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Circulation Research Sep 2020Postoperative atrial fibrillation (POAF) is a common and troublesome complication of cardiac surgery. POAF is generally believed to occur when postoperative triggers act...
RATIONALE
Postoperative atrial fibrillation (POAF) is a common and troublesome complication of cardiac surgery. POAF is generally believed to occur when postoperative triggers act on a preexisting vulnerable substrate, but the underlying cellular and molecular mechanisms are largely unknown.
OBJECTIVE
To identify cellular POAF mechanisms in right atrial samples from patients without a history of atrial fibrillation undergoing open-heart surgery.
METHODS AND RESULTS
Multicellular action potentials, membrane ion-currents (perforated patch-clamp), or simultaneous membrane-current (ruptured patch-clamp) and [Ca]-recordings in atrial cardiomyocytes, along with protein-expression levels in tissue homogenates or cardiomyocytes, were assessed in 265 atrial samples from patients without or with POAF. No indices of electrical, profibrotic, or connexin remodeling were noted in POAF, but Ca-transient amplitude was smaller, although spontaneous sarcoplasmic reticulum (SR) Ca-release events and L-type Ca-current alternans occurred more frequently. CaMKII (Ca/calmodulin-dependent protein kinase-II) protein-expression, CaMKII-dependent phosphorylation of the cardiac RyR2 (ryanodine-receptor channel type-2), and RyR2 single-channel open-probability were significantly increased in POAF. SR Ca-content was unchanged in POAF despite greater SR Ca-leak, with a trend towards increased SR Ca-ATPase activity. Patients with POAF also showed stronger expression of activated components of the NLRP3 (NACHT, LRR, and PYD domains-containing protein-3)-inflammasome system in atrial whole-tissue homogenates and cardiomyocytes. Acute application of interleukin-1β caused NLRP3-signaling activation and CaMKII-dependent RyR2/phospholamban hyperphosphorylation in an immortalized mouse atrial cardiomyocyte cell-line (HL-1-cardiomyocytes) and enhanced spontaneous SR Ca-release events in both POAF cardiomyocytes and HL-1-cardiomyocytes. Computational modeling showed that RyR2 dysfunction and increased SR Ca-uptake are sufficient to reproduce the Ca-handling phenotype and indicated an increased risk of proarrhythmic delayed afterdepolarizations in POAF subjects in response to interleukin-1β.
CONCLUSIONS
Preexisting Ca-handling abnormalities and activation of NLRP3-inflammasome/CaMKII signaling are evident in atrial cardiomyocytes from patients who subsequently develop POAF. These molecular substrates sensitize cardiomyocytes to spontaneous Ca-releases and arrhythmogenic afterdepolarizations, particularly upon exposure to inflammatory mediators. Our data reveal a potential cellular and molecular substrate for this important clinical problem.
Topics: Action Potentials; Aged; Animals; Atrial Fibrillation; Calcium Signaling; Calcium-Calmodulin-Dependent Protein Kinase Type 2; Cardiac Surgical Procedures; Case-Control Studies; Cell Line; Female; Heart Atria; Heart Rate; Humans; Inflammasomes; Inflammation Mediators; Male; Mice; Middle Aged; Myocytes, Cardiac; NLR Family, Pyrin Domain-Containing 3 Protein; Phosphorylation; Ryanodine Receptor Calcium Release Channel; Sarcoplasmic Reticulum
PubMed: 32762493
DOI: 10.1161/CIRCRESAHA.120.316710 -
Catheterization and Cardiovascular... Mar 2020BATMAN is a new technique to prevent left ventricular outflow tract (LVOT) obstruction from transcatheter mitral valve replacement (TMVR) by deploying the transcatheter...
BATMAN is a new technique to prevent left ventricular outflow tract (LVOT) obstruction from transcatheter mitral valve replacement (TMVR) by deploying the transcatheter heart valve from the apex through a perforation of the anterior mitral valve leaflet. The risks of uncontrolled balloon dilatation of the anterior mitral valve leaflet include extension of the tear superiorly into the aorto-mitral curtain or laterally to avulse the trigone from the annulus. Percutaneous laceration of the anterior mitral leaflet, pre-emptive alcohol septal ablation, and transatrial leaflet resection are alternative strategies that prevent LVOT obstruction from TMVR.
