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Van Puyvelde J, Meyns B, Rega F, Gewillig M, Eyskens B, Heying R, Cools B, Salaets T, Hellings PW, Meuris B. Mitral valve replacement in children: balancing durability and risk with mechanical and bioprosthetic valves. Interdiscip Cardiovasc Thorac Surg 2024; 38:ivae034. [PMID: 38447197 PMCID: PMC10948284 DOI: 10.1093/icvts/ivae034] [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: 11/18/2023] [Revised: 02/09/2024] [Accepted: 03/05/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVES To investigate if there is still a place for bioprosthetic mitral valve replacement in children by comparing the prosthetic durability and transplant-free survival after bioprosthetic and mechanical mitral valve replacement. METHODS We reviewed all mitral valve replacements in children between 1981 and 2020. Bioprosthetic mitral valve replacement cases were individually matched to mechanical mitral valve replacement cases. The incidence rate of a 2nd replacement was calculated using the cumulative incidence function that considered death or transplantation as a competing risk. RESULTS The median age at implantation was 3.6 years (interquartile range 0.8-7.9) for the bioprosthetic valve cohort (n = 28) and 3 years (interquartile range 1.3-7.8) for the mechanical valve cohort (n = 28). Seven years after bioprosthetic mitral valve replacement, the cumulative incidence of death or transplantation was 17.9% [95% confidence interval (CI) 6.3-34.1] and the cumulative incidence of a 2nd replacement was 63.6% (95% CI 39.9-80.1). Seven years after mechanical mitral valve replacement, the cumulative incidence of death or transplantation was 28.6% (95% CI 13.3-46) and the cumulative incidence of a 2nd replacement was 10.7% (95% CI 2.6-25.5). Fifteen years after mechanical mitral valve replacement, the cumulative incidence of death or transplantation was 33.6% (95% CI 16.2-52.1) and the cumulative incidence of a 2nd replacement was 41.1% (95% CI 18.4-62.7). The cumulative incidence curves for bioprosthetic and mechanical mitral valve replacement were statistically different for a 2nd valve replacement (P < 0.001) but not for death or transplantation (P = 0.33). CONCLUSIONS There is no difference in transplant-free survival after bioprosthetic and mechanical mitral valve replacement in children. The lifespan of bioprosthetic mitral valves remains limited in children because of structural valve failure due to calcification. After 15 years, 40% of mechanical valves were replaced, primarily because of patient-prosthesis mismatch related to somatic growth.
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Affiliation(s)
- Joeri Van Puyvelde
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Bart Meyns
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Marc Gewillig
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Pediatric and Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Benedicte Eyskens
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Pediatric and Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Ruth Heying
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Pediatric and Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Bjorn Cools
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Pediatric and Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Thomas Salaets
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Pediatric and Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
| | | | - Bart Meuris
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
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McMahon CJ, Milanesi O, Pitkänen-Argillander O, Albert-Brotons DC, Michel-Behnke I, Voges I, Sendzikaite S, Heying R. Assessment for learning of paediatric cardiology trainees in 41 centres from 19 European countries. Cardiol Young 2024; 34:588-596. [PMID: 37641941 DOI: 10.1017/s1047951123003098] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND Limited data exist on how trainees in paediatric cardiology are assessed among countries affiliated with the Association of European Paediatric and Congenital Cardiology. METHODS A structured and approved questionnaire was circulated to educationalists/trainers in 95 Association for European Paediatric and Congenital Cardiology training centres. RESULTS Trainers from 46 centres responded with complete data in 41 centres. Instructional design included bedside teaching (41/41), didactic teaching (38/41), problem-based learning (28/41), cardiac catheterisation calculations (34/41), journal club (31/41), fellows presenting in the multidisciplinary meeting (41/41), fellows reporting on echocardiograms (34/41), clinical simulation (17/41), echocardiography simulation (10/41), and catheterisation simulation (3/41). Assessment included case-based discussion (n = 27), mini-clinical evaluation exercise (mini-CEX) (n = 12), directly observed procedures (n = 12), oral examination (n = 16), long cases (n = 11), written essay questions (n = 6), multiple choice questions (n = 5), and objective structured clinical examination (n = 2). Entrustable professional activities were utilised in 10 (24%) centres. Feedback was summative only in 17/41 (41%) centres, formative only in 12/41 (29%) centres and a combination of formative and summative feedback in 10/41 (24%) centres. Written feedback was provided in 10/41 (24%) centres. Verbal feedback was most common in 37/41 (90 %) centres. CONCLUSION There is a marked variation in instructional design and assessment across European paediatric cardiac centres. A wide mix of assessment tools are used. Feedback is provided by the majority of centres, mostly verbal summative feedback. Adopting a programmatic assessment focusing on competency/capability using multiple assessment tools with regular formative multisource feedback may promote assessment for learning of paediatric cardiology trainees.
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Affiliation(s)
- Colin J McMahon
- Department of Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
- School of Health Professions Education (SHE), Maastricht University, Maastricht, Netherlands
| | - Ornella Milanesi
- Paediatric Cardiac Unit, Department of Paediatrics, University of Padova, School of Medicine, Padua, Italy
| | | | | | - Ina Michel-Behnke
- Division of Pediatric Cardiology, University Hospital for Children and Adolescent Medicine, Paediatric Heart Centre, Medical University Vienna, Vienna, Austria
| | - Inga Voges
- Department for Congenital Heart Disease and Paediatric Cardiology, University Hospital Schleswig Holstein, Kiel, Germany
| | | | - Ruth Heying
- Department of Paediatric Cardiology, University Hospital Leuven, Leuven, Belgium
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McMahon CJ, Voges I, Jenkins P, Brida M, van der Bosch AE, Dellborg M, Heying R, Stein JI, Georgiev B, Mesihovic-Dinarevic S, Prokšelj K, Oskarsson G, Frogoudaki A, Karagöz T, Jossif A, Doros G, Nielsen D, Jalanko M, Sanchez Perez I, Alvares S, Estensen ME, Petropoulos A, Tagen R, Gumbienė L, Michel-Behnke I, Olejnik P, Clift PF, Sendzikaite S, Albert-Brotons DC, Rhodes M, Pitkänen O, Bassareo PP, Gatzoulis MA, Walsh K, Milanesi O, Ladouceur M, Chessa M, Budts W. Adult congenital heart disease training in Europe: current status, disparities and potential solutions. Open Heart 2023; 10:e002558. [PMID: 38097363 PMCID: PMC10729203 DOI: 10.1136/openhrt-2023-002558] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES This study aimed to determine the status of training of adult congenital heart disease (ACHD) cardiologists in Europe. METHODS A questionnaire was sent to ACHD cardiologists from 34 European countries. RESULTS Representatives from 31 of 34 countries (91%) responded. ACHD cardiology was recognised by the respective ministry of Health in two countries (7%) as a subspecialty. Two countries (7%) have formally recognised ACHD training programmes, 15 (48%) have informal (neither accredited nor certified) training and 14 (45%) have very limited or no programme. Twenty-five countries (81%) described training ACHD doctors 'on the job'. The median number of ACHD centres per country was 4 (range 0-28), median number of ACHD surgical centres was 3 (0-26) and the median number of ACHD training centres was 2 (range 0-28). An established exit examination in ACHD was conducted in only one country (3%) and formal certification provided by two countries (7%). ACHD cardiologist number versus gross domestic product Pearson correlation coefficient=0.789 (p<0.001). CONCLUSION Formal or accredited training in ACHD is rare among European countries. Many countries have very limited or no training and resort to 'train people on the job'. Few countries provide either an exit examination or certification. Efforts to harmonise training and establish standards in exit examination and certification may improve training and consequently promote the alignment of high-quality patient care.
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Affiliation(s)
- Colin J McMahon
- Children's Health Ireland at Crumlin, Crumlin, Ireland
- University College Dublin School of Medicine, Dublin, Ireland
| | | | - Petra Jenkins
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Margarita Brida
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
- Medical Rehabilitation, University of Rijeka Faculty of Medicine, Rijeka, Croatia
| | | | - Mikael Dellborg
- Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ruth Heying
- Department Paediatric Cardiology Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Jörg I Stein
- Department of Paediatric Cardiology, Medical University Innsbruck, Innsbruck, Austria
| | | | | | - Katja Prokšelj
- Department of cardiology, University of Ljubljana Faculty of Medicine, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | | | - Tevfik Karagöz
- Department of Paediatric Cardiology, Hacettepe Universty Ihsan Dogramacı Children's Hospital, Ankara, Turkey
| | - Antonis Jossif
- Paedi Center for Specialized Pediatrics, Strovolos, Cyprus
| | - Gabriela Doros
- Paediatric Cardiology, Louis Turcanu Emergency Children Hospital, Timisoara, Romania
| | - Dorte Nielsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Mikko Jalanko
- Heart and Lung Centre, HYKS sairaanhoitopiiri, Helsinki, Finland
| | | | - Sílvia Alvares
- Pediatric Cardiology Department, Oporto Medical Center, Porto, Portugal
| | | | - Andreas Petropoulos
- Ped.Cardiology, Merkezi klinika, Baku, Azerbaijan
- Pediatrics, Azerbaycan Tibb Universiteti Nariman Narimanov, Baku, Azerbaijan
| | - Raili Tagen
- Department of Cardiac Surgery, Tartu University Hospital, Tartu, Estonia
| | - Lina Gumbienė
- Clinic of Cardiac and Vascular Diseases, Vilniaus universitetas Medicinos fakultetas, Vilnius, Lithuania
- Centre of Cardiology and Angiology, Vilniaus Universiteto ligonines Santariskiu klinikos, Vilnius, Lithuania
| | - Ina Michel-Behnke
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Peter Olejnik
- Department of Pediatric Cardiology, Comenius University, Bratislava, Slovakia
| | - Paul F Clift
- Grown Up Congenital Heart Disease Unit, Queen Elizabeth Hospital, Birmingham, UK
| | | | | | | | - Olli Pitkänen
- Divisions of Pediatric Cardiology, Children's Hospital/Helsinki University Hospital, Helsinki, Finland
| | | | - Michael A Gatzoulis
- Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK
| | - Kevin Walsh
- Heart House, Mater Misericordiae Hospital, Dublin, Ireland
| | | | - Magalie Ladouceur
- Cardiology, Hopital Europeen Georges Pompidou, Paris, France
- Pediatric Cardiology, Hopital universitaire Necker-Enfants malades, Paris, France
| | - Massimo Chessa
- Pediatric Cardiology Department and GUCH Unit, Policlinico San Donato, San Donato Milanese, Italy
| | - Werner Budts
- Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium
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Kabirian F, Mozafari M, Mela P, Heying R. Incorporation of Controlled Release Systems Improves the Functionality of Biodegradable 3D Printed Cardiovascular Implants. ACS Biomater Sci Eng 2023; 9:5953-5967. [PMID: 37856240 DOI: 10.1021/acsbiomaterials.3c00559] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
New horizons in cardiovascular research are opened by using 3D printing for biodegradable implants. This additive manufacturing approach allows the design and fabrication of complex structures according to the patient's imaging data in an accurate, reproducible, cost-effective, and quick manner. Acellular cardiovascular implants produced from biodegradable materials have the potential to provide enough support for in situ tissue regeneration while gradually being replaced by neo-autologous tissue. Subsequently, they have the potential to prevent long-term complications. In this Review, we discuss the current status of 3D printing applications in the development of biodegradable cardiovascular implants with a focus on design, biomaterial selection, fabrication methods, and advantages of implantable controlled release systems. Moreover, we delve into the intricate challenges that accompany the clinical translation of these groundbreaking innovations, presenting a glimpse of potential solutions poised to enable the realization of these technologies in the realm of cardiovascular medicine.
