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Barba-Lobo A, García-González B, Guerrero JL, Bolívar JP. Sedimentary environmental quality of a biosphere reserve estuary in southwestern Iberian Peninsula. Mar Pollut Bull 2024; 201:116225. [PMID: 38460435 DOI: 10.1016/j.marpolbul.2024.116225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 02/26/2024] [Accepted: 03/02/2024] [Indexed: 03/11/2024]
Abstract
The Huelva estuary is formed by the common mouths of the Odiel and Tinto Rivers, and inside this ecosystem is the biosphere reserve of the Odiel saltmarshes. This ecosystem has been historically affected by acid mine drainage (AMD) and by releases of pollutants from five phosphoric acid industrial plants and phosphogypsum (PG) waste stacks located in the area. This study carried out a comprehensive assessment of the environmental impact of the biosphere reserve of the Odiel saltmarshes. To this end, it was necessary to find a suitable sedimentary background (Piedras River in our case). To quantify this impact, several pollution indexes were used. According to the values reached by the indexes, this impact was classified as "serious" pollution for most trace elements, excepting the deepest layers, and "low-moderate" pollution for the 238U-series radionuclides, while no pollution for the 232Th-series and 40K radionuclides was found as expected.
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Affiliation(s)
- A Barba-Lobo
- Radiation Physics and Environment Group (FRYMA), Department of Integrated Sciences, Center for Natural Resources, Health and Environment (RENSMA), University of Huelva, 21007 Huelva, Spain; Department of Medical Radiation Sciences, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg SE-413 45, Sweden.
| | - B García-González
- Radiation Physics and Environment Group (FRYMA), Department of Integrated Sciences, Center for Natural Resources, Health and Environment (RENSMA), University of Huelva, 21007 Huelva, Spain
| | - J L Guerrero
- Radiation Physics and Environment Group (FRYMA), Department of Integrated Sciences, Center for Natural Resources, Health and Environment (RENSMA), University of Huelva, 21007 Huelva, Spain; Department of Biology and Geology, Physics and Inorganic Chemistry, Higher School of Experimental Sciences and Technology, Rey Juan Carlos University, c/Tulipán s/n, 28933 Móstoles, Spain
| | - J P Bolívar
- Radiation Physics and Environment Group (FRYMA), Department of Integrated Sciences, Center for Natural Resources, Health and Environment (RENSMA), University of Huelva, 21007 Huelva, Spain
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García-Montoto F, Paz-Martín D, Pestaña D, Soro M, Marcos Vidal JM, Badenes R, Suárez de la Rica A, Bardi T, Pérez-Carbonell A, García C, Cervantes JA, Martínez MP, Guerrero JL, Lorente JV, Veganzones J, Murcia M, Belda FJ. Guidelines for inhaled sedation in the ICU. Rev Esp Anestesiol Reanim (Engl Ed) 2024; 71:90-111. [PMID: 38309642 DOI: 10.1016/j.redare.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/29/2023] [Indexed: 02/05/2024]
Abstract
INTRODUCTION AND OBJECTIVES Sedation is used in intensive care units (ICU) to improve comfort and tolerance during mechanical ventilation, invasive interventions, and nursing care. In recent years, the use of inhalation anaesthetics for this purpose has increased. Our objective was to obtain and summarise the best evidence on inhaled sedation in adult patients in the ICU, and use this to help physicians choose the most appropriate approach in terms of the impact of sedation on clinical outcomes and the risk-benefit of the chosen strategy. METHODOLOGY Given the overall lack of literature and scientific evidence on various aspects of inhaled sedation in the ICU, we decided to use a Delphi method to achieve consensus among a group of 17 expert panellists. The processes was conducted over a 12-month period between 2022 and 2023, and followed the recommendations of the CREDES guidelines. RESULTS The results of the Delphi survey form the basis of these 39 recommendations - 23 with a strong consensus and 15 with a weak consensus. CONCLUSION The use of inhaled sedation in the ICU is a reliable and appropriate option in a wide variety of clinical scenarios. However, there are numerous aspects of the technique that require further study.
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Affiliation(s)
- F García-Montoto
- UCI de Anestesia, Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Cáceres, Cáceres, Spain.
| | - D Paz-Martín
- UCI, Departamento de Anestesia y Cuidados Intensivos, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - D Pestaña
- UCI de Anestesia, Servicio de Anestesiología y Reanimación, Hospital Universitario Ramon y Cajal, Madrid, Spain; Universidad de Alcalá de Henares, Alcalá de Henares, Madrid, Spain
| | - M Soro
- UCI, Servicio de Anestesiología y Cuidados Intensivos, Hospital IMED, Valencia, Spain
| | - J M Marcos Vidal
- Unidad de Reanimación, Servicio de Anestesiología y Reanimación, Complejo Asistencial Universitario de León, León, Spain
| | - R Badenes
- Departamento Cirugía, Facultad de Medicina, Universidad de Valencia, Valencia, Spain; UCI de Anestesia, Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Clínico Universitario de Valencia, Valencia, Spain; INCLIVA Instituto de Investigación Sanitaria, Valencia, Spain
| | - A Suárez de la Rica
- Unidad de Reanimación, Servicio de Anestesiología y Reanimación, Hospital Universitario de La Princesa, Madrid, Spain
| | - T Bardi
- UCI de Anestesia, Servicio de Anestesiología y Reanimación, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - A Pérez-Carbonell
- UCI Quirúrgica, Servicio de Anestesiología, UCI Quirúrgica y Unidad del Dolor, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - C García
- UCI Quirúrgica, Servicio de Anestesiología y Reanimación, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - J A Cervantes
- Unidad de Reanimación, Servicio de Anestesiología y Reanimación, Hospital Universitario Torrecárdenas, Almería, Spain
| | - M P Martínez
- Unidad de Reanimación, Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - J L Guerrero
- Unidad de Reanimación, Servicio de Anestesiología y Reanimación, Hospital Universitario Virgen de la Victoria, Málaga, Spain; Universidad de Málaga, Málaga, Spain; Instituto Biomédico de Málaga, Málaga, Spain
| | - J V Lorente
- Unidad de Reanimación, Servicio de Anestesiología y Reanimación, Hospital Juan Ramón Jiménez, Huelva, Spain
| | - J Veganzones
- Unidad de Reanimación, Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, Spain
| | - M Murcia
- UCI, Servicio de Anestesiología y Cuidados Intensivos, Hospital IMED, Valencia, Spain
| | - F J Belda
- Departamento Cirugía, Facultad de Medicina, Universidad de Valencia, Valencia, Spain
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Guerrero JL, Suárez-Vaz N, Paz-Gómez DC, Pérez-Moreno SM, Bolívar JP. Spatiotemporal evolution of U and Th isotopes in a mine effluent highly polluted by Acid Mine Drainage (AMD). J Hazard Mater 2023; 447:130782. [PMID: 36641853 DOI: 10.1016/j.jhazmat.2023.130782] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
The spatiotemporal evolution of both U and Th isotopes in a mine effluent highly polluted by acid mine drainage (AMD) was evaluated. The acidic tributary, which born from the outflows of an abandoned sulfide mine, flows into the Odiel River. AMD comprises an important source of natural radionuclides, presenting concentrations of 238U and 232Th, two and four orders of magnitude higher, respectively, than the background values of surface continental waters. These natural radionuclides behave conservatively along the mine effluent (pH < 2.5) throughout the hydrological year. Under AMD conditions uranium is in the hexavalent state U(VI) and the main dissolved species are uranyl sulfate complexes. The polluted tributary has a significant impact on the Odiel River acidifying its waters during the low flow season and increasing up to one order of magnitude the activity concentrations of U and Th isotopes. U presented a conservative behavior in the Odiel River during the low flow season (pH ≈ 3), however it is removed from the liquid phase in the wet season (pH ≈ 6), probably due its coprecipitation/adsorption onto Al-phases. Th shows a high sensitivity to small increases of pH, and it is strongly coprecipitated/adsorbed with or onto Fe-oxyhydroxydizes in the river.
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Affiliation(s)
- J L Guerrero
- Department of Integrated Sciences, Center on Natural Resources, Health and the Environment (RENSMA), University of Huelva, Campus El Carmen, 21071, Huelva, Spain; Department of Earth Sciences, Center on Natural Resources, Health and the Environment (RENSMA), University of Huelva, Campus El Carmen, 21071, Huelva, Spain.
| | - N Suárez-Vaz
- Department of Integrated Sciences, Center on Natural Resources, Health and the Environment (RENSMA), University of Huelva, Campus El Carmen, 21071, Huelva, Spain.
| | - D C Paz-Gómez
- Department of Integrated Sciences, Center on Natural Resources, Health and the Environment (RENSMA), University of Huelva, Campus El Carmen, 21071, Huelva, Spain.
| | - S M Pérez-Moreno
- Department of Integrated Sciences, Center on Natural Resources, Health and the Environment (RENSMA), University of Huelva, Campus El Carmen, 21071, Huelva, Spain.
| | - J P Bolívar
- Department of Integrated Sciences, Center on Natural Resources, Health and the Environment (RENSMA), University of Huelva, Campus El Carmen, 21071, Huelva, Spain.
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Nagata Y, Bertrand PB, Baliyan V, Kochav J, Kagan RD, Ujka K, Alfraidi H, van Kampen A, Morningstar JE, Dal-Bianco JP, Melnitchouk S, Holmvang G, Borger MA, Moore R, Hua L, Sultana R, Calle PV, Yum B, Guerrero JL, Neilan TG, Picard MH, Kim J, Delling FN, Hung J, Norris RA, Weinsaft JW, Levine RA. Abnormal Mechanics Relate to Myocardial Fibrosis and Ventricular Arrhythmias in Patients With Mitral Valve Prolapse. Circ Cardiovasc Imaging 2023; 16:e014963. [PMID: 37071717 PMCID: PMC10108844 DOI: 10.1161/circimaging.122.014963] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/08/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND The relation between ventricular arrhythmia and fibrosis in mitral valve prolapse (MVP) is reported, but underlying valve-induced mechanisms remain unknown. We evaluated the association between abnormal MVP-related mechanics and myocardial fibrosis, and their association with arrhythmia. METHODS We studied 113 patients with MVP with both echocardiogram and gadolinium cardiac magnetic resonance imaging for myocardial fibrosis. Two-dimensional and speckle-tracking echocardiography evaluated mitral regurgitation, superior leaflet and papillary muscle displacement with associated exaggerated basal myocardial systolic curling, and myocardial longitudinal strain. Follow-up assessed arrhythmic events (nonsustained or sustained ventricular tachycardia or ventricular fibrillation). RESULTS Myocardial fibrosis was observed in 43 patients with MVP, predominantly in the basal-midventricular inferior-lateral wall and papillary muscles. Patients with MVP with fibrosis had greater mitral regurgitation, prolapse, and superior papillary muscle displacement with basal curling and more impaired inferior-posterior basal strain than those without fibrosis (P<0.001). An abnormal strain pattern with distinct peaks pre-end-systole and post-end-systole in inferior-lateral wall was frequent in patients with fibrosis (81 versus 26%, P<0.001) but absent in patients without MVP with basal inferior-lateral wall fibrosis (n=20). During median follow-up of 1008 days, 36 of 87 patients with MVP with >6-month follow-up developed ventricular arrhythmias associated (univariable) with fibrosis, greater prolapse, mitral annular disjunction, and double-peak strain. In multivariable analysis, double-peak strain showed incremental risk of arrhythmia over fibrosis. CONCLUSIONS Basal inferior-posterior myocardial fibrosis in MVP is associated with abnormal MVP-related myocardial mechanics, which are potentially associated with ventricular arrhythmia. These associations suggest pathophysiological links between MVP-related mechanical abnormalities and myocardial fibrosis, which also may relate to ventricular arrhythmia and offer potential imaging markers of increased arrhythmic risk.
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Affiliation(s)
- Yasufumi Nagata
- Cardiac Ultrasound Laboratory (Y.N., P.B.B., H.A., J.P.D.-B., L.H., M.H.P., J.H., R.A.L.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Philippe B. Bertrand
- Cardiac Ultrasound Laboratory (Y.N., P.B.B., H.A., J.P.D.-B., L.H., M.H.P., J.H., R.A.L.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Vinit Baliyan
- Department of Radiology (V.B., G.H.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jonathan Kochav
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, NY (J. Kochav, R.D.K., R.S., P.V.C., B.Y., J. Kim, J.W.W.)
| | - Ruth D. Kagan
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, NY (J. Kochav, R.D.K., R.S., P.V.C., B.Y., J. Kim, J.W.W.)
| | - Kristian Ujka
- School of Cardiovascular Disease, University of Pisa, Italy (K.U.)
| | - Hassan Alfraidi
- Cardiac Ultrasound Laboratory (Y.N., P.B.B., H.A., J.P.D.-B., L.H., M.H.P., J.H., R.A.L.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Antonia van Kampen
- Cardiac Surgery (A.v.K., S.M.), Massachusetts General Hospital, Harvard Medical School, Boston
- University Department for Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Saxony, Germany (A.v.K., M.A.B.)
| | - Jordan E. Morningstar
- Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston (J.E.M., R.M., R.A.N.)
| | - Jacob P. Dal-Bianco
- Cardiac Ultrasound Laboratory (Y.N., P.B.B., H.A., J.P.D.-B., L.H., M.H.P., J.H., R.A.L.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Serguei Melnitchouk
- Cardiac Surgery (A.v.K., S.M.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Godtfred Holmvang
- Department of Radiology (V.B., G.H.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Michael A. Borger
- University Department for Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Saxony, Germany (A.v.K., M.A.B.)
| | - Reece Moore
- Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston (J.E.M., R.M., R.A.N.)
| | - Lanqi Hua
- Cardiac Ultrasound Laboratory (Y.N., P.B.B., H.A., J.P.D.-B., L.H., M.H.P., J.H., R.A.L.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Razia Sultana
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, NY (J. Kochav, R.D.K., R.S., P.V.C., B.Y., J. Kim, J.W.W.)
| | - Pablo Villar Calle
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, NY (J. Kochav, R.D.K., R.S., P.V.C., B.Y., J. Kim, J.W.W.)
| | - Brian Yum
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, NY (J. Kochav, R.D.K., R.S., P.V.C., B.Y., J. Kim, J.W.W.)
| | - J. Luis Guerrero
- Surgical Cardiovascular Laboratory (J.L.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Tomas G. Neilan
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (T.G.N.)
| | - Michael H. Picard
- Cardiac Ultrasound Laboratory (Y.N., P.B.B., H.A., J.P.D.-B., L.H., M.H.P., J.H., R.A.L.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jiwon Kim
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, NY (J. Kochav, R.D.K., R.S., P.V.C., B.Y., J. Kim, J.W.W.)
| | - Francesca N. Delling
- Division of Cardiovascular Medicine, University of California, San Francisco (F.N.D.)
| | - Judy Hung
- Cardiac Ultrasound Laboratory (Y.N., P.B.B., H.A., J.P.D.-B., L.H., M.H.P., J.H., R.A.L.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Russell A. Norris
- Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston (J.E.M., R.M., R.A.N.)
| | - Jonathan W. Weinsaft
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, NY (J. Kochav, R.D.K., R.S., P.V.C., B.Y., J. Kim, J.W.W.)
| | - Robert A. Levine
- Cardiac Ultrasound Laboratory (Y.N., P.B.B., H.A., J.P.D.-B., L.H., M.H.P., J.H., R.A.L.), Massachusetts General Hospital, Harvard Medical School, Boston
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Menchero JG, Lara Fernandez Y, Gila Bohorquez A, De La Herranz P, Guerrero JL, García Moreno J, Bellido Luque J, Morales Conde S. P-150 TRANSVERSUS ABDOMINIS RELEASE BY MINIMAL INVASIVE SURGERY. OUR EXPERIENCE IN A TERCIARY HOSPITAL. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
We present the experience in the transversus abdominis release (TAR) technique using a minimally invasive approach in our center.
Methods
We expose those W3 defects intervened by laparoscopic TAR(n=6). Step 1:
Releasing adhesions from previous surgeries. Step 2: Bilateral Rives space dissection, as well as the Rossen's space, this one using “down to up” technique. Step 3: Closure of the gap with barbed suture. In all cases, a PVDF mesh has been associated with atraumatic fixation, and 2 drains were placed.
Results
The mean age was 62, 100% men, and their BMI was greater than 25Kg/m2. All underwent scheduled surgery, using a minimally invasive approach, placing the mesh at the retromuscular level. Postoperative stay was 7.6 days. We did not obtain major complications (perforation, bleeding), but a drainage hole wound infection was registered. We had no readmissions or any medical complications.
Follow-up of 12 months, without signs of recurrence or chronic pain.
