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Management of Acute Pituitary Apoplexy After Mechanical Aortic Valve Replacement

Valvular cardiac surgery - Vie, 06/13/2025 - 10:00

JACC Case Rep. 2025 Jun 11;30(14):103675. doi: 10.1016/j.jaccas.2025.103675.

ABSTRACT

Pituitary apoplexy is a clinical syndrome caused by hemorrhage or infarction of the pituitary gland and has been described as a rare complication of cardiac surgery. Management of this complication after mechanical valve replacement is complex, given the need for postoperative anticoagulation and potential neurosurgical resection. This paper presents a case of pituitary apoplexy identified after mechanical root and ascending hemiarch replacement and describes our clinical decision making around anticoagulation selection and optimal surgical timing. The patient underwent successful resection on postoperative day 9 and did not have any major bleeding or valvular thromboembolic complications. Multidisciplinary collaboration was critical to his favorable outcome.

PMID:40514113 | DOI:10.1016/j.jaccas.2025.103675

Categorías: Cirugía valvular

The Hungry Heart: Managing Cardiogenic Shock in Patients with Severe Anorexia Nervosa-A Case Report Series

Extracorporeal circulation - Vie, 06/13/2025 - 10:00

J Clin Med. 2025 Jun 5;14(11):4011. doi: 10.3390/jcm14114011.

ABSTRACT

Background: Cardiogenic shock is a life-threatening condition characterized by the failure of the heart to maintain adequate circulation, leading to multi-organ dysfunction. While it is most commonly associated with acute myocardial infarction or cardiomyopathies, cardiogenic shock can also arise in unusual settings, such as severe malnutrition in patients with anorexia nervosa, a psychiatric disorder characterized by extreme restriction of food intake. Methods: Here, we describe the management of three patients with anorexia nervosa and severe cardiogenic shock, who were treated in our cardiological intensive care unit between December 2022 and January 2025. Two patients were successfully resuscitated after experiencing cardiac arrest, and two required mechanical circulatory support, including Venoarterial Extracorporeal Membrane Oxygenation and microaxial flow pump. The patients presented with a range of complications including multi-organ failure and respiratory distress. Due to the fragile balance between intensive cardiac and nutritional management, as well as the comorbidity of chronic malnutrition, therapeutic decisions were made carefully, including cautious electrolyte management, targeted nutritional therapy, and the use of advanced circulatory support. Conclusions: The treatment approach and beneficious outcomes underline the necessity of a multidisciplinary strategy in managing these critically ill patients with complex, interwoven pathologies. Our experience suggests that early recognition of cardiogenic shock and timely intervention with mechanical circulatory support may significantly improve patient survival in this high-risk cohort. Careful management of nutritional therapy and supplementation of trace elements and vitamins is crucial.

PMID:40507773 | PMC:PMC12155902 | DOI:10.3390/jcm14114011

Optimizing Analgesia After Minimally Invasive Cardiac Surgery: A Randomized Non-Inferiority Trial Comparing Interpectoral Plane Block Plus Serratus Anterior Plane Block to Erector Spinae Plane Block

Anestesia y reanimación cardiovascular - Vie, 06/13/2025 - 10:00

J Clin Med. 2025 May 28;14(11):3786. doi: 10.3390/jcm14113786.

ABSTRACT

Background: Regional anesthesia techniques are increasingly used for pain management in minimally invasive cardiac surgery (MICS). We aimed to evaluate whether the combination of interpectoral plane block (IPB) and superficial serratus anterior plane block (SAPB) provides non-inferior postoperative analgesia compared to erector spinae plane block (ESPB) in adult patients undergoing MICS. Methods: In this prospective, single-center, double-blind, randomized, non-inferiority trial, 40 adult patients scheduled for MICS were allocated to receive either ESPB (n = 20) or a combination of IPB + SAPB (n = 20) prior to surgical incision. All patients received standardized anesthesia. Pain was assessed using the Critical-Care Pain Observation Tool (CPOT) during intubation and the Numerical Rating Scale (NRS) at 6-48 h postoperatively, following extubation. The primary outcome was the NRS score at 24 h. A non-inferiority margin of 2 NRS points was pre-specified, and non-inferiority was evaluated using between-group differences with 95% confidence intervals. Opioid consumption was recorded via PCA fentanyl and rescue analgesics, converted to morphine milligram equivalents (MMEs). Secondary outcomes included extubation time and postoperative nausea and vomiting (PONV). Results: Median 24 h NRS was 3.0 (0-5.0) in the ESPB group and 2.5 (0-5.0) in the IPB + SAPB group. The between-group difference remained within the predefined two-point margin (95% CI: -0.8 to 1.2). Opioid consumption (p = 0.394), extubation time, and PONV incidence were comparable (all p > 0.05). No block-related complications occurred. Conclusions: IPB + SAPB was non-inferior to ESPB for postoperative analgesia in MICS. Despite requiring two injections, it remains an effective alternative. Larger trials are needed to confirm these findings.

