J Physiol Investig. 2025 Sep 17. doi: 10.4103/ejpi.EJPI-D-25-00032. Online ahead of print.
ABSTRACT
The complex pathogenesis of myocardial ischemia-reperfusion (I/R) injury is a major factor influencing clinical prognosis. It has been confirmed that microRNAs are involved in myocardial I/R injury, and that pyroptosis is closely associated with its underlying mechanisms. However, the specific mechanism by which miR-193b-3p inhibits cell death and alleviates myocardial I/R injury remains unclear. This study aimed to investigate whether miR-193b-3p can inhibit pyroptosis and protect injured myocardium by targeting the Gasdermin-D (GSDMD)/Nucleotide-binding oligomerization domain-like receptor thermal protein domain-associated protein 3 (NLRP3) signaling axis, thereby offering a potential therapeutic strategy for myocardial I/R injury. Through bioinformatics analysis, pyroptosis-related signaling pathways and key genes involved in myocardial I/R injury were identified. A myocardial I/R injury model was established, and pathological changes in myocardial tissue were evaluated using hematoxylin and eosin staining. A dual-luciferase reporter assay was conducted to verify the targeting relationship between miR-193b-3p and GSDMD. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and Western blotting were employed to detect mRNA and protein expression levels of miR-193b-3p, GSDMD, and NLRP3. The role of miR-193b-3p in myocardial I/R injury was comprehensively evaluated based on cardiac troponin I levels and the rate of myocardial pyroptosis. The findings confirmed that miR-193b-3p inhibited GSDMD expression, attenuated pathological changes in rat myocardium, downregulated NLRP3 and other pyroptosis-related proteins, and reduced both myocardial pyroptosis and serum cardiac troponin I levels.
PMID:40960060 | DOI:10.4103/ejpi.EJPI-D-25-00032
J Physiol Investig. 2025 Sep 17. doi: 10.4103/ejpi.EJPI-D-25-00033. Online ahead of print.
ABSTRACT
Sepsis-induced myocardial dysfunction (SIMD) is a severe consequence of systemic infection, primarily driven by mitochondrial dysfunction, inflammation, and pyroptosis. Sonlicromanol, a mitochondrial redox-modulating therapeutic agent, has shown promise in preserving mitochondrial function, but its role in sepsis-induced cardiac injury remains unclear. This study evaluates the protective effects of sonlicromanol in a rat model of sepsis-induced cardiac dysfunction, with a focus on mitochondrial dynamics, mitophagy, and inflammasome-pyroptosis pathways. Male Sprague-Dawley rats were subjected to cecal ligation and puncture (CLP) to induce sepsis. Sonlicromanol (50 mg/kg/day) was administered intraperitoneally for 2 weeks before CLP. Rats were divided into five groups: (1) Control, (2) CLP, (3) CLP + sonlicromanol, (4) CLP + Mdivi-1 (mitophagy inhibitor), and (5) CLP + sonlicromanol + Mdivi-1. Cardiac function was evaluated via catheter-based pressure analysis, including left ventricular systolic pressure (LVSP), left ventricular end-diastolic pressure (LVEDP), and left ventricular developed pressure (LVDP). Myocardial injury, histopathology, inflammasome-pyroptosis activation, mitophagy, and mitochondrial dynamics were assessed via enzyme-linked immunosorbent assay, H and E staining, Western blot, and mitochondrial fluorometric assays. CLP-induced septic rats showed reduced LVSP and LVDP, along with elevated LVEDP, cardiotroponin, and B-type natriuretic peptide, and significant myocardial damage. Pyroptosis markers (nucleotide-binding oligomerization domain-like receptor pyrin domain-containing protein 3, cleaved caspase-1, gasdermin-D, interleukin-1 β, and lactate-dehydrogenase) were elevated, while mitophagy markers (PTEN-induced kinase 1 and Parkin) and mitochondrial function (membrane potential and adenosine triphosphate levels) declined. Sonlicromanol significantly improved cardiac function and injury markers, suppressed pyroptosis, restored mitochondrial dynamics (increased mitofusin-2, modulated dynamin-related protein 1), enhanced mitophagy, and improved mitochondrial function. Mdivi-1 co-treatment attenuated these effects, indicating a role for mitochondrial dynamics and mitophagy in sonlicromanol's efficacy. Sonlicromanol ameliorates SIMD by modulating mitochondrial homeostasis and inhibiting pyroptosis. These findings support sonlicromanol as a potential therapy for sepsis-related cardiac injury.
