Agregador de feeds

Transplant Direct. 2025 Jun 12;11(7):e1802. doi: 10.1097/TXD.0000000000001802. eCollection 2025 Jul.

ABSTRACT

BACKGROUND: Kidney transplant physicians believe that the cardiac status of kidney transplant recipients influences posttransplant outcomes. However, the Scientific Registry of Transplant Recipients (SRTR) does not include cardiac variables in its risk-adjustment model, raising the question of whether it fairly risk adjusts recipients.

METHODS: This study conducted a retrospective analysis of the prospectively collected National Surgical Quality Improvement Program Transplant database to assess the impacts of pretransplant cardiac revascularization and left ventricular ejection fraction (LVEF) <55% on posttransplant outcomes in deceased donor renal transplantation. Recipients from 2017 to 2019 were stratified into those with versus without prior revascularization and those with LVEF <55% versus LVEF ≥55%. Primary outcomes included differences in 1-y patient and graft survival. Secondary outcomes included postoperative complications. An a priori-specified multivariable Cox-proportional hazards model including existing SRTR variables assessed the independent effect of prior revascularization on patient and graft survival.

RESULTS: A total of 2377 recipients were included: 13.3% had prior cardiac revascularization and 11.2% had LVEF <55%. Previous revascularization was significantly associated with an increased risk of deep surgical site infection (3.8% versus 1.1%, P = 0.001), delayed graft function (39.2% versus 28.3%, P < 0.001), myocardial infarction (4.4% versus 0.8%, P < 0.001), longer length of stay (6.57 versus 5.54 d, P = 0.001), and more readmissions (32.9% versus 23.1%, P < 0.001). In univariable analysis, previous revascularization was associated with death (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.11-5.1; P = 0.03) but not graft loss (HR, 1.3; 95% CI, 0.54-3.1; P = 0.55). LVEF <55% was only associated with a higher rate of sepsis (4.3% versus 1.7%, P = 0.011). After adjusting for SRTR variables (age, diabetes, peripheral vascular disease), previous revascularization was not independently associated with death (HR, 1.33; 95% CI, 0.57-3.1; P = 0.50).

CONCLUSIONS: Previous cardiac revascularization is associated with patient survival and complications, more than LVEF <55%. However, we show that existing variables of the SRTR risk model largely capture the impact of previous cardiac revascularization on patient survival.

PMID:40519671 | PMC:PMC12165656 | DOI:10.1097/TXD.0000000000001802

J Inflamm Res. 2025 Jun 9;18:7515-7527. doi: 10.2147/JIR.S515437. eCollection 2025.

ABSTRACT

PURPOSE: This study aimed to investigate the effects of the systemic inflammatory response index (SIRI) on the long-term prognosis of patients with acute coronary syndrome (ACS) and obstructive sleep apnea (OSA).

PATIENTS AND METHODS: This prospective cohort study enrolled patients with ACS and OSA at the Beijing Anzhen Hospital between June 2015 and January 2020. The SIRI was calculated at admission for all patients. Patients with SIRI ≥ 1.16 × 109/L were classified into the high SIRI group based on the optimal cutoff value for predicting major adverse cardiovascular and cerebrovascular events (MACCE) determined by the receiver operating characteristic (ROC) curve of our cohort study. The other patients were categorized into the low SIRI group. The primary endpoint was a composite of MACCE, including cardiovascular death, recurrent myocardial infarction (MI), stroke, and ischemia-driven revascularization.

RESULTS: A total of 1011 patients with ACS and OSA were enrolled, 435 of whom (43%) were in the high SIRI group. Over a median follow-up of 2.8 (1.4-3.6) years, 179 patients experienced MACCE. Kaplan-Meier survival analysis showed a higher cumulative incidence of MACCE in the high-SIRI group (log-rank P < 0.001). A restricted cubic spline analysis also showed a monotonic increase with a greater SIRI value for MACCE (P = 0.011). After adjusting for clinically relevant confounders, a high SIRI was independently associated with elevated MACCE risk (adjusted HR = 1.44, 95% CI 1.02-2.05, P = 0.039).

CONCLUSION: A high SIRI was associated with poorer clinical outcomes during long-term follow-up in patients with ACS and OSA.

PMID:40519655 | PMC:PMC12164839 | DOI:10.2147/JIR.S515437

J Tradit Chin Med. 2025 Jun;45(3):538-551. doi: 10.19852/j.cnki.jtcm.2025.03.010.