PMID:40507548 | PMC:PMC12156317 | DOI:10.3390/jcm14113786

Comparison of Dexmedetomidine and Remifentanil on Adropin Expression in Unilateral Lumbar Microdiscectomy: A Prospective Active Controlled Randomized Trial Study

Anestesia y reanimación cardiovascular - Vie, 06/13/2025 - 10:00

J Clin Med. 2025 May 26;14(11):3711. doi: 10.3390/jcm14113711.

ABSTRACT

Background/Objectives: Remifentanil and dexmedetomidine are widely used agents for pain management during general anesthesia. Adropin acts as a regulator of endothelial function by affecting nitric oxide bioavailability and various hemodynamic factors, including blood flow, vascular dilatation, and mean arterial pressure. We aimed to evaluate the effects of remifentanil and dexmedetomidine on adropin and eNOS levels and hemodynamic parameters in patients undergoing unilateral single-level lumbar microdiscectomy under controlled hypotension. Methods: This study included 40 patients who underwent lumbar microdiscectomy and were randomly assigned to two groups: 20 patients received remifentanil, and 20 received dexmedetomidine. Hemodynamic parameters, preoperative and postoperative VAS scores, and intraoperative blood loss were recorded. Adropin and eNOS mRNA levels were measured with RT-qPCR at three time points: preoperative (T1), intraoperative (T2), and postoperative (T3). Adropin protein levels were evaluated using ELISA. Results: The remifentanil and dexmedetomidine groups had similar heart rate, arterial pressure, intraoperative blood loss, surgery time, and VAS scores. The extubation time was longer with remifentanil. Adropin mRNA level was higher in remifentanil at all time points. At T2, the eNOS mRNA level was higher in the remifentanil group. In the dexmedetomidine group, adropin mRNA levels decreased at T2 compared to T1. Adropin protein levels were higher in the remifentanil group at T2 and T3. In the dexmedetomidine group, serum adropin levels decreased at T3 compared to those at T1. Preoperative VAS scores in patients receiving both remifentanil and dexmedetomidine were higher than postoperative VAS scores. No significant correlation was observed between VAS scores and adropin levels or between intraoperative blood loss and adropin protein levels. Conclusions: Both drugs demonstrated similar effects on the hemodynamics of the patients, and adropin levels were not associated with the VAS score and intraoperative blood loss. These findings suggest that dexmedetomidine mediates vasodilation through adropin-independent mechanisms, while remifentanil may provide more favorable surgical conditions through adropin in patients undergoing unilateral single-level lumbar microdiscectomy.

PMID:40507473 | PMC:PMC12156445 | DOI:10.3390/jcm14113711

Preoperative TAPSE/PASP Ratio as a Non-Invasive Predictor of Hypotension After General Anesthesia Induction

Anestesia y reanimación cardiovascular - Vie, 06/13/2025 - 10:00

Diagnostics (Basel). 2025 May 31;15(11):1404. doi: 10.3390/diagnostics15111404.

ABSTRACT

Background: Hypotension is a common adverse event after the induction of general anesthesia and may lead to serious complications. The Tricuspid Annular Plane Systolic Excursion (TAPSE)/Pulmonary Arterial Systolic Pressure (PASP) ratio is an echocardiographic parameter reflecting right ventricular (RV) function and pulmonary circulation. This study aimed to evaluate the predictive value of the TAPSE/PASP ratio for hypotension after general anesthesia induction. Methods: This prospective observational study included 79 patients with no known cardiac disease who were scheduled for elective surgery and classified as having a physical status of I-III according to the American Society of Anesthesiologists (ASA). TAPSE, PASP, and RV function were assessed using transthoracic echocardiography (TTE) within 5-30 min before surgery, and their hemodynamic changes after general anesthesia induction were recorded. Results: Data analysis revealed a significant association between the TAPSE/PASP ratio and the occurrence of hypotension following the induction of general anesthesia (p < 0.001). In addition, a cut-off value of ≤1.98 was determined for predicting hypotension, which demonstrated a sensitivity of 72.5% and a specificity of 64.1% (AUC = 0.733, 95% CI: 0.621-0.826, p < 0.001). Conclusions: The TAPSE/PASP ratio is a potential predictor of hypotension following the induction of general anesthesia. Further studies are required to validate its predictive accuracy and clinical utility in perioperative hemodynamic management.

