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Brazilian Journal of Cardiovascular... Oct 2023Aortic stenosis (AS) is the most common valvular heart disease and the most common indication for aortic valve replacement in adults. Aortic valve neocuspidization...
INTRODUCTION
Aortic stenosis (AS) is the most common valvular heart disease and the most common indication for aortic valve replacement in adults. Aortic valve neocuspidization (AVNeo) with fixed autologous pericardium, also known as the Ozaki procedure, is a possible alternative treatment of AS. Autopericardial valves save the dynamics and physiological anatomy of the aortic root, however, the service life of autopericardial leaflets is limited. There is no data about factors that may influence the development of AVNeo insufficiency. Here, we assessed the effect of autopericardial leaflet symmetry on the development of aortic insufficiency after Ozaki procedure.
METHODS
This study included 381 patients with AS who underwent Ozaki procedure. Patients were divided into group 1 (171 patients with symmetric aortic root) and group 2 (210 patients with asymmetric aortic root).
RESULTS
The maximum observation period was up to 65 months. Sixteen cases of aortic insufficiency were detected in group 1, and 33 cases were detected in group 2. Based on the results of Cox regression, the predictors of aortic insufficiency in the late postoperative period are age and asymmetry of neocusps. According to results of Kaplan-Meier analysis, insufficiency of AVNeo in the maximum follow-up period after surgical correction of AS for group 1 patients was significantly lower than for group 2 patients (P=0.006).
CONCLUSION
Asymmetric neocusps increase the risk of aortic insufficiency in the mid-term period after Ozaki procedure. And the older the patients at the time of surgery, the less likely they develop AVNeo insufficiency.
Topics: Adult; Humans; Aortic Valve; Heart Valve Diseases; Aortic Valve Stenosis; Aortic Valve Insufficiency; Heart Valve Prosthesis; Pericardium; Treatment Outcome
PubMed: 37797236
DOI: 10.21470/1678-9741-2022-0370 -
Current Cardiology Reports Oct 2023We aim to give a concise overview of the different clinical manifestations of both acute and long-term radiotherapy-related pericardial diseases, the underlying... (Review)
Review
PURPOSE OF REVIEW
We aim to give a concise overview of the different clinical manifestations of both acute and long-term radiotherapy-related pericardial diseases, the underlying pathophysiology as well as the diagnosis and treatment options.
RECENT FINDINGS
Radiotherapy-related pericardial disease is common, but despite radiotherapy being a cornerstone of many cancer treatments, this disease entity is relatively underrepresented in clinical trials, resulting in a paucity of research data on pathophysiology and management. Since the development of innovative cancer treatments, survival has significantly improved. Therefore, the importance of long-term treatment-related side effects increases, most notably cancer treatment-related cardiovascular toxicity. In patients undergoing radiotherapy as a part of their cancer treatment, radiotherapy-related pericardial disease can manifest early (during or shortly after radiotherapy administration) or very late (several years to decades after treatment). This exceptionally long latency period confronts physicians with treatment-related side effects of radiotherapy regimens that may have been abandoned already.
Topics: Humans; Heart Diseases; Radiation Injuries; Pericardium
PubMed: 37584875
DOI: 10.1007/s11886-023-01933-3 -
Annales de Pathologie Mar 2024
PubMed: 38336537
DOI: 10.1016/j.annpat.2024.01.007 -
Revue Des Maladies Respiratoires 2023While IgG4-related disease (IgG4-RD) was initially described in the early 2000s, its polymorphic clinical manifestations were previously reported under different... (Review)
Review
INTRODUCTION
While IgG4-related disease (IgG4-RD) was initially described in the early 2000s, its polymorphic clinical manifestations were previously reported under different names ; they have in common the presence of IgG4+ oligoclonal plasma cells and fibrosis.
STATE OF THE ART
Ruling out certain differential diagnoses, the diagnosis of IgG4-RD is based on a bundle of clinical, biological and histological features. Chest involvement is variable and can affect the mediastinum, bronchi, parenchyma, pleura and/or, more rarely, bones and (pericardium, aorta, coronary…) vascular structures. The most frequent radiological manifestations are peribronchovascular thickening, mediastinal lymphadenopathy, and nodular or interstitial patterns. Pleural involvement and posterior mediastinal fibrosis are less frequent, while thoracic paravertebral tissue thickening is highly specific. Systemic corticosteroids are the cornerstone of treatment. In case of relapse or as frontline therapy in case of risk factors for relapse and/or poor tolerance of corticosteroids), a steroid-sparing agent (most often rituximab) is added, and biannual maintenance infusions are associated with a lower risk of relapse.