ABSTRACT

OBJECTIVE: To investigate the mechanism of Dan Ze mixture (, DZM) in the treatment of lipotoxic cardiomyopathy.

METHODS: Ultra-performance liquid chromatography tandem mass spectrometry was employed to characterize the serum migration constituents of DZM. A lipotoxic cardiomyopathy rat model was established through high-fat diet and intervened by different doses of DZM. The cardiac function was assessed using echocardiography, and hematoxylin and eosin, oil red O, and Masson staining were conducted to evaluate morphological changes, lipid accumulation, and fibrosis in myocardial tissue. Serum myocardial enzyme activity, lipid levels, and lipid content of myocardial tissue were measured, while fluorescent staining and colorimetry were used to assess oxidation levels in myocardial tissue. Mitochondrial membrane potential was detected by 5,5', 6,6'-Tetrachloro-1,1',3,3'-tetraethyl-imidacarbocyanineio-dide (JC-1). Transmission electron microscopy was employed to observe ultrastructure and mitochondrial structure changes in myocardial tissue. Fluorescence double staining and colocalization were utilized to observe the binding of autophagosomes and mitochondria, while immunohistochemical staining was used to detect the expression of mitophagy-related proteins. Terminal deoxynucleoitidyl transferase mediated nick end labeling staining was employed for the identification of apoptosis in myocardial tissue, while quantitative real-time reverse transcriptase polymerase chain reaction (qRT-PCR) and Western blot were utilized for the detection of apoptosis, B-cell lymphoma-2 adenovirus E1B 19 kDa-interacting protein 3 (BNIP3)/ mitophagy signaling pathway-related genes and proteins. In palmitic acid-induced Rat H9C2 cardiomyocytes (H9c2) cells, various cellular parameters including cell viability, lactate dehydrogenase release, apoptosis rate, oxidative stress level, mitochondrial structure and function, and mitophagy level were assessed after the treatment of DZM drug-containing serum for a duration of 24 h. The cellular expressions of BNIP3/mitophagy signaling pathway relevant genes and proteins were further evaluated using qRT-PCR and Western blot techniques.

RESULTS: A total of 295 prototypes (e.g., phenolic acids, quinones, terpenoids) were identified in serum of rats after oral administration of DZM. In vivo, DZM therapy has been shown to effectively enhance cardiac function, mitigate high-fat diet-induced myocardial structural damage and lipid accumulation. Furthermore, DZM has demonstrated the ability to reduce lipid levels, attenuate cell apoptosis, combat oxidative stress, enhance mitochondrial structure and function, and activate the BNIP3/mitophagy signaling pathway. Furthermore, the silencing of BNIP3 has been shown to exacerbate palmitic acid-induced damages in H9c2 cells, while inhibiting the BNIP3/mitophagy signaling pathway can mitigate the inhibitory effects of DZM on palmitic acid-induced apoptosis, lipid deposition and oxidative stress.

CONCLUSION: This study presents preliminary evidence for the therapeutic efficacy of DZM on lipotoxic cardiomyopathy through the activating BNIP3/mitophagy signaling pathway.

PMID:40524293 | PMC:PMC12134320 | DOI:10.19852/j.cnki.jtcm.2025.03.010

Free Radic Biol Med. 2025 Jun 14;237:542-557. doi: 10.1016/j.freeradbiomed.2025.06.017. Online ahead of print.

ABSTRACT

Myocardial ischemia-reperfusion injury (MI/RI) is a major contributor to poor outcomes after revascularization in patients with myocardial infarction, largely due to the absence of targeted therapies. Phillygenin (PHI), a bioactive compound isolated from Forsythia suspensa, has been found to confer various pharmacological properties, including anti-inflammatory, hepatoprotective, and renal protective effects. However, the specific role of PHI in MI/RI remains largely unclear. Thus, this study aims to investigate whether PHI exerted cardioprotective effects against MI/RI, and if so, to elucidate the underlying molecular mechanisms. Hypoxia/reoxygenation (H/R) models in H9c2 cardiomyocytes and MI/RI mouse models were established. PHI intervention markedly improved cardiac function, reduced myocardial infarct size, and attenuated cardiomyocyte damage in MI/RI mice. PHI treatment significantly reversed H/R-induced cellular injury and mitochondrial dysfunction in cultured cardiomyocytes. Notably, PHI administration significantly mitigated myocardial cuproptosis, rather than pyroptosis and ferroptosis. Specifically, PHI reduced cardiomyocyte cuproptosis by downregulating the protein expression of ferredoxin 1 (FDX1) and lipoyl synthase (LIAS), and suppressing copper accumulation. Induction of cuproptosis abolished the cardiac benefits of PHI in vivo and in vitro. Mechanistically, PHI promoted the lysosomal localization and degradation of the copper transporter 1 (CTR1), thus alleviating cuproptosis, inflammation, oxidative stress, and mitochondrial injury in cardiomyocytes. Overall, PHI may be a promising therapeutic agent for the alleviation of MI/RI-induced cardiac dysfunction through the inhibition of cuproptosis via facilitating the transfer of CTR1 to the lysosome for degradation.

