Awareness and knowledge of heterozygous familial hypercholesterolemia among Serbian pediatricians

OBJECTIVE

Published reports describing awareness and knowledge of familial hypercholesterolemia (FH) among pediatricians are few and differ considerably across countries. We aimed to assess awareness and knowledge of the FH among pediatricians in Serbia.

METHODS

A web-based cross-sectional study using a self-designed questionnaire was conducted during the annual congress of the Serbian Association of Preventive Pediatrics in 2020.

RESULTS

A total of 141 pediatricians completed the questionnaire (response rate 16.1%). Overall, 91% of participants have knowledge about genetic inheritance of FH, 84.3% were aware of long-term health risks of FH, 77% were familiar with normal cholesterol values in children and 71% knew the FH prevalence in the general population. On the other hand, only 36.8% declared that they were familiar with international guidelines for FH drug treatment and only 26.2% declared to have patients with FH.

CONCLUSION

There is a substantial lack of practical clinical knowledge among Serbian pediatricians on managing children with FH. In addition, an extremely low questionnaire response rate (16.1%) suggests that most pediatricians are not aware of the clinical importance of FH in childhood.

Localized surface plasmon resonance aptasensor for selective detection of SARS-CoV-2 S1 protein

In this work, we designed and developed a method to detect S1 spike protein of SARS-CoV-2. The portable Localized Surface Plasmon Resonance instrument equipped with a two-channel system was combined with the biotin-streptavidin platform on a nanogold surface to immobilize biotinylated aptamers. The proposed assay does not utilize antibodies or enzyme-based reagents, further simplifying the detection method. Using aptamer-protein bioaffinity interactions, the aptasensor selectively and specifically detected in real-time S1 spike protein, rather than S2 spike protein, RBD spike protein, or bovine serum albumin. The dynamic range and limit of detection of the aptasensor was determined to be 1 nM-100 nM and 0.26 nM, respectively. Notably, aptasensor detected preferentially S1 protein of SARS-CoV-2 compared to SARS-CoV and detected S1 protein with >95% recovery in artificial saliva, and serum albumin, excellent repeatability and shelf-life stability. The method may provide a low-cost, rapid, and real-time detection and monitoring of viruses in the general public.

Antiviral nanoparticles for sanitizing surfaces: A roadmap to self-sterilizing against COVID-19

Nanoparticles provide new opportunities in merging therapeutics and new materials, with current research efforts just beginning to scratch the surface of their diverse benefits and potential applications. One such application, the use of inorganic nanoparticles in antiseptic coatings to prevent pathogen transmission and infection, has seen promising developments. Notably, the high reactive surface area to volume ratio and unique chemical properties of metal-based nanoparticles enables their potent inactivation of viruses. Nanoparticles exert their virucidal action through mechanisms including inhibition of virus-cell receptor binding, reactive oxygen species oxidation and destructive displacement bonding with key viral structures. The prevention of viral outbreaks is one of the foremost challenges to medical science today, emphasizing the importance of research efforts to develop nanoparticles for preventative antiviral applications. In this review, the use of nanoparticles to inactivate other viruses, such as influenza, HIV-1, or norovirus, among others, will be discussed to extrapolate broad-spectrum antiviral mechanisms that could also inhibit SARS-CoV-2 pathogenesis. This review analyzes the published literature to highlight the current state of knowledge regarding the efficacy of metal-based nanoparticles and other antiviral materials for biomedical, sterile polymer, and surface coating applications.

