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Multimed Man Cardiothorac Surg. 2025 Jun 30;2025. doi: 10.1510/mmcts.2025.048.

ABSTRACT

Total arterial, anaortic, off-pump coronary artery bypass grafting is seen by many as a complex, specialized operation; however, when broken down into its component parts, it can be approached as multiple reproducible techniques that all trainees should master. These components include skeletonized mammary harvest, construction of composite arterial grafts and off-pump cardiac surgery. In this video tutorial, we describe step-by-step approaches to each of these elements and demonstrate how these principles come together to facilitate an excellent surgical outcome for the patient: revascularization of all diseased coronary arteries with arterial grafts while avoiding arresting the heart or aortic manipulation.

PMID:40583699 | DOI:10.1510/mmcts.2025.048

Acta Pharmacol Sin. 2025 Jun 30. doi: 10.1038/s41401-025-01604-9. Online ahead of print.

ABSTRACT

Circular RNAs (circRNAs) are a distinct class of endogenous RNAs characterized by their covalently closed circular structure. CircRNAs play crucial regulatory roles in various biological processes and pathogenesis. In this study we investigated the role of circRNAs in cardiomyocyte pyroptosis and underlying mechanisms. Ischemia/reperfusion (I/R)-induced myocardial injury was induced in mice by ligation of the left anterior descending coronary artery (LAD). Neonatal mouse cardiomyocytes were subjected to hypoxia/reoxygenation (H/R) assault. By using circRNA microarray, we found that the expression levels of a pyroptosis-related circRNA (designated PYRCR) were markedly decreased in H/R-exposed cardiomyocytes and I/R-injured mouse hearts. Overexpression of PYRCR inhibited cardiomyocyte pyroptosis, attenuated I/R-induced myocardial infarction and ameliorated cardiac function in mice. By RNA pull-down assays coupled with MS analysis followed by molecular validation, we identified developmental regulated GTP-binding protein 2 (DRG2) as the direct downstream target of PYRCR. Cardiac-specific DRG2 knockout mice displayed attenuated pyroptosis and enhanced cardiac function following I/R injury compared to DRG2fl/fl controls. DRG2 directly bound to dynamin-related protein 1 (Drp1), the master regulator of mitochondrial fission, and enhanced its protein stability and expression. Importantly, PYRCR competitively disrupted the DRG2-Drp1 interaction, thereby suppressing DRG2-mediated Drp1 expression and subsequently reducing mitochondrial fission, cardiomyocyte pyroptosis, and myocardial damage. In conclusion, we demonstrate that PYRCR, a novel pyroptosis-related circRNA, protects against I/R-induced myocardial injury through the DRG2-mediated modulation of Drp1 activity, offering promising new therapeutic strategies for preventing cardiac damage mediated by cardiomyocyte pyroptosis.

PMID:40588510 | DOI:10.1038/s41401-025-01604-9

Theranostics. 2025 Jun 9;15(14):6737-6752. doi: 10.7150/thno.110162. eCollection 2025.

ABSTRACT

Rationale: Myocardial ischemia reperfusion (I/R) injury is a major cause of adverse outcomes following revascularization therapy. Although alterations in metabolic activities during reperfusion have been implicated, the molecular mechanisms underlying the pathogenesis of I/R injury remain elusive. Metaxin 2 (MTX2), initially identified as a core component of protein import complexes, has recently been characterized in diverse cellular functions. Nevertheless, its involvement in myocardial I/R injury has yet to be fully elucidated. In this study, we aim to evaluate the role and the underlying mechanism of MTX2 in I/R injury. Methods: The myocardial I/R model was established, and the protein levels of MTX2 were determined at different time points following coronary occlusion. Loss-of-function and gain-of-function strategies were applied via genetic ablation or intra-myocardial adenovirus injection to ascertain the role of MTX2 in myocardial I/R injury. RNA sequencing, seahorse metabolic analysis, and mass spectrometry were conducted to uncover the underlying molecular mechanisms. Results: We observed that the expression of MTX2 was significantly decreased in I/R hearts. Tamoxifen-induced cardiomyocyte-specific deletion of Mtx2 led to aggravated myocardial I/R injury, resulting in impaired cardiac oxidative phosphorylation and glycolysis. Mechanistically, dimeric PKM2, a less active pyruvate kinase form compared with tetrameric PKM2, was found to be dramatically accumulated in Mtx2 deficiency mice after myocardial I/R surgery. The TOM37 domain of MTX2 interacted directly with PKM2 to promote PKM2 tetramerization, thereby modulating glucose metabolic flux. Pharmacological activation of PKM2 by a small-molecule PKM2 activator, TEPP-46, rescued the metabolic and functional outcomes of I/R in Mtx2 deficiency mice. Conclusions: Our results identified, for the first time, a cardioprotective role of MTX2 in modulating cardiac glucose metabolism by facilitating PKM2 tetramerization. Targeting metabolic homeostasis by restoring MTX2 might be a promising therapeutic strategy to mitigate myocardial I/R injury.