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Affiliation(s)
- Fatemeh Kabirian
- Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven 3000, Belgium
| | - Masoud Mozafari
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu FI-90014, Finland
| | - Petra Mela
- Medical Materials and Implants, Department of Mechanical Engineering, Munich Institute of Biomedical Engineering, and TUM School of Engineering and Design, Technical University of Munich, Munich 80333, Germany
| | - Ruth Heying
- Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven 3000, Belgium
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O'Gorman P, Nair L, Kisiel N, Hughes I, Huang K, Hsu CCT, Fagman E, Heying R, Pizzi MN, Roque A, Singh K. Meta-analysis assessing the sensitivity and specificity of 18F-FDG PET/CT for the diagnosis of prosthetic valve endocarditis (PVE) using individual patient data (IPD). Am Heart J 2023; 261:21-34. [PMID: 36934977 DOI: 10.1016/j.ahj.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/27/2023] [Accepted: 03/12/2023] [Indexed: 05/26/2023]
Abstract
IMPORTANCE The use of 18F-FDG PET/CT in diagnostic algorithms for PVE has increased since publication of studies and guidelines advocating its use. The assessment of test accuracy has been limited by small study sizes. We undertook a systematic review using individual patient data (IPD) meta-analysis techniques. OBJECTIVE To estimate the summary sensitivity and specificity of 18F-FDG PET/CT in diagnosing PVE. We also assessed the effect of patient factors on test accuracy as defined by changes in the odds ratios associated with each factor. The effect of the PET/CT study on the final diagnosis was also assessed when compared to the preliminary Duke classification to determine in which patient group 18F-FDG PET/CT had the greatest utility. STUDY SELECTION Studies were included if PET/CT was performed for suspicion of PVE and IPD of both the PET/CT result and final diagnosis defined by a gold-standard assessment was available. There were 3 possible final diagnoses ("definite PVE," "possible PVE," and "rejected PVE"). RESULTS Seventeen studies were included with IPD available for 537 patients (from 538 scans). The summary sensitivity and specificity were 85% (95% CI 74.2%-91.8%) and 86.5% (95% CI 75.8%-92.9%) respectively when patients with final diagnosis of "possible PVE" were classified as positive for PVE. When this group was classified as negative for PVE, sensitivity was 87.4% (95% CI 80.4%-92.1%) and specificity was 84.9% (95% CI 71.5%-92.6%). Patients with a known pathogen (especially coagulase negative staphylococcal species), elevated CRP, a biological or aortic valve infection appeared more likely to have an accurate PET/CT diagnosis. Those with a mechanical valve, prior antibiotic treatment or a transcatheter aortic valve replacement valve were less likely to have an accurate test. Time since valve implantation and the presence of surgical adhesive did not appear to affect test accuracy. Of the patients with a preliminary Duke classification of "possible PVE," 84% received a more conclusive final diagnosis of "definite" or "rejected" PVE after the PET/CT study. CONCLUSIONS AND RELEVANCE 18F-FDG PET/CT has high sensitivity and specificity in diagnosing PVE and the diagnostic utility is greatest in patients with a preliminary Duke classification of "possible PVE." Some patient factors appear to affect test accuracy, though these results should be interpreted with caution given low patient numbers for subgroup analyses.
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Affiliation(s)
- Patricia O'Gorman
- Medical Imaging Department, Gold Coast University Hospital (Queensland Health), Southport, Australia.
| | - Lawrence Nair
- Department of Cardiothoracic Surgery, The Prince Charles Hospital (Queensland Health), Brisbane, Australia
| | - Nadya Kisiel
- Department of Nuclear Medicine, Royal Brisbane and Women's Hospital (Queensland Health), Brisbane, Australia
| | - Ian Hughes
- Office for Research Governance and Development (Biostatistics), Gold Coast University Hospital (Queensland Health), Southport, Australia; School of Medicine, The University of Queensland, Brisbane, Australia
| | - Karen Huang
- Medical Imaging Department, Gold Coast University Hospital (Queensland Health), Southport, Australia
| | - Charlie Chia-Tsong Hsu
- Medical Imaging Department, Gold Coast University Hospital (Queensland Health), Southport, Australia
| | - Erika Fagman
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ruth Heying
- Pediatric Cardiology, University Hospitals Leuven, Belgium
| | - María N Pizzi
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Albert Roque
- Universitat Autònoma de Barcelona, Barcelona, Spain; Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Institut de Diagnòstic per la Imatge (IDI), Barcelona, Spain; Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Kuljit Singh
- Cardiology Department, Gold Coast University Hospital (Queensland Health), Southport, Australia
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Dutilleux T, Farhat N, Heying R, Seghaye MC, Beghetti M. Growing up with Idiopathic Pulmonary Arterial Hypertension: An Arduous Journey. Pediatr Rep 2023; 15:301-310. [PMID: 37218926 PMCID: PMC10204495 DOI: 10.3390/pediatric15020026] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 05/24/2023] Open
Abstract
Idiopathic pulmonary arterial hypertension (IPAH) is an uncommon and severe disease. We report the case of a 7-year-old boy investigated for cardiac murmur and exercise intolerance. Pulmonary hypertension (PH) was suspected at clinical examination and confirmed by echocardiography and cardiac catheterization. This case of pulmonary hypertension was classified as idiopathic given the negative etiological investigation. Vasoreactive testing with oxygen and nitric oxide was negative. Therefore, treatment with sildenafil (1.4 mg/kg/d) and bosentan (3 mg/kg/d) was initiated. This allowed the stabilization of, but not a decrease in, pulmonary artery pressure for the next 5 years, during which the patient's quality of life was significantly reduced. At a later follow-up, the estimated pulmonary pressure was found to have increased and become supra-systemic, with a consequent deterioration in the child's condition. This led to the decision to enter him into a clinical trial that is still ongoing. Idiopathic pulmonary arterial hypertension is a severe disease that can present with non-specific symptoms, such as asthenia and exercise limitation, which are important not to trivialize. The disease is associated with significantly decreased quality of life in affected children and carries a high burden in terms of mortality and morbidity. The current knowledge about IPAH in children is reviewed, with a particular focus on the future prospects for its treatment and the related quality of life of patients.
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Affiliation(s)
- Tanguy Dutilleux
- Department of Pediatric Cardiology, University Hospital Aachen, 52074 Aachen, Germany
| | - Nesrine Farhat
- Department of Pediatric Cardiology, Centre Hospitalier Universitaire de Liège, 4000 Liège, Belgium
| | - Ruth Heying
- Department of Pediatric Cardiology, University Hospital Leuven, 3000 Leuven, Belgium
| | - Marie-Christine Seghaye
- Department of Pediatric Cardiology, Centre Hospitalier Universitaire de Liège, 4000 Liège, Belgium
| | - Maurice Beghetti
- Department of Pediatric Cardiology, Children’s University Hospital Geneva, 1205 Geneva, Switzerland
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Kabirian F, Baatsen P, Smet M, Shavandi A, Mela P, Heying R. Carbon nanotubes as a nitric oxide nano-reservoir improved the controlled release profile in 3D printed biodegradable vascular grafts. Sci Rep 2023; 13:4662. [PMID: 36949216 PMCID: PMC10033655 DOI: 10.1038/s41598-023-31619-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/14/2023] [Indexed: 03/24/2023] Open
Abstract
Small diameter vascular grafts (SDVGs) are associated with a high failure rate due to poor endothelialization. The incorporation of a nitric oxide (NO) releasing system improves biocompatibility by using the NO effect to promote endothelial cell (EC) migration and proliferation while preventing bacterial infection. To circumvent the instability of NO donors and to prolong NO releasing, S-nitroso-N-acetyl-D-penicillamine (SNAP) as a NO donor was loaded in multi-walled carbon nanotubes (MWCNTs). Successful loading was confirmed with a maximum SNAP amount of ~ 5% (w/w) by TEM, CHNS analysis and FTIR spectra. SDVGs were 3D printed from polycaprolactone (PCL) and coated with a 1:1 ratio of polyethylene glycol and PCL dopped with different concentrations of SNAP-loaded matrix and combinations of MWCNTs-OH. Coating with 10% (w/w) SNAP-matrix-10% (w/w) SNAP-MWCNT-OH showed a diminished burst release and 18 days of NO release in the range of 0.5-4 × 10-10 mol cm-2 min-1 similar to the NO release from healthy endothelium. NO-releasing SDVGs were cytocompatible, significantly enhanced EC proliferation and migration and diminished bacterial viability. The newly developed SNAP-loaded MWCNT-OH has a great potential to develop NO releasing biomaterials with a prolonged, controlled NO release promoting in-situ endothelialization and tissue integration in vivo, even as an approach towards personalized medicine.
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Affiliation(s)
- Fatemeh Kabirian
- Department of Cardiovascular Sciences, Cardiovascular Developmental Biology, KU Leuven, Leuven, Belgium.
| | - Pieter Baatsen
- VIB-KU Leuven Center for Brain and Disease Research, Department of Neurosciences, KU Leuven and EM-Platform of VIB Bio Imaging Core at KU Leuven, Leuven, Belgium
| | - Mario Smet
- Department of Chemistry, Polymer Chemistry and Materials, KU Leuven, Leuven, Belgium
| | - Amin Shavandi
- École Polytechnique de Bruxelles, 3BIO-BioMatter, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Petra Mela
- Medical Materials and Implants, Department of Mechanical Engineering and Munich Institute of Biomedical Engineering, TUM School of Engineering and Design, Technical University of Munich, Garching, Germany
| | - Ruth Heying
- Department of Cardiovascular Sciences, Cardiovascular Developmental Biology, KU Leuven, Leuven, Belgium
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Salaets T, Cools B, De Meester P, Heying R, Boshoff D, Eyskens B, Brown S, Meyns B, Rega F, Van Puyvelde J, Budts W, Gewillig M. Stent expansion of restrictive Fontan conduits to nominal diameter and beyond. Catheter Cardiovasc Interv 2022; 100:1059-1066. [DOI: 10.1002/ccd.30438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 09/09/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Thomas Salaets
- Department of Cardiovascular Sciences, Pediatric & Congenital Cardiology, University Hospitals Leuven Catholic University Leuven Leuven Belgium
| | - Bjorn Cools
- Department of Cardiovascular Sciences, Pediatric & Congenital Cardiology, University Hospitals Leuven Catholic University Leuven Leuven Belgium
| | - Pieter De Meester
- Department of Cardiovascular Sciences Catholic University Leuven Leuven Belgium
| | - Ruth Heying
- Department of Cardiovascular Sciences, Pediatric & Congenital Cardiology, University Hospitals Leuven Catholic University Leuven Leuven Belgium
| | - Derize Boshoff
- Department of Cardiovascular Sciences, Pediatric & Congenital Cardiology, University Hospitals Leuven Catholic University Leuven Leuven Belgium
| | - Benedicte Eyskens
- Department of Cardiovascular Sciences, Pediatric & Congenital Cardiology, University Hospitals Leuven Catholic University Leuven Leuven Belgium
| | - Stephen Brown
- Department of Cardiovascular Sciences, Pediatric & Congenital Cardiology, University Hospitals Leuven Catholic University Leuven Leuven Belgium
- Pediatric Cardiology University of the Free State Bloemfontein Free State South Africa
| | - Bart Meyns
- Department of Cardiovascular Sciences Catholic University Leuven Leuven Belgium
| | - Filip Rega
- Department of Cardiovascular Sciences Catholic University Leuven Leuven Belgium
| | - Joeri Van Puyvelde
- Department of Cardiovascular Sciences Catholic University Leuven Leuven Belgium
| | - Werner Budts
- Department of Cardiovascular Sciences Catholic University Leuven Leuven Belgium
| | - Marc Gewillig
- Department of Cardiovascular Sciences, Pediatric & Congenital Cardiology, University Hospitals Leuven Catholic University Leuven Leuven Belgium
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Farhat N, Heying R, Rüffer A, Vazquez-Jimenez J, Beghetti M, Seghaye M. Influence of hemodynamic overload with or without pressure overload on myocardial remodeling in children with congenital cardiac defect: Implication of exosomes and intracellular fibrosis activation pathways. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2022.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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10
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Kabirian F, Haghighipour N, Mela P, Heying R. Editorial: Additive Manufacturing Applications in Cardiovascular Research. Front Bioeng Biotechnol 2022; 10:970932. [PMID: 35903790 PMCID: PMC9315366 DOI: 10.3389/fbioe.2022.970932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Fatemeh Kabirian
- Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- *Correspondence: Fatemeh Kabirian,
| | | | - Petra Mela
- Medical Materials and Implants, Department of Mechanical Engineering and Munich Institute of Biomedical Engineering, TUM School of Engineering and Design, Technical University of Munich, Garching, Germany
| | - Ruth Heying
- Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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11
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Kabirian F, Mela P, Heying R. 4D Printing Applications in the Development of Smart Cardiovascular Implants. Front Bioeng Biotechnol 2022; 10:873453. [PMID: 35694223 PMCID: PMC9174528 DOI: 10.3389/fbioe.2022.873453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/22/2022] [Indexed: 12/25/2022] Open
Abstract
Smart materials are able to react to different stimuli and adapt their shape to the environment. Although the development of 3D printing technology increased the reproducibility and accuracy of scaffold fabrication, 3D printed scaffolds can still be further improved to resemble the native anatomy. 4D printing is an innovative fabrication approach combining 3D printing and smart materials, also known as stimuli-responsive materials. Especially for cardiovascular implants, 4D printing can promisingly create programmable, adaptable prostheses, which facilitates implantation and/or create the topology of the target tissue post implantation. In this review, the principles of 4D printing with a focus on the applied stimuli are explained and the underlying 3D printing technologies are presented. Then, according to the type of stimulus, recent applications of 4D printing in constructing smart cardiovascular implants and future perspectives are discussed.
