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Revue Medicale de Liege May 2018Cardiac tamponade is a vital emergency. It occurs when the accumulation of intra-pericardial fluid exceeds the pericardial adaptation capacity. Pericardial pressure is... (Review)
Review
Cardiac tamponade is a vital emergency. It occurs when the accumulation of intra-pericardial fluid exceeds the pericardial adaptation capacity. Pericardial pressure is equalized with that of cardiac cavities and severe heart failure occurs, most often rapidly. Several clinical presentations are possible. The diagnosis is based on the assessment of pericardial effusion and its impact on the heart by echocardiography. Supportive treatments have limited effectiveness. The only emergency treatment is drainage of the pericardium by direct puncture or by surgical approach.
Topics: Cardiac Tamponade; Drainage; Echocardiography; Humans; Pericardial Effusion
PubMed: 29926566
DOI: No ID Found -
Circulation Research Oct 2022Mesenchymal stem cell (MSC)-derived exosomes are well recognized immunomodulating agents for cardiac repair, while the detailed mechanisms remain elusive. The...
BACKGROUND
Mesenchymal stem cell (MSC)-derived exosomes are well recognized immunomodulating agents for cardiac repair, while the detailed mechanisms remain elusive. The Pericardial drainage pathway provides the heart with immunosurveillance and establishes a simplified model for studying the mechanisms underlying the immunomodulating effects of therapeutic exosomes.
METHODS
Myocardial infarction (MI) models with and without pericardiectomy (corresponding to Tomy MI and NonTomy MI) were established to study the functions of pericardial drainage pathway in immune activation of cardiac-draining mediastinal lymph node (MLN). Using the NonTomy MI model, MSC exosomes or vehicle PBS was intrapericardially injected for MI treatment. Via cell sorting and RNA-seq (RNA-sequencing) analysis, the differentially expressed genes were acquired for integrated pathway analysis to identify responsible mechanisms. Further, through functional knockdown/inhibition studies, application of cytokines and neutralizing antibodies, western blot, flow cytometry, and cytokine array, the molecular mechanisms were studied. In addition, the therapeutic efficacy of intrapericardially injected exosomes for MI treatment was evaluated through functional and histological analyses.
RESULTS
We show that the pericardial draining pathway promoted immune activation in the MLN following MI. Intrapericardially injected exosomes accumulated in the MLN and induced regulatory T cell differentiation to promote cardiac repair. Mechanistically, uptake of exosomes by major histocompatibility complex (MHC)-II antigen-presenting cells (APCs) induced Foxo3 activation via the protein phosphatase (PP)-2A/p-Akt/forkhead box O3 (Foxo3) pathway. Foxo3 dominated APC cytokines (IL-10, IL-33, and IL-34) expression and built up a regulatory T cell (Treg)-inducing niche in the MLN. The differentiation of Tregs as well as their cardiac deployment were elevated, which contributed to cardiac inflammation resolution and cardiac repair.
CONCLUSIONS
This study reveals a novel mechanism underlying the immunomodulation effects of MSC exosomes and provides a promising candidate (PP2A/p-Akt/Foxo3 signaling pathway) with a favorable delivery route (intrapericardial injection) for cardiac repair.
Topics: Humans; Exosomes; Forkhead Box Protein O3; Mesenchymal Stem Cells; Myocardial Infarction; Proto-Oncogene Proteins c-akt; Signal Transduction; Heart Injuries
PubMed: 36252111
DOI: 10.1161/CIRCRESAHA.122.321384 -
Nature Communications Mar 2021Cardiac patches are an effective way to deliver therapeutics to the heart. However, such procedures are normally invasive and difficult to perform. Here, we develop and...
