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Cureus May 2024We present the case of a 42-year-old female with a history of human epidermal growth factor 2 (HER2) receptor-positive breast cancer status post bilateral mastectomy...
We present the case of a 42-year-old female with a history of human epidermal growth factor 2 (HER2) receptor-positive breast cancer status post bilateral mastectomy with metastasis to the spine and to the brain, who underwent transesophageal echocardiography (TEE) after outpatient transthoracic echocardiography (TTE) was suggestive of right atrial thrombus in transit. TEE revealed an atrial mass with a pedunculated stalk attached to the inferior right atrium near the inferior vena cava with a necrotic center. These findings were suggestive of an endocardial metastatic mass secondary to her primary breast cancer. The pericardium is the most common site of cardiac metastasis; meanwhile, endocardial involvement is infrequent, occurring in less than 5% of all cardiac metastases. Right atrial masses may cause evidence of right heart failure and thromboembolism of the pulmonary arteries. Treatment focuses on targeted chemotherapy, radiation therapy, and interventions as indicated. In this case, following the diagnosis of a right atrial mass, the patient was discharged the same day to begin outpatient chemotherapy.
PubMed: 38836153
DOI: 10.7759/cureus.59673 -
The American Journal of Case Reports Jun 2024BACKGROUND Effusive-constrictive pericarditis (ECP) is an uncommon clinical syndrome characterized by the coexistence of pericardial effusion and constriction involving...
BACKGROUND Effusive-constrictive pericarditis (ECP) is an uncommon clinical syndrome characterized by the coexistence of pericardial effusion and constriction involving the visceral pericardium. This differs from constrictive pericarditis, which presents with thickening of the pericardium without effusions. Specific diagnostic criteria of ECP include the failure of right atrial pressure to decrease by 50% or reach a new level below 10 mmHg after normalization of intrapericardial pressure. CASE REPORT We present the case of a 32-year-old obese man with multiple comorbidities who initially presented with flu-like symptoms and pleural effusion with development of constrictive-like symptoms. Despite undergoing numerous pericardiocentesis and appropriate medical management, the patient's condition failed to improve, leading to the likely diagnosis of effusive-constrictive pericarditis. Cultures of pericardial fluid revealed E. -faecium, which required multiple antimicrobial therapy. Despite infection, the exact etiology of ECP remained unknown and likely idiopathic. Common causes of ECP include idiopathic, tuberculosis, cardiac surgery complications, radiation, or neoplasia. Ultimately, the patient underwent a pericardiectomy involving the visceral and parietal pericardium, resulting in hemodynamic stability and resolution of symptoms. CONCLUSIONS This case highlights the challenges in diagnosing and managing ECP, emphasizing the importance of considering surgical intervention in refractory cases. ECP initially presents as a pericardial effusion, often addressed through pericardiocentesis; however, in a small subset of patients, sustained symptoms and altered hemodynamics persist following pericardiocentesis, necessitating further evaluation and management. The success of pericardiectomy in our patient highlights the potential efficacy of surgical intervention in improving outcomes for patients with ECP.
Topics: Humans; Pericarditis, Constrictive; Male; Pericardiectomy; Adult; Pericardial Effusion
PubMed: 38835157
DOI: 10.12659/AJCR.943979 -
Obesity (Silver Spring, Md.) Jul 2024
Topics: Humans; Pericardium; Phenotype; Adipose Tissue; Adipose Tissue, Beige; Male; Female; Middle Aged; Epicardial Adipose Tissue
PubMed: 38828750
DOI: 10.1002/oby.24051 -
Journal of Cardiothoracic Surgery Jun 2024Post-operative atrial fibrillation (POAF) occurs in up to 40% of patients following coronary artery bypass grafting (CABG) and is associated with a higher risk of stroke... (Observational Study)
Observational Study
Epicardial placement of human placental membrane allografts in coronary artery bypass graft surgery is associated with reduced postoperative atrial fibrillation: a pilot study for a future multi-center randomized controlled trial.