PMID:40523538 | DOI:10.1016/j.freeradbiomed.2025.06.017

J Cardiovasc Pharmacol. 2025 Jun 16. doi: 10.1097/FJC.0000000000001721. Online ahead of print.

ABSTRACT

Paraquat, a widely used herbicide, is known to induce oxidative stress and inflammation, which leads to myocardial injury. Klotho, a protein with antioxidative and anti-inflammatory properties, has garnered as a potential cardioprotective factor. This study aimed to investigate whether cardiac-specific overexpression of klotho mitigates paraquat-induced myocardial injury through the activation of the NF-E2-related factor-2 (Nrf-2)/antioxidant response element (ARE) signaling pathway. Our results revealed that both mRNA and protein expressions of Klotho were significantly reduced in the myocardial tissue of paraquat-exposed rats. However, cardiac-specific overexpression of Klotho significantly restored Klotho levels and attenuated paraquat-induced myocardial injury, as evidenced by the decreased lactate dehydrogenase (LDH) and cardiac troponin I (cTnI) contents, and creatine kinase (CK) activity, alongside with apoptosis. Furthermore, cardiac-specific overexpression of Klotho inhibited oxidative stress and inflammation in myocardial tissue of paraquat-subjected rats. Mechanistically, Klotho activated of the Nrf2/ARE signaling pathway, upregulating cytoprotective genes such as NAD(P)H quinone oxidoreductase 1 (NQO1), heme oxygenase-1 (HO-1), glutamate cysteine ligase catalytic (GCLC) subunit, and glutamate cysteine ligase modifier (GCLM) subunit. Our findings indicate that Klotho protects against paraquat-induced myocardial injury by suppressing oxidative stress and inflammation, primarily via the activation of the Nrf2/ARE signaling pathway. These results underscore the potential therapeutic role of Klotho in preventing paraquat-induced myocardial damage.

PMID:40521670 | DOI:10.1097/FJC.0000000000001721

Theranostics. 2025 May 15;15(13):6253-6254. doi: 10.7150/thno.115473. eCollection 2025.

ABSTRACT

[This corrects the article DOI: 10.7150/thno.15162.].

PMID:40521208 | PMC:PMC12159842 | DOI:10.7150/thno.115473

Cytotechnology. 2025 Aug;77(4):122. doi: 10.1007/s10616-025-00759-x. Epub 2025 Jun 11.

ABSTRACT

Atherosclerosis is a progressive pathological disorder resulting in various vital cardiovascular diseases such as myocardial infarction and stroke, leading to high mortality worldwide. Currently, the precise mechanisms of pathogenesis and progression of atherosclerosis remained unclear. Circular RNAs (circRNAs) have been implicated in vital processes of cardiovascular disease. In this study, we aimed to investigate the roles of circSirt1 in vascular smooth muscle cell (VSMC) injury during atherosclerosis. We found circSirt1 was significantly downregulated in VSMCs from atherosclerosis patients compared with those from healthy controls. Under oxidative stress, expression of circSirt1 was remarkedly suppressed in VSMCs. Notably, overexpression of circSirt1 effectively protected the oxidative stress-induced VSMC injury. On the other way, miRNA-27b-3p was high-expressed in VSMCs from atherosclerosis patients and was effectively induced under oxidative stress. Overexpression of miR-27b-3p exacerbated the oxidative stress-induced VSMC injury. From the non-coding RNA service, starBase, circSirt1 was predicted to interact with miR-27b-3p. This association was further validated by RNA pull-down and luciferase assays. We detected glutamine metabolism rate was depressed under oxidative stress and low glutamine supply rendered VSMCs more susceptible to oxidative stress. Furthermore, we identified the glutamine metabolism key enzyme, glutaminase (GLS) as a direct target of miR-27b-3p in VSMCs. miR-27b-3p blocked glutamine metabolism and promoted VSMC cell injury through direct targeting GLS. Finally, rescue experiments verified the circSirt1-protected VSMC injury was through regulating the miR-27b-3p-GLS axis that restoration of miR-27b-3p in circSirt1-overexpressed VSMCs successfully overrode the high-circSirt1-moduated miR-27b-3p and GLS expressions and the oxidative stress-induced VSMC injury. Summarily, these results unveiled vital roles and molecular mechanisms of circSirt1 in oxidative stress-induced VSMC injury during atherosclerosis by regulating the miR-27b-3p-GLS axis, indicating rescue of circSirt1 in VSMCs could be an effectively therapeutic approach to treat atherosclerosis.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10616-025-00759-x.