PMID:40506977 | PMC:PMC12154500 | DOI:10.3390/diagnostics15111404

Contributing factors to the short-term progression of carotid plaque and its relation to cardiovascular outcomes

http:www.cardiocirugia.sld.cu - Jue, 06/12/2025 - 10:00

J Clin Lipidol. 2025 Apr 10:S1933-2874(25)00269-7. doi: 10.1016/j.jacl.2025.04.191. Online ahead of print.

ABSTRACT

BACKGROUND: The temporal changes in carotid plaque progression (PP) and its association with cardiovascular events are not well understood.

OBJECTIVE: This study aimed to evaluate the factors affecting short-term carotid PP and its relation to cardiovascular events.

METHODS: A total of 650 patients who underwent serial carotid ultrasonography over a period of at least 12 months were enrolled and analyzed. The study population was stratified into 2 groups: those with carotid PP (n = 304) and those without PP (n = 346). PP was defined as an increase of plaque number or a ≥20% increase in total plaque thickness compared to previous ultrasonography. The primary endpoint was a 4-year incidence of major adverse cardiovascular events (MACE), defined as a composite of all-cause death, myocardial infarction, coronary revascularization, or stroke.

RESULTS: Among all patients, the initial mean plaque thickness and number were 6.0 ± 6.7 mm and 2.7 ± 2.7, respectively. Upon follow-up, the PP rate was 46.7%, plaque regression was 16.5%, and no change was observed in 36.8%. The incidence of MACE over 4 years was significantly higher in the PP group (26.6%) compared to the no-PP group (13.0%), with a hazard ratio (HR) of 2.19 (95% CI, 1.52-3.15; P < .001). Independent predictors of MACE included age, chronic kidney disease, coronary artery disease, previous stroke, and PP (HR, 2.05; 95% CI, 1.42-2.95; P < .001). Age (HR, 1.02; 95% CI, 1.00-1.03; P = .038) and coronary artery disease (HR, 1.42; 95% CI, 1.04-1.95; P =.030) were independent predictors of PP.

CONCLUSION: Older age and coronary artery disease tended to increase the likelihood of PP during short-term follow-up, which was significantly associated with cardiovascular events.

PMID:40506269 | DOI:10.1016/j.jacl.2025.04.191

Categorías:

Extracellular Vesicle-Enhanced Stem Cell Therapy in Acute Myocardial Infarction: A Case Report of Cardiac Regeneration from a Bypass Surgery

http:www.cardiocirugia.sld.cu - Jue, 06/12/2025 - 10:00

Stem Cell Rev Rep. 2025 Jun 12. doi: 10.1007/s12015-025-10910-y. Online ahead of print.

ABSTRACT

Myocardial infarction is still a significant cause of morbidity and mortality. Coronary artery obstruction reduces blood flow and oxygen supply to the heart muscle, resulting in ischemia and necrosis. Due to the heart's limited healing mechanisms, regenerative therapies to restore cardiac function are being investigated. This case report, describes the utilization of mesenchymal stem cells and extracellular vesicles derived from these cells during coronary artery bypass grafting surgery for the patient who had a recent acute myocardial infarction. A direct injection into the myocardium was performed during surgery after a failed percutaneous coronary intervention. During the follow-up, the patient demonstrated improvements in cardiac function, with the ejection fraction increasing from 28 to 35% as measured by myocardial perfusion scintigraphy, and up to 43% on echocardiographic assessment at six months post-operation, as well as decreases in end-diastolic and end-systolic volumes. Significantly, these advantages remained despite the blockage of the bypass graft. The present case shows that extracellular vesicle-enhanced stem cell treatment may be used in surgical revascularization to restore myocardium in severe ischemic damage.

PMID:40504481 | DOI:10.1007/s12015-025-10910-y

Categorías:

Virtual physiological analysis of non-culprit disease in patients with STEMI and multivessel disease: a substudy of the COMPLETE trial

http:www.cardiocirugia.sld.cu - Jue, 06/12/2025 - 10:00

Eur Heart J Open. 2025 Jun 11;5(3):oeaf057. doi: 10.1093/ehjopen/oeaf057. eCollection 2025 May.