Topics: Cardiac Catheterization; Heart Valve Prosthesis Implantation; Humans; Mitral Valve; Treatment Outcome; Ventricular Outflow Obstruction
PubMed: 32159289
DOI: 10.1002/ccd.28791 -
The Journal of Invasive Cardiology Jan 2023Iatrogenic ventricular perforation of the myocardial wall is a rare but life-threatening complication. It has been described using pulmonary artery catheter, pigtail...
Iatrogenic ventricular perforation of the myocardial wall is a rare but life-threatening complication. It has been described using pulmonary artery catheter, pigtail catheter, and Judkins catheter. Straight wires and catheters can be used to cross the aortic valve for left ventriculogram; however, the risk of perforation is higher compared with J-tip wires. Prompt recognition of cardiac tamponade and pericardial drain insertion is vital, but surgical patch repair may be required for definitive treatment. This case highlights the importance of increased vigilance and prompt management of cardiac tamponade with the use of high-risk equipment during cardiac catheterization.
Topics: Humans; Cardiac Tamponade; Cardiac Catheterization; Heart Ventricles; Pericardium; Heart Injuries; Catheters; Catheterization, Central Venous
PubMed: 36588097
DOI: No ID Found -
Anatomical Record (Hoboken, N.J. : 2007) Jan 2019The complete division of the atrial cavity by a septum, resulting in a left and right atrium, is found in many amphibians and all amniotes (reptiles, birds, and... (Review)
Review
The complete division of the atrial cavity by a septum, resulting in a left and right atrium, is found in many amphibians and all amniotes (reptiles, birds, and mammals). Surprisingly, it is only in eutherian, or placental, mammals that full atrial septation necessitates addition from a second septum. The high incidence of incomplete closure of the atrial septum in human, so-called probe patency, suggests this manner of closure is inefficient. We review the evolution and development of the atrial septum to understand the peculiar means of forming the atrial septum in eutherian mammals. The most primitive atrial septum is found in lungfishes and comprises a myocardial component with a mesenchymal cap on its leading edge, reminiscent to the primary atrial septum of embryonic mammals before closure of the primary foramen. In reptiles, birds, and mammals, the primary foramen is closed by the mesenchymal tissues of the atrioventricular cushions, the dorsal mesenchymal protrusion, and the mesenchymal cap. These tissues are also found in lungfishes. The closure of the primary foramen is preceded by the development of secondary perforations in the septal myocardium. In all amniotes, with the exception of eutherian mammals, the secondary perforations do not coalesce to a secondary foramen. Instead, the secondary perforations persist and are sealed by myocardial and endocardial growth after birth or hatching. We suggest that the error-prone secondary foramen allows large volumes of oxygen-rich blood to reach the cardiac left side, needed to sustain the growth of the extraordinary large offspring that characterizes eutherian mammals. Anat Rec, 302:32-48, 2019. © 2018 The Authors. The Anatomical Record published by Wiley Periodicals, Inc. on behalf of American Association of Anatomists.
Topics: Animals; Atrial Septum; Biological Evolution; Embryo, Mammalian; Humans
PubMed: 30338646
DOI: 10.1002/ar.23914 -
Bioengineered Mar 2022Sepsis-induced myocardial dysfunction (SIMD) is associated with high morbidity and mortality rates; however, it lacks targeted therapies. Modulating cardiomyocyte...