PMID:40960053 | DOI:10.4103/ejpi.EJPI-D-25-00033
J Cardiothorac Vasc Anesth. 2025 Aug 22:S1053-0770(25)00676-7. doi: 10.1053/j.jvca.2025.08.029. Online ahead of print.
ABSTRACT
OBJECTIVE: To compare the efficacy and safety of retrolaminar block (RLB) with erector spinae plane block (ESPB) for perioperative analgesia in pediatric cardiac surgery.
DESIGN: Prospective, randomized, double-blinded, controlled, noninferiority trial.
SETTING: A pediatric cardiac surgical unit at a tertiary care referral center in South India.
PARTICIPANTS: Children aged between 1 day and 18 years who were scheduled for elective cardiac surgery (Risk adjustment for congenital heart surgery categories 1-6) were enrolled in the study. A total of 298 patients were randomly assigned to receive either an ESPB or RLB, with 149 patients in each group.
INTERVENTION: Myofascial blocks were performed by one of four anesthesiologists, each administering either ESPB or RLB under ultrasound guidance according to the assigned group. The treating anesthesiologist and intensive care unit (ICU) intensivist were blinded to group allocation.
MEASUREMENTS AND MAIN RESULTS: This study compared RLB, a safer and less commonly used posterior myofascial block, with ESPB, a widely adopted technique with few reported complications, to establish the noninferiority of RLB. The primary outcome was hemodynamic response to surgical incision, defined as a greater than 10% rise in heart rate. Secondary outcomes included block administration time; intraoperative inhalational anesthetic; dexmedetomidine and opioid use; postoperative pain and sedation scores at 2, 6, and 12 hours; and ICU outcomes such as duration of mechanical ventilation, ICU length of stay, reintubation rate, and cost of ventilator disposables and oxygen. The groups were comparable in baseline characteristics. A rise in heart rate of more than 10% was observed in 46% of patients in the ESPB group and 50% in the RLB group (p = 0.3). Intraoperative drug consumption, pain and sedation scores, as well as ICU outcomes, were similar between the groups.
CONCLUSIONS: RLB is noninferior to ESPB in pediatric cardiac surgery, providing comparable analgesic efficacy, safety, and postoperative recovery outcomes.
PMID:40962665 | DOI:10.1053/j.jvca.2025.08.029
Interv Cardiol Clin. 2025 Oct;14(4):521-534. doi: 10.1016/j.iccl.2025.07.004. Epub 2025 Aug 19.
ABSTRACT
Upper extremity vascular access has become an essential alternative to transfemoral access for structural and congenital cardiac interventions. This section outlines the expanding role of radial and subclavian/axillary approaches across procedures such as TAVR, aortic balloon valvuloplasty, aortic paravalvular leak closure, adult congenital defect interventions, and cardiac mechanical circulatory support placement. Compared with femoral access, upper extremity approaches offer lower complication rates, enhanced safety, and earlier ambulation, but present unique anatomic and technical challenges. With accumulating evidence and operator experience, these strategies are increasingly favored in selected patients and procedural contexts for optimized outcomes in structural heart disease management.
PMID:40962389 | DOI:10.1016/j.iccl.2025.07.004
Thorac Cardiovasc Surg. 2025 Sep 17. doi: 10.1055/a-2695-2498. Online ahead of print.
ABSTRACT
Minimally invasive repair of pectus excavatum (MIRPE) creates an iatrogenic communication between the pleural cavities, known as a "buffalo chest." Patients with pectus excavatum are also at increased risk of spontaneous pneumothorax due to congenital apical blebs. When these two conditions coexist, the risk of bilateral spontaneous pneumothorax becomes potentially life-threatening. This study aims to evaluate the incidence and characteristics of spontaneous pneumothorax following MIRPE, with particular attention to the presence and role of congenital blebs.We retrospectively reviewed patients who underwent MIRPE between 2005 and 2024 to identify cases of spontaneous pneumothorax. Only cases occurring at least 1 month postoperatively and unrelated to intraoperative thoracoscopy were included. Patients were followed for at least 10 months. We analyzed laterality, clinical presentation, presence of blebs, treatment, and outcomes. A systematic literature review was also conducted to explore the relationship between buffalo chest, pneumothorax, and pectus excavatum.Among 795 patients, 7 developed spontaneous pneumothorax: 4 unilateral, 3 bilateral. In six cases, blebs were identified and treated with thoracoscopic bullectomy and pleurodesis. Two patients with bilateral pneumothorax experienced cardiac arrest: one recovered after emergency drainage; the other died in a peripheral hospital, where blebs were suspected but not confirmed. The literature review identified nine similar cases in five reports.Bilateral spontaneous pneumothorax after MIRPE can be a life-threatening emergency due to the buffalo chest. Patients and families should be informed of this rare but serious risk to enable early recognition and prompt treatment. Preoperative detection of apical blebs may help reduce this risk.