PMID:40521053 | PMC:PMC12158877 | DOI:10.1007/s10616-025-00759-x

Front Cardiovasc Med. 2025 May 30;12:1535401. doi: 10.3389/fcvm.2025.1535401. eCollection 2025.

ABSTRACT

Cardiovascular disease (CVD) remains a leading cause of death globally, posing a major public health challenge. Due to the complexity of CVD's etiology, understanding its pathogenesis has been a significant challenge and research focus. In recent years, the communication between organelles has gained increasing attention, with mitochondria-associated endoplasmic reticulum (ER) membranes (MAMs) emerging as a key structural component that facilitates dialogue between the mitochondria and the ER. Numerous studies have highlighted that proteins located in MAMs may play a role in the development of CVD. Among these, mitofusin 2 (MFN2), a protein found on the outer mitochondrial and ER membranes, has garnered particular interest due to its widespread presence in MAMs. This review aims to sort out current research on MFN2, focusing on its potential involvement in myocardial protection through its mediation of MAMs. We discuss how MFN2-mediated MAMs may contribute to the protection against various CVDs, including myocardial ischemia/reperfusion injury, diabetic cardiomyopathy, dilated cardiomyopathy, pathological myocardial hypertrophy, cardiotoxicity, and heart failure. However, given the functional diversity of MFN2, the current body of research remains controversial, and further studies are urgently needed to clarify its precise mechanisms of action.

PMID:40520935 | PMC:PMC12163069 | DOI:10.3389/fcvm.2025.1535401

Cureus. 2025 May 13;17(5):e84064. doi: 10.7759/cureus.84064. eCollection 2025 May.

ABSTRACT

Right-sided heart failure (RHF) remains a clinically challenging and under-researched condition often managed through extrapolated guidance from left-sided heart failure data. This review explores the therapeutic promise of empagliflozin, a sodium-glucose co-transporter 2 inhibitor, for RHF management. While empagliflozin is currently approved for glycemic control and heart failure with reduced ejection fraction, its potential to improve symptoms, functional capacity, and cardiovascular outcomes in RHF warrants focused investigation. In the absence of RHF-specific randomized controlled trials (RCTs), this review synthesizes insights from preclinical models, subgroup analyses, and surrogate markers drawn from major trials such as EMPEROR-Reduced, EMPEROR-Preserved, and EMPIRE-HF. Empagliflozin's mechanisms are conceptually grouped as hemodynamic, reducing preload, afterload, and venous congestion, and improving right ventricle-pulmonary artery coupling and metabolic, enhancing myocardial energetics, reducing inflammation and fibrosis, and inhibiting the Na⁺/H⁺ exchanger (NHE1). Although RHF patients were not separately stratified in these trials, indirect benefits observed through TAPSE improvement, renal protection, and congestion relief support further exploration. This review emphasizes the need for RHF-specific RCTs, mechanistic studies, and real-world cohorts to validate and expand empagliflozin's therapeutic scope. Overall, empagliflozin emerges as a mechanistically sound and clinically promising candidate for transforming the management of RHF by targeting both cardiac and renal dysfunction.

PMID:40519498 | PMC:PMC12163198 | DOI:10.7759/cureus.84064

Int J Cardiol Cardiovasc Risk Prev. 2025 May 29;26:200443. doi: 10.1016/j.ijcrp.2025.200443. eCollection 2025 Sep.

ABSTRACT

BACKGROUND: S100A4 plays a crucial role in myocardial ischemia-reperfusion injury (MIRI), where the interplay between autophagy and inflammation shapes the progression of reperfusion injury. However, the specific mechanisms by which S100A4 influences autophagy and inflammation in this context remain unclear.