Sepsis-induced myocardial dysfunction (SIMD) is associated with high morbidity and mortality rates; however, it lacks targeted therapies. Modulating cardiomyocyte autophagy maintains intracellular homeostasis during SIMD. Clemastine, a histamine receptor inhibitor, promotes autophagy and other effective biological functions. Nevertheless, the effect of clemastine on SIMD remains unclear. This study aimed to explore the underlying mechanism of clemastine in cardiomyocyte injury in cecum ligation and perforation (CLP)-induced rats and lipopolysaccharide (LPS)-stimulated H9c2 cells. Clemastine (10 mg/kg, 30 mg/kg, and 50 mg/kg) was intraperitoneally injected after 30 min of CLP surgery. Serum cTnI levels and the 7-day survival rate were evaluated. Echocardiograms and H&E staining were used to evaluate cardiac function and structure. TEM was used to detect the mitochondrial ultrastructure and autophagosomes. Clemastine significantly improved the survival rate and reduced cTnI production in serum. Clemastine ameliorated cellular apoptosis, improved mitochondrial ultrastructure both and , increased ATP content, decreased dynamin-related protein 1 (DRP1) expression, and decreased mitochondrial ROS levels. Additionally, clemastine treatment increased autophagosome concentration, LC3II/LC3I rate, and Beclin 1 expression. However, 3-methyladenine (3-MA), an autophagy inhibitor, could abolish the effect of clemastine on alleviating myocardial apoptosis. In conclusion, clemastine protected against cardiac structure destruction and function dysfunction, mitochondrial damage, apoptosis, and autophagy and . Moreover, clemastine attenuated myocardial apoptosis by promoting autophagy. This study provides a novel favorable perspective for SIMD therapy.
Topics: Animals; Apoptosis; Autophagy; Cardiomyopathies; Clemastine; Myocardium; Myocytes, Cardiac; Rats; Sepsis
PubMed: 35274595
DOI: 10.1080/21655979.2022.2047256 -
Medicine Sep 2019The aim of this study was to evaluate the application of transthoracic echocardiography for the diagnosis of infective endocarditis (IE) to provide a basis for the...
The aim of this study was to evaluate the application of transthoracic echocardiography for the diagnosis of infective endocarditis (IE) to provide a basis for the better treatment of IE. From October 2016 to October 2018, 87 consecutive patients with IE at our hospital were selected for this study. All the patients were subjected to transthoracic echocardiography. The morphology, structure, activity, and closure of the patients' heart valves were observed for vegetation identification, and the size, number, location, morphology, and echo intensity of vegetation, as well as degree of valve involvement, were determined.The 87 patients investigated in this study included 38 cases of congenital heart disease, 27 cases of nonrheumatic valvular heart disease, 12 patients who underwent valve surgery, 5 cases of rheumatic valvular heart disease, and 5 patients with no obvious signs of heart disease. The most common clinical manifestations were heart murmur in 80 cases and fever in 60 cases. The most common complications were heart failure in 35 cases, followed by organ embolism in 12 cases. There were 36 cases of positive blood cultures, including 26 cases of Gram-positive cocci and 10 cases of Gram-negative bacilli. Echocardiography showed aortic valve involvement in 37 cases, mitral valve involvement in 34 cases, tricuspid valve involvement in 10 cases, pulmonary valve involvement in 2 cases, and the involvement of an artificial valve in 5 cases. Twenty-six of these cases showed multiple valve involvement, and 20 patients exhibited serious complications. No significant differences were found between echocardiography and actual surgical observations with respect to their accuracy in detecting the size, number, and location of vegetation in the 69 patients who underwent surgery (P > .05). Echocardiography could detect the occurrence of severe complications, namely, the rupture of chordae tendineae, valve prolapse, valve perforation, and paravalvular abscess, and no significant difference in diagnostic accuracy was found between echocardiography and surgical observations (P > .05).Transthoracic echocardiography can rapidly and accurately detect IE vegetation and its complications and has important clinical value for guiding clinical treatment and determining prognosis.
Topics: Adolescent; Adult; Aged; Child; Echocardiography; Endocarditis; Female; Heart; Humans; Male; Middle Aged; Myocardium; Young Adult
PubMed: 31567953
DOI: 10.1097/MD.0000000000017141 -
Correlation of cardiac function and cerebral perfusion in a murine model of subarachnoid hemorrhage.Scientific Reports Feb 2021Cerebral hypoperfusion is a key factor for determining the outcome after subarachnoid hemorrhage (SAH). A subset of SAH patients develop neurogenic stress cardiomyopathy...
