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Nature Communications Mar 2017Extension of the vertebrate heart tube is driven by progressive addition of second heart field (SHF) progenitor cells to the poles of the heart. Defects in this process...
Extension of the vertebrate heart tube is driven by progressive addition of second heart field (SHF) progenitor cells to the poles of the heart. Defects in this process cause a spectrum of congenital anomalies. SHF cells form an epithelial layer in splanchnic mesoderm in the dorsal wall of the pericardial cavity. Here we report oriented cell elongation, polarized actomyosin distribution and nuclear YAP/TAZ in a proliferative centre in the posterior dorsal pericardial wall during heart tube extension. These parameters are indicative of mechanical stress, further supported by analysis of cell shape changes in wound assays. Time course and mutant analysis identifies SHF deployment as a source of epithelial tension. Moreover, cell division and oriented growth in the dorsal pericardial wall align with the axis of cell elongation, suggesting that epithelial tension in turn contributes to heart tube extension. Our results implicate tissue-level forces in the regulation of heart tube extension.
Topics: Actomyosin; Animals; Cell Division; Cell Proliferation; Embryo, Mammalian; Epithelium; Heart; Mice, Inbred C57BL; Mutation; Organogenesis; Pericardium; Signal Transduction; Stress, Mechanical; T-Box Domain Proteins
PubMed: 28357999
DOI: 10.1038/ncomms14770 -
Journal of Veterinary Diagnostic... May 2019Pasteurella multocida is the causative agent of fowl cholera, an economically important disease of commercial and backyard poultry. Turkeys are particularly susceptible...
Pasteurella multocida is the causative agent of fowl cholera, an economically important disease of commercial and backyard poultry. Turkeys are particularly susceptible to fowl cholera; both backyard and commercial turkeys can succumb to disease. On April 10, 2018, a dead 9-mo-old male Bronze turkey was submitted to the California Animal Health and Food Safety Laboratory System (CAHFS)-Turlock branch for postmortem examination. History included previous housing and fighting with another male turkey, after which separation by a fence was instituted. Fighting continued, and depression and anorexia of 2 d duration was followed by acute collapse and death. At autopsy, blood clots markedly expanded the pericardium, and a tear was visible in the left ventricular free wall. Vegetative aortic valvular lesions were observed. Microscopically, infarcts were observed in kidney, liver, heart, spleen, and pancreas, with large numbers of gram-negative bacterial colonies present in most organs. P. multocida was isolated from multiple organs, and identified as serotype 2,5 and fingerprint 1604. Septic embolization from the vegetative valvular aortic lesions likely led to infarcts in multiple organs, including the left ventricular free wall, which ultimately caused weakening of the ventricular wall, ventricular rupture, and exsanguination into the pericardial space. Rupture of the left ventricular free wall has not been previously documented in turkeys with P. multocida infection, to our knowledge, and demonstrates an atypical presentation of fowl cholera in this backyard turkey.
Topics: Animals; Fatal Outcome; Heart Rupture; Male; Pasteurella Infections; Pasteurella multocida; Poultry Diseases; Turkeys
PubMed: 30636539
DOI: 10.1177/1040638718823850 -
Frontiers in Veterinary Science 2021This study aims to describe an unusual peritoneopericardial diaphragmatic hernia (PPDH) in an 8-month-old German shepherd dog, associated with a pericardial pseudocyst...
Case Report: Unusual Peritoneopericardial Diaphragmatic Hernia in an 8-Month-Old German Shepherd Dog, Associated With a Pericardial Pseudocyst and Coexisting Severe Pericardial Effusion Resulting in Right-Sided Heart Failure.
