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Dadon Z, Rav Acha M, Orlev A, Carasso S, Glikson M, Gottlieb S, Alpert EA. Artificial Intelligence-Based Left Ventricular Ejection Fraction by Medical Students for Mortality and Readmission Prediction. Diagnostics (Basel) 2024; 14:767. [PMID: 38611680 PMCID: PMC11011323 DOI: 10.3390/diagnostics14070767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 03/28/2024] [Accepted: 03/31/2024] [Indexed: 04/14/2024] Open
Abstract
INTRODUCTION Point-of-care ultrasound has become a universal practice, employed by physicians across various disciplines, contributing to diagnostic processes and decision-making. AIM To assess the association of reduced (<50%) left-ventricular ejection fraction (LVEF) based on prospective point-of-care ultrasound operated by medical students using an artificial intelligence (AI) tool and 1-year primary composite outcome, including mortality and readmission for cardiovascular-related causes. METHODS Eight trained medical students used a hand-held ultrasound device (HUD) equipped with an AI-based tool for automatic evaluation of the LVEF of non-selected patients hospitalized in a cardiology department from March 2019 through March 2020. RESULTS The study included 82 patients (72 males aged 58.5 ± 16.8 years), of whom 34 (41.5%) were diagnosed with AI-based reduced LVEF. The rates of the composite outcome were higher among patients with reduced systolic function compared to those with preserved LVEF (41.2% vs. 16.7%, p = 0.014). Adjusting for pertinent variables, reduced LVEF independently predicted the composite outcome (HR 2.717, 95% CI 1.083-6.817, p = 0.033). As compared to those with LVEF ≥ 50%, patients with reduced LVEF had a longer length of stay and higher rates of the secondary composite outcome, including in-hospital death, advanced ventilatory support, shock, and acute decompensated heart failure. CONCLUSION AI-based assessment of reduced systolic function in the hands of medical students, independently predicted 1-year mortality and cardiovascular-related readmission and was associated with unfavorable in-hospital outcomes. AI utilization by novice users may be an important tool for risk stratification for hospitalized patients.
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Affiliation(s)
- Ziv Dadon
- Jesselson Integrated Heart Center, Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Moshe Rav Acha
- Jesselson Integrated Heart Center, Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Amir Orlev
- Jesselson Integrated Heart Center, Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Shemy Carasso
- Jesselson Integrated Heart Center, Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Michael Glikson
- Jesselson Integrated Heart Center, Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Shmuel Gottlieb
- Jesselson Integrated Heart Center, Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Evan Avraham Alpert
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
- Department of Emergency Medicine, Hadassah Medical Center—Ein Kerem, Jerusalem 9112001, Israel
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Coelho P, Duarte H, Alcafache C, Rodrigues F. The Influence of Pericardial Fat on Left Ventricular Diastolic Function. Diagnostics (Basel) 2024; 14:702. [PMID: 38611615 PMCID: PMC11012189 DOI: 10.3390/diagnostics14070702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/11/2024] [Accepted: 03/15/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Heart failure is a major cause of morbidity and mortality worldwide; left ventricular diastolic dysfunction plays a leading role in this clinical context. Diastolic dysfunction may be predisposed by increased abdominal fat and, consequently, increased pericardial and epicardial adiposity. This study aimed to determine whether pericardial fat (PF) and epicardial fat (EF) are associated with left ventricular diastolic function. METHODS A total of 82 patients had their abdominal circumference measured and underwent transthoracic echocardiography to measure the thickness of PF and EF and assess the left ventricular diastolic function. Two groups were created based on mean pericardial fat (PF) thickness (4.644 mm) and were related to abdominal circumference and echocardiographic parameters. RESULTS Subjects in the PF High group showed a significant decrease in septal e' (p < 0.0001), lateral e' (p < 0.0001), and E/A ratio (p = 0.003), as well as a significant increase in E/e' ratio (p < 0.0001), E wave deceleration time (p = 0.013), left atrial volume (p < 0.0001), the left ventricle mass (p = 0.003), tricuspid regurgitant jet velocity (p < 0.0001), and the left ventricle diameter (p = 0.014) compared to the PF Low group. Correlations were found between pericardial fat and nine echocardiographic parameters in the study, while epicardial fat (EP) only correlated with eight. CONCLUSIONS Measurement of abdominal circumference, PF, and EF is an early indicator of diastolic changes with transthoracic echocardiography being the gold standard exam.
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Affiliation(s)
- Patrícia Coelho
- Higher School of Health Dr Lopes Dias-Polytechnic Institute of Castelo Branco/Escola Superior de Saúde Dr. Lopes Dias, Instituto Politécnico de Castelo Branco, 6001-909 Castelo Branco, Portugal;
- SPRINT-Sport Physical Activity and Health Research & Innovation Center/Centro de Investigação e Inovação em Desporto Atividade Física e Saúde, 6001-909 Castelo Branco, Portugal
| | - Hugo Duarte
- Polytechnic Institute of Castelo Branco, 6001-909 Castelo Branco, Portugal; (H.D.); (C.A.)
| | - Carlos Alcafache
- Polytechnic Institute of Castelo Branco, 6001-909 Castelo Branco, Portugal; (H.D.); (C.A.)
- Guarda Local Health Unit, 6270-498 Seia, Portugal
| | - Francisco Rodrigues
- Higher School of Health Dr Lopes Dias-Polytechnic Institute of Castelo Branco/Escola Superior de Saúde Dr. Lopes Dias, Instituto Politécnico de Castelo Branco, 6001-909 Castelo Branco, Portugal;
- SPRINT-Sport Physical Activity and Health Research & Innovation Center/Centro de Investigação e Inovação em Desporto Atividade Física e Saúde, 6001-909 Castelo Branco, Portugal
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Dadon Z, Steinmetz Y, Levi N, Orlev A, Belman D, Butnaru A, Carasso S, Glikson M, Alpert EA, Gottlieb S. Artificial Intelligence-Powered Left Ventricular Ejection Fraction Analysis Using the LVivoEF Tool for COVID-19 Patients. J Clin Med 2023; 12:7571. [PMID: 38137638 PMCID: PMC10743829 DOI: 10.3390/jcm12247571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
We sought to prospectively investigate the accuracy of an artificial intelligence (AI)-based tool for left ventricular ejection fraction (LVEF) assessment using a hand-held ultrasound device (HUD) in COVID-19 patients and to examine whether reduced LVEF predicts the composite endpoint of in-hospital death, advanced ventilatory support, shock, myocardial injury, and acute decompensated heart failure. COVID-19 patients were evaluated with a real-time LVEF assessment using an HUD equipped with an AI-based tool vs. assessment by a blinded fellowship-trained echocardiographer. Among 42 patients, those with LVEF < 50% were older with more comorbidities and unfavorable exam characteristics. An excellent correlation was demonstrated between the AI and the echocardiographer LVEF assessment (0.774, p < 0.001). Substantial agreement was demonstrated between the two assessments (kappa = 0.797, p < 0.001). The sensitivity, specificity, PPV, and NPV of the HUD for this threshold were 72.7% 100%, 100%, and 91.2%, respectively. AI-based LVEF < 50% was associated with worse composite endpoints; unadjusted OR = 11.11 (95% CI 2.25-54.94), p = 0.003; adjusted OR = 6.40 (95% CI 1.07-38.09, p = 0.041). An AI-based algorithm incorporated into an HUD can be utilized reliably as a decision support tool for automatic real-time LVEF assessment among COVID-19 patients and may identify patients at risk for unfavorable outcomes. Future larger cohorts should verify the association with outcomes.
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Affiliation(s)
- Ziv Dadon
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Yoed Steinmetz
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Nir Levi
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Amir Orlev
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Daniel Belman
- Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | - Adi Butnaru
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | - Shemy Carasso
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- The Azrieli Faculty of Medicine, Bar-Ilan University, Zefat 1311502, Israel
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Evan Avraham Alpert
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
- Department of Emergency Medicine, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | - Shmuel Gottlieb
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Nemes A, Kormányos Á, Ambrus N, Lengyel C. Similarities and Differences between Three-Dimensional Speckle-Tracking Echocardiography-Derived Left and Right Atrial Volumes and Volume-Based Functional Properties in the Same Healthy Adults-A Detailed Analysis from the MAGYAR-Healthy Study. Medicina (Kaunas) 2023; 59:2051. [PMID: 38138154 PMCID: PMC10744728 DOI: 10.3390/medicina59122051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/23/2023] [Accepted: 11/09/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: It would be important to know what happens to the volume and volume-based functional properties of one atrium if the size of the other atrium is larger or smaller than the average. Therefore, the present study aimed to perform three-dimensional speckle-tracking echocardiography (3DSTE)-derived quantification of left atrial (LA) and right atrial (RA) volumes and volume-based functional properties to examine these associations in healthy adults with mean and lower or higher than mean atrial volumes. Materials and Methods: The present study consisted of 179 healthy volunteers with a mean age of 32.3 ± 12.3 years (92 males). Three-dimensional speckle-tracking echocardiography-derived LA and RA volumes and volume-based functional properties were determined in all cases. Results: When different LA or RA volume groups were evaluated, both LA and RA showed the same pattern of volume changes in all phases of atrial function with higher LA or RA volumes. In case of low and mean LA volumes, RA volumes were higher compared to their LA counterpart. In case of mean and high RA volumes, RA volumes proved to be higher as well. In case of mean LA or RA volumes, differences between LA and RA stroke volumes (SVs) could not be detected, but all atrial emptying fractions (EFs) were lower for RA than for LA. Some differences were detected in counterpart LA/RA total, passive, and active atrial SVs and EFs values in the presence of lower/higher than mean LA/RA volume. Conclusions: In case of mean LA or RA volumes, RA volumes are higher compared to their LA counterpart, LA-SVs and RA-SVs are similar, but atrial EFs are lower for RA than for LA. If lower/higher than mean LA or RA volumes are present, some differences in patterns of changes in counterpart atrial volumes-SVs and EFs-could be detected.
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Affiliation(s)
- Attila Nemes
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, 6725 Szeged, Hungary; (Á.K.); (N.A.); (C.L.)
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Bonaca MP, Moslehi JJ, Ledermann JA, Michelon E, Wei C, Moran M, Monk BJ, Pujade-Lauraine E. Left Ventricular Ejection Fraction in Patients With Ovarian Cancer Treated With Avelumab, Pegylated Liposomal Doxorubicin, or Both. Oncologist 2023; 28:e977-e980. [PMID: 37665777 PMCID: PMC10546816 DOI: 10.1093/oncolo/oyad213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/22/2023] [Indexed: 09/06/2023] Open
Abstract
In the phase III JAVELIN Ovarian 200 trial, 566 patients with platinum-resistant/refractory ovarian cancer were randomized 1:1:1 to receive avelumab alone, avelumab plus pegylated liposomal doxorubicin (PLD), or PLD alone. Cardiac monitoring was included for all patients. We report left ventricular ejection fraction (LVEF) data from the trial. Grade ≥3 cardiac adverse events (AEs) occurred in 4 (2.1%), 1 (0.5%), and 0 patients in the avelumab, combination, and PLD arms, respectively. LVEF decreases of ≥10% to below institutional lower limit of normal at any time during treatment were observed in 1 (0.8%), 3 (1.9%), and 2 (1.5%) patients, respectively; 4 had subsequent assessments, and these showed transient decreases. No patient had a cardiovascular AE related to LVEF decrease. This analysis is, to our knowledge, the first analysis of LVEF in patients receiving immune checkpoint inhibitors. CLINICALTRIALS.GOV IDENTIFIER NCT02580058.
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Affiliation(s)
- Marc P Bonaca
- Colorado Prevention Center Clinical Research, Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Javid J Moslehi
- Section of Cardio-Oncology and Immunology, Division of Cardiology and the Cardiovascular Research Institute, UCSF School of Medicine, Cardiovascular Research Institute (CVRI), San Francisco, CA, USA
| | | | | | | | - Michael Moran
- Pfizer Pharma GmbH, Berlin, Germany (Affiliation at the time the research was conducted)
| | - Bradley J Monk
- Arizona Oncology (US Oncology Network), University of Arizona and Creighton University, Phoenix, AZ, USA
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Khush KK, Malinoski D, Luikart H, Wayda B, Groat T, Nguyen J, Belcher J, Nieto J, Neidlinger N, Salehi A, Geraghty PJ, Nicely B, Jendrisak M, Pearson T, Wood RP, Zhang S, Weng Y, Zaroff J. Left Ventricular Dysfunction Associated With Brain Death: Results From the Donor Heart Study. Circulation 2023; 148:822-833. [PMID: 37465972 PMCID: PMC10529108 DOI: 10.1161/circulationaha.122.063400] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 06/26/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Left ventricular dysfunction in potential donors meeting brain death criteria often results in nonuse of donor hearts for transplantation, yet little is known about its incidence or pathophysiology. Resolving these unknowns was a primary aim of the DHS (Donor Heart Study), a multisite prospective cohort study. METHODS The DHS enrolled potential donors by neurologic determination of death (n=4333) at 8 organ procurement organizations across the United States between February 2015 and May 2020. Data included medications administered, serial diagnostic tests, and transthoracic echocardiograms (TTEs) performed: (1) within 48 hours after brain death was formally diagnosed; and (2) 24±6 hours later if left ventricular (LV) dysfunction was initially present. LV dysfunction was defined as an LV ejection fraction <50% and was considered reversible if LV ejection fraction was >50% on the second TTE. TTEs were also examined for presence of LV regional wall motion abnormalities and their reversibility. We assessed associations between LV dysfunction, donor heart acceptance for transplantation, and recipient 1-year survival. RESULTS An initial TTE was interpreted for 3794 of the 4333 potential donors by neurologic determination of death. A total of 493 (13%) of these TTEs showed LV dysfunction. Among those donors with an initial TTE, LV dysfunction was associated with younger age, underweight, and higher NT-proBNP (N-terminal pro-B-type natriuretic peptide) and troponin levels. A second TTE was performed within 24±6 hours for a subset of donors (n=224) with initial LV dysfunction; within this subset, 130 (58%) demonstrated reversibility. Sixty percent of donor hearts with normal LV function were accepted for transplant compared with 56% of hearts with reversible LV dysfunction and 24% of hearts with nonreversible LV dysfunction. Donor LV dysfunction, whether reversible or not, was not associated with recipient 1-year survival. CONCLUSIONS LV dysfunction associated with brain death occurs in many potential heart donors and is sometimes reversible. These findings can inform decisions made during donor evaluation and help guide donor heart acceptance for transplantation.