Cerebral hypoperfusion is a key factor for determining the outcome after subarachnoid hemorrhage (SAH). A subset of SAH patients develop neurogenic stress cardiomyopathy (NSC), but it is unclear to what extent cerebral hypoperfusion is influenced by cardiac dysfunction after SAH. The aims of this study were to examine the association between cardiac function and cerebral perfusion in a murine model of SAH and to identify electrocardiographic and echocardiographic signs indicative of NSC. We quantified cortical perfusion by laser SPECKLE contrast imaging, and myocardial function by serial high-frequency ultrasound imaging, for up to 7 days after experimental SAH induction in mice by endovascular filament perforation. Cortical perfusion decreased significantly whereas cardiac output and left ventricular ejection fraction increased significantly shortly post-SAH. Transient pathological ECG and echocardiographic abnormalities, indicating NSC (right bundle branch block, reduced left ventricular contractility), were observed up to 3 h post-SAH in a subset of model animals. Cerebral perfusion improved over time after SAH and correlated significantly with left ventricular end-diastolic volume at 3, 24, and 72 h. The murine SAH model is appropriate to experimentally investigate NSC. We conclude that in addition to cerebrovascular dysfunction, cardiac dysfunction may significantly influence cerebral perfusion, with LVEDV presenting a potential parameter for risk stratification.
Topics: Animals; Cerebrovascular Circulation; Disease Models, Animal; Electrocardiography; Female; Mice; Models, Cardiovascular; Myocardial Contraction; Myocardium; Subarachnoid Hemorrhage; Ventricular Dysfunction, Left
PubMed: 33558609
DOI: 10.1038/s41598-021-82583-9 -
Journal of the American College of... Apr 2005Amplatzer septal occluder (ASO)-associated cardiac perforation (CP) at our institution prompted this retrospective review. (Review)
Review
OBJECTIVES
Amplatzer septal occluder (ASO)-associated cardiac perforation (CP) at our institution prompted this retrospective review.
BACKGROUND
Cardiac perforation is a rare complication after transcatheter atrial septal defect (ASD) closure.
METHODS
To identify CP after transcatheter ASD closure with ASO, cardiac events (CE) describing definite CP, hemopericardium, pericardial effusion, cardiovascular collapse, or sudden death were analyzed. Cardiac events were identified from published literature (MEDLINE), medical device regulating agencies in North America and the European Commission, and AGA Medical Corporation (Golden Valley, Minnesota). Institutional cases were reviewed. Cardiac events were defined as early (pre-discharge) or late (post-discharge).
RESULTS
Twenty-nine CEs were identified. Five were excluded because findings were inconclusive for device-related CP. Ten patients were <18 years of age. Late CEs occurred in 66.6%; 25% presented weeks later (longest, three years). Three deaths were reported. Cardiac perforation occurred predominantly in the anterosuperior atrial walls and/or adjacent aorta.
CONCLUSIONS
Amplatzer septal occluder-associated CP uniquely involves the anterosuperior atrial walls and adjacent aorta. Pathophysiology remains poorly understood.
Topics: Adult; Aorta; Female; Heart Atria; Heart Injuries; Heart Septal Defects, Atrial; Humans; Prostheses and Implants
PubMed: 15837251
DOI: 10.1016/j.jacc.2004.12.072 -
BMC Cardiovascular Disorders Apr 2022Large pulmonary valve perforation, which is rarely seen with infective endocarditis, general atrophy, or congenital fenestration, often leads to potentially fatal...
BACKGROUND
Large pulmonary valve perforation, which is rarely seen with infective endocarditis, general atrophy, or congenital fenestration, often leads to potentially fatal outcomes, including heart failure.
CASE PRESENTATION
Transthoracic and transesophageal echocardiographic evaluation of a 69-year-old woman revealed a severely eccentric pulmonary regurgitation with concomitant pulmonary valve stenosis, patent ductus arteriosus, patent foramen ovale, and pulmonary artery aneurysm. In the operation, a large perforation was found in the pulmonary valve leaflet. She underwent complicated surgery that involved closure of the congenital heart defects and replacement of a pulmonary valve with successful results. But the cause of her pulmonary valve perforation remained undetermined.
CONCLUSION
This case highlights two important points: the need for timely management of congenital heart disease and being aware of the possibility of pulmonary valve perforation, which in this case was indicated by an eccentric pulmonary regurgitant jet seen on echocardiography.
Topics: Aged; Echocardiography, Transesophageal; Endocarditis; Endocarditis, Bacterial; Female; Heart Defects, Congenital; Humans; Pulmonary Valve
PubMed: 35397515
DOI: 10.1186/s12872-022-02595-9 -
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