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Journal of Surgical Case Reports Jun 2024Acute mitral regurgitation (MR) secondary to papillary muscle rupture is a rare mechanical complication of acute myocardial infarction occurring in 0.05-0.26% of all...
The use of veno-veno-arterial ECMO as a successful strategy in acute mitral regurgitation secondary to papillary muscle rupture causing cardiogenic shock and profound hypoxemia: a case report.
Acute mitral regurgitation (MR) secondary to papillary muscle rupture is a rare mechanical complication of acute myocardial infarction occurring in 0.05-0.26% of all cases of myocardial infarction. The only treatment is emergency mitral valve surgery with high operative mortality reaching up to 39%. The use of extracorporeal membrane oxygenator (ECMO) as a stabilization strategy and a bridge to recovery may potentially improve the outcome of such cases. Here, we report a case of acute MR presenting with cardiogenic shock and severe hypoxia that required insertion of veno-veno-arterial ECMO initially and followed by emergency mitral valve replacement. This strategy proved useful with full recovery of the patient.
PubMed: 38845794
DOI: 10.1093/jscr/rjae408 -
Folia Morphologica Jun 2024In this study, it was aimed to evaluate morphometrically and morphologically the left fibrous ring, mitral leaflets, tendinous cords, and papillary muscles, which are...
BACKGROUND
In this study, it was aimed to evaluate morphometrically and morphologically the left fibrous ring, mitral leaflets, tendinous cords, and papillary muscles, which are the components of the left atrioventricular valve complex (LAVC), and to reveal their clinical relationships.
MATERIALS AND METHODS
A total of 120 human hearts were examined at the Forensic Medicine Institute. Cases aged 30 years and older, less than 24 hours after their death, were included in the study. Heart length, width, height/width ratio, anteroposterior and mediolateral diameters of the annulus, annular area, length and width of leaflets, number and attachment sites of tendinous cords, number, shape, length, the width of papillary muscles, and distances to various points were recorded to determine their spatial configurations. As well as the measurement data of LAVC components in cases with and without cardiovascular disease (CVD), the relationships of these data with the demographic characteristics of the cases are also explained.
RESULTS
In the diagnostic performance test (ROC analysis), it was determined that body mass index (> 26.7), heart weight (> 414 g), heart height/width ratio (≤ 1.24), mitral valve width (> 99.96 mm), left ventricular wall thickness (> 15.08 mm), annular area (> 619.37 mm²) and mediolateral diameter of the annulus (> 30.71 mm) are important diagnostic criteria in determining CVD if they are outside the specified reference values.
CONCLUSIONS
This study provides anatomical information about LAVC, as well as recommendations for diagnosis and surgical treatment planning. We therefore believe that our findings will be useful to clinicians.
PubMed: 38842077
DOI: 10.5603/fm.99585 -
World Journal of Cardiology May 2024Mitral valvuloplasty using artificial chordae tendineae represents an effective surgical approach for treating mitral regurgitation. Achieving precise measurements of...
BACKGROUND
Mitral valvuloplasty using artificial chordae tendineae represents an effective surgical approach for treating mitral regurgitation. Achieving precise measurements of artificial chordae tendineae length (CL) is an important factor in the procedure; however, no objective index currently exists to facilitate this measurement. Therefore, preoperative assessment of CL is critical for surgical planning and support. Four-dimensional x-ray micro-computed tomography (4D-CT) may be useful for accurate CL measurement considering that it allows for dynamic three-dimensional (3D) evaluation compared to that with transthoracic echocardiography, a conventional inspection method.
AIM
To investigate the behavior and length of mitral chordae tendineae during systole using 4D-CT.
METHODS
Eleven adults aged > 70 years without mitral valve disease were evaluated. A 64-slice CT scanner was used to capture 20 phases in the cardiac cycle in electrocardiographic synchronization. The length of the primary chordae tendineae was measured from early systole to early diastole using the 3D image. The primary chordae tendineae originating from the anterior papillary muscle and attached to the A1-2 region and those from the posterior papillary muscle and attached to the A2-3 region were designated as cA and cP, respectively. The behavior and maximum lengths [cA (ma), cP (max)] were compared, and the correlation with body surface area (BSA) was evaluated.