PERSPECTIVES
An international consensus has recently led to the development of classification criteria that should standardize the diagnostic approach and homogenize the enrolment of patients in epidemiological as well as therapeutic studies. Other treatments are also under evaluation, including biologics targeting T2 inflammation, CD-19 (inebilizumab, obexelimab), SLAMF7 (elotuzumab) surface proteins, Bruton's tyrosine kinase, and the JAK/STAT pathway.
CONCLUSIONS
Substantial progress has been made over recent years in understanding IgG4-RD pathophysiology, and personalized patient care seems to be an achievable medium-term goal.
Topics: Humans; Immunoglobulin G4-Related Disease; Autoimmune Diseases; Janus Kinases; STAT Transcription Factors; Signal Transduction; Adrenal Cortex Hormones; Fibrosis; Recurrence
PubMed: 37858433
DOI: 10.1016/j.rmr.2023.10.001 -
The Journal of International Medical... Nov 2023Angiosarcoma is the most invasive and malignant cardiac tumor and most commonly originates from the right atrium. Early diagnosis is essential, and echocardiography has...
Angiosarcoma is the most invasive and malignant cardiac tumor and most commonly originates from the right atrium. Early diagnosis is essential, and echocardiography has an important role in diagnosis. This tumor grows aggressively, and metastases to other sites makes it difficult to control. Surgical treatment remains the best option for patients who do not respond to chemoradiotherapy. We herein report a case of a 17-year-old patient with cardiac angiosarcoma who presented with dyspnea, chest pain, dry cough, and fever. Although we considered the most probable diagnosis to be constrictive pericarditis, pathologic examination revealed a primary angiosarcoma originating from the pericardium. The patient underwent total pericardiectomy. However, despite receiving chemotherapy for 2 weeks postoperatively, she developed complications including leukopenia and eventually died of respiratory failure. Late diagnosis of angiosarcoma often occurs, resulting in progression to end-stage disease and a very poor prognosis. Therefore, a thorough understanding of this entity, knowledge of its pitfalls in management, and establishment of an accurate treatment guideline would help to develop a reliable and life-saving treatment approach for these patients.
Topics: Female; Humans; Adolescent; Hemangiosarcoma; Mediastinal Neoplasms; Thymus Neoplasms; Heart Neoplasms; Chemoradiotherapy
PubMed: 37987637
DOI: 10.1177/03000605231211772 -
European Journal of Radiology Dec 2023Although pericoronary adipose tissue (PCAT) is a component of the epicardial adipose tissue (EAT) depot, they may have different associations to coronary artery disease...
INTRODUCTION
Although pericoronary adipose tissue (PCAT) is a component of the epicardial adipose tissue (EAT) depot, they may have different associations to coronary artery disease (CAD). We explored relationships between pericoronary adipose tissue mean attenuation (PCAT) and EAT measurements in coronary CT angiography (CCTA) in patients with and without CAD.
MATERIAL AND METHODS
CCTA scans of 185 non-CAD and 81 CAD patients (86.4% >50% stenosis) were included and retrospectively analyzed. PCAT and EAT density/volume were measured and analyzed by sex, including associations with age, risk factors and tube voltage using linear regression models.
RESULTS
In non-CAD and CAD, mean PCAT and EAT volume were higher in men than in women (non-CAD: -92.5 ± 10.6HU vs -96.2 ± 8.4HU, and 174.4 ± 69.1 cm vs 124.1 ± 57.3 cm; CAD: -92.2 ± 9.0HU vs -97.4 ± 9.7HU, and 193.6 ± 62.5 cm vs 148.5 ± 50.5 cm (p < 0.05)). EAT density was slightly lower in men than women in non-CAD (-96.4 ± 6.3HU vs -94.4 ± 5.5HU (p < 0.05)), and similar in CAD (-98.2 ± 5.2HU vs 98.2 ± 6.4HU). There was strong correlation between PCAT and EAT density (non-CAD: r = 0.725, p < 0.001, CAD: r = 0.686, p < 0.001) but no correlation between PCAT and EAT volume (non-CAD: r = 0.018, p = 0.81, CAD: r = -0.055, p = 0.63). A weak inverse association was found between EAT density and EAT volume (non-CAD: r = -0.244, p < 0.001, CAD: r = -0.263, p = 0.02). In linear regression models, EAT density was significantly associated with PCAT in both non-CAD and CAD patients independent of risk factors and tube voltage.
CONCLUSION
In CAD and non-CAD patients, EAT density, but not EAT volume, showed significant associations with PCAT. Compared to women, men had higher PCAT and EAT volume independently of disease status, but similar or slightly lower EAT density. Differences in trends and relations of PCAT and EAT by sex could indicate that personalized interpretation and thresholding is needed.
