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De Simone R, Wolf I, Hoda R, Mikhail B, Mottl-Link S, Meinzer HP, Hagl S. Three-Dimensional Assessment of Left Ventricular Geometry and Annular Dilatation Provides New Mechanistic Insights into the Surgical Correction of Ischemic Mitral Regurgitation. Thorac Cardiovasc Surg 2006; 54:452-8. [PMID: 17089311 DOI: 10.1055/s-2006-924435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The aim of this study was to investigate the relationship between LV geometry, annular shape and the amount of regurgitation in patients with ischemic mitral regurgitation (group 1, n = 30) compared to patients with primary mitral valve lesions (group 2, n = 30). METHODS LV geometry was assessed by the sphericity index, i.e., LV volume divided by the volume of a sphere with a diameter equal to the longest axis. Annular geometry was evaluated by diameters, areas and their percentual shortening. The degree of mitral regurgitation was assessed as jet volumes by 3D-echocardiography. RESULTS Group 1 showed significantly larger longitudinal (54.3 +/- 3.1 vs. 40.9 +/- 2.6 mm) and antero-posterior (32.2 +/- 3.3 vs. 27.1 +/- 2.9 mm) annulus diameters and areas (993.3 +/- 66.6 vs. 702.1 +/- 47.9 mm (2)) than group 2. No asymmetric annular enlargement was found in either group. Annular enlargement correlated to the degree of mitral regurgitation in group 1 but not in group 2. Annular area shortening was significantly impaired in group 2 and the sphericity index was larger in group 1 than in group 2. In group 1, the sphericity index was significantly correlated to the degree of mitral regurgitation (r = 0.87; P < 0.001). CONCLUSIONS These findings suggest that ischemic mitral regurgitation was mostly associated with a global left ventricular enlargement, in which annulus dilatation and its reduced contraction play a significant role.
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Koch A, Tochtermann U, Remppis A, Dengler TJ, Schnabel PA, Hagl S, Sack FU. The Eurotransplant High-Urgency Heart Transplantation Program: An Option for Patients in Acute Heart Failure? Thorac Cardiovasc Surg 2006; 54:414-7. [PMID: 16967379 DOI: 10.1055/s-2006-924245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The Eurotransplant High-Urgency (HU) Heart Transplantation Program allows urgent heart transplants to be carried out in rapidly deteriorating patients with acute-to-chronic heart failure on the elective waiting list. But do the results of HU heart transplantation justify performing primary heart transplantation in these critically ill patients and offer an acceptable outcome? METHODS Between 2000 and 2004, 64 heart transplantations (HTx) (32 elective and 32 HU-HTx) were performed in our department. After having been accepted in an auditing process based on HU criteria, intensive care patients in NYHA functional class IV (cardiac index 1.7 l/min/qm BS), in end-organ failure (creatinine 1.5 mg/dl), and with catecholamine dependence (dobutamine 8 microg/kg/min), are given priority with respect to organ allocation, and their data were compared to data from elective patients from the same period. RESULTS HU requests were accepted in 97 % of cases. Two requests were not accepted, and both patients with contraindications for assist device implantation died within one week. The HU patients were 100 % in NYHA class IV, 93 % of the elective patients were in NYHA class III. Waiting time on the HU list was 13 days, and 7 of these patients died before HTx. Following heart transplantation, survival rates at 30 days and at one year of the HU group were 88 % and 85 % versus 94 % and 93 % in the elective group. CONCLUSIONS This study shows that end-stage heart failure patients in the HU program can be transplanted primarily with good results if an organ is available in time. We are still in the position where the HU program only manages the organ shortage; there are still too many patients on the waiting list who die before receiving a donor organ.
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Szabó G, Seres L, Soós P, Flechtenmacher C, Zsengellér Z, Sack FU, Szabó C, Hagl S. Poly-ADP-ribose polymerase inhibition reduces mesenteric injury after cardiopulmonary bypass. Thorac Cardiovasc Surg 2006; 52:338-43. [PMID: 15573274 DOI: 10.1055/s-2004-821274] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND We investigated the effects of PARS inhibition on intestinal injury in a canine model of cardiopulmonary bypass (CPB). METHODS Twelve dogs underwent 90 minutes of hypothermic CPB. 6 dogs received 5 mg/kg PJ34, a selective PARP inhibitor during CPB, 6 vehicle-treated animals served as controls. Mesenteric blood flow (MBF) and mesenteric vascular resistance (MVR) were measured before and 60 minutes after weaning from CPB. Endothelium-dependent vasorelaxation to acetylcholine (ACH) and endothelium-independent vasorelaxation to sodium-nitroprusside (SNP) were expressed as percent change of MVR. In addition, mesenteric creatine kinase (CK) and lactate release were determined. RESULTS Baseline hemodynamics, MBF, response to ACH (- 41 +/- 3 vs. - 55 +/- 6 %) and SNP (- 60 +/- 2 vs. - 56 +/- 4 %) did not differ significantly between the groups. The response to ACH decreased significantly in the control group while it remained unchanged in the PJ34 group (- 29 +/- 5 vs. - 46 +/- 9 %, p < 0.05). The response to SNP did not change. Mesenteric CK release (325 +/- 99 vs. 16 +/- 10 U/l, p < 0.05) and lactate production (0.96 +/- 0.17 vs. 0.4 +/- 0.2 mmol/l, p < 0.05) were significantly lower in the PJ34 group. CONCLUSION PARP inhibition prevents CPB-induced mesenteric endothelial dysfunction and tissue damage.
