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Cardiac Electrophysiology Clinics Sep 2020Accessing the epicardial space without a sternotomy or a surgical pericardial window to treat ventricular arrhythmias in Chagas disease became a medical necessity in... (Review)
Review
Accessing the epicardial space without a sternotomy or a surgical pericardial window to treat ventricular arrhythmias in Chagas disease became a medical necessity in South America. Since the introduction of the dry percutaneous epicardial access approach, epicardial access has been standard procedure for management of ventricular arrhythmias in ischemic and nonischemic cardiomyopathies and atrioventricular accessory pathways after failed conventional endocardial ablation. Understanding the epicardial space and neighboring structures has become an important subject of teachings in electrophysiology. The evolution of complex ablation procedures to treat atrial and ventricular arrhythmias and device interventions to prevent cardioembolic stroke requires thorough understanding of pericardial anatomy.
Topics: Cardiac Imaging Techniques; Catheter Ablation; Epicardial Mapping; Heart Diseases; Humans; Pericardium
PubMed: 32771183
DOI: 10.1016/j.ccep.2020.06.001 -
JACC. Clinical Electrophysiology Jul 2022Epicardial access is becoming increasingly important for various cardiovascular interventions. Access to dry pericardial space can be challenging and is often associated... (Review)
Review
Epicardial access is becoming increasingly important for various cardiovascular interventions. Access to dry pericardial space can be challenging and is often associated with significant complications. A novel concealed-needle blunt-tip device is designed to capture the parietal pericardium layer and retract it into the distal end of the device, which houses a fixated concealed needle, in a bid to minimize the likelihood of lacerating the visceral layer of the pericardium. This prospective single-arm study evaluated the feasibility of use of this device in 11 human subjects with successful access attained in 91% (10 of 11) of cases without adverse events. (Pericardial Access With ViaOne Device; NCT05006157).
Topics: Clinical Studies as Topic; Feasibility Studies; Humans; Pericardium; Prospective Studies
PubMed: 35750622
DOI: 10.1016/j.jacep.2022.04.016 -
Multimedia Manual of Cardiothoracic... Oct 2021Aortic valve neocuspidization with fixed autologous pericardium according to the Ozaki technique has been proven to be an effective therapy for the treatment of aortic...
Aortic valve neocuspidization with fixed autologous pericardium according to the Ozaki technique has been proven to be an effective therapy for the treatment of aortic valvulopathies of various entities (aortic stenosis, aortic regurgitation, aortic valve endocarditis) in both tricuspid and bicuspid aortic valves. Thus, aortic valve neocuspidization with fixed autologous pericardium represents a versatile alternative to complex aortic valve repair, with better hemodynamics compared to biological aortic valve replacement and without the need for lifelong anticoagulation, which characterizes mechanical aortic valve replacement. The authors meticulously describe all the technical steps of this highly reproducible, standardized procedure.
Topics: Aortic Valve; Aortic Valve Insufficiency; Aortic Valve Stenosis; Bioprosthesis; Heart Valve Prosthesis; Humans; Pericardium; Treatment Outcome
PubMed: 34672143
DOI: 10.1510/mmcts.2021.060 -
Acta Biomaterialia Dec 2022Bioprosthetic heart valves (BHVs) have been widely used due to the revolutionary transcatheter aortic valve replacement (TAVR) techniques but suffer from a limited...
Dual-crosslinked bioprosthetic heart valves prepared by glutaraldehyde crosslinked pericardium and poly-2-hydroxyethyl methacrylate exhibited improved antithrombogenicity and anticalcification properties.