PMID:40962257 | DOI:10.1055/a-2695-2498
JACC Case Rep. 2025 Sep 17:105363. doi: 10.1016/j.jaccas.2025.105363. Online ahead of print.
ABSTRACT
BACKGROUND: Weaning from cardiopulmonary bypass in pediatric cardiac surgery is challenging, especially after prolonged procedures. Delayed chest closure may be necessary in cases of low cardiac output syndrome (LCOS) to support hemodynamic recovery. Although near-infrared spectroscopy is standard for neuromonitoring, amplitude-integrated electroencephalography (aEEG) and continuous electroencephalography (cEEG) are emerging tools.
CASE SUMMARY: We report the case of a 6-month-old infant with transposition of the great arteries who required delayed chest closure after surgical repair. LCOS recurred after chest closure on postoperative day 3 despite stable near-infrared spectroscopy values. Retrospective aEEG/cEEG analysis, unintentionally initiated before closure, showed early EEG abnormalities preceding clinical signs, which were resolved after chest reopening.
DISCUSSION: This case highlights the potential of aEEG/cEEG to detect early cerebral compromise due to LCOS, even when conventional monitoring appears normal, an association not well established in the literature.
TAKE-HOME MESSAGE: Cerebral distress may be detected earlier with aEEG compared with standard monitoring, supporting timely LCOS identification and management.
PMID:40960437 | DOI:10.1016/j.jaccas.2025.105363
Surg Case Rep. 2025;11(1):25-0329. doi: 10.70352/scrj.cr.25-0329. Epub 2025 Sep 9.
ABSTRACT
INTRODUCTION: The main causes of right-to-left shunting (RLS) in patients with atrial septal defect (ASD) are pulmonary hypertension, right ventricular outflow tract obstruction, severe tricuspid regurgitation, and a large ASD resulting in equal bi-atrial pressures. Reports of a case of an unintentional connection of the inferior vena cava (IVC) to the left atrium (LA) discovered many years after the repair of ASD are rare.
CASE PRESENTATION: A 47-year-old male with a history of congenital ASD repair was found to have large RLS during examination of choledocholithiasis. Details of the former surgeries, performed twice for some reason, were unknown. He had cyanosis of fingers, but neither pulmonary hypertension nor right ventricular outflow obstruction. Transesophageal echocardiography, cardiac CT, and cardiac catheterization demonstrated a direct connection between the IVC and the LA as well as a residual ASD. The patient subsequently underwent successful surgical repair. It was speculated that the eustachian valve (EV) of the IVC had been wrongly taken as the lower margin of the defect in the first repair, and then a new ASD was created in the second surgery to maintain his hemodynamics. Though he had RLS with ASD, he subsequently lived a normal life for approximately 40 years, albeit with exertional dyspnea and mild cyanosis.
CONCLUSIONS: We report on a case of iatrogenic RLS after ASD closure. The surgeon must always check the intracardiac anatomy carefully and close the ASD without using other structures such as the EV.
PMID:40959850 | PMC:PMC12435984 | DOI:10.70352/scrj.cr.25-0329
Front Cardiovasc Med. 2025 Sep 1;12:1633002. doi: 10.3389/fcvm.2025.1633002. eCollection 2025.