Conclusions
Although Robotic surgery and Botulinum toxin in surgery seems to be the future, in our experience TAR technique performed by laparoscopy is useful for large midline incisional hernias treatment as well as those associated with a lateral component in a terciary Hospital. We obtain good results in terms of recurrence and restoration of the abdominal wall dynamics. However, further studies are necessary to be carried out by experienced teams to reach conclusions.
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Affiliation(s)
| | | | | | | | - J L Guerrero
- Surgery, Hospital de Riotinto , Riotinto , Spain
| | | | - J Bellido Luque
- Surgery, Hospital Universitario Virgen Macarena , Sevilla , Spain
| | - S Morales Conde
- Surgery, Hospital Universitario Virgen del Rocio , Sevilla , Spain
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Gómez Menchero J, Guerrero JL, Lara Fernandez Y, Navarro L, De La Herranz P, Gila Bohorquez A, Garcia Moreno J, Morales Conde S. OC-066 LIRA TECHNIQUE, A NEW PROCEDURE. WHERE ARE WE NOW? OUR RESULTS IN A MEDIUM FOLLOW-UP. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
LIRA technique (Laparoscopic Intracorporeal Rectus Aponeuroplasty) was described in 2018 in order to reduce the tension in the midline as an alternative to defect closure (CD) in Laparoscopic Ventral Hernia Repair. We present our results in LIRA series in patients with a medium follow up
Methods
A prospective controlled study from January 2015 to December 2020 to evaluate (LIRA) performed on patients with midline w2 hernias (EHS Classification). Data analyzed included patient demographics, operative parameters and complications.
Tomography was performed preoperatively and postoperatively (1 month and 1 year) to evaluate recurrence, distance between rectus and seroma. Clinical examination were performed yearly.
Results
49 patients. Mean Age was 58± 10.59 years old and BMI 33.11± 6.61 kg/m2. Mean width of the defect was 6.19± 1.49 cm. Average VAS (24 h) was 5.09 ± 5, 0.38(1 month) and 0 (1 year). Mean preoperative distance between rectus was 5.55± 1.61 cm; postoperative was 2.15 ± 0.79 cm (1 month) and 2.20±0.68 cm (1 year). Radiological seroma at first month was detected in 40%. Seroma after 1 year was 4,08% Mean follow-up was 24 months. Bulging detected only in 1 case (2.04%) after 1 year follow up. No recurrence is data.
Conclusion
LIRA technique could be considered as an alternative to CD for w2 defects with a low rate of complication, and could be related to a low rate of postoperative pain with no recurrence and a low rate of bulging compared to CD, being a safe, feasible and reproducible technique.
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Affiliation(s)
| | - J L Guerrero
- Surgery, Hospital de Riotinto , Riotinto , Spain
| | | | - L Navarro
- Surgery, Hospital Quiron , Sevilla , Spain
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Gómez Menchero J, Gila Bohorquez A, De La Herranz P, Guerrero JL, Lara Fernandez Y, Bellido Luque J, Garcia Moreno J, Navarro L, Morales Conde S. V-043 NEW CONCEPTS IN LIRA TECHNIQUE IN LAPAROSCOPIC VENTRAL HERNIA REPAIR. LIRA -LESS STEP BY STEP. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
LIRA (Laparoscopic Intracorporeal Rectus Aponeuroplasty) described in 2018 by our group showed advantages in preliminary results in terms of recurrence and bulging because a reduced tension in the midline in W2 defects following the EHS Classification. Otherwise permanent fixation in inlay meshes is related with and increase of pain and adhesions. We present LIRA-LESS step to step as an evolution in LIRA technique.
Material and methods
A 58 years old male affected by a M3W2 hernia. A LIRA procedure is proposed.
Step 1: adhesions release and sac content reduced.
Step 2: defect measurement and flap designed following the LIRA Technique principles with the neumoperitoneum deflated and flap mobilized and suture in the midline.
Step 3 An in lay mesh of PVDF is positioned reducing permanent fixation in cardinal points combined with Cianocrilate in a 3:1 way.
Step 4 A TAP-block anesthesia is performed in this case with Ropivacaine 2%.
Results
Operative time was 95 min. VAS 1 day was 3 and was discharge without complications. VAS 7 day in clinical office was 0. There were not recurrence or Bulkging in CT -Scan 1 month after the surgery.
Discussion
LIRA technique is a safe procedure with a low tension in the midline with good reults in terms of recurrence and bulging. LIRA-LESS concept allows a reduction in traumatic permanent fixation with good results in terms of pain and recurrence.
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Affiliation(s)
| | | | | | - J L Guerrero
- Surgery, Hospital de Riotinto , Riotinto , Spain
| | | | - J Bellido Luque
- Surgery, Hospital Universitario Virgen Macarena , Sevilla , Spain
| | | | - L Navarro
- Surgery, Hospital Quiron Sevilla , Sevilla , Spain
| | - S Morales Conde
- Surgery, Hospital Universitario Virgen del Rocio , Sevilla , Spain
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8
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Alvandi Z, Nagata Y, Passos LSA, Hashemi Gheinani A, Guerrero JL, Wylie‐Sears J, Romero DC, Morris BA, Sullivan SM, Yaghoubian KM, Alvandi A, Adam RM, Aikawa E, Levine RA, Bischoff J. Wnt Site Signaling Inhibitor Secreted Frizzled‐Related Protein 3 Protects Mitral Valve Endothelium From Myocardial Infarction–Induced Endothelial‐to‐Mesenchymal Transition. J Am Heart Assoc 2022; 11:e023695. [PMID: 35348006 PMCID: PMC9075477 DOI: 10.1161/jaha.121.023695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
The onset and mechanisms of endothelial‐to‐mesenchymal transition (EndMT) in mitral valve (MV) leaflets following myocardial infarction (MI) are unknown, yet these events are closely linked to stiffening of leaflets and development of ischemic mitral regurgitation. We investigated whether circulating molecules present in plasma within days after MI incite EndMT in MV leaflets.
Methods and Results
We examined the onset of EndMT in MV leaflets from 9 sheep with inferior MI, 8 with sham surgery, and 6 naïve controls. Ovine MVs 8 to 10 days after inferior MI displayed EndMT, shown by increased vascular endothelial cadherin/α‐smooth muscle actin–positive cells. The effect of plasma on EndMT in MV endothelial cells (VECs) was assessed by quantitative polymerase chain reaction, migration assays, and immunofluorescence. In vitro, post‐MI plasma induced EndMT marker expression and enhanced migration of mitral VECs; sham plasma did not. Analysis of sham versus post‐MI plasma revealed a significant drop in the Wnt signaling antagonist sFRP3 (secreted frizzled‐related protein 3) in post‐MI plasma. Addition of recombinant sFRP3 to post‐MI plasma reversed its EndMT‐inducing effect on mitral VECs. RNA‐sequencing analysis of mitral VECs exposed to post‐MI plasma showed upregulated FOXM1 (forkhead box M1). Blocking FOXM1 reduced EndMT transcripts in mitral VECs treated with post‐MI plasma. Finally, FOXM1 induced by post‐MI plasma was downregulated by sFRP3.
Conclusions
Reduced sFRP3 in post‐MI plasma facilitates EndMT in mitral VECs by increasing the transcription factor FOXM1. Restoring sFRP3 levels or inhibiting FOXM1 soon after MI may provide a novel strategy to modulate EndMT in the MV to prevent ischemic mitral regurgitation and heart failure.
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Affiliation(s)
- Zahra Alvandi
- Vascular Biology Program Boston Children’s Hospital Boston MA
- Department of Surgery Harvard Medical School Boston MA
| | - Yasufumi Nagata
- Cardiac Ultrasound Laboratory Massachusetts General HospitalHarvard Medical School Boston MA
| | | | - Ali Hashemi Gheinani
- Department of Surgery Harvard Medical School Boston MA
- Broad Institute of MIT and Harvard Cambridge MA
- Department of Urology Boston Children’s Hospital Boston MA
| | - J. Luis Guerrero
- Cardiac Ultrasound Laboratory Massachusetts General HospitalHarvard Medical School Boston MA
| | | | - Dayana Carolina Romero
- Cardiac Ultrasound Laboratory Massachusetts General HospitalHarvard Medical School Boston MA
| | - Brittan A. Morris
- Cardiac Ultrasound Laboratory Massachusetts General HospitalHarvard Medical School Boston MA
| | - Suzanne M. Sullivan
- Cardiac Ultrasound Laboratory Massachusetts General HospitalHarvard Medical School Boston MA
| | - Koushiar M. Yaghoubian
- Cardiac Ultrasound Laboratory Massachusetts General HospitalHarvard Medical School Boston MA
| | - Amirhossein Alvandi
- Department of Mathematics and Statistics University of Massachusetts Amherst MA
| | - Rosalyn M. Adam
- Department of Surgery Harvard Medical School Boston MA
- Department of Urology Boston Children’s Hospital Boston MA
| | - Elena Aikawa
- Center for Excellence in Vascular Biology Brigham and Women’s Hospital Harvard Medical School Boston MA
- Center for Interdisciplinary Cardiovascular Sciences Cardiovascular MedicineBrigham and Women’s HospitalHarvard Medical School Boston MA
| | - Robert A. Levine
- Cardiac Ultrasound Laboratory Massachusetts General HospitalHarvard Medical School Boston MA
| | - Joyce Bischoff
- Vascular Biology Program Boston Children’s Hospital Boston MA
- Department of Surgery Harvard Medical School Boston MA
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9
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Gutiérrez-Álvarez I, Guerrero JL, Martín JE, Adame JA, Vargas A, Bolívar JP. Radon transport events associated with the impact of a NORM repository in the SW of Europe. Environ Pollut 2021; 289:117963. [PMID: 34426198 DOI: 10.1016/j.envpol.2021.117963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/19/2021] [Accepted: 08/11/2021] [Indexed: 06/13/2023]
Abstract
Two radon measurement stations located to the north and south of a NORM (Naturally Occurring Radioactive Materials) repository of phosphogypsum (southwest of Europe) were used to monitor radon behavior during 2018. The stations are located at opposing sides of the repository, one in Huelva City to the north and other one in a rural area to the south. This setup aimed to identify the influence of the NORM repository on each station and use radon levels as a marker of atmospheric transport in the local area. To achieve this, a comparison was carried out with other coastal stations in the south of Spain, finding higher average concentrations in Huelva City, ~3.3 Bq m-3. Hierarchical clustering was applied to identify days with different radon patterns at each Huelva station, detecting possible local radon transport events from the repository. Three events were investigated with WRF (Weather Research and Forecasting) and FLEXPART-WRF (FLEXible PARTicle dispersion model). It was found that both sampling sites required atmospheric stagnant conditions to reach high radon concentration. However, under these conditions the urban station showed high radon regardless of wind direction while the rural station also required radon transport from the repository, either directly or indirectly.
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Affiliation(s)
- I Gutiérrez-Álvarez
- Integrated Sciencies Department, University of Huelva, Spain; Research Centre of Natural Resources, Health and the Environment (RENSMA), University of Huelva, Huelva, Spain.
| | - J L Guerrero
- Integrated Sciencies Department, University of Huelva, Spain; Research Centre of Natural Resources, Health and the Environment (RENSMA), University of Huelva, Huelva, Spain
| | - J E Martín
- Integrated Sciencies Department, University of Huelva, Spain; Research Centre of Natural Resources, Health and the Environment (RENSMA), University of Huelva, Huelva, Spain
| | - J A Adame
- Atmospheric Sounding Station - El Arenosillo, Atmospheric Research and Instrumentation Branch. National Institute for Aerospace Technology, INTA, Mazagón, Huelva, Spain
| | - A Vargas
- Institute of Energy Technologies, Technical University of Catalonia, Spain
| | - J P Bolívar
- Integrated Sciencies Department, University of Huelva, Spain; Research Centre of Natural Resources, Health and the Environment (RENSMA), University of Huelva, Huelva, Spain
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10
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Paz-Gómez DC, Pérez-Moreno SM, Gázquez MJ, Guerrero JL, Ruiz-Oria I, Ríos G, Bolívar JP. Arsenic removal procedure for the electrolyte from a hydro-pyrometallurgical complex. Chemosphere 2021; 281:130651. [PMID: 34010721 DOI: 10.1016/j.chemosphere.2021.130651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/07/2021] [Accepted: 04/21/2021] [Indexed: 06/12/2023]
Abstract
Commercial copper (Cu) is obtained by a hydro-pyrometallurgical process, where the Cu anodes obtained in the furnaces (Cu > 99.5%) are enriched up to 99.99% in "cathodes" by electrorefining at an electrolysis plant. During this process, some impurities accumulate in the electrolyte, mainly arsenic (As), which decrease the quality of the Cu cathode. For this reason, the electrolyte is sent to an electrolyte cleaning plant (ECP) for its purification. Electrolyte sludge (ES) is produced in the last stage of purification and is recirculated back to the furnace due to the high Cu content. This recirculation involves a severe problem of As accumulation in the industrial process. The objective of this work was to develop a procedure to fully dissolve the ES, removing the As and recovering its Cu content. The ES dissolution process was optimised (dissolution efficiency > 99%) in H2SO4 (1.4 M)/HNO3 (1.8 M) medium using a 1:20 g mL-1 solid-to-liquid ratio. As was removed from the ES solution by its precipitation as iron (III) arsenate, with high efficiency (more than 70%). After As removal, the Cu can be precipitated as copper sulphate, which is used in several applications.
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Affiliation(s)
- D C Paz-Gómez
- Department of Integrated Sciences, Research Centre on Natural Resources, Health and the Environment (RENSMA), University of Huelva, 21007, Huelva, Spain
| | - S M Pérez-Moreno
- Department of Integrated Sciences, Research Centre on Natural Resources, Health and the Environment (RENSMA), University of Huelva, 21007, Huelva, Spain
| | - M J Gázquez
- Department of Applied Physics, Marine Research Institute (INMAR), University of Cadiz, 11510, Cádiz, Spain.
| | - J L Guerrero
- Department of Integrated Sciences, Research Centre on Natural Resources, Health and the Environment (RENSMA), University of Huelva, 21007, Huelva, Spain
| | - I Ruiz-Oria
- Atlantic Copper S.L.U., 21001, Huelva, Spain
| | - G Ríos
- Atlantic Copper S.L.U., 21001, Huelva, Spain
| | - J P Bolívar
- Department of Integrated Sciences, Research Centre on Natural Resources, Health and the Environment (RENSMA), University of Huelva, 21007, Huelva, Spain
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11
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Hajjarian Z, Toussaint JD, Guerrero JL, Nadkarni SK. In-vivo mechanical characterization of coronary atherosclerotic plaques in living swine using intravascular laser speckle imaging. Biomed Opt Express 2021; 12:2064-2078. [PMID: 33996217 PMCID: PMC8086462 DOI: 10.1364/boe.418939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/07/2021] [Accepted: 02/09/2021] [Indexed: 05/13/2023]
Abstract
The ability to evaluate the viscoelastic properties of coronary arteries is crucial for identifying mechanically unstable atherosclerotic plaques. Here, we demonstrate for the first time in living swine, the capability of intravascular laser speckle imaging (ILSI) to measure an index of coronary plaque viscoelasticity, τ, using a human coronary to swine xenograft model. Cardiac motion effects are evaluated by comparing the EKG-non-gated τ ¯ N G , and EKG-gated τ ¯ G among different plaque types. Results show that both τ ¯ N G and τ ¯ G are significantly lower in necrotic-core plaques compared with stable lesions. Discrete-point pullback measurements demonstrate the capability of ILSI for rapid mechanical characterization of coronary segments under physiological conditions, in-vivo.
