOR pathways (mammalian target of rapamycin, p = 3.00 × 10-4, FDR q = 3.13 × 10-2). The microarray analysis with human atrial tissue using the GSEA indicated that the mTOR pathway was suppressed in AF cases compared with non-AF cases, validating the MAGENTA results, but not CTCF pathway. CONCLUSIONS: MAGENTA identified a novel pathway, mTOR, followed by GSEA with human atrial tissue samples. mTOR pathway is a key interface that adapts the change of environments by pressure overload and metabolic perturbation. Our results indicate that the MTOR pathway is involved in the pathogenesis of AF, although the details of the basic mechanism remain unknown and further analysis for causal-relationship of mTOR pathway to AF is required. CTCF pathway is essential for construction of chromatin structure and transcriptional process. The gene-set components of CTCF overlap with those of mTOR in Biocarta.

[Catheter-induced Pulmonary Artery Injury and Pseudoaneurysm after Cardiac Surgery].

The pulmonary artery catheter( PAC) has been used for hemodynamic monitoring in patients undergoing cardiac surgery. Pulmonary artery injury and pseudoaneurysm formation are the most serious and fatal complications of PAC. A 73-year-old female with aortic stenosis and angina underwent aortic valve replacement and coronary artery bypass grafting. PAC was inserted without difficulty before cardiac surgery in the operating room. The operation proceeded uneventfully. On the 1st postoperative day, massive hemoptysis suddenly occurred in the intensive care unit. The patient was treated with mechanical ventilation with positive end expiratory pressure. An enhanced computed tomography scan showed a pulmonary artery pseudoaneurysm, whith was successfully occluded by transcatheter arterial embolization. The patient was discharged in good health.

Reexamination of chlorophyllase function implies its involvement in defense against chewing herbivores.

Chlorophyllase (CLH) is a common plant enzyme that catalyzes the hydrolysis of chlorophyll to form chlorophyllide, a more hydrophilic derivative. For more than a century, the biological role of CLH has been controversial, although this enzyme has been often considered to catalyze chlorophyll catabolism during stress-induced chlorophyll breakdown. In this study, we found that the absence of CLH does not affect chlorophyll breakdown in intact leaf tissue in the absence or the presence of methyl-jasmonate, which is known to enhance stress-induced chlorophyll breakdown. Fractionation of cellular membranes shows that Arabidopsis (Arabidopsis thaliana) CLH is located in the endoplasmic reticulum and the tonoplast of intact plant cells. These results indicate that CLH is not involved in endogenous chlorophyll catabolism. Instead, we found that CLH promotes chlorophyllide formation upon disruption of leaf cells, or when it is artificially mistargeted to the chloroplast. These results indicate that CLH is responsible for chlorophyllide formation after the collapse of cells, which led us to hypothesize that chlorophyllide formation might be a process of defense against chewing herbivores. We found that Arabidopsis leaves with genetically enhanced CLH activity exhibit toxicity when fed to Spodoptera litura larvae, an insect herbivore. In addition, purified chlorophyllide partially suppresses the growth of the larvae. Taken together, these results support the presence of a unique binary defense system against insect herbivores involving chlorophyll and CLH. Potential mechanisms of chlorophyllide action for defense are discussed.

[Aortic valve replacement in a patient with antiphospholipid syndrome; report of a case].

A 76-year-old woman with primary antiphospholipid syndrome (APS) was referred to our hospital due to severe aortic valve stenosis. We performed aortic valve replacement using a bioprosthetic valve. Her postoperative course was uneventful. She was discharged in good health on postoperative day 33. As for cardiovascular operations in APS patients, high rates have been reported of perioperative mortality and thromboembolic and bleeding events. Perioperative management of anticoagulation must be strict.

Prevention of atrial fibrillation with ultra-low dose landiolol after off-pump coronary artery bypass grafting.

PURPOSE: Postoperative atrial fibrillation (AF) is a common complication of cardiac surgery that is associated with an increased incidence of other complications. The goal of this prospective randomized study was to evaluate the effect of ultra-low dose landiolol hydrochloride for prevention of AF after off-pump coronary artery bypass grafting (CABG). METHODS: The subjects were 47 patients who underwent isolated CABG and were randomly divided into those who received landiolol from ICU admission until the beginning of oral drug intake (Group L) and those administered diltiazem hydrochloride over the same period (Group D). The incidence of AF within one week after surgery was examined as the primary endpoint. Heart rate, blood pressure, cardiac output, and other hemodynamic parameters were used as secondary endpoints. The rates of adverse events were also recorded. RESULTS: The incidences of AF in the first postoperative week were 4.8% and 27% in Groups L and D, respectively (p = 0.046). There were no differences in hemodynamic parameters between the Groups. In multivariate analysis, no factor emerged as a significant risk factor for postoperative AF. Two patients had adverse events of asthma and hypotension, respectively, in Group L. CONCLUSION: Ultra-low dose landiolol is effective for preventing AF after CABG without worsening hemodynamics.

Long-term results of modified Bentall procedure using flanged composite aortic prosthesis.

PURPOSE: We have been using the flanged composite aortic prosthesis and Carrel button technique to re-attach the coronary ostia in aortic root replacement procedures at our institution over the last twenty five years. Our objective was to evaluate the long-term results of aortic root replacement with this technique. METHODS: A total of 73 patients from January 1984 to August 2010 were included in this study. The median age was 52.7 ± 14.4 years (range 28-80 years). There were 48 male and 25 female patients. 44 patients (60.3%) had annuloaortic ectasia, and 15 patients (20.5%) had acute type A aortic dissection. Marfan syndrome was recognized in 12 patients (16.5%). RESULTS: The early mortality rate was 5.5% (n = 4). Causes of death were multiple organ failures in two patients and sepsis in another two patients. The actuarial survival rate was 84.2% at 5 years, 64.3% at 15 years and 51.9% at 25 years. Only one patient with aortitis needed a reoperation because of coronary pseudoaneurysm after 23 years from the previous operation. CONCLUSION: This modified Bentall procedure is reliable and safe, with superior long-term survival and a low rate of aortic reoperation.