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Affiliation(s)
- Fatemeh Kabirian
- Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- *Correspondence: Fatemeh Kabirian,
| | - Petra Mela
- Medical Materials and Implants, Department of Mechanical Engineering and Munich School of BioEngineering, Technical University of Munich, Munich, Germany
| | - Ruth Heying
- Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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12
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Eildermann K, Sigler M, Scheidmann R, Ditkowski B, Heying R. Defined Structural Features Can Favor Infective Endocarditis in Bovine Jugular Vein Valved Conduits. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1743013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- K. Eildermann
- Department of Paediatrics – Paediatric Cardiology, Intensive Care Medicine and Pneumology, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - M. Sigler
- Department of Paediatrics – Paediatric Cardiology, Intensive Care Medicine and Pneumology, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - R. Scheidmann
- Pädiatrische Pneumologie und Allergologie, Altona Children's Hospital, Hamburg, Deutschland
| | - B. Ditkowski
- Giga Cardiovascular, University of Liège, Liège, Belgium
| | - R. Heying
- Pediatric Cardiology, UZ Leuven, Leuven, Belgium
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13
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McMahon CJ, Tretter JT, Redington AN, Bu’Lock F, Zühlke L, Heying R, Mattos S, Krishna Kumar R, Jacobs JP, Windram JD. Medical education and training within congenital cardiology: current global status and future directions in a post COVID-19 world. Cardiol Young 2022; 32:185-197. [PMID: 33843546 PMCID: PMC8111178 DOI: 10.1017/s1047951121001645] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/29/2021] [Accepted: 04/05/2021] [Indexed: 12/26/2022]
Abstract
Despite enormous strides in our field with respect to patient care, there has been surprisingly limited dialogue on how to train and educate the next generation of congenital cardiologists. This paper reviews the current status of training and evolving developments in medical education pertinent to congenital cardiology. The adoption of competency-based medical education has been lauded as a robust framework for contemporary medical education over the last two decades. However, inconsistencies in frameworks across different jurisdictions remain, and bridging gaps between competency frameworks and clinical practice has proved challenging. Entrustable professional activities have been proposed as a solution, but integration of such activities into busy clinical cardiology practices will present its own challenges. Consequently, this pivot towards a more structured approach to medical education necessitates the widespread availability of appropriately trained medical educationalists, a development that will better inform curriculum development, instructional design, and assessment. Differentiation between superficial and deep learning, the vital role of rich formative feedback and coaching, should guide our trainees to become self-regulated learners, capable of critical reasoning yet retaining an awareness of uncertainty and ambiguity. Furthermore, disruptive innovations such as "technology enhanced learning" may be leveraged to improve education, especially for trainees from low- and middle-income countries. Each of these initiatives will require resources, widespread advocacy and raised awareness, and publication of supporting data, and so it is especially gratifying that Cardiology in the Young has fostered a progressive approach, agreeing to publish one or two articles in each journal issue in this domain.
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Affiliation(s)
- Colin J McMahon
- Department of Paediatric Cardiology, Children’s Health Ireland at Crumlin, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - Justin T Tretter
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew N Redington
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Frances Bu’Lock
- Department of Paediatric Cardiology, East Midlands Congenital Heart Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Liesl Zühlke
- Division of Paediatric Cardiology, Department of Paediatrics, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital University of Cape Town, Cape Town, South Africa
| | - Ruth Heying
- Department of Paediatric Cardiology, Leuven, Belgium
| | - Sandra Mattos
- Department of Paediatric Cardiology, Royal Portuguese Hospital, Recife, Brazil
| | - R Krishna Kumar
- Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Jeffrey P Jacobs
- Congenital Heart Center, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida, USA
| | - Jonathan D Windram
- Department of Cardiology, Mazankowski Heart Institute, University of Alberta, Edmonton, Alberta, Canada
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14
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Heying R, Corno AF. Editorial: Insights in pediatric cardiology: 2021. Front Pediatr 2022; 10:1059894. [PMID: 36545672 PMCID: PMC9760917 DOI: 10.3389/fped.2022.1059894] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 11/10/2022] [Indexed: 12/07/2022] Open
Affiliation(s)
- Ruth Heying
- Department of Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Antonio F Corno
- Children Heart Institute, Children's Memorial Hermann Hospital, UT Health Science Center, McGovern Medical School, Houston, TX, United States
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15
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Heying R, d'Udekem Y, Gewillig M, Rychik J. Editorial: The fontan circulation: Problems and solutions. Front Pediatr 2022; 10:1087739. [PMID: 36533231 PMCID: PMC9752022 DOI: 10.3389/fped.2022.1087739] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/18/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- R Heying
- Department of Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Y d'Udekem
- The George Washington University School of Medicine and Health Sciences, Washington, DC, United States.,Division of Cardiovascular Surgery, Children's National Hospital, Washington, DC, USA
| | - M Gewillig
- Department of Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - J Rychik
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, United States
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16
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Theys H, Van den Eynde J, Herregods MC, Moreillon P, Heying R, Oosterlinck W. The role of antiaggregant agents and anticoagulants in the prevention of aortic valve endocarditis: A double-cohort retrospective study. JTCVS Open 2021; 8:301-312. [PMID: 36004157 PMCID: PMC9390520 DOI: 10.1016/j.xjon.2021.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 10/19/2021] [Indexed: 11/23/2022]
Abstract
Objective Antiaggregants (Ag) could prevent infective endocarditis (IE) in preclinical studies. In this study we investigated whether Ag or anticoagulants (Ac) were also protective in humans. Methods In part I we determined the incidence of IE of bioprosthetic aortic valves (PVE) in 333 consecutive patients who underwent aortic valve replacement for noninfective aortic insufficiency between 2009 and 2019. In part II we retrospectively analyzed data of 137 patients who had developed IE of the native aortic valve (NVE) between 2007 and 2015. Multivariable Fine–Gray and logistic regression models were used to investigate associations between Ag and Ac therapy and IE. Results Sixteen of 333 (4.8%) aortic valve replacement recipients developed PVE after a median of 3.72 years. There was no association between Ag and PVE, whereas Ac was associated with a higher IE occurrence (no association for vitamin K antagonists but significant for fondaparinux or low molecular-weight heparins; hazard ratio, 4.61; 95% CI, 1.01-21.9). In contrast, among the 137 patients in part II, vitamin K antagonists (odds ratio [OR], 7.52; 95% CI, 2.51-22.6), double antiplatelet therapy (OR, 44.3; 95% CI, 4.83-407), novel oral Ac (OR, 4.17; 95% CI, 1.15-15.1), and fondaparinux or low molecular-weight heparins (OR, 9.87; 95% CI, 1.81-53.9), but not acetylsalicylic acid, were associated with NVE. Conclusions Ac were associated with IE in both cohorts, whereas Ag were not associated with PVE. This might reflect differences in the studied populations, with Ag and Ac being prescribed for conditions associated with long-term IE risk in the NVE cohort. Therefore, determining the potential protective effect of Ag and Ac will necessitate further well–controlled studies.
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Affiliation(s)
- Hanne Theys
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Jef Van den Eynde
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, Md
| | - Marie-Christine Herregods
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Philippe Moreillon
- Department of Fundamental Microbiology, University Lausanne, Lausanne, Switzerland
| | - Ruth Heying
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Pediatric and Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Wouter Oosterlinck
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Address for reprints: Wouter Oosterlinck, MD, PhD, Department of Cardiovascular Diseases, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
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17
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Leeten K, Ditkowski B, Jashari R, Mela P, Jones EAV, Heying R. An In Vitro Model to Study Endothelialization of Cardiac Graft Tissues Under Flow. Tissue Eng Part C Methods 2021; 27:233-241. [PMID: 33544046 DOI: 10.1089/ten.tec.2020.0359] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Pulmonary valve replacement is performed with excellent resultant hemodynamics in patients that have underlying congenital or acquired heart valve defects. Despite recent advancements in right ventricular outflow tract reconstruction, an increased risk of developing infective endocarditis remains, which has a more common occurrence for conduits of bovine jugular vein (BJV) origin compared with cryopreserved homografts. The reason for this is unclear although it is hypothesized to be associated with an aberrant phenotypic state of cells that reendothelialize the graft tissue postimplantation. The aim of this study was to develop an in vitro model that enables the analysis of endothelial cell (EC) attachment to cardiac graft tissues under flow. In the experiments, EC attachment was optimized on bovine pericardium (BP) patch using human umbilical vein ECs. Different biological coatings, namely gelatin, fibronectin, plasma, or a combination of fibronectin and plasma were tested. After cell adaptation, graft tissues were exposed to laminar flow in a parallel-plate flow chamber. Cell retention to the tissue was analyzed after nuclear staining with YO-PRO-1 and a membranous localization of VE-cadherin. Experiments showed that combined coating with fibronectin and blood plasma together with a two-phased shear pattern resulted in a relevant cell monolayer on BP patch and cryopreserved homograft. For BJV tissue, no adherent cells under both static and shear conditions were initially observed. In conclusion, having established the new flow chamber system we could obtain EC layers on the surface of BP patch and cryopreserved pulmonary homograft tissues. The presented in vitro system can serve as a competent model to study cell phenotypes on cardiac grafts in the close-to-physiologic environment. Moreover, this approach allows broad applications and enables further development by testing more complex conditions.
