Subject(s)
Aortic Valve Insufficiency/etiology , Aortic Valve/surgery , Heart Valve Prosthesis Implantation , Pericardium/surgery , Postoperative Complications/etiology , Aged , Animals , Aortic Valve Insufficiency/diagnostic imaging , Aortic Valve Stenosis/surgery , Bioprosthesis , Cattle , Diabetes Mellitus, Type 2/complications , Heart Valve Prosthesis , Humans , Hypertension/complications , Male , UltrasonographySubject(s)
Aortic Valve/pathology , Aortic Valve/physiopathology , Coronary Vessels/anatomy & histology , Coronary Vessels/physiopathology , Adult , Anatomic Variation , Aortic Valve/diagnostic imaging , Aortic Valve Insufficiency/complications , Aortic Valve Insufficiency/physiopathology , Coronary Angiography , Coronary Vessels/diagnostic imaging , Echocardiography, Transesophageal , Heart Murmurs/etiology , Heart Murmurs/physiopathology , Heart Valve Prosthesis Implantation , Humans , Hypertrophy, Left Ventricular/diagnostic imaging , Hypertrophy, Left Ventricular/physiopathology , Male , Tomography, X-Ray ComputedSubject(s)
Dizziness/diagnostic imaging , Heart Septal Defects, Atrial/diagnostic imaging , Pulmonary Veins/diagnostic imaging , Vena Cava, Superior/diagnostic imaging , Dizziness/etiology , Heart Septal Defects, Atrial/complications , Humans , Male , Middle Aged , Pulmonary Veins/abnormalities , Ultrasonography , Vena Cava, Superior/abnormalitiesSubject(s)
Aorta/diagnostic imaging , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Dissection/diagnostic imaging , Endothelium, Vascular/diagnostic imaging , Aortic Dissection/surgery , Aorta/surgery , Aortic Aneurysm, Thoracic/surgery , Endothelium, Vascular/surgery , Humans , Male , Middle Aged , UltrasonographySubject(s)
Aneurysm, False/surgery , Heart Aneurysm/surgery , Heart Rupture, Post-Infarction/surgery , Heart Ventricles/surgery , Postoperative Complications/surgery , Aged , Aneurysm, False/diagnosis , Bioprosthesis , Blood Vessel Prosthesis Implantation , Cardiac-Gated Imaging Techniques , Echocardiography , Female , Heart Aneurysm/diagnosis , Heart Rupture, Post-Infarction/diagnosis , Humans , Magnetic Resonance Imaging , Postoperative Complications/diagnosis , Recurrence , Reoperation , Suture TechniquesSubject(s)
Dental Caries/microbiology , Ventricular Dysfunction, Left/diagnosis , Ventricular Dysfunction, Left/etiology , Abscess/diagnosis , Abscess/diagnostic imaging , Aortic Valve/surgery , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/diagnostic imaging , Fatal Outcome , Heart Valve Prosthesis Implantation , Humans , Intraoperative Complications , Male , Middle Aged , Mitral Valve/surgery , Mitral Valve Insufficiency/complications , Mitral Valve Insufficiency/diagnostic imaging , Streptococcal Infections/complications , Streptococcal Infections/microbiology , Streptococcus , Ultrasonography, Doppler, Color , Ventricular Dysfunction, Left/microbiologyABSTRACT
BACKGROUND: The lanthanide cation, gadolinium (GdCl3) protects the myocardium against infarction following ischemia and reperfusion. Neutrophils and macrophages are the main leukocytes responsible for infarct expansion after reperfusion. GdCl3 interferes with macrophage and neutrophil function in the liver by decreasing macrophage secretion of inflammatory cytokines and neutrophil infiltration. We hypothesized that GdCl3 protects against ischemia and reperfusion injury by decreasing inflammation. We determined the impact of GdCl3 treatment for reperfusion injury on 1) circulating monoctye and neutrophil counts, 2) secretion of inflammatory cytokines, and 3) influx of monocytes and neutrophils into the myocardium. METHODS: Rats (n = 3-6/gp) were treated with saline or GdCl3 (20 mumol/kg) 15 min prior to a 30 min period of regional ischemia and 120 min reperfusion. Sham rats were not subject to ischemia. Blood was collected either after 30 min ischemia or 120 min reperfusion and hearts were harvested at 120 min reperfusion for tissue analysis. Blood was analyzed for leukocytes counts and cytokines. Tissue was analyzed for cytokines and markers of neutrophil and monocyte infiltration by measuring myeloperoxidase (MPO) and alpha-naphthyl acetate esterase (ANAE). RESULTS: GdCl3 did not affect the number of circulating neutrophils prior to ischemia. Two hours reperfusion resulted in a 2- and 3- fold increase in circulating monocytes and neutrophils, respectively. GdCl3 decreased the number of circulating monocytes and neutrophils during reperfusion to levels