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Affiliation(s)
- Kiran K. Khush
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Darren Malinoski
- Department of Surgery, Division of Trauma, Critical Care, and Acute Care Surgery, Oregon Health and Science University, Portland, OR
| | - Helen Luikart
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Brian Wayda
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Tahnee Groat
- Department of Surgery, Division of Trauma, Critical Care, and Acute Care Surgery, Oregon Health and Science University, Portland, OR
| | - John Nguyen
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA
| | | | - Javier Nieto
- LifeGift Organ Procurement Organization, Houston, TX
| | - Nikole Neidlinger
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | | | | | | | | | | | - Shiqi Zhang
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Yingjie Weng
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Jonathan Zaroff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
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7
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Hitsumoto T, Tsukamoto O, Matsuoka K, Li J, Liu L, Kuramoto Y, Higo S, Ogawa S, Fujino N, Yoshida S, Kioka H, Kato H, Hakui H, Saito Y, Okamoto C, Inoue H, Hyejin J, Ueda K, Segawa T, Nishimura S, Asano Y, Asanuma H, Tani A, Imamura R, Komagawa S, Kanai T, Takamura M, Sakata Y, Kitakaze M, Haruta JI, Takashima S. Restoration of Cardiac Myosin Light Chain Kinase Ameliorates Systolic Dysfunction by Reducing Superrelaxed Myosin. Circulation 2023; 147:1902-1918. [PMID: 37128901 PMCID: PMC10270284 DOI: 10.1161/circulationaha.122.062885] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 04/05/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Cardiac-specific myosin light chain kinase (cMLCK), encoded by MYLK3, regulates cardiac contractility through phosphorylation of ventricular myosin regulatory light chain. However, the pathophysiological and therapeutic implications of cMLCK in human heart failure remain unclear. We aimed to investigate whether cMLCK dysregulation causes cardiac dysfunction and whether the restoration of cMLCK could be a novel myotropic therapy for systolic heart failure. METHODS We generated the knock-in mice (Mylk3+/fs and Mylk3fs/fs) with a familial dilated cardiomyopathy-associated MYLK3 frameshift mutation (MYLK3+/fs) that had been identified previously by us (c.1951-1G>T; p.P639Vfs*15) and the human induced pluripotent stem cell-derived cardiomyocytes from the carrier of the mutation. We also developed a new small-molecule activator of cMLCK (LEUO-1154). RESULTS Both mice (Mylk3+/fs and Mylk3fs/fs) showed reduced cMLCK expression due to nonsense-mediated messenger RNA decay, reduced MLC2v (ventricular myosin regulatory light chain) phosphorylation in the myocardium, and systolic dysfunction in a cMLCK dose-dependent manner. Consistent with this result, myocardium from the mutant mice showed an increased ratio of cardiac superrelaxation/disordered relaxation states that may contribute to impaired cardiac contractility. The phenotypes observed in the knock-in mice were rescued by cMLCK replenishment through the AAV9_MYLK3 vector. Human induced pluripotent stem cell-derived cardiomyocytes with MYLK3+/fs mutation reduced cMLCK expression by 50% and contractile dysfunction, accompanied by an increased superrelaxation/disordered relaxation ratio. CRISPR-mediated gene correction, or cMLCK replenishment by AAV9_MYLK3 vector, successfully recovered cMLCK expression, the superrelaxation/disordered relaxation ratio, and contractile dysfunction. LEUO-1154 increased human cMLCK activity ≈2-fold in the Vmax for ventricular myosin regulatory light chain phosphorylation without affecting the Km. LEUO-1154 treatment of human induced pluripotent stem cell-derived cardiomyocytes with MYLK3+/fs mutation restored the ventricular myosin regulatory light chain phosphorylation level and superrelaxation/disordered relaxation ratio and improved cardiac contractility without affecting calcium transients, indicating that the cMLCK activator acts as a myotrope. Finally, human myocardium from advanced heart failure with a wide variety of causes had a significantly lower MYLK3/PPP1R12B messenger RNA expression ratio than control hearts, suggesting an altered balance between myosin regulatory light chain kinase and phosphatase in the failing myocardium, irrespective of the causes. CONCLUSIONS cMLCK dysregulation contributes to the development of cardiac systolic dysfunction in humans. Our strategy to restore cMLCK activity could form the basis of a novel myotropic therapy for advanced systolic heart failure.
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Affiliation(s)
- Tatsuro Hitsumoto
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, Suita, Osaka, Japan (T.H., O.T., K.M., H. Kioka, H. Kato, H.H., Y.S., C.O., H.I., J.H., K.U., T.S., S.N., S.T.)
| | - Osamu Tsukamoto
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, Suita, Osaka, Japan (T.H., O.T., K.M., H. Kioka, H. Kato, H.H., Y.S., C.O., H.I., J.H., K.U., T.S., S.N., S.T.)
| | - Ken Matsuoka
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, Suita, Osaka, Japan (T.H., O.T., K.M., H. Kioka, H. Kato, H.H., Y.S., C.O., H.I., J.H., K.U., T.S., S.N., S.T.)
| | - Junjun Li
- Department of Cardiovascular Surgery (J.L., L.L.), Osaka University Graduate School of Medicine. Suita, Osaka, Japan
| | - Li Liu
- Department of Cardiovascular Surgery (J.L., L.L.), Osaka University Graduate School of Medicine. Suita, Osaka, Japan
| | - Yuki Kuramoto
- Department of Cardiology (Y.K., S.H., S.O., H. Kioka, HY.H., S.N., Y.A., Y.S.), Osaka University Graduate School of Medicine. Suita, Osaka, Japan
| | - Shuichiro Higo
- Department of Cardiology (Y.K., S.H., S.O., H. Kioka, HY.H., S.N., Y.A., Y.S.), Osaka University Graduate School of Medicine. Suita, Osaka, Japan
| | - Shou Ogawa
- Department of Cardiology (Y.K., S.H., S.O., H. Kioka, HY.H., S.N., Y.A., Y.S.), Osaka University Graduate School of Medicine. Suita, Osaka, Japan
| | - Noboru Fujino
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kanazawa University. Kanazawa, Ishikawa, Japan (N.F., S.Y., M.T.)
| | - Shohei Yoshida
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kanazawa University. Kanazawa, Ishikawa, Japan (N.F., S.Y., M.T.)
| | - Hidetaka Kioka
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, Suita, Osaka, Japan (T.H., O.T., K.M., H. Kioka, H. Kato, H.H., Y.S., C.O., H.I., J.H., K.U., T.S., S.N., S.T.)
- Department of Cardiology (Y.K., S.H., S.O., H. Kioka, HY.H., S.N., Y.A., Y.S.), Osaka University Graduate School of Medicine. Suita, Osaka, Japan
| | - Hisakazu Kato
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, Suita, Osaka, Japan (T.H., O.T., K.M., H. Kioka, H. Kato, H.H., Y.S., C.O., H.I., J.H., K.U., T.S., S.N., S.T.)
| | - Hideyuki Hakui
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, Suita, Osaka, Japan (T.H., O.T., K.M., H. Kioka, H. Kato, H.H., Y.S., C.O., H.I., J.H., K.U., T.S., S.N., S.T.)
- Department of Cardiology (Y.K., S.H., S.O., H. Kioka, HY.H., S.N., Y.A., Y.S.), Osaka University Graduate School of Medicine. Suita, Osaka, Japan
| | - Yuki Saito
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, Suita, Osaka, Japan (T.H., O.T., K.M., H. Kioka, H. Kato, H.H., Y.S., C.O., H.I., J.H., K.U., T.S., S.N., S.T.)
| | - Chisato Okamoto
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, Suita, Osaka, Japan (T.H., O.T., K.M., H. Kioka, H. Kato, H.H., Y.S., C.O., H.I., J.H., K.U., T.S., S.N., S.T.)
| | - Hijiri Inoue
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, Suita, Osaka, Japan (T.H., O.T., K.M., H. Kioka, H. Kato, H.H., Y.S., C.O., H.I., J.H., K.U., T.S., S.N., S.T.)
| | - Jo Hyejin
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, Suita, Osaka, Japan (T.H., O.T., K.M., H. Kioka, H. Kato, H.H., Y.S., C.O., H.I., J.H., K.U., T.S., S.N., S.T.)
| | - Kyoko Ueda
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, Suita, Osaka, Japan (T.H., O.T., K.M., H. Kioka, H. Kato, H.H., Y.S., C.O., H.I., J.H., K.U., T.S., S.N., S.T.)
| | - Takatsugu Segawa
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, Suita, Osaka, Japan (T.H., O.T., K.M., H. Kioka, H. Kato, H.H., Y.S., C.O., H.I., J.H., K.U., T.S., S.N., S.T.)
| | - Shunsuke Nishimura
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, Suita, Osaka, Japan (T.H., O.T., K.M., H. Kioka, H. Kato, H.H., Y.S., C.O., H.I., J.H., K.U., T.S., S.N., S.T.)
- Department of Cardiology (Y.K., S.H., S.O., H. Kioka, HY.H., S.N., Y.A., Y.S.), Osaka University Graduate School of Medicine. Suita, Osaka, Japan
| | - Yoshihiro Asano
- Department of Cardiology (Y.K., S.H., S.O., H. Kioka, HY.H., S.N., Y.A., Y.S.), Osaka University Graduate School of Medicine. Suita, Osaka, Japan
- Department of Genomic Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan (Y.A.)
| | - Hiroshi Asanuma
- Department of Internal Medicine, Meiji University of Integrative Medicine, Nantan, Kyoto, Japan (H.A.)
| | - Akiyoshi Tani
- Compound Library Screening Center (A.T.), Graduate School of Pharmaceutical Sciences, Osaka University, Suita, Osaka, Japan
| | - Riyo Imamura
- Drug Discovery Initiative, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Bunkyo-ku, Tokyo, Japan (R.I.)
| | - Shinsuke Komagawa
- Lead Explorating Units (S.K., T.K., J.-i.H.), Graduate School of Pharmaceutical Sciences, Osaka University, Suita, Osaka, Japan
| | - Toshio Kanai
- Lead Explorating Units (S.K., T.K., J.-i.H.), Graduate School of Pharmaceutical Sciences, Osaka University, Suita, Osaka, Japan
| | - Masayuki Takamura
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kanazawa University. Kanazawa, Ishikawa, Japan (N.F., S.Y., M.T.)
| | - Yasushi Sakata
- Department of Cardiology (Y.K., S.H., S.O., H. Kioka, HY.H., S.N., Y.A., Y.S.), Osaka University Graduate School of Medicine. Suita, Osaka, Japan
| | | | - Jun-ichi Haruta
- Lead Explorating Units (S.K., T.K., J.-i.H.), Graduate School of Pharmaceutical Sciences, Osaka University, Suita, Osaka, Japan
| | - Seiji Takashima
- Department of Medical Biochemistry, Osaka University Graduate School of Medicine/Frontier Biosciences, Suita, Osaka, Japan (T.H., O.T., K.M., H. Kioka, H. Kato, H.H., Y.S., C.O., H.I., J.H., K.U., T.S., S.N., S.T.)
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8
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Olsen FJ, Gordon LB, Smoot L, Kleinman ME, Gerhard-Herman M, Hegde SM, Mukundan S, Mahoney T, Massaro J, Ha S, Prakash A. Progression of Cardiac Abnormalities in Hutchinson-Gilford Progeria Syndrome: A Prospective Longitudinal Study. Circulation 2023; 147:1782-1784. [PMID: 37276254 DOI: 10.1161/circulationaha.123.064370] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Flemming Javier Olsen
- From the Departments of Cardiology (F.J.O., L.S., S.H., A.P.), Boston Children's Hospital and Harvard Medical School, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA (F.J.O., L.B.G., L.S., M.E.K., A.P.)
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Hellerup, Denmark (F.J.O.)
| | - Leslie B Gordon
- Anesthesia (L.B.G., M.E.K.), Boston Children's Hospital and Harvard Medical School, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA (F.J.O., L.B.G., L.S., M.E.K., A.P.)
- Department of Pediatrics, Hasbro Children's Hospital, and Warren Alpert Medical School of Brown University, Providence, RI (L.B.G.)
| | - Leslie Smoot
- From the Departments of Cardiology (F.J.O., L.S., S.H., A.P.), Boston Children's Hospital and Harvard Medical School, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA (F.J.O., L.B.G., L.S., M.E.K., A.P.)
| | - Monica E Kleinman
- Critical Care Medicine (M.E.K.), Boston Children's Hospital and Harvard Medical School, MA
- Anesthesia (L.B.G., M.E.K.), Boston Children's Hospital and Harvard Medical School, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA (F.J.O., L.B.G., L.S., M.E.K., A.P.)
| | - Marie Gerhard-Herman
- Departments of Medicine, Cardiovascular Medicine (M.G.-H., S.M.H.), Brigham and Women's Hospital, Boston, MA
| | - Sheila M Hegde
- Departments of Medicine, Cardiovascular Medicine (M.G.-H., S.M.H.), Brigham and Women's Hospital, Boston, MA
| | | | - Taylor Mahoney
- Department of Mathematics and Statistics, Boston University, MA (T.M., J.M.)
- Harvard Clinical Research Institute, Boston, MA (T.M., J.M.)
| | - Joseph Massaro
- Department of Mathematics and Statistics, Boston University, MA (T.M., J.M.)