Giant dermatofibrosarcoma protuberans vulvae: rare clinical presentation and literature review

Dermatofibrosarcoma protuberans (DFSP) is a rare, slow-growing fibro-cutaneous tumor of low to intermediate grade malignancy. It is characterized by local dermal and subcutaneous infiltration, but also with destructive infiltration of the surrounding tissues (muscle, fascia, and bone). The size of the tumor varies from small nodular to large neglected masses. Males and females are equally affected. The tumor is most often localized in the trunk and the proximal extremities. At a molecular level, more than 90% of all DFSP arise from the translocation of chromosomes 17 and 22. Clinically, it usually occurs in the form of flesh-colored or slightly yellow-brown skin tumor, irregular borders or multinodular appearance. The definitive diagnosis of DFSP is made by biopsy in combination with histological morphology and immunohistochemistry. The standard treatment for DFSP is surgical resection. Radiation treatment is an option for primary inoperable tumors and prior multiple recurrences. There is no consensus about chemotherapy regimens. Imatinib - a tyrosine kinase inhibitor - is approved in Europe for the treatment of inoperable primary tumors, locally inoperable recurrent disease, and metastatic DFSP. The recommended dose is 400-600 mg/daily. DFSP of the vulva is extremely rare, with less than 60 cases reported in the literature. Tumor behavior of DFSP of the vulva does not differ from other DFSP localizations. Spontaneous regressions are common while distant metastases are rare. Multidisciplinary approach requiring wide resection, margin assessment and reconstruction is the therapy of choice.

Heart rate recovery time in metabolically healthy and metabolically unhealthy obese children

BACKGROUND

Autonomic dysfunction is an emerging non-traditional cardiovascular risk factor that correlates with obesity, components of metabolic syndrome, as well as cardiorespiratory fitness. As a simple and validated index of autonomic balance, heart rate recovery (HRR) has been reported as a useful biomarker for predicting cardiovascular morbidity and mortality.

OBJECTIVES

The aim of this study was to compare HRR in metabolically healthy vs. metabolically unhealthy obese children.

METHODS

A total of 56 obese children of whom 31 had metabolic syndrome were examined. All the participants underwent the multistage submaximal cycle ergometer test and HRR was determined one minute after the test.

RESULTS

The HRR was significantly lower (18.9 ± 3.7) in a group of metabolically unhealthy obese children compared to metabolically healthy obese children (24 ± 4.1) p < 0.001. Logistic regression analysis showed that reduction in HRR was also influenced by higher BMI.

CONCLUSION

Our findings implicate the presence of the autonomic dysfunction as reflected by impaired heart rate recovery (HRR) in obese children with metabolic syndrome.

The Acceptance of Cosmetic Surgery Scale: Confirmatory Factor Analyses and Validation among Serbian Adults

We examined the validity of the Serbian version of the Acceptance of Cosmetic Surgery Scale (ACSS; Henderson-King and Henderson-King 2005). A total of 622 Serbian adults completed the ACSS, along with Serbian translations of measures for the discrepancy between actual body weight and ideal body weight, body appreciation, sociocultural attitudes toward appearance, and demographics. Confirmatory factor analyses were conducted to compare how different ACSS models fitted the collected data. A three-factor model provided the best fit to the data relative to two- and one-factor models. The three-factor model had good internal consistency, convergent and discriminant validity, and nomological validity. The ACSS seems to be a valid instrument for use in Serbian populations. Our study will contribute towards better understanding of the acceptance of cosmetic surgery from a cross-cultural perspective.

EFR3s are palmitoylated plasma membrane proteins that control responsiveness to G-protein-coupled receptors

The yeast Efr3p protein is a main regulator of the Stt4p phosphatidylinositol 4-kinase at contact sites between the endoplasmic reticulum and the plasma membrane. A mutation in its fly homologue Rbo, leads to diminished light responses in the eye attributed to progressively impaired PLC signaling. Here, we find that Efr3s plays a role in maintaining responsiveness to the type-I angiotensin II (AngII) receptors. siRNA-mediated depletion of EFR3A and EFR3B impaired the sustained phase of cytosolic Ca(2+) response to high concentration of AngII in HEK293 cells that express wild type but not truncated AGTR1 (AT1a receptor), missing the phosphorylation sites. Efr3 depletion had minimal effect on the recovery of plasma membrane phosphoinositides during stimulation, and AT1 receptors still underwent ligand-induced internalization. A higher level of basal receptor phosphorylation and a larger response was observed after stimulation. Moreover, Gq activation more rapidly desensitized after AngII stimulation in Efr3 downregulated cells. A similar but less pronounced effect of EFR3 depletion was observed on the desensitization of the cAMP response after stimulation with isoproterenol. These data suggest that mammalian Efr3s contribute to the control of the phosphorylation state and, hence, desensitization of AT1a receptors, and could affect responsiveness of G-protein-coupled receptors in higher eukaryotes.