METHODS: An ischemia-reperfusion (I/R) model was established in mice. The optimal timing for inducing reperfusion injury was determined, and mice were divided into sham and experimental groups. The experimental group underwent 2 h of ischemia/reperfusion injury followed by a 2-day reperfusion period. In the I/R + S100A4-shRNA group, S100A4 silencing was achieved through the injection of short hairpin RNA (shRNA). Myocardial ischemia was induced by occluding the left anterior descending branch (LAD) of the coronary artery. Diagnostic procedures, including electrocardiogram assessments, cardiac function testing, cardiac enzyme analyses, and 2,3,5-triphenyl tetrazolium chloride (TTC) staining, were performed to assess myocardial injury. Immunohistochemistry, immunofluorescence staining, hematoxylin-eosin (HE) staining, and Masson trichrome staining were used to evaluate the expression levels of IL-1, TNF-a, morphological changes in cardiomyocytes, and cardiac fibrosis. Protein blotting was conducted to examine autophagy-related proteins and Bnip3 signaling-related proteins.

RESULTS: The study showed an increase in S100A4 expression, as well as upregulation of autophagy orchestrating proteins (Beclin-1 and LC3), contributing to myocardial injury and expansion of myocardial infarction (MI). S100A4 played a multifaceted role by regulating autophagy through the BNIP3 pathway in MIRI. Silencing S100A4 resulted in reduced autophagy and inflammation, leading to decreased infarct size and improved cardiac function.

CONCLUSIONS: S100A4 is upregulated during MIRI and orchestrates autophagy through the BNIP3 pathway, influencing the progression of reperfusion injury following myocardial infarction. Inhibition of autophagy and mitigation of inflammatory responses by S100A4-shRNA provide protection against the detrimental effects of IRI on the heart.

PMID:40519234 | PMC:PMC12164005 | DOI:10.1016/j.ijcrp.2025.200443

Am Heart J. 2025 Jun 14:S0002-8703(25)00197-8. doi: 10.1016/j.ahj.2025.06.008. Online ahead of print.

ABSTRACT

BACKGROUND: The long-term effect of open fenestration in Fontan patients is unclear, leading to wide practice variation of fenestration creation and closure. We evaluated the long-term outcomes of the fenestration using data from the Fontan Outcome Registry using Cardiac magnetic resonance Examinations (FORCE) study.

METHODS: Patients were categorized by fenestration status determined by post-Fontan cardiac magnetic resonance imaging (CMR) as open fenestration, non-fenestrated Fontan, spontaneous closure, and device closure. The primary outcome was the time from the CMR to the earliest event of death, listing or receiving a heart transplant, plastic bronchitis, or protein-losing enteropathy. The association between fenestration status and the outcome measure was evaluated using Cox proportional hazard models, adjusted for patients' clinical and CMR characteristics.

RESULTS: The cohort consisted of 2,923 patients with a median age at CMR of 14.3 years. Patients with open fenestration were younger and less likely to have a systemic left ventricle. Non-fenestrated Fontan patients were more likely to have a systemic left ventricle and lower indexed single ventricle end-diastolic volume (SVEDVi). An open fenestration was associated with adverse outcomes adjusted for clinical variables (hazard ratio 1.70, 95% CI [1.09, 2.64], p=0.02). The association was no longer significant when adjusted for CMR variables, while every 10ml/m2 increase in SVEDVi was associated with a 5% increase in the hazard of clinical outcomes (p<0.0001).

CONCLUSIONS: Open fenestration is associated with adverse outcomes when adjusted for clinical characteristics. The association disappeared when additionally adjusting for CMR variables. The current practice of fenestration closure in selected patients leads to comparable outcomes with spontaneous closure and non-fenestrated Fontan.

PMID:40523442 | DOI:10.1016/j.ahj.2025.06.008

J Neurosurg Case Lessons. 2025 Jun 16;9(24):CASE24894. doi: 10.3171/CASE24894. Print 2025 Jun 16.

ABSTRACT

BACKGROUND: Neuroenteric cysts are exceedingly rare congenital anomalies. Although the exact pathogenesis is incompletely understood, neuroenteric cysts can arise when foregut duplication cysts extend into the spinal canal. This process is likely related to failure of endodermal cell separation from ectodermal counterparts during week 3 of development, and symptoms depend on location and degree of encroachment on surrounding structures. Complete resection remains the treatment of choice with the lowest incidence of recurrence, but the optimal surgical approach is debated. Associated congenital anomalies can add surgical complexity.