Cardiac patches are an effective way to deliver therapeutics to the heart. However, such procedures are normally invasive and difficult to perform. Here, we develop and test a method to utilize the pericardial cavity as a natural "mold" for in situ cardiac patch formation after intrapericardial injection of therapeutics in biocompatible hydrogels. In rodent models of myocardial infarction, we demonstrate that intrapericardial injection is an effective and safe method to deliver hydrogels containing induced pluripotent stem cells-derived cardiac progenitor cells or mesenchymal stem cells-derived exosomes. After injection, the hydrogels form a cardiac patch-like structure in the pericardial cavity, mitigating immune response and increasing the cardiac retention of the therapeutics. With robust cardiovascular repair and stimulation of epicardium-derived cells, the delivered therapeutics mitigate cardiac remodeling and improve cardiac functions post myocardial infarction. Furthermore, we demonstrate the feasibility of minimally-invasive intrapericardial injection in a clinically-relevant porcine model. Collectively, our study establishes intrapericardial injection as a safe and effective method to deliver therapeutic-bearing hydrogels to the heart for cardiac repair.
Topics: Animals; Cardiac Surgical Procedures; Cardiovascular Agents; Cell Differentiation; Drug Delivery Systems; Exosomes; Extracellular Matrix; Hydrogels; Induced Pluripotent Stem Cells; Male; Materials Testing; Mesenchymal Stem Cells; Mice; Minimally Invasive Surgical Procedures; Myocardial Infarction; Myocytes, Cardiac; Pericardium; Rats; Swine
PubMed: 33658506
DOI: 10.1038/s41467-021-21682-7 -
European Heart Journal May 2023Epicardium and epicardium-derived cells are critical players in myocardial fibrosis. Mesenchymal stem cell-derived extracellular vesicles (EVs) have been studied for...
AIMS
Epicardium and epicardium-derived cells are critical players in myocardial fibrosis. Mesenchymal stem cell-derived extracellular vesicles (EVs) have been studied for cardiac repair to improve cardiac remodelling, but the actual mechanisms remain elusive. The aim of this study is to investigate the mechanisms of EV therapy for improving cardiac remodelling and develop a promising treatment addressing myocardial fibrosis.
METHODS AND RESULTS
Extracellular vesicles were intrapericardially injected for mice myocardial infarction treatment. RNA-seq, in vitro gain- and loss-of-function experiments, and in vivo studies were performed to identify targets that can be used for myocardial fibrosis treatment. Afterward, a lipid nanoparticle-based long non-coding RNA (lncRNA) therapy was prepared for mouse and porcine models of myocardial infarction treatment. Intrapericardial injection of EVs improved adverse myocardial remodelling in mouse models of myocardial infarction. Mechanistically, Tcf21 was identified as a potential target to improve cardiac remodelling. Loss of Tcf21 function in epicardium-derived cells caused increased myofibroblast differentiation, whereas forced Tcf21 overexpression suppressed transforming growth factor-β signalling and myofibroblast differentiation. LncRNA-Tcf21 antisense RNA inducing demethylation (TARID) that enriched in EVs was identified to up-regulate Tcf21 expression. Formulated lncRNA-TARID-laden lipid nanoparticles up-regulated Tcf21 expression in epicardium-derived cells and improved cardiac function and histology in mouse and porcine models of myocardial infarction.
CONCLUSION
This study identified Tcf21 as a critical target for improving cardiac fibrosis. Up-regulating Tcf21 by using lncRNA-TARID-laden lipid nanoparticles could be a promising way to treat myocardial fibrosis. This study established novel mechanisms underlying EV therapy for improving adverse remodelling and proposed a lncRNA therapy for cardiac fibrosis.
