Expression and transcriptional regulation of functionally distinct Bmf isoforms in B-chronic lymphocytic leukemia cells

Bmf is a BH3-only Bcl-2 family member that is normally sequestered to myosin V motors by binding to the dynein light chain 2 (DLC2). Certain damage signals release Bmf, which then binds prosurvival Bcl-2 proteins and triggers apoptosis. Here, two novel isoforms of human Bmf, Bmf-II and Bmf-III, were identified and cloned from cDNA derived from B-chronic lymphocytic leukemia (B-CLL) cells. Bmf-II and Bmf-III were characterized as two splice variants, lacking the BH3 domain but retaining the DLC2 binding domain. Bmf (here called Bmf-I) expression in HeLa cells induced apoptosis and reduced colony formation in contrast to Bmf-II and Bmf-III, which had no effect on apoptosis and instead increased colony formation. While bmf-I mRNA was expressed in many cell types, expression was higher in B lymphoid cells and bmf-II and bmf-III were mainly detected in B-CLL and normal B cells. bmf-I mRNA was upregulated in normal and leukemic B cells, while bmf-III mRNA was downregulated only in B-CLL cells by serum deprivation. We show that Bmf is regulated by transcriptional activation and alternative splicing and conclude that the relative levels of Bmf isoforms may have a role in regulating growth and survival in B cells and leukemic B-CLL cells.

A slow form of alpha-2-macroglobulin in diseased and healthy dogs

Alpha-macroglobulins (AMs) function as non-specific protease inhibitors by using a so-called trapping mechanism, which is a compaction of the molecule that can be seen as a "fast" form in native polyacrylamide gel electrophoresis (PAGE). AMs also play a role in the transport and clearance of cytokines and growth factors from the circulation. In the dog, two AMs are known, alpha-1-macroglobulin (A1M) and alpha-2-macroglobulin (A2M). Using agarose and polyacrylamide gel electrophoresis of canine serum or plasma, we detected a cathodal, slow form of A2M. Upon activation with elastase, slow A2M resembled normal A2M in agarose gel electrophoresis, showing decreased negative charge at semi-saturation but not at full saturation with enzyme. In PAGE, however, slow A2M, unlike normal A2M, did not exhibit a "fast" form after short-term incubation with elastase. After incubation overnight, the "fast" form was seen, indicating a retarded reaction. Incubation of slow A2M with ammonium sulphate, a known activator of AMs, resulted in decreased negative charge in agarose gel electrophoresis and no reaction or partial reaction in PAGE. Slow A2M is present in fresh blood samples or may develop from partial alterations within a few days of storage. Moreover, it is sometimes reversible. Our findings may indicate that slow A2M is a result of an instability of the molecule, leading to a conformational change, which affects electrical charge and impairs the ability to develop into the "fast" form upon activation. This may lead to a delayed clearance of protease and inflammatory mediators from the circulation. Slow A2M was predominantly found in diseased dogs, especially in the Labrador retriever.

Left ventricular diastolic function is related to glucose in a middle-aged population

OBJECTIVES

To examine the relation between left ventricular (LV) diastolic function and glucose metabolism in individuals without previously diagnosed diabetes mellitus.

DESIGN

A cross-sectional population-based study.

SETTING

A university hospital.

SUBJECTS

Thirty-five men and women 56-58 years of age without previously diagnosed diabetes or heart disease.

MAIN OUTCOME MEASURES

Left ventricular diastolic function assessed by pulsed Doppler tissue imaging and its relation to fasting plasma glucose, glucose postload and glycated haemoglobin. LV diastolic function was determined by measuring early diastolic filling peak velocity (Em wave cm s-1), late diastolic filling peak velocity (Am wave cm s-1) and their ratio Em/Am.

