Assuntos
Estimulação Cardíaca Artificial/efeitos adversos , Remoção de Dispositivo/instrumentação , Dispositivos de Proteção Embólica , Embolia Paradoxal/cirurgia , Endocardite Bacteriana/cirurgia , Contaminação de Equipamentos , Marca-Passo Artificial/efeitos adversos , Infecções Estafilocócicas/cirurgia , Idoso , Fibrilação Atrial/terapia , Ecocardiografia Doppler em Cores , Ecocardiografia Transesofagiana , Embolia Paradoxal/diagnóstico , Embolia Paradoxal/microbiologia , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Desenho de Equipamento , Feminino , Forame Oval Patente/complicações , Humanos , Desenho de Prótese , Radiografia Intervencionista , Síndrome do Nó Sinusal/terapia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Resultado do TratamentoRESUMO
OPINION STATEMENT: Transcatheter aortic valve implantation (TAVI) is a less invasive approach to aortic valve replacement than traditional open chest surgery. It has been very successful in elderly and sick patients who might have otherwise been turned down for surgery. However, many patients who have the procedure develop conduction disease, including new LBBB or complete heart block, and may need permanent pacing or ongoing follow-up to monitor for worsening conduction problems. Here we discuss the risk for conduction disease with TAVI, identifying which patients may need a pacemaker or long-term rhythm follow-up, and methods to decrease the risk of worsening conduction.
RESUMO
Proteoglycans consist of a protein core complexed to glycosaminoglycan (GAG) side chains, are abundant in skeletal muscle cell membranes and basal lamina, and have important functions in neuromuscular synapse development. Treatment with chlorate results in the undersulfation of heparan sulfate and chondroitin sulfate GAGs in cell culture. In addition, chlorate treatment decreases the frequency of spontaneous acetylcholine receptor (AChR) clustering in skeletal muscle cell culture. AChRs and other molecules cluster to form the postsynaptic component of neuromuscular synapses. Chlorate treatment is shown here to decrease the frequency of agrin-induced AChR clustering and agrin-induced tyrosine phosphorylation of the AChR beta-subunit. These data suggest that reduced GAG chain sulfation decreases the frequency of AChR clustering by diminishing the agrin signal transduction pathway.