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Affiliation(s)
- Kirsten Leeten
- Department of Cardiovascular Sciences, KU Leuven Center for Molecular and Vascular Biology, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven Cardiovascular Developmental Biology, Leuven, Belgium
| | - Bartosz Ditkowski
- Department of Cardiovascular Sciences, KU Leuven Center for Molecular and Vascular Biology, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven Cardiovascular Developmental Biology, Leuven, Belgium
| | - Ramadan Jashari
- Saint Jean Clinique, European Homograft Bank, Brussels, Belgium
| | - Petra Mela
- Department of Mechanical Engineering and Munich School of BioEngineering, Medical Materials and Implants, Technical University Munich, Munich, Germany
| | - Elizabeth A V Jones
- Department of Cardiovascular Sciences, KU Leuven Center for Molecular and Vascular Biology, Leuven, Belgium.,Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Ruth Heying
- Department of Cardiovascular Sciences, KU Leuven Center for Molecular and Vascular Biology, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven Cardiovascular Developmental Biology, Leuven, Belgium
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18
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Rouatbi H, Farhat N, Heying R, Vazquez-Jimenez JF, Parent AS, Seghaye MC. Myocardial Expression of Estrogen Receptor-mRNA Is Associated With Lower Markers of Post-operative Organ Damage in Young Patients With Congenital Cardiac Defect. Front Pediatr 2021; 9:729198. [PMID: 34631625 PMCID: PMC8493930 DOI: 10.3389/fped.2021.729198] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Estrogen receptors (ERs) relate to cardio-protection in adults, but their role in younger patients is not known. We aimed to assess the myocardial expression of ERα- and ERβ- mRNA in young patients with congenital cardiac disease and to analyze their putative protective role. Patients and Methods: Twenty children and young adults (seven females and 13 males) with a median age of 13.8 years (interquartile range: 12.3 years) were enrolled in this prospective study. The myocardial expression of ER-mRNA and genes involved in inflammation, growth, and stress response was assessed by real-time PCR and was correlated to post-operative (po) outcome. Results: ER-mRNA was detected in the myocardium of all patients, independently of gender and age. The expression of ER-mRNA correlated with that of mRNA coding for brain natriuretic peptide and for all cytokines tested. A higher ERα-mRNA expression correlated with lower troponin T concentrations at 24 h po (p = 0.032), higher PaO2/FiO2 ratio at 4 h po (p = 0.059), lower fluid retention at 4 h po (p = 0.048), and lower aspartate aminotransferase (AST) levels at 24 h po (p = 0.047). A higher ERβ-mRNA expression was also correlated with lower fluid retention at 24 h po (p = 0.048). Patients in whom the levels of ERα- and ERβ-mRNA were >P50 had lower troponin T (p = 0.003, respectively) and lower AST concentrations at 24 h po (p = 0.043, respectively) than the others. Conclusions: The expression of ERα- and ERβ-mRNA is present in the myocardium of children and young adults with congenital cardiac defect and is associated with lower markers of po organ damage. This suggests that ERs may provide perioperative organ protection in this population.
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Affiliation(s)
- Hatem Rouatbi
- Department of Pediatrics and Pediatric Cardiology, University Hospital Liège, Liège, Belgium
| | - Nesrine Farhat
- Department of Pediatrics and Pediatric Cardiology, University Hospital Liège, Liège, Belgium
| | - Ruth Heying
- Department of Pediatric Cardiology, University Hospital Leuven, Leuven, Belgium
| | - Jaime F Vazquez-Jimenez
- Department of Pediatric and Congenital Cardiac Surgery, University Hospital Aachen, Aachen, Germany
| | - Anne-Simone Parent
- Department of Pediatric Endocrinology, University Hospital Liège, Liège, Belgium
| | - Marie-Christine Seghaye
- Department of Pediatrics and Pediatric Cardiology, University Hospital Liège, Liège, Belgium
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19
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Bos D, De Wolf D, Cools B, Eyskens B, Hubrechts J, Boshoff D, Louw J, Frerich S, Ditkowski B, Rega F, Meyns B, Budts W, Sluysmans T, Gewillig M, Heying R. Infective endocarditis in patients after percutaneous pulmonary valve implantation with the stent-mounted bovine jugular vein valve: Clinical experience and evaluation of the modified Duke criteria. Int J Cardiol 2020; 323:40-46. [PMID: 32860844 DOI: 10.1016/j.ijcard.2020.08.058] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 01/03/2020] [Revised: 07/21/2020] [Accepted: 08/17/2020] [Indexed: 01/11/2023]
Abstract
AIMS Percutaneous pulmonary valve implantation (PPVI) has proven good hemodynamic results. As infective endocarditis (IE) remains a potential complication with limited available clinical data, we reviewed our patient records to improve future strategies of IE prevention, diagnosis and treatment. METHODS Medical records of all patients diagnosed with Melody® valve IE according to the modified Duke criteria were retrospectively analyzed in three Belgian tertiary centers. RESULTS 23 IE episodes in 22 out of 240 patients were identified (incidence 2.4% / patient year) with a clear male predominance (86%). Median age at IE was 17.9 years (range 8.2-45.9 years) and median time from PPVI to IE was 2.4 years (range 0.7-8 years). Streptococcal species caused 10 infections (43%), followed by Staphylococcus aureus (n = 5, 22%). In 13/23 IE episodes a possible entry-point was identified (57%). IE was classified as definite in 15 (65%) and as possible in 8 (35%) cases due to limitations of imaging. Echocardiography visualized vegetations in only 10 patients. PET-CT showed positive FDG signals in 5/7 patients (71%) and intracardiac echocardiography a vegetation in 1/1 patient (100%). Eleven cases (48%) had a hemodynamically relevant pulmonary stenosis at IE presentation. Nine early and 6 late percutaneous or surgical re-interventions were performed. No IE related deaths occurred. CONCLUSIONS IE after Melody® valve PPVI is associated with a relevant need of re-interventions. Communication to patients and physicians about risk factors is essential in prevention. The modified Duke criteria underperformed in diagnosing definite IE, but inclusion of new imaging modalities might improve diagnostic performance.
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Affiliation(s)
- D Bos
- Pediatric Cardiology, Department of Cardiovascular Developmental Biology, University Hospitals Leuven, Belgium
| | - D De Wolf
- Pediatric Cardiology, University Hospital of Ghent, Belgium
| | - B Cools
- Pediatric Cardiology, Department of Cardiovascular Developmental Biology, University Hospitals Leuven, Belgium
| | - B Eyskens
- Pediatric Cardiology, Department of Cardiovascular Developmental Biology, University Hospitals Leuven, Belgium
| | - J Hubrechts
- Pediatric Cardiology, Department of Cardiovascular Developmental Biology, University Hospitals Leuven, Belgium
| | - D Boshoff
- Pediatric Cardiology, Department of Cardiovascular Developmental Biology, University Hospitals Leuven, Belgium
| | - J Louw
- Pediatric Cardiology, AZM, Maastricht, the Netherlands
| | - S Frerich
- Pediatric Cardiology, AZM, Maastricht, the Netherlands
| | - B Ditkowski
- Pediatric Cardiology, Department of Cardiovascular Developmental Biology, University Hospitals Leuven, Belgium
| | - F Rega
- Division of Clinical Cardiac Surgery, KU Leuven, Leuven, Belgium
| | - B Meyns
- Division of Clinical Cardiac Surgery, KU Leuven, Leuven, Belgium
| | - W Budts
- Congenital and Structural Cardiology, University Hospitals Leuven, and Department of Cardiovascular Sciences, Catholic University Leuven, Belgium
| | - T Sluysmans
- Pediatric Cardiology, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - M Gewillig
- Pediatric Cardiology, Department of Cardiovascular Developmental Biology, University Hospitals Leuven, Belgium
| | - R Heying
- Pediatric Cardiology, Department of Cardiovascular Developmental Biology, University Hospitals Leuven, Belgium,.
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Kabirian F, Brouki Milan P, Zamanian A, Heying R, Mozafari M. Additively manufactured small‐diameter vascular grafts with improved tissue healing using a novel SNAP impregnation method. J Biomed Mater Res B Appl Biomater 2020; 108:1322-1331. [DOI: 10.1002/jbm.b.34481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/16/2019] [Accepted: 08/06/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Fatemeh Kabirian
- Bioengineering Research Group, Nanotechnology and Advanced Materials DepartmentMaterials and Energy Research Center (MERC) Tehran Iran
- Department of Tissue Engineering and Regenerative MedicineFaculty of Advanced Technologies in Medicine, Iran University of Medical Sciences Tehran Iran
- Cardiovascular Developmental Biology, Department of Cardiovascular SciencesKU Leuven Leuven Belgium
| | - Peiman Brouki Milan
- Department of Tissue Engineering and Regenerative MedicineFaculty of Advanced Technologies in Medicine, Iran University of Medical Sciences Tehran Iran
| | - Ali Zamanian
- Bioengineering Research Group, Nanotechnology and Advanced Materials DepartmentMaterials and Energy Research Center (MERC) Tehran Iran
| | - Ruth Heying
- Cardiovascular Developmental Biology, Department of Cardiovascular SciencesKU Leuven Leuven Belgium
| | - Masoud Mozafari
- Department of Tissue Engineering and Regenerative MedicineFaculty of Advanced Technologies in Medicine, Iran University of Medical Sciences Tehran Iran
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21
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Roggen M, Cools B, Brown S, Boshoff D, Heying R, Eyskens B, Gewillig M. Can ductus arteriosus morphology influence technique/outcome of stent treatment? Catheter Cardiovasc Interv 2020; 95:1149-1157. [DOI: 10.1002/ccd.28725] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 12/13/2019] [Accepted: 01/01/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Mieke Roggen
- Department of Pediatric and Congenital CardiologyUniversity Hospitals Leuven Leuven Belgium
| | - Bjorn Cools
- Department of Pediatric and Congenital CardiologyUniversity Hospitals Leuven Leuven Belgium
| | - Stephen Brown
- Department of Pediatric and Congenital CardiologyUniversity Hospitals Leuven Leuven Belgium
- Department of Pediatric CardiologyUniversity of the Free State Bloemfontein South Africa
| | - Derize Boshoff
- Department of Pediatric and Congenital CardiologyUniversity Hospitals Leuven Leuven Belgium
| | - Ruth Heying
- Department of Pediatric and Congenital CardiologyUniversity Hospitals Leuven Leuven Belgium
| | - Benedicte Eyskens
- Department of Pediatric and Congenital CardiologyUniversity Hospitals Leuven Leuven Belgium
| | - Marc Gewillig
- Department of Pediatric and Congenital CardiologyUniversity Hospitals Leuven Leuven Belgium
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22
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Rouatbi H, Farhat N, Heying R, Gérard A, Vazquez-Jimenez JF, Seghaye MC. Right Atrial Myocardial Remodeling in Children With Atrial Septal Defect Involves Inflammation, Growth, Fibrosis, and Apoptosis. Front Pediatr 2020; 8:40. [PMID: 32117843 PMCID: PMC7033500 DOI: 10.3389/fped.2020.00040] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 01/27/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction: Myocardial remodeling due to large atrial septum defect (ASD) is macroscopically characterized by dilation of the right-sided cardiac cavities secondary to volume overload, the cellular mechanisms of which are not yet understood. We postulated that inflammation, fibrosis, and cell death are actors of right atrial remodeling secondary to ASD. Patients and Methods: In 12 children with large ASD (median age: 63 months), expression of genes coding for proteins involved in the response to cell stress and -protection, inflammation, growth and angiogenesis, fibrosis, and apoptosis was assessed by RT-PCR in right atrial myocardial biopsies taken during cardiac surgery. The presence of cytokines in myocardial cells was confirmed by immunohistochemistry and effective apoptosis by TUNEL assay. Results: In all patients investigated, a cellular response to early mechanical stress with the initiation of early protective mechanisms, of inflammation (and its control), -growth, and -angiogenesis, of fibrosis and apoptosis was present. The apoptotic index assessed by TUNEL assay averaged 0.3%. Conclusions: In children with large ASD, macroscopic right atrial remodeling relates to cellular mechanisms involving the expression of numerous genes that either still act to protect cells and tissues but that also harm as they initiate and/or sustain inflammation, fibrosis, and cell death by apoptosis. This may contribute to long term morbidity in patients with ASD.