Topics: Mice; Animals; Swine; RNA, Long Noncoding; RNA, Antisense; Ventricular Remodeling; Myocardial Infarction; Fibrosis; Demethylation
PubMed: 36916305
DOI: 10.1093/eurheartj/ehad114 -
The Turkish Journal of Pediatrics 2019Yuan SM, Lin H. Fetal intrapericardial teratomas. Turk J Pediatr 2019; 61: 153-158. Fetal intrapericardial teratomas are rare and benign. However, they can be... (Review)
Review
Yuan SM, Lin H. Fetal intrapericardial teratomas. Turk J Pediatr 2019; 61: 153-158. Fetal intrapericardial teratomas are rare and benign. However, they can be life-threatening owing to the complicated massive pericardial effusions, tamponade, or cardiorespiratory distress. The purpose of this review is to give an overview on clinical features, management and prognoses of fetal intrapericardial teratomas. The materials of this study were based on a comprehensive literature retrieval of fetal intrapericardial teratomas published in the past two decades. It was noteworthy that fetal pericardial/pleural effusions or ascites were detected since 19-week gestation, and tumors could be found since 21-week gestation. A growing trend of tumors was observed in more than half of the cases. Prenatal centesis and postnatal tumor resection were required in most of the cases. Fetoneonatal deaths (including fetal demise, termination of pregnancy and neonatal death) occurred in one-third of the cases. The neonatal survival rate was 59.4%. Symptomatic fetuses usually required perinatal maneuvers, such as pericardiocentesis, or thoraco-/ pericardio-amniotic shunt in order to improve fetal hemodynamic status and prolong the pregnancy for lung maturity. Open fetal surgery and ex utero intrapartum treatment (EXIT) procedure can be considered, however, impact of EXIT procedure on later delivery remains uncertain. Postnatal operation is a curative and symptom-relieving method for those cases with prenatally diagnosed intrapericardial teratomas. As a result, the fetoneonatal outcomes are somewhat promising.
Topics: Abortion, Induced; Female; Fetal Death; Fetal Heart; Heart Neoplasms; Humans; Hydrops Fetalis; Infant, Newborn; Paracentesis; Pericardial Effusion; Perinatal Death; Pregnancy; Prenatal Diagnosis; Teratoma
PubMed: 31951327
DOI: 10.24953/turkjped.2019.02.001 -
Radiology. Cardiothoracic Imaging Aug 2022
PubMed: 36059382
DOI: 10.1148/ryct.220100 -
Multimedia Manual of Cardiothoracic... Jan 2006Intrapericardial pneumonectomy is a major thoracic surgical procedure which is employed to resect locally advanced bronchogenic carcinoma. The procedure differs slightly...
Intrapericardial pneumonectomy is a major thoracic surgical procedure which is employed to resect locally advanced bronchogenic carcinoma. The procedure differs slightly in the left side than in the right side due to the anatomical differences of the two pulmonary hila and adjacent mediastinal structures. The common beginning of the operation is the longitudinal opening of the pericardium behind the phrenic nerve. On the left side, the pulmonary artery is dissected under the aortic arch and the ligamentum arteriosum is divided. Subsequently, the superior and inferior pulmonary veins are dissected and prepared intrapericardially and finally the bronchus is prepared posteriorly to the hilum. On the right side, the pulmonary artery is dissected from the superior vena cava and the procedure follows as on the left side. The mortality of intrapericardial pneumonectomy is in the range of 5-10% and the complication rate is about 20%.
PubMed: 24415394
DOI: 10.1510/mmcts.2004.000091 -
European Heart Journal Supplements :... Apr 2023Sudden cardiac death (SCD) pathophysiological point of view can be either mechanical or electrical. In case of mechanical SCD, the most frequent causes are pulmonary...
Sudden cardiac death (SCD) pathophysiological point of view can be either mechanical or electrical. In case of mechanical SCD, the most frequent causes are pulmonary thromboembolism and cardiac tamponade due to intrapericardial rupture (aortic dissection, heart rupture). This distinction is important because cardiac arrest retains survival potential through cardiopulmonary resuscitation and defibrillators only if the rhythm is shockable. The heart diseases that can cause SCD vary according to the age of the individual. In young people, primary electrical diseases ('ion channel diseases') and cardiomyopathies (particularly hypertrophic and arrhythmogenic), both genetically determined and therefore potentially recurred in the proband's family, as well as myocarditis and coronary anomalies prevail; in adult-elderly populations, coronary atherosclerosis with its complications and degenerative valve diseases (aortic stenosis and mitral valve prolapse) predominate. In this short text, the main structural heart diseases characterized by electrical instability at risk of SCD will be recalled, with a focus on coronary, myocardial, and valvular diseases.