PMID:40585998 | PMC:PMC12203670 | DOI:10.7150/thno.110162

Theranostics. 2025 Jun 9;15(14):6753-6767. doi: 10.7150/thno.104124. eCollection 2025.

ABSTRACT

Rationale: Cardiomyocyte apoptosis critically contributes to ischemic heart failure (IHF) progression. While the endosome-lysosome system governs cellular homeostasis, the functional significance of its master regulator RAB7 in cardiac pathophysiology remains unexplored. Methods: Using myocardial infarction (MI) models via left anterior descending coronary artery ligation in cardiomyocyte-specific RAB7 knockout mice and adeno-associated virus-mediated RAB7 overexpression models, we assessed cardiac function and adverse remodeling through echocardiography and pathophysiological assessment. Mitophagy flux was quantified using mt-Keima mice and confocal imaging. Molecular mechanisms were dissected through immunoprecipitation coupled with mass spectrometry (IP-MS) analysis and molecular experiment validation. Results: RAB7 expression decreased in ischemic myocardium. Cardiomyocyte-specific RAB7 ablation exacerbated while RAB7 overexpression attenuated post-MI cardiac dysfunction and maladaptive remodeling. RAB7 enhanced mitophagic clearance of damaged mitochondria, reducing cardiomyocyte apoptosis under ischemic stress both in vitro and in vivo. Mechanistically, TUFM, a mitochondrial translation elongation factor, was identified as a novel effector of RAB7. RAB7 facilitated the recruitment of TUFM and LC3 to damaged mitochondria, thereby enhancing mitophagy. TUFM knockdown significantly diminished the protective effects of RAB7 on mitophagy and cardiomyocyte survival. Finally, administration of ML-098, a chemical RAB7 activator, promoted mitophagy and mitigated IHF progression in mice. Conclusion: We identify RAB7 as a novel coordinator of cardioprotective mitophagy through TUFM-mediated machinery assembly. The RAB7-TUFM axis represents a therapeutic target for IHF that warrants further clinical evaluation.

PMID:40585970 | PMC:PMC12203679 | DOI:10.7150/thno.104124

Geriatr Orthop Surg Rehabil. 2025 Jun 28;16:21514593251353114. doi: 10.1177/21514593251353114. eCollection 2025.

ABSTRACT

INTRODUCTION: Surgical fixation of hip fractures in older adults is associated with significant morbidity and mortality. We investigated whether regional anesthesia, which excluded epidural, spinal, or combined epidural-spinal, was associated with lower postoperative complication rates compared to general or spinal anesthesia in patients aged 50 years and older undergoing hip fracture surgery.

METHODS: A retrospective analysis was conducted using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) Targeted Hip Fracture dataset from January 1, 2016, to December 31, 2022. Propensity score matching was used to compare regional anesthesia with general and spinal anesthesia. Given the NSQIP database excludes epidural, spinal, and combined epidural-spinal anesthesia from the regional classification, it was presumed that the remaining regional anesthesia patients received a peripheral nerve block. The primary outcome measure was a 30-day composite of death, myocardial infarction, or stroke.