RESULTS
In all cases, the mitral anterior leaflet chordae tendineae could be measured. In most cases, the cA and cP chordae tendineae could be measured visually. The mean cA (max) and cP (max) were 20.2 mm ± 1.95 mm and 23.5 mm ± 4.06 mm, respectively. cP (max) was significantly longer. The correlation coefficients (r) with BSA were 0.60 and 0.78 for cA (max) and cP (max), respectively. Both cA and cP exhibited constant variation in CL during systole, with a maximum 1.16-fold increase in cA and a 1.23-fold increase in cP from early to mid-systole. For cP, CL reached a plateau at 15% and remained elongated until end-systole, whereas for cA, after peaking at 15%, CL shortened slightly and then moved toward its peak again as end-systole approached.
CONCLUSION
The study suggests that 4D-CT is a valuable tool for accurate measurement of both the length and behavior of chordae tendineae within the anterior leaflet of the mitral valve.
PubMed: 38817650
DOI: 10.4330/wjc.v16.i5.274 -
Cureus Apr 2024Sarcopenic dysphagia is defined as dysphagia caused by sarcopenia of the whole body and swallowing-related muscles. We present a case of sarcopenic dysphagia with...
Sarcopenic dysphagia is defined as dysphagia caused by sarcopenia of the whole body and swallowing-related muscles. We present a case of sarcopenic dysphagia with improved swallowing function after strength training of swallowing-related muscles using neuromuscular electrical stimulation (NMES). A 78-year-old man was admitted to our hospital with an intraductal papillary mucinous tumor of the pancreatic duct. After admission, the patient developed aspiration pneumonia and was placed on strict bed rest without oral intake, which resulted in progressive malnutrition. At the start of swallowing rehabilitation, he had whole-body sarcopenia, nutritional impairment, and weakness in swallowing-related muscles, with a maximum tongue pressure of 21.4 kPa and an opening force of 5.1 kg. In the videofluoroscopic swallowing study, he aspirated 3 cc of a moderately thick liquid. Consequently, as part of swallowing rehabilitation, strengthening training of swallowing-related muscles with NMES was undertaken for about three weeks. As a result, the maximum tongue pressure and opening force improved to 28.4 kPa and 6.8 kg, respectively. A subsequent videofluoroscopic swallowing study showed no obvious aspiration during any procedure. The patient was discharged on the 86th day on a regular diet. As a component of swallowing rehabilitation, NMES may offer therapeutic benefits for patients with sarcopenic dysphagia.
PubMed: 38813342
DOI: 10.7759/cureus.59256 -
HeartRhythm Case Reports May 2024
Catheter ablation of premature ventricular contractions from the anterior papillary muscle of the tricuspid valve: A case report of a combined ECG imaging and remote magnetic navigation approach.
PubMed: 38799601
DOI: 10.1016/j.hrcr.2023.12.020 -
Circulation. Arrhythmia and... Jun 2024Endocardial catheter-based pulsed field ablation (PFA) of the ventricular myocardium is promising. However, little is known about PFA's ability to target intracavitary...
BACKGROUND
Endocardial catheter-based pulsed field ablation (PFA) of the ventricular myocardium is promising. However, little is known about PFA's ability to target intracavitary structures, epicardium, and ways to achieve transmural lesions across thick ventricular tissue.
METHODS
A lattice-tip catheter was used to deliver biphasic monopolar PFA to swine ventricles under general anesthesia, with electroanatomical mapping, fluoroscopy and intracardiac echocardiography guidance. We conducted experiments to assess the feasibility and safety of repetitive monopolar PFA applications to ablate (1) intracavitary papillary muscles and moderator bands, (2) epicardial targets, and (3) bipolar PFA for midmyocardial targets in the interventricular septum and left ventricular free wall.