below those present prior to ischemia. Furthermore, after 120 min of reperfusion, GdCl3 decreased ANAE and MPO activity in the myocardium by 1.9-fold and 6.5-fold respectively. GdCl3 decreased MPO activity to levels below those measured in the Sham group. Serum levels of the major neutrophil chemoattractant cytokine, IL-8 were increased from pre-ischemic levels during ischemia and reperfusion in both control and GdCl3 treated rats. Likewise, IL-8 levels increased throughout the 3 hour time period in the Sham group. There was no difference in IL-8 detected in the myocardium after 120 min reperfusion between groups. In contrast, after 120 min reperfusion GdCl3 decreased the myocardial tissue levels of macrophage secreted cytokines, GM-CSF and IL-1. CONCLUSION: GdCl3 treatment prior to ischemia and reperfusion injury decreased circulating monocytes and neutrophils, macrophage secreted cytokines, and leukocyte infiltration into injured myocardium. These results suggest GdCl3 decreased monoctye and neutrophil migration and activation and may be a novel treatment for inflammation during ischemia and reperfusion.
ABSTRACT
We describe the use of extracorporeal membrane oxygenation to temporize circulatory instability during almost incessant ventricular fibrillation in a patient with Brugada syndrome who had electively discontinued chronic amiodarone therapy. The extracorporeal membrane oxygenation was continued for 3 days after emergent delivery of the neonate, during which time the number of ventricular fibrillation episodes and internal defibrillations markedly decreased concomitant with administration of intravenous amiodarone and verapamil. Oral anti-arrhythmic therapy was subsequently reinstituted, and the remainder of the patient's hospital course was uneventful.
Subject(s)
Atrial Fibrillation/complications , Atrial Fibrillation/surgery , Brugada Syndrome/complications , Brugada Syndrome/surgery , Extracorporeal Membrane Oxygenation/methods , Heart Failure/surgery , Hypoxia/surgery , Pregnancy Complications, Cardiovascular/surgery , Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/physiopathology , Brugada Syndrome/physiopathology , Cesarean Section , Combined Modality Therapy , Female , Heart Failure/physiopathology , Hemodynamics/physiology , Humans , Infant, Newborn , Male , Pacemaker, Artificial , Pregnancy , Pregnancy Complications, Cardiovascular/physiopathology , Recurrence , Young AdultABSTRACT
Aortic stenosis due to supravalvular membrane usually presents in children. It may be associated with fusion of the left coronary leaflet and the supravalvular membrane, causing obstruction of the left coronary ostium, and resulting in myocardial ischemia. Despite the immobilization of the left coronary leaflet, these patients present in childhood with aortic stenosis and not regurgitation, with or without accompanying myocardial ischemia. The case is described of an adult patient with supravalvular aortic membrane presenting with severe aortic regurgitation and myocardial infarction due to fusion of the left coronary leaflet with the supravalvular membrane.
Subject(s)
Aortic Stenosis, Supravalvular/diagnosis , Aortic Valve Insufficiency/diagnosis , Aortic Stenosis, Supravalvular/complications , Aortic Stenosis, Supravalvular/surgery , Aortic Valve Insufficiency/complications , Aortic Valve Insufficiency/surgery , Humans , Male , Middle Aged , Myocardial Infarction/complications , Myocardial Infarction/diagnosis , Severity of Illness IndexABSTRACT
A 57-year-old patient presented with a long history of minimally symptomatic mitral valve prolapse (MVP). The patient eventually developed severe mitral regurgitation (MR) and clinical evidence of congestive heart failure over 10 years duration before admission. He described a 34-year history of MVP. A transesophageal echocardiography examination demonstrated left atrial enlargement and severe prolapse of the posterior mitral leaflet associated with severe MR to the dome of the left atrium. Left ventricular size and function were normal. A quadrangular resection of prolapse segment and placement of a posterior annuloplasty ring were used to successfully repair the valve using a minimally invasive approach. The current case emphasizes that patients with MVP complicated by MR may remain clinically asymptomatic for prolonged periods, only to subsequently develop left atrial enlargement, severe MR, and congestive heart failure late in the natural history of the disease.