The crystal structure of the phosphatidylinositol 4-kinase IIα

Phosphoinositides are a class of phospholipids generated by the action of phosphoinositide kinases with key regulatory functions in eukaryotic cells. Here, we present the atomic structure of phosphatidylinositol 4-kinase type IIα (PI4K IIα), in complex with ATP solved by X-ray crystallography at 2.8 Å resolution. The structure revealed a non-typical kinase fold that could be divided into N- and C-lobes with the ATP binding groove located in between. Surprisingly, a second ATP was found in a lateral hydrophobic pocket of the C-lobe. Molecular simulations and mutagenesis analysis revealed the membrane binding mode and the putative function of the hydrophobic pocket. Taken together, our results suggest a mechanism of PI4K IIα recruitment, regulation, and function at the membrane.

Recruitment of arfaptins to the trans-Golgi network by PI(4)P and their involvement in cargo export

The BAR (Bin/Amphiphysin/Rvs) domain proteins arfaptin1 and arfaptin2 are localized to the trans-Golgi network (TGN) and, by virtue of their ability to sense and/or generate membrane curvature, could play an important role in the biogenesis of transport carriers. We report that arfaptins contain an amphipathic helix (AH) preceding the BAR domain, which is essential for their binding to phosphatidylinositol 4-phosphate (PI(4)P)-containing liposomes and the TGN of mammalian cells. The binding of arfaptin1, but not arfaptin2, to PI(4)P is regulated by protein kinase D (PKD) mediated phosphorylation at Ser100 within the AH. We also found that only arfaptin1 is required for the PKD-dependent trafficking of chromogranin A by the regulated secretory pathway. Altogether, these findings reveal the importance of PI(4)P and PKD in the recruitment of arfaptins at the TGN and their requirement in the events leading to the biogenesis of secretory storage granules.

E-cadherin expression in acquired cholesteatoma

OBJECTIVES

The epithelial cell adhesion molecule E-cadherin is important for maintenance normal tissue architecture and for cell-cell communication and immune cell migration. E-cadherin is also present in cholesteatomas. This study determined E-cadherin expression in acquired cholesteatomas and analyzed its expression according to cholesteatoma clinical and histological characteristics.

METHODS

We investigated E-cadherin expression in 30 samples from operated patients with acquired middle ear cholesteatomas that were classified according to their clinical and histological characteristics. E-cadherin expression in cholesteatoma was determined immunohistochemically. A semi quantitative method was used to determine the index of expression of E-cadherin and t-tests, Mann-Whitney U tests and Spearman correlation analysis were used for statistical analysis.

RESULTS

We found significant expression of E-cadherin on CD1, CD3 total, CD4 (p < 0.05), high expression of E-cadherin on CD8 total and CD19/CD38 lymphocytes (p < 0.01) and very high expression of E-cadherin on mast cells and antigen-presenting cells, including Langerhans cells (p < 0.005). We graduated results as no statistically significant (p>0.05), statistically significant (0.05 > p > 0.01), highly statistically significant (0.01 > p > 0.005) and very highly statistically significant (p < 0.005).

CONCLUSION

E-cadherin expression was the same in the cholesteatoma matrix in all samples. There were no differences in expression according to the clinical and histological characteristics of the cholesteatomas.