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Affiliation(s)
- Hatem Rouatbi
- Department of Pediatrics & Pediatric Cardiology, University Hospital Liège, Liège, Belgium
| | - Nesrine Farhat
- Department of Pediatrics & Pediatric Cardiology, University Hospital Liège, Liège, Belgium
| | - Ruth Heying
- Department of Pediatric Cardiology, University Hospital Leuven, Leuven, Belgium
| | - Arlette Gérard
- Department of Pediatrics, GIGA Neurosciences, University Hospital Liège, Liège, Belgium
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23
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Bos D, Cools B, Eyskens B, Boshoff D, Meyns B, Rega F, Slysmans T, Wolf D, Gewillig M, Heying R. Infective Endocarditis in Stent-Mounted Bovine Jugular Vein Conduits: Clinical Experience and Evaluation of the Modified Duke Criteria. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hubrechts J, Cools B, Brown SC, Eyskens B, Heying R, Boshoff D, Gewillig M. Percutaneous obliteration of the right ventricle to avoid coronary damage by sinusoids in patients with pulmonary atresia intact ventricular septum during staged single ventricle palliation. Catheter Cardiovasc Interv 2019; 94:722-726. [PMID: 31433549 DOI: 10.1002/ccd.28457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 02/01/2019] [Revised: 08/08/2019] [Accepted: 08/12/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND AIMS Suprasystemic pressure waves can damage the coronary arteries resulting in myocardial ischemia and excess early mortality. We aimed to reduce the coronary pressure wave through the sinusoids by abolishing RV volume with percutaneous devices. METHODS AND RESULTS Four patients with PA-IVS and coronary sinusoids from the hypertensive rudimentary RV were evaluated at a median age 26.6 months (range: 2.7-51.7). Right ventricle coronary dependent flow to the left ventricular myocardium was excluded. All four patients had dual perfusion with competitive flow from the RV through the sinusoids to the coronary arteries. Devices used were: Amplatzer vascular plug II of 10-16 mm; 27 coils (diameter 5-15 mm) in the oldest patient. Right ventricular angiography after cavity obliteration showed no more significant coronary perfusion through the sinusoids. There were no complications or deaths. Only minor and transient changes in the levels of troponin were observed. Coronary angiography at pre-Fontan evaluation showed no progress of coronary abnormalities in two patients. CONCLUSION In selected patients with functionally single left ventricle, obliteration of the hypertensive RV cavity by percutaneous devices is safe and abolishes the systolic pressure wave in coronary sinusoids. When performed early, this may halt coronary damage and avoid excess mortality.
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Affiliation(s)
- Jelena Hubrechts
- Department of Pediatric and Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Bjorn Cools
- Department of Pediatric and Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Stephen C Brown
- Department of Pediatric and Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium.,Department of Pediatric and Congenital Cardiology, University of the Free State, Bloemfontein, Free State, South Africa
| | - Benedicte Eyskens
- Department of Pediatric and Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Ruth Heying
- Department of Pediatric and Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Derize Boshoff
- Department of Pediatric and Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Marc Gewillig
- Department of Pediatric and Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
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25
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Affiliation(s)
- Ruth Heying
- Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Thomas Vanassche
- Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Philippe Moreillon
- Department of Fundamental Microbiology, University Lausanne, Lausanne, Switzerland
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26
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Maleux G, Storme E, Cools B, Heying R, Boshoff D, Louw JJ, Frerich S, Malekzadeh‐Milanii S, Hubrechts J, Brown SC, Gewillig M. Percutaneous embolization of lymphatic fistulae as treatment for protein‐losing enteropathy and plastic bronchitis in patients with failing Fontan circulation. Catheter Cardiovasc Interv 2019; 94:996-1002. [DOI: 10.1002/ccd.28501] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 09/04/2019] [Accepted: 09/07/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Geert Maleux
- Interventional RadiologyUniversity Hospitals Leuven Leuven Belgium
| | - Emma Storme
- Department of Paediatric and Congenital CardiologyUniversity Hospitals Leuven Leuven Belgium
| | - Bjorn Cools
- Department of Paediatric and Congenital CardiologyUniversity Hospitals Leuven Leuven Belgium
| | - Ruth Heying
- Department of Paediatric and Congenital CardiologyUniversity Hospitals Leuven Leuven Belgium
| | - Derize Boshoff
- Department of Paediatric and Congenital CardiologyUniversity Hospitals Leuven Leuven Belgium
| | - Jacoba J. Louw
- Paediatric CardiologyUniversity Hospital Maastricht Maastricht the Netherlands
| | - Stefan Frerich
- Paediatric CardiologyUniversity Hospital Maastricht Maastricht the Netherlands
| | | | - Jelena Hubrechts
- Department of Paediatric and Congenital CardiologyUniversity Hospitals Leuven Leuven Belgium
| | - Stephen C. Brown
- Department of Paediatric and Congenital CardiologyUniversity Hospitals Leuven Leuven Belgium
- Paediatric CardiologyUniversity of the Free State Bloemfontein South Africa
| | - Marc Gewillig
- Department of Paediatric and Congenital CardiologyUniversity Hospitals Leuven Leuven Belgium
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27
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Kabirian F, Brouki Milan P, Zamanian A, Heying R, Mozafari M. Nitric oxide-releasing vascular grafts: A therapeutic strategy to promote angiogenic activity and endothelium regeneration. Acta Biomater 2019; 92:82-91. [PMID: 31059835 DOI: 10.1016/j.actbio.2019.05.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/26/2019] [Accepted: 05/01/2019] [Indexed: 02/06/2023]
Abstract
Small-diameter vascular grafts (SDVGs) are associated with a high incidence of failure due to infection and obstruction. Although several vascular grafts are commercially available, specific anatomical differences of defect sites require patient-based design and fabrication. Design and fabrication of such custom-tailored grafts are possible with 3d-printing technology. The aim of this study is to develop 3d-printed SDVGs with a nitric oxide (NO)-releasing coating to improve the success rate of implantation. The SDVGs were printed from polylactic acid and coated with blending of 10 wt% S-nitroso-N-acetyl-D-penicillamine into the polymeric substrate consisting of poly (ethylene glycol) and polycaprolactone. Our results show that NO is released in the physiological range (0.5-4 × 10-10 mol·cm-2·min-1) for 14 days and NO-releasing coating showed significant antibacterial potential against Gram-positive and Gram-negative strains. It was shown that both NO-releasing and control grafts are biocompatible in-vitro and in-vivo. Interestingly, the NO-releasing SDVGs dramatically enhanced ECs proliferation and significantly enhanced ECs migration in-vitro compared to control grafts. In addition, the NO-releasing SDVGs showed angiogenic potential in-vivo which can further prove the results of our in-vitro study. These findings are expected to facilitate tissue regeneration and integration of custom-made vascular implants with enhanced clinical success. STATEMENT OF SIGNIFICANCE: A series of 3d-printed small-diameter vascular grafts (SDVGs, <6 mm) with controlled release of nitric oxide (NO) were prepared to combine the advantages of 3D printing technology and NO-releasing systems. The resulting NO-releasing grafts were promisingly showing sustained NO release in the physiological range over a two weeks period. In addition to the evaluation of endothelial cell migration in-vitro, we implanted for the first time the NO-releasing vascular grafts in a chick chorioallantoic membrane (CAM) to investigate the effect of the prepared grafts on the angiogenesis in-vivo. The fabricated grafts also exhibited bactericidal properties which prevent the formation of a biofilm layer and can thereby enhance the chance of endothelialization on the surface. Taken together, the innovative combination of rapid and highly accurate 3d-printing technology as a patient-specific fabrication method with NO-releasing coating represents a promising approach to develop bactericidal SDVGs with improved endothelialization.
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Affiliation(s)
- Fatemeh Kabirian
- Bioengineering Research Group, Nanotechnology and Advanced Materials Department, Materials and Energy Research Center (MERC), Tehran, Iran; Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Peiman Brouki Milan
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Tissue Engineering & Regenerative Medicine, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Ali Zamanian
- Bioengineering Research Group, Nanotechnology and Advanced Materials Department, Materials and Energy Research Center (MERC), Tehran, Iran
| | - Ruth Heying
- Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Masoud Mozafari
- Bioengineering Research Group, Nanotechnology and Advanced Materials Department, Materials and Energy Research Center (MERC), Tehran, Iran; Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Tissue Engineering & Regenerative Medicine, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.
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Mancini S, Oechslin F, Menzi C, Que YA, Claes J, Heying R, Veloso TR, Vanassche T, Missiakas D, Schneewind O, Moreillon P, Entenza JM. Marginal role of von Willebrand factor-binding protein and coagulase in the initiation of endocarditis in rats with catheter-induced aortic vegetations. Virulence 2019; 9:1615-1624. [PMID: 30280967 PMCID: PMC7000203 DOI: 10.1080/21505594.2018.1528845] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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] [Indexed: 01/30/2023] Open
Abstract
Staphylococcus aureus is the leading cause of infective endocarditis (IE). While the role of S. aureus cell-wall associated protein clumping factor A (ClfA) in promoting IE has been already demonstrated, that of the secreted plasma-clotting factors staphylocoagulase (Coa) and von Willebrand factor-binding protein (vWbp) has not yet been elucidated. We investigated the role of Coa and vWbp in IE initiation in rats with catheter-induced aortic vegetations, using Lactococcus lactis expressing coa, vWbp, clfA or vWbp/clfA, and S. aureus Newman Δcoa, ΔvWbp, ΔclfA or Δcoa/ΔvWbp/ΔclfA mutants. vWbp-expression increased L. lactis valve infection compared to parent and coa-expressing strains (incidence: 62%, versus 0% and 13%, respectively; P < 0.01). Likewise, expression of clfA increased L. lactis infectivity (incidence: 80%), which was not further affected by co-expression of vWbp. In symmetry, deletion of the coa or vWbp genes in S. aureus did not decrease infectivity (incidence: 68 and 64%, respectively) whereas deletion of clfA did decrease valve infection (incidence: 45%; P = 0.03 versus parent), which was not further affected by the triple deletion Δcoa/ΔvWbp/ΔclfA (incidence: 36%; P > 0.05 versus ΔclfA mutant). Coa does not support the initial colonization of IE (in L. lactis) without other key virulence factors and vWbp contributes to initiation of IE (in L. lactis) but is marginal in the present of ClfA.