Topics: Humans; Male; Female; Coronary Artery Disease; Retrospective Studies; Coronary Angiography; Tomography, X-Ray Computed; Pericardium; Adipose Tissue
PubMed: 37944331
DOI: 10.1016/j.ejrad.2023.111154 -
Diabetes & Metabolism Journal May 2024Heart failure (HF) management guidelines recommend individualized assessments based on HF phenotypes. Adiposity is a known risk factor for HF. Recently, there has been... (Review)
Review
Heart failure (HF) management guidelines recommend individualized assessments based on HF phenotypes. Adiposity is a known risk factor for HF. Recently, there has been an increased interest in organ-specific adiposity, specifically the role of the epicardial adipose tissue (EAT), in HF risk. EAT is easily assessable through various imaging modalities and is anatomically and functionally connected to the myocardium. In pathological conditions, EAT secretes inflammatory cytokines, releases excessive fatty acids, and increases mechanical load on the myocardium, resulting in myocardial remodeling. EAT plays a pathophysiological role in characterizing both HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). In HFrEF, EAT volume is reduced, reflecting an impaired metabolic reservoir, whereas in HFpEF, the amount of EAT is associated with worse biomarker and hemodynamic profiles, indicating increased EAT activity. Studies have examined the possibility of therapeutically targeting EAT, and recent studies using sodium glucose cotransporter 2 inhibitors have shown potential in reducing EAT volume. However, further research is required to determine the clinical implications of reducing EAT activity in patients with HF.
Topics: Humans; Heart Failure; Pericardium; Adipose Tissue; Stroke Volume; Adiposity; Sodium-Glucose Transporter 2 Inhibitors; Risk Factors; Epicardial Adipose Tissue
PubMed: 38310880
DOI: 10.4093/dmj.2023.0190 -
European Heart Journal. Acute... Jul 2023Pericardial effusions can result in acute haemodynamic compromise and require rapid intervention. Understanding pericardial restraint is essential to determine the... (Review)
Review
Pericardial effusions can result in acute haemodynamic compromise and require rapid intervention. Understanding pericardial restraint is essential to determine the approach to newly identified pericardial effusions in the intensive care unit. As pericardial effusions stretch the pericardium, the pericardial compliance reserve is eventually exhausted, with an exponential rise in compressive pericardial pressure. The severity of pericardial pressure increase depends on both the rapidity and volume of pericardial fluid accumulation. This increase in pericardial pressure is reflected in an increase in measured left- and right-sided 'filling' pressures, but paradoxically left ventricular end-diastolic volume (the true left ventricular preload) is decreased. This uncoupling of filling pressures and preload is the hallmark of pericardial restraint. When this occurs acutely from a pericardial effusion, rapid recognition and pericardiocentesis can be lifesaving. In this review, we will discuss the haemodynamics and pathophysiology of acute pericardial effusions, provide a physiological guide to determine the need for pericardiocentesis in acute care, and discuss important caveats to management.
Topics: Humans; Pericardial Effusion; Pericarditis, Constrictive; Pericardiocentesis; Pericardium; Hemodynamics; Cardiac Tamponade
PubMed: 37202863
DOI: 10.1093/ehjacc/zuad050 -
The Veterinary Clinics of North... Jul 2024Laparoscopic herniorrhaphy provides a feasible minimally invasive treatment option for dogs with peritoneal-pericardial hernias with careful case selection. This article... (Review)
Review
Laparoscopic herniorrhaphy provides a feasible minimally invasive treatment option for dogs with peritoneal-pericardial hernias with careful case selection. This article describes the techniques, instrumentation, and challenges associated with laparoscopic peritoneal-pericardial diaphragmatic hernia repair.
Topics: Animals; Laparoscopy; Dogs; Dog Diseases; Hernia, Diaphragmatic; Herniorrhaphy; Pericardium
PubMed: 38519368
DOI: 10.1016/j.cvsm.2024.02.003 -
International Journal of Cardiology Jun 2024Heart failure is an important cause of mortality and morbidity worldwide. Heart failure with preserved ejection fraction (HFpEF) incidence and prevalence is increasing,... (Review)
Review
Heart failure is an important cause of mortality and morbidity worldwide. Heart failure with preserved ejection fraction (HFpEF) incidence and prevalence is increasing, and the phenotype associated with obesity is the most frequent. Epicardial adipose tissue (EAT) is directly associated with systemic obesity and several previous studies have shown a clear link between EAT and HFpEF. Moreover, the restriction induced by the pericardium is also linked to HFpEF. In this review we will describe the epidemiological association between the pericardium, EAT and HFpEF, how to quantify EAT, what are the pathophysiological mechanism to explain theses association and how can the pericardium and EAT be a treatment target in patients with HFpEF.
PubMed: 38944349
DOI: 10.1016/j.ijcard.2024.132303