Journal of Cardiovascular and Thoracic Research最新文献

Iatrogenic aortic regurgitation after mitral valve surgery is the consequence of either direct stitching-related perforation or indirect distortion of aortomitral fibrous continuity by the mitral ring/prosthesis. This review aims at describing the reported cases of iatrogenic aortic valve regurgitation following mitral valve surgery, focusing primarily on its management. PubMed, ScienceDirect, DOAJ, and Cochrane databases were searched from inception until December 2023 for case reports and case series describing iatrogenic aortic valve regurgitation following mitral valve surgery. The literature review found 17 articles describing 20 cases of new onset aortic valve regurgitation after mitral valve surgery. Among them, 5 patients did not undergo reoperation, either due to medical decision or patient refusal. The non-coronary cusp was predominantly affected (11 cases), the left coronary cusp involved in 4 cases, and a mixed mechanism occurred in 5 cases. Subsequent surgical interventions included aortic valve replacements in 5 cases and aortic valve repair in 4 cases. A suggested management decision algorithm is finally proposed. Iatrogenic aortic valve regurgitation after mitral valve surgery remains an unfortunate complication. Attention should be given to prevent this complication. Intraoperative transesophageal echocardiography plays a crucial role for early detection. Management strategies vary from medical therapy to surgical interventions. The reparative strategy requires a surgical procedure associated with significant mortality.

Introduction: Coronary artery disease is a significant public health concern worldwide, with coronary angiography being a crucial diagnostic procedure. The safety and clinical outcomes of fasting versus non-fasting before elective coronary angiography have been a topic of debate. This study aimed to address this issue and explore the impact of fasting on patient outcomes.

Methods: A total of 600 candidates for coronary angiography were enrolled in this study and divided into two groups: fasting and non-fasting. Demographic data and clinical outcomes were collected and compared between the two groups. Various parameters, including pulmonary aspiration, hypoglycemia, gastrointestinal symptoms, vasovagal reactions, hypotension, and patient satisfaction, were evaluated.

Results: This study revealed that fasting before coronary angiography did not significantly impact patient outcomes. Also, there were statistically significant differences between the groups in terms of hypoglycemia during hospitalization in fasting patients (P-value=0.001), gastrointestinal symptoms in fasting patients (P=0.007), hypotension during the procedure in fasting patients (P=0.002), and vasovagal responses during sheath removal in fasting patients (P<0.001). In addition, none of our patients experienced pulmonary aspiration during the procedure. Interestingly, patient satisfaction was similar between the two groups (P=0.09). Indicating that fasting may not be necessary before elective coronary angiography.

Conclusion: Based on the findings of this study, it can be concluded that fasting before elective coronary angiography may not be essential and does not lead to serious adverse outcomes. These results have important implications for clinical practice and may help improve patient experience and optimize care in the cardiac diagnostic setting.

Introduction: Intraoperative transit time flowmetry (TTF) is an essential technique for evaluating graft function during off-pump coronary artery bypass grafting (OPCABG). This study compares graft quality and outcomes using TTF in two surgical approaches: sequential and Y-type saphenous vein grafting.

Methods: A total of 120 patients with triple-vessel coronary artery disease were enrolled and randomized into two groups: Group 1 (n=60) received sequential grafts; Group 2 (n=60) received Y-grafts. Mean graft flow (MGF) and pulsatility index (PI) were measured intraoperatively. Graft function was classified based on flow>15 ml/min and PI<2.5. All patients underwent coronary CT angiography at 48 months to assess graft patency.

Results: Intraoperative TTF showed no significant difference in MGF or PI between graft types, although sequential grafts demonstrated slightly higher flow and lower resistance. Intraoperative graft failure occurred in 1.7% (sequential) vs. 3.3% (Y-grafts). At 48-month follow-up, sequential grafts showed 100% patency, while Y-grafts had a 7.0% occlusion rate. Multivariate analysis identified vessel diameter and conduit type as significant predictors of graft performance; graft configuration (sequential vs. Y) was not independently predictive.

Conclusion: TTF is a valuable intraoperative tool for ensuring graft functionality in OPCABG. While both techniques are viable, sequential grafting demonstrated superior mid-term patency and lower failure rates. These findings support the preferential use of sequential grafting when anatomically feasible and highlight the importance of routine TTF to optimize surgical outcomes.