BACKGROUND
Post-operative atrial fibrillation (POAF) occurs in up to 40% of patients following coronary artery bypass grafting (CABG) and is associated with a higher risk of stroke and mortality. This study investigates how POAF may be mitigated by epicardial placement of aseptically processed human placental membrane allografts (HPMAs) before pericardial closure in CABG surgery. This study was conducted as a pilot feasibility study to collect preliminary for a forthcoming multi-center randomized controlled trial.
METHODS
This retrospective observational study of patients undergoing CABG surgery excluded patients with pre-operative heart failure, chronic kidney disease, or a history of atrial fibrillation. The "treatment" group (n = 24) had three HPMAs placed epicardially following cardiopulmonary bypass decannulation but before partial pericardial approximation and chest closure. The only difference in clinical protocol for the control group (n = 54) was that they did not receive HPMA.
RESULTS
HPMA-treated patients saw a significant, greater than four-fold reduction in POAF incidence compared to controls (35.2-8.3%, p = 0.0136). Univariate analysis demonstrated that HPMA treatment was associated with an 83% reduction in POAF (OR = 0.17, p = 0.0248). Multivariable analysis yielded similar results (OR = 0.07, p = 0.0156) after controlling for other covariates. Overall length of stay (LOS) between groups was similar, but ICU LOS trended lower with HPMA treatment (p = 0.0677). Post-operative inotrope and vasopressor requirements were similar among groups. There was no new-onset post-operative heart failure, stroke, or death reported up to thirty days in either group.
CONCLUSIONS
Epicardial HPMA placement can be a simple intervention at the end of CABG surgery that may provide a new approach to reduce post-operative atrial fibrillation by modulating local inflammation, possibly reducing ICU and hospital stay, and ultimately improving patient outcomes.
Topics: Humans; Atrial Fibrillation; Coronary Artery Bypass; Female; Pilot Projects; Male; Retrospective Studies; Middle Aged; Postoperative Complications; Aged; Placenta; Pregnancy; Allografts; Pericardium; Feasibility Studies
PubMed: 38824517
DOI: 10.1186/s13019-024-02822-8 -
Annals of Pediatric Cardiology 2023Pentalogy of Cantrell is a rare congenital anomaly involving the anterior diaphragm, pericardium, sternum, peritoneum, and associated intracardiac defects. In this...
Pentalogy of Cantrell is a rare congenital anomaly involving the anterior diaphragm, pericardium, sternum, peritoneum, and associated intracardiac defects. In this report, we describe a neonate with pentalogy of Cantrell evaluated with multimodality imaging and successfully managed by a multidisciplinary team.
PubMed: 38817252
DOI: 10.4103/apc.apc_188_23 -
Vascular May 2024The aim of this study was to evaluate the effectiveness of protein-based tissue adhesive (Bioglue) in reducing time to haemostasis in patients undergoing peripheral...
OBJECTIVES
The aim of this study was to evaluate the effectiveness of protein-based tissue adhesive (Bioglue) in reducing time to haemostasis in patients undergoing peripheral vascular surgery.
METHODS
From January to December 2021, 100 consecutive patients from 4 centres have been treated with open peripheral vascular surgery including upper and lower limb interventions. Patients have been allocated in each centre into control with no use of Bioglue (, 50 patients) or use of Bioglue (, 50 patients) by a block randomization method 10:10 until the required sample size was reached. Perioperative parameters including time to haemostasis, number of adjunctive stitches, and in-hospital bleeding have been analysed and compared in the two groups by means of mean independent-samples T -test and Gehan-Breslow-Wilcoxon test.