RESULTS: The study analyzed 54,623 patients, from which 323 received regional anesthesia. These were separately matched with 323 cases of general anesthesia and 323 cases of spinal anesthesia. Regional anesthesia was associated with a lower incidence of the primary composite outcome compared to both general anesthesia (3% vs 7%, risk ratio 0.3, 95% CI: 0.2 to 0.6, P < 0.001) and spinal anesthesia (3% vs 7%, risk ratio 0.5, 95% CI: 0.3 to 0.9, P = 0.01). A subgroup effect was detected, with high-risk patients (ASA IV-V) experiencing the greatest protective benefit from regional anesthesia.

CONCLUSIONS: Regional anesthesia techniques, excluding epidural, spinal, or combined epidural-spinal techniques, were associated with lower rates of major postoperative complications in older adults undergoing hip fracture surgery compared to general or spinal anesthesia. This benefit was more pronounced in high-risk patients. Our findings suggest that regional anesthesia, most likely administered via a peripheral nerve block, may offer benefits beyond pain control in this population, potentially improving postoperative outcomes.

PMID:40585866 | PMC:PMC12206264 | DOI:10.1177/21514593251353114

Circulation. 2025 Jun 30. doi: 10.1161/CIRCULATIONAHA.124.069737. Online ahead of print.

ABSTRACT

BACKGROUND: Pathological cardiac remodeling after myocardial infarction (MI) is a leading cause of heart failure and sudden death. The detailed mechanisms underlying the transition to heart failure after MI are not fully understood. Disruptions in the endoplasmic reticulum (ER)-mitochondria connectivity, along with mitochondrial dysfunction, are substantial contributors to this remodeling process. In this study, we aimed to explore the impact of mitochondrial tumor suppressor 1A (Mtus1A) on cardiac remodeling subsequent to MI and elucidate its regulatory role in ER-mitochondria interactions.

METHODS: Single-nucleus RNA sequencing analysis was performed to delineate the expression patterns of Mtus1 in human cardiomyocytes under ischemic stress. MI models were induced in mice by left coronary artery ligation and replicated in vitro using primary neonatal rat ventricular myocytes exposed to oxygen glucose deprivation. Cardiac-specific deletion of Mtus1 was achieved by crossing floxed Mtus1 mice with the Myh6-MerCreMer mice. The impact of Mtus1A, a mitochondrial isoform of Mtus1, on cardiac function and the molecular mechanisms were investigated in both in vivo and in vitro settings. Mitochondria-associated ER membranes coupling levels were evaluated by transmission electron microscopy and live-cell imaging. Protein interactions involving Mtus1A were explored through immunoprecipitation-mass spectrometry, coimmunoprecipitation, and proximity ligation assay. The roles of Mtus1A and Fbxo7 (F-box protein 7) were validated in a murine MI model using adeno-associated virus serotype 9 (AAV9).

RESULTS: Bioinformatics analysis revealed a significant downregulation of Mtus1 expression in human cardiomyocytes under ischemic conditions, indicating its potential role in stress response. The predominant isoform in murine cardiomyocytes, Mtus1A, showed reduced expression in the left ventricle of mice after MI, which is consistent with the decreased levels of its orthologs in heart tissues from patients with MI. Cardiac-specific knockout of Mtus1 in mice exacerbated cardiac dysfunction after MI. Both in vitro and in vivo studies demonstrated the vital role of Mtus1A in modulating mitochondria-associated ER membranes coupling and preserving mitochondrial function. Mechanistically, Mtus1A functions as a scaffold protein that maintains the formation of inositol 1,4,5-trisphosphate receptor 1 (IP3R1)-glucose-regulated protein 75 (Grp75)-voltage-dependent anion channel 1 (VDAC1) complex through its amino acid sequence 189-219. In addition, Mtus1A protein is stabilized by K6-linked ubiquitination through the E3 ubiquitin ligase Fbxo7. Mtus1A overexpression in mice mitigated MI-induced cardiac dysfunction and remodeling by maintaining ER-mitochondria connectivity.

CONCLUSIONS: Our study demonstrates that Mtus1A is crucial for modulating MI-induced cardiac remodeling by preserving ER-mitochondria communication and ameliorating mitochondrial function in cardiomyocytes. Mtus1A may serve as a potential therapeutic target for treating heart failure after MI.