- Harvard Clinical Research Institute, Boston, MA (T.M., J.M.)
| | - Sendy Ha
- From the Departments of Cardiology (F.J.O., L.S., S.H., A.P.), Boston Children's Hospital and Harvard Medical School, MA
| | - Ashwin Prakash
- From the Departments of Cardiology (F.J.O., L.S., S.H., A.P.), Boston Children's Hospital and Harvard Medical School, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA (F.J.O., L.B.G., L.S., M.E.K., A.P.)
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9
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Zoroufian A, Sahebjam M, Rezaee M, Hosseini K, Fallahzadeh A, Jalali A, Salehi S. Evaluating the pure effect of weight on cardiac function in patients with cardiac syndrome X. Echocardiography 2023. [PMID: 37195205 DOI: 10.1111/echo.15589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/16/2023] [Accepted: 05/02/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Obese patients have more coronary artery disease (CAD) risk factors that may affect myocardial function. We aimed to assess the ability of echocardiography-derived conventional parameters, left atrial strain, and global longitudinal strain to detect early diastolic and systolic dysfunction in obese individuals with almost no CAD risk factors. METHOD We studied 100 participants with structurally normal hearts, ejection fractions above 50%, almost normal coronary arteries in coronary angiogram (syndrome X), and no cardiovascular risk factor except dyslipidemia. Participants were classified as normal-weight (BMI < 25.0 kg/m2 , n = 28) and high-weight (BMI ≥ 25.0 kg/m2 , n = 72). Conventional echocardiographic parameters and two-dimensional speckle tracking (2DSTE) were used to measure peak LA strain and global longitudinal strain to evaluate diastolic and systolic function, respectively. RESULT There was no significant difference in the standard and conventional echocardiographic parameters between the two groups. 2DSTE echocardiographic parameters of the longitudinal deformation of the LV myocardium were not significantly different within the two groups. However, there were significant differences between the subjects with normal-weight and high-weight in terms of LA strain (34.51 ± 8.98% vs. 39.06 ± 8.62%, p = .021). The normal-weight group had lower LA strain, in compression with the high-weight group. All echocardiographic parameters were in the normal range. CONCLUSION In the present study we demonstrated that global longitudinal subendocardial deformations, for the evaluation of systolic function, and conventional echocardiographic parameters, for the evaluation of diastolic function, were not significantly different between normal- and high-weight groups. Although LA strain was higher among overweight patients, it was not above the normal range of diastolic dysfunction.
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Affiliation(s)
- Arezou Zoroufian
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sahebjam
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Malihe Rezaee
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kaveh Hosseini
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Aida Fallahzadeh
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Safoura Salehi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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10
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Xue Y, Liu C, Lin B, Ding P, Qi H. Large left paraduodenal hernia identified and repaired by laparoscopy: A case report. J Int Med Res 2023; 51:3000605231159967. [PMID: 37026451 PMCID: PMC10087622 DOI: 10.1177/03000605231159967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Paraduodenal hernias (PDHs) are rare types of internal hernias that pose a significant diagnostic and therapeutic challenge because they can present with non-specific symptoms ranging from digestive disorders and chronic abdominal pain to symptoms of intestinal obstruction which may be life-threatening. We describe here a woman in her early 30's who presented to the emergency department with a three-hour history of generalized intermittent crampy abdominal pain. She had experienced multiple similar episodes of this pain over the past 20 years. Totally laparoscopic technique was used to complete the diagnosis and treatment of a large left PHD with accompanying acute intestinal obstruction. The operation was successful and the patient was discharged from hospital 10 days later. PDH should be considered if a patient complains of recurrent abdominal pain without any other obvious explanation; a laparoscopic approach can be used to identify and repair the hernia.
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Affiliation(s)
- Yingming Xue
- Department of General Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Chao Liu
- Department of General Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Bin Lin
- Department of General Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Pengcheng Ding
- Graduate school, Dalian Medical University, 36674, Dalian, China
| | - Hong Qi
- Department of General Surgery, Qingdao Municipal Hospital, Qingdao, China
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11
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Cioffi S, Di Domenico F, Russo G, De Nigris A, Guarino S, Miraglia del Giudice E, Marzuillo P, Di Sessa A. Diagnostic Clues in Pediatric Nutcracker Syndrome: From Two Clinical Cases to Current Literature Analysis. Children (Basel) 2022; 9:children9121988. [PMID: 36553431 PMCID: PMC9777484 DOI: 10.3390/children9121988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Revised: 12/10/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
Nutcracker syndrome (NCS) is a rare pediatric disease caused by left kidney vein compression. Besides the "Triade's symptoms", including hematuria, proteinuria, and flank pain, a wide spectrum of clinical manifestations has been reported. As the significant hemodynamic changes secondary to the dilatation of the left renal vein, serious consequences such as renal vein thrombosis and severe anemia might occur in these children. NCS diagnosis includes a variety of invasive and non-invasive imaging tools, but cutoff values need to be further validated. A conservative treatment represents the most common therapeutic approach for these patients, but operative options are available in selected cases. To complicate matters, a standard diagnostic and treatment algorithm is currently lacking and scientific pediatric evidence in this field is still poor and limited. In this perspective, early recognition of NCS is crucial but challenging for pediatricians. Therefore, a better knowledge of the disease is recommended. Starting from two different clinical presentations of NCS, we aimed to provide a comprehensive overview of the disease in children.
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12
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Min K, Polizio AH, Kour A, Thel MC, Walsh K. Experimental ASXL1-Mediated Clonal Hematopoiesis Promotes Inflammation and Accelerates Heart Failure. J Am Heart Assoc 2022; 11:e026154. [PMID: 36129058 PMCID: PMC9673733 DOI: 10.1161/jaha.122.026154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Kyung‐Duk Min
- Hematovascular Biology Center, Robert M. Berne Cardiovascular Research CenterUniversity of Virginia School of MedicineCharlottesvilleVA
| | - Ariel H. Polizio
- Hematovascular Biology Center, Robert M. Berne Cardiovascular Research CenterUniversity of Virginia School of MedicineCharlottesvilleVA
| | - Anupreet Kour
- Hematovascular Biology Center, Robert M. Berne Cardiovascular Research CenterUniversity of Virginia School of MedicineCharlottesvilleVA
| | - Mark C. Thel
- Hematovascular Biology Center, Robert M. Berne Cardiovascular Research CenterUniversity of Virginia School of MedicineCharlottesvilleVA
| | - Kenneth Walsh
- Hematovascular Biology Center, Robert M. Berne Cardiovascular Research CenterUniversity of Virginia School of MedicineCharlottesvilleVA
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13
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Pesce M, LaPar D, Kalfa D, Bacha E, Freud L. Peri-operative changes in diastolic function and outcomes in congenital aortic valve surgery. Echocardiography 2022; 39:178-184. [PMID: 35014728 PMCID: PMC9305218 DOI: 10.1111/echo.15274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 11/01/2021] [Accepted: 11/21/2021] [Indexed: 11/30/2022] Open
Abstract
Background The ratio of early diastolic mitral inflow velocity (E) to early diastolic mitral annular tissue velocity (e’), or E/e’, is an echocardiographic measure of left ventricular filling pressure. Peri‐operative changes in E/e’ and association with outcomes have been demonstrated in adults undergoing surgery for aortic stenosis (AS). We sought to explore changes in E/e’ and other diastolic indices in the setting of congenital AS surgery and to assess for association with post‐operative outcomes among children and young adults. Methods A retrospective, single‐center study was performed among patients 6 months to 30 years of age who underwent congenital AS surgery from 2006 to 2018. Tissue Doppler indices were collected from pre‐ and post‐operative echocardiograms. Post‐operative outcomes were reviewed. Results Sixty‐six subjects with subvalvar (45%), valvar (47%), and supravalvar (8%) AS underwent surgery at a median age of 9.5 years (IQR: 4.0–14.8). Pre‐operatively, the lateral E/e’ ratio was 8.6 (6.7–11.0); 33% had E/e’≥10. Post‐operatively, the lateral e’ decreased to 9.9 cm/s (8.0–11.4), the E/e’ ratio increased to 10.4 (8.3–13.1); and 53% had E/e’≥10 (p‐values < 0.0001, 0.0072, and < 0.001, respectively). Pre‐operative lateral e’ correlated modestly with duration of intubation (ρ = −0.24, p‐value 0.048) and post‐operative lateral e’ correlated modestly with duration of intubation and length of hospital stay (ρ = −0.28 and −0.26, p‐values = 0.02 and 0.04, respectively). Conclusions Children and young adults who underwent congenital AS surgery had echocardiographic evidence of diastolic dysfunction pre‐operatively that worsened post‐operatively. Lateral e’ may be a sensitive indicator of impaired ventricular relaxation in these patients and may impact duration of intubation and hospital stay.
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Affiliation(s)
- Meredith Pesce
- Department of Pediatrics, Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of NewYork Presbyterian/Columbia University Irving Medical Center, New Haven, Connecticut, USA
| | - Damien LaPar
- Department of Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, New York, New York, USA
| | - David Kalfa
- Department of Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, New York, New York, USA
| | - Emile Bacha
- Department of Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, New York, New York, USA
| | - Lindsay Freud
- Department of Pediatrics, Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of NewYork Presbyterian/Columbia University Irving Medical Center, New Haven, Connecticut, USA
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14
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Natalucci A, Ferrero JP. Social mobilization and political change in countries governed by the left: The cases of Argentina and Brazil. Br J Sociol 2021; 72:1479-1496. [PMID: 34528708 DOI: 10.1111/1468-4446.12894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 07/28/2021] [Accepted: 08/23/2021] [Indexed: 06/13/2023]
Abstract
This paper analyses the socio-political dynamics after the financial crash in two countries governed by the left, Argentina and Brazil. Whilst the economic crisis had an effect on the general distributive capacity of leftwing coalitions, it remains unclear why the political resolution of such a crisis adopted anti-regime features in Brazil and the form of an institutional alternation of power in Argentina. Our aim is to understand the new socio-political dynamics and their implications in the crisis of the left turn, especially the relationship between social mobilization and political change in the context of Argentina and Brazil. In doing so, the paper contributes to the growing body of literature interested in the intersections between social movements and the state. Based on the analysis of original qualitative and quantitative data on social protests events in both countries 2011-2015, the paper suggests that the complexity of changes in the socio-political dynamics can be captured by looking at three dimensions of the problem: grammar of mobilization, social imaginaries, and political representation. The main argument is that the different types of left turn strategy developed in both countries affected in turn the responses to the economic crisis and the new cycle of mobilization. The kirchnerist's movimentista strategy in Argentina contrasted with the demobilizing strategy of the PT in Brazil. Whilst the former contributed to channel the high and polarized levels of activism within the polity, the latter resulted in the crisis of the long cycle of political representation opened with the transition to democracy.
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Affiliation(s)
| | - Juan Pablo Ferrero
- Department of Politics, Languages and International Studies, University of Bath, Bath, UK
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15
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Najm H, Gupta S, Weingarten N, Stewart R, Ahmad M, Lane J, Amdani S, Karamlou T. Infant Ross-Konno, Endocardial Fibroelastosis Resection and Mitral Valve Repair. World J Pediatr Congenit Heart Surg 2021; 13:389-392. [PMID: 34775844 DOI: 10.1177/21501351211054380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Optimal management of critical aortic stenosis (AS) in infants depends on the left ventricle's (LV's) ability to maintain adequate output. Determining feasibility of biventricular repair may be difficult, particularly in those with mitral disease, endocardial fibroelastosis (EFE), multi-level obstruction, and uncertain physiologic capacity. We report a case of a three-month-old with critical AS, severely reduced LV function, EFE, and moderate mitral regurgitation (MR), who underwent a Ross-Konno procedure with concomitant EFE resection and mitral valve repair. Although the technical sequence is challenging, definitive surgery completely relieved multi-level obstruction and MR with markedly improved LV function.
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Affiliation(s)
- Hani Najm
- 22508Cleveland Clinic Children's Hospital, Vascular, and Thoracic Institute, Cleveland
| | - Sohini Gupta
- 2546Case Western Reserve University School of Medicine, Cleveland
| | | | - Robert Stewart
- 22508Cleveland Clinic Children's Hospital, Vascular, and Thoracic Institute, Cleveland.,1079Akron Children's Hospital, Akron
| | - Munir Ahmad
- 22508Cleveland Clinic Children's Hospital, Vascular, and Thoracic Institute, Cleveland
| | - John Lane
- 1079Akron Children's Hospital, Akron
| | | | - Tara Karamlou
- 22508Cleveland Clinic Children's Hospital, Vascular, and Thoracic Institute, Cleveland
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16
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Okuno T, Lanz J, Stortecky S, Heg D, Bernhard B, Gräni C, Huber A, Praz F, Räber L, Valgimigli M, Siontis GCM, Windecker S, Pilgrim T. Clinical impact of left atrial appendage filling defects in patients undergoing transcatheter aortic valve implantation. Eur Heart J Cardiovasc Imaging 2021; 23:1354-1364. [PMID: 34463717 DOI: 10.1093/ehjci/jeab142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/07/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Incidental detection of left atrial appendage (LAA) filling defects is a common finding on multi-detector computed tomography in aortic stenosis patients under evaluation for transcatheter aortic valve implantation (TAVI). We aimed to investigate the incidence of LAA filling defects before TAVI and its impact on clinical outcomes. METHODS AND RESULTS In a prospective registry, LAA filling defects were retrospectively evaluated and categorized into one of four sub-types: thrombus-like, heterogeneous, horizontal, and Hounsfield Unit (HU)-run-off. The primary endpoint was the composite of cardiovascular death or disabling stroke up to 1-year follow-up. Among 1621 patients undergoing TAVI between August 2007 and June 2018, LAA filling defects were present in 177 patients (11%), and categorized as thrombus-like in 22 (1.4%), heterogeneous in 37 (2.3%), horizontal in 80 (4.9%), and HU-run-off in 38 (2.4%). Compared to patients with normal LAA filling, patients with LAA filling defects had greater prevalence of atrial fibrillation (84.7% vs. 26.4%, P < 0.001) and history of cerebrovascular events (16.4% vs. 10.9%, P = 0.045). The primary endpoint occurred in 131 patients (9.2%) with normal LAA filling and in 36 patients (21.2%) with LAA filling defects (P < 0.001). Subgroup analysis suggested that the risk of disabling stroke was greatest in the thrombus-like pattern (23.0%), followed by the HU-run-off (8.0%), the heterogeneous (6.2%), and the horizontal pattern (1.2%). CONCLUSION LAA filling defects were observed in 11% of aortic stenosis patients undergoing TAVI and associated with an increased risk of cardiovascular death and disabling stroke up to 1 year following TAVI. TRIAL REGISTRATION https://www.clinicaltrials.gov. NCT01368250.