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Affiliation(s)
- Stefano Mancini
- a Department of Fundamental Microbiology , University of Lausanne , Lausanne , Switzerland
| | - Frank Oechslin
- a Department of Fundamental Microbiology , University of Lausanne , Lausanne , Switzerland
| | - Carmen Menzi
- a Department of Fundamental Microbiology , University of Lausanne , Lausanne , Switzerland
| | - Yok Ai Que
- b Department of Intensive Care Medicine , Bern University Hospital , Bern , Switzerland
| | - Jorien Claes
- c Cardiovascular Developmental Biology, Department of Cardiovascular Sciences , KU Leuven , Leuven , Belgium.,d Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences , KU Leuven , Leuven , Belgium
| | - Ruth Heying
- c Cardiovascular Developmental Biology, Department of Cardiovascular Sciences , KU Leuven , Leuven , Belgium
| | - Tiago Rafael Veloso
- a Department of Fundamental Microbiology , University of Lausanne , Lausanne , Switzerland
| | - Thomas Vanassche
- d Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences , KU Leuven , Leuven , Belgium
| | | | - Olaf Schneewind
- e Department of Microbiology , University of Chicago , Chicago , IL , USA
| | - Philippe Moreillon
- a Department of Fundamental Microbiology , University of Lausanne , Lausanne , Switzerland
| | - José Manuel Entenza
- a Department of Fundamental Microbiology , University of Lausanne , Lausanne , Switzerland
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29
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Kabirian F, Ditkowski B, Zamanian A, Hoylaerts MF, Mozafari M, Heying R. Controlled NO-Release from 3D-Printed Small-Diameter Vascular Grafts Prevents Platelet Activation and Bacterial Infectivity. ACS Biomater Sci Eng 2019; 5:2284-2296. [DOI: 10.1021/acsbiomaterials.9b00220] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Fatemeh Kabirian
- Nanotechnology and Advanced Materials Department, Materials and Energy Research Center (MERC), P.O. Box 14155-4777, Tehran, Iran
- Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Bartosz Ditkowski
- Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Ali Zamanian
- Nanotechnology and Advanced Materials Department, Materials and Energy Research Center (MERC), P.O. Box 14155-4777, Tehran, Iran
| | - Marc F. Hoylaerts
- Center of Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Masoud Mozafari
- Nanotechnology and Advanced Materials Department, Materials and Energy Research Center (MERC), P.O. Box 14155-4777, Tehran, Iran
- Cellular and Molecular Research Center, Iran University of Medical Sciences (IUMS), Tehran, 1449614535, Iran
- Department of Tissue Engineering & Regenerative Medicine, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences (IUMS), Tehran, 1449614535, Iran
| | - Ruth Heying
- Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium
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30
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Ditkowski B, Veloso TR, Bezulska-Ditkowska M, Lubig A, Jockenhoevel S, Mela P, Jashari R, Gewillig M, Meyns B, Hoylaerts MF, Heying R. An In Vitro Model of a Parallel-Plate Perfusion System to Study Bacterial Adherence to Graft Tissues. J Vis Exp 2019. [PMID: 30663688 DOI: 10.3791/58476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Various valved conduits and stent-mounted valves are used for right ventricular outflow tract (RVOT) valve replacement in patients with congenital heart disease. When using prosthetic materials however, these grafts are susceptible to bacterial infections and various host responses. Identification of bacterial and host factors that play a vital role in endovascular adherence of microorganisms is of importance to better understand the pathophysiology of the onset of infections such as infective endocarditis (IE) and to develop preventive strategies. Therefore, the development of competent models to investigate bacterial adhesion under physiological shear conditions is necessary. Here, we describe the use of a newly designed in vitro perfusion chamber based on parallel plates that allows the study of bacterial adherence to different components of graft tissues such as exposed extracellular matrix, endothelial cells and inert areas. This method combined with colony-forming unit (CFU) counting is adequate to evaluate the propensity of graft materials towards bacterial adhesion under flow. Further on, the flow chamber system might be used to investigate the role of blood components in bacterial adhesion under shear conditions. We demonstrated that the source of tissue, their surface morphology and bacterial species specificity are not the major determining factors in bacterial adherence to graft tissues by using our in-house designed in vitro perfusion model.
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Affiliation(s)
- Bartosz Ditkowski
- Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven;
| | - Tiago R Veloso
- Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven
| | - Martyna Bezulska-Ditkowska
- Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven; Centre for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven
| | - Andreas Lubig
- Department of Biohybrid & Medical Textiles, AME - Helmholtz Institute for Biomedical Engineering, RWTH Aachen University
| | - Stefan Jockenhoevel
- Department of Biohybrid & Medical Textiles, AME - Helmholtz Institute for Biomedical Engineering, RWTH Aachen University
| | - Petra Mela
- Department of Biohybrid & Medical Textiles, AME - Helmholtz Institute for Biomedical Engineering, RWTH Aachen University
| | | | - Marc Gewillig
- Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven
| | - Bart Meyns
- Division of Clinical Cardiac Surgery, Department of Cardiovascular Sciences, KU Leuven
| | - Marc F Hoylaerts
- Centre for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven
| | - Ruth Heying
- Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven
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31
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Cools B, Brown S, Budts W, Heying R, Troost E, Boshoff D, Eyskens B, Gewillig M. Up to 11 years of experience with the Melody valved stent in the right ventricular outflow tract. EUROINTERVENTION 2018; 14:e988-e994. [DOI: 10.4244/eij-d-18-00054] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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32
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Veloso TR, Ditkowski B, Mela P, Hoylaerts MF, Heying R. Are plasma proteins key players in the pathogenesis of infective endocarditis? J Thorac Cardiovasc Surg 2018; 156:738-739. [PMID: 30011766 DOI: 10.1016/j.jtcvs.2018.04.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 04/11/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Tiago Rafael Veloso
- Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Bartosz Ditkowski
- Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Petra Mela
- Department of Tissue Engineering & Textile Implants, AME-Helmholtz Institute for Biomedical Engineering, Aachen, Germany
| | - Marc F Hoylaerts
- Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Ruth Heying
- Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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33
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Walravens AS, Vanhaverbeke M, Ottaviani L, Gillijns H, Trenson S, Driessche NV, Luttun A, Meyns B, Herijgers P, Rega F, Heying R, Sampaolesi M, Janssens S. Molecular signature of progenitor cells isolated from young and adult human hearts. Sci Rep 2018; 8:9266. [PMID: 29915261 PMCID: PMC6006291 DOI: 10.1038/s41598-018-26969-2] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 05/08/2018] [Indexed: 12/17/2022] Open
Abstract
The loss of endogenous cardiac regenerative capacity within the first week of postnatal life has intensified clinical trials to induce cardiac regeneration in the adult mammalian heart using different progenitor cell types. We hypothesized that donor age-related phenotypic and functional characteristics of cardiac progenitor cells (CPC) account for mixed results of cell-based cardiac repair. We compared expression profiles and cell turnover rates of human heart-derived c-kitpos progenitors (c-kitpos CPC) and cardiosphere-derived cells (CDC) from young and adult donor origin and studied their in vitro angiogenic and cardiac differentiation potential, which can be relevant for cardiac repair. We report that 3-dimensional CDC expansion recapitulates a conducive environment for growth factor and cytokine release from adult donor cells (aCDC) that optimally supports vascular tube formation and vessel sprouting. Transdifferentiation capacity of c-kitpos CPCs and CDCs towards cardiomyocyte-like cells was modest, however, most notable in young c-kitpos cells and adult CDCs. Progenitors isolated with different methods thus show cell- and donor-specific characteristics that may account for variable contributions in functional myocardial recovery.
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Affiliation(s)
| | | | - Lara Ottaviani
- Department of Cardiovascular Sciences, KU Leuven, 3000, Leuven, Belgium
| | - Hilde Gillijns
- Department of Cardiovascular Sciences, KU Leuven, 3000, Leuven, Belgium
| | - Sander Trenson
- Department of Cardiovascular Sciences, KU Leuven, 3000, Leuven, Belgium
| | | | - Aernout Luttun
- Department of Cardiovascular Sciences, KU Leuven, 3000, Leuven, Belgium
| | - Bart Meyns
- Department of Cardiovascular Sciences, KU Leuven, 3000, Leuven, Belgium
| | - Paul Herijgers
- Department of Cardiovascular Sciences, KU Leuven, 3000, Leuven, Belgium
| | - Filip Rega
- Department of Cardiovascular Sciences, KU Leuven, 3000, Leuven, Belgium
| | - Ruth Heying
- Department of Cardiovascular Sciences, KU Leuven, 3000, Leuven, Belgium
| | - Maurilio Sampaolesi
- Department of Development and Regeneration, KU Leuven, 3000, Leuven, Belgium
| | - Stefan Janssens
- Department of Cardiovascular Sciences, KU Leuven, 3000, Leuven, Belgium.
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Claes J, Ditkowski B, Liesenborghs L, Veloso TR, Entenza JM, Moreillon P, Vanassche T, Verhamme P, Hoylaerts MF, Heying R. Assessment of the Dual Role of Clumping Factor A in S. Aureus Adhesion to Endothelium in Absence and Presence of Plasma. Thromb Haemost 2018; 118:1230-1241. [PMID: 29909601 DOI: 10.1055/s-0038-1660435] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Adhesion of Staphylococcus aureus to endothelial cells (ECs) is paramount in infective endocarditis. Bacterial proteins such as clumping factor A (ClfA) and fibronectin binding protein A (FnbpA) mediate adhesion to EC surface molecules and (sub)endothelial matrix proteins including fibrinogen (Fg), fibrin, fibronectin (Fn) and von Willebrand factor (vWF). We studied the influence of shear flow and plasma on the binding of ClfA and FnbpA (including its sub-domains A, A16+, ABC, CD) to coverslip-coated vWF, Fg/fibrin, Fn or confluent ECs, making use of Lactococcus lactis, expressing these adhesins heterologously. Global adherence profiles were similar in static and flow conditions. In the absence of plasma, L. lactis-clfA binding to Fg increased with shear forces, whereas binding to fibrin did not. The degree of adhesion of L. lactis-fnbpA to EC-bound Fn and of L. lactis-clfA to EC-bound Fg, furthermore, was similar to that of L. lactis-clfA to coated vWF domain A1, in the presence of vWF-binding protein (vWbp). Yet, in plasma, L. lactis-clfA adherence to activated EC-vWF/vWbp dropped over 10 minutes by 80% due to vWF-hydrolysis by a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13 and that of L. lactis-fnbpA likewise by > 70% compared to the adhesion in absence of plasma. In contrast, plasma Fg supported high L. lactis-clfA binding to resting and activated ECs. Or, in plasma S. aureus adhesion to active endothelium occurs mainly via two complementary pathways: a rapid but short-lived vWF/vWbp pathway and a stable integrin-coupled Fg-pathway. Hence, the pharmacological inhibition of ClfA-Fg interactions may constitute a valuable additive treatment in infective endocarditis.
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Affiliation(s)
- Jorien Claes
- Division of Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, KU Leuven, Leuven, Belgium
| | - Bartosz Ditkowski
- Division of Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Laurens Liesenborghs
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, KU Leuven, Leuven, Belgium
| | - Tiago Rafael Veloso
- Division of Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Jose M Entenza
- Department of Fundamental Microbiology, University of Lausanne, Lausanne, Switzerland
| | - Philippe Moreillon
- Department of Fundamental Microbiology, University of Lausanne, Lausanne, Switzerland
| | - Thomas Vanassche
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, KU Leuven, Leuven, Belgium
| | - Peter Verhamme
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, KU Leuven, Leuven, Belgium
| | - Marc F Hoylaerts
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, KU Leuven, Leuven, Belgium
| | - Ruth Heying
- Division of Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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35
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Veloso TR, Claes J, Van Kerckhoven S, Ditkowski B, Hurtado-Aguilar LG, Jockenhoevel S, Mela P, Jashari R, Gewillig M, Hoylaerts MF, Meyns B, Heying R. Bacterial adherence to graft tissues in static and flow conditions. J Thorac Cardiovasc Surg 2018; 155:325-332.e4. [DOI: 10.1016/j.jtcvs.2017.06.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 05/19/2017] [Accepted: 06/01/2017] [Indexed: 12/29/2022]
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36
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Kabirian F, Ditkowski B, Zamanian A, Heying R, Mozafari M. An innovative approach towards 3D-printed scaffolds for the next generation of tissue-engineered vascular grafts. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.matpr.2018.04.167] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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37
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Gewillig M, Brown SC, Roggen M, Eyskens B, Heying R, Givron P, Cools B, de Catte L. Dysfunction of the foetal arterial duct results in a wide spectrum of cardiovascular pathology. Acta Cardiol 2017; 72:625-635. [PMID: 28745124 DOI: 10.1080/00015385.2017.1314876] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Foetal ductal problems may have various cardiopulmonary consequences. This study aimed to identify the spectrum of ductus arteriosus (DA) dysfunction (closure, constriction, kinking, aneurysm and thrombosis) and the resultant clinical and echocardiographic presentation in foetuses and neonates. METHODS AND RESULTS This is a retrospective analysis of serial pre- and post-natal data of 27 cases of foetal ductal dysfunction diagnosed at a median gestational age of 33 weeks (range 20-39). The most common abnormalities observed were premature closure of the DA in 56% (15/27) and constriction in 29% (8/27). Right ventricular hypertrophy was present in 75% (n = 11/15) of foetuses with premature DA closure, while ventricular dilation (4/7, 57%) was a more common feature in foetuses with ductal constriction. After birth, 63% (17/27) of new borns presented with cyanosis and pulmonary hypertension that required active treatment. Three infants died after birth. Abnormalities resolved spontaneously after birth in about 50% of patients. In some children, pulmonary valve stenosis and regurgitation was progressive and required further treatment. CONCLUSIONS An abnormal right heart on foetal four-chamber ultrasound view should alert the sonographer to the possible presence of foetal ductal dysfunction. Ductal occlusion, transient or fixed constriction, kinking and aneurysm formation are associated with foetal cardiopulmonary sequelae. Symptoms and pathology is probably related to the type, foetal age, rapidity of progression and duration of intrauterine ductal dysfunction. Correspondingly, clinical outcomes vary ranging from little or no symptoms to severe respiratory distress and even foetal or neonatal death.