RESULTS

Peak Em velocity, peak Am velocity and their ratio Em/Am correlated with fasting plasma glucose (r=-0.42, P=0.01; r=0.47, P=0.04 and r=-0.53, P=0.001, respectively). There was a correlation between peak Em velocity, the ratio of Em/Am and glycated haemoglobin. LV diastolic function was also related to glucose postload.

CONCLUSIONS

Left ventricular diastolic function is related to concentrations of fasting plasma glucose, glucose postload and glycated haemoglobin even below the threshold of diabetes. This indicates that glucose concentrations already in the upper end of the normal range has negative impact on cardiac function.

Sensitization to TRAIL-induced apoptosis and modulation of FLICE-inhibitory protein in B chronic lymphocytic leukemia by actinomycin D

Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) is a potent activator of the cell death pathway and exerts tumoricidal activity in vivo with minimal toxicity. In order to investigate the therapeutic potential of TRAIL in B chronic lymphocytic leukemia (B-CLL) we have analyzed the expression of TRAIL receptors (TRAIL-Rs) in leukemic cells from B-CLL patients and their in vitro sensitivity to apoptosis induced by recombinant human TRAIL. We have found TRAIL-R1 and -R2 death receptor, and TRAIL-R3 and -R4 decoy receptor mRNA expression in most of the 57 B-CLL patients studied (R1 82%, R2 100%, R3 96% and R4 82%). TRAIL-R1 and R2 proteins were expressed on the surface and within the cells, whereas R3 and R4 decoy receptors were almost exclusively expressed in the cytoplasm. Despite TRAIL death receptor expression, B-CLL cells were relatively resistant to induction of apoptosis by recombinant human TRAIL (300 ng/ml). However, the susceptibility to TRAIL-induced apoptosis was increased by treatment of B-CLL cells with actinomycin D (Act D). Western blot analysis showed higher constitutive expression of the long form of FLICE-inhibitory protein (FLIP(L)) in B-CLL as compared to normal tonsillar B cells. Act D treatment down-regulated both long and short FLIP expression, which was correlated with the increase in B-CLL sensitivity to TRAIL. Although the surface TRAIL death receptor expression was up-regulated both by cell culture and by Act D treatment, the changes were not correlated with a gain in susceptibility to TRAIL. In addition, neither decoy receptors nor Bcl-2 expression were affected by Act D. Our findings suggest the possible involvement of FLIP in regulating TRAIL-mediated apoptosis in B-CLL.

Increased retinoid signaling in vascular smooth muscle cells by proinflammatory cytokines

Retinoids have been shown to modulate inflammation and the immune response in many cell types including macrophages, endothelial cells, and vascular smooth muscle cells. However, present knowledge of whether inflammatory mediators modulate vitamin A status in these cells is limited. To identify the role of inflammation on retinoid metabolism in vascular smooth muscle cells, the cells were exposed to a combination of proinflammatory cytokines: interleukin-1beta, interferon-gamma, and lipopolysaccharides. Without stimulation with proinflammatory cytokines, vascular smooth muscle cells expressed retinol dehydrogenases-2 and 5 mRNA detected by RT-PCR. Stimulation with the combination of cytokines induced a substantial increase of retinol dehydrogenase-5 mRNA. This was associated with increased production of ligands for retinoic acid receptors, when assayed in a retinoic acid receptor-dependent luciferase reporter system. Our results demonstrate that inflammatory mediators activate the retinoid metabolic pathway in vascular smooth muscle cells, which potentially may modulate the inflammatory response in the vascular wall.