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Affiliation(s)
- Taishi Okuno
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Dik Heg
- Clinical Trials Unit Bern, University of Bern, Bern, Switzerland
| | - Benedikt Bernhard
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Adrian Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - George C M Siontis
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, CH-3010 Bern, Switzerland
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17
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Kook H, Lee HJ, Kim MN, Yu CW, Kim JS, Joo HJ, Park JH, Hong SJ, Kim TH, Jang HJ, Park JS, Choi RK, Choi YJ, Kim YM, Lim DS, Ro YM. Effects of deferred versus immediate stenting on left ventricular function in patients with ST elevation myocardial infarction. Medicine (Baltimore) 2021; 100:e26598. [PMID: 34260542 PMCID: PMC8284705 DOI: 10.1097/md.0000000000026598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/21/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Previous studies have shown conflicting results on the benefits of deferred stenting (DS) in infarct size and the incidence of microvascular obstruction in patients with ST elevation myocardial infarction (STEMI). However, effect of DS on left ventricular (LV) function was not known. We aimed to evaluate whether DS improve LV function and relevant clinical outcomes after STEMI, using follow-up data from the INNOVATION study (NCT02324348). METHODS In total, 114 patients were randomly assigned to DS group or immediate stenting (IS) group at a 1:1 ratio. LV functional remodeling indices and MACE (major adverse cardiac events: a composite of death, non-fatal MI, unplanned target vessel revascularization, or hospitalization due to heart failure) were compared between DS and IS groups. RESULTS Serial echocardiographic analyses were completed in 89 subjects (78%). There were no significant changes in LV volume in either group. While LV ejection fraction and wall motion score index (WMSI) improved in both groups during follow-up, the increments were not statistically different between the 2 groups (4.3 ± 8.2 vs 3.2 ± 7.1, P = .504 for ΔLV ejection fraction; -0.16 ± 0.25 vs -0.16 ± 0.25, P = .99 for ΔWMSI). However, E/e'' was decreased and e' was increased only in the DS group (-3.31 ± 5.60 vs -0.46 ± 3.10, P = .005 for ΔE/e'; 0.77 ± 1.71 vs -0.22 ± 1.64, P = .009 for Δe'). The incidence of major adverse cardiac events was numerically lower in the DS group than in the IS group without a statistical significance at 1-year follow-up. CONCLUSIONS Routine DS improved LV diastolic function but not systolic function compared with IS in patients with STEMI.
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Affiliation(s)
- Hyungdon Kook
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Hyun-Jong Lee
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Mi-Na Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University School of Medicine, Seoul, Republic of Korea
| | - Cheol Woong Yu
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University School of Medicine, Seoul, Republic of Korea
| | - Je Sang Kim
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Hyung Joon Joo
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University School of Medicine, Seoul, Republic of Korea
| | - Jae Hyoung Park
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University School of Medicine, Seoul, Republic of Korea
| | - Soon Jun Hong
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University School of Medicine, Seoul, Republic of Korea
| | - Tae Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Cha University School of Medicine, Goyang, Republic of Korea
| | - Ho-Jun Jang
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Jin-Shik Park
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Rak Kyeong Choi
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Young Jin Choi
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
| | - Yang Min Kim
- Department of Radiology, Sejong General Hospital, Bucheon, Republic of Korea
| | - Do-Sun Lim
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University School of Medicine, Seoul, Republic of Korea
| | - Young Moo Ro
- Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea
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18
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Abstract
Sebastian Ocklenburg and colleagues have written an important and exciting summary of where laterality research might go. Perhaps reiterating some of their points, it seems important to understand the nuances of laterality. Laterality research can fall into the trap of "dichotomania" - where all laterality is seen in terms of left versus right. However, important insights can also be gained by examining the strength of laterality as well as the cooperation and competition between the hemispheres. Care also needs to be taken when examining individual differences between left- and right-handers. Studies, which may suffer from type 1 errors, often stigmatise left-handers with a host of negative traits. Pre-registration and the reporting of effect size may eliminate this bias.
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Affiliation(s)
- Michael E R Nicholls
- College of Education, Psychology and social Work, Flinders University, Adelaide, Australia
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19
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Malankar DP, Patil S, Mali S, Dhake S, Mhatre A, Bind D, Soni B, Kandavel D, Garekar S. Primary Arterial Switch Operation for TGA/IVS and Regressed Left Ventricle: How and When to Use Left Ventricular Assist Device. World J Pediatr Congenit Heart Surg 2020; 11:97-100. [PMID: 31835987 DOI: 10.1177/2150135119879876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Numerous attempts have been made to extend the boundaries of arterial switch operation (ASO) in children presenting late with transposition of great arteries with intact ventricular septum (TGA/IVS) and regressed left ventricle (rLV). Many children tolerate the delayed ASO uneventfully, whereas others need mechanical circulatory support (MCS) to sustain the systemic circulation while the left ventricle undergoes retraining. DESCRIPTION In this article, we describe six consecutive children with TGA/IVS and rLV who underwent primary ASO. RESULTS Three were managed medically, while three required MCS in the form of Centrimag left ventricular assist device (LVAD). All patients survived the operation and were discharged home in a stable condition. CONCLUSIONS Primary ASO can be safely performed in children with TGA/IVS and rLV, provided the center has MCS options. Supporting the rLV with LVAD is feasible and can be achieved safely.
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Affiliation(s)
- Dhananjay P Malankar
- Department of Paediatric Cardiac Surgery, Fortis Paediatric and Congenital Heart Centre, Mulund, Mumbai, India
| | - Sachin Patil
- Department of Paediatric Cardiac Anaesthesia and Critical Care, Fortis Paediatric and Congenital Heart Centre, Mulund, Mumbai, India
| | - Shivaji Mali
- Department of Paediatric Cardiac Anaesthesia and Critical Care, Fortis Paediatric and Congenital Heart Centre, Mulund, Mumbai, India
| | - Shyam Dhake
- Department of Paediatric Cardiac Anaesthesia and Critical Care, Fortis Paediatric and Congenital Heart Centre, Mulund, Mumbai, India
| | - Amit Mhatre
- Department of Paediatric Cardiac Anaesthesia and Critical Care, Fortis Paediatric and Congenital Heart Centre, Mulund, Mumbai, India
| | - Dilip Bind
- Department of Paediatric Cardiac Anaesthesia and Critical Care, Fortis Paediatric and Congenital Heart Centre, Mulund, Mumbai, India
| | - Bharat Soni
- Department of Paediatric Cardiac Surgery, Fortis Paediatric and Congenital Heart Centre, Mulund, Mumbai, India
| | - Dinesh Kandavel
- Department of Paediatric Cardiac Surgery, Fortis Paediatric and Congenital Heart Centre, Mulund, Mumbai, India
| | - Swati Garekar
- Department of Paediatric Cardiology, Fortis Paediatric and Congenital Heart Centre, Mulund, Mumbai, India
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20
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Abstract
Based on current guidelines, 15% to 20% of patients undergoing mitral valve repair for regurgitation develop left ventricular dysfunction (ejection fraction < 50%-55%) despite a normal baseline. Two schools of thought have been debated: preexisting myocardial disease or suboptimal intraoperative myocardial protection. In our view, they could be reconciled. It is well recognized that left ventricular ejection fraction with a standard cut off at 50%-55% has limited sensitivity in detecting early systolic impairment in mitral regurgitation patients. Mitral regurgitation also leads to mitochondrial oxidative stress, thus rendering the myocardium more susceptible to ischemia-reperfusion injury and precipitating postoperative cardiac dysfunction. The fall in left ventricular ejection fraction early after mitral valve repair was shown to be caused by the reduction in both myocardial contractility and left ventricular stroke volume. To mitigate the risk to myocardial reperfusion injury, appropriate cardioplegia volume and distribution and well-defined surgical repair processes are equally important. We use transesophageal echocardiography-guided cardioplegia delivery, imaging the intramyocardial flow and ensuring adequate protection of the subendocardium during mitral valve repair. Mild aortic regurgitation on a beating heart often leads to left ventricular dilatation with diminished cardioplegia flow in the myocardium, thus requiring direct ostia cardioplegia. Systematic transesophageal echocardiography assessment before surgery is essential for establishing the mitral regurgitation mechanisms and translating them into precise surgical repair strategies. The benefits of transesophageal echocardiography-guided cardioplegia delivery warrant further clinical trials in order to evolve into part of a high surgical standard.
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Affiliation(s)
- Xu Yu Jin
- Department of Cardiothoracic Surgery, Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK.,Surgical Echo and Genomics Group, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Rana Sayeed
- Department of Cardiothoracic Surgery, Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK
| | - John Pepper
- Department of Cardiac Surgery, Royal Brompton Hospital, London, UK
| | - Mario Petrou
- Department of Cardiac Surgery, Royal Brompton Hospital, London, UK
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21
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Gupta K, Shah D, Naik D, Chandan A, Bhavsar N, Shah B. Dengue fever after coronary artery bypass grafting with ventricular dysfunction. Asian Cardiovasc Thorac Ann 2020; 29:220-222. [PMID: 33016077 DOI: 10.1177/0218492320963957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 67-year-old man who had undergone a percutaneous coronary intervention, presented with cardiac symptoms. He was managed for acute coronary syndrome and left ventricular dysfunction. After stabilization, he underwent coronary artery bypass grafting but developed dengue hemorrhagic fever postoperatively. He was monitored for hematocrit, platelet count, liver enzymes, and daily fluid balance. His platelet count fell below 40,000/µL, and due to the increased risk of bleeding, warfarin was discontinued and single antiplatelet therapy (aspirin) was continued. After 2 weeks, parameters had normalized. Regular monitoring of hematocrit, platelet count, liver enzymes, and fluid balance played a vital role in the patient's successful recovery.
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Affiliation(s)
- Kishore Gupta
- Department of Cardiac Surgery, Care Institute of Medical Sciences Hospital, Ahmedabad, India
| | - Dhiren Shah
- Department of Cardiac Surgery, Care Institute of Medical Sciences Hospital, Ahmedabad, India
| | - Dhaval Naik
- Department of Cardiac Surgery, Care Institute of Medical Sciences Hospital, Ahmedabad, India
| | - Amit Chandan
- Department of Cardiac Surgery, Care Institute of Medical Sciences Hospital, Ahmedabad, India
| | - Niren Bhavsar
- Department of Cardiac Surgery, Care Institute of Medical Sciences Hospital, Ahmedabad, India
| | - Bhagyesh Shah
- Department of Cardiac Surgery, Care Institute of Medical Sciences Hospital, Ahmedabad, India
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22
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Matsushima S, Burri M, Strbad M, Ruf B, Lange R, Hörer J, Cleuziou J. The Konno Operation Is a Durable Option for Relief of Aortic Stenosis in Patients With Complex Left Ventricular Outflow Tract Obstruction-A Single-Center 20-Year Experience. World J Pediatr Congenit Heart Surg 2020; 10:678-685. [PMID: 31701836 DOI: 10.1177/2150135119872476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND A Konno operation with a mechanical prosthesis may be applied in patients with complex left ventricular outflow tract obstruction to avoid further operations. We reviewed our 20-year experience with the Konno operation. METHODS All patients who underwent the Konno operation between 1996 and 2015 were evaluated. Study end points were survival and reoperations. RESULTS Twenty-one consecutive patients were included. The median age at operation was 12 years (5 months to 34 years). Twenty (95%) patients had prior interventions for left-sided heart lesions. Additional mitral valve disease was present in 17 (81%) patients. The preoperative mean pressure gradient over the left ventricular outflow tract was 50 ± 25 mm Hg. The median size of implanted valve prostheses was 21 mm (16-25 mm). Concomitant procedures for left-sided heart lesions were performed in six patients, including two mitral valve replacements. There were two hospital mortalities (9.5%) and four late mortalities (19%). Overall survival was 85% ± 7.8% and 72% ± 11% at 5 and 10 years, respectively. In two patients, mitral valve replacement was performed during the same hospital admission. During a mean follow-up time of 7.6 ± 4.8 years, two patients required late reoperations, one for mitral valve replacement and one for heart transplantation. Freedom from late reoperation at 10 years was 89% ± 7.4%. CONCLUSIONS The Konno operation can be considered as a definitive option with a low probability of reoperation on the left ventricular outflow tract in patients with complex left ventricular heart disease. Subsequent operations focus on the treatment of additional mitral valve disease, which remains the cause of mortality and morbidity.