Subject(s)
Mitral Valve Prolapse/surgery , Echocardiography, Transesophageal , Humans , Male , Middle Aged , Minimally Invasive Surgical Procedures , Mitral Valve Prolapse/diagnostic imagingSubject(s)
Dyspnea/complications , Kidney Failure, Chronic/complications , Physical Exertion/physiology , Renal Dialysis , Systolic Murmurs/complications , Adult , Aortic Valve/diagnostic imaging , Aortic Valve Insufficiency/diagnostic imaging , Aortic Valve Insufficiency/etiology , Aortic Valve Insufficiency/surgery , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/etiology , Aortic Valve Stenosis/surgery , Calcinosis/complications , Calcinosis/diagnostic imaging , Calcinosis/surgery , Dyspnea/etiology , Echocardiography, Transesophageal , Glomerulonephritis/complications , Heart Valve Prosthesis Implantation , Humans , Kidney Failure, Chronic/diagnostic imaging , Male , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/etiology , Mitral Valve Insufficiency/surgery , Systolic Murmurs/diagnostic imaging , Systolic Murmurs/etiologySubject(s)
Aortic Valve/diagnostic imaging , Heart Valve Prosthesis Implantation , Heart Valve Prosthesis , Postoperative Complications/diagnostic imaging , Abscess/diagnostic imaging , Abscess/etiology , Aged , Aortic Valve Insufficiency/diagnostic imaging , Aortic Valve Insufficiency/etiology , Endocarditis/diagnostic imaging , Endocarditis/etiology , Humans , Male , Surgical Wound Dehiscence , Ultrasonography, Doppler, ColorSubject(s)
Aortic Aneurysm, Thoracic/diagnosis , Aortic Aneurysm, Thoracic/surgery , Aortic Coarctation/complications , Aortic Coarctation/surgery , Aortic Rupture/diagnosis , Aortic Rupture/surgery , Chest Pain/etiology , Hemoptysis/etiology , Postoperative Complications/surgery , Adult , Aortic Aneurysm, Thoracic/etiology , Aortic Coarctation/diagnostic imaging , Aortic Rupture/etiology , Chest Pain/diagnostic imaging , Echocardiography, Transesophageal , Hemoptysis/diagnostic imaging , Humans , Male , Postoperative Complications/etiology , RadiographySubject(s)
Aortic Aneurysm/diagnosis , Aortic Dissection/diagnosis , Adult , Aortic Dissection/physiopathology , Aortic Aneurysm/physiopathology , Blood Flow Velocity , Chronic Disease , Echocardiography, Doppler, Color , Echocardiography, Transesophageal , Humans , Male , Tomography, X-Ray ComputedABSTRACT
The lanthanide cation, gadolinium (Gd) attenuates post-ischemic myocardial stunning. This study tests the hypothesis that Gd also preconditions the myocardium against infarction following ischemia-reperfusion (IR) and explores potential mechanisms underlying Gd-induced cardioprotection. Regional myocardial infarction was induced in rats by occluding the left anterior descending artery for 30 min and reperfusing for 120 min. Rats (n=6/group) were administered intravenous Gd (1 to 100 micromol/kg) 15 min prior to ischemia. Hearts were excised after reperfusion to determine infarct size (IS) and area at risk (AAR). The ratio IS/AAR (%) was reduced by Gd in a "U"-shaped, dose-dependent manner. The minimum dose that reduced IS/AAR was 5 micromol/kg (52+/-5% vs. 64+/-4%), while the dose that reduced IS/AAR maximally was 20 micromol/kg (44+/-4%). Gd also reduced IS/AAR when given 1 min before reperfusion (47+/-3%) but not when given 10 s after reperfusion (60+/-3%). Cardioprotection was maintained if IR was delayed 24-72 h after Gd administration. Cardioprotection by Gd was abolished by inhibition of JAK-2 with AG-490, of p42/44 MAPK with PD98059 or of K(ATP) channels with glibenclamide. None of these agents given alone altered IS/AAR compared with controls. Inhibition of JAK-2 also blocked Gd-induced delayed cardioprotection. Gd may have broad potential roles in IR, as it conferred immediate cardioprotection when given prior to ischemia or prior to reperfusion and delayed cardioprotection for up to 72 h after administration. The mechanism underlying Gd-induced preconditioning appears to be multi-factorial, involving JAK-2, STAT-3 and p44 MAPK pathways, as well as K(ATP) channels.