Activation of Ras, Raf-1 and protein kinase C in differentiating human neuroblastoma cells after treatment with phorbolester and NGF

The human neuroblastoma cell line SH-SY5Y/TrkA differentiates in vitro and acquires a sympathetic phenotype in response to phorbolester (activator of protein kinase C, PKC) in the presence of serum or growth factors, or nerve growth factor (NGF). We have now investigated to what extent phorbolester and NGF cause activation of Ras and Raf-1 and the involvement of PKC in this response in differentiating SH-SY5Y/TrkA cells. NGF stimulated increased accumulation of Ras-GTP and a threefold activation of Raf-1. In contrast, 12-O-tetradecanoylphorbol-13-acetate (TPA) had no effect on the amount of Ras-GTP but led to a smaller activation of Raf-1. NGF caused a limited increase in phosphorylation of Raf-1 compared with TPA, and NGF-induced Raf activity was independent of PKC. Analysis of phosphorylation of the endogenous PKC substrate myristoylated alanine-rich C-kinase substrate (MARCKS), and of subcellular distribution of PKC-alpha, -delta, and -epsilon revealed that NGF only caused a very small activation of PKC in SH-SY5Y/TrkA cells. The results identify Raf-1 as a target for both TPA- and NGF-induced signals in differentiating SH-SY5Y/TrkA cells and demonstrate that signalling to Raf-1 was mediated via distinct mechanisms.

Distribution of DDT residues in fish from the Songkhla Lake, Thailand

Since the early 1950s DDT has been extensively used in Thailand as a malaria repellent and as an agricultural pesticide, but was finally banned in 1994. In this study concentrations of p,p'-DDT, p,p'-DDE, and p,p'-DDD in 113 fish of four species (Scatophagus argus, Protosus canius, Channa striata and Zonichthys nigrofasciata) are reported from the large, brackish Songkhla Lake and the Gulf of Thailand. The mean sigma DDT concentrations at different locations in the analysed fish species ranged from 33 to 170 ng/g lipid wt. (0.086-7.7 ng/g fresh wt.). This is well below the recommended maximum residue levels in aquatic animals used for human consumption (5000 ng/g fresh wt.) in Thailand. The comparatively low residue levels could be due to the high temperature and solar radiation in the region, which may result in a high volatilising and degradation rate of DDT. Also, the high productivity of the lake could result in a dilution effect, when DDT is distributed in a large amount of organic matter, followed by a high biological degradation of the substance.

Semantic processing without conscious identification: evidence from event-related potentials

Three event-related potential (ERP) experiments examined whether semantic content can be accessed from visually presented words that cannot be consciously identified. Category labels were shown to participants, followed by masked, briefly exposed words that were either exemplars of the category or not exemplars. The task was to verify the category, by guessing if necessary, and to identify the word, naming it if possible. Exposure durations were selected to allow identification in approximately half the trials. For identified words, there was a marked difference in the ERP response between in-category and out-of-category words because of an N400 component. For unidentified words, there was a similar although smaller difference. Conscious identification was defined using a variety of approaches: verbal report, 6-alternative forced choice, and binary categorization (in the context of the regression method; A. G. Greenwald, M. R. Klinger, & E. S. Schuh, 1995). By any definition, ERPs for unidentified words showed evidence of semantic processing. In addition, there were differences in the neuronal populations recruited to process above-threshold versus below-threshold words, suggesting qualitative differences.

Sexual abuse during childhood and adolescence among Nicaraguan men and women: a population-based anonymous survey

AIMS

The objective was to describe experiences of sexual abuse occurring before 19 years of age among men and women in León, Nicaragua and to explore the possible association to later sexual risk behavior.

METHOD

A sub-sample of literate urban men and women 25-44 years of age was selected from a representative sample of households in León. After an invitation to a public health event, 154 men (53% of the invited) and 213 women (66% of those invited) participated in giving written answers to an anonymous questionnaire.

RESULTS

Twenty percent of men and 26% of women reported that they had experienced sexual abuse. Women had been victims of attempted or completed rape twice as often as men, 15% as compared to 7%. Thirty-three percent of the abuse towards boys and 66% of the abuse towards girls was committed by family members. Women who had experienced attempted or completed rape were more likely to later have had a higher number of sexual partners compared to non-abused or moderately abused women.