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Affiliation(s)
- Shunsuke Matsushima
- Department of Cardiovascular Surgery, German Heart Center Munich, Technical University of Munich, School of Medicine, Munich, Germany
| | - Melchior Burri
- Department of Cardiovascular Surgery, German Heart Center Munich, Technical University of Munich, School of Medicine, Munich, Germany.,Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Martina Strbad
- Department of Congenital and Paediatric Heart Surgery, German Heart Center Munich, Technical University of Munich, School of Medicine, Munich, Germany
| | - Bettina Ruf
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University of Munich, School of Medicine, Munich, Germany
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Center Munich, Technical University of Munich, School of Medicine, Munich, Germany.,Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany.,DZHK (German Center for Cardiovascular Research)-Partner Site Munich Heart Alliance, Munich, Germany
| | - Jürgen Hörer
- Department of Congenital and Paediatric Heart Surgery, German Heart Center Munich, Technical University of Munich, School of Medicine, Munich, Germany
| | - Julie Cleuziou
- Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany.,Department of Congenital and Paediatric Heart Surgery, German Heart Center Munich, Technical University of Munich, School of Medicine, Munich, Germany
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23
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Daprati A, Sassi CG, Garatti A, Saitto G, Menicanti L. Congenital left ventricular aneurysm with myocardial noncompaction pattern. Asian Cardiovasc Thorac Ann 2020; 28:504-506. [PMID: 32757654 DOI: 10.1177/0218492320949833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Congenital left ventricular aneurysm or diverticulum is very rare. Most congenital left ventricular aneurysms are asymptomatic but some cause systemic embolization, left ventricular free wall rupture, or ventricular arrhythmias causing sudden cardiac death. A 29-year-old woman with congenital left ventricular aneurysm and nonsustained ventricular tachycardia underwent surgical plication of the aneurysm with left ventricular reshaping to improve heart failure symptoms, prevent rupture of the aneurysm wall and the possibility of thrombus formation, and excise the fibrotic tissue of the left ventricular aneurysm, which could be a trigger for left ventricular aneurysm arrhythmias. The postoperative course was unremarkable.
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Affiliation(s)
- Andrea Daprati
- Department of Cardiovascular Disease "E. Malan", Cardiac Surgery Unit, IRCCS Policlinico S. Donato Hospital, San Donato Milanese, Italy
| | - Carlo Gaetano Sassi
- Department of Cardiovascular Disease "E. Malan", Cardiac Surgery Unit, IRCCS Policlinico S. Donato Hospital, San Donato Milanese, Italy
| | - Andrea Garatti
- Department of Cardiovascular Disease "E. Malan", Cardiac Surgery Unit, IRCCS Policlinico S. Donato Hospital, San Donato Milanese, Italy
| | - Gugliemo Saitto
- Department of Cardiovascular Disease "E. Malan", Cardiac Surgery Unit, IRCCS Policlinico S. Donato Hospital, San Donato Milanese, Italy
| | - Lorenzo Menicanti
- Department of Cardiovascular Disease "E. Malan", Cardiac Surgery Unit, IRCCS Policlinico S. Donato Hospital, San Donato Milanese, Italy
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24
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Abstract
The growth of social media has catalyzed a shift in marketing expenditure away from traditional print media. As Instagram posts featuring left cheek poses gain more "likes" than right cheek poses, advertisers and social media influencers would likely benefit from favoring the left cheek. While previous investigations of posing biases in print advertising present a conflicting picture, research has yet to investigate posing biases in Instagram advertisements. Given that left cheek images garner more "likes" than right cheek images, we hypothesized a left cheek bias for Instagram advertisements. Two thousand posts (F = M) were sourced by searching Instagram's "Most Recent" feed using the #ad, and coded for pose orientation, image type, and model gender. As predicted, Instagram advertisements showed a left cheek bias (59.8 percent) that was evident across genders and image types, being stronger for female than male models, and for full body than head and torso poses. As such, these data indicate that the left cheek bias that characterizes painted and photographic portraits extends to paid Instagram promotions. The difference in bias from previous investigations of posing orientation in print media advertisements may reflect the importance of emotion in driving attentional capture in social media's highly competitive and content-overloaded landscape.
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Affiliation(s)
- Julia Messina
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Annukka K Lindell
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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25
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Jin ZW, Hayashi S, Murakami G, Wilting J, Rodríguez-Vázquez JF, Abe S. Left/right difference in the course and division of the pulmonary arterial branches in the lung upper lobe: A study using human embryos and early fetuses. J Anat 2020; 237:854-860. [PMID: 32706936 DOI: 10.1111/joa.13264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 11/28/2022] Open
Abstract
Although left/right differences in a configuration of the pulmonary artery (PA) and its branches are well known, there is little information as to when and how such differences are established. Examination of serial sagittal sections of 25 embryos and fetuses at 6-7 weeks of gestation demonstrated that, at O'Rahilly stages 18-20, the right earliest first branch of PA originated in the anterior side of the upper lobar bronchus and overlay the upper bronchi, in contrast to the left branch which was located posteriorly and constricted medially by the upper posterior bronchus B1 + 2b. The right earliest branch was most likely to correspond to the future superior trunk, while the left branch might be a lingual artery. At stages 21-23, the upper posterior parenchyma was still underdeveloped in the left lung, since the ductus arteriosus and the left common cardinal vein seemed to make the left upper thoracic cavity narrow. Conversely, in the right lung, the thick S2 seemed to require a double arterial supply from both the superior and inferior arterial trunks. On the left, A3 originated at the lung apex and took a long descending course along the lung anterior surface. This high position of A3 might soon be corrected by an increased volume of S3. Overall, in contrast to the lower and middle lobes, early-developed branches of the PA did not accompany upper segmental and subsegmental bronchi. A mechanism "differential growth" seemed to explain how to correct the fetal morphology to provide the adult morphology with variations.
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Affiliation(s)
- Zhe Wu Jin
- Department of Anatomy, Wuxi School of Medicine, Jiangnan University, Wuxi, China
| | - Shogo Hayashi
- Department of Anatomy, School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Gen Murakami
- Division of Internal Medicine, Jikoukai Clinic of Home Visit, Sapporo, Japan
| | - Jörg Wilting
- Institute of Anatomy and Cell Biology, School of Medicine, Georg-August-Universität Göttingen, Göttingen, Germany
| | | | - Shinichi Abe
- Department of Anatomy, Tokyo Dental College, Tokyo, Japan
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26
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Alsalehi M, Jeewa A, Wan A, Contreras J, Yoo SJ, Laks JA. A case series of left main coronary artery ostial atresia and a review of the literature. CONGENIT HEART DIS 2019; 14:901-923. [PMID: 31532081 DOI: 10.1111/chd.12842] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 08/29/2019] [Indexed: 11/29/2022]
Abstract
Left main coronary artery ostial atresia (LMCAOA) is a rare congenital anomaly of the coronary arteries. The published literature regarding the current diagnostic and management recommendations are limited. We present three case series of LMCAOA from our institution, including one with a unique association with anomalous origin of left coronary artery (LCA) from pulmonary artery. In addition, this report includes a review of 50 pediatric and 43 adult cases from literature. The majority of the patients were symptomatic. Sudden cardiac death occurred in 10% of pediatric patients and 7% of adult patients. Almost half of pediatric patients had additional cardiac lesions. At the time of diagnosis, 82% of patients had abnormal exercise stress test and 73% had abnormal myocardial perfusion imaging (MPI). The diagnosis of LMCAOA was suspected by echocardiography in 47% of pediatric patients, while 26% were initially misdiagnosed as anomalous origin of LCA from pulmonary artery. Coronary angiography confirmed the diagnosis in most cases and 70.5% of pediatric patients had small collaterals, while 80.5% of adult patients had large collaterals. Nine pediatric patients had no revascularization surgery with five deaths. Revascularization surgery was performed in 39 pediatric patients with four deaths. After 2005, there is a gradual shift toward performing coronary osteoplasty rather than coronary artery bypass grafting. Eighteen adult patients had revascularization surgery and all survived. Fifteen adult patients had no revascularization surgery, of which there were five deaths. In patients with LMCAOA, revascularization surgery is currently recommended in the presence of symptoms, ischemic changes on electrocardiogram or exercise stress test, myocardial perfusion defect on MPI, global left ventricular systolic dysfunction on echocardiogram, severe mitral regurgitation, or small-sized collaterals in coronary angiography. Short-term and mid-term outcomes are encouraging.
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Affiliation(s)
- Mahmoud Alsalehi
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Aamir Jeewa
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Wan
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Juan Contreras
- Division of Cardiovascular Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Shi-Joon Yoo
- Division of Cardiac Imaging, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jessica A Laks
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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27
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Thomas L, Flores S, Wong J, Loomba R. Acute Effects of Hypoxic Gas Admixtures on Pulmonary Blood Flow and Regional Oxygenation in Children Awaiting Norwood Palliation. Cureus 2019; 11:e5693. [PMID: 31720161 PMCID: PMC6823009 DOI: 10.7759/cureus.5693] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction Oxygen delivery in patients with functionally univentricular hearts awaiting Norwood palliation depends on a balance between systemic blood flow (Qs) and pulmonary blood flow (Qp). Modulations of pulmonary vascular resistance and systemic vascular resistance are utilized to maintain balanced Qp:Qs in a circulation prone to pulmonary overcirculation at the expense of systemic perfusion. This study aimed to characterize changes in Qp:Qs and regional (cerebral and renal) oxygen delivery in patients awaiting Norwood palliation receiving hypoxic gas admixture therapy. Methods Patients who received care prior to Norwood palliation were identified from 2014 to 2018. Of these patients, those with cerebral and renal near-infrared spectroscopy were identified (NIRS). Arterial oxygen saturation by pulse oximetry, renal NIRS, and cerebral NIRS prior to hypoxic gas admixture initiation were compared to values six hours, 12 hours, and 24 hours after initiation. Results A total of 28 patients were eligible for inclusion in the study. Arterial saturation by pulse oximetry was 91% prior to initiation and decreased to 86% 24 hours after initiation (p<0.001). Cerebral NIRS were a mean of 60 prior to initiation compared to 58 at 24 hours (p=0.187). Renal NIRS were a mean of 60 prior to initiation compared to 57 at 24 hours (p=0.120). Calculated Qp:Qs was 9.6 at baseline compared to 2.5 at 24 hours (p=0.006). Arteriovenous difference and lactate did not significantly change with hypoxic gas admixture administration. Conclusion Administration of hypoxic gas admixture to patients with functionally univentricular hearts awaiting Norwood palliation decreases the ratio of Qp and Qs but does not improve regional oxygenation delivery.
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Affiliation(s)
- Lisha Thomas
- Cardiology, Advocate Children's Hospital, Chicago, USA
| | - Saul Flores
- Cardiology, Texas Children's Hospital, Houston, USA
| | - Joshua Wong
- Pediatric Cardiology, Advocate Children's Hospital, Chicago, USA
| | - Rohit Loomba
- Cardiology, Advocate Children's Hospital, Chicago, USA
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28
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Yoshino T, Portnoy DC, Obermannová R, Bodoky G, Prausová J, Garcia-Carbonero R, Ciuleanu T, García-Alfonso P, Cohn AL, Van Cutsem E, Yamazaki K, Lonardi S, Muro K, Kim TW, Yamaguchi K, Grothey A, O'Connor J, Taieb J, Wijayawardana SR, Hozak RR, Nasroulah F, Tabernero J. Biomarker analysis beyond angiogenesis: RAS/RAF mutation status, tumour sidedness, and second-line ramucirumab efficacy in patients with metastatic colorectal carcinoma from RAISE-a global phase III study. Ann Oncol 2019; 30:124-131. [PMID: 30339194 PMCID: PMC6336001 DOI: 10.1093/annonc/mdy461] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background : Second-line treatment with ramucirumab+FOLFIRI improved overall survival (OS) versus placebo+FOLFIRI for patients with metastatic colorectal carcinoma (CRC) [hazard ratio (HR)=0.84, 95% CI 0.73-0.98, P = 0.022]. Post hoc analyses of RAISE patient data examined the association of RAS/RAF mutation status and the anatomical location of the primary CRC tumour (left versus right) with efficacy parameters. Patients and methods Patient tumour tissue was classified as BRAF mutant, KRAS/NRAS (RAS) mutant, or RAS/BRAF wild-type. Left-CRC was defined as the splenic flexure, descending and sigmoid colon, and rectum; right-CRC included transverse, ascending colon, and cecum. Results RAS/RAF mutation status was available for 85% of patients (912/1072) and primary tumour location was known for 94.4% of patients (1012/1072). A favourable and comparable ramucirumab treatment effect was observed for patients with RAS mutations (OS HR = 0.86, 95% CI 0.71-1.04) and patients with RAS/BRAF wild-type tumours (OS HR = 0.86, 95% CI 0.64-1.14). Among the 41 patients with BRAF-mutated tumours, the ramucirumab benefit was more notable (OS HR = 0.54, 95% CI 0.25-1.13), although, as with the other genetic sub-group analyses, differences were not statistically significant. Progression-free survival (PFS) data followed the same trend. Treatment-by-mutation status interaction tests (OS P = 0.523, PFS P = 0.655) indicated that the ramucirumab benefit was not statistically different among the mutation sub-groups, although the small sample size of the BRAF group limited the analysis. Addition of ramucirumab to FOLFIRI improved left-CRC median OS by 2.5 month over placebo (HR = 0.81, 95% CI 0.68-0.97); median OS for ramucirumab-treated patients with right-CRC was 1.1 month over placebo (HR = 0.97, 95% CI 0.75-1.26). The treatment-by-sub-group interaction was not statistically significant for tumour sidedness (P = 0.276). Conclusions In the RAISE study, the addition of ramucirumab to FOLFIRI improved patient outcomes, regardless of RAS/RAF mutation status, and tumour sidedness. Ramucirumab treatment provided a numerically substantial benefit in BRAF-mutated tumours, although the P-values were not statistically significant. ClinicalTrials.gov number NCT01183780.