ABSTRACT

AIMS: In the complete revascularization with multivessel PCI for myocardial infarction (COMPLETE) trial, staged complete revascularization in patients with ST-segment-elevation myocardial infarction (MI) reduced major adverse cardiovascular events compared with culprit-only revascularization. Inclusion was based on angiographic criteria.

OBJECTIVES: We modelled non-culprit virtual fractional flow reserve (vFFR) and investigated interactions between physiological lesion severity and the benefits of complete revascularization in COMPLETE.

METHODS AND RESULTS: All suitable angiograms from COMPLETE underwent software-based 3-dimensional (3D) arterial reconstruction and analysis of 3D-quantitative coronary angiography (QCA) and vFFR using computational fluid dynamics software. Physiological lesion significance was defined as vFFR ≤0.80 and was compared with operators' visual angiographic analysis, 2D-QCA and 3D-QCA. vFFR was computed in 635 patients (710 lesions). 302 patients (48%) had ≥1 physiologically significant lesion and 333 (52%) had none. 321 (45%) lesions were physiologically significant and 389 (55%) were not. There was no statistically significant interaction between physiological lesion significance and any of the trial co-primary or key secondary clinical outcomes, or an exploratory outcome of ischaemia-driven revascularization without preceding MI (all interaction P > 0.30). 3D-QCA predicted vFFR significance more accurately than visual and 2D-QCA (concordance 73% vs. 49% vs. 59%, respectively).

CONCLUSION: In this virtual physiological substudy of the COMPLETE trial, 52% of patients lacked any physiologically significant lesions and the benefits of complete revascularization appeared to be independent of physiological lesion significance. 3D-QCA was a better predictor of physiological significance than either 2D-QCA or operator visual analysis. Further research is warranted to compare angiography-guided and physiology-guided complete revascularization strategies.

PMID:40503340 | PMC:PMC12152305 | DOI:10.1093/ehjopen/oeaf057

Categorías:

Extracellular Vesicle-Enhanced Stem Cell Therapy in Acute Myocardial Infarction: A Case Report of Cardiac Regeneration from a Bypass Surgery

Terapia celular - Jue, 06/12/2025 - 10:00

Stem Cell Rev Rep. 2025 Jun 12. doi: 10.1007/s12015-025-10910-y. Online ahead of print.

ABSTRACT

Myocardial infarction is still a significant cause of morbidity and mortality. Coronary artery obstruction reduces blood flow and oxygen supply to the heart muscle, resulting in ischemia and necrosis. Due to the heart's limited healing mechanisms, regenerative therapies to restore cardiac function are being investigated. This case report, describes the utilization of mesenchymal stem cells and extracellular vesicles derived from these cells during coronary artery bypass grafting surgery for the patient who had a recent acute myocardial infarction. A direct injection into the myocardium was performed during surgery after a failed percutaneous coronary intervention. During the follow-up, the patient demonstrated improvements in cardiac function, with the ejection fraction increasing from 28 to 35% as measured by myocardial perfusion scintigraphy, and up to 43% on echocardiographic assessment at six months post-operation, as well as decreases in end-diastolic and end-systolic volumes. Significantly, these advantages remained despite the blockage of the bypass graft. The present case shows that extracellular vesicle-enhanced stem cell treatment may be used in surgical revascularization to restore myocardium in severe ischemic damage.

PMID:40504481 | DOI:10.1007/s12015-025-10910-y

Categorías: Terapia celular

Hemodynamic profiling of patients with a Fontan circulation using pulmonary pressure/flow relations during dobutamine stress and pulmonary vasodilation testing

Congenital cardiac surgery - Jue, 06/12/2025 - 10:00

Am J Physiol Heart Circ Physiol. 2025 Jun 12. doi: 10.1152/ajpheart.00105.2025. Online ahead of print.

