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Veterinarni Medicina Feb 2023This study aims to describe the most important cardiac structures in the through echocardiography and anatomical dissection. Echocardiographic and echo-Doppler...
This study aims to describe the most important cardiac structures in the through echocardiography and anatomical dissection. Echocardiographic and echo-Doppler measurements were performed on twenty healthy adult (10.10). The values of the ventricular length, aortic diameter, pulmonary trunk diameter, the mean thickness of the interventricular septum, and thicknesses of the wall of the (Cav. P) and (Cav. A), were measured. The aortic flow and pulmonary trunk flow were recorded. Two dead specimens (1.1) were dissected. The male's pulmonary trunk diameter was bigger compared to the female's in both the long and short axis. The reproductive ecology of has yet to be fully elucidated upon, however, male territorialism and dispersal from the hibernacula, and multiple male courtships toward a single female were described, hence, the more active reproductive activity of the male and the consequent sexual selection toward a higher aerobic performance can be hypothesised. A moderate interventricular right to left shunt was noticed in the Cav. V of all the specimens, which is considered normal and should not confuse the clinician. Congenital defects, cardiomyopathies, valvulopathies, and pericardial diseases are known to occur in ophidians and other reptiles. Reliable data and profound knowledge of the anatomy and physiology of the ophidian heart are fundamental for the diagnosis of cardiac diseases in snakes.
PubMed: 38332762
DOI: 10.17221/63/2022-VETMED -
CJC Open Jan 2022Mulibrey nanism (MUL) is a rare condition with profound growth delay. Congestive heart failure is a major determinant of prognosis. The aim was to delineate pericardial...
BACKGROUND
Mulibrey nanism (MUL) is a rare condition with profound growth delay. Congestive heart failure is a major determinant of prognosis. The aim was to delineate pericardial constriction and myocardial functional abnormalities in a pediatric MUL sample.
METHODS
A total of 23 MUL patients and 23 individually sex- and age-matched healthy control subjects were prospectively assessed in a cross-sectional study with echocardiography.
RESULTS
Clinical signs of heart failure were present in 7 MUL patients, with severe congestive heart failure in 2. Significant diastolic dysfunction, mainly related to constriction, was found in MUL patients without pericardiectomy (N = 18)-septal bounce, pronounced hepatic vein atrial reversal and right heart inflow-outflow variations, and decreased inferior vena cava collapse during respiration. The appearance of the pericardium was not different from that of control subjects. Longitudinal diastolic myocardial velocities were similar to those in control subjects, suggesting an absence of significant myocardial restriction. Right ventricular free wall longitudinal systolic strain and bilateral longitudinal myocardial systolic velocities were decreased in MUL patients, indicating mild biventricular systolic dysfunction. Myocardial motion abnormalities and persistent congestive heart failure were common (in 3 of 6) in MUL patients with a history of pericardiectomy. Cardiac dimensions were similar between MUL patients and control subjects when adjusting for body size, except for smaller biventricular volumes.
CONCLUSIONS
MUL disease presents with significant constriction-related diastolic dysfunction and mild bilateral systolic dysfunction. Constriction-restriction assessments during follow-up could be of benefit in decision-making regarding pericardiectomy in MUL disease. Myocardial abnormalities were prevalent among MUL patients who had undergone pericardiectomy and are consistent with progression of myocardial disease in a significant proportion of patients.
PubMed: 35072025
DOI: 10.1016/j.cjco.2021.08.012 -
Vascular Health and Risk Management 2024We aim to access the effect of pericardiectomy for constrictive pericarditis with or without cardiopulmonary bypass. (Review)
Review
AIM
We aim to access the effect of pericardiectomy for constrictive pericarditis with or without cardiopulmonary bypass.
METHODS
This was a review of pericardiectomy for constrictive pericarditis.
RESULTS
Cardiopulmonary bypass is actually an important maneuver to attain complete relief of the constriction. The short additional time of cardiopulmonary bypass during the procedure has very little effect on the risk of morbidity of the main operation.
CONCLUSION
Incomplete pericardiectomy perhaps was the cause of postoperative remnant constriction and high diastolic filling pressure leading to multiorgan failure. Complete pericardiectomy (removal of phrenic-to-phrenic and the postero-lateral and inferior wall pericardial thickening) using cardiopulmonary bypass should be the routine for total relief of the constriction of the heart.
Topics: Humans; Pericarditis, Constrictive; Pericardiectomy; Cardiopulmonary Bypass; Postoperative Complications
PubMed: 38348404
DOI: 10.2147/VHRM.S439292 -
Romanian Journal of Morphology and... 2023Pericardial cysts (PCs) or pleuropericardial cysts are rare congenital mediastinal lesions with an approximate incidence of one in 100 000 persons. Usually, they are...