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Affiliation(s)
- Zeinab Hajjarian
- Wellman Center for Photomedicine, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA
- Authors contributed equally to the manuscript
| | - Jimmy D. Toussaint
- Wellman Center for Photomedicine, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA
- Authors contributed equally to the manuscript
| | - J. Luis Guerrero
- Surgical Cardiovascular Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Seemantini K. Nadkarni
- Wellman Center for Photomedicine, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA
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12
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Guerrero JL, Pérez-Moreno SM, Gutiérrez-Álvarez I, Gázquez MJ, Bolívar JP. Behaviour of heavy metals and natural radionuclides in the mixing of phosphogypsum leachates with seawater. Environ Pollut 2021; 268:115843. [PMID: 33143977 DOI: 10.1016/j.envpol.2020.115843] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/30/2020] [Accepted: 10/11/2020] [Indexed: 06/11/2023]
Abstract
Phosphogypsum (PG) is disposed worldwide in large stacks usually placed in coastal zones, as in the case of Huelva (SW of Spain), where around 100 Mt of PG are stored on the salt marshes of the Tinto River estuary covering a surface of about 1000 ha. This management generates the weathering of PG, and due to its high acidity (pH ≈ 2) and pollutant load can provoke significant emissions into their surroundings. In this work were evaluated by laboratory experiments the effects of pH increase in the behaviour of heavy metals and natural radionuclides during the mixing of phosphogypsum leachates with seawater. The acidic phosphogypsum leachates showed concentrations of heavy metals from two to three orders of magnitude higher than natural continental waters, and natural radionuclides (U-isotopes and 210Po) from four to five orders of magnitude higher than unperturbed aquatic systems. Major elements and some heavy metals as Mn, Ni, Cd, As, Sb and Co showed a conservative behaviour during the neutralisation of the leachates with seawater, remaining in the liquid phase, while other ones as Al, Fe, Cr, Zn, Cu, Pb precipitated and/or were adsorbed onto the solid phase. The U-isotopes and 210Po showed a clear non-conservative behaviour probably due to coprecipitation/adsorption processes onto the formed precipitates, but while 210Po reached a total removal at pH ≈ 7, U- isotopes after a total removal at pH ≈ 5 returned into the liquid phase due to redissolution/desorption processes at near neutral pH. The formed precipitates, mainly composed by iron phosphates particles, showed heavy metal and natural radionuclide concentrations from one to three orders of magnitude higher than unperturbed soils. All these facts demonstrate the serious environmental impact produced by the PG stacks into their surroundings and the urgency of effective restoration measures.
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Affiliation(s)
- J L Guerrero
- Department of Integrated Sciences, Center for Natural Resources, Health and Environment (RENSMA), University of Huelva, 21071, Huelva, Spain.
| | - S M Pérez-Moreno
- Department of Integrated Sciences, Center for Natural Resources, Health and Environment (RENSMA), University of Huelva, 21071, Huelva, Spain.
| | - I Gutiérrez-Álvarez
- Department of Integrated Sciences, Center for Natural Resources, Health and Environment (RENSMA), University of Huelva, 21071, Huelva, Spain.
| | - M J Gázquez
- Department of Applied Physics, University of Cadiz, University Marine Research Institute (INMAR), 11510, Cádiz, Spain.
| | - J P Bolívar
- Department of Integrated Sciences, Center for Natural Resources, Health and Environment (RENSMA), University of Huelva, 21071, Huelva, Spain.
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13
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Marsit O, Clavel MA, Côté-Laroche C, Hadjadj S, Bouchard MA, Handschumacher MD, Clisson M, Drolet MC, Boulanger MC, Kim DH, Guerrero JL, Bartko PE, Couet J, Arsenault M, Mathieu P, Pibarot P, Aïkawa E, Bischoff J, Levine RA, Beaudoin J. Attenuated Mitral Leaflet Enlargement Contributes to Functional Mitral Regurgitation After Myocardial Infarction. J Am Coll Cardiol 2020; 75:395-405. [PMID: 32000951 DOI: 10.1016/j.jacc.2019.11.039] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/08/2019] [Accepted: 11/13/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Mitral leaflet enlargement has been identified as an adaptive mechanism to prevent mitral regurgitation in dilated left ventricles (LVs) caused by chronic aortic regurgitation (AR). This enlargement is deficient in patients with functional mitral regurgitation, which remains frequent in the population with ischemic cardiomyopathy. Maladaptive fibrotic changes have been identified in post-myocardial infarction (MI) mitral valves. It is unknown if these changes can interfere with valve growth and whether they are present in other valves. OBJECTIVES This study sought to test the hypothesis that MI impairs leaflet growth, seen in AR, and induces fibrotic changes in mitral and tricuspid valves. METHODS Sheep models of AR, AR + MI, and controls were followed for 90 days. Cardiac magnetic resonance, echocardiography, and computed tomography were performed at baseline and 90 days to assess LV volume, LV function, mitral regurgitation and mitral leaflet size. Histopathology and molecular analyses were performed in excised valves. RESULTS Both experimental groups developed similar LV dilatation and dysfunction. At 90 days, mitral valve leaflet size was smaller in the AR + MI group (12.8 ± 1.3 cm2 vs. 15.1 ± 1.6 cm2, p = 0.03). Mitral regurgitant fraction was 4% ± 7% in the AR group versus 19% ± 10% in the AR + MI group (p = 0.02). AR + MI leaflets were thicker compared with AR and control valves. Increased expression of extracellular matrix remodeling genes was found in both the mitral and tricuspid leaflets in the AR + MI group. CONCLUSIONS In these animal models of AR, the presence of MI was associated with impaired adaptive valve growth and more functional mitral regurgitation, despite similar LV size and function. More pronounced extracellular remodeling was observed in mitral and tricuspid leaflets, suggesting systemic valvular remodeling after MI.
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Affiliation(s)
- Ons Marsit
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Quebec, Canada
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Quebec, Canada
| | - Claudia Côté-Laroche
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Quebec, Canada
| | - Sandra Hadjadj
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Quebec, Canada
| | - Marc-André Bouchard
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Quebec, Canada
| | - Mark D Handschumacher
- Center for Excellence in Vascular Biology, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marine Clisson
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Quebec, Canada
| | - Marie-Claude Drolet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Quebec, Canada
| | - Marie-Chloé Boulanger
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Quebec, Canada
| | - Dae-Hee Kim
- Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - J Luis Guerrero
- Cardiac Ultrasound Lab, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Philipp Emanuel Bartko
- Cardiac Ultrasound Lab, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jacques Couet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Quebec, Canada
| | - Marie Arsenault
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Quebec, Canada
| | - Patrick Mathieu
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Quebec, Canada
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Quebec, Canada
| | - Elena Aïkawa
- Cardiac Ultrasound Lab, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joyce Bischoff
- Vascular Biology Program and Department of Surgery, Boston Children's Hospital and Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Robert A Levine
- Cardiac Ultrasound Lab, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jonathan Beaudoin
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Quebec, Canada.
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14
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Guerrero JL, Pérez-Moreno SM, Mosqueda F, Gázquez MJ, Bolívar JP. Radiological and physico-chemical characterization of materials from phosphoric acid production plant to assess the workers radiological risks. Chemosphere 2020; 253:126682. [PMID: 32283426 DOI: 10.1016/j.chemosphere.2020.126682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 03/29/2020] [Accepted: 03/31/2020] [Indexed: 06/11/2023]
Abstract
The industry devoted to the production of phosphoric acid by using as raw material sedimentary phosphate rock (PR) is considered as a NORM activity (Naturally Occurring Radioactive Materials), due to the high levels of U-series radionuclides contained in this ore, which are 1-2 orders of magnitude higher than those in unperturbed soils. This fact allowed us to develop a deep characterization of the raw materials, wastes, main intermediate materials, and final products obtained at a typical phosphoric acid factory. The elemental composition (major, minor and trace elements), radionuclide concentrations, grain size distribution, mineralogy and micro-structural composition were analyzed. The aim of this characterization was to obtain information for operators and maintenance personnel involved in clean-up and waste management operations. The highest concentrations of some heavy metals and radionuclide activity concentrations were found in the "scales" (or internal incrustations)from the pipes that carry either phosphoric acid (PA) or the phosphogypsum waste (PG). The highest concentrations where found for 226Ra and 40K,with values up to 9 and 5 Bq g-1, respectively. In addition, high concentrations of many toxic heavy metals and trace elements, such as Cd, Cr, Ni, Sr, Y, V, Zn, Th, and U, were found in some sludge samples. The shielding effect of the containers/vessels/pipes has an essential role in the measured external dose in the intermediate products. The radiological implications of natural radionuclides with higher activity showed that if the maximum particulate matter concentration established in the Spanish regulation is verified, and taking into account the most conservative scenario, the annual limit of 1 mSv y-1 is not exceeded.
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Affiliation(s)
- J L Guerrero
- Department of Integrated Sciences, Center for Natural Resources, Health and Environment (RENSMA), University of Huelva, 21071, Huelva, Spain
| | - S M Pérez-Moreno
- Department of Integrated Sciences, Center for Natural Resources, Health and Environment (RENSMA), University of Huelva, 21071, Huelva, Spain
| | - F Mosqueda
- Department of Integrated Sciences, Center for Natural Resources, Health and Environment (RENSMA), University of Huelva, 21071, Huelva, Spain
| | - M J Gázquez
- Department of Applied Physics, University of Cadiz, University Marine Research Institute (INMAR), Cadiz, 11510, Spain.
| | - J P Bolívar
- Department of Integrated Sciences, Center for Natural Resources, Health and Environment (RENSMA), University of Huelva, 21071, Huelva, Spain
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15
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Gutiérrez-Álvarez I, Guerrero JL, Martín JE, Adame JA, Bolívar JP. Influence of the accumulation chamber insertion depth to measure surface radon exhalation rates. J Hazard Mater 2020; 393:122344. [PMID: 32126424 DOI: 10.1016/j.jhazmat.2020.122344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/05/2020] [Accepted: 02/16/2020] [Indexed: 06/10/2023]
Abstract
A common method to measure radon exhalation rates relies on the accumulation chamber technique. Usually, this approach only considers one-dimensional gas transport within the soil that neglects lateral diffusion. However, this lateral transport could reduce the reliability of the method. In this work, several cylindrical-shaped accumulation chambers were built with different heights to test if the insertion depth of the chamber into the soil improves the reliability of the method and, in that case, if it could limit the radon lateral diffusion effects. To check this hypothesis in laboratory, two reference exhalation boxes were manufactured using phosphogypsum from a repository located nearby the city of Huelva, in the southwest of Spain. Laboratory experiments showed that insertion depth had a deep impact in reducing the effective decay constant of the system, extending the interval where the linear fitting can be applied, and consistently obtaining reliable exhalation measurements once a minimum insertion depth is employed. Field experiments carried out in the phosphogypsum repository showed that increasing the insertion depth could reduce the influence of external effects, increasing the repeatability of the method. These experiments provided a method to obtain consistent radon exhalation measurements over the phosphogypsum repository.
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Affiliation(s)
- I Gutiérrez-Álvarez
- Integrated Sciences Department, Research Centre of Natural Resources, Health and the Environment (RENSMA), University of Huelva, Huelva, Spain.
| | - J L Guerrero
- Integrated Sciences Department, Research Centre of Natural Resources, Health and the Environment (RENSMA), University of Huelva, Huelva, Spain
| | - J E Martín
- Integrated Sciences Department, Research Centre of Natural Resources, Health and the Environment (RENSMA), University of Huelva, Huelva, Spain
| | - J A Adame
- Atmospheric Sounding Station - El Arenosillo, Atmospheric Research and Instrumentation Branch, National Institute for Aerospace Technology. INTA, Mazagón-Huelva, Spain
| | - J P Bolívar
- Integrated Sciences Department, Research Centre of Natural Resources, Health and the Environment (RENSMA), University of Huelva, Huelva, Spain
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16
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Guehl NJ, Pelletier-Galarneau M, Wooten DW, Guerrero JL, Kas A, Normandin MD, Fakhri GE, Alpert NM. Preclinical Validation of a Single-Scan Rest/Stress Imaging Technique for 13N-Ammonia Positron Emission Tomography Cardiac Perfusion Studies. Circ Cardiovasc Imaging 2020; 13:e009407. [PMID: 31959009 DOI: 10.1161/circimaging.119.009407] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We previously proposed a technique for quantitative measurement of rest and stress absolute myocardial blood flow (MBF) using a 2-injection single-scan imaging session. Recently, we validated the method in a pig model for the long-lived radiotracer 18F-Flurpiridaz with adenosine as a pharmacological stressor. The aim of the present work is to validate our technique for 13NH3. METHODS Nine studies were performed in 6 pigs; 5 studies were done in the native state and 4 after infarction of the left anterior descending artery. Each study consisted of 3 dynamic scans: a 2-injection rest-rest single-scan acquisition (scan A), a 2-injection rest/stress single-scan acquisition (scan B), and a conventional 1-injection stress acquisition (scan C). Variable doses of adenosine combined with dobutamine were administered to induce a wide range of MBF. The 2-injection single-scan measurements were fitted with our nonstationary kinetic model (MGH2). In 4 studies, 13NH3 injections were paired with microsphere injections. MBF estimates obtained with our method were compared with those obtained with the standard method and with microspheres. We used a model-based method to generate separate rest and stress perfusion images. RESULTS In the absence of stress (scan A), the MBF values estimated by MGH2 were nearly the same for the 2-radiotracer injections (mean difference: 0.067±0.070 mL·min-1·cc-1, limits of agreement: [-0.070 to 0.204] mL·min-1·cc-1), showing good repeatability. Bland-Altman analyses demonstrated very good agreement with the conventional method for both rest (mean difference: -0.034±0.035 mL·min-1·cc-1, limits of agreement: [-0.103 to 0.035] mL·min-1·cc-1) and stress (mean difference: 0.057±0.361 mL·min-1·cc-1, limits of agreement: [-0.651 to 0.765] mL·min-1·cc-1) MBF measurements. Positron emission tomography and microsphere MBF measurements correlated closely. Very good quality perfusion images were obtained. CONCLUSIONS This study provides in vivo validation of our single-scan rest-stress method for 13NH3 measurements. The 13NH3 rest/stress myocardial perfusion imaging procedure can be compressed into a single positron emission tomography scan session lasting less than 15 minutes.
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Affiliation(s)
- Nicolas J Guehl
- Department of Radiology, Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston (N.J.G., M.P.-G., D.W.W., J.L.G., M.D.N., G.E.F., N.M.A.)
| | - Matthieu Pelletier-Galarneau
- Department of Radiology, Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston (N.J.G., M.P.-G., D.W.W., J.L.G., M.D.N., G.E.F., N.M.A.).,Department of Radiology and Nuclear Medicine, Montreal Heart Institute, Québec, CA (M.P.-G.)
| | - Dustin W Wooten
- Department of Radiology, Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston (N.J.G., M.P.-G., D.W.W., J.L.G., M.D.N., G.E.F., N.M.A.)
| | - J Luis Guerrero
- Department of Radiology, Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston (N.J.G., M.P.-G., D.W.W., J.L.G., M.D.N., G.E.F., N.M.A.)
| | - Aurélie Kas
- AP-HP, Department of Nuclear Medicine, Pitié-Salpêtrière Hospital, Sorbonne University, UPMC Paris 06, CNRS UMR 7371, INSERM U1146, France (A.K.)
| | - Marc D Normandin
- Department of Radiology, Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston (N.J.G., M.P.-G., D.W.W., J.L.G., M.D.N., G.E.F., N.M.A.)
| | - Georges El Fakhri
- Department of Radiology, Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston (N.J.G., M.P.-G., D.W.W., J.L.G., M.D.N., G.E.F., N.M.A.)
| | - Nathaniel M Alpert
- Department of Radiology, Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston (N.J.G., M.P.-G., D.W.W., J.L.G., M.D.N., G.E.F., N.M.A.)
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17
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Collen D, Stassen JM, Yasuda T, Refino C, Paoni N, Keyt B, Roskams T, Guerrero JL, Lijnen HR, Gold HK, Bennett WF. Comparative Thrombolytic Properties of Tissue-Type Plasminogen Activator and of a Plasminogen Activator Inhibitor-1 -Resistant Glycosylation Variant, in a Combined Arterial and Venous Thrombosis Model in the Dog. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1648819] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Summaryrt-PA-K, a variant of recombinant tissue-type plasminogen activator (rt-PA) with substitution of amino acids 296 to 299 with alanine (KHRR296-299AAAA) has increased fibrin-specificity and reduced sensitivity to plasminogen activator inhibitor-1; rt-PA-T, with threonine 103 replaced by asparagine has an additional glycosylation site and a reduced clearance; and rt-PA-N, with asparagine 117 mutagen-ized to glutamine lacks the high mannose carbohydrate side chain. We have investigated whether combination of these properties in a single molecule might yield an improved thrombolytic agent.The thrombolytic potency and fibrin-specificity of the combination mutant rt-PA-TNK was compared with that of rt-PA in a combined venous whole blood clot model and platelet-rich arterial eversion graft thrombosis model in dogs given intravenous heparin and aspirin. Infusion of 0.125 to 1.0 mg/kg over 60 min in groups of 4 to 5 dogs produced dose-dependent fibrin-specific venous clot lysis. The thrombolytic potency (percent lysis per mg compound administered per kg body weight) of rt-PA-TNK was significantly higher than that of rt-PA as evidenced by a higher maximal rate of lysis of 480 ± 100% versus 140 ± 40% within the 2 h observation period per mg of compound administered per kg body weight (mean ± SEM, p = 0.004) and a significantly lower dose of 0.08 ± 0.01 versus 0.21 ± 0.04 mg/kg body weight at which the maximal rate of lysis was obtained (p = 0.004). This higher thrombolytic potency was the result of a significantly reduced clearance (240 ± 32 versus 540 ± 49 ml/min, p = 0.002) and a similar specific thrombolytic activity (percent lysis per |ig/ml plasma antigen level). Arterial reflow was obtained with 1 mg/kg rt-PA and with 0.5 mg/kg rt-PA-TNK, but with each agent recanalization was consistently associated with cyclic reocclusion and reflow. The frequency of arterial recanalization was somewhat higher with rt-PA-TNK (10/12) than with rt-PA (4/12) (p = 0.07) but the total patency times during a 2 h observation period were similar.