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Affiliation(s)
- T Yoshino
- National Cancer Center Hospital East, Kashiwa, Japan.
| | | | | | - G Bodoky
- St. Laszlo Hospital, Budapest, Hungary
| | - J Prausová
- Fakultni Nemocnice v MOTOLE, Prague, Czech Republic
| | - R Garcia-Carbonero
- Hospital Universitario Doce de Octubre, IIS imas12, UCM, CNIO, CIBERONC, Madrid, Spain
| | - T Ciuleanu
- Institutul Oncologic Ion Chiricuta and UMF Iuliu Hatieganu, Cluj-Napoca, Romania
| | | | - A L Cohn
- Rocky Mountain Cancer Center, LLP, Denver, USA
| | - E Van Cutsem
- Univ Hospital Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | | | - S Lonardi
- Istituto Oncologico Veneto-IRCCS, Padova, Italy
| | - K Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - T W Kim
- Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - K Yamaguchi
- The Cancer Institute Hospital of JFCR, Tokyo, Japan
| | | | - J O'Connor
- Instituto Alexander Fleming, Buenos Aires, Argentina
| | - J Taieb
- Sorbonne Paris Cité, Paris Descartes University, Georges Pompidou European Hospital, Paris, France
| | | | - R R Hozak
- Eli Lilly and Company, Indianapolis, USA
| | - F Nasroulah
- Eli Lilly and Company, Buenos Aires, Argentina
| | - J Tabernero
- Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, CIBERONC, Barcelona, Spain
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Schweisfurth MA, Frahm J, Farina D, Schweizer R. Comparison of fMRI Digit Representations of the Dominant and Non-dominant Hand in the Human Primary Somatosensory Cortex. Front Hum Neurosci 2018; 12:492. [PMID: 30618677 PMCID: PMC6295472 DOI: 10.3389/fnhum.2018.00492] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/21/2018] [Indexed: 11/13/2022] Open
Abstract
The tactile digit representations in the primary somatosensory cortex have so far been mapped for either the left or the right hand. This study localized all ten digit representations in right-handed subjects and compared them within and across the left and right hands to assess potential differences in the functional organization of the digit map between hands and in the structural organization between hemispheres. Functional magnetic resonance imaging of tactile stimulation of each fingertip in BA 3b confirmed the expected lateral-anterior-inferior to medial-posterior-superior succession from thumb to little-finger representation, located in the post-central gyrus opposite to the motor hand knob. While the more functionally related measures, such as the extent and strength of activation as well as the Euclidean distance between neighboring digit representations, showed significant differences between the digits, no side difference was detected: the layout of the functional digit-representation map did not consistently differ between the left, non-dominant, and the right, dominant hand. Comparing the absolute spatial coordinates also revealed a significant difference for the digits, but not between the left and right hand digits. Estimating the individual subject's digit coordinates of one hand by within-subject mirroring of the other-hand digit coordinates across hemispheres yielded a larger estimation error distance than using averaged across-subjects coordinates from within the same hemisphere. However, both methods should only be used with care for single-subject clinical evaluation, as an average estimation error of around 9 mm was observed, being slightly higher than the average distance between neighboring digits.
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Affiliation(s)
- Meike A Schweisfurth
- Biomedizinische NMR, Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany.,Fakultät Life Sciences, Hochschule für Angewandte Wissenschaften Hamburg, Hamburg, Germany
| | - Jens Frahm
- Biomedizinische NMR, Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany
| | - Dario Farina
- Department of Bioengineering, Imperial College London, Royal School of Mines, London, United Kingdom
| | - Renate Schweizer
- Biomedizinische NMR, Max-Planck-Institut für biophysikalische Chemie, Göttingen, Germany.,Leibniz-ScienceCampus Primate Cognition, Göttingen, Germany
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Liao CK, Chiang JM, Tsai WS, You JF, Hsieh PS, Hung HY, Chen HH, Tang RP, Chen JS, Yeh CY. Primary tumor location in stage III colon cancer has prognostic impact on subsequent liver metastasis. J Surg Oncol 2018; 118:1301-1310. [PMID: 30408183 DOI: 10.1002/jso.25270] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/16/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVES We aim to investigate whether a difference exists between right-sided and left-sided colon cancer at the same disease stage and subsequent liver metastasis and identify whether tumor location can independently influence survival. METHODS Right-sided colon cancer was defined as malignancy arising from the cecum to the transverse colon; left-sided colon cancer was defined as malignancy arising from the splenic flexure to the sigmoid colon. Clinicopathological features and survival data were collected for analysis. RESULTS Overall, 1442 patients were included for analysis. The median follow-up time was 58.2 months. Patients with left-sided colon cancer had better 5-year overall survival (75.2% vs 61.7%, P = 0.005), 5-year cancer-specific survival (81.6% vs 73.4%, P = 0.001), and 5-year recurrence-free survival (70.9% vs 66.5%, P = 0.033) compared with patients having right-sided colon cancer. After the presentation of subsequent liver metastasis, patients with primary left-sided colon cancer had better 3-year cancer-specific survival ( P < 0.001). In the multivariate analysis, cancer location was an independent prognostic factor for cancer-specific survival (right vs left, HR: 1.276, 95% CI: 1.002-1.625). CONCLUSIONS The primary tumor location can serve as a prognostic factor for treatment outcomes either in primary stage III colon cancer or subsequent liver metastasis.
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Affiliation(s)
- Chun-Kai Liao
- Department of Surgery, Colorectal Section, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jy-Ming Chiang
- Department of Surgery, Colorectal Section, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Sy Tsai
- Department of Surgery, Colorectal Section, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan, Taiwan
| | - Jeng-Fu You
- Department of Surgery, Colorectal Section, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan, Taiwan
| | - Pao-Shiu Hsieh
- Department of Surgery, Colorectal Section, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Yuan Hung
- Department of Surgery, Colorectal Section, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan, Taiwan
| | - Hong-Hwa Chen
- Department of Surgery, Colorectal Section, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan, Taiwan
| | - Rei-Ping Tang
- Department of Surgery, Colorectal Section, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan, Taiwan
| | - Jinn-Shiun Chen
- Department of Surgery, Colorectal Section, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Yuh Yeh
- Department of Surgery, Colorectal Section, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan, Taiwan
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31
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Kutuk MS, Kilic A, Ak M, Ozgun M. Infectious complications in morbidly adherent placenta treated with leaving placenta in situ: a cohort series and suggested approach . J Matern Fetal Neonatal Med 2018; 32:3520-3525. [PMID: 29671364 DOI: 10.1080/14767058.2018.1465918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background: The aim of this study is to assess the clinical and microbiological features of infections in patients with morbidly adherent placenta (MAP) treated by leaving placenta in situ (LPIS). Materials and methods: Retrospective analysis of MAP cases who were treated by LPIS between 2 May 2010 and 15 March 2017. The inclusion criteria were gestational age at or above 24 weeks, prenatal diagnosis, elective operation, and complete data. Results: Nineteen MAP cases were treated by LPIS during the study period. The mean ± SD duration for total placental resorbtion was 145 ± 47 days. Three patients were readmitted to the hospital because of fever (3/19). A total of 65 culture samples were taken from the patients during their follow- up periods. In four cases (4/12) cervical cultures showed positive growth [Escherichia coli (2), Klebsiella pneumoniae (1), mixed culture with Enterococcus spp. and E. coli (1)]. Fifteen (15/26) urine samples were sterile, three were polymicrobial. In eight cases, urine culture revealed E. coli growth (one E. coli and Enterococcus spp.). Three out of 16 (3/16) surgical incision samples revealed growth of E. coli. No bacterial growth was detected in blood cultures. Susceptibility results of Gram-negatives indicate that the resistance rates of beta-lactam antibiotics are high (14/20, 70%). No secondary surgical intervention occurred during the study period due to infection. Conclusions: Majority of postpartum cervical discharge, fever, and increased CRP levels do not represent morbid infections and/or sepsis. With early detection, and implementation of antibiotherapy (combination of an aminoglycoside and clindamycin), they can be easily controlled and secondary surgical interventions can be prevented.
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Affiliation(s)
- Mehmet Serdar Kutuk
- a Faculty of Medicine, Obstetrics and Gynecology , Bezmialem Foundation University , İstanbul , Turkey
| | - Aysegul Kilic
- b Faculty of Medicine, Clinical Microbiology and İnfectious Disease , Erciyes University , Kayseri , Turkey
| | - Mehmet Ak
- c Faculty of Medicine, Obstetrics and Gynecology , Erciyes University , Kayseri , Turkey
| | - Mahmut Ozgun
- c Faculty of Medicine, Obstetrics and Gynecology , Erciyes University , Kayseri , Turkey
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Wang B, Li H, Zhang L, He L, Zhang J, Liu C, Wang J, Lv Q, Shang X, Liu J, Xie M. Congenital left atrial appendage aneurysm: A rare case report and literature review. Medicine (Baltimore) 2018; 97:e9344. [PMID: 29480827 PMCID: PMC5943883 DOI: 10.1097/md.0000000000009344] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONALE Left atrial appendage aneurysms (LAAA) are rare. Patients with LAAA are often diagnosed incidentally or after cardiac tachyarrhythmia or systemic thromboembolism happen. Early diagnosis and surgical resection is of utmost importance to prevent hazardous adverse events. PATIENT CONCERNS We present a case of 46-year-old man with congenital LAAA. The individual in this manuscript has given written informed consent to publish these case details. DIAGNOSES Imaging studies, such as echocardiography, cardiovascular computed tomography (CT) and magnetic resonance imaging (MRI), demonstrated the large cavity arising from the left atrial appendage. The diagnosis of LAAA was confirmed. INTERVENTIONS The patient underwent an aneurysmectomy without any complications. OUTCOMES TTE confirmed the disappearance of the LAAA from the left parasternal short-axis view of the aortic root postoperatively. The patient remained asymptomatic without any adverse events at his 3-month follow-up visits. LESSONS The associated high risk of life-threatening complications and the relative ease of surgical removal suggest that prompt evaluation should be considered in patients with lesions adjacent to the left heart border.
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Affiliation(s)
- Bin Wang
- Department of Ultrasound
- Hubei Key Laboratory of Molecular Imaging
| | - He Li
- Department of Ultrasound
- Hubei Key Laboratory of Molecular Imaging
| | - Li Zhang
- Department of Ultrasound
- Hubei Key Laboratory of Molecular Imaging
| | - Lin He
- Department of Ultrasound
- Hubei Key Laboratory of Molecular Imaging
| | - Jing Zhang
- Department of Ultrasound
- Hubei Key Laboratory of Molecular Imaging
| | - Cong Liu
- Department of Ultrasound
- Hubei Key Laboratory of Molecular Imaging
| | - Jing Wang
- Department of Ultrasound
- Hubei Key Laboratory of Molecular Imaging
| | - Qing Lv
- Department of Ultrasound
- Hubei Key Laboratory of Molecular Imaging
| | - Xiaoke Shang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinping Liu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound
- Hubei Key Laboratory of Molecular Imaging
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Price J, Clarke N, Turer A, Quintana E, Mestres C, Huffman L, Peltz M, Wait M, Ring WS, Jessen M, Bajona P. Hypertrophic obstructive cardiomyopathy: review of surgical treatment. Asian Cardiovasc Thorac Ann 2017; 25:594-607. [PMID: 28901158 DOI: 10.1177/0218492317733111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hypertrophic cardiomyopathy ranks among the most common congenital cardiac diseases, affecting up to 1 in 200 of the general population. When it causes left ventricular outflow tract obstruction, treatment is guided to reduce symptoms and the risk of sudden cardiac death. Pharmacologic therapy is the first-line treatment, but when it fails, surgical myectomy or percutaneous ablation of the hypertrophic myocardium are the standard therapies to eliminate subaortic obstruction. Both surgical myectomy and percutaneous ablation are proven safe and effective treatments; however, myectomy is the gold standard with a significantly lower complication rate and more complete and lasting reduction of left ventricular outflow tract obstruction.
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Affiliation(s)
- Jonathan Price
- 1 Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nicholas Clarke
- 1 Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Aslan Turer
- 2 Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Eduard Quintana
- 3 Hospital Clínic de Barcelona, Cardiovascular Surgery Department, Cardiovascular Institute, University of Barcelona Medical School, Barcelona, Spain
| | - Carlos Mestres
- 4 Department of Cardiovascular Surgery, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Lynn Huffman
- 1 Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Matthias Peltz
- 1 Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michael Wait
- 1 Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - W Steves Ring
- 1 Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michael Jessen
- 1 Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Pietro Bajona
- 1 Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,5 Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy
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Abstract
A 68-year-old woman with a history of bipolar disorder was admitted to another hospital with a gastric ulcer. On admission, Takotsubo cardiomyopathy was suspected because her electrocardiogram was abnormal and the characteristic left ventricular wall motion was apparent. On hospital day 11, echocardiography revealed a thrombus in the apex of the left ventricle. She was transferred to our hospital and heparin treatment was commenced. On follow-up echocardiography, the left ventricular wall motion had normalized but thrombus mobility had increased. Thrombectomy was performed via a transmitral approach with endoscopic assistance. Endoscopy allowed excellent visualization of the intracardiac structure.
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Affiliation(s)
- Kenta Zaikokuji
- Department of Cardiovascular Surgery, Heart Valve Center, Komaki City Hospital, Komaki, Aichi, Japan
| | - Masaru Sawazaki
- Department of Cardiovascular Surgery, Heart Valve Center, Komaki City Hospital, Komaki, Aichi, Japan
| | - Shiro Tomari
- Department of Cardiovascular Surgery, Heart Valve Center, Komaki City Hospital, Komaki, Aichi, Japan
| | - Tomonari Uemura
- Department of Cardiovascular Surgery, Heart Valve Center, Komaki City Hospital, Komaki, Aichi, Japan
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35
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Chen H, Yang B, Ju W, Zhang F, Yang G, Gu K, Li M, Liu H, Wang Z, Cao K, Chen M. Substrate characteristics and ablation outcome of left atrial tachycardia in rheumatic mitral valve disease. Pacing Clin Electrophysiol 2017; 40:924-931. [PMID: 28594430 DOI: 10.1111/pace.13099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 03/03/2017] [Accepted: 03/19/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Right atrial tachycardia (AT) is a common arrhythmia postsurgical valve replacement in patients with rheumatic heart disease (RHD). However, the substrate and the mechanism of left AT in such patients and the ablation efficacy is less known. METHODS AND RESULTS Twenty-seven RHD patients with AT were enrolled in this study; nine of them (33%) had left AT. Five and four patients had left AT during the first and second procedure, respectively. A spontaneous scar in the left posterior wall was identified in all patients, and obvious anterior scar in three patients. Dual-roof-dependent AT was found in three patients and macroreentry AT surrounding right pulmonary vein was identified in one patient, two of whom had left anterior scar. Three patients had AT circuit going around the mitral annulus, one of whom had left anterior scar. Entrainment pacing at different sites confirmed the mechanism of these macroreentries. Two patients had a focal origin, one was localized in posterior wall at the edge of the scar and the other one was originated from the left septum with normal voltage. After a mean follow-up of 27.4 ± 7.9 months, the left AT group had a similar recurrence rate compared with the right AT group alone (67% vs 56%, P = 0.58). In the left AT group, 11% of patients had AT recurrence and 56% of patients developed atrial fibrillation. CONCLUSION Left atrial AT can occur in RHD patients postmitral valve replacement. Catheter ablation is feasible with high acute success rate. The incidence of late development atrial fibrillation is considerable after successful ablation.