ABSTRACT
This study aimed to investigate the long-term effects of different ASD closure methods on cardiovascular events in adults. A retrospective analysis was conducted using data obtained from the Korean National Health Insurance Service, focusing on patients aged ≥20 years diagnosed with ASD between 2004 and 2015. Participants were categorized into the observation, device closure, and surgery groups. Propensity score matching (PSM) was employed to mitigate imbalances among the groups. The Cox proportional hazards model was utilized to compare the occurrence of major adverse cardiovascular events (MACE), including stroke, myocardial infarction (MI), coronary revascularization, and all-cause death. In total, 20,643 patients with ASD were included in this study. After PSM, there were 6,636 in the observation group and 3,318 each in the device closure and surgery group. Over a 5-year follow-up period, the adjusted hazard ratios for MACE were significantly lower in the surgery (0.72; 95% CI: 0.66-0.79) and device closure groups (0.85; 95% CI: 0.78-0.92) than in the observation group. Beneficial effects on stroke and all-cause mortality were observed in both intervention groups. Additionally, a beneficial effect on coronary revascularization was observed in the surgery group, whereas the impact on MI was not significantly different between the groups. ASD closure, whether by surgery or using a device, is associated with a decreased incidence of cardiovascular outcomes in adults. The benefits on cardiovascular outcomes vary with the type of closure method, underscoring the need for a tailored approach to manage ASD in adults.
PMID:40959496 | PMC:PMC12434082 | DOI:10.3389/fcvm.2025.1633002
Food Sci Nutr. 2025 Sep 14;13(9):e70907. doi: 10.1002/fsn3.70907. eCollection 2025 Sep.
ABSTRACT
Breastfeeding offers critical health benefits for infants, including those with mild congenital heart disease (CHD). However, breastfeeding in this population faces multifaceted challenges. At the individual level, maternal anxiety associated with the CHD diagnosis may undermine breastfeeding confidence; at the systemic level, institutional support for establishing and sustaining breastfeeding remains inadequate. Behavioral interventions may influence feeding practices for these infants. To evaluate the effect of a Behavioral Breastfeeding Intervention Program (BBIP) for infants with mild CHD on maternal breastfeeding behavior, exclusive breastfeeding (EBF) rates, and infant growth. Sixty-eight mother-infant dyads were randomly assigned to the BBIP group (n = 34) or a control group receiving routine care (n = 34). The BBIP was grounded in the Behavior Change Wheel (BCW) behavior change theory and included personalized counseling, home visits, and ongoing support via social media. The primary outcome was breastfeeding behavioral scores. Secondary outcomes included EBF rates, the proportion of breast milk in the daily diet, and infant growth metrics assessed at 1, 3, and 6 months. Mothers in the BBIP group reported significantly higher breastfeeding behavioral scores (p < 0.001). EBF rates at 1, 3, and 6 months were 47.1%, 45.5%, and 43.8%. Proportion of breast milk in the daily diet was approximately 78.35%, 69.67%, and 56.40%. Growth data over 6 months showed non-inferiority in outcomes for infants with CHD. The behavioral intervention significantly enhanced breastfeeding practices among mothers of infants with mild CHD through multidimensional strategies. Non-inferior growth trajectories were observed in breastfed infants.
PMID:40959176 | PMC:PMC12433894 | DOI:10.1002/fsn3.70907
Braz J Cardiovasc Surg. 2025 Sep 1;40(5):e20240370. doi: 10.21470/1678-9741-2024-0370.
ABSTRACT
INTRODUCTION: Conventional surgical approaches for aortic root aneurysms, including valved grafts and valve-sparing techniques, present inherent limitations such as the requirement for anticoagulation and the potential for late reoperation. Personalized External Aortic Root Support (PEARS), utilizing the ExoVasc® implant, represents a novel approach that aims to overcome these limitations.
METHODS: This report presents the initial clinical experience with the ExoVasc® PEARS implant in the Americas, encompassing 10 patients (six males, age range 30 - 52 years, mean age 37.8 years) diagnosed with aortic root aneurysms. Indications for PEARS included Marfan syndrome (eight patients, including one reoperation), bicuspid aortic valve (two patients, including one with anomalous coronary artery), and associated valvular dysfunction. Cardiopulmonary bypass was utilized in four cases.
RESULTS: No major adverse postoperative events were observed. Postoperative recovery was generally uneventful, with minor complications, including pericarditis and atrial fibrillation, successfully managed with medical therapy. Aortic dimensions remained stable at 30-day and one-year follow-ups.