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Affiliation(s)
- Désiré Collen
- The Center for Molecular and Vascular Biology, University of Leuven, Belgium
| | - Jean-Marie Stassen
- The Center for Molecular and Vascular Biology, University of Leuven, Belgium
| | - Tsunehiro Yasuda
- Division of Cardiology, Massachusetts General Hospital Harvard Medical School, Boston, MA, USA
| | - Canio Refino
- Department of Cardiovascular Pharmacology, Genentech Inc, South San Francisco, CA, USA
| | - Nicholas Paoni
- Department of Cardiovascular Pharmacology, Genentech Inc, South San Francisco, CA, USA
| | - Bruce Keyt
- Department of Cardiovascular Pharmacology, Genentech Inc, South San Francisco, CA, USA
| | - Tania Roskams
- Department of Pathology, University of Leuven, Belgium
| | - J Luis Guerrero
- Division of Cardiology, Massachusetts General Hospital Harvard Medical School, Boston, MA, USA
| | - Henri R Lijnen
- The Center for Molecular and Vascular Biology, University of Leuven, Belgium
| | - Herman K Gold
- Division of Cardiology, Massachusetts General Hospital Harvard Medical School, Boston, MA, USA
| | - William F Bennett
- Department of Cardiovascular Pharmacology, Genentech Inc, South San Francisco, CA, USA
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Calfon Press MA, Mallas G, Rosenthal A, Hara T, Mauskapf A, Nudelman RN, Sheehy A, Polyakov IV, Kolodgie F, Virmani R, Guerrero JL, Ntziachristos V, Jaffer FA. Everolimus-eluting stents stabilize plaque inflammation in vivo: assessment by intravascular fluorescence molecular imaging. Eur Heart J Cardiovasc Imaging 2018; 18:510-518. [PMID: 28039209 DOI: 10.1093/ehjci/jew228] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 10/02/2016] [Indexed: 01/27/2023] Open
Abstract
Aims Inflammation drives atherosclerosis complications and is a promising therapeutic target for plaque stabilization. At present, it is unknown whether local stenting approaches can stabilize plaque inflammation in vivo. Here, we investigate whether everolimus-eluting stents (EES) can locally suppress plaque inflammatory protease activity in vivo using intravascular near-infrared fluorescence (NIRF) molecular imaging. Methods and results Balloon-injured, hyperlipidaemic rabbits with atherosclerosis received non-overlapping EES and bare metal stents (BMS) placement into the infrarenal aorta (n = 7 EES, n = 7 BMS, 3.5 mm diameter x 12 mm length). Four weeks later, rabbits received an injection of the cysteine protease-activatable NIRF imaging agent Prosense VM110. Twenty-four hours later, co-registered intravascular 2D NIRF, X-ray angiography and intravascular ultrasound imaging were performed. In vivo EES-stented plaques contained substantially reduced NIRF inflammatory protease activity compared with untreated plaques and BMS-stented plaques (P = 0.006). Ex vivo macroscopic NIRF imaging of plaque protease activity corroborated the in vivo results (P = 0.003). Histopathology analyses revealed that EES-treated plaques showed reduced neointimal and medial arterial macrophage and cathepsin B expression compared with unstented and BMS-treated plaques. Conclusions EES-stenting stabilizes plaque inflammation as assessed by translational intravascular NIRF molecular imaging in vivo. These data further support that EES may provide a local approach for stabilizing inflamed plaques.
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Affiliation(s)
- Marcella A Calfon Press
- Cardiology Division, Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Simches Research Building Room 3206, 185 Cambridge Street, Boston, MA 02114, USA.,Department of Cardiology, Ronald Reagan Medical Center, University of California in Los Angeles, Los Angeles CA, USA
| | - Georgios Mallas
- Cardiology Division, Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Simches Research Building Room 3206, 185 Cambridge Street, Boston, MA 02114, USA.,Department of Electrical and Computer Engineering, Northeastern University, Boston, MA, USA
| | - Amir Rosenthal
- Cardiology Division, Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Simches Research Building Room 3206, 185 Cambridge Street, Boston, MA 02114, USA.,Institute for Biological and Medical Imaging (IBMI), Helmholtz Center Munich & Technical University of Munich, Munich, Germany
| | - Tetsuya Hara
- Cardiology Division, Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Simches Research Building Room 3206, 185 Cambridge Street, Boston, MA 02114, USA
| | - Adam Mauskapf
- Cardiology Division, Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Simches Research Building Room 3206, 185 Cambridge Street, Boston, MA 02114, USA
| | - R Nika Nudelman
- Institute for Biological and Medical Imaging (IBMI), Helmholtz Center Munich & Technical University of Munich, Munich, Germany
| | | | | | | | | | - J Luis Guerrero
- Cardiology Division, Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Simches Research Building Room 3206, 185 Cambridge Street, Boston, MA 02114, USA
| | - Vasilis Ntziachristos
- Institute for Biological and Medical Imaging (IBMI), Helmholtz Center Munich & Technical University of Munich, Munich, Germany
| | - Farouc A Jaffer
- Cardiology Division, Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Simches Research Building Room 3206, 185 Cambridge Street, Boston, MA 02114, USA.,Center for Molecular Imaging Research, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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19
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Abstract
Ischemic mitral regurgitation (IMR) is a common complication of ischemic heart disease that doubles mortality after myocardial infarction and is a major driving factor increasing heart failure. IMR is caused by left ventricular (LV) remodeling which displaces the papillary muscles that tether the mitral valve leaflets and restrict their closure. IMR frequently recurs even after surgical treatment. Failed repair associates with lack of reduction or increase in LV remodeling, and increased heart failure and related readmissions. Understanding mechanistic and molecular mechanisms of IMR has largely attributed to the development of large animal models. Newly developed therapeutic interventions targeted to the primary causes can also be tested in these models. The sheep is one of the most suitable models for the development of IMR. In this chapter, we describe the protocols for inducing IMR in sheep using surgical ligation of obtuse marginal branches. After successful posterior myocardial infarction involving posterior papillary muscle, animals develop significant mitral regurgitation around 2 months after the surgery.
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Affiliation(s)
- Dae-Hee Kim
- Cardiac Imaging Center, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
- Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brittan Morris
- Surgical Cardiovascular Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - J Luis Guerrero
- Surgical Cardiovascular Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Suzanne M Sullivan
- Surgical Cardiovascular Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Judy Hung
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert A Levine
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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20
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Beaudoin J, Dal-Bianco JP, Aikawa E, Bischoff J, Guerrero JL, Sullivan S, Bartko PE, Handschumacher MD, Kim DH, Wylie-Sears J, Aaron J, Levine RA. Mitral Leaflet Changes Following Myocardial Infarction: Clinical Evidence for Maladaptive Valvular Remodeling. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006512. [PMID: 29042413 DOI: 10.1161/circimaging.117.006512] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 09/06/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ischemic mitral regurgitation (MR) is classically ascribed to functional restriction of normal leaflets, but recent studies have suggested post-myocardial infarction (MI) mitral valve (MV) leaflet fibrosis and thickening, challenging valve normality. Progression of leaflet thickness post-MI has not been studied. We hypothesized that excessive MV remodeling post-MI contributes to MR. Our objectives are to characterize MV changes after MI and relate them to MR. METHODS AND RESULTS Three groups of 40 patients with serial echocardiograms over a mean of 23.4 months were identified from an echocardiography database: patients first studied early (6±12 days) and late (12±7 years) after an inferior MI and normal controls. MV thickness was correlated with MR. We studied the mechanisms for MV changes in a sheep model (6 apical MI versus 6 controls) followed for 8 weeks, with MV cellular and histopathologic analyses. Early post-MI, leaflet thickness was found to be similar to controls (2.6±0.5 vs 2.5±0.4 mm; P=0.23) but significantly increased over time (2.5±0.4 to 2.9±0.4 mm; P<0.01). In this group, patients tolerating maximal doses of renin-angiotensin blocking agents had less thickening (25% of patients; P<0.01). The late-MI group had increased thickness (3.2±0.5 vs 2.5±0.4 mm; P<0.01) without progression. At follow-up, 48% of post-MI patients had more than mild MR. Increased thickness was independently associated with MR. Experimentally, 8 weeks post-MI, MVs were 2-fold thicker than controls, with increased collagen, profibrotic transforming growth factor-β, and endothelial-to-mesenchymal transformation, confirmed by flow cytometry. CONCLUSIONS MV thickness increases post-MI and correlates with MR, suggesting an organic component to ischemic MR. MV fibrotic remodeling can indicate directions for future therapy.
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Affiliation(s)
- Jonathan Beaudoin
- From the Cardiac Ultrasound Laboratory, Massachusetts General Hospital (J.B., J.P.D.-B., J.L.G., S.S., P.E.B., M.D.H., D.-H.K., R.A.L.), Vascular Biology Program and Department of Surgery, Children's Hospital (J.B., J.W.-S.), Vascular Biology Program, Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital (E.A., J.A.), Harvard Medical School, Boston, and Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea (D.-H.K.)
| | - Jacob P Dal-Bianco
- From the Cardiac Ultrasound Laboratory, Massachusetts General Hospital (J.B., J.P.D.-B., J.L.G., S.S., P.E.B., M.D.H., D.-H.K., R.A.L.), Vascular Biology Program and Department of Surgery, Children's Hospital (J.B., J.W.-S.), Vascular Biology Program, Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital (E.A., J.A.), Harvard Medical School, Boston, and Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea (D.-H.K.)
| | - Elena Aikawa
- From the Cardiac Ultrasound Laboratory, Massachusetts General Hospital (J.B., J.P.D.-B., J.L.G., S.S., P.E.B., M.D.H., D.-H.K., R.A.L.), Vascular Biology Program and Department of Surgery, Children's Hospital (J.B., J.W.-S.), Vascular Biology Program, Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital (E.A., J.A.), Harvard Medical School, Boston, and Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea (D.-H.K.)
| | - Joyce Bischoff
- From the Cardiac Ultrasound Laboratory, Massachusetts General Hospital (J.B., J.P.D.-B., J.L.G., S.S., P.E.B., M.D.H., D.-H.K., R.A.L.), Vascular Biology Program and Department of Surgery, Children's Hospital (J.B., J.W.-S.), Vascular Biology Program, Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital (E.A., J.A.), Harvard Medical School, Boston, and Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea (D.-H.K.)
| | - J Luis Guerrero
- From the Cardiac Ultrasound Laboratory, Massachusetts General Hospital (J.B., J.P.D.-B., J.L.G., S.S., P.E.B., M.D.H., D.-H.K., R.A.L.), Vascular Biology Program and Department of Surgery, Children's Hospital (J.B., J.W.-S.), Vascular Biology Program, Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital (E.A., J.A.), Harvard Medical School, Boston, and Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea (D.-H.K.)
| | - Suzanne Sullivan
- From the Cardiac Ultrasound Laboratory, Massachusetts General Hospital (J.B., J.P.D.-B., J.L.G., S.S., P.E.B., M.D.H., D.-H.K., R.A.L.), Vascular Biology Program and Department of Surgery, Children's Hospital (J.B., J.W.-S.), Vascular Biology Program, Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital (E.A., J.A.), Harvard Medical School, Boston, and Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea (D.-H.K.)
| | - Philipp Emanuel Bartko
- From the Cardiac Ultrasound Laboratory, Massachusetts General Hospital (J.B., J.P.D.-B., J.L.G., S.S., P.E.B., M.D.H., D.-H.K., R.A.L.), Vascular Biology Program and Department of Surgery, Children's Hospital (J.B., J.W.-S.), Vascular Biology Program, Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital (E.A., J.A.), Harvard Medical School, Boston, and Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea (D.-H.K.)
| | - Mark D Handschumacher
- From the Cardiac Ultrasound Laboratory, Massachusetts General Hospital (J.B., J.P.D.-B., J.L.G., S.S., P.E.B., M.D.H., D.-H.K., R.A.L.), Vascular Biology Program and Department of Surgery, Children's Hospital (J.B., J.W.-S.), Vascular Biology Program, Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital (E.A., J.A.), Harvard Medical School, Boston, and Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea (D.-H.K.)
| | - Dae-Hee Kim
- From the Cardiac Ultrasound Laboratory, Massachusetts General Hospital (J.B., J.P.D.-B., J.L.G., S.S., P.E.B., M.D.H., D.-H.K., R.A.L.), Vascular Biology Program and Department of Surgery, Children's Hospital (J.B., J.W.-S.), Vascular Biology Program, Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital (E.A., J.A.), Harvard Medical School, Boston, and Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea (D.-H.K.)
| | - Jill Wylie-Sears
- From the Cardiac Ultrasound Laboratory, Massachusetts General Hospital (J.B., J.P.D.-B., J.L.G., S.S., P.E.B., M.D.H., D.-H.K., R.A.L.), Vascular Biology Program and Department of Surgery, Children's Hospital (J.B., J.W.-S.), Vascular Biology Program, Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital (E.A., J.A.), Harvard Medical School, Boston, and Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea (D.-H.K.)
| | - Jacob Aaron
- From the Cardiac Ultrasound Laboratory, Massachusetts General Hospital (J.B., J.P.D.-B., J.L.G., S.S., P.E.B., M.D.H., D.-H.K., R.A.L.), Vascular Biology Program and Department of Surgery, Children's Hospital (J.B., J.W.-S.), Vascular Biology Program, Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital (E.A., J.A.), Harvard Medical School, Boston, and Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea (D.-H.K.)
| | - Robert A Levine
- From the Cardiac Ultrasound Laboratory, Massachusetts General Hospital (J.B., J.P.D.-B., J.L.G., S.S., P.E.B., M.D.H., D.-H.K., R.A.L.), Vascular Biology Program and Department of Surgery, Children's Hospital (J.B., J.W.-S.), Vascular Biology Program, Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital (E.A., J.A.), Harvard Medical School, Boston, and Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea (D.-H.K.).
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21
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Parry TJ, Ganguly A, Troy EL, Luis Guerrero J, Iaci JF, Srinivas M, Vecchione AM, Button DC, Hackett CS, Zolty R, Sawyer DB, Caggiano AO. Effects of neuregulin GGF2 (cimaglermin alfa) dose and treatment frequency on left ventricular function in rats following myocardial infarction. Eur J Pharmacol 2016; 796:76-89. [PMID: 27993643 DOI: 10.1016/j.ejphar.2016.12.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 12/14/2016] [Accepted: 12/15/2016] [Indexed: 11/17/2022]
Abstract
Neuregulins are important growth factors involved in cardiac development and response to stress. Certain isoforms and fragments of neuregulin have been found to be cardioprotective. The effects of a full-length neuregulin-1β isoform, glial growth factor 2 (GGF2; USAN/INN; also called cimaglermin) were investigated in vitro. Various dosing regimens were then evaluated for their effects on left ventricular (LV) function in rats with surgically-induced myocardial infarction. In vitro, GGF2 bound with high affinity to erythroblastic leukemia viral oncogene (ErbB) 4 receptors, potently promoted Akt phosphorylation, as well as reduced cell death following doxorubicin exposure in HL1 cells. Daily GGF2 treatment beginning 7-14 days after left anterior descending coronary artery ligation produced improvements in LV ejection fraction and other measures of LV function and morphology. The improvements in LV function (e.g. 10% point increase in absolute LV ejection fraction) with GGF2 were dose-dependent. LV performance was substantially improved when GGF2 treatment was delivered infrequently, despite a serum half-life of less than 2h and could be maintained for more than 10 months with treatment once weekly or once every 2 weeks. These studies confirm previous findings that GGF2 may improve contractile performance in the failing rat heart and that infrequent exposure to GGF2 may improve LV function and impact remodeling in the failing myocardium. GGF2 is now being developed for the treatment of heart failure in humans.