Pericardial cysts (PCs) or pleuropericardial cysts are rare congenital mediastinal lesions with an approximate incidence of one in 100 000 persons. Usually, they are asymptomatic, being incidentally discovered during a routine chest imaging examination or an autopsy exam. The study involved a retrospective evaluation of clinicopathological findings in a 6-year series of PCs, treated in the Clinic of Pulmonary Diseases, Iaşi, Romania. A group of five cases of PCs, four females and one male, were evaluated. All patients displayed different symptoms, such as dyspnea, chest pain, chronic cough, fatigue, palpitation, and epigastric pain. The cystic lesions were located in the right and left cardiophrenic angle, in four cases, and in the central mediastinum in a single case. The lesions had a fluid content and a maximum diameter that ranged between 35 and 95 mm. The microscopic examination of the surgical resection tissues revealed a thin connective tissue wall without any associated smooth muscle cells. The loose connective tissue band was lined by a layer of mesothelial cells with no cellular atypia, which displayed discrete papillary projections, in one case. Although PCs are rare incidental findings, they should be considered in differential diagnoses of mediastinal cysts, especially as they are associated with non-specific symptoms. Furthermore, considering the possibility of development of severe complications, PCs should be thoroughly explored for suitable patients' management.
Topics: Female; Humans; Male; Mediastinal Cyst; Retrospective Studies; Diagnosis, Differential; Autopsy; Chronic Cough
PubMed: 38184832
DOI: 10.47162/RJME.64.4.08 -
Frontiers in Pediatrics 2021Ewing sarcomas of the chest wall, historically known as "Askin tumors" represent highly aggressive pediatric malignancies with a reported 5-year survival ranging only...
Interdisciplinary Radical "En-Bloc" Resection of Ewing Sarcoma of the Chest Wall and Simultaneous Chest Wall Repair Achieves Excellent Long-Term Survival in Children and Adolescents.
Ewing sarcomas of the chest wall, historically known as "Askin tumors" represent highly aggressive pediatric malignancies with a reported 5-year survival ranging only between 40 and 60% in most studies. Multimodal oncological treatment according to specific Ewing sarcoma protocols and radical "en-bloc" resection with simultaneous chest wall repair are key factors for long-term survival. However, the surgical complexity depends on tumor location and volume and potential infiltrations into lung, pericardium, diaphragm, esophagus, spine and major vessels. Thus, the question arises, which surgical specialties should join their comprehensive skills when approaching a child with Ewing sarcoma of the chest wall. All pediatric patients with Ewing sarcomas of the chest wall treated between 1990 and 2020 were analyzed focusing on complete resection, chest wall reconstruction, surgical complications according to Clavien-Dindo (CD) and survival. Patients received neo-adjuvant chemotherapy according to the respective Ewing sarcoma protocols. Depending on tumor location and organ infiltration, a multi-disciplinary surgical team was orchestrated to perform radical en-bloc resection and simultaneous chest wall repair. Thirteen consecutive patients (seven boys and six girls) were included. Median age at presentation was 10.9 years (range 2.2-21 years). Neo-adjuvant chemotherapy ( = 13) and irradiation ( = 3) achieved significant reduction of the median tumor volume (305.6 vs. 44 ml, < 0.05). En-bloc resection and simultaneous chest wall reconstruction was achieved without major complications despite multi-organ involvement. Postoperatively, one patient with infiltration of the costovertebral joint and laminectomy required surgical re-intervention (CD IIIb). 11/13 patients were treated with clear resections margins (R1 resection in one patient with infiltration of the costovertebral joint and marginal resection <1 mm in one child with multiple pulmonary metastases). All patients underwent postoperative chemotherapy; irradiation was performed in four children. Two deaths occurred 18 months and 7.5 years after diagnosis, respectively. Median follow-up for the remaining patients was 8.8 years (range: 0.9-30.7 years). The 5-year survival rate was 89% and the overall survival 85%. EWING specific oncological treatment and multi-disciplinary surgery performing radical en-bloc resections and simultaneous chest wall repair contribute to an improved survival of children with Ewing sarcoma of the chest wall.