CONCLUSIONS

Sexual abuse of children and adolescents of both sexes is common in Nicaragua. The results underscore the urgent need to address this serious problem more openly, and to make more resources available for the prevention of sexual abuse and for support to victims.

[Atrial septal defect--catheter-based closure now feasible!]

Atrial septal defects (ASD) of hemodynamic significance are usually treated surgically in early childhood. However, many cases will not be detected until the patient has become an adult. As there is a risk of development of pulmonary hypertension and tachyarrythmia in hemodynamically significant defects, closure is necessary. Although surgery is considered a safe procedure with very low perioperative mortality, there is a risk of complications and prolonged hospitalization, and postoperative convalescence is two months. Today we are able to offer patients with ASD of the secundum type an alternative treatment using catheter technique. The devices used are self expanding and easy to deploy, with a high success rate and low complication rate. Post-procedural convalescence is two days.

Semantic processing without conscious identification: evidence from event-related potentials

Three event-related potential (ERP) experiments examined whether semantic content can be accessed from visually presented words that cannot be consciously identified. Category labels were shown to participants, followed by masked, briefly exposed words that were either exemplars of the category or not exemplars. The task was to verify the category, by guessing if necessary, and to identify the word, naming it if possible. Exposure durations were selected to allow identification in approximately half the trials. For identified words, there was a marked difference in the ERP response between in-category and out-of-category words because of an N400 component. For unidentified words, there was a similar although smaller difference. Conscious identification was defined using a variety of approaches: verbal report, 6-alternative forced choice, and binary categorization (in the context of the regression method; A. G. Greenwald, M. R. Klinger, & E. S. Schuh, 1995). By any definition, ERPs for unidentified words showed evidence of semantic processing. In addition, there were differences in the neuronal populations recruited to process above-threshold versus below-threshold words, suggesting qualitative differences.

Is it necessary to suture all lacerations after a vaginal delivery?

BACKGROUND

Midwives tend to leave minor perineal lacerations to heal spontaneously, and clinical experience and studies show that women can suffer from their stitched lacerations. The study purpose was to determine any differences in the healing process and experience of minor perineal lacerations when they were sutured or not sutured.

METHODS

Eighty term pregnant primiparas with minor perineal lacerations of grades I-II were randomized after childbirth. The experimental group was nonsutured and the control group was sutured. A follow-up examination was performed at 2 to 3 days, 8 weeks, and 6 months after the delivery. Participants were asked about the type of discomfort, and the effect of the laceration on breastfeeding and sexual intercourse.

RESULTS

No significant differences were found in the healing process. The type of pain differed between the groups, but the amount of discomfort was the same. The sutured group had to visit the midwife more often because of discomfort from the stitches. Sixteen percent of the women in the sutured group, but none in the nonsutured group (p = 0.0385), considered that the laceration had had a negative influence on breastfeeding.

CONCLUSIONS

Minor perineal lacerations can be left to heal spontaneously. The benefits for the woman include the possibility of having a choice, avoiding the discomfort of anesthesia and suturing, providing positive affects on breastfeeding.

Retinoic acid inhibits nitric oxide synthase-2 expression through the retinoic acid receptor-alpha

Retinoids are multipotent modulators of cellular functions and suppress cytokine-induced production of nitric oxide (NO) in several cell types. We have explored the mechanisms by which retinoic acid (RA) regulates NO production in rat aortic smooth muscle cells (VSMC), which express NOS2 in response to proinflammatory cytokines. RA inhibited interleukin-1beta (IL-1beta)-induced NOS2 mRNA expression and NO production. These effects were attenuated by the retinoic acid receptor (RAR) antagonist CD3106, indicating that they were mediated through retinoic acid receptors (RARs). The synthetic retinoid agonists CD336 (which specifically binds RARalpha) and CD367 (which binds all RARs) but not agonists specific for RARbeta, RARgamma, or RXRs reduced IL-1beta-induced NOS2 expression and NO production. When transfecting VSMC with a 1570-bp NOS2 promoter fragment fused to a luciferase reporter gene, the NOS2 promoter activity was inhibited by RA. These results indicate that retinoids modulate NO production in VSMC via RARalpha, which inhibits the transcription of the NOS2 gene.