RESULTS
(1) Papillary muscles (n=13) were successfully ablated and then evaluated at 2, 7, and 21 days. Nine lesions with stable contact measured 18.3±2.4 mm long, 15.3±1.5 mm wide, and 5.8±1.0 mm deep at 2 days. Chronic lesions demonstrated preserved chordae without mitral regurgitation. Two targeted moderator bands were transmurally ablated without structural disruption. (2) Transatrial saline/carbon dioxide assisted epicardial access was obtained successfully and epicardial monopolar lesions had a mean length, width, and depth of 30.4±4.2, 23.5±4.1, and 9.1±1.9 mm, respectively. (3) Bipolar PFA lesions were delivered across the septum (n=11) and the left ventricular free wall (n=7). Twelve completed bipolar lesions had a mean length, width, and depth of 29.6±5.5, 21.0±7.3, and 14.3±4.7 mm, respectively. Chronically, these lesions demonstrated uniform fibrotic changes without tissue disruption. Bipolar lesions were significantly deeper than the monopolar epicardial lesions.
CONCLUSIONS
This in vivo evaluation demonstrates that PFA can successfully ablate intracavitary structures and create deep epicardial lesions and transmural left ventricular lesions.
Topics: Animals; Ventricular Septum; Catheter Ablation; Swine; Heart Ventricles; Feasibility Studies; Papillary Muscles; Time Factors; Pericardium; Cardiac Catheters; Ultrasonography, Interventional; Electrophysiologic Techniques, Cardiac; Equipment Design; Female
PubMed: 38753535
DOI: 10.1161/CIRCEP.124.012734 -
European Heart Journal. Case Reports May 2024
PubMed: 38736996
DOI: 10.1093/ehjcr/ytae225 -
American Journal of Clinical and... 2024Sex-determining region Y-box 2 (SOX2) is a transcription factor with a central role in embryologic development. SOX2 is also an oncogene in several cancer types. Prior...
Sex-determining region Y-box 2 (SOX2) is a transcription factor with a central role in embryologic development. SOX2 is also an oncogene in several cancer types. Prior work by our group has shown SOX2 activity associates with cell cycle dysregulation in early-stage bladder cancer. The present study was thus undertaken to broadly investigate SOX2 in bladder cancer, with emphasis on associations with tumor stage, clinical outcomes, and tumorigenicity. Gene expression was quantified by immunohistochemistry in an established tissue microarray (n=303 cystectomy specimens, all stages) and whole tissue sections of noninvasive papillary urothelial carcinoma (n=25). Gene expression by RNA sequencing was evaluated in non-muscle invasive and muscle-invasive cohorts from publicly available repositories. By immunohistochemistry, SOX2 was expressed in 40% of whole tissue sections of noninvasive papillary carcinoma, which correlated with expression by RNA sequencing (r=0.6, P=0.001, Spearman correlation). Expression tended to be focal (median H-score =6). SOX2 was expressed in only 9% of TMA cases, consistent with focal expression. expression was substantially higher in muscle-invasive compared with noninvasive papillary urothelial carcinoma by RNA sequencing (P<0.001, Wilcoxon rank sum test). expression associated with stage progression in lamina-propria invasive cancers (hazard ratio =2, P=0.05, Cox model, binary, RNA sequencing) but not noninvasive papillary cancers (P=0.5, Cox model, binary, RNA sequencing). expression did not associate with overall survival in muscle-invasive carcinoma. Activity of SOX2 in bladder cancer was tested using murine allografts created with MB49 cells that express human SOX2 (MB49-SOX). MB49-SOX allografts expressed this protein focally by immunohistochemistry, much like human tumors. Compared with controls, MB49 allografts demonstrated larger tumor size (P=0.03, Wilcoxon rank sum test) and higher tumor burden in mesenteric metastases (P=0.009, Wilcoxon rank sum test). Though SOX2 expression is focal within tumors, it may drive tumorigenesis, increase growth rate, and promote aggressive features of bladder cancer, particularly stage progression of early-stage disease.
PubMed: 38736621
DOI: 10.62347/MEQO6014 -
International Journal of Molecular... Apr 2024Non-muscle-invasive papillary urothelial carcinoma (NMIPUC) of the urinary bladder is the most common type of bladder cancer. Intravesical Bacille Calmette-Guerin (BCG)...