CONCLUSION: This initial experience demonstrates the feasibility, safety, and efficacy of the PEARS technique for the treatment of aortic root aneurysms. Potential advantages over traditional approaches include the possibility for off-pump procedures, reduced risk of aortic valve dysfunction, shorter hospital stays, and elimination of the need for long-term anticoagulation therapy. Further investigation is warranted to evaluate the long-term durability and clinical outcomes of this innovative approach.
PMID:40961275 | PMC:PMC12443440 | DOI:10.21470/1678-9741-2024-0370
Braz J Cardiovasc Surg. 2025 Nov 1;40(6):e20240313. doi: 10.21470/1678-9741-2024-0313.
ABSTRACT
OBJECTIVE: We herein probed the effects of ozone autohemotherapy (O3-AHT) on inflammatory response and postoperative cognitive function in patients undergoing valve replacement with cardiopulmonary bypass (CPB).
METHODS: Totally, 130 patients undergoing valve replacement with CPB were included in the study (O3-AHT) and control (banked blood transfusion) groups. Blood samples were taken for blood gas analysis, with arterial oxygen saturation, jugular venous oxygen saturation, partial pressure of arterial oxygen and jugular venous PO₂, hemoglobin, and cerebral oxygen extraction rate documented. Interleukin (IL)-6, tumor necrosis factor alpha (TNF-α), and IL-1β levels and serum S100β and neuron-specific enolase (NSE) concentrations were measured by enzyme-linked immunosorbent assay, followed by cognitive function assessment by Mini-Mental State Examination and Montreal Cognitive Assessment scales.
RESULTS: The research group exhibited elevated thrombin time, activated partial thromboplastin time, and prothrombin time and decreased fibrinogen level immediately after surgery; it also presented reduced 24-hour postoperative serum IL-6, TNF-α, IL-1β, S100β, and NSE levels. Intraoperative cerebral oxygen metabolism was improved, and cognitive dysfunction was alleviated in the research group. The comparison of transfusion complication incidence between the two groups showed no significant difference.
CONCLUSION: The application of O3-AHT in patients undergoing valve replacement with CPB enhanced intraoperative brain oxygen metabolism and reduced postoperative 24-hour inflammatory response and cognitive dysfunction.
PMID:40961278 | PMC:PMC12448251 | DOI:10.21470/1678-9741-2024-0313
BMJ Open. 2025 Sep 16;15(9):e099044. doi: 10.1136/bmjopen-2025-099044.
ABSTRACT
INTRODUCTION: Early and balanced replacement of blood products appears to be the key factor in improving outcomes of major bleeding patients including acute trauma, cardiac, obstetric and transplant surgery patients. Definitive clinical guidance regarding the optimal ratio of blood products, including those containing fibrinogen, is still lacking. Therefore, we tested the hypothesis that increasing the fibrinogen content to erythrocyte suspension ratio improves the mortality and functional outcomes of patients undergoing surgeries with expected major bleeding.
METHODS AND ANALYSIS: The Approximate Dose-Equivalent of Fibrinogen-to-Erythrocyte Suspension (ADEFES) ratio is a multicentre, prospective, observational, cohort study of patients undergoing major surgical procedures with expected major perioperative bleeding (ie, requiring packed red blood cells (PRBC)>4U/24 hours). For 5U of cryoprecipitate and 1.5 U of fresh frozen plasma (FFP), the approximate dose-equivalent for fibrinogen is considered as 1 gram of fibrinogen. Association of the ADEFES ratio at 24 hours will be assessed on the primary objective, which will consist of the composite of 30-day all-cause mortality, 30-day bleeding-specific mortality and the 'highly-dependent scores' of Katz index of independence in activities of daily living.
ETHICS AND DISSEMINATION: The study protocol was approved by the Ethics Committee of Ankara Bilkent City Hospital (approval no. E2-23-4265, dated 07 June 2023; Chair: Prof. Dr. F.E. Canpolat) and by the institutional review boards of all participating centres. The study will be conducted in accordance with the principles of the Declaration of Helsinki and the Strengthening the Reporting of Observational Studies in Epidemiology guidelines, as well as in compliance with national regulations on data protection and Good Clinical Practice standards. Written informed consent will be obtained from all participants prior to inclusion in the study.The results of this study will be disseminated through peer-reviewed scientific journals, presentations at national and international conferences, and communication with relevant stakeholders including clinical practitioners and healthcare institutions. If applicable, study outcomes will also be shared via institutional newsletters and digital platforms to reach a broader audience in the medical community.
