Case report: Surgical resection of a primary cardiac diffuse large B-cell lymphoma and reconstruction of involved right heart structures.

INTRODUCTION AND IMPORTANCE: Lymphoma can either be Hodgkin or non-Hodgkin (NHL) with diffuse large B cell lymphoma (DLBL) being a type of the latter with an aggressive behavior. Although NHL involvement of the heart in late stages is not uncommon, disease that primarily originates from the heart is rare and therefore poses a diagnostic challenge. CASE PRESENTATION: Herein, we report the case of a 52-year-old patient who presented to the hospital with non-specific signs and symptoms and was found to have a heterogeneous echogenic irregular mass across the tricuspid valve in the right atrium and right ventricle. The majority of the mass was located in the right atrium, with the tip attached to the right ventricular free wall near the tricuspid annulus. Initially thought to be an atrial myxoma but later confirmed histologically to be diffuse large B cell Lymphoma, and the patient underwent right atrial mass resection, followed by chemotherapy. The patient showed improvement following treatment. CLINICAL DISCUSSION: Primary cardiac lymphoma (PCL) is a rare form of lymphoma that is confined exclusively to the heart and/or pericardium, without the involvement of other lymph nodes or extra-nodal tissues or organs. Pathological analysis confirms PCL as either non-Hodgkin's lymphoma (NHL) or Hodgkin's lymphoma (HL). PCL accounts for approximately 1.3 % of primary cardiac tumors and 0.5 % of extra-nodal lymphomas. CONCLUSION: Our case report provides valuable insights for clinicians to better understand this uncommon disease and reduce the incidence of misdiagnosis.

FPR1 gene silencing suppresses cardiomyocyte apoptosis and ventricular remodeling in rats with ischemia/reperfusion injury through the inhibition of MAPK signaling pathway.

Ischemia/reperfusion (I/R) injury, one of the leading health problems in the world, is defined as a cause of cardiomyocytes death. In the present study, we investigate the role of formyl peptide receptor 1 (FPR1) in cardiomyocyte apoptosis and ventricular remodeling of I/R injury rats and the underlying mechanism involving mitogen-activated protein kinase (MAPK) signaling pathway. The important differentially expressed genes (DEGs) in I/R injury were screened out and downstream pathways affected by DEGs were predicted. We grouped 90 rats into sham, I/R, NC siRNA, FRP1 siRNA, empty vector, and FRP1 vector groups and established a model of I/R injury in rats. CVF value, myocardial infarct areas and positive expression rate of FPR1 and MAPK were detected. Levels of FPR1 and MAPK pathway-related genes were determined by RT-qPCR and western blot analysis. MTT assay was performed to evaluate cell proliferation and flow cytometry to evaluate cell cycle progression and apoptosis. GSE19804 and GSE27262 were screened from Gene Expression Omnibus database. FPR1 was higher in patients with I/R injury and activate the MAPK signaling pathway. FRP1 gene silencing decreased CVF value, infarct area, apoptotic index, positive expression rates of FPR1 and MAPK, decreased FPR1, p38, ERK, JNK, MMP-2, TIMP-2, NF-kB, Bax, p-p38, p-ERK, and p-JNK levels, increased Bcl-2 level, promoted cell proliferation and cell cycle progression, and inhibited cell apoptosis rate. Overall, our study demonstrates that the silencing of FPR1 gene depresses inflammation, cardiomyocyte apoptosis and ventricular remodeling in rats with I/R injury through the suppressing the activation of the MAPK signaling pathway.

Evaluation of transventricular placement of porcine small intestinal submucosa stent valves in the pulmonary position in juvenile sheep model.

OBJECTIVES: We assessed the transventricular placement of porcine small intestinal submucosa (SIS) stent valves in a juvenile sheep model at the 3-month follow-up evaluation. METHODS: We constructed a pulmonary stent valve by suturing a porcine SIS bicuspid valve into a bell-shaped 'Z' nitinol stent and implanted 7 SIS stent valves transventricularly in the pulmonary position in 7 sheep. The function of the stent valves was assessed using a pulsatile flow simulation system in vitro. Haemodynamic, angiographic, echocardiographic, histologic and radiographic examinations were carried out before, immediately after implantation and 3 months after implantation. RESULTS: All SIS stent valves were successfully implanted in the pulmonary position in 7 sheep. Angiographic, echocardiographic, haemodyamic and macroscopic studies confirmed firm anchoring and good positioning of the stents immediately after implantation and at 3-month follow-up. All stent valves had good function immediately after implantation and at the end of the protocol, with the exception of 1 stent valve with mild stenosis detected at the end of the protocol. All SIS valves were free of calcifications and thrombus formation, and all stents were intact with no fractures and migration based on postmortem examination and X-radiography. CONCLUSIONS: We demonstrated successful implantation of porcine SIS stent valves in the pulmonary position in sheep with excellent valve function at the 3-month follow-up evaluation. Porcine SIS has potential superiority as a pulmonary stent bioprosthetic valve material, and the bell-shaped nitinol stent has potential superiority as a frame for pulmonary stent valves.