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Affiliation(s)
- Marc Gewillig
- Department of Fetal and Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Stephen C. Brown
- Department of Fetal and Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Pediatric Cardiology, University of the Free State, Bloemfontein, South Africa
| | - Mieke Roggen
- Department of Fetal and Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Benedicte Eyskens
- Department of Fetal and Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Ruth Heying
- Department of Fetal and Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Patrice Givron
- Department of Fetal and Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Bjorn Cools
- Department of Fetal and Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Luc de Catte
- Department of Fetal and Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
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Heying R, Gevel J, Que YA, Moreillon P, Beekhuizen H. Fibronectin-binding proteins and clumping factor A in Staphylococcus aureus experimental endocarditis: FnBPA is sufficient to activate human endothelial cells. Thromb Haemost 2017. [DOI: 10.1160/th06-11-0640] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummarySurface molecules of Staphylococcus aureus are involved in the colonization of vascular endothelium which is a crucial primary event in the pathogenesis of infective endocarditis (IE).The ability of these molecules to also launch endothelial procoagulant and proinflammatory responses, which characterize IE, is not known. In the present study we investigated the individual capacities of three prominent S. aureus surface molecules; fibronectinbinding protein A (FnBPA) and B (FnBPB) and clumping factor A (ClfA), to promote bacterial adherence to cultured human endothelial cells (ECs) and to activate phenotypic and functional changes in these ECs. Non-invasive surrogate bacterium Lactococcus lactis, which, by gene transfer, expressed staphylococcal FnBPA, FnBPB or ClfA molecules were used. Infection of ECs increased 50- to 100-fold with FnBPA- or FnBPB-positive recombinant lactococci. This coincided with EC activation, interleukin- 8 secretion and surface expression of ICAM-1 andVCAM-1 and concomitant monocyte adhesion. Infection with ClfA-positive lactococci did not activate EC. FnBPA-positive L. lactis also induced a prominent tissue factor-dependent endothelial coagulation response that was intensified by cell-bound monocytes. Thus S. aureus FnBPs, but not ClfA, confer invasiveness and pathogenicity to non-pathogenic L. lactis organisms indicating that bacterium-EC interactions mediated by these adhesins are sufficient to evoke inflammation as well as procoagulant activity at infected endovascular sites.
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Heying R, Gevel JVD, Que YA, Piroth L, Moreillon P, Beekhuizen H. Contribution of (sub)domains of Staphylococcus aureus fibronectin-binding protein to the proinflammatory and procoagulant response of human vascular endothelial cells. Thromb Haemost 2017. [DOI: 10.1160/th08-06-0395] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryThe Staphylococcus aureus fibronectin (Fn) -binding protein A (FnBPA) is involved in bacterium-endothelium interactions which is one of the crucial events leading to infective endocarditis (IE). We previously showed that the sole expression of S. aureus FnBPA was sufficient to confer to non-invasive Lactococcus lactis bacteria the capacity to invade human endothelial cells (ECs) and to launch the typical endothelial proinflammatory and procoagulant responses that characterize IE. In the present study we further questioned whether these bacterium-EC interactions could be reproduced by single or combined FnBPA subdomains (A, B, C or D) using a large library of truncated FnBPA constructs expressed in L. lactis. Significant invasion of cultured ECs was found for L. lactis expressing the FnBPA subdomains CD (aa 604–877) or A4+16 (aa 432–559). Moreover, this correlates with the capacity of these fragments to elicit in vitro a marked increase in EC surface expression of both ICAM-1 and VCAM-1 and secretion of the CXCL8 chemokine and finally to induce a tissue factor-dependent endothelial coagulation response. We thus conclude that (sub)domains of the staphylococcal FnBPA molecule that express Fn-binding modules, alone or in combination, are sufficient to evoke an endothelial proinflammatory as well as a procoagulant response and thus account for IE severity.
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Abstract
Objective The aim of the study was to assess the feasibility of using commonly available catheterization laboratory equipment for radiofrequency perforation of the pulmonary valve in patients with pulmonary atresia and intact ventricular septum. Methods The system (off-label use for all items) is made up of a co-axial telescopic arrangement consisting of a 0.014" PT 2 ™ coronary guidewire, for insulation inside a 2.7-F microcatheter which has an inner lumen of 0.021". The microcatheter was passed via a standard 4-F right coronary catheter to just below the atretic pulmonary valve. Radiofrequency (RF) energy was delivered using a standard electrosurgical system. In vitro testing had been performed and indicated that 5-10 W for 2-5 s would be sufficient for valve perforation. Results Radiofrequency perforation was successfully performed in all (n = 5, 100%) patients at a median age of 3 days (range: 1-36) and weight 2.7 kg (range 2.3-3.0). In one patient the pericardium was entered during the initial attempt; the generator was put on coagulation mode during retrieval of the guidewire and no haemopericardium occurred. The pulmonary valve was dilated in all; in three patients (n = 3) the ductus arteriosus was stented during the same session. Conclusion Results of the study show that it is feasible to perforate the pulmonary valve safely using this system. Availability, simplicity and cost are noteworthy benefits.
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Affiliation(s)
- Stephen C. Brown
- Fetal and Pediatric Cardiology, University Hospitals Leuven, Belgium
- Pediatric Cardiology, University of the Free State, South Africa
| | - Bjorn Cools
- Fetal and Pediatric Cardiology, University Hospitals Leuven, Belgium
| | - Derize Boshoff
- Fetal and Pediatric Cardiology, University Hospitals Leuven, Belgium
| | - Ruth Heying
- Fetal and Pediatric Cardiology, University Hospitals Leuven, Belgium
| | - Benedicte Eyskens
- Fetal and Pediatric Cardiology, University Hospitals Leuven, Belgium
| | - Marc Gewillig
- Fetal and Pediatric Cardiology, University Hospitals Leuven, Belgium
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De Mey W, Cools B, Heying R, Budts W, Louw JJ, Boshoff DE, Brown SC, Gewillig M. Can a volume challenge pinpoint the limiting factor in a Fontan circulation? Acta Cardiol 2017. [DOI: 10.1080/ac.70.5.3110514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Wim De Mey
- Dept. of Paediatric Cardiology, University Hospitals Leuven, Belgium
| | - Bjorn Cools
- Dept. of Paediatric Cardiology, University Hospitals Leuven, Belgium
| | - Ruth Heying
- Dept. of Paediatric Cardiology, University Hospitals Leuven, Belgium
| | - Werner Budts
- Dept. of Cardiology, University Hospitals Leuven, Belgium
| | - Jacoba J. Louw
- Dept. of Paediatric Cardiology, University Hospitals Leuven, Belgium
| | - Derize E. Boshoff
- Dept. of Paediatric Cardiology, University Hospitals Leuven, Belgium
| | - Stephen C. Brown
- Dept. of Paediatric Cardiology, University of the Free State, Bloemfontein, Zuid-Afrika
| | - Marc Gewillig
- Dept. of Paediatric Cardiology, University Hospitals Leuven, Belgium
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Claes J, Liesenborghs L, Peetermans M, Veloso TR, Missiakas D, Schneewind O, Mancini S, Entenza JM, Hoylaerts MF, Heying R, Verhamme P, Vanassche T. Clumping factor A, von Willebrand factor-binding protein and von Willebrand factor anchor Staphylococcus aureus to the vessel wall. J Thromb Haemost 2017; 15:1009-1019. [PMID: 28182324 PMCID: PMC6232194 DOI: 10.1111/jth.13653] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [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: 09/06/2016] [Indexed: 01/10/2023]
Abstract
Essentials Staphylococcus aureus (S. aureus) binds to endothelium via von Willebrand factor (VWF). Secreted VWF-binding protein (vWbp) mediates S. aureus adhesion to VWF under shear stress. vWbp interacts with VWF and the Sortase A-dependent surface protein Clumping factor A (ClfA). VWF-vWbp-ClfA anchor S. aureus to vascular endothelium under shear stress. SUMMARY Objective When establishing endovascular infections, Staphylococcus aureus (S. aureus) overcomes shear forces of flowing blood by binding to von Willebrand factor (VWF). Staphylococcal VWF-binding protein (vWbp) interacts with VWF, but it is unknown how this secreted protein binds to the bacterial cell wall. We hypothesized that vWbp interacts with a staphylococcal surface protein, mediating the adhesion of S. aureus to VWF and vascular endothelium under shear stress. Methods We studied the binding of S. aureus to vWbp, VWF and endothelial cells in a micro-parallel flow chamber using various mutants deficient in Sortase A (SrtA) and SrtA-dependent surface proteins, and Lactococcus lactis expressing single staphylococcal surface proteins. In vivo adhesion of bacteria was evaluated in the murine mesenteric circulation using real-time intravital vascular microscopy. Results vWbp bridges the bacterial cell wall and VWF, allowing shear-resistant binding of S. aureus to inflamed or damaged endothelium. Absence of SrtA and Clumping factor A (ClfA) reduced adhesion of S. aureus to vWbp, VWF and activated endothelial cells. ADAMTS-13 and an anti-VWF A1 domain antibody, when combined, reduced S. aureus adhesion to activated endothelial cells by 90%. Selective overexpression of ClfA in the membrane of Lactococcus lactis enabled these bacteria to bind to VWF and activated endothelial cells but only in the presence of vWbp. Absence of ClfA abolished bacterial adhesion to the activated murine vessel wall. Conclusions vWbp interacts with VWF and with the SrtA-dependent staphylococcal surface protein ClfA. The complex formed by VWF, secreted vWbp and bacterial ClfA anchors S. aureus to vascular endothelium under shear stress.
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Affiliation(s)
- J Claes
- Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - L Liesenborghs
- Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - M Peetermans
- Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - T R Veloso
- Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - D Missiakas
- Department of Microbiology, University of Chicago, Chicago, IL, USA
| | - O Schneewind
- Department of Microbiology, University of Chicago, Chicago, IL, USA
| | - S Mancini
- Department of Fundamental Microbiology, University of Lausanne, Lausanne, Switzerland
| | - J M Entenza
- Department of Fundamental Microbiology, University of Lausanne, Lausanne, Switzerland
| | - M F Hoylaerts
- Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - R Heying
- Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - P Verhamme
- Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - T Vanassche
- Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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Cools B, Brown SC, Boshoff DE, Eyskens B, Heying R, Rega F, Meyns B, Gewillig M. Percutaneous intervention for central shunts: new routes, new strategies. Acta Cardiol 2017; 72:142-148. [PMID: 28597797 DOI: 10.1080/00015385.2017.1291156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/19/2022]
Abstract
Introduction In traditional locations, the standard Blalock-Taussig shunt presents numerous technical difficulties for percutaneous intervention. We changed our strategy to a central type shunt (Laks-type) with end-to-side pulmonary and side-to-side aortic anastomosis. The aim of this study was to determine whether this modified strategy would allow easier percutaneous manipulation in patients with small pulmonary arteries. Methods All children with a stretchable central vascular graft who required any form of percutaneous intervention were prospectively enrolled in the study. Results Eleven infants were evaluated a median time of 3 months (range 0.9-4.4) following initial shunt placement; the median weight at intervention was 5.7 kg (range: 4.0 - 10.0). All shunts (100%) were easily and swiftly entered without the need for special catheters or co-axial systems. In four patients other interventions in distal pulmonary arteries were first performed: cutting balloon treatment in three and balloon angioplasty of peripheral pulmonary artery stenosis in one. The shunts were then augmented with a stent with a diameter increasing from 3.5 ± 0.4 mm to 4.7 ± 0.8 mm and saturation increasing from 76% (range: 69-88) to 84% (range: 77-88) (P < 0.05). Several months later, two children required further interventions that could easily be performed via the stented shunts. No complications were observed. Conclusions The Laks-type shunt provides easy access for percutaneous procedures of the distal pulmonary arteries including cutting balloons; this shunt can predictably be expanded to augment pulmonary flow. This study highlights how co-operation between the interventionalist and the surgeon can improve strategies to manage these difficult patients.