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Affiliation(s)
- Tom J Parry
- Acorda Therapeutics, Inc., 420 Saw Mill River Rd, Ardsley, NY 10502, USA.
| | - Anindita Ganguly
- Acorda Therapeutics, Inc., 420 Saw Mill River Rd, Ardsley, NY 10502, USA.
| | - Erika L Troy
- Acorda Therapeutics, Inc., 420 Saw Mill River Rd, Ardsley, NY 10502, USA.
| | - J Luis Guerrero
- Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA.
| | - Jennifer F Iaci
- Acorda Therapeutics, Inc., 420 Saw Mill River Rd, Ardsley, NY 10502, USA.
| | - Maya Srinivas
- Acorda Therapeutics, Inc., 420 Saw Mill River Rd, Ardsley, NY 10502, USA.
| | - Andrea M Vecchione
- Acorda Therapeutics, Inc., 420 Saw Mill River Rd, Ardsley, NY 10502, USA.
| | - Donald C Button
- Acorda Therapeutics, Inc., 420 Saw Mill River Rd, Ardsley, NY 10502, USA.
| | - Craig S Hackett
- Acorda Therapeutics, Inc., 420 Saw Mill River Rd, Ardsley, NY 10502, USA.
| | - Ronald Zolty
- University of Nebraska Medical Center, 982265 S 42nd St & Emile St, Omaha, NE 68198, USA.
| | | | - Anthony O Caggiano
- Acorda Therapeutics, Inc., 420 Saw Mill River Rd, Ardsley, NY 10502, USA.
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22
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Bischoff J, Casanovas G, Wylie-Sears J, Kim DH, Bartko PE, Guerrero JL, Dal-Bianco JP, Beaudoin J, Garcia ML, Sullivan SM, Seybolt MM, Morris BA, Keegan J, Irvin WS, Aikawa E, Levine RA. CD45 Expression in Mitral Valve Endothelial Cells After Myocardial Infarction. Circ Res 2016; 119:1215-1225. [PMID: 27750208 DOI: 10.1161/circresaha.116.309598] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 11/16/2022]
Abstract
RATIONALE Ischemic mitral regurgitation, a complication after myocardial infarction (MI), induces adaptive mitral valve (MV) responses that may be initially beneficial but eventually lead to leaflet fibrosis and MV dysfunction. We sought to examine the MV endothelial response and its potential contribution to ischemic mitral regurgitation. OBJECTIVE Endothelial, interstitial, and hematopoietic cells in MVs from post-MI sheep were quantified. MV endothelial CD45, found post MI, was analyzed in vitro. METHODS AND RESULTS Ovine MVs, harvested 6 months after inferior MI, showed CD45, a protein tyrosine phosphatase, colocalized with von Willebrand factor, an endothelial marker. Flow cytometry of MV cells revealed significant increases in CD45+ endothelial cells (VE-cadherin+/CD45+/α-smooth muscle actin [SMA]+ and VE-cadherin+/CD45+/αSMA- cells) and possible fibrocytes (VE-cadherin-/CD45+/αSMA+) in inferior MI compared with sham-operated and normal sheep. CD45+ cells correlated with MV fibrosis and mitral regurgitation severity. VE-cadherin+/CD45+/αSMA+ cells suggested that CD45 may be linked to endothelial-to-mesenchymal transition (EndMT). MV endothelial cells treated with transforming growth factor-β1 to induce EndMT expressed CD45 and fibrosis markers collagen 1 and 3 and transforming growth factor-β1 to 3, not observed in transforming growth factor-β1-treated arterial endothelial cells. A CD45 protein tyrosine phosphatase inhibitor blocked induction of EndMT and fibrosis markers and inhibited EndMT-associated migration of MV endothelial cells. CONCLUSIONS MV endothelial cells express CD45, both in vivo post MI and in vitro in response to transforming growth factor-β1. A CD45 phosphatase inhibitor blocked hallmarks of EndMT in MV endothelial cells. These results point to a novel, functional requirement for CD45 phosphatase activity in EndMT. The contribution of CD45+ endothelial cells to MV adaptation and fibrosis post MI warrants investigation.
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Affiliation(s)
- Joyce Bischoff
- From the Vascular Biology Program and Department of Surgery, Boston Children's Hospital, Harvard Medical School, MA (J.B., G.C., J.W.-S.); Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston (D.-H.K., P.E.B., J.L.G., J.P.D.-B., J.B., M.L.G., S.M.S., M.M.S., B.A.M., R.A.L.); Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea (D.-H.K.); and Center for Excellence in Vascular Biology, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.K., W.S.I., E.A.).
| | - Guillem Casanovas
- From the Vascular Biology Program and Department of Surgery, Boston Children's Hospital, Harvard Medical School, MA (J.B., G.C., J.W.-S.); Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston (D.-H.K., P.E.B., J.L.G., J.P.D.-B., J.B., M.L.G., S.M.S., M.M.S., B.A.M., R.A.L.); Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea (D.-H.K.); and Center for Excellence in Vascular Biology, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.K., W.S.I., E.A.)
| | - Jill Wylie-Sears
- From the Vascular Biology Program and Department of Surgery, Boston Children's Hospital, Harvard Medical School, MA (J.B., G.C., J.W.-S.); Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston (D.-H.K., P.E.B., J.L.G., J.P.D.-B., J.B., M.L.G., S.M.S., M.M.S., B.A.M., R.A.L.); Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea (D.-H.K.); and Center for Excellence in Vascular Biology, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (J.K., W.S.I., E.A.)
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23
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Sihag S, Haas MS, Kim KM, Guerrero JL, Beaudoin J, Alicot EM, Schuerpf F, Gottschall JD, Puro RJ, Madsen JC, Sachs DH, Newman W, Carroll MC, Allan JS. Natural IgM Blockade Limits Infarct Expansion and Left Ventricular Dysfunction in a Swine Myocardial Infarct Model. Circ Cardiovasc Interv 2016; 9:e002547. [PMID: 26671971 DOI: 10.1161/circinterventions.115.002547] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Acute coronary syndrome is the leading cause of mortality worldwide. However, treatment of acute coronary occlusion inevitably results in ischemia-reperfusion injury. Circulating natural IgM has been shown to play a significant role in mouse models of ischemia-reperfusion injury. A highly conserved self-antigen, nonmuscle myosin heavy chain II, has been identified as a target of pathogenic IgM. We hypothesized that a monoclonal antibody (m21G6) directed against nonmuscle myosin heavy chain II may inhibit IgM binding and reduce injury in a preclinical model of myocardial infarction. Thus, our objective was to evaluate the efficacy of intravenous m21G6 treatment in limiting infarct expansion, troponin release, and left ventricular dysfunction in a swine myocardial infarction model. METHODS AND RESULTS Massachusetts General Hospital miniature swine underwent occlusion of the midleft anterior descending coronary artery for 60 minutes, followed by 1 hour, 5-day, or 21-day reperfusion. Specificity and localization of m21G6 to injured myocardium were confirmed using fluorescently labeled m21G6. Treatment with m21G6 before reperfusion resulted in a 49% reduction in infarct size (P<0.005) and a 61% reduction in troponin-T levels (P<0.05) in comparison with saline controls at 5-day reperfusion. Furthermore, m21G6-treated animals recovered 85.4% of their baseline left ventricular function as measured by 2-dimensional transthoracic echocardiography in contrast to 67.1% in controls at 21-day reperfusion (P<0.05). CONCLUSIONS Treatment with m21G6 significantly reduced infarct size and troponin-T release, and led to marked preservation of cardiac function in our study. Overall, these findings suggest that pathogenic IgM blockade represents a valid therapeutic strategy in mitigating myocardial ischemia-reperfusion injury.
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Affiliation(s)
- Smita Sihag
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - Michael S Haas
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - Karen M Kim
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - J Luis Guerrero
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - Jonathan Beaudoin
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - Elisabeth M Alicot
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - Franziska Schuerpf
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - James D Gottschall
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - Robyn J Puro
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - Joren C Madsen
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - David H Sachs
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - Walter Newman
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - Michael C Carroll
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - James S Allan
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
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Kollmann-Camaiora A, Alsina E, Domínguez A, Del Blanco B, Yepes MJ, Guerrero JL, García A. Clinical protocol for the management of malignant hyperthermia. ACTA ACUST UNITED AC 2016; 64:32-40. [PMID: 27633384 DOI: 10.1016/j.redar.2016.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 06/16/2016] [Accepted: 06/17/2016] [Indexed: 11/24/2022]
Abstract
Malignant hyperthermia is a hypermetabolic syndrome that appears in susceptible patients after exposure to certain anaesthetic drugs (succinylcholine, inhalation anaesthetics). Its incidence in Spain is 1 in 40,000 adults, with a 10% mortality rate. It is induced by an abnormal regulation of the ryanodine receptors, producing a massive release of calcium from the sarcoplasmic reticulum in the striate muscle. Clinical manifestations include: CO2 increase, tachycardia, haemodynamic instability, metabolic and respiratory acidosis, profuse sweating, hyperpyrexia, CPK increase, myoglobinuria, kidney failure, disseminated intravascular coagulation (DIC), and ending in cardiac arrest. Dantrolene sodium is a ryanodine receptor antagonist, and inhibits the release of intracellular calcium. Definitive diagnosis is achieved by the exposure of muscle fibres to caffeine and halothane. Protocols can help guarantee a reliable and secure management when this severe event occurs.
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Affiliation(s)
- A Kollmann-Camaiora
- Departamento de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España.
| | - E Alsina
- Departamento de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - A Domínguez
- Departamento de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, España
| | - B Del Blanco
- Departamento de Anestesiología y Reanimación, Hospital Clínico Universitario San Carlos, Madrid, España
| | - M J Yepes
- Departamento de Anestesiología y Reanimación, Clínica Universidad de Navarra, Pamplona, Navarra, España
| | - J L Guerrero
- Departamento de Anestesiología y Reanimación, Hospital Virgen de la Victoria, Málaga, España
| | - A García
- Departamento de Anestesiología y Reanimación, Hospital Virgen de la Victoria, Málaga, España
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Dal-Bianco JP, Aikawa E, Bischoff J, Guerrero JL, Hjortnaes J, Beaudoin J, Szymanski C, Bartko PE, Seybolt MM, Handschumacher MD, Sullivan S, Garcia ML, Mauskapf A, Titus JS, Wylie-Sears J, Irvin WS, Chaput M, Messas E, Hagège AA, Carpentier A, Levine RA. Myocardial Infarction Alters Adaptation of the Tethered Mitral Valve. J Am Coll Cardiol 2016; 67:275-87. [PMID: 26796392 DOI: 10.1016/j.jacc.2015.10.092] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 10/16/2015] [Accepted: 10/20/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND In patients with myocardial infarction (MI), leaflet tethering by displaced papillary muscles induces mitral regurgitation (MR), which doubles mortality. Mitral valves (MVs) are larger in such patients but fibrosis sets in counterproductively. The investigators previously reported that experimental tethering alone increases mitral valve area in association with endothelial-to-mesenchymal transition. OBJECTIVES The aim of this study was to explore the clinically relevant situation of tethering and MI, testing the hypothesis that ischemic milieu modifies mitral valve adaptation. METHODS Twenty-three adult sheep were examined. Under cardiopulmonary bypass, the papillary muscle tips in 6 sheep were retracted apically to replicate tethering, short of producing MR (tethered alone). Papillary muscle retraction was combined with apical MI created by coronary ligation in another 6 sheep (tethered plus MI), and left ventricular remodeling was limited by external constraint in 5 additional sheep (left ventricular constraint). Six sham-operated sheep were control subjects. Diastolic mitral valve surface area was quantified by 3-dimensional echocardiography at baseline and after 58 ± 5 days, followed by histopathology and flow cytometry of excised leaflets. RESULTS Tethered plus MI leaflets were markedly thicker than tethered-alone valves and sham control subjects. Leaflet area also increased significantly. Endothelial-to-mesenchymal transition, detected as α-smooth muscle actin-positive endothelial cells, significantly exceeded that in tethered-alone and control valves. Transforming growth factor-β, matrix metalloproteinase expression, and cellular proliferation were markedly increased. Uniquely, tethering plus MI showed endothelial activation with vascular adhesion molecule expression, neovascularization, and cells positive for CD45, considered a hematopoietic cell marker. Tethered plus MI findings were comparable with external ventricular constraint. CONCLUSIONS MI altered leaflet adaptation, including a profibrotic increase in valvular cell activation, CD45-positive cells, and matrix turnover. Understanding cellular and molecular mechanisms underlying leaflet adaptation and fibrosis could yield new therapeutic opportunities for reducing ischemic MR.
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Affiliation(s)
- Jacob P Dal-Bianco
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Leducq Transatlantic Mitral Network, Fondation Leducq, Paris, France
| | - Elena Aikawa
- Leducq Transatlantic Mitral Network, Fondation Leducq, Paris, France; Center for Excellence in Vascular Biology, Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Joyce Bischoff
- Leducq Transatlantic Mitral Network, Fondation Leducq, Paris, France; Vascular Biology Program, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - J Luis Guerrero
- Surgical Cardiovascular Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jesper Hjortnaes
- Center for Excellence in Vascular Biology, Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jonathan Beaudoin
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Leducq Transatlantic Mitral Network, Fondation Leducq, Paris, France
| | - Catherine Szymanski
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Leducq Transatlantic Mitral Network, Fondation Leducq, Paris, France
| | - Philipp E Bartko
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Margo M Seybolt
- Surgical Cardiovascular Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mark D Handschumacher
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Suzanne Sullivan
- Surgical Cardiovascular Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael L Garcia
- Surgical Cardiovascular Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Adam Mauskapf
- Surgical Cardiovascular Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - James S Titus
- Surgical Cardiovascular Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jill Wylie-Sears
- Vascular Biology Program, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Whitney S Irvin
- Center for Excellence in Vascular Biology, Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Miguel Chaput
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Leducq Transatlantic Mitral Network, Fondation Leducq, Paris, France
| | - Emmanuel Messas
- Leducq Transatlantic Mitral Network, Fondation Leducq, Paris, France; Departments of Cardiology and Cardiovascular Surgery, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, University Paris Descartes, INSERM Unit 633, Paris, France
| | - Albert A Hagège
- Leducq Transatlantic Mitral Network, Fondation Leducq, Paris, France; Departments of Cardiology and Cardiovascular Surgery, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, University Paris Descartes, INSERM Unit 633, Paris, France
| | - Alain Carpentier
- Leducq Transatlantic Mitral Network, Fondation Leducq, Paris, France; Departments of Cardiology and Cardiovascular Surgery, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, University Paris Descartes, INSERM Unit 633, Paris, France
| | - Robert A Levine
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Leducq Transatlantic Mitral Network, Fondation Leducq, Paris, France; Departments of Cardiology and Cardiovascular Surgery, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, University Paris Descartes, INSERM Unit 633, Paris, France.
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Zeng X, Zou L, Levine RA, Guerrero JL, Handschumacher MD, Sullivan SM, Braithwaite GJC, Stone JR, Solis J, Muratoglu OK, Vlahakes GJ, Hung J. Efficacy of polymer injection for ischemic mitral regurgitation: persistent reduction of mitral regurgitation and attenuation of left ventricular remodeling. JACC Cardiovasc Interv 2015; 8:355-363. [PMID: 25596792 DOI: 10.1016/j.jcin.2014.09.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 09/22/2014] [Accepted: 09/25/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of this study was to examine the chronic effects of polyvinyl-alcohol (PVA) injection on mitral regurgitation (MR) reduction, mitral valve geometry, and left ventricular (LV) remodeling in a chronic ischemic MR sheep model. BACKGROUND Previous studies have demonstrated acute efficacy of PVA hydrogel polymer injection into infarcted myocardium underlying the papillary muscle to relieve MR by papillary muscle repositioning. However, the chronic efficacy of PVA injection in the chronic infarction setting remains unclear. METHODS Sixteen sheep developed chronic MR 8 weeks after induced inferoposterior myocardial infarction. Ten consecutive sheep underwent PVA injection (PVA group) and 6 sheep served as control subjects with saline injection. Epicardial 2-/3-dimensional echocardiography was performed at the baseline, chronic MR (pre-injection), and sacrifice (8 weeks after injection) stages. RESULTS Both groups were comparable at the baseline and chronic MR stages. At sacrifice, MR decreased from moderate to trace or mild (vena contracta: 0.17 ± 0.08 cm vs. 0.56 ± 0.10 cm, p < 0.001) in the PVA group but progressed to moderate to severe in the control group. End-systolic and -diastolic volumes remained stable in the PVA group but increased significantly in the control group (both p < 0.05). At sacrifice, compared with the control group, the PVA group had significantly less left ventricular remodeling (end-systolic volume: 41.1 ± 10.4 ml vs. 55.9 ± 12.4 ml, p < 0.05), lower MR severity (vena contracta: 0.17 ± 0.08 cm vs. 0.60 ± 0.14 cm, p < 0.01), and favorable changes in mitral valve geometry. CONCLUSIONS Polymer injection in a chronic ischemic MR model results in persistent reduction of MR and attenuation of continued left ventricular remodeling over 8 weeks of follow-up.