RESULTS
Both groups were homogeneous in terms of demographic data, preoperative risk factors, and preoperative medical therapy except for a higher percentage of active smokers in (52% vs. 24%, = 0.004). Femoral endarterectomy was most common in (44% vs. 24%, = 0.03), whilst the percentage of lower limb vein bypasses was higher in (50% vs. 36%, = 0.03). Bovine pericardium was the preferred material in (20 cases, 40%), whilst autologous vein is mostly used in (26 cases, 52%) ( = 0.01). Time to haemostasis was faster in (4.4 vs. 9.6 minutes, < 0.001). The need for adjunctive stitches was higher in (8 cases, 16%, vs. 25 cases, 50%, ; < 0.001). The overall rate of in-hospital bleeding, including those requiring reintervention, was not different between the two groups (9 cases, 18%, vs. 7 cases, 14%, ; = 0.39).
CONCLUSIONS
The protein-based tissue adhesive Bioglue reduced time to haemostasis and need for adjunctive stitches in peripheral vascular surgery. However, it did not affect the overall rate of perioperative bleedings. Further studies with larger sample sizes are needed to validate these outcomes.
PubMed: 38817014
DOI: 10.1177/17085381241258556 -
Clinics in Chest Medicine Jun 2024The pericardium comprises a double-walled fibrous-serosal sac that encloses the heart. Reflections of the serosal layer form sinuses and recesses. With advances in... (Review)
Review
The pericardium comprises a double-walled fibrous-serosal sac that encloses the heart. Reflections of the serosal layer form sinuses and recesses. With advances in multidetector computed tomography (CT) technology, pericardial recesses are frequently detected with thin-section CT. Knowledge of pericardial anatomy on imaging is crucial to avoid misinterpretation of fluid-filled pericardial sinuses and recesses as adenopathy/pericardial metastasis or aortic dissection, which can impact patient management and treatment decisions. The authors offer a comprehensive review of pericardial anatomy and its variations observed on CT, potential pitfalls in image interpretation, and implications for the pulmonologist with respect to unnecessary diagnostic procedures or interventions.
Topics: Humans; Pericardium; Tomography, X-Ray Computed; Pulmonologists; Multidetector Computed Tomography
PubMed: 38816085
DOI: 10.1016/j.ccm.2024.02.002 -
Cellular and Molecular Biology... May 2024Milrinone, a phosphodiesterase III inhibitor with contractile and vasodilatory effects, is widely used in acute decompensated heart failure and medically refractory...
Milrinone, a phosphodiesterase III inhibitor with contractile and vasodilatory effects, is widely used in acute decompensated heart failure and medically refractory end-stage heart failure (HF). The adverse reactions of milrinone have been extensively explored clinically, but its possible toxicities and underlying molecular mechanisms in embryo development need further understanding as its clinical applications increase. Herein, we assessed the milrinone toxicity using the zebrafish embryotoxicity test (ZET), with a view of providing evidence and guidance for gravidas medicine. We carried out ZET by exposing embryos to a milrinone culture with a series concentration gradients since 1.5 hours post fertilization (hpf) and observed and assessed mortality and hatching rates of drug-treated zebrafishes at 24, 48, 72, and 96 hpf. No significant lethal effect was found in milrinone-treated zebrafish, but hatching rate of eggs at 48 hpf was up-regulated with the increase of milrinone concentration. The impact of milrinone on embryogenesis was assessed through body length, eye area, yolk sac area, swim bladder inflation area, pericardial area and venous congestion area at 96hpf. 150 μg/mL or higher milrinone treatment showed significant effects in the indicators. Organ disorders including enlarged pericardium, liver atrophy and decreased blood vessels were observed in dysplasia individuals versus controls. TUNEL assay suggested the ability of milrinone to induce apoptosis in malformation embryos. Quantitative real-time PCR showed aberrant expressions of transcription factors associated with heart development and genes related to liver development and apoptosis regulation. Therefore, ZET is feasible for the milrinone toxicity test, and high-dose milrinone causes harm to the embryonic development of zebrafish, especially in embryonic carcinogenesis, vasculogenesis, and hepatogenesis.