TRIAL REGISTRATION NUMBER: NCT06021184.
PMID:40962355 | PMC:PMC12443187 | DOI:10.1136/bmjopen-2025-099044
Radiology. 2025 Sep;316(3):e250078. doi: 10.1148/radiol.250078.
ABSTRACT
Background Left atrial (LA) structural and functional parameters are associated with prognosis after acute myocardial infarction (AMI). Purpose To explore the prognostic value of LA minimum volume index (LAVImin) as measured at cardiac MRI and its incremental predictive value beyond LA functional parameters for predicting major adverse cardiovascular events (MACE) after AMI in a large population. Materials and Methods This prospective study enrolled patients with AMI who underwent percutaneous coronary intervention and subsequent cardiac MRI between February 2014 and January 2024. MACE included all-cause death, reinfarction, unplanned revascularization, and heart failure hospitalization. Univariable and multivariable Cox regression analyses were used to evaluate the association between LAVImin and MACE. Receiver operating characteristic analysis and Kaplan-Meier analysis were used to evaluate the prognostic value of LAVImin in participants with AMI. Results A total of 1191 participants (mean age, 58 years ± 11 [SD]; 1007 male participants) were included. Among them, 183 individuals experienced MACE over a median follow-up of 38 months (IQR, 20-57 months). After adjusting for clinical risk factors and cardiac MRI parameters, a larger LAVImin was independently associated with MACE (hazard ratio, 1.06 [95% CI: 1.05, 1.08]; P < .001). Receiver operating characteristic analysis revealed that LAVImin (area under the receiver operating characteristic curve [AUC], 0.74) had better discriminative ability for MACE than LA maximum volume index (LAVImax) (AUC, 0.65; P < .001) and LA conduit strain (AUC, 0.64; P < .001). Traditional risk predictors plus LAVImin had greater prognostic value for MACE (C index, 0.75) than traditional risk factors alone (C index, 0.69; P < .001) or traditional risk predictors plus LAVImax (C index, 0.72; P = .03). Conclusion LAVImin was an independent predictor of MACE after AMI, with incremental prognostic value and improved discriminative ability over traditional risk factors including cardiac MRI parameters. © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Weir-McCall and Hua in this issue.
PMID:40956159 | DOI:10.1148/radiol.250078
Ann Ital Chir. 2025 Aug 7;96(9):1218-1225. doi: 10.62713/aic.4017.
ABSTRACT
AIM: We aim to investigate the relationship between the synergy between percutaneous coronary intervention and cardiac surgery (SYNTAX) scoring system created with coronary angiographic and clinical parameters and the Visceral Adiposity Index (VAI), which includes anthropometric parameters and blood lipid values and is to evaluate their predictive power complications after coronary artery bypass grafting (CABG).
METHODS: This prospective observational clinical study was conducted between 15 August 2023 to 1 December 2023. A total of 173 patients who underwent isolated CABG were included. SYNTAX 2 scores, VAI results, and complications occurring in the postoperative period were recorded. All patients were divided into two separate groups, low and high, according to the median value of the SYNTAX 2 score and VAI. Postoperative complications were compared between groups, and correlation and predictive analyses were performed.
RESULTS: Intra-Aortic balloon pump (IABP) use and low cardiac output were more frequent in the group with a high SYNTAX 2 score. However, this difference was significant for IABP use but not for low cardiac output (LCO) (p = 0.011 and p = 0.109). A positive correlation was observed between VAI and intensive care unit stay and postoperative respiratory complications (p = 0.018 and p = 0.035). There was no statistically significant correlation between SYNTAX 2 score and VAI value (p = 0.540). In Receiver Operating Characteristic (ROC) analysis, it was determined that VAI could predict respiratory complications and SYNTAX 2 score could predict IABP requirement [area under the curve (AUC): 0.639, 95% CI: 0.531-0.746, p = 0.036 and, AUC: 0.799, 95% CI: 0.678-0.920, p = 0.001].
CONCLUSIONS: In our study, no correlation was found between SYNTAX 2 score and VAI. However, we found that high VAI can predict postoperative respiratory complications and that a high SYNTAX 2 score is associated with postoperative IABP requirement. These parameters can be taken into account in risk assessments.