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Affiliation(s)
- Xin Zeng
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Lin Zou
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Robert A Levine
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - J Luis Guerrero
- Cardiac Surgery Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Mark D Handschumacher
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Suzanne M Sullivan
- Cardiac Surgery Division, Massachusetts General Hospital, Boston, Massachusetts
| | | | - James R Stone
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jorge Solis
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Orhun K Muratoglu
- Biomaterials Laboratory, Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Gus J Vlahakes
- Cardiac Surgery Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Judy Hung
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston, Massachusetts.
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Beaudoin J, Levine RA, Guerrero JL, Yosefy C, Sullivan S, Abedat S, Handschumacher MD, Szymanski C, Gilon D, Palmeri NO, Vlahakes GJ, Hajjar RJ, Beeri R. Late repair of ischemic mitral regurgitation does not prevent left ventricular remodeling: importance of timing for beneficial repair. Circulation 2013; 128:S248-52. [PMID: 24030415 DOI: 10.1161/circulationaha.112.000124] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Ischemic mitral regurgitation (MR) is a frequent complication of myocardial infarction associated with left ventricular (LV) dilatation and dysfunction, which doubles mortality. At the molecular level, moderate ischemic MR is characterized by a biphasic response, with initial compensatory rise in prohypertrophic and antiapoptotic signals, followed by their exhaustion. We have shown that early MR repair 30 days after myocardial infarction is associated with LV reverse remodeling. It is not known whether MR repair performed after the exhaustion of compensatory mechanisms is also beneficial. We hypothesized that late repair will not result in LV reverse remodeling. METHODS AND RESULTS Twelve sheep underwent distal left anterior descending coronary artery ligation to create apical myocardial infarction and implantation of an LV-to-left atrium shunt to create standardized moderate volume overload. At 90 days, animals were randomized to shunt closure (late repair) versus sham (no repair). LV remodeling was assessed by 3-dimensional echocardiography, dP/dt, preload-recruitable stroke work, and myocardial biopsies. At 90 days, animals had moderate volume overload, LV dilatation, and reduced ejection fraction (all P<0.01 versus baseline, P=NS between groups). Shunt closure at 90 days corrected the volume overload (regurgitant fraction 6 ± 5% versus 27 ± 16% for late repair versus sham, P<0.01) but was not associated with changes in LV volumes (end-diastolic volume 106 ± 15 versus 110 ± 22 mL; end-systolic volume 35 ± 6 versus 36 ± 6 mL) or increases in preload-recruitable stroke work (41 ± 7 versus 39 ± 13 mL mm Hg) or dP/dt (803 ± 210 versus 732 ± 194 mm Hg/s) at 135 days (all P=NS). Activated Akt, central in the hypertrophic process, and signal transducer and activator of transcription 3 (STAT3), a critical node in the hypertrophic stimulus by cytokines, were equally depressed in both groups. CONCLUSIONS Late correction of moderate volume overload after myocardial infarction did not improve LV volume or contractility. Upregulation of prohypertrophic intracellular pathways was not observed. This contrasts with previously reported study in which early repair (30 days) reversed LV remodeling. This suggests a window of opportunity to repair ischemic MR after which no beneficial effect on LV is observed, despite successful repair.
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Affiliation(s)
- Jonathan Beaudoin
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA (J.B., R.A.L., J.L.G., C.Y., S.S., M.D.H., C.S., N.O.P., G.J.V., R.B.); Cardiovascular Research Center, Heart Institute, Hadassah-Hebrew University Medical Center, Ein-Karem, Jerusalem, Israel (S.A., D.G., R.B.); and Cardiovascular Research Center, Cardiovascular Institute, Mt Sinai School of Medicine, New York, NY (R.J.H.)
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Duncan C, Savage K, Williams M, Dickerson B, Kondas AV, Fitzpatrick KA, Guerrero JL, Spraker T, Kersh GJ. Multiple strains of Coxiella burnetii are present in the environment of St. Paul Island, Alaska. Transbound Emerg Dis 2012; 60:345-50. [PMID: 22747976 DOI: 10.1111/j.1865-1682.2012.01353.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In 2010, Coxiella burnetii was identified at a high prevalence in the placentas of Northern fur seals (Callorhinus ursinus) collected at a single rookery on St. Paul Island Alaska; an area of the United States where the agent was not known to be present. As contamination was hypothesized as a potential cause of false positives, but nothing was known about environmental C. burnetii in the region, an environmental survey was conducted to look for the prevalence and distribution of the organism on the island. While environmental prevalence was low, two strains of the organism were identified using PCR targeting the COM1 and IS1111 genes. The two strains are consistent with the organism that has been increasingly identified in marine mammals as well as a strain type more commonly found in terrestrial environments and associated with disease in humans and terrestrial animals. Further work is needed to elucidate information regarding the ecology of this organism in this region, particularly in association with the coastal environment.
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Affiliation(s)
- C Duncan
- Veterinary Diagnostic Lab, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO 80523, USA.
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Hung J, Solis J, Handschumacher MD, Guerrero JL, Levine RA. Persistence of mitral regurgitation following ring annuloplasty: is the papillary muscle outside or inside the ring? J Heart Valve Dis 2012; 21:218-224. [PMID: 22645858 PMCID: PMC3509931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Ischemic mitral regurgitation (IMR) often persists, despite annular ring reduction. It has been hypothesized that persistent IMR following ring annuloplasty was related to a continued tethering of the mitral leaflets, as defined by the distance by which the papillary muscles (PMs) were displaced outside the mitral annular ring. METHODS Seven sheep (four acute, three chronic) with persistent mitral regurgitation (MR) following ring annuloplasty for IMR were studied using three-dimensional (3D) echocardiography to examine the mitral valve geometry. The three stages examined were: Stage 1, baseline; Stage 2, post myocardial infarction (via ligation of the obtuse marginal branches); and Stage 3, post undersized ring annuloplasty. The 3D echocardiography measurements included mitral annular area, tethering distance from the ischemic PM to the anterior annulus, and the outside displacement of the PM relative to ring PM displacement. RESULTS Persistent moderate MR remained in these seven sheep following undersized ring annuloplasty (MR vena contracta change (pre versus post ring): 7.0 versus 5.8 +/- 2.4 mm, p = NS), despite a reduction in the mitral annular area of 50 +/- 18% (10.3 +/- 6.3 versus 4.7 +/- 1.3 cm2). Ring annuloplasty shifted the posterior annulus towards the anterior annulus, such that the infarcted PM became displaced outside the mitral annulus. The projected displacement distance of the PM outside versus inside the annular ring was 8.4 +/- 2.4 mm outside mitral annulus post ring versus 3.6 +/- 2.5 mm within mitral annulus pre ring, p < 0001). The displacement distance from the infarcted PM to the mitral annulus restricted the ability of the posterior leaflet to move anteriorly, preventing effective coaptation. By multivariate analysis, this displacement distance was an important determinant of residual MR (p < 0.02). CONCLUSION Persistent MR following ring annuloplasty for IMR relates to persistently abnormal leaflet tethering, with restricted posterior leaflet motion due to PM displacement outside of the mitral annulus.
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Affiliation(s)
- Judy Hung
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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Romero P, Rodríguez E, Muñoz M, Delucchi A, Guerrero JL, Lillo AM, Cano F, Matilde Osses S, Romero MI, Gonzalez Roca C. Voiding dysfunction: another etiology of vulvovaginitis in young girls. J Pediatr Adolesc Gynecol 2011; 24:189-91. [PMID: 21600807 DOI: 10.1016/j.jpag.2011.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 01/13/2011] [Accepted: 01/20/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the prevalence of voiding dysfunction (VD) in patients with persistent vulvovaginitis (PVV), and to evaluate the clinical response of PVV in the treatment of VD. PATIENTS AND METHODS Girls four years or older who consulted for PVV for at least one month and who did not respond to general measures. A physical examination was performed with visual inspection and colposcopy; vaginal samples for culture and vaginoscopy were carried out. On every patient urodynamic studies were performed. Girls who were diagnosed with VD were treated. A pediatric gynecologist did the follow-up; a successful response was considered when inflammatory symptoms and vaginal discharge ceased. RESULTS Twenty patients were included, mean age 8.6 years (range: 4.6-14 years); 75% prepubertal symptoms lasted for 1.8 years; 19 (95%) had urodynamia, 10 (52.6%) had an overactive bladder, 8 (42.1%) external bladder sphincter dyssynergia, 1 (5.2%) hypotonic bladder, and 13 (65%) showed improvement. CONCLUSION VD is an important cause when considering the etiology of PVV.
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Affiliation(s)
- P Romero
- Pediatric Gynecology Unit, Calvo Mackenna Children's Hospital, Santiago, Chile.
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Yosefy C, Beeri R, Guerrero JL, Vaturi M, Scherrer-Crosbie M, Handschumacher MD, Levine RA. Mitral regurgitation after anteroapical myocardial infarction: new mechanistic insights. Circulation 2011; 123:1529-36. [PMID: 21444880 DOI: 10.1161/circulationaha.110.977843] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mitral regurgitation (MR) generally accompanies inferobasal myocardial infarction (MI), with leaflet tethering by displaced papillary muscles. Mitral regurgitation is also reported with anteroapical MI without global dilatation or inferior wall motion abnormalities. We hypothesized that anteroapical MI extending to the inferior apex displaces the papillary muscles, tethering the mitral leaflets to cause MR. METHODS AND RESULTS In the retrospective part of the study, consecutive anteroapical MI patients were studied. Moderate-severe MR occurred in 9% of 234 patients with only anteroapical MI versus 17% of 242 with inferoapical extension (P<0.001). Ejection fraction was only mildly different (41 ± 4% versus 46 ± 5%; P<0.01). In the human mechanistic portion of the study, 60 anteroapical MI patients (20 with only 2 apical segments involved and 40 with involvement of all 4 apical segments; 20 with MR and 20 without MR) were compared with 20 normal controls. Those with MR (≥ moderate) had higher systolic papillary muscle-to-annulus tethering length (P < 0.01). Mitral regurgitation grade correlated most strongly with tethering length (r = 0.70) and its diminished systolic shortening (r = -0.65). In the animal study, 9 sheep with left anterior descending coronary artery ligation were analyzed. Four sheep that developed MR had inferoapical MI extension with tethering length increasing over 1.5 months (2.1 ± 0.4 to 2.9 ± 0.4 cm, P < 0.001) versus no significant increase in 5 sheep without MR (2.0 ± 0.4 to 2.1 ± 0.3 cm, P not statistically significant). In MR sheep, the normal decrease in tethering length from diastole to systole was eliminated (P < 0.01). CONCLUSIONS Anteroapical MI with inferoapical extension can mechanically displace papillary muscles, causing MR despite the absence of basal and midinferior wall motion abnormalities. This suggests the possibility of repositioning treatments for this condition.
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Affiliation(s)
- Chaim Yosefy
- Cardiac Ultrasound Laboratory, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114-2696, USA.
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Solis J, Levine RA, Johnson B, Guerrero JL, Handschumacher MD, Sullivan S, Lam K, Berlin J, Braithwaite GJC, Muratoglu OK, Vlahakes GJ, Hung J. Polymer injection therapy to reverse remodel the papillary muscles: efficacy in reducing mitral regurgitation in a chronic ischemic model. Circ Cardiovasc Interv 2010; 3:499-505. [PMID: 20736444 DOI: 10.1161/circinterventions.109.850255] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ischemic mitral regurgitation (MR) results from displacement of the papillary muscles caused by ischemic ventricular distortion. Progressive left ventricular (LV) remodeling has challenged therapy. Our hypothesis is that repositioning of the papillary muscles can be achieved by injection of polyvinyl-alcohol (PVA) hydrogel polymer into the myocardium in chronic MR despite advanced LV remodeling. METHODS AND RESULTS Ten sheep underwent ligation of the circumflex branches to produce chronic ischemic MR over 8 weeks. PVA was injected into the myocardium underlying the infarcted papillary muscle. Two-dimensional and 3D echocardiograms and hemodynamic data were obtained before infarct (baseline), before PVA (chronic MR), and after PVA. PVA injection significantly decreased MR from moderate to severe to trace (MR vena contracta, 5.8±1.2 to1.8±1.3 mm; chronic MR to post-PVA stage; P=0.0003). This was associated with a decrease in infarcted papillary muscle-to-mitral annulus tethering distance (30.3±5.7 to 25.9±4.6 mm, P=0.02), tenting volume (1.8±0.7 to 1.4±0.5 mL, P=0.01), and leaflet closure area (8.8±1.3 cm(2)to 7.6±1.3 cm(2), P=0.004) from chronic MR to post-PVA stages. PVA was not associated with significant decreases in LV ejection fraction (41±3% versus 40±3%, P=NS), end-systolic elastance, τ (82±36 ms to 72±26, P=NS), or LV stiffness coefficient (0.05±0.04 to 0.03±0.01). CONCLUSIONS PVA hydrogel injections improve coaptation and reduce remodeling in chronic MR without impairing LV systolic and diastolic function. This new approach offers a potential alternative for relieving tethering and ischemic MR by correcting papillary muscle position.
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Affiliation(s)
- Jorge Solis
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston, Mass., USA
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Beeri R, Chaput M, Guerrero JL, Kawase Y, Yosefy C, Abedat S, Karakikes I, Morel C, Tisosky A, Sullivan S, Handschumacher MD, Gilon D, Vlahakes GJ, Hajjar RJ, Levine RA. Gene delivery of sarcoplasmic reticulum calcium ATPase inhibits ventricular remodeling in ischemic mitral regurgitation. Circ Heart Fail 2010; 3:627-34. [PMID: 20634484 DOI: 10.1161/circheartfailure.109.891184] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mitral regurgitation (MR) doubles mortality after myocardial infarction (MI). We have demonstrated that MR worsens remodeling after MI and that early correction reverses remodeling. Sarcoplasmic reticulum Ca(+2)-ATPase (SERCA2a) is downregulated in this process. We hypothesized that upregulating SERCA2a might inhibit remodeling in a surgical model of apical MI (no intrinsic MR) with independent MR-type flow. METHODS AND RESULTS In 12 sheep, percutaneous gene delivery was performed by using a validated protocol to perfuse both the left anterior descending and circumflex coronary arteries with occlusion of venous drainage. We administered adeno-associated virus 6 (AAV6) carrying SERCA2a under a Cytomegalovirus promoter control in 6 sheep and a reporter gene in 6 controls. After 2 weeks, a standardized apical MI was created, and a shunt was implanted between the left ventricle and left atrium, producing regurgitant fractions of ≈30%. Animals were compared at baseline and 1 and 3 months by 3D echocardiography, Millar hemodynamics, and biopsies. The SERCA2a group had a well-maintained preload-recruitable stroke work at 3 months (decrease by 8±10% vs 42±12% with reporter gene controls; P<0.001). Left ventricular dP/dt followed the same pattern (no change vs 55% decrease; P<0.001). Left ventricular end-systolic volume was lower with SERCA2a (82.6±9.6 vs 99.4±9.7 mL; P=0.03); left ventricular end-diastolic volume, reflecting volume overload, was not significantly different (127.8±6.2 vs 134.3±9.4 mL). SERCA2a sheep showed a 15% rise in antiapoptotic pAkt versus a 30% reduction with the reporter gene (P<0.001). Prohypertrophic activated STAT3 was also 41% higher with SERCA2a than in controls (P<0.001). Proapoptotic activated caspase-3 rose >5-fold during 1 month in both SERCA2a and control animals (P=NS) and decreased by 19% at 3 months, remaining elevated in both groups. CONCLUSIONS In this controlled model, upregulating SERCA2a induced better function and lesser remodeling, with improved contractility, smaller volume, and activation of prohypertrophic/antiapoptotic pathways. Although caspase-3 remained activated in both groups, SERCA2a sheep had increased molecular antiremodeling "tone." We therefore conclude that upregulating SERCA2a inhibits MR-induced post-MI remodeling in this model and thus may constitute a useful approach to reduce the vicious circle of remodeling in ischemic MR.