OBSERVATIONS: The authors present the case of a 7-week-old infant diagnosed with a large mediastinal extradural neuroenteric cyst, along with multiple other congenital anomalies. A combined thoracic and laparoscopic abdominal approach was required for complete resection.

LESSONS: This case illustrates the importance of multispecialty collaboration, advanced imaging for preoperative planning, and thoughtful timing of intervention. A combined thoracoscopic/thoracotomy and laparoscopic approach, while surgically demanding, was safe and provided excellent visibility for complete resection of the large neuroenteric cyst. https://thejns.org/doi/10.3171/CASE24894.

PMID:40523345 | PMC:PMC12171098 | DOI:10.3171/CASE24894

J Extra Corpor Technol. 2025 Jun;57(2):66-73. doi: 10.1051/ject/2024037. Epub 2025 Jun 16.

ABSTRACT

Medical procedural registries are uniquely positioned to support shared decision-making through risk prediction modeling, support quality assessment and improvement through performance benchmarking, and provide public reporting of evidence-based practices and outcomes. For example, the Centers for Disease Control and Prevention (CDC) consulted the Extracorporeal Life Support Organization (ELSO) registry to assess the severity of the swine flu outbreak in 2009-2010. The development and growth of The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) has positively contributed to the congenital heart surgery community by developing objective mortality STAT categories and complexity stratification for operations, a common nomenclature for classifying operations and reporting the costs associated with complications for nine benchmark operations. Within the setting of adult cardiac surgery, the Perfusion Down Under Collaborative has used its registry to develop quality improvement initiatives, including those related to the management of arterial outlet temperature, glucose, and arterial pCO2. The PERForm registry leverages data from nearly 50 US hospitals to support targeted quality improvement initiatives within the setting of adult cardiac surgery. The PERForm registry participants receive benchmark reports and participate in quarterly collaborative learning meetings noted for unblinding hospital performance data. In 2014, with no current congenital cardiopulmonary bypass (CPB) registries, various experts within the congenital perfusion community and leaders from the PERForm registry began working to develop a pediatric perfusion registry. From this work, the PediPERForm Learning Network (PLN) and its associated congenital perfusion registry became active and began collecting data in October 2021.

PMID:40523133 | PMC:PMC12169737 | DOI:10.1051/ject/2024037

Front Cardiovasc Med. 2025 May 30;12:1556289. doi: 10.3389/fcvm.2025.1556289. eCollection 2025.

ABSTRACT

BACKGROUND: Patients with congenital heart disease (CHD) who are operated on after birth are at risk for neurodevelopmental (ND) impairment. Before birth, altered fetal hemodynamics due to the CHD may lead to reduced cerebral perfusion and oxygen supply. The placenta as a critical organ may enhance this pathology.

METHODS: Neonates with operated complex CHD were included. We scored the placental pathology and analyzed structural and volumetric brain changes of perioperative brain MRI and ND outcome data using the Bayley III at 1 year of age.

RESULTS: A total of 45 (13 female) patients with D-transposition of the great arteries (n = 19, 42.2%), single ventricle CHD (n = 14, 31.1%), left ventricular outflow tract CHD (n = 7, 15.6%), and other (n = 5, 11.1%) were analyzed. Placental findings were abnormal in 21 of 45 patients (46.7%). Pre- and postoperative cMRI were analyzed in 26 (57.8%) and 36 (80%) patients, respectively, while 18 (40%) patients had both (pre-/postoperative) cMRI. Half of our patients had structural brain lesions before (50%) and after (52.8%) surgery, mild intracerebral hemorrhages (pre, 11.1%; post, 22.2%), small cerebral strokes (pre/post, 8.9%), white matter injury (pre/post, 0%/4.5%), and mild hypoxia (pre/post, 4.5%). Abnormal placental findings were not associated with more structural brain lesions but were associated with smaller total brain volumes, cortical gray matter, and cerebellar structures (all p < 0.05), but not with ND outcome at 1 year of age.

CONCLUSIONS: Abnormal placental findings in patients with complex CHD are associated with smaller brain volumes, underlining the impact of placental function on brain development as a cofactor in patients with CHD.

PMID:40520938 | PMC:PMC12162681 | DOI:10.3389/fcvm.2025.1556289

J Am Heart Assoc. 2025 Jun 17;14(12):e041384. doi: 10.1161/JAHA.125.041384. Epub 2025 Jun 16.