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Affiliation(s)
- Bjorn Cools
- Paediatric Cardiology and Cardiothoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Stephen C. Brown
- Paediatric Cardiology and Cardiothoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- University of the Free State, Bloemfontein, South Africa
| | - Derize E. Boshoff
- Paediatric Cardiology and Cardiothoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Benedicte Eyskens
- Paediatric Cardiology and Cardiothoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Ruth Heying
- Paediatric Cardiology and Cardiothoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Filip Rega
- Paediatric Cardiology and Cardiothoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Bart Meyns
- Paediatric Cardiology and Cardiothoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Marc Gewillig
- Paediatric Cardiology and Cardiothoracic Surgery, University Hospitals Leuven, Leuven, Belgium
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Pagourelias ED, Daraban AM, Mada RO, Duchenne J, Mirea O, Cools B, Heying R, Boshoff D, Bogaert J, Budts W, Gewillig M, Voigt JU. Right ventricular remodelling after transcatheter pulmonary valve implantation. Catheter Cardiovasc Interv 2017; 90:407-417. [PMID: 28296032 DOI: 10.1002/ccd.26966] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 06/12/2016] [Revised: 12/13/2016] [Accepted: 01/16/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To define the optimal timing for percutaneous pulmonary valve implantation (PPVI) in patients with severe pulmonary regurgitation (PR) after Fallot's Tetralogy (ToF) correction. BACKGROUND PPVI among the aforementioned patients is mainly driven by symptoms or by severe right ventricular (RV) dilatation/dysfunction. The optimal timing for PPVI is still disputed. METHODS Twenty patients [age 13.9 ± 9.2 years, (range 4.3-44.9), male 70%] with severe PR (≥3 grade) secondary to previous correction of ToF, underwent Melody valve (Medtronic, Minneapolis, MN) implantation, after a pre-stent placement. Full echocardiographic assessment (traditional and deformation analysis) and cardiovascular magnetic resonance evaluation were performed before and at 3 months after the intervention. 'Favorable remodelling' was considered the upper quartile of RV size decrease (>20% in 3 months). RESULTS After PPVI, indexed RV effective stroke volume increased from 38.4 ± 9.5 to 51.4 ± 10.7 mL/m2 , (P = 0.005), while RV end-diastolic volume and strain indices decreased (123.1 ± 24.1-101.5 ± 18.3 mL/m2 , P = 0.005 and -23.5 ± 2.5 to -21 ± 2.5%, P = 0.002, respectively). After inserting pre-PPVI clinical, RV volumetric and deformation parameters in a multiple regression model, only time after last surgical correction causing PR remained as significant regressor of RV remodelling [R2 = 0.60, beta = 0.387, 95%CI(0.07-0.7), P = 0.019]. Volume reduction and functional improvement were more pronounced in patients treated with PPVI earlier than 7 years after last RV outflow tract (RVOT) correction, reaching close-to-normal values. CONCLUSIONS Early PPVI (<7 years after last RVOT operation) is associated with a more favorable RV reverse remodelling toward normal range and should be considered, before symptoms or RV damage become apparent. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Ana M Daraban
- Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, 3000, Belgium
| | - Razvan O Mada
- Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, 3000, Belgium
| | - Jürgen Duchenne
- Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, 3000, Belgium
| | - Oana Mirea
- Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, 3000, Belgium
| | - Bjorn Cools
- Department of Pediatric Cardiology, University Hospital Leuven, Leuven, 3000, Belgium
| | - Ruth Heying
- Department of Pediatric Cardiology, University Hospital Leuven, Leuven, 3000, Belgium
| | - Derize Boshoff
- Department of Pediatric Cardiology, University Hospital Leuven, Leuven, 3000, Belgium
| | - Jan Bogaert
- Department of Radiology, University Hospital Leuven, Leuven, 3000, Belgium
| | - Werner Budts
- Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, 3000, Belgium
| | - Marc Gewillig
- Department of Pediatric Cardiology, University Hospital Leuven, Leuven, 3000, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospital Leuven, Leuven, 3000, Belgium
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Veloso T, Claes J, van Kerckhoven S, Hurtado-Aguilar L, Jockenhoevel S, Mela P, Jashari R, Gewillig M, Hoylaerts M, Meyns B, Heying R. Bacterial Adhesion to Tissues Used for RVOT Reconstruction under Static and Shear Stress Conditions. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1599004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- T.R. Veloso
- Department of Cardiovascular Sciences, Cardiovascular Developmental Biology - KU Leuven, Leuven, Belgium
| | - J. Claes
- Department of Cardiovascular Sciences, Cardiovascular Developmental Biology - KU Leuven, Leuven, Belgium
| | - S. van Kerckhoven
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology - KU Leuven, Leuven, Belgium
| | - L.G. Hurtado-Aguilar
- Department of Tissue Engineering and Textile Implants, Helmholtz Institute - RWTH Aachen University, Aachen, Germany
| | - S. Jockenhoevel
- Department of Tissue Engineering and Textile Implants, Helmholtz Institute - RWTH Aachen University, Aachen, Germany
| | - P. Mela
- Department of Tissue Engineering and Textile Implants, Helmholtz Institute - RWTH Aachen University, Aachen, Germany
| | - R. Jashari
- European Homograft Bank (EHB) International Association, Brussels, Belgium
| | - M. Gewillig
- Department of Cardiovascular Sciences, Cardiovascular Developmental Biology - KU Leuven, Leuven, Belgium
| | - M.F. Hoylaerts
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology - KU Leuven, Leuven, Belgium
| | - B. Meyns
- Division of Clinical Cardiac Surgery - KU Leuven, Department of Cardiovascular Sciences, Leuven, Belgium
| | - R. Heying
- Department of Cardiovascular Sciences, Cardiovascular Developmental Biology - KU Leuven, Leuven, Belgium
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Brown SC, Eyskens B, Boshoff D, Cools B, Heying R, Rega F, Meyns B, Gewillig M. Bailout shunt/banding for backward left heart failure after adequate neonatal coarctectomy in borderline left hearts. Interact Cardiovasc Thorac Surg 2016; 23:929-932. [DOI: 10.1093/icvts/ivw254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/10/2016] [Accepted: 06/27/2016] [Indexed: 11/12/2022] Open
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De Praetere H, Vandesande J, Rega F, Daenen W, Marc G, Eyskens B, Heying R, Cools B, Meyns B. 20 years of arterial switch operation for simple TGA. Acta Chir Belg 2016. [DOI: 10.1080/00015458.2014.11680988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- H. De Praetere
- Department of Cardiac Surgery, & Department of Cardiovascular Sciences, University Hospitals Leuven KULeuven, Belgium
| | - J. Vandesande
- Department of Cardiac Surgery, & Department of Cardiovascular Sciences, University Hospitals Leuven KULeuven, Belgium
| | - F. Rega
- Department of Cardiac Surgery, & Department of Cardiovascular Sciences, University Hospitals Leuven KULeuven, Belgium
| | - W. Daenen
- Department of Cardiac Surgery, & Department of Cardiovascular Sciences, University Hospitals Leuven KULeuven, Belgium
| | - G. Marc
- Department of Pediatric Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - B. Eyskens
- Department of Pediatric Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - R. Heying
- Department of Pediatric Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - B. Cools
- Department of Pediatric Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - B. Meyns
- Department of Cardiac Surgery, & Department of Cardiovascular Sciences, University Hospitals Leuven KULeuven, Belgium
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De Mey W, Cools B, Heying R, Budts W, Louw JJ, Boshoff DE, Brown SC, Gewillig M. Can a volume challenge pinpoint the limiting factor in a Fontan circulation? Acta Cardiol 2015; 70:536-42. [PMID: 26567813 DOI: 10.2143/ac.70.5.3110514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE It is difficult to indicate whether the limitation in a failing Fontan circulation lies within the pulmonary vasculature or the heart. Such differentiation is crucial to direct adequate therapy. This study was set out to determine if a volume challenge could identify the limiting factor. METHODS AND STUDY POPULATION Thirty-two catheterizations in 28 patients with a Fontan circulation were included. Pressures and oxygen saturations were measured before and after volume challenge (NaCl 0.9%; 15 cc/Kg). The changes in data were grouped based on the location of the major pressure increase. Ventricular function was measured in the resting state. RESULTS The majority of the patients showed an increase in aortic oxygen saturation, mixed venous oxygen saturation, systolic, pulmonary and systemic venous pressures. The arterio-venous oxygen gradient decreased, suggesting an increase in cardiac output. Different patterns in pressure changes were observed. Most (n=17) showed a similar increase of ventricular end-diastolic pressure and mean venous pressure (MVP); some (n=7) showed a lower increase of MVP, suggesting pulmonary reserve and recruitment; others (n=8) showed a significant higher increase in MVP, suggesting increased pulmonary vascular resistance. All volume challenge was well tolerated. CONCLUSION Most patients were preload-responsive. The pressure changes following volume load showed patterns with a potential of differentiating between patients with a major pulmonary or cardiac limiting factor.
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Liersch PN, Schwarz A, Sachweh J, Hermanns-Sachweh B, Heying R, Vázquez-Jimènez JF, Albert A, Seghaye MC. Gene expression of cytokines, growth factors and apoptosis regulators in a neonatal model of pulmonary stenosis. Future Cardiol 2015; 11:297-307. [PMID: 26021636 DOI: 10.2217/fca.15.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 01/09/2023] Open
Abstract
BACKGROUND Right ventricular remodeling due to pulmonary stenosis increases morbidity in children. Its pathophysiology needs to be clarified. METHODS Six newborn lambs underwent pulmonary arterial banding, seven sham operation. mRNA encoding for cytokines, growth factors and regulators of apoptosis was sequentially measured in myocardium and blood before and up to 12 weeks postoperatively. RESULTS Experimental animals showed hypertrophy and fibrosis of the right ventricular myocardium, myocardial over-expression of CT-1-mRNA and higher blood concentrations of mRNA encoding for VEGF, TGF-β, Bak and BcL-xL than controls, respectively. CONCLUSION Neonatal pulmonary stenosis leads to myocardial hypertrophy that is associated with CT-1 gene expression and with activation of growth- and apoptosis pathways in blood cells.
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Affiliation(s)
- Peter N Liersch
- 1Department of Pediatric Cardiology, University Hospital Aachen, Germany
| | - Andreas Schwarz
- 1Department of Pediatric Cardiology, University Hospital Aachen, Germany
| | - Joerg Sachweh
- 2Department of Pediatric Cardiac Surgery, University Hospital Aachen, Germany
| | | | - Ruth Heying
- 4Department of Pediatric Cardiology, University Hospital Leuven, Belgium
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Cools B, Brown SC, Heying R, Jansen K, Boshoff DE, Budts W, Gewillig M. Percutaneous pulmonary valve implantation for free pulmonary regurgitation following conduit-free surgery of the right ventricular outflow tract. Int J Cardiol 2015; 186:129-35. [DOI: 10.1016/j.ijcard.2015.03.108] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 01/14/2015] [Accepted: 03/07/2015] [Indexed: 11/24/2022]
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