ABSTRACT

The hemodynamics of Fontan pathophysiology and the effects of pulmonary vasodilator therapy are insufficiently understood. The aim was to evaluate hemodynamic responses to dobutamine induced stress and the effect of concomitant acute pulmonary vasodilation testing (APV) in patients with a Fontan circulation to identify hemodynamic phenotypes. Sixteen adult patients undergoing cardiac catheterization for clinical indication were included. Hemodynamic phenotyping was performed during baseline, dobutamine induced stress and concomitant APV (inhaled nitric-oxide with FIO2 1.0). Pulmonary vascular disease (PVD) was defined by pulmonary vascular resistance (PVR)>2Wood units or pulmonary artery pressure/pulmonary blood flow-slope (mPAP/Qp)>3mmHg/L/min. Patients were assigned to Group-A without PVD (N=8) or Group-B with PVD (N=8 mPAP/Qp>3 with N=3 PVR>2). For the total group; median cardiac output (Qs) was 5.2L/min and increased to 7.3L/min with dobutamine (p=0.005) without further change with APV (p=0.255). However, subgroup-analysis revealed that during dobutamine the increase in Qs occurred only in Group-A (+3.5L/min, p=0.012), and Qs decreased APV(-1.3L/min, p=0.0036). In contrast, in group-B Qs did not change with dobutamine (p=0.236), nor with APV (p=0.327). However, in contrast to group-A (p=0.889), in group-B Qp increased with APV(+1.3L/min, p=0.017) while the mPAP/Qp-slope improved significantly (6.2 to 1mmHg/L/min, p=0.017). Suggesting that APV improved Qp and oxygenation in patients with PVD, but had negative effects in those without PVD. This study shows that hemodynamic response to dobutamine induced stress and APV differs in patients with a Fontan circulation depending on the presence of pulmonary vascular disease. Hemodynamic phenotyping with sophisticated identification of pulmonary vascular disease potentially allows for patient-tailored treatment.

PMID:40506093 | DOI:10.1152/ajpheart.00105.2025

Categorías: Cirugía congénitos

Surgical Sagittal Correction of Symptomatic Sweeping Thoracolumbar Lordosis in an Adolescent With Congenital Kyphoscoliosis

Congenital cardiac surgery - Jue, 06/12/2025 - 10:00

J Am Acad Orthop Surg Glob Res Rev. 2025 Jun 11;9(6):e24.00343. doi: 10.5435/JAAOSGlobal-D-24-00343. eCollection 2025 Jun 1.

ABSTRACT

A healthy 15-year-old male athlete presented with upper thoracic congenital kyphoscoliosis, causing notable pain and limiting participation in competitive sports. In addition to mid and low back pain related to sagittal profile, the patient also expressed concerns regarding shape of his back from the compensatory thoracolumbar lordosis relative to his desired physical activities. Imaging demonstrated an abnormal fusion segment from T4-T8 with hemivertebrae at T6 and T7. After failing conservative management, the patient underwent T2-L2 posterior spinal fusion with posterior column osteotomies, successfully restoring sagittal alignment and allowing a return to high-impact sports. Unfavorable symptoms associated with abnormal sagittal spinal alignment should be considered even in a stable, nonprogressive deformity. Sagittal correction with posterior spinal instrumented fusion can effectively restore sagittal posture and function in athletes with congenital kyphoscoliosis associated with a sweeping and symptomatic thoracolumbar lordosis, altering the natural history of the deformity and improving quality of life.

PMID:40505129 | PMC:PMC12168692 | DOI:10.5435/JAAOSGlobal-D-24-00343

Categorías: Cirugía congénitos

Impact of Polyhexanide Care Bundle on Surgical Site Infections in Paediatric and Neonatal Cardiac Surgery: A Propensity Score-Matched Retrospective Cohort Study

Congenital cardiac surgery - Jue, 06/12/2025 - 10:00

Int Wound J. 2025 Jun;22(6):e70710. doi: 10.1111/iwj.70710.

ABSTRACT

The primary aim of this study was to evaluate the impact of the polyhexamethylene biguanide (PHMB) care bundle on the occurrence rates of surgical site infections (SSIs) in paediatric and neonatal cardiac surgery, addressing a critical gap in paediatric-specific infection prevention protocols. A retrospective cohort study included patients under 18 years old who underwent cardiac surgery at IRCCS Policlinico San Donato. Cohort A (n = 117) received the PHMB care bundle from April to December 2023, while Cohort B (n = 801) received conventional care from September 2020 to March 2023. The 1:1 propensity score matching was used to balance covariates between cohorts, resulting in two comparable cohorts (Cohort A = 114 patients and Cohort B = 112). The study found a significant reduction in SSIs among patients receiving the PHMB care bundle compared with those receiving conventional care (1.8% vs. 7.1%, p = 0.048). The comprehensive nature of the PHMB care bundle, including educational programs, preoperative and postoperative antimicrobial treatments, and consistent application of best practices, was instrumental in achieving these outcomes. Implementing antimicrobial care bundles could significantly reduce SSIs in paediatric cardiac surgery. Future research is needed to refine the tested bundle with prospective approaches.