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Osswald B, Tochtermann U, Badowski-Zyla D, Thomas G, Hagl S. Coronary reconstructive surgery versus coronary artery bypass grafting--a documentation gap. Thorac Cardiovasc Surg 2006; 54:239-43. [PMID: 16755444 DOI: 10.1055/s-2005-873065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Over the last years, there has been a clear trend that an increasing number of patients are admitted for CABG with advanced disease, complex pathomorphological alterations and impaired left ventricular function. The necessity of performing extensive reconstructive coronary surgery rather than coronary bypass grafting, in its original sense, is not appropriately documented by the current version of the German Documentation System for Cardiac Surgery, nor in other national and international documentation systems. PATIENTS AND METHODS 5821 consecutive, unselected patients underwent isolated CABG from 7/1995 through 12/2003 at a single institution. A closing date follow-up procedure up to 8 years postoperatively was performed with a completeness of 98.8%. RESULTS The need for reconstructive surgery in terms of extended anastomoses with or without coronary endarterectomy has doubled in our patients since 1995 and is steadily increasing with 15.7 % (n=102) of these patients requiring such surgery in 2003. Current documentation does not allow any prediction of complex coronary morphology. The Kaplan-Meier survival curve reveals no substantial difference between patients with and without coronary reconstructive surgery up to 8 years after CABG. CONCLUSION The increase of complexity in CABG procedures currently remains undetected, since preoperative imaging methods often fail to predict complex coronary morphology. Survival after coronary reconstructive surgery is comparable to that of "classical" CABG. Therefore, a standardized documentation is required to evaluate surgical results and to contribute to the improvement of medical decision-making which presupposes valid data.
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Schoenhoff F, Kayhan N, Thomas G, Haase KK, Borggrefe M, Katus HA, Hagl S, Vahl CF. Bridge to Operation with the GPIIb/IIIa Inhibitor Abciximab in High-Risk Coronary Patients. Thorac Cardiovasc Surg 2006; 54:150-6. [PMID: 16639674 DOI: 10.1055/s-2005-873067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Glycoprotein-IIb/IIIa inhibitors are now frequently used in the cardiological treatment of high-risk coronary patients even if the patient is considered suitable for surgical intervention. However, there is no consensus whether GPIIb/IIIa inhibitors should be stopped before operation because of an increased risk of bleeding or if surgery should even be delayed until the anticoagulating effect subsides. METHODS From June 2002 to August 2003 140 patients who had to undergo primary aorto-coronary bypass for ongoing myocardial ischemia were enrolled in the present study. The patients received either clopidogrel, aspirin and heparin or additionally abciximab until operation. RESULTS Although the intraoperative need for blood products was higher in the abciximab group, there was no significant difference in postoperative blood loss. The hemodynamic situation of the abciximab patients after the operation was better compared to the other groups. 30-day mortality was not increased when compared to the elective control group (6.7 % vs. 6.1 %). CONCLUSION The GPIIb/IIIa inhibitor abciximab can be safely used as a bridge to operation and results in a better hemodynamic outcome in high-risk coronary patients while reducing the incidence of major ischemic events.