Forward leaning reaching task in sitting (FLRS): a new measure for clinical evaluation of hamstring length in children

BACKGROUND AND PURPOSE

In this study, the rotation of the pelvis was taken into account when assessing the length of hamstrings. A new measure for clinical evaluation was developed to establish reference values of hamstring length in children without movement disabilities for different age groups. Subjects (N = 60) were 3-, 6-, 10- and 14-year-old children (N = 15 for each age group). These values could be helpful in deciding treatment interventions in children with movement disabilities, for example cerebral palsy, when hamstring length is in question.

METHOD

The study was performed with subjects sitting and reaching for a touch control on a wall whilst voluntarily rotating the pelvis forwards. By use of digitized video frames, the spatial angles of the lumbar spine and pelvis, as well as the joint angles of hip and knee, were computed at the initial and end positions of a forward leaning reaching task in sitting (FLRS). The active forward leaning induced a forward rotation of the pelvis, causing stretch on the hamstring muscle with extended knee.

RESULTS

The results of spatial and joint angle measurements suggest that the difference of the hip joint angle between initial erect and final forward leaned sitting may be used as reference values for hamstring length. Reference values are based on the mean (+/- SE) of means (mean of 15 children, that is, group and individual means of ten trials).

CONCLUSIONS

The age group reference values obtained may indirectly give information as to whether the hamstring length of a child with cerebral palsy is within the normative value of age-related control subjects. The new test developed in this study provides a convenient means for measuring hamstring length and could enhance clinical evaluation.

Cerivastatin gender effect: sub-analyses of results from a multinational, randomised, double-blind study. Cerivastatin Study Group

We previously reported the results of a multicentre, randomised, double-blind, parallel-group study comparing the efficacy and safety of cerivastatin 0.4 mg/day and cerivastatin 0.2 mg/day in patients with primary hypercholesterolaemia. Exploratory analysis in this study suggested a gender difference in the 0.4 mg group: mean low-density lipoprotein cholesterol (LDL-C) decreased by 44.4 +/- 8.9% in women, compared with a mean decrease of 37.0 +/- 0.9% in men (p < 0.046). This paper reports the results of further sub-analyses from this study. Overall in the per-protocol (PP) population, 71.5% (n = 73) of women taking cerivastatin 0.4 mg had an LDL-C decrease of > 40%, compared with 38.0% (n = 76) of men taking the same dose. In the cerivastatin 0.2 mg PP population, 34% (n = 17) of women had an LDL-C decrease of > 40%, compared with 19% (n = 18) of men. Mean LDL-C/HDL-C ratio decreased by 43% from baseline to the end of the study in the cerivastatin 0.4 mg PP group: -41.3% in males vs. -48.3% in females. In the cerivastatin 0.2 mg group, the decrease in LDL-C/HDL-C ratio from baseline to endpoint did not markedly differ between genders: -37.0% for males vs. -37.3% for females. Categorial analysis of the LDL-C/HDL-C ratio found that 90% of PP patients taking cerivastatin 0.4 mg, and 84% of PP patients taking cerivastatin 0.2 mg, had a low CHD risk (defined as a LDL-C/HDL-C ratio < or = 3) after 8 weeks of treatment. The 6th and 95th percentiles of the distribution of LDL-C reduction from baseline revealed that 90% of PP patients taking cerivastatin 0.4 mg had an LDL-C reduction of between 22% and 56%. The mean LDL-C reduction for this 90% subset of patients was 40.1%. The same analysis for PP patients taking cerivastatin 0.2 mg found that 90% had an LDL-C reduction of between 13% and 49%. The mean LDL-C reduction in this 90% subset of patients was 31.5%. Of the patients taking cerivastatin 0.4 mg and valid for treatment according to National Cholesterol Education Program (NCEP) criteria, 71% (149/211) achieved NCEP targets for LDL-C at Week 16.