PubMed: 33791262
DOI: 10.3389/fped.2021.661025 -
Frontiers in Endocrinology 2021In March 2020, the WHO declared coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a global pandemic. Obesity... (Review)
Review
In March 2020, the WHO declared coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a global pandemic. Obesity was soon identified as a risk factor for poor prognosis, with an increased risk of intensive care admissions and mechanical ventilation, but also of adverse cardiovascular events. Obesity is associated with adipose tissue, chronic low-grade inflammation, and immune dysregulation with hypertrophy and hyperplasia of adipocytes and overexpression of pro-inflammatory cytokines. However, to implement appropriate therapeutic strategies, exact mechanisms must be clarified. The role of white visceral adipose tissue, increased in individuals with obesity, seems important, as a viral reservoir for SARS-CoV-2 angiotensin-converting enzyme 2 (ACE2) receptors. After infection of host cells, the activation of pro-inflammatory cytokines creates a setting conducive to the "cytokine storm" and macrophage activation syndrome associated with progression to acute respiratory distress syndrome. In obesity, systemic viral spread, entry, and prolonged viral shedding in already inflamed adipose tissue may spur immune responses and subsequent amplification of a cytokine cascade, causing worse outcomes. More precisely, visceral adipose tissue, more than subcutaneous fat, could predict intensive care admission; and lower density of epicardial adipose tissue (EAT) could be associated with worse outcome. EAT, an ectopic adipose tissue that surrounds the myocardium, could fuel COVID-19-induced cardiac injury and myocarditis, and extensive pneumopathy, by strong expression of inflammatory mediators that could diffuse paracrinally through the vascular wall. The purpose of this review is to ascertain what mechanisms may be involved in unfavorable prognosis among COVID-19 patients with obesity, especially cardiovascular events, emphasizing the harmful role of excess ectopic adipose tissue, particularly EAT.
Topics: Adipose Tissue; Angiotensin-Converting Enzyme 2; COVID-19; Cardiomyopathies; Heart Diseases; Humans; Inflammation; Intra-Abdominal Fat; Obesity; Pericardium; Prognosis; SARS-CoV-2; Serine Endopeptidases
PubMed: 34484128
DOI: 10.3389/fendo.2021.726967 -
Computers in Biology and Medicine Mar 2024Aortic valve disease is often treated with bioprosthetic valves. An alternative treatment is aortic valve neocuspidization which is a relatively new reparative procedure...
Aortic valve disease is often treated with bioprosthetic valves. An alternative treatment is aortic valve neocuspidization which is a relatively new reparative procedure whereby the three aortic cusps are replaced with patient pericardium or bovine tissues. Recent research indicates that aortic blood flow is disturbed, and turbulence effects have yet to be evaluated in either bioprosthetic or aortic valve neocuspidization valve types in patient-specific settings. The aim of this study is to better understand turbulence production in the aorta and evaluate its effects on laminar and turbulent wall shear stress. Four patients with aortic valve disease were treated with either bioprosthetic valves (n=2) or aortic valve neocuspidization valvular repair (n=2). Aortic geometries were segmented from magnetic resonance images (MRI), and 4D flow MRI was used to derive physiological inlet and outlet boundary conditions. Pulsatile large-eddy simulations were performed to capture the full range of laminar, transitional and turbulence characteristics in the aorta. Turbulence was produced in all aortas with highest levels occurring during systolic deceleration. In the ascending aorta, turbulence production is attributed to a combination of valvular skew, valvular eccentricity, and ascending aortic dilation. In the proximal descending thoracic aorta, turbulence production is dependent on the type of arch-descending aorta connection (e.g., a narrowing or sharp bend) which induces flow separation. Laminar and turbulent wall shear stresses are of similar magnitude throughout late systolic deceleration and diastole, although turbulent wall shear stress magnitudes exceed laminar wall shear stresses between 27.3% and 61.1% of the cardiac cycle. This emphasises the significance of including turbulent wall shear stress to improve our comprehension of progressive arterial wall diseases. The findings of this study recommend that aortic valve treatments should prioritise minimising valvular eccentricity and skew in order to mitigate turbulence generation.
Topics: Humans; Animals; Cattle; Aortic Valve; Blood Flow Velocity; Hemodynamics; Aorta; Aortic Valve Disease; Stress, Mechanical
PubMed: 38354498
DOI: 10.1016/j.compbiomed.2024.108123 -
Journal of Medical Cases Nov 2021Cardiac lymphoma is a rare neoplasm involving heart, pericardium or both, usually seen in immunocompromised patients. We report a 61-year-old male presenting with...
Cardiac lymphoma is a rare neoplasm involving heart, pericardium or both, usually seen in immunocompromised patients. We report a 61-year-old male presenting with worsening shortness of breath and 20-pound weight loss. Investigations showed right-sided tumor with interatrial septal wall perforation and left atrial expansion. The diagnosis was confirmed with mediastinal mass biopsy. After receiving the appropriate treatment, there was a steady improvement clinically and on the transesophageal echocardiography.
