ABSTRACT
BACKGROUND: While patients with chronic kidney disease (CKD) have a high prevalence of classical coronary risk factors, there is increasing evidence that atherosclerosis is different in renal compared to nonrenal patients. Therefore, the present study compares changes in different vessels obtained at cardiac surgery between patients with early and advanced CKD and nonrenal control patients. METHODS AND RESULTS: Fifty patients undergoing cardiac bypass surgery were divided into three groups: (i) 24 control patients with creatinine <1.3mg/dl, (ii) 14 patients with early CKD (creatinine 1.3-2.0mg/dl), and (iii) 12 patients with advanced CKD (creatinine >2.0mg/dl). Aorta, arteria mammaria interna, and vena saphena (V. saphena) were analyzed using morphometry, Kossa stain for vascular calcification, and immunohistochemistry for markers of inflammation and proosteogenic differentiation of vascular smooth muscle cells (VSMCs). Thereby, aortic wall thickness and calcification score of aortic intima and of V. saphena were significantly higher in advanced CKD patients than in nonrenal control patients, whereas significant vascular inflammation and proosteogenic dedifferentiation of VSMC and calcification of the aortic media were already present in early CKD. Interestingly, marked calcification of the V. saphena magna was seen in advanced CKD. Of note, calcium-phosphate product correlated well with markers of inflammation, but not with calcification itself. CONCLUSIONS: Early stages of CKD are already associated with local up-regulation of proinflammatory and proosteogenic molecules in the vascular wall and calcification of the aortic media. These findings point to the importance of local microinflammation in CKD and may shed new light on the potentially overestimated role of the calcium-phosphate product for vessel calcification.
Subject(s)
Aorta/pathology , Renal Insufficiency, Chronic/pathology , Vascular Calcification/pathology , Aged , Aged, 80 and over , Female , Humans , Immunohistochemistry , Inflammation/pathology , Male , Middle Aged , Muscle, Smooth, Vascular/pathology , Saphenous Vein/pathology , Tunica Media/pathologySubject(s)
Aortic Valve , Endocarditis/diagnostic imaging , Heart Valve Prosthesis/adverse effects , Aortic Valve/microbiology , Aortic Valve/surgery , Endocarditis/prevention & control , Endocarditis/surgery , Heart Valve Prosthesis/microbiology , Humans , Male , Middle Aged , Postoperative Complications/diagnostic imaging , Postoperative Complications/prevention & control , Postoperative Complications/surgery , Radiography , RecurrenceSubject(s)
Heart Aneurysm/diagnostic imaging , Extracorporeal Membrane Oxygenation , Fetal Diseases/diagnostic imaging , Heart Aneurysm/embryology , Heart Aneurysm/surgery , Heart Diseases/diagnostic imaging , Heart Diseases/surgery , Humans , Infant, Newborn , Male , Postoperative Care , Pressure , Thrombectomy , Thrombosis/diagnostic imaging , Thrombosis/surgery , Ultrasonography, PrenatalABSTRACT
Cardiac lipomas are rare tumors often detected incidentally during routine examinations. They usually remain asymptomatic for a long time and cause arrhythmia, heart valve dysfunction, or embolization in the later stages. In this article, we report a case of a 64-year-old patient with a very rare cardiac hibernoma located in the right atrium. Transesophageal echocardiography and computed tomography have been shown to be useful for differentiating between benign and malignant tumors in order to plan surgery. The treatment of choice for these tumors is resection. The tumor was excised with the use of cardiopulmonary bypass surgery. Histology confirmed diagnosis of a benign cardiac hibernoma.