ABSTRACT

BACKGROUND: Literature reporting neurodevelopmental outcomes for patients who undergo ventricular assist device (VAD) therapy is limited to posttransplant cohorts. This study aims to determine the prevalence of optimal neurodevelopmental outcome and factors associated with nonoptimal outcome in patients implanted with a VAD at ≤15 months of age.

METHODS: Patients followed by the Complex Pediatric Therapies Follow-Up Program were included in a prospective-inception cohort study if born between January 2006 and December 2022 and implanted with a VAD at ≤15 months of age. A modified optimal neurodevelopmental outcome was defined as scores of ≥80 on the Bayley Scales of Infant and Toddler Development and on the Adaptive Behavior Assessment System, and in the absence of cerebral palsy, permanent hearing loss, visual impairment, or seizure disorder. Firth multiple regression analysis was used to determine independent factors associated with nonoptimal outcome.

RESULTS: A total of 56 patients underwent VAD implant at ≤15 months with neurodevelopmental assessments available for 39/40 patients who survived to 2 years. The mean age of VAD implant was 5.45 (SD 3.99) months, 69.2% were male, and 38.5% had congenital heart disease. Optimal neurodevelopmental outcome was seen in 25.6% of patients. Neurological insult (OR, 12.34 [95% CI, 1.29-1660.36], P=0.026) was the only independent factor identified associated with nonoptimal outcome.

CONCLUSIONS: Optimal outcome was demonstrated in one quarter of patients who had a VAD at ≤15 months of age and underwent neurodevelopmental testing at 2 years of age. A potentially modifiable factor of neurological insult was demonstrated as being independently associated with nonoptimal outcome.

PMID:40519203 | DOI:10.1161/JAHA.125.041384

Front Cardiovasc Med. 2025 May 30;12:1455947. doi: 10.3389/fcvm.2025.1455947. eCollection 2025.

ABSTRACT

Cardiac papillary fibroelastomas (PFEs) are the most common benign cardiac tumors and are typically solitary. PFEs affecting both sides of the heart are exceptionally rare, with only four cases reported in the literature. Herein, we report a case of a 63-year-old male presenting with signs and symptoms of embolic strokes and an embolism in the coronary arteries. An echocardiogram showed multiple masses on both the mitral and tricuspid valve leaflets. Because of the risk of embolism, he underwent successful valve-sparing surgical resection without complications. The follow-up echocardiogram at 6 months showed no recurrence and competence of both the mitral and tricuspid valves with minimal regurgitation.

PMID:40520929 | PMC:PMC12163016 | DOI:10.3389/fcvm.2025.1455947

Cureus. 2025 May 15;17(5):e84146. doi: 10.7759/cureus.84146. eCollection 2025 May.

ABSTRACT

Caseous mitral annular calcification (CMAC), a rare variant of mitral annular calcification (MAC), predominantly affects older adults. CMAC represents a very small fraction of MAC, and it features a necrotic core with peripheral calcifications, mimicking neoplasms. Multimodal imaging is essential for diagnosis. We present a case of an 86-year-old hypertensive male patient who presented with exertional dyspnea. Transthoracic echocardiography revealed severe left ventricular hypertrophy, a left cardiac mass, and severe MAC. Cardiac MRI confirmed CMAC (12×14 mm calcified mass). He was managed medically and surveilled with serial echocardiograms. While asymptomatic cases may regress, complications (emboli, valve dysfunction) warrant surgery. Advanced imaging prevents misdiagnosis, guiding intervention. CMAC necessitates multimodal imaging for accurate diagnosis. Conservative management with serial monitoring is appropriate in asymptomatic patients, underscoring the importance of clinician awareness to mitigate complications. Early recognition ensures optimal outcomes in these rarer etiologies.

PMID:40519475 | PMC:PMC12166507 | DOI:10.7759/cureus.84146

J Extra Corpor Technol. 2025 Jun;57(2):96-104. doi: 10.1051/ject/2025008. Epub 2025 Jun 16.

ABSTRACT

BACKGROUND: It is difficult to clinically detect a new infection in patients with Mechanical Circulatory Support (MCS; including veno-arterial and veno-veno extracorporeal membrane oxygenation, and ventricular assist devices). The prompt, accurate identification of new infection utilizing plasma biomarkers could prompt earlier initiation of antimicrobial agents and may improve outcomes.