Phosphorylation of Thr-948 at the C terminus of the plasma membrane H(+)-ATPase creates a binding site for the regulatory 14-3-3 protein

The plant plasma membrane H(+)-ATPase is activated by the binding of 14-3-3 protein to the C-terminal region of the enzyme, thus forming an H(+)-ATPase-14-3-3 complex that can be stabilized by the fungal toxin fusicoccin. A novel 14-3-3 binding motif, QQXYpT(948)V, at the C terminus of the H(+)-ATPase is identified and characterized, and the protein kinase activity in the plasma membrane fraction that phosphorylates this threonine residue in the H(+)-ATPase is identified. A synthetic peptide that corresponds to the C-terminal 16 amino acids of the H(+)-ATPase and that is phosphorylated on Thr-948 prevents the in vitro activation of the H(+)-ATPase that is obtained in the presence of recombinant 14-3-3 and fusicoccin. Furthermore, binding of 14-3-3 to the H(+)-ATPase in the absence of fusicoccin is absolutely dependent on the phosphorylation of Thr-948, whereas binding of 14-3-3 in the presence of fusicoccin occurs independently of phosphorylation but still involves the C-terminal motif YTV. Finally, by complementing yeast that lacks its endogenous H(+)-ATPase with wild-type and mutant forms of the Nicotiana plumbaginifolia H(+)-ATPase isoform PMA2, we provide physiological evidence for the importance of the phosphothreonine motif in 14-3-3 binding and, hence, in the activation of the H(+)-ATPase in vivo. Indeed, replacing Thr-948 in the plant H(+)-ATPase with alanine is lethal because this mutant fails to functionally replace the yeast H(+)-ATPase. Considering the importance of the motif QQXYpTV for 14-3-3 binding and yeast growth, this motif should be of vital importance for regulating H(+)-ATPase activity in the plant and thus for plant growth.

Halogenated environmental contaminants in perch (Perca fluviatilis) from Latvian coastal areas

The environmental contamination situation in coastal areas of the former Soviet Union has up to now been more or less unknown. This study on perch (Perca fluviatilis), collected at three locations along the coast of Latvia during 1994 and 1995, provides concentrations of several ubiquitous environmental contaminants (PCBs, HCB, HCHs, 4,4'-DDT, 4,4'-DDE, 4,4'-DDD, trans-Nonachlor, 2,2',4,4'-tetrabromodiphenyl ether). The concentrations of total PCB were similar at all study locations [0.7-1.4 ppm on a lipid weight (l.w.) basis], although a site close to the City of Riga indicated the presence of a local PCB contamination source. The contamination source was identified mainly by a higher relative content of lower chlorinated PCB congeners in the samples. Local pollution sources were also indicated for HCH and DDT. A large variation in the HCH isomer composition between 1994 and 1995 at one location demonstrates short half-lives of HCHs in the environment. The brominated flame retardant compound 2,2',4,4'-tetrabromdiphenyl ether was present in the range of 6.4-10 ng/g l.w. in the perch. The clean-up method applied in this study allowed for quantification of two semi-polar contaminants frequently overlooked in Baltic biota, namely Dieldrin and bis(4-chlorophenyl) sulfone (BCPS). Concentrations of BCPS were remarkably high, i.e. in the same magnitude as the most abundant PCB congeners. The results presented shows that the contamination of, e.g. PCB in an area of the former Soviet Union, the Gulf of Riga, is similar to that observed in other parts of the Baltic area.

Efficacy and safety of fixed-dose oral sildenafil in the treatment of erectile dysfunction of various etiologies

OBJECTIVES

To determine the efficacy and safety of fixed-dose oral sildenafil in patients with erectile dysfunction (ED) of various etiologies.