This study aims to describe an unusual peritoneopericardial diaphragmatic hernia (PPDH) in an 8-month-old German shepherd dog, associated with a pericardial pseudocyst and coexisting severe pericardial effusion resulting in right-sided heart failure. An 8-month-old, male, intact, German shepherd dog, was referred for ascites. Echocardiography revealed a severe pericardial effusion with a cyst-like structure within the pericardium and consequently decompensated right-sided heart failure. The ascites was secondary to right-sided heart failure (cardiac tamponade). Computed tomography (CT) of the thorax and abdomen was performed and showed PPDH with severe pericardial effusion and presence of a pericardial cyst-like structure; xyphoid cleft and Y-shaped seventh sternebra; and mild thickening along the cranioventral abdominal wall consistent with scar tissue from the previous umbilical hernia surgical repair. During surgery, the PPDH was corrected, and it was revealed that the remnant of the umbilical cord passed through it, into the pericardium. The cyst-like structure was successfully resected and sent for pathology. Histopathology showed signs of a chronic suppurative inflammation, with absence of a mesothelial or endothelial wall layer, thus consistent with a pseudocyst. Based on tomographic and surgical findings, it is suspected that the pseudocyst, together with the pericardial effusion, evolved by an inflammation of the remnant of the umbilical cord during the umbilical hernia surgical repair 1 month prior to presentation. The underlying PPDH most likely favored the development of the pericardial pseudocyst. However, due to prior antibiotic therapy initiated by the private vet, an infectious origin cannot be ruled out completely. There are a few case reports describing PPDH and/or pericardial pseudocysts in veterinary patients, but the current case report is unique, since it describes PPDH associated with a pericardial pseudocyst and coexisting severe pericardial effusion resulting in cardiac tamponade. As far as the authors know, such a case has not been described in veterinary medicine before.
PubMed: 34164453
DOI: 10.3389/fvets.2021.673543 -
The Journal of International Medical... Mar 2022Paediatric airway surgery in the setting of complex tracheobronchial defects is challenging. This report describes the surgical management and outcomes of pericardial...
Paediatric airway surgery in the setting of complex tracheobronchial defects is challenging. This report describes the surgical management and outcomes of pericardial flap repair in three children. The first patient was a 4-month-old boy with a history of tracheoesophageal fistula repair who presented after out-of-hospital cardiac arrest. He was treated by re-do tracheobronchial reconstruction of the carina using a pedicled pericardial flap. The second patient was an 11-month-old boy who presented following aspiration of a button battery. Bronchoscopy showed erosion of the battery through both main bronchi and the oesophagus. The patient underwent emergency reconstruction of the extensive tracheobronchial defect with pedicled right and left pericardial patches. The third patient was a 5-year-old girl who fell from a swing, resulting in avulsion of the right main bronchus. Pedicled pericardium was used to reconstruct the damaged posterior tracheal wall and the right and left main bronchi. All three patients underwent successful repair of complex tracheobronchial defects with good outcomes in terms of survival and quality of life during 6 to 21 months of follow-up. Pedicled pericardial flap repair may be a viable option for achieving improved results in children with severe tracheobronchial defects.
Topics: Bronchi; Bronchoscopy; Child; Child, Preschool; Female; Humans; Infant; Male; Quality of Life; Surgical Flaps; Trachea
PubMed: 35259976
DOI: 10.1177/03000605221081726 -
BMC Cardiovascular Disorders May 2017Myocardial involvement in young adults has various causes. Acute myopericarditis is one of the myocardial involvements in young adults. It is easy to confuse with acute...
BACKGROUND
Myocardial involvement in young adults has various causes. Acute myopericarditis is one of the myocardial involvements in young adults. It is easy to confuse with acute ST-elevation myocardial infarction because of the electrocardiographic features. This study aims to investigate a number of imaging techniques and clinical features for acute myopericarditis in young adults (<30 years of age).
METHODS
This retrospective study included 147 patients selected from the 2147 patients at the age of <30 with acute chest pain admitted into emergency service between 2010 and 2016. Of 147 patients, 77 patients were diagnosed with acute myopericarditis (group I) (between 18 and 30 aged) and 70 patients had ST-elevation myocardial infarction (group II). The echocardiographic pictures and information of the patients in both groups were rechecked in terms of impaired segmental wall-motion abnormalities, pericardial effusion, and additional features.
RESULTS
The patients in group I had focal echobright, which was defined as myocardial brightness in the left ventricle regions, especially in posterior and lateral wall. Focal echobright was observed in the 75 of 77 cases of acute myopericarditis in transthoracic echocardiogram. This sign was confirmed by cardiac magnetic resonance imaging. Focal echobright sensitivity was 95%; its specificity was 93%; its predictive was 95.2%. Pericardial effusion (83%) was observed in group I behind posterior wall. Its specificity was 81%; its sensitivity was 65%; predictivity was 73%.
CONCLUSIONS
Pericardial effusion and myocardial focal echobright in echocardiography can be quite sensitive indicators for acute myopericarditis in young adults.
Topics: Acute Disease; Adolescent; Adult; Coronary Angiography; Diagnosis, Differential; Echocardiography, Doppler; Electrocardiography; Female; Humans; Magnetic Resonance Imaging; Male; Myocarditis; Myocardium; Pericardial Effusion; Pericarditis; Predictive Value of Tests; Reproducibility of Results; Retrospective Studies; ST Elevation Myocardial Infarction; Young Adult
PubMed: 28532506
DOI: 10.1186/s12872-017-0564-8 -
BMJ Case Reports Jun 2017A 56-year-old woman presented with acute onset of typical chest pain. She was diagnosed with acute coronary syndrome with ST-segment elevation myocardial infarction....