Epicardial adipose tissue (EAT) is a fat layer of the heart located between the pericardium and myocardium and considered to be an important fat depot of the heart bearing thermoregulatory and protective functions, amongst others. Understanding of the dynamics of EAT, both positive and negative, opens new avenues for future cardiovascular research, including the development of new diagnostic and therapeutic tools. The aim of the study was to conduct a comprehensive literature review on the role of EAT, the factors influencing the change of its size, and to learn a causative relationship between fluctuations of EAT and different physiological and pathological conditions. Overall, 516 human studies indexed in PubMed, Embase, and Cochrane Library search engines (from inception up to January 2025) were screened. A total of 467 articles were excluded because they did not meet the inclusion criteria. Finally, 44 articles published from inception until January 2025 were reviewed. Our review categorises these factors into modifiable and non-modifiable, as well as aggravating and mitigating groups, to better understand their impact on EAT and cardiovascular health. Fluctuations of EAT may potentially represent a biomarker in cardiovascular research and medicine, however, it requires further validation in future studies. In such studies, it is advisable that the influencing factors are taken into consideration with adjusted normal reference ranges of EAT. Besides, the role of modifiable factors in coronary artery disease should be studied in future trials, which may shed light on the applicability of EAT as a biomarker and improve therapeutic modalities in heart disease.

A 28-year-old male with a relatively short history of progressive dyspnea and a large pericardial effusion with tamponade was found to have an intracardiac mass localized in right atrium (RA) on echocardiography. Multimodality imaging revealed an irregular mass abutting the lateral wall of RA, with infiltration into surrounding pericardium and superior venacava. Positron emission tomography (PET) scan confirmed the mass as metabolically active lesion, along with uptake in mediastinal structures and lymph nodes. After an unrewarding percutaneous endomyocardial biopsy, open surgical biopsy was performed. Histologic examination confirmed the diagnosis of cardiac angiosarcoma. Unfortunately, patient had refractory shock and recurrent massive pericardial effusion (hemorrhagic) after biopsy and succumbed. The case highlights diagnostic dilemma of pericardial effusion in tuberculosis-endemic areas, role of multi-modality imaging in confirming cardiac malignancy and poor outcome of such patients.

Ischemic mitral regurgitation (IMR) presents a clinical challenge amidst evolving treatment paradigms, particularly when accompanied by coronary artery disease (CAD). Controversies persist regarding the optimal surgical approach, resulting in a lack of definitive guidelines. A comprehensive review of seminal studies from 2000 to 2020 was conducted to elucidate the evolving discourse and treatment landscape for IMR. Studies encompassing varied interventions, including coronary revascularization and concomitant mitral valve procedures, were scrutinized to gauge their impact on patient outcomes. Early studies diverged in advocating for or against adjunct mitral valve intervention during coronary artery bypass grafting (CABG) in IMR patients. Subsequent trials like the POINT and RIME trials highlighted benefits associated with concomitant mitral interventions. However, the Cardiothoracic Surgical Trials Network (CTSN) trials raised concerns regarding adverse events and recurrence rates post-mitral repair.The ambiguity in guidelines for IMR management persists, leaving surgeons to navigate individualized treatment decisions. Recommendations from the American Heart Association (AHA) offer moderate support for mitral valve interventions, yet a clear consensus remains elusive. The necessity for refined guidelines reflecting current evidence is imperative to optimize outcomes in IMR patients.

Introduction: Acknowledging lacking of recognition on postoperative aortic remodeling by intraoperative transition of cannulation perfusion mode during the open repair surgery of DeBakey type I acute aortic dissection (AAD), this study aims to investigate the effect of interactive cannulation strategy on the maximum false lumen area (MFLA) ratio.

Methods: A total of 321 AAD patients were retrospectively reviewed from March 2017 to March 2023, of which 166 patients receiving peripheral cannulation (PC, right axillary and femoral artery) and 155 patients receiving peripheral-to-centric cannulation (PCC, transition from right axillary and femoral artery to one branch of the tetrafurcated graft). The primary outcome was postoperative MFLA ratio in descending thoracic aorta. Secondary outcomes were postoperative inflammation response and anaerobic metabolism, hepatorenal dysfunction, and the ostium condition of branch artery of abdominal aorta involved by false lumen.

Results: There was a lower postoperative MFLA ratio in PCC group than that in PC group, respectively (0.36±0.11 vs. 0.44±0.13, P<0.001). The abdominal branch arteries involved by false lumen was also deceased in PCC group. There was also a lower serum inflammation response (24 hours, hr-CRP: 111.8±14.1mg/L vs. 116.8±15.0mg/L, P=0.002; IL-6: 104.4±49.9pg/ml vs. 124.0±50.1pg/ml, P<0.001), anaerobic metabolism (8 hours, lactate: 8.3±1.5mmol/L vs. 8.8±1.6mmol/L, P=0.002), impaired liver function (15.5% vs. 39.8%, P<0.001) and need for renal replacement therapy (10.3% vs. 20.5%, P=0.012) in PCC group than those in PC group.