METHODS

In a 12-week, double-blind, randomized, placebo-controlled, fixed-dose study, 514 men (mean age 56 years) with ED were randomized to receive 25, 50, or 100 mg of sildenafil or placebo. The primary etiology of ED was determined to be organic in 32% of men, psychogenic in 25%, or mixed in 43%. Sildenafil or placebo was taken in the home setting approximately 1 hour before sexual activity, not more than once daily. Efficacy was determined by responses to question 3 (ability to achieve an erection) and question 4 (ability to maintain an erection) of the 15-item International Index of Erectile Function (IIEF). Other measures of efficacy included the five sexual function domains of the IIEF, a global efficacy question, event log data, and a partner questionnaire.

RESULTS

Sildenafil significantly increased patients' ability to achieve and maintain erections (P <0.0001), with efficacy increasing with increasing dose. Significant improvements were also observed in the IIEF domains for erectile function, orgasmic function, intercourse satisfaction, and overall sexual satisfaction (P <0.0001). The proportion of subjects who felt that treatment with sildenafil improved their erections was significantly greater (67% to 86%) than that with placebo treatment (24%, P <0.0001). The proportion of successful attempts at sexual intercourse also increased significantly with sildenafil treatment (P <0.001). Partner responses corroborated patient reports. Sildenafil was well tolerated at the three doses studied.

CONCLUSIONS

Oral sildenafil is an effective, well-tolerated treatment for ED of various etiologies.

Polychlorinated biphenyls and some pesticides in perch (Perca fluviatilis) from inland waters of Latvia

Polychlorinated biphenyls (PCBs), DDT-related substances, hexachlorocyclohexane (HCH) isomers and hexachlorobenzene (HCB) were analysed in perch (Perca fluviatilis) from Latvian lakes and rivers. DDE is present in the highest concentrations in all samples; 62-170 ng/g lipid weight in perch from rural areas and 460 ng/g in perch from the Riga area. Individual dominating PCB congeners were in the range 16-45 ng/g and 200-210 ng/g, respectively. The degree of contamination of rural areas in Latvia of these organohalogen substances is in the same range as in background areas in Sweden. Riga, the major urban area in Latvia, is shown to be more polluted with PCBs than other areas in Latvia.

Frequency and long term follow up of valvar insufficiency caused by retrograde aortic radiofrequency catheter ablation procedures

OBJECTIVE

To assess the frequency of valvar complications caused by left sided radiofrequency catheter ablation using the retrograde aortic technique.

METHODS

179 patients (118 male) with a mean (SD) age of 43 (17) years underwent 216 procedures at one centre. The target of the ablation was an accessory atrioventricular pathway in 144 patients, the atrioventricular junction in 29 patients, and a ventricular tachycardia in six patients. In 25 patients structural heart disease was identified before the procedure (ischaemic heart disease 10, cardiomyopathy nine, valvar three, other three). Echo/Doppler examinations were performed the day before the procedure and within 24 hours postablation; the investigations were all reviewed by the same investigator. Patients with identified valvar injury caused by the procedure were followed for 42 (7) months.

RESULTS

Valvar injury caused by the ablation procedure was identified in four young (age 30 (8) years), otherwise healthy patients with left lateral atrioventricular accessory pathways. Mild mitral insufficiency with a central regurgitation jet was detected in two patients and remained unchanged at follow up. Mild aortic insufficiency was detected in another two patients. In one of these the regurgitation jet was central and remained unchanged at follow up. In one patient the regurgitation jet was located between the non-coronary and left cusps in relation to a loosely attached structure. Both the structure and the valvar regurgitation disappeared during follow up. No clinical complications occurred in any of the patients during follow up.

CONCLUSION

In this study, the frequency of valvar complications after left sided radiofrequency catheter ablation using the retrograde aortic technique was 1.9%.