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Affiliation(s)
- Hongwu Chen
- Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bing Yang
- Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Weizhu Ju
- Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fengxiang Zhang
- Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Gang Yang
- Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kai Gu
- Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Mingfang Li
- Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hailei Liu
- Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zidun Wang
- Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kejiang Cao
- Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Minglong Chen
- Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Abstract
Painted and photographic portraits of others show an asymmetric bias: people favor their left cheek. Both experimental and database studies confirm that the left cheek bias extends to selfies. To date all such selfie studies have been cross-sectional; whether individual selfie-takers tend to consistently favor the same pose orientation, or switch between multiple poses, remains to be determined. The present study thus examined intra-individual consistency in selfie pose orientations. Two hundred selfie-taking participants (100 male and 100 female) were identified by searching #selfie on Instagram. The most recent 10 single-subject selfies for the each of the participants were selected and coded for type of selfie (normal; mirror) and pose orientation (left, midline, right), resulting in a sample of 2000 selfies. Results indicated that selfie-takers do tend to consistently adopt a preferred pose orientation (α = 0.72), with more participants showing an overall left cheek bias (41%) than would be expected by chance (overall right cheek bias = 31.5%; overall midline bias = 19.5%; no overall bias = 8%). Logistic regression modellng, controlling for the repeated measure of participant identity, indicated that sex did not affect pose orientation. However, selfie type proved a significant predictor when comparing left and right cheek poses, with a stronger left cheek bias for mirror than normal selfies. Overall, these novel findings indicate that selfie-takers show intra-individual consistency in pose orientation, and in addition, replicate the previously reported left cheek bias for selfies and other types of portrait, confirming that the left cheek bias also presents within individuals’ selfie corpora.
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Affiliation(s)
- Annukka K Lindell
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora VIC, Australia
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37
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Wang Y, Shan G, Shen J, Zhou Q, Tan B, Liu Y, Luo R, Zhao S, Bi W, Yao F, Li G. Assessment of left ventricular function in chronic alcoholics by real-time three-dimensional echocardiography. Medicine (Baltimore) 2017; 96:e6033. [PMID: 28151910 PMCID: PMC5293473 DOI: 10.1097/md.0000000000006033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Chronic alcohol consumption may lead to progressive cardiac dysfunction. The aim of this study was to evaluate the feasibility of using real-time 3-dimensional echocardiography (3DE) on assessing left ventricular (LV) function in chronic alcoholics.We classified 92 male alcoholics into mild, moderate, and severe groups; 30 age-matched controls were also recruited. LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), LV ejection fraction (LVEF), LV mass (LVM), LV mass index (LVMI), and systolic dyssynchrony index (SDI) were measured by 3DE and 2-dimensional echocardiography (2DE).Compared to the control group, LV volume and mass were higher in the moderate and severe alcoholic groups (P < 0.05). The severe alcoholic (symptomatic) group demonstrated decreased LVEF and increased SDI (detected by 3DE) (P < 0.05).Real-time 3DE can detect the increases of LV volumes and mass in asymptomatic alcoholics, and the changes of LVEF and systolic synchrony index in symptomatic alcoholics.
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Affiliation(s)
- Yuanzheng Wang
- Department of Ultrasound, The Xinhua Affiliated Hospital of Dalian University, Shahekou District, Dalian, Liaoning
| | - Guoxin Shan
- Department of Ultrasound, the Weifang Traditional Chinese Hospital, Kuiwen District, Weifang, Shandong, China
| | - Jiaqi Shen
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University
| | - Qiao Zhou
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University
| | - Bijun Tan
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University
| | - Yue Liu
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University
| | - Runlan Luo
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University
| | - Shifen Zhao
- Department of Ultrasound, The Xinhua Affiliated Hospital of Dalian University, Shahekou District, Dalian, Liaoning
| | - Wenjun Bi
- Department of Ultrasound, The Xinhua Affiliated Hospital of Dalian University, Shahekou District, Dalian, Liaoning
| | - Fangyi Yao
- Department of Ultrasound, The Xinhua Affiliated Hospital of Dalian University, Shahekou District, Dalian, Liaoning
| | - Guangsen Li
- Department of Ultrasound, The Second Affiliated Hospital of Dalian Medical University
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Conrotto F, D'Ascenzo F, D'Amico M, Moretti C, Pavani M, Scacciatella P, Omedè P, Montefusco A, Biondi-Zoccai G, Gaita F, Maisano F, Nietlispach F. Outcomes of patients with low-pressure aortic gradient undergoing transcatheter aortic valve implantation: A Meta-analysis. Catheter Cardiovasc Interv 2016; 89:1100-1106. [PMID: 27862874 DOI: 10.1002/ccd.26839] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 10/08/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND The risk/benefit balance of transcatheter aortic valve implantation (TAVI) in patients with low-gradient aortic stenosis (LGAS) remains to be well defined. Aim of the study was to investigate the impact of LGAS in patients undergoing TAVI. METHODS Medline, Cochrane Library, and Scopus were searched for articles reporting outcome of patients with LGAS undergoing TAVI. The primary endpoint was 12-months all-cause mortality and the secondary endpoint was 30-day all-cause mortality. Using event-rates as dependent variable, a meta-regression was performed to test for interaction between baseline clinical features (age, gender, diabetes mellitus, coronary artery disease, left ventricular ejection fraction (LVEF) and type of implanted valve) and transaortic gradient for the primary endpoint. RESULTS Eight studies with a total of 12,589 patients were included. Almost one-third of the patients presented with LGAS (27.3%: 24.4-29.2). Median LVEF was 48% in patients with LGAS and 56% in patients with high-gradient AS. Patients with LGAS were more likely to have diabetes mellitus, previous coronary artery disease, higher mean Logistic EuroSCORE, and lower EF. At 12 (12-16.6) months, low transaortic gradient emerged as independently associated with all-cause death, both if evaluated as a dichotomous and continuous value (respectively OR 1.17; 1.11-1.23 and OR 1.02; 1-1.04, all CI 95%). Clinical variables, including EF did not affect this result. CONCLUSIONS In a population of TAVI patients, LGAS appears to be independently related to dismal prognosis. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Federico Conrotto
- Division of Cardiology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Maurizio D'Amico
- Division of Cardiology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Claudio Moretti
- Division of Cardiology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Marco Pavani
- Division of Cardiology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Paolo Scacciatella
- Division of Cardiology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Pierluigi Omedè
- Division of Cardiology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Antonio Montefusco
- Division of Cardiology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Francesco Maisano
- Heart Surgery and Cardiology, University Heart Center, Zurich, Switzerland
| | - Fabian Nietlispach
- Heart Surgery and Cardiology, University Heart Center, Zurich, Switzerland
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Abstract
Preserving the subvalvular mitral valve apparatus during mitral valve replacement is extremely important to minimize progressive postoperative left ventricular remodeling and dysfunction. We describe a simple and reproducible surgical technique that prevents the complications that can occur after total mitral anterior leaflet preservation.
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Affiliation(s)
- Javier Gualis
- Department of Cardiac Surgery, Complejo Asistencial Universitario de León, León, Spain
| | - Mario Castaño
- Department of Cardiac Surgery, Complejo Asistencial Universitario de León, León, Spain
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40
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Organ CL, Otsuka H, Bhushan S, Wang Z, Bradley J, Trivedi R, Polhemus DJ, Tang WHW, Wu Y, Hazen SL, Lefer DJ. Choline Diet and Its Gut Microbe-Derived Metabolite, Trimethylamine N-Oxide, Exacerbate Pressure Overload-Induced Heart Failure. Circ Heart Fail 2015; 9:e002314. [PMID: 26699388 DOI: 10.1161/circheartfailure.115.002314] [Citation(s) in RCA: 230] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 11/12/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Trimethylamine N-oxide (TMAO), a gut microbe-dependent metabolite of dietary choline and other trimethylamine-containing nutrients, is both elevated in the circulation of patients having heart failure and heralds worse overall prognosis. In animal studies, dietary choline or TMAO significantly accelerates atherosclerotic lesion development in ApoE-deficient mice, and reduction in TMAO levels inhibits atherosclerosis development in the low-density lipoprotein receptor knockout mouse. METHODS AND RESULTS C57BL6/J mice were fed either a control diet, a diet containing choline (1.2%) or a diet containing TMAO (0.12%) starting 3 weeks before surgical transverse aortic constriction. Mice were studied for 12 weeks after transverse aortic constriction. Cardiac function and left ventricular structure were monitored at 3-week intervals using echocardiography. Twelve weeks post transverse aortic constriction, myocardial tissues were collected to evaluate cardiac and vascular fibrosis, and blood samples were evaluated for cardiac brain natriuretic peptide, choline, and TMAO levels. Pulmonary edema, cardiac enlargement, and left ventricular ejection fraction were significantly (P<0.05, each) worse in mice fed either TMAO- or choline-supplemented diets when compared with the control diet. In addition, myocardial fibrosis was also significantly greater (P<0.01, each) in the TMAO and choline groups relative to controls. CONCLUSIONS Heart failure severity is significantly enhanced in mice fed diets supplemented with either choline or the gut microbe-dependent metabolite TMAO. The present results suggest that additional studies are warranted examining whether gut microbiota and the dietary choline → TMAO pathway contribute to increased heart failure susceptibility.
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Affiliation(s)
- Chelsea L Organ
- From the Department of Pharmacology, Cardiovascular Center of Excellence, Louisiana State University Health Sciences Center, New Orleans (C.L.O., H.O., S.B., J.B., R.T., D.J.P., D.J.L.); Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, OH (Z.W., W.H.W.T., S.L.H.); and Department of Mathematics, Cleveland State University, OH (Y.W.)
| | - Hiroyuki Otsuka
- From the Department of Pharmacology, Cardiovascular Center of Excellence, Louisiana State University Health Sciences Center, New Orleans (C.L.O., H.O., S.B., J.B., R.T., D.J.P., D.J.L.); Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, OH (Z.W., W.H.W.T., S.L.H.); and Department of Mathematics, Cleveland State University, OH (Y.W.)
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Manoğlu B, Yılmaz EM, Erdoğan A, Özkan MB, Özçiftci VM. Report of a rare case: Double recurrent laryngeal nerve. Ulus Cerrahi Derg 2015; 32:298-299. [PMID: 28149132 DOI: 10.5152/ucd.2015.2910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 11/24/2014] [Indexed: 11/22/2022]
Abstract
One of the most important and feared complications of thyroid and parathyroid surgery is injury to the recurrent laryngeal nerve. The main reason for this type of injury is anatomical variations. Currently, nerve monitoring is being widely used to reduce complications due to the high variation rate. However, it is not being used extensively in our country, due to cost related issues. In this case, we present a left sided double recurrent laryngeal nerve.
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Affiliation(s)
- Berke Manoğlu
- Department of General Surgery, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Eyüp Murat Yılmaz
- Department of General Surgery, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Ahmet Erdoğan
- Clinic of General Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Murat Bulut Özkan
- Clinic of General Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
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Affiliation(s)
- Meena Nathan
- Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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Li X, Yu S, Li L, Han D, Dai S, Gao Y. Cirrhosis-related changes in left ventricular function and correlation with the model for end-stage liver disease score. Int J Clin Exp Med 2014; 7:5751-5757. [PMID: 25664102 PMCID: PMC4307549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 11/25/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The purpose of our study is to investigate cirrhosis-related left ventricular remodeling and functional changes, further to analyze the correlations with model for end-stage liver disease (MELD) score. METHODS A total of 89 cirrhotic patients were enrolled for study and subgrouped according to MELD score: ≤ 9, 10-19, and ≥ 20. Thirty healthy individuals were enrolled as controls. All study participants underwent cardiac assessment of the left ventricle with Doppler echocardiography; the parameters assessed included left ventricular-end systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), left atrial diameter (LAD), left ventricular ejection fraction (LVEF), cardiac output (CO), mitral flow velocity (VE/VA ratio), and E-wave deceleration time (DT). RESULTS The cirrhotic patients had significantly higher LVESD, LVEDD, IVST, LAD, CO and DT than the control group, but significantly lower VE/VA ratio (all P < 0.05). Subgroup analysis showed that the higher the MELD score, the greater the increase in LVESD, LVEDD, IVST, LAD and DT (all P < 0.05). Nearly one-half of the cirrhotic patients showed left atrial enlargement and a VE/VA ratio ≤ 1, and these features were more common in patients with MELD score ≥ 20. LAD, LVEDD and DT were positively correlated with MELD score (r = 0.208, 0.319 and 0.197, respectively; all P < 0.05). CONCLUSIONS Patients with cirrhosis had impaired cardiac function, mainly present as left ventricular diastolic dysfunction, and the extent of dysfunction was correlated with the MELD score. Left atrial enlargement and VE/VA ratio ≤ 1 may serve as useful diagnostic indexes for cirrhotic cardiomyopathy.