PMID:40503594 | PMC:PMC12159764 | DOI:10.1111/iwj.70710

Categorías: Cirugía congénitos

Drug Induced Sleep Endoscopy in a Child with Poland's Syndrome: A Clinical Challenge

Congenital cardiac surgery - Jue, 06/12/2025 - 10:00

Indian J Otolaryngol Head Neck Surg. 2025 Jul;77(7):2689-2692. doi: 10.1007/s12070-025-05563-9. Epub 2025 May 22.

ABSTRACT

Drug induced sleep endoscopy (DISE) is an accepted diagnostic tool to pinpoint sites of dynamic obstruction in sleep apnoea. However, the challenges increase manifold in a child with Poland's syndrome (PS), a congenital condition characterised by hypoplasia or agenesis of thoracic musculoskeletal elements, with rare limb anomalies. There are numerous risks associated with anaesthesia, including difficulties with ventilation and the potential for malignant hyperthermia. We describe a case of a child with Poland's syndrome, with sleep disordered breathing. The patient was taken up for DISE-guided surgery. To our best knowledge, this is the first case of Poland's syndrome described with respect to DISE in literature. We discuss the case and our experience - both surgical and anaesthesia related Poland's syndrome.

PMID:40503156 | PMC:PMC12149053 | DOI:10.1007/s12070-025-05563-9

Categorías: Cirugía congénitos

Pseudoaneurysms: a rare complication of infective endocarditis in an adolescent with bicuspid aortic valve

Congenital cardiac surgery - Jue, 06/12/2025 - 10:00

Eur Heart J Case Rep. 2025 May 28;9(6):ytaf270. doi: 10.1093/ehjcr/ytaf270. eCollection 2025 Jun.

NO ABSTRACT

PMID:40502811 | PMC:PMC12152536 | DOI:10.1093/ehjcr/ytaf270

Categorías: Cirugía congénitos

Infective endocarditis on a patent ductus arteriosus revealed by a ruptured pulmonary artery trunk aneurysm in the pericardium: a case report

Congenital cardiac surgery - Jue, 06/12/2025 - 10:00

Eur Heart J Case Rep. 2025 May 24;9(6):ytaf267. doi: 10.1093/ehjcr/ytaf267. eCollection 2025 Jun.

ABSTRACT

BACKGROUND: Infective endocarditis on a patent ductus arteriosus (PDA) is a rare but serious condition that can lead to life-threatening complications, such as mycotic aneurysms. We report a case of endocarditis on a PDA, complicated by multiple mycotic aneurysms, including a partially ruptured aneurysm of the pulmonary artery (PA) trunk.

CASE SUMMARY: A 20-year-old female presented with progressive dyspnoea, worsening over 48 h, accompanied by fever. Echocardiography revealed a large pericardial effusion with cardiac tamponade, necessitating the drainage of 500 mL of haemorrhagic fluid. Imaging studies revealed a false aneurysm of the PA trunk, with contrast extravasation into the pericardial space. Blood cultures and pericardial fluid cultures were positive for Staphylococcus aureus. Emergency surgery involved resection of the aneurysm, ligation of the PDA, and pericardial drainage. The patient recovered after 4 weeks of intravenous antibiotics and was discharged with good clinical and biological outcomes.

CONCLUSION: This case illustrates the importance of early diagnosis and management of infective endocarditis associated with congenital heart defects, as the delay can result in severe complications such as aneurysm rupture.

PMID:40502810 | PMC:PMC12152474 | DOI:10.1093/ehjcr/ytaf267

Categorías: Cirugía congénitos

A 54-Year-Old Woman With Recurrent Exertional Dyspnea After Surgical Repair for Atrial Septal Defect

Valvular cardiac surgery - Jue, 06/12/2025 - 10:00

Chest. 2025 Jun;167(6):e195-e199. doi: 10.1016/j.chest.2025.01.021.

ABSTRACT

A 54-year-old woman with a history of recurrent exertional dyspnea for 5 years was admitted for evaluation. Six months prior, she noted a worsening of her symptoms, with progressive physical activity limitation caused by exertional fatigue and dyspnea (climbing 2 to 3 flights of stairs). She also experienced palpitations, with an estimated heart rate that ranged from 120 to 150 beats per minute. The patient denied chest pain, hemoptysis, or other notable symptoms. Notably, the patient underwent surgical repair of an atrial septal defect more than 20 years earlier, with a good postoperative recovery. Regular postoperative echocardiograms revealed no residual shunt, no valvular abnormalities, and no pulmonary hypertension. The patient had no history of smoking, drug abuse, or alcohol consumption.