PMID:40583767 | DOI:10.1161/CIRCULATIONAHA.124.069737

Medicine (Baltimore). 2025 Jun 27;104(26):e43122. doi: 10.1097/MD.0000000000043122.

ABSTRACT

RATIONALE: To evaluate the effect of pharmaceutical care provided by clinical pharmacists during COVID-19 treated with nirmatrelvir/ritonavir in heart transplant (HT) patients.

PATIENT CONCERNS: Three HT recipients were admitted to the hospital after testing positive for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) nucleic acid. Due to factors such as underlying immunosuppression resulting from the heart transplantation and the use of antirejection medications, patients who have undergone heart transplantation and become infected with SARS-CoV-2 exhibit significant differences in pathological responses and drug metabolism in the body compared to other patients. During the treatment period with nirmatrelvir/ritonavir, clinical pharmacists provided comprehensive pharmaceutical care for these patients throughout the course.

DIAGNOSES: After heart transplantation, testing positive for SARS-CoV-2 nucleic acid.

INTERVENTIONS: During the treatment of the 3 patients with nirmatrelvir/ritonavir for COVID-19, clinical pharmacists provided pharmaceutical care from aspects such as medication indications, dosage administration, drug adjustments, drug interactions, and adverse reaction monitoring, in order to develop individualized medication regimens for the patients.

OUTCOMES: Clinical pharmacists actively predicted, identified, and resolved issues that arose during the treatment of HT recipients with nirmatrelvir/ritonavir. They monitored the blood concentration of tacrolimus and the interactions between nirmatrelvir/ritonavir and other medications throughout the treatment process. All 3 patients were cured and discharged from the hospital.

LESSONS: During the treatment process, managing complex polypharmacy posed significant challenges. Clinical pharmacists implemented individualized therapeutic drug monitoring to optimize antiviral efficacy. Through rational and effective pharmaceutical care, the clinical cure rate for HT recipients infected with COVID-19 was improved.

PMID:40587671 | PMC:PMC12212775 | DOI:10.1097/MD.0000000000043122

J Vis Exp. 2025 Jun 13;(220). doi: 10.3791/68349.

ABSTRACT

Although significant progress has been made in heart transplantation, issues such as graft preservation, primary graft dysfunction, cardiac allograft vasculopathy, and long-term immune tolerance remain unresolved. Due to anatomical size and immunological differences, mouse models are unable to effectively replicate clinical heart transplantation surgeries and immune responses. In contrast, pig models, which share more similarities with humans in terms of heart anatomy and immune response, are particularly suitable for orthotopic heart transplantation research. In this study, we established a biatrial orthotopic heart transplantation model in Bama miniature pigs. The transplanted hearts demonstrated prompt and robust contractility postoperatively without signs of elevated central venous pressure or other hemodynamic complications. Following a short period of intensive care unit monitoring, the pigs regained consciousness and resumed spontaneous feeding, indicating stable postoperative recovery. In summary, this model offers a clinically relevant experimental platform for evaluating new technologies and therapeutic approaches in the field of heart transplantation research.

PMID:40587422 | DOI:10.3791/68349

Natl Med J India. 2025 Mar-Apr;38(2):94-95. doi: 10.25259/NMJI_336_2023.

ABSTRACT

Infective endocarditis (IE) is caused by viral, bacterial or fungal pathogens, with high morbidity and mortality. Fungal endocarditis is rare and is associated with severe complications with poor prognosis despite combined medical and surgical treatment. Although Candida albicans is the most common fungal agent of this severe form of endocarditis, Candida parapsilosis is the most common non-albicans causative species. A 17-year-old patient who had had a liver transplant was referred to our paediatric cardiovascular surgery ward with a diagnosis of right heart failure. He had had coronary artery bypass graft and aortic valve replacement in 2021. He came to the outpatient clinic with complaints of fever, weakness, nausea and vomiting. On physical examination, he had pallor, dyspnoea and tachycardia. His fever was 38 °C and a grade 2/6 systolic ejection murmur was detected on auscultation. Amphotericin B in a dose of 4 mg/kg/day was started based on the antifungal sensitivity test.

PMID:40587274 | DOI:10.25259/NMJI_336_2023

CJC Open. 2025 Mar 24;7(6):813-820. doi: 10.1016/j.cjco.2025.03.015. eCollection 2025 Jun.

