Low expression of ESR1 correlates with ascending aortic dilation and acute type A aortic dissection.

BACKGROUND: The common genetic signatures of ascending aortic dilation and acute type A aortic dissection (AAAD) remained unclear. This study aims to investigate the role of ESR1 in ascending aortic dilation and AAAD via a multi-omics approach combining transcriptome-wide association study (TWAS) and mRNA expression profiles. METHODS: The TWAS analysis was performed by integrating expression quantitative trait loci (eQTL) data of aorta and the GWAS dataset of ascending aortic diameter using the FUSION software. Joint/Conditional Analysis was used to screen conditionally independent genes from TWAS significant regions. mRNA expression profiles were used to confirm the differential expression of ESR1 in ascending aortic dilation and AAAD. An independent mRNA expression profile dataset was used to validate the diagnostic efficiency of ESR1 expression on thoracic aortic aneurysm (TAA). Gene set enrichment analysis (GSEA) was utilized to explore the potential molecular function of ESR1 in mouse aorta. Immune infiltration analysis was performed to evaluate the association between ESR1 and immune infiltration in AAAD. RESULTS: ESR1 was among the top 10 most significant genes identified by TWAS of ascending aortic diameter (Z score = -7.3, PTWAS = 3.30 × 10-13). mRNA expression profiles confirmed the low expression of ESR1 both in ascending aortic dilation (PmRNA = 0.0361) and AAAD (PmRNA = 0.0142). The diagnostic efficiency of peripheral blood ESR1 expression on TAA was further validated by an independent mRNA expression profile dataset. GSEA showed that GO terms and KEGG pathways mainly involved in metabolism and oxidoreductase activity were enriched in aortic tissue of ERα knockout mice. The immune infiltration ration of naive CD8 + T cells was significantly lower in AAAD compared with normal aorta, and was positively correlated with ESR1 expression. CONCLUSION: Low expression of ESR1 is associated with ascending aortic dilation and AAAD. Peripheral blood ESR1 expression may be a novel diagnostic biomarker of TAA. ESR1 expression is positively correlated with immune infiltration ration of naive CD8 + T cells in AAAD.

Cardiac Metastasis of Cervical Cancer: A Case Report and Review of The Literature.

BACKGROUND: Cervical cancer cardiac metastasis is a rare disease with a poor prognosis. It has been reported that the disease often is more detected at autopsy and has no standardized treatment options. CASE PRESENTATION: Here, we report a patient with cardiac metastasis from cervical cancer who initially suffered nonspecific symptoms, such as chest tightness. CONCLUSION: A review of cases of cardiac metastasis from cervical cancer in over a decade was performed. Pretreatment data were provided for such matters, which may be helpful for diagnosis and treatment in the future.

Minimally Invasive Isolated Tricuspid Valve Repair After Left-Sided Valve Surgery: A Single-Center Experience.

Background: Tricuspid regurgitation after left-sided valve surgery was associated with terrible outcomes and high perioperative mortality for surgical treatment. In current years, minimally invasive isolated tricuspid valve repair is increasingly performed in our institution to address tricuspid regurgitation. Methods: Thirty-seven consecutive patients with previous left-sided valve surgery underwent minimally invasive isolated tricuspid valve repair in our institution between November 2017 and December 2020. Twenty-nine patients(78.4%) were women and the mean age of patients was 58.4 ± 8.5 years. Follow-up was 100% complete with a mean follow-up time of 17.2 ± 9.5 months. Results: Both the in-hospital and 30-day mortalities were 2.7%. The overall NYHA class had improved significantly during the follow-up (p < 0.001). The grade of TR had decreased before discharge (p < 0.001) and during the follow-up (p < 0.001) compared with the preoperative level although severe TR was recurrent in one patient. Conclusions: Minimally invasive isolated tricuspid valve repair has acceptable early and midterm outcomes, may be the preferred surgical option to address tricuspid regurgitation after previous left-sided valve surgery when it is feasible.

Right Coronary-Left Ventricular Fistula and Its Course: A Case Report.

BACKGROUND: Coronary fistula is a relatively rare cardiac disease. The incidence of coronary fistula flowing into the right heart structure is much higher than in inflow into the left heart structures. Opportunities for surgical intervention and treatment strategies for these patients still need to build more consensus.  Case presentation: Here, we report a case of right coronary artery-left ventricular fistula combined with a giant coronary artery aneurysm during the treatment course. CONCLUSION: Because of its rarity as well as its specificity of coronary artery fistula, each case requires an individualized evaluation. More consideration also can be given to the choice of surgical approach.

Large mural thrombus in the non-aneurysmal and non-atherosclerotic ascending aorta: a case report.

BACKGROUND: The mural thrombus in the ascending aorta is rare, most of which are associated with aneurysm or atherosclerotic lesions, with high risks of causing catastrophic thrombotic events. A mural thrombus in the non-aneurysmal and non-atherosclerotic ascending aorta is exceptionally uncommon. CASE PRESENTATION: We reported a large mural thrombus in normal ascending aorta of an asymptomatic patient. Preoperative imaging confirmed the presence of the sessile thrombus located at the left anterior wall of ascending aorta. Given that it had the potential to cause fatal thrombotic complications, surgical removal and segment of ascending aorta replacement were executed. The patient had an uneventful recovery and discharged 14 days after surgery. CONCLUSIONS: Anticoagulant is the therapeutic cornerstone of ascending aortic thrombus, but surgery should be performed aggressively when the thrombus is large or floating to avoid severe embolic complications or recurrence.