Spatial Distribution of Macrophage and Lymphocyte Subtypes within Tumor Microenvironment to Predict Recurrence of Non-Muscle-Invasive Papillary Urothelial Carcinoma after BCG Immunotherapy.
Non-muscle-invasive papillary urothelial carcinoma (NMIPUC) of the urinary bladder is the most common type of bladder cancer. Intravesical Bacille Calmette-Guerin (BCG) immunotherapy is applied in patients with a high risk of recurrence and progression of NMIPUC to muscle-invasive disease. However, the tumor relapses in about 30% of patients despite the treatment, raising the need for better risk stratification. We explored the potential of spatial distributions of immune cell subtypes (CD20, CD11c, CD163, ICOS, and CD8) within the tumor microenvironment to predict NMIPUC recurrence following BCG immunotherapy. Based on analyses of digital whole-slide images, we assessed the densities of the immune cells in the epithelial-stromal interface zone compartments and their distribution, represented by an epithelial-stromal interface density ratio (IDR). While the densities of any cell type did not predict recurrence, a higher IDR of CD11c (HR: 0.0012, -value = 0.0002), CD8 (HR: 0.0379, -value = 0.005), and ICOS (HR: 0.0768, -value = 0.0388) was associated with longer recurrence-free survival (RFS) based on the univariate Cox regression. The history of positive repeated TUR (re-TUR) (HR: 4.93, -value = 0.0001) and T1 tumor stage (HR: 2.04, -value = 0.0159) were associated with shorter RFS, while G3 tumor grade according to the 1973 WHO classification showed borderline significance (HR: 1.83, -value = 0.0522). In a multivariate analysis, the two models with a concordance index exceeding 0.7 included the CD11c IDR in combination with either a history of positive re-TUR or tumor stage. We conclude that the CD11c IDR is the most informative predictor of NMIPUC recurrence after BCG immunotherapy. Our findings highlight the importance of assessment of the spatial distribution of immune cells in the tumor microenvironment.
Topics: Humans; Tumor Microenvironment; Urinary Bladder Neoplasms; Male; BCG Vaccine; Neoplasm Recurrence, Local; Female; Immunotherapy; Aged; Middle Aged; Macrophages; Carcinoma, Papillary; Lymphocyte Subsets; Prognosis; Aged, 80 and over
PubMed: 38731992
DOI: 10.3390/ijms25094776 -
Journal of Clinical Medicine May 2024Mitral valve prolapse (MVP) and mitral annular disjunction (MAD) are common valvular abnormalities that have been associated with ventricular arrhythmias (VA). Cardiac...
Mitral valve prolapse (MVP) and mitral annular disjunction (MAD) are common valvular abnormalities that have been associated with ventricular arrhythmias (VA). Cardiac magnetic resonance imaging (CMR) has a key role in risk stratification of VA, including assessment of late gadolinium enhancement (LGE). Single-center retrospective analysis of patients with MVP or MAD who had >1 CMR and >1 24 h Holter registration available. Data are presented in detail, including evolution of VA and presence of LGE over time. A total of twelve patients had repeated CMR and Holter registrations available, of which in four (33%) patients, it was conducted before and after minimal invasive mitral valve repair (MVR). After a median of 4.7 years, four out of eight (50%) patients without surgical intervention had new areas of LGE. New LGE was observed in the papillary muscles and the mid to basal inferolateral wall. In four patients, presenting with syncope or high-risk non-sustained ventricular tachycardia (VT), programmed ventricular stimulation was performed and in two (50%), sustained monomorphic VT was easily inducible. In two patients who underwent MVR, new LGE was observed in the basal inferolateral wall of which one presented with an increased burden of VA. In patients with MVP and MAD, repeat CMR may show new LGE in a small subset of patients, even shortly after MVR. A subgroup of patients who presented with an increase in VA burden showed new LGE upon repeat CMR. VA in patients with MVP and MAD are part of a heterogeneous spectrum that requires further investigation to establish risk stratification strategies.
PubMed: 38731198
DOI: 10.3390/jcm13092669