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Affiliation(s)
- Ronen Beeri
- Cardiac Ultrasound Laboratory and Cardiac Surgery Department, Heart Center, Massachusetts General Hospital, Boston, Mass 02114, USA
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Shoup TM, Elmaleh DR, Brownell AL, Zhu A, Guerrero JL, Fischman AJ. Evaluation of (4-[18F]Fluorophenyl)triphenylphosphonium Ion. A Potential Myocardial Blood Flow Agent for PET. Mol Imaging Biol 2010; 13:511-517. [DOI: 10.1007/s11307-010-0349-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Thiagalingam A, D'Avila A, Foley L, Guerrero JL, Lambert H, Leo G, Ruskin JN, Reddy VY. Importance of catheter contact force during irrigated radiofrequency ablation: evaluation in a porcine ex vivo model using a force-sensing catheter. J Cardiovasc Electrophysiol 2010; 21:806-11. [PMID: 20132400 DOI: 10.1111/j.1540-8167.2009.01693.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Ablation electrode-tissue contact has been shown to be an important determinant of lesion size and safety during nonirrigated ablation but little data are available during irrigated ablation. We aimed to determine the importance of contact force during irrigated-tip ablation. METHODS AND RESULTS Freshly excised hearts from 11 male pigs were perfused and superfused using fresh, heparinized, oxygenated swine blood in an ex vivo model. One-minute ablations were placed using one of 3 different power control strategies (impedance control-15 Omega target impedance drop, and 20 W or 30 W fixed power) and 3 different contact forces (2 g, 20 g, and 60 g) to give a grid of 9 ablation groups. The force sensing catheter (Tacticath, Endosense SA) was irrigated at 17 mL/min for all of the ablations. Of a total 101 ablations, no thrombus formation was noted but popping was seen in 17 lesions. The lesion depth and incidence of pops was 5.0 +/- 1.3 mm /0%, 5.0 +/- 1.6 mm /10% and 6.7 +/- 2.5 mm /45% for the 15 Omega, 20 W, and 30 W groups (P < 0.01), respectively, and 4.4 +/- 1.8 mm /3%, 5.8 +/- 1.6 mm /17% and 6.6 +/- 2.0 mm /37% for the 2 g, 20 g, and 60 g groups, respectively (P < 0.01). The impedance drop in the first 5 seconds was significantly correlated to catheter contact force: 9.7 +/- 9.9 Omega, 22.3 +/- 11.0 Omega, and 41.7 +/- 22.1 Omega, respectively, for the 2 g, 20 g, and 60 g groups (Pearson's r = 0.65, P < 0.01). CONCLUSION Catheter contact force has an important impact on both ablation lesion size and the incidence of pops.
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Affiliation(s)
- Aravinda Thiagalingam
- Cardiac Electrophysiology Department, Massachusetts General Hospital, Boston, Massachusetts, USA
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Chaput M, Handschumacher MD, Guerrero JL, Holmvang G, Dal-Bianco JP, Sullivan S, Vlahakes GJ, Hung J, Levine RA. Mitral leaflet adaptation to ventricular remodeling: prospective changes in a model of ischemic mitral regurgitation. Circulation 2009; 120:S99-103. [PMID: 19752393 DOI: 10.1161/circulationaha.109.844019] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ischemic mitral regurgitation is caused by systolic traction on the mitral leaflets related to ventricular distortion. Little is known about how chronic tethering affects leaflet area, in part because it cannot be measured repeatedly in situ. Recently, a new method for 3D echocardiographic measurement of mitral leaflet area was developed and validated in vivo against sheep valves, later excised. Clinical studies (n=80) showed that mitral leaflet area increased by >30% in patients with inferior myocardial infarction and dilated cardiomyopathy versus normal; greater adaptation independently predicted less mitral regurgitation. This study explored whether mitral valve area changes over time within the same heart with ischemic mitral regurgitation. METHODS AND RESULTS Twelve sheep were studied at baseline and 3 months after inferior myocardial infarction by 3D echocardiography; 6 were untreated and 6 were treated initially with an epicardial patch to limit left ventricular dilation and mitral regurgitation. Untreated sheep developed left ventricular dilation at 3 months, with global dysfunction (mean+/-SD ejection fraction, 24+/-10% versus 44+/-10% with patching, P=0.02) and moderate mitral regurgitation (vena contracta, 5.0+/-1.0 versus 0.8+/-1.0 mm, P<0.0002). In untreated sheep, total diastolic leaflet area increased from 13.1+/-1.3 to 18.1+/-2.5 cm(2) (P=0.0001). In patched sheep, leaflet area at 3 months was not significantly different from baseline sheep values (13.0+/-1.1 versus baseline, 12.1+/-1.8 cm(2), P=0.31). CONCLUSIONS Mitral valve area, independent of systolic stretch, increases over time as the left ventricular remodels after inferior myocardial infarction. This increase, however, fails to compensate adequately for tethering to prevent mitral regurgitation. Understanding the mechanism of valve adaptation can potentially suggest new biological and surgical therapeutic targets.
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Affiliation(s)
- Miguel Chaput
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Dal-Bianco JP, Aikawa E, Bischoff J, Guerrero JL, Handschumacher MD, Sullivan S, Johnson B, Titus JS, Iwamoto Y, Wylie-Sears J, Levine RA, Carpentier A. Active adaptation of the tethered mitral valve: insights into a compensatory mechanism for functional mitral regurgitation. Circulation 2009; 120:334-42. [PMID: 19597052 DOI: 10.1161/circulationaha.108.846782] [Citation(s) in RCA: 214] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND In patients with left ventricular infarction or dilatation, leaflet tethering by displaced papillary muscles frequently induces mitral regurgitation, which doubles mortality. Little is known about the biological potential of the mitral valve (MV) to compensate for ventricular remodeling. We tested the hypothesis that MV leaflet surface area increases over time with mechanical stretch created by papillary muscle displacement through cell activation, not passive stretching. METHODS AND RESULTS Under cardiopulmonary bypass, the papillary muscle tips in 6 adult sheep were retracted apically short of producing mitral regurgitation to replicate tethering without confounding myocardial infarction or turbulence. Diastolic leaflet area was quantified by 3-dimensional echocardiography over 61+/-6 days compared with 6 unstretched sheep MVs. Total diastolic leaflet area increased by 2.4+/-1.3 cm(2) (17+/-10%) from 14.3+/-1.9 to 16.7+/-1.9 cm(2) (P=0.006) with stretch with no change in the unstretched valves despite sham open heart surgery. Stretched MVs were 2.8 times thicker than normal (1.18+/-0.14 versus 0.42+/-0.14 mm; P<0.0001) at 60 days with an increased spongiosa layer. Endothelial cells (CD31(+)) coexpressing alpha-smooth muscle actin were significantly more common by fluorescent cell sorting in tethered versus normal leaflets (41+/-19% versus 9+/-5%; P=0.02), indicating endothelial-mesenchymal transdifferentiation. alpha-Smooth muscle actin-positive cells appeared in the atrial endothelium, penetrating into the interstitium, with increased collagen deposition. Thickened chordae showed endothelial and subendothelial alpha-smooth muscle actin. Endothelial-mesenchymal transdifferentiation capacity also was demonstrated in cultured MV endothelial cells. CONCLUSIONS Mechanical stresses imposed by papillary muscle tethering increase MV leaflet area and thickness, with cellular changes suggesting reactivated embryonic developmental pathways. Understanding such actively adaptive mechanisms can potentially provide therapeutic opportunities to augment MV area and reduce ischemic mitral regurgitation.
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Affiliation(s)
- Jacob P Dal-Bianco
- Massachusetts General Hospital, Cardiac Ultrasound Laboratory, Harvard Medical School, Boston, MA 02114, USA
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Hung J, Solis J, Guerrero JL, Braithwaite GJC, Muratoglu OK, Chaput M, Fernandez-Friera L, Handschumacher MD, Wedeen VJ, Houser S, Vlahakes GJ, Levine RA. A novel approach for reducing ischemic mitral regurgitation by injection of a polymer to reverse remodel and reposition displaced papillary muscles. Circulation 2008; 118:S263-9. [PMID: 18824765 DOI: 10.1161/circulationaha.107.756502] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Ischemic mitral regurgitation (MR) relates to displacement of the papillary muscles from ischemic ventricular distortion. We tested the hypothesis that repositioning of the papillary muscles can be achieved by injection of polyvinyl-alcohol (PVA) polymer, a biologically inert biomaterial that has been specially formulated to produce an encapsulated, stable, resilient gel once injected into the myocardium. The purpose is to materially support the infarcted myocardium while at the same time repositioning the papillary muscles that become apically tethered in MR. METHODS AND RESULTS Nine sheep underwent ligation of circumflex branches to produce acute ischemic MR. PVA polymer was then injected by echo guidance into the myocardium underlying the infarcted papillary muscle. Hemodynamic data, left ventricular ejection fraction, elastance, tau (relaxation constant), left ventricular stiffness coefficient, and 2-dimensional and 3-dimensional echocardiograms were obtained post-MR and post-PVA injection. One animal died after coronary ligation and 2 did not develop MR. In the remaining 6, moderate MR developed. With PVA injection, the MR decreased significantly from moderate to trace-mild (vena contracta: 5+/-0.4 mm versus 2+/-0.7 mm, post-MR versus post-PVA injection; P<0.0001). This was associated with a decrease in infarcted papillary muscle-to-mitral annulus tethering distance (27+/-4 to 24+/-4 mm, post-MR versus post-PVA, P<0.001). Importantly, PVA injection was not associated with significant decreases in left ventricular ejection fraction (43+/-6% versus 37+/-4%, post-MR versus post-PVA, P=nonsignificant), elastance (3.5+/-1.4 versus 2.9+/-1.3; post-MR versus post-PVA injection, P=nonsignificant). Measures of left ventricular diastolic function, tau (100+/-51 ms to 84+/-37 ms, post-MR versus post-PVA; P=nonsignificant), and left ventricular stiffness coefficient (0.18+/-0.12 versus 0.14+/-0.08, post-MR versus post-PVA; P=nonsignificant) did not increase post-PVA. CONCLUSIONS PVA polymer injection resulted in acute reverse remodeling of the ventricle with papillary muscle repositioning to decrease MR. This was not associated with an adverse effect on left ventricular systolic and diastolic function. This new approach to alter pathological anatomy after infarction may offer an alternative strategy for relieving ischemic MR by correcting the position of the affected papillary muscle, thus relieving apical tethering.
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Affiliation(s)
- Judy Hung
- Massachusetts General Hospital, Cardiac Ultrasound Laboratory, Blake 256, 55 Fruit Street, Boston, MA 02114, USA.
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Tournoux F, Chan RC, Handschumacher MD, Salgo IS, Manzke R, Settlemier S, Guerrero JL, Cury RC, Weyman AE, Picard MH. Estimation of Radial Strain and Rotation Using a New Algorithm Based on Speckle Tracking. J Am Soc Echocardiogr 2008; 21:1168-74. [DOI: 10.1016/j.echo.2008.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Indexed: 11/15/2022]
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Chaput M, Handschumacher MD, Tournoux F, Hua L, Guerrero JL, Vlahakes GJ, Levine RA. Mitral leaflet adaptation to ventricular remodeling: occurrence and adequacy in patients with functional mitral regurgitation. Circulation 2008; 118:845-52. [PMID: 18678770 DOI: 10.1161/circulationaha.107.749440] [Citation(s) in RCA: 213] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Functional mitral regurgitation (MR) is caused by systolic traction on the mitral leaflets related to ventricular distortion. Little is known about whether chronic tethering causes the mitral leaflet area to adapt to the geometric needs imposed by tethering, in part because of inability to reconstruct leaflet area in vivo. Our aim was to explore whether adaptive increases in leaflet area occur in patients with functional MR compared with normal subjects and to test the hypothesis that leaflet area influences MR severity. METHODS AND RESULTS A new method for 3-dimensional echocardiographic measurement of mitral leaflet area was developed and validated in vivo against 15 sheep heart valves, later excised. This method was then applied in 80 consecutive patients from 3 groups: patients with normal hearts by echocardiography (n=20), patients with functional MR caused by isolated inferior wall-motion abnormality or dilated cardiomyopathy (n=29), and patients with inferior wall-motion abnormality or dilated cardiomyopathy but no MR (n=31). Leaflet area was increased by 35+/-20% in patients with LV dysfunction compared with normal subjects. The ratio of leaflet to annular area was 1.95+/-0.40 and was not different among groups, which indicates a surplus leaflet area that adapts to left-heart changes. In contrast, the ratio of total leaflet area to the area required to close the orifice in midsystole was decreased in patients with functional MR compared with those with normal hearts (1.29+/-0.15 versus 1.78+/-0.39, P=0.001) and compared with patients with inferior wall-motion abnormality or dilated cardiomyopathy but no MR (1.81+/-0.38, P=0.001). After adjustment for measures of LV remodeling and tethering, a leaflet-to-closure area ratio <1.7 was associated with significant MR (odds ratio 23.2, 95% confidence interval 2.0 to 49.1, P=0.02). CONCLUSIONS Mitral leaflet area increases in response to chronic tethering in patients with inferior wall-motion abnormality and dilated cardiomyopathy, but the development of significant MR is associated with insufficient leaflet area relative to that demanded by tethering geometry. The varying adequacy of leaflet adaptation may explain in part the heterogeneity of this disease among patients. The results suggest the need to understand the mechanisms that underlie leaflet adaptation and whether leaflet area can potentially be modified as part of the therapeutic approach.
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Affiliation(s)
- Miguel Chaput
- Division of Cardiothoracic Surgery and Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Poh KK, Levine RA, Solis J, Shen L, Flaherty M, Kang YJ, Guerrero JL, Hung J. Assessing aortic valve area in aortic stenosis by continuity equation: a novel approach using real-time three-dimensional echocardiography. Eur Heart J 2008; 29:2526-35. [PMID: 18263866 DOI: 10.1093/eurheartj/ehn022] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Two-dimensional echocardiographic (2DE) continuity-equation derived aortic valve area (AVA) in aortic stenosis (AS) relies on non-simultaneous measurement of left ventricular outflow tract (LVOT) velocity and geometric assumptions of LVOT area, which can amplify error, especially in upper septal hypertrophy (USH). We hypothesized that real-time three-dimensional echocardiography (RT3DE) can improve accuracy of AVA by directly measuring LVOT stroke volume (SV) in one window. METHODS AND RESULTS RT3DE colour Doppler and 2DE were acquired in 68 AS patients (74 +/- 12 yrs) prospectively. SV was derived from flow obtained from a sampling curve placed orthogonal to LVOT (Tomtec Imaging). Agreement between continuity-equation derived AVA by RT3DE (AVA(3D-SV)) and 2DE (AVA(2D)) and predictors of discrepancies were analysed. Validation of LVOT SV was performed by aortic flow probe in a sheep model with balloon inflation of septum to mimic USH. There was only modest correlation between AVA(2D) and AVA(3D-SV) (r = 0.71, difference 0.11 +/- 0.23 cm(2)). The degree of USH was significantly associated with difference in AVA calculation (r = 0.4, P = 0.005). In experimentally distorted LVOT geometry in sheep, RT3DE correlated better with flow probe assessment (r = 0.96, P < 0.001) than 2DE (r = 0.71, P = 0.006). CONCLUSION RT3DE colour Doppler-derived LVOT SV in the calculation of AVA by continuity equation is more accurate than 2D, including in situations such as USH, common in the elderly, which modify LVOT geometry.
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Affiliation(s)
- Kian Keong Poh
- Division of Cardiology, Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Beeri R, Yosefy C, Guerrero JL, Nesta F, Abedat S, Chaput M, del Monte F, Handschumacher MD, Stroud R, Sullivan S, Pugatsch T, Gilon D, Vlahakes GJ, Spinale FG, Hajjar RJ, Levine RA. Mitral Regurgitation Augments Post-Myocardial Infarction Remodeling. J Am Coll Cardiol 2008; 51:476-86. [PMID: 18222360 DOI: 10.1016/j.jacc.2007.07.093] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2007] [Revised: 07/09/2007] [Accepted: 07/16/2007] [Indexed: 12/01/2022]
Affiliation(s)
- Ronen Beeri
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
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Delucchi A, Valenzuela M, Ferrario M, Lillo AM, Guerrero JL, Rodriguez E, Cano F, Cavada G, Godoy J, Rodriguez J, Gonzalez CG, Buckel E, Contreras L. Early steroid withdrawal in pediatric renal transplant on newer immunosuppressive drugs. Pediatr Transplant 2007; 11:743-8. [PMID: 17910651 DOI: 10.1111/j.1399-3046.2007.00735.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Steroids have been a cornerstone in renal transplant immunosuppression. New immunosuppressive drugs have led to protocols using early steroid withdrawal or complete avoidance. A prospective protocol in 23 pediatric renal transplant (ages 2-14 yr) who received decreasing steroid doses stopping at day 7 post-Tx, FK, and MMF were compared with a CsA, AZT, historically matched steroid-based control group. Basiliximab was used in two doses. Anthropometric, biochemical variables, AR rates, and CMV infection were evaluated and compared using Student's t-test and regression analysis. A better growth pattern was seen in steroid withdrawal group. GFR rate and serum glucose were similar in both groups. Total serum cholesterol levels were significantly lower in steroid withdrawal group. The incidence of AR at 12 months was 4.3% in steroid withdrawal group vs. 8.6% in steroid-based group (p = ns). No difference in CMV infection was observed. Hemoglobin levels were low during the first months in both groups; reached normal values after six months. SBP became higher at 12 months in steroid-based group. Patient and graft survival was 98% in both groups at one-yr post-transplant. Early steroid withdrawal was efficacious, safe, and did not increase risk of rejection, preserving optimal growth, renal function, and reducing cardiovascular risk factors.