βIII spectrin regulates the structural integrity and the secretory protein transport of the Golgi complex

A spectrin-based cytoskeleton is associated with endomembranes, including the Golgi complex and cytoplasmic vesicles, but its role remains poorly understood. Using new generated antibodies to specific peptide sequences of the human βIII spectrin, we here show its distribution in the Golgi complex, where it is enriched in the trans-Golgi and trans-Golgi network. The use of a drug-inducible enzymatic assay that depletes the Golgi-associated pool of PI4P as well as the expression of PH domains of Golgi proteins that specifically recognize this phosphoinositide both displaced βIII spectrin from the Golgi. However, the interference with actin dynamics using actin toxins did not affect the localization of βIII spectrin to Golgi membranes. Depletion of βIII spectrin using siRNA technology and the microinjection of anti-βIII spectrin antibodies into the cytoplasm lead to the fragmentation of the Golgi. At ultrastructural level, Golgi fragments showed swollen distal Golgi cisternae and vesicular structures. Using a variety of protein transport assays, we show that the endoplasmic reticulum-to-Golgi and post-Golgi protein transports were impaired in βIII spectrin-depleted cells. However, the internalization of the Shiga toxin subunit B to the endoplasmic reticulum was unaffected. We state that βIII spectrin constitutes a major skeletal component of distal Golgi compartments, where it is necessary to maintain its structural integrity and secretory activity, and unlike actin, PI4P appears to be highly relevant for the association of βIII spectrin the Golgi complex.

A model for the role of EHD1-containing membrane tubules in endocytic recycling

The C-terminal Eps15 homology domain-containing protein, EHD1, is an important regulator of receptor recycling back to the plasma membrane. In addition to its vesicular localization, EHD1 also localizes to a unique array of tubular membrane structures that emanate from the endocytic recycling compartment. While these structures have been described over seven years ago, addressing their lipid composition and physiological function has been challenging. Moreover, it was not known whether EHD1 itself induces tubule formation, or whether it localizes to pre-existing tubular membrane structures. We have demonstrated that in vivo, EHD1 localizes to pre-existing tubular membranes that contain both phosphatidylinositol-4-phosphate and phosphatidylinositol-(4,5)-bisphosphate. Moreover, we have determined that 'non-tubular' EHD1 mutants with a single residue substitution do not efficiently facilitate receptor recycling. Our data suggest that EHD1-associated tubules are required for efficient recycling and we propose models that describe the potential mechanisms by which EHD1 functions.

Mechanism for the selective interaction of C-terminal Eps15 homology domain proteins with specific Asn-Pro-Phe-containing partners

Epidermal growth factor receptor tyrosine kinase substrate 15 (Eps15) homology (EH)-domain proteins can be divided into two classes: those with an N-terminal EH-domain(s), and the C-terminal Eps15 homology domain-containing proteins (EHDs). Whereas many N-terminal EH-domain proteins regulate internalization events, the best characterized C-terminal EHD, EHD1, regulates endocytic recycling. Because EH-domains interact with the tripeptide Asn-Pro-Phe (NPF), it is of critical importance to elucidate the molecular mechanisms that allow EHD1 and its paralogs to interact selectively with a subset of the hundreds of NPF-containing proteins expressed in mammalian cells. Here, we capitalize on our findings that C-terminal EH-domains possess highly positively charged interaction surfaces and that many NPF-containing proteins that interact with C-terminal (but not N-terminal) EH-domains are followed by acidic residues. Using the recently identified EHD1 interaction partner molecule interacting with CasL (MICAL)-Like 1 (MICAL-L1) as a model, we have demonstrated that only the first of its two NPF motifs is required for EHD1 binding. Because only this first NPF is followed by acidic residues, we have utilized glutathione S-transferase pulldowns, two-hybrid analysis, and NMR to demonstrate that the flanking acidic residues "fine tune" the binding affinity to EHD1. Indeed, our NMR solution structure of the EHD1 EH-domain in complex with the MICAL-L1 NPFEEEEED peptide indicates that the first two flanking Glu residues lie in a position favorable to form salt bridges with Lys residues within the EH-domain. Our data provide a novel explanation for the selective interaction of C-terminal EH-domains with specific NPF-containing proteins and allow for the prediction of new interaction partners with C-terminal EHDs.