A 56-year-old woman presented with acute onset of typical chest pain. She was diagnosed with acute coronary syndrome with ST-segment elevation myocardial infarction. Although significant obstructive coronary artery disease was ruled out by coronary angiography, cardiac MRI showed transmural necrosis of the lateral free wall with extensive microvascular obstruction consistent with ischaemic heart disease. Within 48 hours after initial presentation, the patient suddenly arrested due to pulseless electrical activity with futile resuscitation efforts. Autopsy revealed myocardial perforation with extensive haematothorax due to pericardial laceration, caused by the mechanical chest compressions. Eventually, histology identified diffuse necrotising coronary vasculitis as a rare cause of ischaemic heart disease.
Topics: Acute Coronary Syndrome; Arteritis; Coronary Vessels; Fatal Outcome; Female; Heart Arrest; Hemothorax; Humans; Magnetic Resonance Imaging; Middle Aged; Myocardial Infarction; Myocardial Ischemia; Myocardium; Necrosis; Pericardium; Resuscitation
PubMed: 28663358
DOI: 10.1136/bcr-2017-219489 -
International Journal of Surgery Case... 2016Pericardial decompression syndrome is defined as paradoxical hemodynamic instability, left ventricular or bi ventricular systolic dysfunction and pulmonary edema after...
BACKGROUND
Pericardial decompression syndrome is defined as paradoxical hemodynamic instability, left ventricular or bi ventricular systolic dysfunction and pulmonary edema after pericardial fluid drainage. Pericardial Decompression Syndrome is an unexpected clinical scenario with an incidence less than 5% in all surgically or percutaneously managed pericardial tamponade patients. The aim of this manuscript was to describe a case with cardiac tamponade in whom acute biventricular heart failure and pulmonary edema developed after surgical creation of a pericardial window, and to discuss this case in light of the literature.
CASE REPORT
A 43-year-old woman who underwent mitral valve replacement three weeks ago admitted to our hospital with dyspnea, tachycardia, and atrial fibrillation. Large quantity of pericardial fluid (35mm in the posterior wall, 25mm in the anterior wall) with partial compression of the right ventricle and 50% left ventricle ejection fraction (LVEF) was determined via transthoracic echocardiography (TTE). After creation of pericardio-pleural window, more than 1000ml of serosanguineous fluid were quickly removed from the pericardial space. During the following hours of the decompression, the patient's condition deteriorated and overt pulmonary edema developed. On the second day, biventricular systolic dysfunction, global diffuse hypokinesia and 15-20% LVEF was observed via TTE. High-dose inotropic support and diuretics was continued. During follow up she was progressively weaned off inotropes, LVEF were raised to 35%. Two weeks later, repeated TTE showed normal biventricular systolic function and LVEF was 50%.
CONCLUSION
We recommend gradual removal of pericardial effusion under hemodynamic monitoring, especially in patient with postcardiotomy tamponade.
PubMed: 27710875
DOI: 10.1016/j.ijscr.2016.09.045 -
Journal of Cardiothoracic Surgery Oct 2023Left ventricular free wall rupture (LVFWR) is a rare but fatal complication of acute myocardial infarction (AMI). An 81-year-old female patient with several...
Left ventricular free wall rupture (LVFWR) is a rare but fatal complication of acute myocardial infarction (AMI). An 81-year-old female patient with several cardiovascular risk factors presented to the emergency department with symptoms of developing a chronic stomachache and cold sweat. An echocardiograph showed wall motion abnormalities from the lateral to posterior wall, as well as pericardial effusion containing clots of up to 17 mm in the posterior wall that indicated LVFWR after AMI. Although she was conscious after being brought to the initial care unit, she suddenly lost consciousness and fell into electromechanical dissociation (EMD). Endotracheal intubation was immediately initiated and her pericardial drainage and intra aortic balloon pump (IABP) placement, and hemodynamics recovered. Although she had 100% obstruction in the left circumflex artery (LCX) #12 on coronary angiography (CAG), she was discharged to the Intensive Care Unit (ICU) without percutaneous coronary intervention (PCI). Conservative treatment such as intubation, sedation, pericardiocentesis and strict blood pressure management as well as treatment by IABP long-term support led to the patient being uneventfully discharged after 60 days.