PMID:40506133 | DOI:10.1016/j.chest.2025.01.021

Categorías: Cirugía valvular

Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With 3-Vessel Coronary Artery Disease and Diabetes

http:www.cardiocirugia.sld.cu - Mié, 06/11/2025 - 10:00

J Am Heart Assoc. 2025 Jun 17;14(12):e039663. doi: 10.1161/JAHA.124.039663. Epub 2025 Jun 11.

ABSTRACT

BACKGROUND: Coronary artery bypass grafting (CABG) has been associated with reduced mortality, myocardial infarction, and repeat revascularization compared with percutaneous coronary intervention (PCI) for patients with 3-vessel coronary artery disease (CAD) and diabetes. The majority of previous studies have been limited to follow-up of <10 years. Herein, we compared CABG and PCI in patients with 3-vessel coronary artery disease and diabetes with a maximum long-term follow-up of 14 years.

METHODS: Patients with diabetes and 3-vessel coronary artery disease but without ST-segment-elevation myocardial infarction who underwent coronary angiography followed by CABG or PCI from 2009 to 2018 were included in this study. The primary outcome was mortality, and the secondary outcomes included myocardial infarction, stroke, or repeat revascularization. Outcomes were adjusted for age, sex, and clinical comorbidities.

RESULTS: A total of 1210 patients underwent PCI (median follow-up, 9.1 years) while 477 underwent CABG (median follow-up, 8.1 years). Patients who underwent CABG were less likely to experience mortality (49.6% versus 57.6%, P=0.003, adjusted hazard ratio [aHR], 0.75 [95% CI, 0.61-0.91]), myocardial infarction (15.6% versus 28.1%, P<0.001, aHR, 0.45 [95% CI, 0.33-0.61]), or require repeat revascularization (7.7% versus 26.9%, P<0.001, aHR, 0.21 [95% CI, 0.14-0.30]) at longest follow-up. Risk of rehospitalization (82.6% versus 83.4%, P=0.656) and stroke (11.6% versus 12.2%, P=0.794) did not significantly differ between groups.

CONCLUSIONS: In this study, we describe one of the longest follow-up periods for patients with diabetes and 3-vessel coronary artery disease who underwent CABG or PCI and confirmed that the shorter-term benefits seen in randomized trials do translate into longer-term reductions in risk of death, myocardial infarction, or repeat revascularization.

PMID:40497515 | DOI:10.1161/JAHA.124.039663

Categorías:

Inpatient Outcomes for Patients With Peripheral Artery Disease Hospitalized for Acute Myocardial Infarction

http:www.cardiocirugia.sld.cu - Mié, 06/11/2025 - 10:00

J Am Heart Assoc. 2025 Jun 17;14(12):e040526. doi: 10.1161/JAHA.124.040526. Epub 2025 Jun 11.

ABSTRACT

BACKGROUND: Patients with both peripheral artery disease (PAD) and coronary artery disease are at heightened risk for adverse cardiovascular outcomes. Although long-term risk has been well documented, contemporary in-hospital outcomes for patients with PAD presenting with acute myocardial infarction (AMI) are less well characterized.

METHODS: We analyzed 493 740 AMI hospitalizations from 670 US sites in the NCDR (National Cardiovascular Data Registry) Chest Pain-MI Registry between January 2019 and March 2023. Primary outcomes were in-hospital mortality and major bleeding; secondary end points included cardiac arrest, cardiogenic shock, heart failure, stroke, and new dialysis initiation. Subgroup analyses were conducted by age, sex, race, AMI type, revascularization status, and extent of coronary disease. We used the NCDR validated risk model for multivariable adjustment.

RESULTS: PAD was present in 36 274 patients with AMI (7.4%). In-hospital mortality was significantly higher in patients with PAD compared with those without (8.23% versus 4.87%; adjusted odds ratio [aOR], 1.25 [95% CI, 1.19-1.31]). Increased mortality persisted across age groups (<65 years: aOR, 1.42; ≥65 years: aOR, 1.18) and AMI type (non-ST-segment-elevation MI: aOR, 1.14; ST-segment-elevation MI: aOR, 1.46), with significant interactions by both age and AMI type. Among revascularized patients, mortality was elevated in those with PAD (aOR, 1.49). PAD was associated with increased rates of major bleeding (aOR, 1.23), particularly among revascularized patients (aOR, 1.31), as well as cardiac arrest, shock, heart failure, stroke, and new dialysis.