The early endosome: a busy sorting station for proteins at the crossroads

Endocytosis marks the entry of internalized receptors into the complex network of endocytic trafficking pathways. Endocytic vesicles are rapidly targeted to a distinct membrane-bound endocytic organelle referred to as the early endosome. Despite the existence of numerous internalization routes, early endosomes (EE) serve as a focal point of the endocytic pathway. Sorting events initiated at this compartment determine the subsequent fate of internalized proteins and lipids, destining them either for recycling to the plasma membrane, degradation in lysosomes or delivery to the trans-Golgi network. Sorting of endocytic cargo to the latter compartments is accomplished through the formation of distinct microdomains within early endosomes, through the coordinate recruitment and assembly of the sorting machinery. An elaborate network of interactions between endocytic regulatory proteins ensures synchronized sorting of cargo to microdomains followed by morphological changes at the early endosomal membranes. Consequently, the cargo targeted either for recycling back to the plasma membrane, or for retrograde transport to the trans-Golgi network, localizes to newly-formed tubular membranes. With a high ratio of membrane surface to lumenal volume, these tubules effectively concentrate the recycling cargo, ensuring efficient transport out of the EE. Conversely, receptors sorted for degradation cluster at the flat clathrin lattices involved in invaginations of the limiting membrane, associating with newly formed intralumenal vesicles. In this review we will discuss the characteristics of early endosomes, their role in the regulation of endocytic transport, and their aberrant function in a variety of diseases.

Perfect angiographic patency of the arterial coronary-coronary conduit five years following surgery

Five years ago, the left internal thoracic artery free segment was used as a coronary-coronary bypass over a single, distal lesion of the large left anterior descending coronary artery in a patient with triple vessel disease. The patient has recently been readmitted, complaining of chest discomfort. Although he was scheduled for percutaneous coronary intervention due to disease progression on the circumflex coronary artery, the perfect angiographic patency of the arterial coronary-coronary conduit has been confirmed.

"Mini-array" transcriptional analysis of the Listeria monocytogenes lecithinase operon as a class project: A student investigative molecular biology laboratory experience*

This report describes a molecular biotechnology-based laboratory curriculum developed to accompany an undergraduate genetics course. During the course of a semester, students researched the pathogen, developed a research question, designed experiments, and performed transcriptional analysis of a set of genes that confer virulence to the food-borne pathogen, Listeria monocytogenes. Gene fragments were amplified via PCR and utilized in "mini-arrays," a dot-blot-based format suitable for the simultaneous transcriptional analysis of multiple genes. The project provides exposure to a wide range of molecular techniques and can be easily modified for variations in class size. Data are generated at various steps of the process, allowing for student interpretation, troubleshooting, and assessment opportunities.

Interactions between EHD proteins and Rab11-FIP2: a role for EHD3 in early endosomal transport

Eps15 homology domain (EHD) 1 enables membrane recycling by controlling the exit of internalized molecules from the endocytic recycling compartment (ERC) en route to the plasma membrane, similar to the role described for Rab11. However, no physical or functional connection between Rab11 and EHD-family proteins has been demonstrated yet, and the mode by which they coordinate their regulatory activity remains unknown. Here, we demonstrate that EHD1 and EHD3 (the closest EHD1 paralog), bind to the Rab11-effector Rab11-FIP2 via EH-NPF interactions. The EHD/Rab11-FIP2 associations are affected by the ability of the EHD proteins to bind nucleotides, and Rab11-FIP2 is recruited to EHD-containing membranes. These results are consistent with a coordinated role for EHD1 and Rab11-FIP2 in regulating exit from the ERC. However, because no function has been attributed to EHD3, the significance of its interaction with Rab11-FIP2 remained unclear. Surprisingly, loss of EHD3 expression prevented the delivery of internalized transferrin and early endosomal proteins to the ERC, an effect differing from that described upon EHD1 knockdown. Moreover, the subcellular localization of Rab11-FIP2 and endogenous Rab11 were altered upon EHD3 knockdown, with both proteins absent from the ERC and retained in the cell periphery. The results presented herein promote a coordinated role for EHD proteins and Rab11-FIP2 in mediating endocytic recycling and provide evidence for the function of EHD3 in early endosome to ERC transport.