Topics: Humans; Female; Aged, 80 and over; Percutaneous Coronary Intervention; Conservative Treatment; Myocardial Infarction; Heart Rupture; Echocardiography
PubMed: 37805478
DOI: 10.1186/s13019-023-02397-w -
Journal of Cardiology Cases Jul 2018Incomplete rupture of the ventricle free wall can occur after myocardial infarction. This occurs when an organized thrombus and the pericardium seal the ventricular...
Incomplete rupture of the ventricle free wall can occur after myocardial infarction. This occurs when an organized thrombus and the pericardium seal the ventricular perforation. This can progress to the formation of a left ventricle pseudoaneurysm (LVPA). A 70-year-old male with an antero-septal ST-elevation myocardial infarction (STEMI) underwent an emergent left heart catheterization which revealed severe three-vessel disease with occluded grafts, non-amenable to re-vascularization, and an apical thrombus. As he was high-risk for repeat coronary artery bypass graft, he was medically managed. Transthoracic echocardiogram (TTE) showed a normal left ventricle ejection fraction (LVEF), apical anterior and inferior wall akinesis, moderate sized apical thrombus, and pericardial thickening. On hospital day 7, examination revealed a new 3/6 to-and-fro murmur that was loudest at the apex. The patient was asymptomatic with normal vital signs. A repeat TTE revealed an apical wall rupture with flow into the pericardial cavity and absence of the apical thrombus. A LVPA was diagnosed and the patient was immediately referred for surgical repair. This case illustrates the potential for developing LVPA in STEMI patients and the importance of physical examination. If identified early a potential emergent situation in a previously asymptomatic patient can be averted, thereby preventing fatal consequences. < With the growing use of diagnostic testing the importance of physical examination is being lost. However, with an astute cardiac examination, potential complications such as a left ventricular pseudoaneurysm can be identified and promptly managed. In addition, a ventricular pseudoaneurysm must be considered in the differential as a rare complication in post ST-elevation myocardial infarction patients with a new murmur.>.
PubMed: 30279903
DOI: 10.1016/j.jccase.2018.03.002 -
Journal of Cardiovascular Magnetic... May 2009Pericardial adipose tissue (PAT) has been shown to be an independent predictor of coronary artery disease. To date its assessment has been restricted to the use of...
BACKGROUND
Pericardial adipose tissue (PAT) has been shown to be an independent predictor of coronary artery disease. To date its assessment has been restricted to the use of surrogate echocardiographic indices such as measurement of epicardial fat thickness over the right ventricular free wall, which have limitations. Cardiovascular magnetic resonance (CMR) offers the potential to non-invasively assess total PAT, however like other imaging modalities, CMR has not yet been validated for this purpose. Thus, we sought to describe a novel technique for assessing total PAT with validation in an ovine model.
METHODS
11 merino sheep were studied. A standard clinical series of ventricular short axis CMR images (1.5T Siemens Sonata) were obtained during mechanical ventilation breath-holds. Beginning at the mitral annulus, consecutive end-diastolic ventricular images were used to determine the area and volume of epicardial, paracardial and pericardial adipose tissue. In addition adipose thickness was measured at the right ventricular free wall. Following euthanasia, the paracardial adipose tissue was removed from the ventricle and weighed to allow comparison with corresponding CMR measurements.
RESULTS
There was a strong correlation between CMR-derived paracardial adipose tissue volume and ex vivo paracardial mass (R2 = 0.89, p < 0.001). In contrast, CMR measurements of corresponding RV free wall paracardial adipose thickness did not correlate with ex vivo paracardial mass (R2 = 0.003, p = 0.878).
CONCLUSION
In this ovine model, CMR-derived paracardial adipose tissue volume, but not the corresponding and conventional measure of paracardial adipose thickness over the RV free wall, accurately reflected paracardial adipose tissue mass. This study validates for the first time, the use of clinically utilised CMR sequences for the accurate and reproducible assessment of pericardial adiposity. Furthermore this non-invasive modality does not use ionising radiation and therefore is ideally suited for future studies of PAT and its role in cardiovascular risk prediction and disease in clinical practice.
Topics: Adipose Tissue; Adiposity; Animals; Image Interpretation, Computer-Assisted; Magnetic Resonance Imaging, Cine; Models, Animal; Organ Size; Pericardium; Predictive Value of Tests; Reproducibility of Results; Sheep
PubMed: 19416534
DOI: 10.1186/1532-429X-11-15