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Sack FU, Dollner R, Reidenbach B, Koch A, Gebhard MM, Hagl S. Intravital Microscopy of Pulmonary Microcirculation After Single Lung Transplantation in Pigs. Transplant Proc 2006; 38:737-40. [PMID: 16647459 DOI: 10.1016/j.transproceed.2006.01.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Pulmonary reperfusion injury is a significant risk factor following lung transplantation (LTx). Unfortunately, in vivo observations and quantitative analyses of the pulmonary microcirculation following LTx are technically demanding. METHODS Pigs, weighing 18 to 22 kg, served as the laboratory animals. The left lung was harvested and preserved using donor aortic vessel segments, the pulmonary artery, and the cuff of the lung veins were extended. After 4 hours of ischemia, the lungs were transplanted by direct connection of the conduits to the left atrial appendage and the left pulmonary artery of the recipient. The lungs were placed extrathoracically and ventilated. The recipient left lung was excluded. With this procedure, mechanical trauma to the lung and moving artefacts were avoided. Intravital microscopic observation became feasible. RESULTS Following reperfusion, oxygenation of pulmonary venous blood was excellent. However, blood flow distribution was significantly reduced to the transplanted lung compared with the native right recipient lung. Pulmonary vascular resistance was significantly increased, dropping from 3500 to 1000 dynes x s x cm(-5) during reperfusion compared to a value of 500 for the native right lung. The pulmonary microcirculation showed a significant number of no-reflow areas with extremely reduced red blood cell velocities. Greater than 90% of microvessels (<30 microm) showed velocities below 0.1 mm/sec. In conclusion, microvascular injury seems to be a major pathogenic factor for the development reperfusion failure. Quantification of alterations within the microvasculature may shed light on various treatment modalities that reduce perfusion failure.
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Koch A, Sebening C, DeSimone R, Jahn L, Sack FU, Hagl S. Coronary fistula of right coronary artery to vena cava superior and ectasia of pulmonary artery. ACTA ACUST UNITED AC 2006; 94:813-6. [PMID: 16382382 DOI: 10.1007/s00392-005-0291-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Accepted: 07/01/2005] [Indexed: 10/25/2022]
Abstract
We report on a patient with coronary heart disease, a coronary fistula of right coronary artery to vena cava superior and pulmonary hypertension. Combined with coronary artery revascularization, the coronary fistula was closed successfully.
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De Simone R, Glombitza G, Ambrus J, Woo YR, Wolf I, Meinzer HP, Hagl S. In vitro study of jet volumes and regurgitant flow rates for quantitative assessment of mitral valve regurgitation. Thorac Cardiovasc Surg 2006. [DOI: 10.1055/s-2006-925821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Szabó G, Stumpf NA, Hagl S, Szabó C. Poly (ADP-ribose) polymerase inhibition improves safe cardiac preservation times and cardiac function during heart transplantation. Thorac Cardiovasc Surg 2006. [DOI: 10.1055/s-2006-925763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Badowski-Zyla D, Tochtermann U, Gegouskov V, Osswald BR, Hagl S. Valvular noise after bileaflet mechanical valve replacement – a disregarded problem? Thorac Cardiovasc Surg 2006. [DOI: 10.1055/s-2006-925825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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De Simone R, Mottl-Link S, Wolf I, Hoda R, Mikhail B, Meinzer HP, Hagl S. Three-dimensional assessment of left ventricular geometry and annular dilatation provides new mechanistic insights into the surgical correction of ischemic mitral regurgitation. Thorac Cardiovasc Surg 2006. [DOI: 10.1055/s-2006-925735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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62
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Gegouskov V, Osswald BR, Tochtermann U, Badowski-Zyla D, Hagl S. Long-term results after coronary artery reconstructive surgery. Thorac Cardiovasc Surg 2006. [DOI: 10.1055/s-2006-925731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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63
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Beller CJ, Radovits T, Kosse J, Gerö D, Szabó C, Hagl S, Szabó G. Activation of the peroxynitrite-poly (ADP-ribose) polymerase pathway during neointima proliferation: a new target to prevent restenosis after endarterectomy? Thorac Cardiovasc Surg 2006. [DOI: 10.1055/s-2006-925746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Szabó G, Beller CJ, Seres L, Hagl S. Inosine improves cardiac and pulmonary function after cardiopulmonary bypass. Thorac Cardiovasc Surg 2006. [DOI: 10.1055/s-2006-925762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Szabó G, Stumpf NA, Gerö D, Beller CJ, Szabó C, Hagl S. Contractile dysfunction in experimental cardiac allograft rejection: role of the poly (ADP-ribose) polymerase pathway. Thorac Cardiovasc Surg 2006. [DOI: 10.1055/s-2006-925864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Szabó G, Stumpf NA, Hagl S, Dengler T. Direct immunosuppressive properties of poly (ADP-Ribose) polymerase inhibition contribute to increased survival after cardiac transplantation. Thorac Cardiovasc Surg 2006. [DOI: 10.1055/s-2006-925744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kayhan N, Peivandi AA, Hagl S, Vahl CF. Right ventricular function in mitral valve incompetence. The impact of additional tricuspid valve surgery in mitral valve repair. Thorac Cardiovasc Surg 2006. [DOI: 10.1055/s-2006-925736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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68
