Conquering the obstacles during the intervention of a proximal chronic total occlusion of right coronary artery with a concurrent significant ostial stenosis: a case report.

Percutaneous coronary intervention (PCI) on a proximal chronic total occlusion (CTO) of the right coronary artery (RCA) with concurrent ostial stenosis can be challenging because of the significant difficulty in properly engaging the catheter and providing stable support during the procedure. We report the case of a 57-year-old man with chronic coronary syndrome who underwent an elective PCI at the Dr. Soetomo General Hospital in Surabaya, on April 13th, 2022. At the beginning of the procedure, there was difficulty in intubating the RCA, which required the guide catheter replacement. The angiography revealed a significant lesion at the ostium, a CTO at proximal to mid- RCA with bridging collaterals, and a significant distal lesion. Several strategies to improve guiding catheter support during PCI are using large and supportive shape guide catheters, deep guide catheter intubation, extra support wire, microcatheter and guide catheter extension. The risk of pressure dampening and ischaemia upon engagement should always be kept under consideration.

Managing tricuspid valve pathology in multiple valvular heart disease.

Introduction: Multiple valvular heart disease (MVD) is a general term to describe regurgitant and stenotic combination involving the same valve and/or occurring in ≥2 cardiac valves. Limited data and paucity in guidelines render the diagnosis and management. This article aims to provide a state-of-the-art review concerning the diagnosis and management strategies of MVD. Case presentation: We report a 46-year-old female with worsening dyspnea and fatigue. We perform multiple echocardiography parameters. We diagnose patients with the stenotic mitral valve, stenotic-regurgitant aortic valve, and stenotic-regurgitant tricuspid valve (TV). Double mechanical valve replacement and TV commissurotomy with Kay procedure were done with excellent results. Clinical discussion: The prevalence of MVD is 15% in those undergoing cardiac surgery; however only 1% of those who underwent triple valve surgery involve TV. The presence of TV lesion may complicate the natural history, clinical presentation, management, and outcomes. Echocardiography with valid method remains an important tool in assessment of patients with MVD. Multidiscipline heart team discussion is essential in determining individual risk, appropriate management methods, and long-term survival. Conclusion: The expertise of multidisciplinary heart valve team is of utmost importance in determining diagnosis and optimal management strategy.

Association between donor's age and expression of cardiomyocyte marker quantity on adipocyte-derived mesenchymal stem cell.

Aim Adipocyte-derived mesenchymal stem cells (AMSCs) have recently been studied as a potential new approach for regeneration treatment of heart failure and ischemic myocardium. However, donor's age is thought to affect the ability of AMSC cells to differentiate into cardiomyocytes. This study aimed to analyse the association between donor's age with the expression of cardiomyocyte marker cardiac isoform of Troponin-T (cTnT) quantity on AMSCs. Methods Subcutaneous adipose tissue was taken from donors of 3 different age groups (30-40, 41-50, and >50 years old), and then processed into AMSC cells by insert culture. AMSC cell phenotype was identified by assessing the quantity of mesenchymal markers expression (CD34, CD45, CD90, CD105) using indirect immunofluorescence technique. Afterwards, cTnT expression, a marker for cardiomyocyte differentiation from AMSC cells, was evaluated under the fluorescent microscope. The comparison was done between the 3 different age groups. Results The comparative test and post hoc analysis showed that there were differences in the expression of CD34, CD45, CD90, CD105, and cTnT between the three age groups (all p<0.05). Furthermore, there were strong negative correlations between age and CD34, CD90, CD105 and cTnT (r= -0.844, -0.914, -0.899, and -0.738, respectively), while the correlation was positive between age and CD45 (r=0.899). Conclusion Expression quantity of mesenchymal markers and cardiomyocyte markers from AMSC cells were affected by the donor's age. The higher the donor age group, the lower the expression quantity of mesenchymal markers (except CD45) and cTnT.