PubMed: 37091646
DOI: 10.1093/eurheartjsupp/suad077 -
The New England Journal of Medicine Jan 2004Effusive-constrictive pericarditis is an uncommon pericardial syndrome characterized by concomitant tamponade, caused by tense pericardial effusion, and constriction,...
BACKGROUND
Effusive-constrictive pericarditis is an uncommon pericardial syndrome characterized by concomitant tamponade, caused by tense pericardial effusion, and constriction, caused by the visceral pericardium. We conducted a prospective study of its clinical evolution and management.
METHODS
From 1986 through 2001, all patients with effusive-constrictive pericarditis were prospectively evaluated. Combined pericardiocentesis and cardiac catheterization were performed in all patients, and pericardiectomy was performed in those with persistent constriction. Follow-up ranged from 1 month to 15 years (median, 7 years).
RESULTS
A total of 1184 patients with pericarditis were evaluated, 218 of whom had tamponade. Of these 218, 190 underwent combined pericardiocentesis and catheterization. Fifteen of these patients had effusive-constrictive pericarditis and were included in the study. All patients presented with clinical tamponade; however, concomitant constriction was recognized in only seven patients. At catheterization, all patients had elevated intrapericardial pressure (median, 12 mm Hg; interquartile range, 7 to 18) and elevated right atrial and end-diastolic right and left ventricular pressures. After pericardiocentesis, the intrapericardial pressure decreased (median value, -5 mm Hg; interquartile range, -5 to 0), whereas right atrial and end-diastolic right and left ventricular pressures, although slightly reduced, remained elevated, with a dip-plateau morphology. The causes were diverse, and death was mainly related to the underlying disease. Pericardiectomy was required in seven patients, all of whom had involvement of the visceral pericardium. Three patients had spontaneous resolution.
CONCLUSIONS
Effusive-constrictive pericarditis is an uncommon pericardial syndrome that may be missed in some patients who present with tamponade. Although evolution to persistent constriction is frequent, idiopathic cases may resolve spontaneously. In our opinion, extensive epicardiectomy is the procedure of choice in patients requiring surgery.
Topics: Adolescent; Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal; Cardiac Tamponade; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pericardial Effusion; Pericardiectomy; Pericardiocentesis; Pericarditis, Constrictive; Prospective Studies; Treatment Outcome
PubMed: 14749455
DOI: 10.1056/NEJMoa035630 -
International Journal of Hypertension 2014Functioning paraganglioma is extra-adrenal catecholamine-secreting tumours that may cause secondary hypertension. Primary intrapericardial paragangliomas are very rare... (Review)
Review
Functioning paraganglioma is extra-adrenal catecholamine-secreting tumours that may cause secondary hypertension. Primary intrapericardial paragangliomas are very rare and are located adjacent to the great vessels or heart, typically near the left atrium. These tumours are an exceptionally uncommon finding during the investigation of refractory hypertension. However, in recent years, intrapericardial paragangliomas have been diagnosed incidentally with increased frequency, due to the extensive use of radiologic chest imaging. The mainstay of treatment of functioning intrapericardial paraganglioma is surgical removal, which usually achieves blood pressure normalization. Due to the locations of these tumours, the surgical approach is through a median sternotomy or posterolateral thoracotomy, and manipulation-induced catecholamine release may cause paroxysmal hypertension. Typically in these patients, blood pressure fluctuates dramatically intra- and post-operatively, increasing the risk of cardiovascular complications. We review here the current modalities of perioperative fluid and hypotensive drug administration in the setting of surgery for functioning intrapericardial paraganglioma and discuss the recently proposed paradigm shift that omits preoperative preparation.
PubMed: 24688789
DOI: 10.1155/2014/812598