MicroRNAs as potential biomarkers in congenital heart surgery.

OBJECTIVE: Pediatric congenital heart surgery (CHS) involves intracardiac, valvular, and vascular repairs. Accurate tools to aid short-term outcome prediction in pediatric CHS are lacking. Clinical scores, such as the vasoactive-inotrope score and ventilation index, are used to define outcome in clinical studies. MicroRNA-1-3p (miR-1) is expressed by both cardiomyocytes and vascular cells and is regulated by hypoxia. In adult patients, miR-1 increases in the circulation after open-heart cardiac surgery, suggesting its potential as a clinical biomarker. Thus, we investigated whether perioperative circulating miR-1 measurements can help predict post-CHS short-term outcomes in pediatric patients. METHODS: Plasma miR-1 was retrospectively measured in a cohort of 199 consecutive pediatric CHS patients (median age 1.2 years). Samples were taken before surgery and at the end of the operation. Plasma miR-1 concentration was measured by reverse transcription-quantitative polymerase chain reaction and expressed as miR-1 copies/µL and as relative expression to spiked-in exogenous cel-miR-39. RESULTS: Baseline plasma miR-1 did not vary across different diagnoses, increased during surgery (204-fold median relative increase, P < .001), and was associated with aortic crossclamp duration postoperatively (P < .001). Importantly, miR-1 levels at the end of the operation positively correlated with intensive care stay (P < .001), early severe cardiovascular events (P = .01), and with high vasoactive-inotrope score (P = .001) and ventilation index (P < .001), suggesting that miR-1 could accelerate the identification of patients with cardiopulmonary bypass-related ischemic complications, requiring more intensive support. CONCLUSIONS: Our study suggests miR-1 as a novel potential circulating biomarker to predict early postoperative outcome and inform clinical management in pediatric heart surgery.

Could left ventricular apical ballooning represent spontaneous myocardial infarction abortion?

Left ventricular apical ballooning, also named tako-tsubo cardiomyopathy, is a syndrome characterized by chest pain, transient left ventricular dysfunction and specific electrocardiographic changes mimicking an acute myocardial infarction without significant stenosis on the coronary angiogram. Although the aetiology remains unknown, several reports have found that preceding psychological stress could act as a trigger. This report describes a case of tako-tsubo-like left ventricular apical ballooning in a patient with "soft" atherosclerotic plaque at the middle portion of the left anterior descending coronary artery.