Bioprosthetic heart valves (BHVs) have been widely used due to the revolutionary transcatheter aortic valve replacement (TAVR) techniques but suffer from a limited lifespan. Previous modification methods of BHVs mainly rely on glutaraldehyde precrosslinking and subsequent modification. In this study, we have engineered a Poly-2-Hydroxyethyl methacrylate (pHEMA) coated BHV based on co-crosslinking and co-polymerization strategies. Our BHV overcomes previous limitations of glutaraldehyde prefixation by introducing free molecules before crosslinking to achieve the crosslinking and allyl moiety immobilization simultaneously. Decellularized porcine pericardium and 2-Amino-4-pentenoic acid (APA) are firstly co-crosslinked by glutaraldehyde to obtain alkenylated porcine pericardium (APA-PP), then APA-PP is copolymerized with hydrophilic monomer 2-Hydroxyethyl methacrylate (HEMA) to prepare pHEMA grafted porcine pericardium (HEMA-PP). Compared with traditional glutaraldehyde crosslinked pericardium (GA), HEMA-PP exhibits decreased cytotoxicity and significantly increased endothelialial cells proliferation (7-folds higher than GA after 3-day incubation). In vitro and ex vivo hemocompatibility studies demonstrate the superiority of HEMA-PP in anti-thrombogenicity, where the platelet adhesion decreased by levels of approximately 89% compared to GA. Moreover, HEMA-PP maintains structurally stable with a low level of calcification in the subcutaneous model. The hydrodynamic performance and durability are proven to meet the requirements of ISO 5840-3. Altogether, HEMA-PP may have the potential for future clinical application. STATEMENT OF SIGNIFICANCE: Currently, bioprosthetic heart valves (BHVs) have drawbacks including cytotoxicity, calcification and thrombosis, which would accelerate structural valvular degeneration and limit the service life of BHVs. We developed a new modification strategy that could simultaneously improve the biocompatibility, anti-calcification and anti-thrombotic properties of BHVs. Moreover, the appropriate durability and hydrodynamic property demonstrated the potential of our strategy for clinical application. This work will potentially prolong the service life of BHVs and provide new insight for the modification of BHVs.
Topics: Swine; Animals; Bioprosthesis; Glutaral; Heart Valve Prosthesis; Heart Valves; Pericardium; Calcinosis
PubMed: 36306983
DOI: 10.1016/j.actbio.2022.10.036 -
The Annals of Thoracic Surgery Oct 2022
Topics: Catheter Ablation; Cryosurgery; Hot Temperature; Humans; Pericardium
PubMed: 34902304
DOI: 10.1016/j.athoracsur.2021.11.018 -
Frontiers in Endocrinology 2023In recent decades, the epicardial adipose tissue (EAT) has been at the forefront of scientific research because of its diverse role in the pathogenesis of cardiovascular... (Review)
Review
In recent decades, the epicardial adipose tissue (EAT) has been at the forefront of scientific research because of its diverse role in the pathogenesis of cardiovascular diseases (CVDs). EAT lies between the myocardium and the visceral pericardium. The same microcirculation exists both in the epicardial fat and the myocardium. Under physiological circumstances, EAT serves as cushion and protects coronary arteries and myocardium from violent distortion and impact. In addition, EAT acts as an energy lipid source, thermoregulator, and endocrine organ. Under pathological conditions, EAT dysfunction promotes various CVDs progression in several ways. It seems that various secretions of the epicardial fat are responsible for myocardial metabolic disturbances and, finally, leads to CVDs. Therefore, EAT might be an early predictor of CVDs. Furthermore, different non-invasive imaging techniques have been proposed to identify and assess EAT as an important parameter to stratify the CVD risk. We also present the potential therapeutic possibilities aiming at modifying the function of EAT. This paper aims to provide overview of the potential role of EAT in CVDs, discuss different imaging techniques to assess EAT, and provide potential therapeutic options for EAT. Hence, EAT may represent as a potential predictor and a novel therapeutic target for management of CVDs in the future.
Topics: Humans; Cardiovascular Diseases; Pericardium; Myocardium; Coronary Vessels; Adipose Tissue
PubMed: 37260440
DOI: 10.3389/fendo.2023.1167952 -
Journal of the American Society of... Aug 2023Routine echocardiography using a standard-frequency ultrasound probe has insufficient spatial resolution to clearly visualize the parietal pericardium (PP)....