CONCLUSIONS: PAD was independently associated with markedly worse in-hospital outcomes in AMI, highlighting the need for risk mitigation strategies in this high-risk population.

PMID:40497502 | DOI:10.1161/JAHA.124.040526

Categorías:

Prognostic Value of Plaque Radial Wall Strain Analysis in Patients With Acute Myocardial Infarction After Complete Revascularization

http:www.cardiocirugia.sld.cu - Mié, 06/11/2025 - 10:00

Catheter Cardiovasc Interv. 2025 Jun 11. doi: 10.1002/ccd.31680. Online ahead of print.

ABSTRACT

BACKGROUND: Even after complete revascularization (CR), patients with acute myocardial infarction (AMI) still face significant risks of adverse events, frequently linked to vulnerable plaque progression in nonsignificant stenosis.

AIMS: To investigate the relationship between the radial wall strain (RWS) of nonsignificant stenosis lesions and major adverse cardiac events (MACE) in patients with AMI following CR.

METHODS: This cohort study included patients with AMI who received CR of all culprit and non-culprit lesions with diameter stenosis (DS%) > 70% during index or staged percutaneous coronary intervention within 45 days, with at least one de novo native lesion (DS% of 30%-70%) for RWS analysis. The primary outcome was MACE comprising cardiovascular death, nonfatal myocardial infarction, unstable angina, and heart failure.

RESULTS: During a median follow-up of 3.6 years, 55 among 225 patients (24.4%) experienced MACE, mainly driven by unstable angina. Maximum RWS (RWSmax) was predictive of MACE with an area under the curve of 0.84 (95% CI: 0.78-0.90; p < 0.001) and an optimal cutoff > 14.5%. In the multivariable Cox regression model, RWSmax > 14.5% was an independent predictor for MACE among patients with AMI after CR (HR: 8.06; 95% CI: 3.98-16.35; p < 0.001). In patients with Murray law-based quantitative flow ratio (μQFR) > 0.8, the prognostic impact of RWSmax on MACE was comparable to that observed in patients with μQFR < 0.8 (P for interaction = 0.236).

CONCLUSIONS: Among patients with AMI who received CR, a high-strain pattern detected by RWS analysis in nonsignificant stenosis lesions was associated with a worse clinical outcome.

PMID:40495557 | DOI:10.1002/ccd.31680

Categorías:

Pericardial Administration of Extracellular Vesicles Derived from Bone Marrow Stem Cells Improved Doxorubicin-induced Heart Failure with Mid Range Ejection Fraction (HFmrEF) in Rats

Terapia celular - Mié, 06/11/2025 - 10:00

Cardiovasc Drugs Ther. 2025 Jun 11. doi: 10.1007/s10557-025-07721-1. Online ahead of print.

ABSTRACT

PURPOSE: This study investigates the therapeutic effects of extracellular vesicles (EVs) derived from bone marrow mesenchymal stem cells (BMSCs) on heart failure in rats through intrapericardial injection.

METHODS: Initially, doxorubicin was used to induce apoptosis in H9C2 cells, and the protective effects of EVs on these cells were evaluated. EVs were injected into the pericardial cavity of rats with heart failure, followed by real-time in vivo imaging and immunofluorescence detection to confirm the implantation of EVs in the myocardium. Cardiac function was assessed via echocardiography after the pericardial injection. Immunohistochemical techniques were employed to measure the expression of BNP, IL-6, CD31, and VEGFA in rat heart tissue. Additionally, the collagen fiber content in the heart tissue was detected using Masson staining.

RESULTS: The results showed that EVs derived from BMSCs at a concentration of 100 μg/ml most effectively promoted the proliferation of H9C2 cells and protected them from doxorubicin-induced damage. Compared to the heart failure group, EV treatment significantly increased LVEF, LVFS, and CO. Following intrapericardial injection of BMSCs, in vivo imaging revealed high-intensity fluorescence signals in the cardiac region, and immunofluorescence confirmed the implantation of EVs in the myocardium. Post-EV treatment, the expression levels of BNP and IL-6 and collagen content in myocardial tissue were significantly reduced, whereas the levels of CD31 and VEGFA were significantly increased.

CONCLUSION: EVs derived from BMSCs, when injected into the pericardial cavity, significantly improved cardiac function in heart failure rats through anti-inflammatory and pro-angiogenic mechanisms.

PMID:40498225 | DOI:10.1007/s10557-025-07721-1

Categorías: Terapia celular
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