Conclusion: Interactive cannulation with prompt transition from peripheral artery to centric perfusion during surgical repair of AAD was associated with the reduction of MFLA and hepatorenal dysfunction.

Introduction: Neutrophil Gelatinase-Associated Lipocalin (NGAL) is a specific early diagnostic biomarker for acute kidney injury and has shown high diagnostic value across various types of injuries with different etiologies. However, its role in heart failure (HF) diagnosis remains under investigation. This study aims to assess NGAL levels as a potential biomarker for the early detection of HF in patients without of kidney disease.

Methods: A total of 118 participants were enrolled from Shahid Ashrafi and Saei Khomeini Hospitals, including 59 patients with HF and 59 healthy controls. The patients was 48 years, while the healthy controls had an average age of 46 years. The patient group was diagnosed with heart failure with reduced ejection fraction (HFREF, EF<40%) and had no history of kidney disease. After providing written informed consent, they were enrolled in the study: (code IR.IAU. FALA.REC.1397.024). Blood samples were collected from all participants to measure BUN (Blood Urea Nitrogen), creatinine, cardiac troponin I (CTNI), C-reactive protein (CRP), NGAL, and white blood cell (WBC) count.

Results: The results revealed significantly higher serum levels of NGAL, CRP, CTNI, CR, and BUN in the patient group compared to healthy controls. A significant relationship was found between these biomarkers and the incidence of HF in individuals without prior kidney disease (P value<0.001).

Conclusion: In conclusion, NGAL can be used to accurately predict the presence of HF without a history of kidney disease of cases, suggesting its potential as an early diagnostic tool for HF in such patients.

Introduction: Atrial fibrillation (AFib) is a sustained form of cardiac arrythmia that occurs due to sympathetic overdrive, neurohumoral and electrophysiological changes. Sympatho-renal modulatory approach via miRNA-based therapeutics is likely to be an important treatment option for AFib. The study was aimed to unravel the common miRNAs as therapeutic targets involved in sympatho- renovascular axis to combat AFib.

Methods: We employed the bioinformatics approach to discover differentially expressed genes (DEGs) from microarray gene expression datasets GSE41177 and GSE79768 of AFib patients. Concomitantly, genes associated with sympathetic cardio-renal axis, from Genetic Testing Registry (GTR) of National Center for Biotechnology Information (NCBI) were also analyzed. Overlapping miRNAs that target the maximum number of genes across all three pathological conditions perpetuating AFib were shortlisted. To confirm the reliability of the identified miRNAs, differential expression analysis was performed on miRNA expression profiles GSE190898, GSE68475, GSE70887 and GSE28954 derived from AFib patient samples.

Results: ShinyGO analysis revealed enrichment in beta-adrenergic signaling, calcium signaling, as well as G protein-coupled receptor (GPCR) signaling involved in post synaptic membrane potential. The intersection of top 10 modules in miRNA-mRNA network revealed hub miRNAs having highest node degree, maximum neighborhood component (MNC), and maximal clique centrality (MCC) scores. Differential expression analysis revealed hub miRNAs identified through integrated approach were found to be significantly dysregulated in AFib patients.

Conclusion: This integrated approach identified 6 hub miRNAs, 4 reported (miR-101-3p, miR-23-3p, miR-27-3p, miR-25-3p) and 2 novel (miR-32-5p, miR-92-3p) miRNAs that might act as putative biomarkers for AFib.

Introduction: The natural course and clinical significance of moderate mitral regurgitation (MR) in patients undergoing isolated coronary artery bypass graft (CABG) surgery are still debated. This study aimed to determine the course of moderate functional MR after CABG.

Methods: In this registry-based cohort, patients who underwent isolated elective CABG at Tehran Heart Center between 2010 and 2017 were included. Transthoracic echocardiography was performed at baseline before CABG and after 12 months of follow-up. The outcomes of interest were both improvement and progression of MR during the study.

Results: Among 291 patients with moderate functional MR, the mean age was 66.1±9.6 years, and 204 (70.1%) were males. Most of the study population had extensive coronary disease (240 patients; 82.5% with thee-vessel disease). Moreover, 101 patients (34.7%) had suffered a prior myocardial infarction. The mean LVEF before CABG was 42.0±9.9 and 145 patients (49.8%) had an LVEF≤40% prior to surgery.The median follow-up duration was 10.1 months (9.0-11.2). Only four patients had improvements in MR at follow-up. Eleven patients (3.8%) in the study population showed worsening MR after isolated CABG. In this group of patients, mean LVEF dropped from 44.1±10.9 at baseline to 41.8±11.5 during follow-up Due to the low number of cases with regression and progression, an analysis of predictors of MR change was not performed.

Conclusion: This study showed that in patients with moderate functional MR, isolated CABG did not result in significant changes in the degree of MR.