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Radovits T, Gerö D, Seres L, Szabó C, Hagl S, Szabó G. Potent novel peroxynitrite decomposition catalyst FP15 improves ageing-associated cardiac and vascular dysfunction. Thorac Cardiovasc Surg 2006. [DOI: 10.1055/s-2006-925748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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69
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Loukanov T, Sebening C, Springer W, Ulmer H, Hagl S. Use of cardiopulmonary bypass for pediatric tracheal surgery. Thorac Cardiovasc Surg 2005. [DOI: 10.1055/s-2005-922374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Osswald BR, Bagiazidou S, Tochtermann U, Badowski-Zyla D, Thomas G, Hagl S. The increasing challenge of CABG. Thorac Cardiovasc Surg 2005. [DOI: 10.1055/s-2005-922395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Tochtermann U, Schnabel P, Osswald BR, Badowski-Zyla D, Hagl S. Structural changes of the left ventricular outflow tract – an important issue in aortic valve replacement. Thorac Cardiovasc Surg 2005. [DOI: 10.1055/s-2005-922331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Badowski-Zyla D, Osswald BR, Tochtermann U, Thomas G, Hagl S. Biological graft material in Coronary Artery Disease – A different view on the results of saphenous versus IMA grafts. Thorac Cardiovasc Surg 2005. [DOI: 10.1055/s-2005-922386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schupp DJ, Huck BP, Sykora J, Flechtenmacher C, Gorenflo M, Koch A, Sack FU, Haass M, Katus HA, Ulmer HE, Hagl S, Otto HF, Schnabel PA. Right ventricular expression of extracellular matrix proteins, matrix-metalloproteinases, and their inhibitors over a period of 3 years after heart transplantation. Virchows Arch 2005; 448:184-94. [PMID: 16160874 DOI: 10.1007/s00428-005-0050-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2005] [Accepted: 07/15/2005] [Indexed: 10/25/2022]
Abstract
Fibrillar collagens I and III, nonfibrillar collagen IV, and the glycoproteins fibronectin and laminin, are elements of the myocardial extracellular matrix (ECM). Alterations in the normal concentrations and ratios of these elements may reflect remodeling in response to physiologic stress. In the case of patients' post-heart transplantation (HTx), specific patterns of alteration may herald myocardial dysfunction. Right ventricular biopsies were taken from the same 28 HTx patients before implantation and 1 week, 2 weeks, and 1, 2, and 3 years after HTx. The above-noted five ECM proteins, six matrix metalloproteinases (MMPs) and two of their tissue inhibitors (TIMPs) were detected by immunohistochemistry and scored as cells per square millimeter or semiquantitatively. The total connective tissue fibers were detected by connective tissue stain and morphometry. Variations in these ECM components were followed in the same patient cohort over 3 years. In summary, during the first 2 weeks after HTx, a predominant increase in connective tissue occurred. Increases in MMP-8 and MMP-9 were found. By 3 years after transplantation, there was a decrease of connective tissue fibers and a significant reduction of all ECM components and an increase in MMPs and TIMPs. These findings may reflect a pattern of remodeling specific to the transplanted heart.
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Demirakca S, Ullmann M, Neumayer S, Hagl S, Gorenflo M. Veränderungen der exhalativen Stickstoffmonoxid (NO) Produktion in der Lunge bei experimentellem Links-Rechts-Shunt und akuter pulmonaler Hypertension. Z Geburtshilfe Neonatol 2005. [DOI: 10.1055/s-2005-871393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Herpel E, Singer S, Flechtenmacher C, Pritsch M, Sack FU, Hagl S, Katus HA, Haass M, Otto HF, Schnabel PA. Extracellular matrix proteins and matrix metalloproteinases differ between various right and left ventricular sites in end-stage cardiomyopathies. Virchows Arch 2005; 446:369-78. [PMID: 15806380 DOI: 10.1007/s00428-004-1177-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2004] [Accepted: 11/10/2004] [Indexed: 10/25/2022]
Abstract
This study was undertaken to investigate whether there might be differences in the distribution of extracellular matrix (ECM) proteins and matrix metalloproteinases (MMPs), depending on their specific sites within the heart. We investigated 33 explanted human hearts, 15 with dilated cardiomyopathy (DCM) and 18 with ischemic cardiomyopathy (ICM). Transmural samples from the right ventricle, the interventricular septum and the left ventricle, either from near the apex or from near the base were taken from every heart. Frozen sections were processed for connective tissue staining and immunohistochemistry for collagens type I, III, IV, laminin and fibronectin, as well as MMP-1, -2 and -9. Volume densities of laminin in ICM as well as of fibronectin and collagen types I and IV in DCM showed significant differences between right and left ventricular sites. The volume densities of matrix proteins usually did not reveal significant differences among the three left ventricular sites tested in both DCM and ICM. MMPs partly showed differences between the right and the left ventricular myocardium. These results suggest that the distributions of ECM proteins and MMPs differ between the two ventricles in both end-stage DCM and ICM. This gives rise to the hypothesis that a specific pattern of ECM degradation exists in the right and left ventricular myocardium.
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