PMID:40955196 | DOI:10.62713/aic.4017
Sci Rep. 2025 Sep 16;15(1):32098. doi: 10.1038/s41598-025-17224-6.
ABSTRACT
Myocardial infarction (MI) remains the leading cause of death worldwide. We previously found that a specific population of human fetal cardiac fibroblasts (fCFs), which express vascular cell adhesion molecule 1 (VCAM1), have cardioprotective effects after MI, inducing reparative cardiac lymphangiogenesis. This study investigated whether adult cardiac fibroblasts (aCFs), which are more feasible for autologous transplantation, differ in surface marker expression and lymphangiogenic potential compared to fCFs. Furthermore, we examined whether aCFs could be exogenously manipulated to acquire fCF-like lymphangiogenic potential and serve as a cell therapy for MI and MI-associated heart failure. In vivo MI models (rat and mouse) and in vitro coculture assays with lymphatic endothelial cells were conducted. We found that TNF-α and IL-4 stimulation induced aCFs to express VCAM1 via NF-κB and STAT6 signaling, yielding a subpopulation termed adult VCAM1+ cardiac fibroblasts (aVCFs). These aVCFs, distinct from myofibroblasts, expressed CD90 and improved cardiac function post-MI. Adrenomedullin (ADM) was identified as a key paracrine effector, and its knockdown attenuated the pro-lymphangiogenic and cardioprotective effects of aVCFs. Our findings demonstrate that aVCFs promote cardiac lymphangiogenesis and protect cardiac function following MI, highlighting their potential as an autologous cell therapy.
PMID:40957875 | PMC:PMC12441115 | DOI:10.1038/s41598-025-17224-6
Spectrochim Acta A Mol Biomol Spectrosc. 2025 Sep 12;346:126933. doi: 10.1016/j.saa.2025.126933. Online ahead of print.
ABSTRACT
Myocardial ischemia-reperfusion injury (MIRI) presents significant clinical challenges due to its complex multimechanistic pathophysiology. Although hydrogen sulfide (H₂S) and carbon monoxide (CO) exhibit individual cardioprotective effects via anti-apoptotic/anti-inflammatory pathways, their synergistic potential remains underexplored due to the absence of delivery systems enabling spatiotemporal co-regulation of these gasotransmitters. Current approaches face technical limitations in simultaneous gas quantification and therapeutic delivery, often compromising treatment efficacy through gas leakage during monitoring. To address these challenges, we developed HSCOD, a theranostic donor featuring cysteine-activated H₂S release followed by light-controlled CO generation, while incorporating self-reporting fluorescence for real-time gas tracking. In cellular and zebrafish MIRI models, dual-gas co-delivery demonstrated superior efficacy to monotherapies, significantly reducing apoptosis, pyroptosis, oxidative stress, and inflammation through coordinated cardioprotection. This study further validated the "gas waltz therapy" concept of spatiotemporally orchestrated gas interactions, with HSCOD serving as both a therapeutic agent and research tool for decoding gas crosstalk in multifactorial diseases. The platform overcomes critical limitations in gas therapy by integrating controlled release with real-time tracking, advancing targeted treatment strategies for complex pathologies.
PMID:40957205 | DOI:10.1016/j.saa.2025.126933
Anesth Analg. 2025 Oct 1;141(4):706-717. doi: 10.1213/ANE.0000000000007290. Epub 2024 Nov 13.
ABSTRACT
BACKGROUND: Failing heart is more likely to suffer from myocardial ischemia/reperfusion (I/R) injury. This poses a great challenge for anesthesiologists in managing patients with heart failure during major surgery. Evidence from animal studies suggests that the delta-opioid receptor (DOR) contributes to alleviating acute myocardial injuries. However, little is known regarding the cardioprotective effects of cardiac DOR in patients with chronic heart failure. This study aimed to examine DOR expression in failing hearts and explore how DOR regulates the Janus kinase signal transducer and activator of the transcription-3 (JAK/STAT3) pathway to mediate morphine-induced cardio protection in heart failure.
METHODS: We measured the DOR protein levels in human and rat heart tissues with chronic heart failure. To investigate the cardioprotective role of DOR, we administered the DOR-specific antagonist, naltrindole (NTD), and JAK2 inhibitor, AG490, before morphine preconditioning (MPC) in an isolated perfusion model of myocardial I/R injury in postinfarcted failing rat heart. We examined the infarct size, cardiac enzymes, cardiac function, cardiomyocyte apoptosis, apoptosis-related proteins, and STAT3 phosphorylation in the heart.