Topics: Animals; Milrinone; Zebrafish; Embryo, Nonmammalian; Embryonic Development; Apoptosis; Toxicity Tests; Gene Expression Regulation, Developmental
PubMed: 38814231
DOI: 10.14715/cmb/2024.70.5.12 -
Arteriosclerosis, Thrombosis, and... Jul 2024Pericoronary epicardial adipose tissue (EAT) is a unique visceral fat depot that surrounds the adventitia of the coronary arteries without any anatomic barrier. Clinical... (Comparative Study)
Comparative Study
BACKGROUND
Pericoronary epicardial adipose tissue (EAT) is a unique visceral fat depot that surrounds the adventitia of the coronary arteries without any anatomic barrier. Clinical studies have demonstrated the association between EAT volume and increased risks for coronary artery disease (CAD). However, the cellular and molecular mechanisms underlying the association remain elusive.
METHODS
We performed single-nucleus RNA sequencing on pericoronary EAT samples collected from 3 groups of subjects: patients undergoing coronary bypass surgery for severe CAD (n=8), patients with CAD with concomitant type 2 diabetes (n=8), and patients with valvular diseases but without concomitant CAD and type 2 diabetes as the control group (n=8). Comparative analyses were performed among groups, including cellular compositional analysis, cell type-resolved transcriptomic changes, gene coexpression network analysis, and intercellular communication analysis. Immunofluorescence staining was performed to confirm the presence of CAD-associated subclusters.
RESULTS
Unsupervised clustering of 73 386 nuclei identified 15 clusters, encompassing all known cell types in the adipose tissue. Distinct subpopulations were identified within primary cell types, including adipocytes, adipose stem and progenitor cells, and macrophages. macrophages and adipocytes were significantly expanded in CAD. In comparison to normal controls, both disease groups exhibited dysregulated pathways and altered secretome in the primary cell types. Nevertheless, minimal differences were noted between the disease groups in terms of cellular composition and transcriptome. In addition, our data highlight a potential interplay between dysregulated circadian clock and altered physiological functions in adipocytes of pericoronary EAT. ANXA1 (annexin A1) and SEMA3B (semaphorin 3B) were identified as important adipokines potentially involved in functional changes of pericoronary EAT and CAD pathogenesis.
CONCLUSIONS
We built a complete single-nucleus transcriptomic atlas of human pericoronary EAT in normal and diseased conditions of CAD. Our study lays the foundation for developing novel therapeutic strategies for treating CAD by targeting and modifying pericoronary EAT functions.
Topics: Humans; Pericardium; Transcriptome; Female; Male; Middle Aged; Coronary Artery Disease; Aged; Adipose Tissue; Diabetes Mellitus, Type 2; Adipocytes; Heart Valve Diseases; Gene Expression Profiling; Case-Control Studies; Coronary Artery Bypass; Single-Cell Analysis; Macrophages; Gene Regulatory Networks; Epicardial Adipose Tissue
PubMed: 38813696
DOI: 10.1161/ATVBAHA.124.320923 -
Texas Heart Institute Journal May 2024Left main occlusion presenting as ST-segment elevation myocardial infarction is an exceedingly morbid condition. This article reports a case of cardiac arrest in a...
Left main occlusion presenting as ST-segment elevation myocardial infarction is an exceedingly morbid condition. This article reports a case of cardiac arrest in a patient after a treadmill stress test. Coronary angiography revealed 100% occlusion of the left main coronary artery. Left ventricular unloading with the Impella CP heart pump (ABIOMED/Johnson & Johnson MedTech) was used, after which epicardial blood flow was restored without angioplasty. The patient underwent surgical revascularization. Despite a prolonged revascularization time, there was no evidence of severe myocardial injury postoperatively.
Topics: Humans; Middle Aged; Coronary Angiography; Coronary Circulation; Coronary Occlusion; Electrocardiography; Heart-Assist Devices; Myocardial Revascularization; Pericardium; Prosthesis Design; Recovery of Function; ST Elevation Myocardial Infarction; Treatment Outcome; Ventricular Function, Left; Female
PubMed: 38805372
DOI: 10.14503/THIJ-23-8322