The radial artery for coronary artery bypass grafting

Coronary artery bypass grafting (CABG) is the standard surgical procedure for the treatment of advanced coronary artery disease. CABG surgery has been demonstrated to improve symptoms and, in specific subgroups of patients, to prolong life. Despite its success, the long-term outcome of coronary bypass surgery is strongly influenced by the fate of the vascular conduits used. Previous long-term studies have shown unsatisfactory patency of saphenous vein grafts used for myocardial revascularisation, compared with internal mammary artery grafts. Recently, the use of radial artery for CABG has enjoyed a revival, on the basis of the belief that it will help improving long-term results of coronary operations. The recent reports of encouraging mid-term and long-term patency rates of the radial artery, supports its continued use as a bypass conduit. In this paper, we review the current knowledge about the radial artery as a bypass graft, with special emphasis on the clinical results.

Molecular typing of the Legionella pneumophila population isolated from several locations in a contaminated water network

The RAPD (random amplified polymorphic DNA) technique has been developed for the molecular typing of Legionella in order to characterise the populations of hot water systems. During this study, 22 primers were tested and the four most informative ones were selected. The optimisation of the PCR conditions allowed the setting up of a powerful discriminative genotyping method. Moreover, the definition of a quality management method allowed definition of the key steps and the number of replicates to ensure reproducibility of the RAPD pattern. The RAPD was used to study the hot water network of a building. Legionella colonies (91) were isolated from seven locations and genotyped. The diversity of the population in one sample could vary from one to seven different strains. The study of the traceability showed that, in most of the cases, different populations could be present at different locations of the same network.

[Diffuse and binodular goiter in a patient with tuberous sclerosis]

Tuberous sclerosis complex is hereditary multisystemic, neurocutaneous disorder characterized by hamartomatous lesions mainly involving the brain, skin and viscera. Thyroid gland is rarely affected in these patients. Case history of a patient with tuberous sclerosis complex and diffuse and binodular goiter was presented. No epileptic seizures occurred despite multiple intracranial calcifications, cortical and subependimal tubers, revealed by neuroimaging. Borderline intellectual functioning was determined. Ultrasonographic findings of the heart, abdomen and pelvis were normal. Bone radiographs revealed multiple cystic lesions of the metacarpal, metatarsal and terminal phalanges. Clinical, endocrine and metabolic evaluations were performed because of anxiety, mild weight loss, transient problems of swallowing and breathing complaints, developing when she was 39 years old. Palpable diffuse and asymmetric thyroid enlargement was found. Laboratory tests of thyroid function, ultrasonographic examination and scintiscanning of the thyroid gland and patohistological analysis of fine-needle aspiration biopsy revealed the euthyroid, inactive, diffuse and binodular goiter. Unusual association of goiter and tuberous sclerosis was discussed.

