Atrial natriuretic peptide property on the ischemic myocardium inducing HSP72.

BACKGROUND: The purpose of this study was to investigate the effectiveness of atrial natriuretic peptide on ischemic myocardium through the induction of heat-shock protein 72. METHODS: 30 isolated rabbit hearts perfused on isolated heart apparatus were randomly assigned to receive either warm Krebs-Henseleit solution with 1 µmol L(-1) atrial natriuretic peptide (n = 15) or warm Krebs-Henseleit solution without atrial natriuretic peptide (n = 15) in preischemic, ischemic, and postischemic conditions. In all rabbit hearts, global ischemia was produced by clamping the aortic and atrial inflow lines. Concentrations of atrial natriuretic peptide were measured in hearts with left ventricular dysfunction following ischemia, and correlated with the hypertrophic growth sustained by overexpression of heat-shock protein 72 microRNA-133. RESULTS: The levels of atrial natriuretic peptide were markedly higher in the group that received atrial natriuretic peptide, and strongly correlated with both band lengths of heat-shock protein 72 and overexpression of microRNA-133 in the hypertrophic myocyte. CONCLUSIONS: Perfusion levels of atrial natriuretic peptide induce increased expression of heat-shock protein 72 microRNA-133 in dysfunctional left ventricle.

Giant congenital fistula of the circumflex coronary artery with drainage into right atrium.

A dilated and tortuous fistula from circumflex coronary artery draining into the right atrium was diagnosed by transthoracic echocardiography and selective angiography in a 64-year old female. Transcatheter closure was excluded by the cardiologist because of the presence of a large huge at the drainage site so the patient was scheduled for surgical ligation. Intraoperative and postoperative controls were performed by echocardiography. The Authors discuss on differential diagnosis, indications and types of treatment in all cases presenting coronary artery fistula.

Structural deterioration of the cryopreserved mitral homograft valve.

OBJECTIVE: The aim of this study was to evaluate the long-term fate of the cryopreserved mitral homograft focusing on structural valve deterioration. METHODS: Homograft replacement of the mitral valve was performed in 106 patients. The causes of mitral disease were rheumatic disease (n=75), endocarditis (n=24), and others (n=7). There were 40 partial homografts and 66 total homografts. RESULTS: Mean follow-up was 9.3+4.7 years (up to 17.8 years). There were 5 early (<3 months) and 15 late deaths. There have been 5 early (<3 months) and 30 late reoperations. Five patients had endocarditis, and 5 patients had an ischemic/hemorrhagic event. Compared with baseline, follow-up echography showed progression of mitral regurgitation grade (from 0.4 to 1.3; P<.001) with stenosis (elevated gradient: from 3.9 to 7.0 mm Hg; P<.001) and decreased valve area (from 2.3 to 1.7 cm2, P<.001). Freedom from structural valve deterioration was 90%, 76%, and 65% at 5, 10, and 15 years, respectively. Structural valve deterioration was more frequent in total homografts (P=.018 vs partial homografts) and in case of pregnancy (P=.016 vs no pregnancy). Stenosis related to structural valve deterioration was more pronounced for age less than 40 years (P=.03) and ring size 30 mm or less (P=.002). Pathologic analysis of the explanted homografts almost invariably showed dense fibrosis with calcification and no cellularity. CONCLUSIONS: Mitral homografting was accomplished with early echographic results similar to those of valve repair. Structural valve deterioration produced mixed stenosis with insufficiency, and its incidence was comparable to that of bioprostheses structural valve deterioration. An improvement in the preservation mode of valvular homografts is warranted.

Papillary fibroblastoma of tricuspid valve with pulmonary embolization.

A 53-year-old man was diagnosed with a papillary fibroelastoma of the tricuspid valve with pulmonary embolization and associated coronary artery disease. He underwent excision of the tumor and coronary bypass grafting. Due to potential embolization, it is recommended that all such fibroelastomas be excised.

Perioperative patency of coronary artery bypass grafting is not influenced by off-pump technique.

BACKGROUND: Some concerns have been raised about technical accuracy and quality of distal anastomoses in off-pump myocardial revascularization (OPCAB), which could affect graft patency. METHODS: Transit-time flowmetric results and clinical, enzymatic, and echocardiographic findings from 201 consecutive isolated on-pump coronary artery bypass graft cases (cardiopulmonary bypass coronary artery bypass grafting; group A) were compared with 96 consecutive OPCAB (group B) cases performed at our institution between January 2003 and December 2004. Maximum, mean, minimum flow, and pulsatility index were compared, stratifying the two groups according to graft type and coronaries revascularized. Graft flow reserve was evaluated in patients undergoing preoperative intraaortic balloon pump during baseline conditions and at a 1 to 1 ratio of intraaortic balloon pump augmentation. RESULTS: No differences were recorded between the two groups in hospital mortality, perioperative myocardial infarction, postoperative enzymatic leakage, echocardiographic recovery, or hospital stay (p = not significant). Off-pump coronary artery bypass and cardiopulmonary bypass coronary artery bypass grafting demonstrated similar intraoperative maximum (75.8 +/- 10.4 mL/min vs 82.3 +/- 15.8; p = 0.190), mean (50.1 +/- 13.3 vs 46.3 +/- 7.7; p = 0.420), minimum flow (12.7 +/- 5.3 vs 11.9 +/- 5.4; p = 0.811), and pulsatility index (2.9 +/- 0.2 vs 2.6 +/- 0.8; p = 0.360). After stratifying the population according to graft type, no differences were detected between the two groups in transit-time flowmetric results of left internal mammary artery, radial artery, and single and sequential saphenous vein grafts. A one to one ratio of intraaortic balloon pump augmentation did not result in any difference in graft flow reserve when left internal mammary artery (p = 0.699), radial artery (p = 0.066), and saphenous vein graft anastomoses (p = 0.772) were considered. CONCLUSIONS: Off-pump coronary artery bypass grafting and cardiopulmonary bypass coronary artery bypass grafting demonstrated similar clinical, biochemical, and transit-time flowmetric results, as well as comparable graft flow reserve. These data exclude a lower anastomotic quality in off-pump coronary artery bypass grafting.