ABSTRACT

Clinical characteristics of progressive heart failure warranting advanced heart failure (AHF) therapies are not well defined in patients with atypical cause-specific cardiomyopathies, as in conventional ischemic and dilated cardiomyopathies. Some of these specific cardiomyopathies are associated with systemic diseases, and the impact and the severity of extracardiac involvement is crucial in defining the appropriate choice of AHF therapies. This review focuses on special considerations in cause-specific cardiomyopathies, such as hypertrophic cardiomyopathy, cardiac sarcoidosis, cardiac amyloidosis, and arrhythmogenic right ventricular cardiomyopathy. The review evaluates AHF therapies, including heart transplantation and durable mechanical circulatory support devices, along with nuances in the management of these patients after they receive AHF therapies.

PMID:40586021 | PMC:PMC12198592 | DOI:10.1016/j.cjco.2025.03.015

Transpl Int. 2025 Jun 2;38:14153. doi: 10.3389/ti.2025.14153. eCollection 2025.

ABSTRACT

To address the shortage of organs for kidney transplantation, the Eurotransplant Senior Program (ESP) was established to enhance kidney allocation from elderly donors. This study aimed to evaluate post-transplant outcomes of deceased donor grafts and identify prognostic factors within the ESP population. We therefore analyzed patient data from 64 ESP recipients and their donors transplanted at our center between 2017 and 2022. Time-zero biopsies were analyzed using AI image analysis software for glomerular density and glomerulosclerosis. One-year patient and allograft survival rates were 96.9% and 85.9%. 5-year survival rate was 74.6%, as opposed to about 41.0% historically reported for patients on dialysis. Delayed Graft Function occurred in 29.7% of cases, with recipient coronary heart disease, BMI-disparities, and prolonged cold ischemia time as major predictors (P < 0.05). Histopathological analysis revealed that the degree of glomerulosclerosis and interstitial fibrosis and tubular atrophy (IFTA) were associated with graft failure in multivariable analyses (P < 0.05). Arteriolosclerosis (arteriolar hyalinosis) correlated with a higher risk for primary non-function (P < 0.05). The number of HLA mismatches was not significantly associated with graft outcome. Including prognostic baseline characteristics as well as histopathological AI analysis into individual allocation decisions during organ-acceptance process might improve allograft survival within the ESP and should prospectively be studied.

PMID:40585890 | PMC:PMC12203019 | DOI:10.3389/ti.2025.14153

Transpl Int. 2025 Jun 2;38:13971. doi: 10.3389/ti.2025.13971. eCollection 2025.

ABSTRACT

Normothermic ex-vivo organ perfusion (EVP) systems not only provide a physiological environment that preserves donor organ function outside the body but may also serve as platforms for ex-vivo organ modification via gene therapy. In this study, we demonstrated that a rationally designed muscle-tropic recombinant AAV, AAV-SLB101, delivered to the donor heart during brief normothermic EVP achieves durable cardiac transgene expression out to 90 and 120 days post-transplant in a porcine preclinical model. Moreover, transgene expression was detectable as early as 48 h post-transplant. Histological and MRI analyses of the donor myocardium showed no functional or structural impact on the allograft and no off-target gene expression in the recipient. This work will serve as a critical foundation to inform translational studies with therapeutic transgenes to improve allo-, xeno-, and auto-heart transplant outcomes.

PMID:40585889 | PMC:PMC12203020 | DOI:10.3389/ti.2025.13971

J Vasc Surg Cases Innov Tech. 2025 May 16;11(4):101844. doi: 10.1016/j.jvscit.2025.101844. eCollection 2025 Aug.

ABSTRACT

A 61-year-old female with previous liver transplantation was volume overloaded, requiring intubation and veno-venous extracorporeal membrane oxygenation. Workup was significant for mitral valve stenosis, for which she underwent repair. This was complicated by injury to the inferior vena cava with avulsion from the liver, which was reconstructed with bovine pericardium. Postoperatively, hemodynamic monitoring suggested poor venous return. She was taken for a venogram, demonstrating stenosis of the suprahepatic inferior vena cava, which was treated with placement of a bare metal self-expanding stent. This case report demonstrates an endovascular salvage technique for suprahepatic inferior vena cava stenosis after reconstruction during cardiac surgery.