[Detection of B-lymphocyte clonality in samples of salivary gland tissue in patients with primary Sjogren syndrome]

Intensive lymphoplasmocytic infiltration with atrophy of glandular tissue structures is the dominant patohistological feature found in exocrine glands of patients with Sjögren syndrome (SS). The infiltrates consist of T and B lymphocyte clusters that make the structures resembling germinal centers, and numerous plasmocytes that are secreting imunoglobulines locally, including autoantibodies. By applying the polymerase chain reaction (PCR) in our study we have shown the existence of dominant B cell clone in salivary glands samples of 4 out of 6 patients with SS, in the absence of clinical, routine laboratory, and patohistological signs of the lymphoma. B lymphocyte clones were detected upon the amplification of gene segment that encoded variable heavy chain immunoglobulin CDR3 region. Finding of single, dominant B lymphocyte clone could be of predictive significance, because these patients are predisposed to non-Hodgkin lymphoma (NHL) for which there is an assumption that it originates out of salivary glands from one of the clusters of proliferating B lymphocytes.

Tension-free left ITA graft -- the pericardial strip technique

Emphysematous lung occupying the whole dome of the left pleural cavity and expanding well over the midline may occasionally present a significant problem for positioning of the left internal thoracic artery, although the graft has been mobilized up to its origin. To avoid an undue tension on it, we combined a well known technique of the pericardial incision with the pericardial strip technique, enabling the lung to expand freely.

Ventricular performance following valve replacement for chronic mitral regurgitation: importance of chordal preservation

OBJECTIVE

To assess immediate and late changes in left ventricular performance after mitral valve replacement (MVR) for mitral regurgitation with or without preservation of chordae tendineae.

EXPERIMENTAL DESIGN

a prospective, one year follow-up, study.

SETTING

university cardiosurgical hospital.

PATIENTS

Fourteen patients with symptomatic chronic mitral regurgitation were divided into Group A (n = 7), which underwent MVR with chordal preservation, and Group B (n = 7) which underwent MVR with chordal transection.

METHODS

Transesophageal echocardiography, obtained simultaneously with radial artery and pulmonary capillary wedge pressures over a range of loading conditions, was used to estimate left ventricular elastance (Eps), calculated as the slope of peak systolic pressure/end-systolic volume relation, and preload recruitable stroke work (PRSW). Measurements were taken intraoperatively before and after cardiopulmonary bypass, 6 hours later and 10 days later. Transthoracic echocardiography follow-up data were obtained after 3 months and one year.

RESULTS

Eps significantly decreased immediately after MVR (p = 0.018), with no difference among 2 groups. Eps gradually increased to preoperative levels 10 days after surgery. PRSW also significantly decreased after MVR (p = 0.01). The decrease was significantly larger in Group B (p = 0.038). During follow-up, Group A showed a significantly better ejection fraction (p = 0.008), and a smaller end-systolic volume index (p = 0.01) and left ventricular mass index (p = 0.04), than Group B.

CONCLUSIONS

These data support the hypothesis that chordal preservation during MVR has beneficial effects on left ventricular performance.

Chordal preservation improves postoperative ventricular performance following valve replacement for chronic mitral regurgitation

Worsening of left ventricular performance had been recognized after mitral valve replacement for mitral regurgitation. The effects of chordal preservation on ventricular performance after mitral valve replacement have been assessed. Twelve patients with mitral regurgitation were allocated to group A (undergoing mitral valve replacement with chordal preservation), or to group B (undergoing mitral valve replacement with chordal excision). Transoesophageal echocardiography was recorded simultaneously with radial artery and pulmonary capillary wedge pressures. Load was varied by withdrawal of blood from a venous line of cardiopulmonary bypass and/or nitroglycerine bolus. Ventricular performance was assessed by the slope of peak systolic pressure-end-systolic volume relation (Eps), and by the slope of the left ventricular stroke work-end-diastolic volume relationship. Eps significantly decreased immediately after mitral valve replacement (P < 0.02), with no difference among two groups. Eps gradually increased to preoperative levels 10 days after surgery. Pre-load recruitable stroke work also significantly decreased after mitral valve replacement (P = 0.01). The decrease was significantly larger in group B (P < 0.04). These data support the hypothesis that chordal preservation during mitral valve replacement has beneficial effects on left ventricular performance.