METHODS: We utilized ELISA to evaluate novel biomarkers, soluble Triggering Receptor Expressed on Myeloid cells (sTREM-1) and Presepsin, as well as existing biomarkers (C-Reactive Protein (CRP) and Procalcitonin) before MCS, daily for the first week of MCS and for the 72 h in advance of the development of a new infection for patients prospectively enrolled in a biobank and who developed a culture positive infection.

RESULTS: Serial samples from 18 patients were analyzed. On average post-cannulation Presepsin and sTREM-1 values were not significantly different, however they have higher baseline values than reported in other patient populations. On average during periods of infection, Presepsin was 41% lower (51,462-30,188 pg/mL) (P = 0.001) and procalcitonin was 51% lower (0.77-0.38 ng/mL) (P < 0.001) compared to non-infected periods. Neither CRP or sTREM-1 were significantly different between infected and un-infected periods.

CONCLUSION: Presepsin and Procalcitonin decreased in advance of the development of a new infection in the MCS patient population, a direction of change different than expected. These findings highlight the importance of biomarker studies specifically performed in the MCS patient population, and the potential lack of translatability of biomarkers in other patient populations to the MCS patient population.

PMID:40523137 | PMC:PMC12169701 | DOI:10.1051/ject/2025008

J Extra Corpor Technol. 2025 Jun;57(2):82-88. doi: 10.1051/ject/2025007. Epub 2025 Jun 16.

ABSTRACT

INTRODUCTION: Perfusion safety in cardiothoracic surgery is critical, particularly in Pakistan where variability in practice standards exists. This survey investigates the current perfusion practices among Pakistani perfusionists, focusing on the adherence to safety standards during cardiopulmonary bypass (CPB) procedures.

METHODS: The survey was conducted over two weeks to explore key areas of perfusion practice, including the use of bubble detectors, level detectors, arterial filters, and saturation monitoring during CPB procedures. Out of approximately 350 practicing perfusionists in Pakistan, 66 responded, resulting in a response rate of 18.9%. The data was collected through an online platform, ensuring anonymity and voluntary participation. The survey included mainly Yes/No questions. To ensure reliability and validity, the questionnaire was reviewed by experts, pilot tested, and refined based on feedback, ensuring it was effective in gathering meaningful insights.

RESULTS: The survey results indicate a variable use of essential safety devices such as bubble and level detectors, arterial filters, and continuous venous saturation and cerebral saturation monitoring. While some perfusionists adhere to recommended safety protocols, gaps in the use of critical monitoring equipment were evident.

CONCLUSION: The findings highlight the need for standardized perfusion practices in Pakistan to ensure safety and efficacy during CPB. Addressing the gaps in the use of safety and monitoring equipment could lead to improved patient outcomes. Further research is needed to explore the barriers to uniform safety standards and to develop strategies for enhancing perfusion safety across the country.

PMID:40523135 | PMC:PMC12169702 | DOI:10.1051/ject/2025007

J Extra Corpor Technol. 2025 Jun;57(2):66-73. doi: 10.1051/ject/2024037. Epub 2025 Jun 16.

ABSTRACT

Medical procedural registries are uniquely positioned to support shared decision-making through risk prediction modeling, support quality assessment and improvement through performance benchmarking, and provide public reporting of evidence-based practices and outcomes. For example, the Centers for Disease Control and Prevention (CDC) consulted the Extracorporeal Life Support Organization (ELSO) registry to assess the severity of the swine flu outbreak in 2009-2010. The development and growth of The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) has positively contributed to the congenital heart surgery community by developing objective mortality STAT categories and complexity stratification for operations, a common nomenclature for classifying operations and reporting the costs associated with complications for nine benchmark operations. Within the setting of adult cardiac surgery, the Perfusion Down Under Collaborative has used its registry to develop quality improvement initiatives, including those related to the management of arterial outlet temperature, glucose, and arterial pCO2. The PERForm registry leverages data from nearly 50 US hospitals to support targeted quality improvement initiatives within the setting of adult cardiac surgery. The PERForm registry participants receive benchmark reports and participate in quarterly collaborative learning meetings noted for unblinding hospital performance data. In 2014, with no current congenital cardiopulmonary bypass (CPB) registries, various experts within the congenital perfusion community and leaders from the PERForm registry began working to develop a pediatric perfusion registry. From this work, the PediPERForm Learning Network (PLN) and its associated congenital perfusion registry became active and began collecting data in October 2021.

PMID:40523133 | PMC:PMC12169737 | DOI:10.1051/ject/2024037