PMID:40585579 | PMC:PMC12206025 | DOI:10.1016/j.jvscit.2025.101844

JHLT Open. 2025 May 27;9:100297. doi: 10.1016/j.jhlto.2025.100297. eCollection 2025 Aug.

ABSTRACT

Immunosuppression advances have enabled organ transplant recipients to consider parenthood, but pregnancy poses risks to maternal and fetal health. This systematic review examines pregnancy outcomes and immunosuppression management in cardiothoracic transplant recipients. We conducted a literature search of PubMed/Medline, Embase, and Maternity and Infant Care Database in December 2022. We identified 54 relevant studies and data from the Transplant Pregnancy Registry International, covering 404 pregnancies from 272 heart recipients (HTR) and 148 pregnancies from 121 lung recipients (LTR). Live births occurred in 74.3% of HTR and 65.5% of LTR pregnancies (22% preterm). Graft dysfunction developed in 11.5% (during) and 12.4% (after) of HTR pregnancies and 17.6% (during) and 18% (after) of LTR pregnancies. Other complications included hypertension (HTR: 36.9%, LTR: 58.8%), preeclampsia (HTR: 19.7%, LTR: 12.2%), and diabetes (HTR: 11%, LTR: 27%). Mortality was 17.4% for HTR and 26.5% for LTR. Half of HTR and two-thirds of LTR were on Tacrolimus. Common immunosuppression changes included discontinuation of Mycophenolate Mofetil, Azathioprine, or Sirolimus with corticosteroid dose adjustment. Despite high successful pregnancy rates, heart and lung transplant recipients may face substantial risks of graft dysfunction and maternal death post-pregnancy.

PMID:40584723 | PMC:PMC12205842 | DOI:10.1016/j.jhlto.2025.100297

JHLT Open. 2025 Jun 2;9:100288. doi: 10.1016/j.jhlto.2025.100288. eCollection 2025 Aug.

ABSTRACT

Post-myocardial infarction (MI) ventricular septal defects (VSDs) are rare but life-threatening. Temporary mechanical support options range from intra-aortic balloon pumps (IABPs) to venoarterial extracorporeal membrane oxygenation (VA-ECMO). There are few anecdotes of the Impella as a bridge to repair. We present a case of post-MI VSD and cardiogenic shock requiring combined Impella 5.5 and VA-ECMO (ECPELLA) as a bridge to transplant.

PMID:40584722 | PMC:PMC12205820 | DOI:10.1016/j.jhlto.2025.100288

JHLT Open. 2025 May 22;9:100277. doi: 10.1016/j.jhlto.2025.100277. eCollection 2025 Aug.

ABSTRACT

BACKGROUND: We aim to describe the effect of belatacept on de novo donor-specific antibodies (DSA) formation, rejection, and renal function in heart transplant recipients.

METHODS: The cohort comprises 60 adult heart or heart-kidney recipients transplanted between 2005 and 2022. Twelve recipients initialized at ∼90 days post-transplantation on a belatacept-based immunosuppression regimen with tapered tacrolimus trough levels were matched to 48 standard tacrolimus-based regimen controls. Differences in the distribution of recipients with emergent de novo DSA and rejection were assessed over the first 85 days baseline period, the average duration pre-belatacept. Survival analysis assessed regimen group differences in the probability of remaining de novo DSA and rejection free over the follow-up period spanning 86 to 540 days. Renal function and cytomegalovirus viremia were examined as secondary outcomes.

RESULTS: There were no statistically significant regimen group differences in the distribution of recipients with de novo DSA or rejection during the baseline period. Furthermore, differences in the probability of remaining de novo DSA and rejection free during the follow-up period remained insignificant (log-rank test, p = 0.12). Belatacept-treated recipients, at follow-up, had no incidence of developing de novo DSA, unlike 19% of the controls. Additionally, there were no statistically significant differences in acute cellular and antibody mediated rejection events, renal function, and CMV viremia by regimen group.