Effects of astragalus polysaccharide on apoptosis of myocardial microvascular endothelial cells in rats undergoing hypoxia/reoxygenation by mediation of the PI3K/Akt/eNOS signaling pathway.

The study explores the effect of astragalus polysaccharide (APS) mediating P13K/Akt/eNOS signaling pathway on apoptosis of myocardial microvascular endothelial cells (MMECs) in hypoxia/reoxygenation (H/R). MMECs were classified into blank, H/R, H/R + 25 mg/L APS, H/R + 50 mg/L APS, H/R + 100 mg/L APS, H/R + LY, and HR + 100 mg/L APS + LY groups. Cell viability was detected using MTT assay and apoptotic cell morphological changes by Hoechst staining. NO content, cell cycle and apoptosis, PI3K/Akt/eNOS signaling pathway proteins were detected using nitrate reductase assay, flow cytometry and Western blotting. An increased cell survival rate, NO content and expression of PI3K/Akt/eNOS signaling pathway associated proteins, and a decreased apoptosis rate was observed in the H/R + 50 mg/L APS and H/R + 100 mg/L APS groups compared with the H/R and H/R + 25 mg/L APS groups. Compared with the H/R + 50 mg/L APS group, the apoptosis rate decreased, whereas the cell survival rate, NO content and expression of PI3K/Akt/eNOS signaling pathway associated proteins increased in the H/R + 100 mg/L APS group. The H/R + LY and HR + 100 mg/L APS + LY groups followed opposite trends. In comparison to the HR + 100 mg/L APS group, the apoptosis rate in the H/R + LY and HR + 100 mg/L APS + LY groups increased, and the cell survival rate, NO content and expression of PI3K/Akt/eNOS signaling pathway associated proteins decreased. Collectively, APS improves the damage caused by H/P by mediating PI3K/Akt/eNOS signaling pathway.

Implantation of a modified stented bovine pulmonary valve in a beating heart sheep model.

PURPOSE: The aim of this research was to assess the performance of a modified bovine stent valve implanted transventricularly in the pulmonary position in sheep with a 3-month follow-up period. MATERIALS AND METHODS: Seven modified pulmonary bovine stent valves were transventricularly implanted in the pulmonary position into seven sheep using a delivery system. Stent valve performance was investigated and evaluated hemodynamically, angiographically, and with echocardiograms before, immediately after, and 3 months following implantation. Macroscopic, histologic, and radiographic examinations were performed on the explanted graft at 3 months. RESULTS: The modified stent valves were all deployed and implanted successfully in the pulmonary position in seven sheep. Angiographic, echocardiographic, hemodynamic, and macroscopic analyses confirmed firm anchoring of the stents in the target position in the early and 3-month follow-up period. All modified stent valves showed satisfactory function, except one moderate stenosis (32 mmHg gradient) with mild regurgitation that was discovered at 3 months. All seven valves were free of any calcification and thrombus formation at postmortem macroscopic examination, which was confirmed by histologic and radiographic examination. All stents were intact without any fracture at microscopic or radiographic examination. CONCLUSIONS: Transventricular implantation of a modified nitinol pulmonary valve stent showed good structural and functional outcomes without stent fracture or migration.

Perventricular closure of a post-traumatic muscular ventricular septal defect guided by transesophageal echocardiogram.

Minimally invasive perventricular closure is emerging as an alternative to conventional open surgery in treating traumatic ventricular septal defects (VSDs). We report a case of successful perventricular closure of a post-traumatic muscular VSD in a patient who sustained blunt chest trauma in a motor vehicle accident. A larger Amplatzer muscular VSD occluder (16 mm in diameter) was used to close the VSD near the apex.

Off-pump pulmonary valve implantation of a valved stent with an anchoring mechanism.

PURPOSE: The purpose of this study was to evaluate the longitudinal performance and anti-migration effect of a bovine valved stent equipped with an anchoring mechanism implanted off-pump in the pulmonary position. DESCRIPTION: Through a delivery system, the bell-shaped pulmonary valved stents were implanted off-pump in the pulmonary valve position into six sheep by the transventricular approach. Hemodynamic, angiographic, and echocardiographic evaluations were carried out before, immediately after, and 2 months after implantation. Macroscopic and radiographic examination were performed for evaluation. EVALUATION: The valved stents were all successfully implanted off-pump in the pulmonary position on six sheep. Early and late angiographic, echocardiographic, hemodynamic, and macroscopic studies confirmed firm anchoring and good positions of the stents. All valved stents were potent, except one mild stenosis with a 24 mm Hg transvalvular pressure gradient that developed and one mild insufficiency that were discovered at the end of the study. CONCLUSIONS: Transventricular implantation of the bell-shaped pulmonary valved stents was evaluated during a 2-month period in the sheep in the present study and showed a good structural and functional outcome with no migration.