PubMed: 34804301
DOI: 10.14740/jmc3773 -
The Journal of Physiology Sep 2022Hypertensive heart disease (HHD) increases risk of ventricular tachycardia (VT) and ventricular fibrillation (VF). The roles of structural vs. electrophysiological...
Hypertensive heart disease (HHD) increases risk of ventricular tachycardia (VT) and ventricular fibrillation (VF). The roles of structural vs. electrophysiological remodelling and age vs. disease progression are not fully understood. This cross-sectional study of cardiac alterations through HHD investigates mechanistic contributions to VT/VF risk. Risk was electrically assessed in Langendorff-perfused, spontaneously hypertensive rat hearts at 6, 12 and 18 months, and paced optical membrane voltage maps were acquired from the left ventricular (LV) free wall epicardium. Distributions of LV patchy fibrosis and 3D cellular architecture in representative anterior LV mid-wall regions were quantified from macroscopic and microscopic fluorescence images of optically cleared tissue. Imaging showed increased fibrosis from 6 months, particularly in the inner LV free wall. Myocyte cross-section increased at 12 months, while inter-myocyte connections reduced markedly with fibrosis. Conduction velocity decreased from 12 months, especially transverse to the myofibre direction, with rate-dependent anisotropy at 12 and 18 months, but not earlier. Action potential duration (APD) increased when clustered by age, as did APD dispersion at 12 and 18 months. Among 10 structural, functional and age variables, the most reliably linked were VT/VF risk, general LV fibrosis, a measure quantifying patchy fibrosis, and non-age clustered APD dispersion. VT/VF risk related to a quantified measure of patchy fibrosis, but age did not factor strongly. The findings are consistent with the notion that VT/VF risk is associated with rate-dependent repolarization heterogeneity caused by structural remodelling and reduced lateral electrical coupling between LV myocytes, providing a substrate for heterogeneous intramural activation as HHD progresses. KEY POINTS: There is heightened arrhythmic risk with progression of hypertensive heart disease. Risk is related to increasing left ventricular fibrosis, but the nature of this relationship has not been quantified. This study is a novel systematic characterization of changes in active electrical properties and fibrotic remodelling during progression of hypertensive heart disease in a well-established animal disease model. Arrhythmic risk is predicted by several left ventricular measures, in particular fibrosis quantity and structure, and epicardial action potential duration dispersion. Age alone is not a good predictor of risk. An improved understanding of links between arrhythmic risk and fibrotic architectures in progressive hypertensive heart disease aids better interpretation of late gadolinium-enhanced cardiac magnetic resonance imaging and electrical mapping signals.
Topics: Action Potentials; Animals; Arrhythmias, Cardiac; Cross-Sectional Studies; Fibrosis; Multimodal Imaging; Pericardium; Rats; Rats, Inbred SHR; Tachycardia, Ventricular; Ventricular Fibrillation
PubMed: 35984854
DOI: 10.1113/JP282526 -
Heart Failure Reviews Jan 2023Cardiac magnetic resonance (CMR) has become an essential tool for the evaluation of patients affected or at risk of developing cardiomyopathies (CMPs). In fact, CMR not... (Review)
Review
Clinical application of CMR in cardiomyopathies: evolving concepts and techniques : A position paper of myocardial and pericardial diseases and cardiac magnetic resonance working groups of Italian society of cardiology.
Cardiac magnetic resonance (CMR) has become an essential tool for the evaluation of patients affected or at risk of developing cardiomyopathies (CMPs). In fact, CMR not only provides precise data on cardiac volumes, wall thickness, mass and systolic function but it also a non-invasive characterization of myocardial tissue, thus helping the early diagnosis and the precise phenotyping of the different CMPs, which is essential for early and individualized treatment of patients. Furthermore, several CMR characteristics, such as the presence of extensive LGE or abnormal mapping values, are emerging as prognostic markers, therefore helping to define patients' risk. Lastly new experimental CMR techniques are under investigation and might contribute to widen our knowledge in the field of CMPs. In this perspective, CMR appears an essential tool to be systematically applied in the diagnostic and prognostic work-up of CMPs in clinical practice. This review provides a deep overview of clinical applicability of standard and emerging CMR techniques in the management of CMPs.
Topics: Humans; Cardiomyopathies; Heart; Heart Diseases; Magnetic Resonance Imaging; Cardiology; Magnetic Resonance Spectroscopy; Predictive Value of Tests; Contrast Media; Magnetic Resonance Imaging, Cine
PubMed: 35536402
DOI: 10.1007/s10741-022-10235-9