CONCLUSION: Recipients treated with belatacept-based regimen exhibited a trend of reduced de novo DSA development compared to standard tacrolimus-based regimen controls. Larger studies are needed to evaluate the benefit of belatacept use in heart transplant populations.

PMID:40584719 | PMC:PMC12205671 | DOI:10.1016/j.jhlto.2025.100277

CASE (Phila). 2025 Apr 1;9(6):187-193. doi: 10.1016/j.case.2025.02.003. eCollection 2025 Jun.

ABSTRACT

PMID:40583872 | PMC:PMC12198111 | DOI:10.1016/j.case.2025.02.003

Multimed Man Cardiothorac Surg. 2025 Jun 30;2025. doi: 10.1510/mmcts.2025.048.

ABSTRACT

Total arterial, anaortic, off-pump coronary artery bypass grafting is seen by many as a complex, specialized operation; however, when broken down into its component parts, it can be approached as multiple reproducible techniques that all trainees should master. These components include skeletonized mammary harvest, construction of composite arterial grafts and off-pump cardiac surgery. In this video tutorial, we describe step-by-step approaches to each of these elements and demonstrate how these principles come together to facilitate an excellent surgical outcome for the patient: revascularization of all diseased coronary arteries with arterial grafts while avoiding arresting the heart or aortic manipulation.

PMID:40583699 | DOI:10.1510/mmcts.2025.048

Neoreviews. 2025 Jul 1;26(7):e477-e489. doi: 10.1542/neo.26-7-034.

ABSTRACT

Double outlet right ventricle (DORV) is a complex congenital heart disease with a wide spectrum of anatomical variations and clinical presentations. In this conotruncal anomaly, greater than 50% of the semilunar valve diameter of both the aorta and pulmonary artery arises from the morphologic right ventricle. Additionally, patients with DORV have a ventricular septal defect that allows blood to egress from the left ventricle and may obstruct either the pulmonary or systemic circulations. Physiological characteristics differ among patients based on the orientation of the great arteries, the presence of additional intracardiac shunts, and cardiac abnormalities. A thorough understanding of an individual's clinical features based on their DORV phenotype is essential for clinicians caring for these vulnerable patients. Knowledge of the expected postnatal hemodynamic derangements as transitional physiology evolves allows for tailored therapeutic approaches at the bedside. In this review, we will discuss the main DORV subtypes, delineate the physiology of each subtype, and provide clinical considerations and medical management strategies to guide the care for patients with this complex cardiac lesion.

PMID:40588272 | DOI:10.1542/neo.26-7-034

J Neurosurg Case Lessons. 2025 Jun 30;9(26):CASE25253. doi: 10.3171/CASE25253. Print 2025 Jun 30.

ABSTRACT

BACKGROUND: Neurenteric cysts are rare congenital lesions of the CNS, typically found in the cervical or thoracic spine and presenting in early life. Only 5% of spinal neurenteric cysts are intramedullary. The authors report the case of an intradural intramedullary neurenteric cyst in a 68-year-old woman.

OBSERVATIONS: The patient presented with 4 months of progressive left extremity numbness, weakness, and imbalance consistent with cervical myelopathy. MRI revealed a 1-cm cystic lesion in the intradural intramedullary cervical spine. Multilevel posterior cervical laminectomy for cyst resection was performed with gross-total resection. Histopathological analysis revealed squamous, columnar, and pseudostratified epithelium positive for epithelial membrane antigen and cytokeratin and negative for glial fibrillary acidic protein and S100 protein, consistent with a neurenteric cyst. Her symptoms and examination significantly improved after surgery.

LESSONS: Neurenteric cysts comprise 1% of spinal lesions, and 5% are intradural intramedullary. Symptoms progress gradually but may fluctuate with cyst size changes. MRI is the preferred imaging, with histopathological analysis required for diagnosis. Operative intervention for gross-total resection is the recommended management. This case emphasizes that neurenteric cysts should be considered in older adults with cervical myelopathy and a cystic intramedullary mass and demonstrates the benefit of complete surgical removal. https://thejns.org/doi/10.3171/CASE25253.

PMID:40587885 | PMC:PMC12210062 | DOI:10.3171/CASE25253