BACKGROUND
Routine echocardiography using a standard-frequency ultrasound probe has insufficient spatial resolution to clearly visualize the parietal pericardium (PP). High-frequency ultrasound (HFU) has enhanced axial resolution. The aim of this study was to use a commercially available high-frequency linear probe to evaluate apical PP thickness (PPT) and pericardial adhesion in both normal pericardium and pericardial diseases.
METHODS
From April 2002 to March 2022, 227 healthy individuals, 205 patients with apical aneurysm (AA) and 80 patients with chronic constrictive pericarditis (CP) were recruited to participate in this study. All subjects underwent both standard-frequency ultrasound and HFU to image the apical PP (APP) and pericardial adhesion. Some subjects underwent computed tomography (CT).
RESULTS
Apical PPT was measured using HFU and found to be 0.60 ± 0.01 mm (0.37-0.87 mm) in normal control subjects, 1.22 ± 0.04 mm (0.48-4.53 mm) in patients with AA, and 2.91 ± 0.17 mm (1.13-9.01 mm) in patients with CP. Tiny physiologic effusions were observed in 39.2% of normal individuals. Pericardial adhesion was detected in 69.8% of patients with local pericarditis due to AA and 97.5% of patients with CP. Visibly thickened visceral pericardium was observed in six patients with CP. Apical PPT measurements obtained by HFU correlated well with those obtained by CT in those patients with CP. However, CT could clearly visualize the APP in only 45% of normal individuals and 37% of patients with AA. In 10 patients with CP, both HFU and CT demonstrated equal ability to visualize the very thickened APP.
CONCLUSIONS
Apical PPT measured using HFU in normal control subjects ranged from 0.37 to 0.87 mm, consistent with previous reports from necropsy studies. HFU had higher resolution in distinguishing local pericarditis of the AA from normal individuals. HFU was superior to CT in imaging APP lesions, as CT failed to visualize the APP in more than half of both normal individuals and patients with AA. The fact that all 80 patients with CP in our study had significantly thickened APP raises doubt regarding the previously reported finding that 18% of patients with CP had normal PPT.
Topics: Humans; Pericardium; Pericarditis, Constrictive; Ultrasonography; Pericarditis; Echocardiography
PubMed: 37019343
DOI: 10.1016/j.echo.2023.03.010 -
Journal of Nuclear Cardiology :... Oct 2022Primary pericardial angiosarcoma is a rare malignant cardiac neoplasm with early metastasis and poor prognosis. There are currently no guidelines or effective...
Primary pericardial angiosarcoma is a rare malignant cardiac neoplasm with early metastasis and poor prognosis. There are currently no guidelines or effective therapeutic strategies. Here we report a case of a 22-year-old man who presented with chest pain, suffocation and transient syncope over the course of 4 months. Further workup showed a large mass in the right pericardium, histopathologic examination revealed angiosarcoma. The patient subsequently received a total of 8 cycles of chemotherapy (paclitaxel and doxorubicin). This patient has an overall survival of 1 year to date. The current examination methods and reported cases revealed that early detection of primary pericardial angiosarcoma with imaging examinations is critical for prognosis.
Topics: Adult; Doxorubicin; Heart Neoplasms; Hemangiosarcoma; Humans; Male; Mediastinal Neoplasms; Paclitaxel; Pericardium; Thymus Neoplasms; Young Adult
PubMed: 33559092
DOI: 10.1007/s12350-020-02470-0 -
Internal Medicine (Tokyo, Japan) Dec 2021
Topics: Heart Neoplasms; Humans; Lymphoma; Pericardium
PubMed: 34121016
DOI: 10.2169/internalmedicine.7643-21 -
Nature Reviews. Cardiology Sep 2021
Topics: Humans; Infarction; Pericardium
PubMed: 34211158
DOI: 10.1038/s41569-021-00596-3