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Affiliation(s)
- Xiaopeng Li
- Department of Ultrasonic Medicine, The Second Affiliated Hospital, Xi’an Jiaotong University School of MedicineXi’an, China
- Department of Pediatric Surgery, The Second Affiliated Hospital, Xi’an Jiaotong University School of MedicineXi’an, China
| | - Shanshan Yu
- Department of Ultrasonic Medicine, The Second Affiliated Hospital, Xi’an Jiaotong University School of MedicineXi’an, China
| | - Lu Li
- Department of Gastroenterology, The Second Affiliated Hospital, Xi’an Jiaotong University School of MedicineXi’an, China
| | - Donggang Han
- Department of Ultrasonic Medicine, The Second Affiliated Hospital, Xi’an Jiaotong University School of MedicineXi’an, China
| | - Shejiao Dai
- Department of Gastroenterology, The Second Affiliated Hospital, Xi’an Jiaotong University School of MedicineXi’an, China
| | - Ya Gao
- Department of Pediatric Surgery, The Second Affiliated Hospital, Xi’an Jiaotong University School of MedicineXi’an, China
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Zhang H, Liu T, Wang Y, Liu HF, Zhang JT, Wu YS, Lei L, Wang HB. Laparoscopic left hepatectomy in swine: a safe and feasible technique. J Vet Sci 2014; 15:417-22. [PMID: 24962406 PMCID: PMC4178143 DOI: 10.4142/jvs.2014.15.3.417] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 06/19/2014] [Indexed: 01/09/2023] Open
Abstract
A purely laparoscopic four-port approach was created for left hepatectomy in pigs. A polyethylene loop was placed on the left two hepatic lobes for traction and lift. Next, penetrating ligation of the lobes using of a double row of silk sutures was performed to control bleeding. A direct hepatic transection was completed using a monopolar hook electrode without meticulous dissection of the left hepatic vein. The raw surface of the liver was coagulated and sealed with fibrin glue. Lobes were retrieved through an enlarged portal. Laparoscopic hepatic lobectomy was completed in all pigs without the use of specialized instruments and with a mean operative time of 179 ± 9 min. No significant perioperative complications were observed. The average weight of each resected lobe was 180 ± 51 g. Complete blood count as well as serum organics and enzyme levels normalized after about 2 weeks. During necropsy, adhesion of the hepatic raw surface to the gastric wall and omentum were observed. No other abnormalities were identified. This minimally invasive left hepatectomy technique in swine could serve as a useful model for investigating liver diseases and regeneration, and offer preclinical information to improve hepatobiliary surgical procedures.
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Affiliation(s)
- Hua Zhang
- Department of Veterinary Surgery, College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, China
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Abstract
OBJECTIVE The impact of diastolic function on the clinical outcome of surgical ventricular restoration remains controversial. METHODS 71 patients undergoing surgical ventricular restoration between 1999 and 2012 were investigated. Perioperative echocardiographic parameters were compared, risk factors for deaths and cardiac events were analyzed, and actuarial freedom from death and cardiac events was computed. RESULTS Preoperatively, the left ventricular end-systolic volume index was 77 ± 40 mL·m(-2) and left ventricular ejection fraction was 33% ± 11%. Postoperatively, left ventricular systolic function was significantly improved (end-systolic volume index 49 ± 31 mL·m(-2), ejection fraction 42.1% ± 11.7%) with a 33.8% ± 21.9% reduction in left ventricular end-systolic volume index. The transmitral filling deceleration time decreased from 198 ± 54 to 150 ± 46 ms, and the ratio of early peak filling velocities increased significantly postoperatively (from 16 ± 10 to 21 ± 17). Freedom from death and cardiac events at 5 years was 78% ± 5% and 64% ± 6%, respectively. Multivariate analyses revealed that age was a significant risk factor for all-cause death, postoperative transmitral inflow pattern for cardiac death, and preoperative mitral regurgitation and postoperative transmitral inflow pattern for cardiac events. CONCLUSION Despite its positive impact on systolic function, surgical ventricular restoration negatively affects postoperative diastolic function. Postoperative severe diastolic dysfunction may correlate with late mortality and cardiac events.
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Affiliation(s)
- Takeshi Shimamoto
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Genichi Sakaguchi
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
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Abstract
Paraduodenal hernia is a rare congenital anomaly that arises from an error of rotation of the midgut. The duodenum and the small intestine become trapped in a sac which is lined by the peritoneum, behind the mesentery of the colon, either to the right or left of the midline. It is therfore a rare and potentially life-threatening condition that can cause intestinal obstruction progressing to strangulation and perforation. We report a case of a 55-year-old patient presenting a left paraduodenal hernia diagnosed intraoperatively after being operated on in the emergency setting for acute abdomen. The small bowel was twisted upon its mesentery and was entrapped in a large left paraduodenal space. Fortunately, once the bowel was reduced from the paraduodenal space, the blood flow was reestablished and the small bowel resumed a proper functioning. The mouth of the sac was obliterated by suture opposition to the posterior wall. The patient's subsequent hospital course was uneventful, and he was discharged in satisfactory condition 4 days postoperatively.
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Affiliation(s)
- Karim Ibn Majdoub Hassani
- Faculté de Médecine et de Pharmacie de Fès, Université Sidi Mohammed Ben Abdellah, Département de Chirurgie, CHU Hassan II, Fès, Maroc
| | - Younes Aggouri
- Faculté de Médecine et de Pharmacie de Fès, Université Sidi Mohammed Ben Abdellah, Département de Chirurgie, CHU Hassan II, Fès, Maroc
| | - Said Ait Laalim
- Faculté de Médecine et de Pharmacie de Fès, Université Sidi Mohammed Ben Abdellah, Département de Chirurgie, CHU Hassan II, Fès, Maroc
| | - Imane Toughrai
- Faculté de Médecine et de Pharmacie de Fès, Université Sidi Mohammed Ben Abdellah, Département de Chirurgie, CHU Hassan II, Fès, Maroc
| | - Khalid Mazaz
- Faculté de Médecine et de Pharmacie de Fès, Université Sidi Mohammed Ben Abdellah, Département de Chirurgie, CHU Hassan II, Fès, Maroc
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Abstract
BACKGROUND In some patients with ischemic cardiomyopathy, despite large increases in ventricular size with decreased cardiac output, the paradox of preserved stroke volume has been observed. Following surgical ventricular restoration, despite marked improvements clinically and in ventricular volumes and ejection fraction, a decrease in stroke volume was observed. METHODS 101 consecutive patients with postinfarction left ventricular aneurysms were studied by 2-dimensional echocardiography and contrast ventriculography at baseline, and 57 of these patients at 1.7 to 2.2 years (mean 1.95 ± 0.44 years) after surgical ventricular restoration. RESULTS Surgical ventricular restoration resulted in a decrease in end-diastolic volume index of 40.2 mL (95% confidence interval: 33.6-46.7) and stroke volume index of 10.0 mL (95% confidence interval: 6.6-13.5), and an increase in ejection fraction of 6.7% (95% confidence interval: 5.5-7.9). The stroke volume index had a significant linear relationship with the end-diastolic volume index at rest in patients with end-diastolic volume index < 150 mL (r = 0.64, p < 0.001). In patients with end-diastolic volume index >150 mL, this linear relationship was not seen. The change in end-diastolic volume index and stroke volume index had a significant linear relationship (r = 0.72, p < 0.001) that persisted at 1.95 years after surgery. CONCLUSIONS In ischemic cardiomyopathy, stroke volume increases linearly with increases in end-diastolic volume up to a certain magnitude of end-diastolic volume, beyond which it decreases. Hence, following surgical ventricular restoration, decreases in stroke volume are not a reflection of impaired cardiac function.
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Herting MM, Colby JB, Sowell ER, Nagel BJ. White matter connectivity and aerobic fitness in male adolescents. Dev Cogn Neurosci 2013; 7:65-75. [PMID: 24333926 PMCID: PMC4020709 DOI: 10.1016/j.dcn.2013.11.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 11/14/2013] [Accepted: 11/16/2013] [Indexed: 11/25/2022] Open
Abstract
DTI was collected for 34 male adolescents, ages 15–17. Aerobic fitness related to white matter connectivity in frontal and motor tracts. HF had higher tractography streamline counts in CST and Fminor compared to LF. A negative relationship was seen between VO2 peak and FA in the L CST. Exercise is an important environmental factor to consider during neurodevelopment.
Exercise has been shown to have positive effects on the brain and behavior throughout various stages of the lifespan. However, little is known about the impact of exercise on neurodevelopment during the adolescent years, particularly with regard to white matter microstructure, as assessed by diffusion tensor imaging (DTI). Both tract-based spatial statistics (TBSS) and tractography-based along-tract statistics were utilized to examine the relationship between white matter microstructure and aerobic exercise in adolescent males, ages 15–18. Furthermore, we examined the data by both (1) grouping individuals based on aerobic fitness self-reports (high fit (HF) vs. low fit (LF)), and (2) using VO2 peak as a continuous variable across the entire sample. Results showed that HF youth had an overall higher number of streamline counts compared to LF peers, which was driven by group differences in corticospinal tract (CST) and anterior corpus callosum (Fminor). In addition, VO2 peak was negatively related to FA in the left CST. Together, these results suggest that aerobic fitness relates to white matter connectivity and microstructure in tracts carrying frontal and motor fibers during adolescence. Furthermore, the current study highlights the importance of considering the environmental factor of aerobic exercise when examining adolescent brain development.
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Affiliation(s)
- Megan M Herting
- Department of Pediatrics, Keck School of Medicine at USC/Children's Hospital of Los Angeles, Los Angeles, CA, USA.
| | - John B Colby
- David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Elizabeth R Sowell
- Department of Pediatrics, Keck School of Medicine at USC/Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Bonnie J Nagel
- Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail-Code: DC7P, Portland, OR 97239, USA; Department of Behavioral Neuroscience, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail-Code: DC7P, Portland, OR 97239, USA
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Abstract
BACKGROUND Postoperative atrial fibrillation is the most common arrhythmia after coronary artery bypass grafting, with a reported incidence of 10% to 60%. Preoperative clinical and echocardiographic data, especially the atrial electromechanical interval, predict postoperative atrial fibrillation in elective coronary artery bypass patients. METHODS A prospective study evaluated preoperative clinical and echocardiographic data in 192 patients who underwent elective coronary artery bypass from 2010 to 2012. RESULTS 18 (9.37%) patients developed postoperative atrial fibrillation. Compared to patients without postoperative atrial fibrillation, these 18 had significantly longer intensive care unit and hospital stays, they were significantly older (58.62 ± 10.02 vs. 53.22 ± 8.23 years; p = 0.02), with a larger left atrial volume (83.39 ± 8.31 vs. 55.47 ± 8.37 cm(3), p = 0.001), longer atrial electromechanical interval (133.67 ± 8.15 vs. 98.05 ± 6.71 ms p < 0.0001), and lower tissue Doppler imaging systolic velocity wave amplitude (6.6 ± 1 vs. 9.4 ± 2.2 cm·s(-1); p = 0.001); they also had a higher prevalence of hypertension (61.11% vs. 38.5%; p = 0.04). Using 115 ms as the cutoff value of atrial electromechanical interval enabled us to detect patients who developed postoperative atrial fibrillation with 100% sensitivity, 77% specificity, 78% positive predictive value, and 100% negative predictive value. CONCLUSION Older hypertensive patients are at higher risk of developing postoperative atrial fibrillation. Preoperative measurement of atrial electromechanical interval by tissue Doppler echocardiography is a useful predictor of postoperative atrial fibrillation in coronary artery bypass patients.
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Affiliation(s)
- Mohamed Ahmed Elawady
- Saud Al-Babtain Cardiac Center, Dammam, Saudi Arabia Cardiothoracic Surgery Department, Banha Faculty of Medicine, Banha University, Egypt
| | - Mohamed Bashandy
- Saud Al-Babtain Cardiac Center, Dammam, Saudi Arabia Cardiology Department, Faculty of Medicine, Alazhar University, Egypt
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Stephen JM, Coffman BA, Jung RE, Bustillo JR, Aine CJ, Calhoun VD. Using joint ICA to link function and structure using MEG and DTI in schizophrenia. Neuroimage 2013; 83:418-30. [PMID: 23777757 DOI: 10.1016/j.neuroimage.2013.06.038] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 06/05/2013] [Accepted: 06/07/2013] [Indexed: 11/19/2022] Open
Abstract
In this study we employed joint independent component analysis (jICA) to perform a novel multivariate integration of magnetoencephalography (MEG) and diffusion tensor imaging (DTI) data to investigate the link between function and structure. This model-free approach allows one to identify covariation across modalities with different temporal and spatial scales [temporal variation in MEG and spatial variation in fractional anisotropy (FA) maps]. Healthy controls (HC) and patients with schizophrenia (SP) participated in an auditory/visual multisensory integration paradigm to probe cortical connectivity in schizophrenia. To allow direct comparisons across participants and groups, the MEG data were registered to an average head position and regional waveforms were obtained by calculating the local field power of the planar gradiometers. Diffusion tensor images obtained in the same individuals were preprocessed to provide FA maps for each participant. The MEG/FA data were then integrated using the jICA software (http://mialab.mrn.org/software/fit). We identified MEG/FA components that demonstrated significantly different (p<0.05) covariation in MEG/FA data between diagnostic groups (SP vs. HC) and three components that captured the predominant sensory responses in the MEG data. Lower FA values in bilateral posterior parietal regions, which include anterior/posterior association tracts, were associated with reduced MEG amplitude (120-170 ms) of the visual response in occipital sensors in SP relative to HC. Additionally, increased FA in a right medial frontal region was linked with larger amplitude late MEG activity (300-400 ms) in bilateral central channels for SP relative to HC. Step-wise linear regression provided evidence that right temporal, occipital and late central components were significant predictors of reaction time and cognitive performance based on the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) cognitive assessment battery. These results point to dysfunction in a posterior visual processing network in schizophrenia, with reduced MEG amplitude, reduced FA and poorer overall performance on the MATRICS. Interestingly, the spatial location of the MEG activity and the associated FA regions are spatially consistent with white matter regions that subserve these brain areas. This novel approach provides evidence for significant pairing between function (neurophysiology) and structure (white matter integrity) and demonstrates that this multivariate, multimodal integration technique is sensitive to group differences in function and structure.
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Affiliation(s)
- J M Stephen
- The Mind Research Network and Lovelace Biomedical and Environmental Research Institute, 1101 Yale Blvd NE, Albuquerque, NM 87106, USA.
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