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44
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Beeri R, Yosefy C, Guerrero JL, Abedat S, Handschumacher MD, Stroud RE, Sullivan S, Chaput M, Gilon D, Vlahakes GJ, Spinale FG, Hajjar RJ, Levine RA. Early Repair of Moderate Ischemic Mitral Regurgitation Reverses Left Ventricular Remodeling: A Functional and Molecular Study. Circulation 2007; 116:I288-93. [PMID: 17846319 DOI: 10.1161/circulationaha.106.681114] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mitral regurgitation (MR) doubles postmyocardial infarction (MI) mortality. We have shown that moderate MR augments remodeling in an apical MI model (no intrinsic MR) with independent left ventricle-to-left atrial MR-type flow. We hypothesized that repairing moderate MR 1 month after MI reverses this remodeling. METHODS AND RESULTS Anteroapical MIs were created in 18 sheep, and a left ventricle-to-left atrial shunt implanted in 12 (regurgitant fraction, 30%). Six sheep had the shunt closed at 1 month (repair group). Sheep were compared at baseline, and at 1 and 3 months. Sheep in the MI+MR (unrepaired) and repaired groups remodeled during the first month (120% increased left ventricular end-systolic volume [ESV; P<0.01]), but shunt closure reversed remodeling at 3 months, with end-diastolic volume (EDV) and ESV 135% and 128% of baseline versus 220% and 280% without repair (P<0.001). At 3 months, dP/dt and preload-recruitable stroke work were relatively maintained in the repaired and MI-only groups versus nearly 50% decreases without repair. Prohypertrophic gp130 and antiapoptotic pAkt increased followed by exhaustion below baseline without repair, but remained elevated at 3 months with repair or MI only. With repair, matrix metalloproteinase-2 decreased to < or = 50% that without repair in remote and border zones at 3 months, and the matrix metalloproteinase inhibitor TIMP-4 increased dramatically. CONCLUSIONS Early repair of moderate MR in the setting of apical MI substantially reverses the otherwise progressive remodeling process, with reduced left ventricular volumes, relatively maintained contractility, persistently activated intracellular signals promoting hypertrophy and opposing apoptosis, and reduced matrix proteolytic activity. These findings are of interest for the current controversy regarding potential benefits of repair of MR after MI.
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Affiliation(s)
- Ronen Beeri
- Cardiac Ultrasound Laboratory, Cardiovascular Research Center, and Cardiothoracic Surgery Department, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
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45
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Hung J, Chaput M, Guerrero JL, Handschumacher MD, Papakostas L, Sullivan S, Solis J, Levine RA. Persistent Reduction of Ischemic Mitral Regurgitation by Papillary Muscle Repositioning: Structural Stabilization of the Papillary Muscle Ventricular Wall Complex. Circulation 2007; 116:I259-63. [PMID: 17846314 DOI: 10.1161/circulationaha.106.679951] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recurrent ischemic mitral regurgitation (IMR) is frequent despite initial reduction by annuloplasty because continued LV remodeling increases tethering to the infarcted papillary muscle (PM). We have previously shown that PM repositioning by an external patch device can acutely reduce IMR. In this study, we tested the hypothesis that IMR reduction persists despite possible continued LV remodeling. METHODS AND RESULTS In 7 sheep, we used a chronic ischemic posterior infarct model that produces LV dilatation and MR over 10 weeks. An epicardial patch device was adjusted under echo guidance to reduce MR, with follow-up over a further 8 weeks and evaluation by 3D echo and sonomicrometry. In all 7 sheep, moderate IMR resolved with acute patch application and PM repositioning (6.5+/-1.8 mm to 0.6+/-1.3 mm proximal jet width, P<0.001) without decrease in LVEF (43+/-3% to 44+/-8%). Eight weeks after PM repositioning, MR was not significantly greater (0.6+/-1.3 mm versus 1.0+/-1.0 mm, P=NS) despite an increase in LV volumes in 3 animals (2 had increases of 50+/-15%). On average, LV volumes did not change significantly (ESV: 46+/-8 mL versus 49+/-15 mL; P=NS and EDV: 85+/-16 mL versus 89+/-30 mL; P=NS). LVEF was unchanged from acute to chronic patch (44+/-8% versus 43+/-8%). Contractility as end-systolic elastance did not decrease from the chronic MI to the acute and chronic patch stages, nor were there any significant changes in dP/dt, LV stiffness constant, or time constant of LV relaxation (Tau). CONCLUSION PM repositioning is persistently effective in reducing moderate chronic IMR, even when LV volume increases. This may reflect structural stabilization by an external patch device of the papillary muscle-LV wall complex that controls mitral valve tethering.
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Affiliation(s)
- Judy Hung
- Massachusetts General Hospital, Cardiac Ultrasound Laboratory, Blake 256, 55 Fruit Street, Boston, MA 02114, USA.
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46
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Messas E, Yosefy C, Chaput M, Guerrero JL, Sullivan S, Menasché P, Carpentier A, Desnos M, Hagege AA, Vlahakes GJ, Levine RA. Chordal Cutting Does Not Adversely Affect Left Ventricle Contractile Function. Circulation 2006; 114:I524-8. [PMID: 16820631 DOI: 10.1161/circulationaha.105.000612] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Severing a limited number of second-order chordae to the anterior leaflet can improve ischemic mitral regurgitation (MR). Some concerns have been raised regarding possible influence on regional and global left ventricle (LV) function. We evaluated changes in cardiac function in 5 normal sheep with cutting of pre-instrumented chords in the beating heart to maintain constant load.
Methods and Results—
Under cardiopulmonary bypass, wires were placed around the 2 central basal chordae and brought outside the heart, which was restarted. Hemodynamic and imaging data were collected before and after chordal cutting by radiofrequency ablation using those wires. Segmental contractility was assessed invasively using sonomicrometers and noninvasively using Doppler tissue velocity and strain rate (with strain rate viewed as less load-dependent than ejection fraction) at 6 sites: base, mid-ventricle, and apex along the anteroseptal and posterolateral walls. We found no changes from before to after chordal cutting in LV end-diastolic volume (47.2±3.3 after cutting versus 48.4±4.6 mL before cutting,
P
=0.66), end-systolic volume (21.5±1.2 versus 22.3±2.8 mL,
P
=0.68), ejection fraction (54.2±1.8 versus 54.2±2.7%,
P
=0.96), systolic ventricular elastance (7.28±1.68 versus 7.66±2.11 mm Hg/mL,
P
=0.64), preload-recruitable stroke work (46.6±7.7 versus 50.2±10.7 mm Hg,
P
=0.76), and LVdP/dt (1480±238 versus 1392±250 mm Hg/s,
P
=0.45). Doppler tissue velocities and longitudinal strain rates surrounding the papillary muscles were unchanged, as were sonomicrometer longitudinal and mediolateral absolute strains. No wall motion abnormalities were visible around the papillary muscles, and no MR developed.
Conclusion—
We find no evidence for acutely decreased global or segmental LV contractility with chordal cutting. This absence of adverse effects is consistent with long-term clinical experience with cutting these chords in valve repair.
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Affiliation(s)
- Emmanuel Messas
- Université René Descartes Paris, Faculté de Médecine, INSERM U633, Assistance Publique-Hôpitaux de Paris, Department of Cardiology, Hôpital Européen Georges Pompidou, Paris, France.
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47
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Lewis GD, Witzke C, Colon-Hernandez P, Guerrero JL, Bloch KD, Semigran MJ. Sildenafil improves coronary artery patency in a canine model of platelet-mediated cyclic coronary occlusion after thrombolysis. J Am Coll Cardiol 2006; 47:1471-7. [PMID: 16580539 DOI: 10.1016/j.jacc.2005.11.060] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2005] [Revised: 11/03/2005] [Accepted: 11/21/2005] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We sought to assess the effect of sildenafil, a highly-specific type 5 phosphodiesterase (PDE5) inhibitor, on platelet-mediated cyclic coronary flow reductions occurring in a canine model of coronary thrombosis despite aspirin therapy. BACKGROUND The PDE5 inhibitors augment the antithrombotic effects of nitric oxide in vitro and in vivo, but it has been proposed that the PDE5 inhibitor sildenafil is prothrombotic. METHODS Cyclic coronary flow reductions were induced in the left anterior descending coronary artery by creation of a stenosis, endothelial injury, and thrombus formation followed by treatment with aspirin, heparin, and tissue plasminogen activator. After an initial observation period, dogs were treated with or without sildenafil (100 microg/kg bolus followed by 4 microg/kg/min infusion). RESULTS Cyclic coronary flow reductions ceased in five of six animals 18 +/- 5 min after initiation of sildenafil but continued in all six control animals. The portion of the observation period during which the coronary artery was patent increased from 52 +/- 9% to 83 +/- 5% after sildenafil administration (p = 0.008) but did not differ between the first and second observation periods in untreated dogs (49 +/- 11% vs. 44 +/- 11%, respectively). Among animals with plasma free sildenafil levels > or =20 nmol/l, cyclic coronary flow reductions were 73 +/- 12% less frequent and the time to cessation of cycling 72 +/- 14% shorter than in animals with levels <20 nmol/l (p < 0.05 for both). Sildenafil transiently decreased blood pressure 7 +/- 1% but did not change heart rate. Sildenafil treatment reduced ex vivo thrombin-induced platelet aggregation by 39 +/- 3% (p < 0.005). CONCLUSIONS Sildenafil improves coronary patency in a canine model of platelet-mediated coronary artery thrombosis, likely via inhibition of platelet aggregation.
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Affiliation(s)
- Gregory D Lewis
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
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48
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Delucchi A, Ferrario M, Varela M, Cano F, Rodriguez E, Guerrero JL, Lillo AM, Wolff E, Godoy J, Buckel E, Gonzalez G, Rodriguez J, Cavada G. Pediatric renal transplantation: a single center experience over 14 years. Pediatr Transplant 2006; 10:193-7. [PMID: 16573606 DOI: 10.1111/j.1399-3046.2005.00423.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Between 1989 and 2003, 100 transplants were performed in 96 patients at the pediatric nephrology unit of the Calvo Mackenna Children's Hospital. Mean age 10.9 +/- 3.9 yr (1-17.6), 30% from LD. Donors were younger than 5 yr in five patients and all recipients received an 'en bloc' graft. Original disease was hypo/dysplasia 27%, reflux nephropathy 22 and 17% chronic glomerulonephritis. The immunosuppressive protocol during the first period (n = 56, 1989-2000): Cyclosporine, steroids and azathioprine, and during the second period (n = 44, 2001-2003): FK, steroids, MMF and anti-CD25 antibody (mAbs). AR was reported in 22 patients, 11% in LD, 31% in DD (p < 0.01). The AR rate decreased from 40 to 8% after anti-CD25 monoclonal induction. Patient actuarial survival rate at 1, 3 and 5 yr was 100% for LD and 96% for DD. The overall actuarial graft survival at 1,3, and 5 yr was 96.7, 96.7 and 71% for LD and 89, 76 and 73% for DD donors. Graft survival rate improved from the first period (1989-2000) to the second period (2001-2003; p = 0.05). No difference in graft survival rate with HLA-A,B,DR matching was found. Graft survival rate was better when cold ischemia time was <24 h (p < 0.01). CMV infections increased from 19 to 40% when MMF and anti-CD25 Ab were introduced (p < 0.01). The height/age Z score at 1, 3 and 5 yr post-transplant was -2.2, -2.1, -2.2, respectively, for children older than 7 yr and -1.8, -1.9, -2.1 for those transplanted younger than 7 yr of age who were switched to alternate day steroids (p < 0.01). The cause of graft lost was: chronic rejection eight, non-adherence four, AR four and vascular thrombosis two. The cause of death in two patients was fungus septicemia and accelerated rejection. Pediatric renal transplantation can be performed in our group with acceptable morbidity, low mortality and graft survival rates similar to other reports in North America and Western Europe. Graft survival rate improved with newer immunosuppression and greater experience at the center. Management of non-adherence and chronic rejection remain the major challenges.
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Affiliation(s)
- A Delucchi
- Pediatric and Transplant Departments, School of Medicine, Luis Calvo Mackenna Children's Hospital, University of Chile, Santiago, Chile.
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49
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Schmidt U, Zhu X, Lebeche D, Huq F, Guerrero JL, Hajjar RJ. In vivo gene transfer of parvalbumin improves diastolic function in aged rat hearts. Cardiovasc Res 2005; 66:318-23. [PMID: 15820200 DOI: 10.1016/j.cardiores.2004.06.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2004] [Revised: 06/25/2004] [Accepted: 06/29/2004] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE Diastolic dysfunction is a characteristic finding of the aged mammalian heart. Parvalbumin acts as a Ca2+ sink and enhances relaxation in skeletal muscle, and overexpression of parvalbumin in myocardium increased cardiac relaxation in vitro as well as in vivo. Therefore, the objective of this study is to test the hypothesis that in vivo gene transfer of parvalbumin will improve diastolic dysfunction in aged rat heart. METHODS We used adenovirus to transfer parvalbumin into two different rat models of aging: the Fischer 344 (F344) and the Fischer 344 x Brown Norway F1 hybrid (F344 x BN). Cardiac function was measured and compared after gene transfer. RESULTS In vivo overexpression of parvalbumin in both rat aging models had no effect on systolic parameters but reduced left ventricular diastolic pressure and the time course of pressure decline. Overexpression of parvalbumin also improved the force frequency relationship in senescent rats. CONCLUSION In vivo overexpression of parvalbumin improves diastolic dysfunction in two rat models of senescence, and this effect is independent of the rat strain investigated. The results show promise that gene therapy of parvalbumin may address the impaired Ca2+ homeostasis and diastolic dysfunction without an increase in energy expenditure.
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Affiliation(s)
- Ulrich Schmidt
- Department of Anesthesia and Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
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50
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Sebag IA, Handschumacher MD, Ichinose F, Morgan JG, Hataishi R, Rodrigues ACT, Guerrero JL, Steudel W, Raher MJ, Halpern EF, Derumeaux G, Bloch KD, Picard MH, Scherrer-Crosbie M. Quantitative Assessment of Regional Myocardial Function in Mice by Tissue Doppler Imaging. Circulation 2005; 111:2611-6. [PMID: 15897347 DOI: 10.1161/circulationaha.104.474411] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Tissue Doppler imaging (TDI) is a novel echocardiographic method to quantify regional myocardial function. The objective of this study was to assess whether myocardial velocities and strain rate (SR) could be obtained by TDI in mice and whether these indices accurately quantified alterations in left ventricular (LV) systolic function.
Methods and Results—
TDI was performed in 10 healthy mice to measure endocardial (v
endo
) and epicardial systolic velocities and SR. In further experiments, TDI indices were compared with dP/dt
max
and with sonomicrometer-derived regional velocities, at rest and after administration of dobutamine or esmolol. TDI indices were also studied serially in 8 mice before and 4 and 7 hours after endotoxin challenge. Myocardial velocities and SR were obtained in all mice with low measurement variability. TDI indices increased with administration of dobutamine (v
endo
from 2.2±0.3 to 3.8±0.2 cm/s [
P
<0.01]; SR from 12±2 to 20±2 s
−1
[
P
<0.05]) and decreased with administration of esmolol (v
endo
1.4±0.2 cm/s [
P
<0.05]; SR 6±1 s
−1
[
P
<0.01]). Both indices correlated strongly with dP/dt
max
(
r
2
=0.79 for SR and
r
2
= 0.69 for v
endo
; both
P
<0.0001). SR and shortening fraction were predictors of dP/dt
max
even after adjustment for the confounding effect of the other variables. V
endo
correlated closely with sonomicrometer-measured velocity (
r
2
=0.71,
P
<0.0005). After endotoxin challenge, decreases in both v
endo
and SR were detected before decreases in shortening fraction became manifest.
Conclusions—
Myocardial velocities and SR can be measured noninvasively in mice with the use of TDI. Both indices are sensitive markers for quantifying LV global and regional function in mice.
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Affiliation(s)
- Igal A Sebag
- Cardiac Ultrasound Laboratory in the Cardiology Division of the Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Mas 02114, USA
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