RESULTS: The protein levels of DOR were significantly elevated in the myocardial tissues of humans and rats with chronic heart failure, by 1.4-fold (mean difference 0.41; 95% confidence interval [CI], 0.04-0.78; P = .032) and 2.3-fold (mean difference 1.26; 95% CI, 0.25-2.28; P = .009), respectively, compared to control tissues. Disease severity positively correlated with DOR expression (human: R2 = 0.316, P = .004; rat: R2 = 0.871, P = .021). Blocking DOR substantially reversed the cardioprotective effects of MPC in postinfarcted rat hearts, increasing the mean (standard deviation) percentage of infarct size from 15.0 (3.9)% to 30.8 (7.7)% (P < .001). Similarly, AG490 inhibited MPC restoration of cardiomyocyte apoptosis (33.3 [4.2]% vs 16.6 [3.4]%; P < .001). Both NTD and AG490 markedly suppressed STAT3 phosphorylation by 60.1% (mean difference 0.60; 95% CI, 0.27-0.93; P = .002) and 44.1% (mean difference 0.44; 95% CI, 0.06-0.83; P = .027), respectively, and also lowered the Bcl-2/Bax ratio by 85.5% (mean difference 0.86; 95% CI, 0.28-1.43; P = .006) and 68.2% (mean difference 0.68; 95% CI, 0.51-0.85; P < .001) respectively in heart tissues at the end of reperfusion.
CONCLUSIONS: DOR protein levels increased in failing hearts of both humans and rats. Blocking cardiac DOR selectively reduced morphine-induced cardio protection by inhibiting the JAK2/STAT3 pathway. These findings indicate that cardiac DOR is a potential therapeutic target for protecting against heart failure due to I/R injury.
PMID:40956785 | DOI:10.1213/ANE.0000000000007290
Adv Healthc Mater. 2025 Sep 15:e02975. doi: 10.1002/adhm.202502975. Online ahead of print.
ABSTRACT
Typically occurring in individuals with a genetic predisposition, long QT syndrome (LQTS) is characterized by prolonged ventricular repolarization (QT interval prolongation) and susceptibility to tip torsion, ventricular tachycardia, ventricular fibrillation, and sudden cardiac death. Currently, treatment options for LQTS include medication and surgery, but these may cause patient discomfort and disease recurrence. In this study, using biocompatible carrier-free nanomachine-based flexible bubbles are proposed to deliver phycocyanin (PC) for heart protection associated with electrophysiological stability in LQTS in vivo in mice. To form the structures, l-arginine (L-Arg) is polymerized with PC through electrostatic interactions, and Au is sputtered onto one side of the surface of L-arg/PC, functioning as a trigger for generating nitric oxide (NO) in the in vivo microenvironment. The asymmetrically released NO cargo provided a means of improving heart function and arrhythmia by delivering PC, and acted as a propellant for transporting the nanomachine to the target site. After accumulating at the site of heart damage, the nanomachines are triggered by reactive oxygen species (ROS). The accumulated nanomachines provided considerable diffusion of PC, which attenuated heart damage. The nanomachines, with ROS-induced targeting and delivery of PC, have immense potential for providing heart protection by modulating myocardial gap junction proteins and the hypoxic environment, and by ameliorating electrical remodeling in LQTS, and therefore may support future clinical testing.
PMID:40954980 | DOI:10.1002/adhm.202502975
Pediatr Surg Int. 2025 Sep 16;41(1):295. doi: 10.1007/s00383-025-06196-3.
ABSTRACT
BACKGROUND: Anterior anus (AA) is a congenital anatomical variant with unclear clinical implications and management strategies. This study evaluated the clinical features, associated anomalies, and outcomes of AA in female infants.
METHODS: This multicenter retrospective cohort study included infants diagnosed with AA between 2020 and 2024 at six tertiary referral centers in South Korea. The clinical characteristics, coexisting anomalies, and outcomes including constipation and urinary tract infections were analyzed.
RESULTS: Among the 64 patients included in this study, 51.6% had a concomitant perineal groove. Congenital heart diseases were the most common coexisting anomaly, occurring in 32 patients. During a mean follow-up of 22.9 months, constipation was observed in 23% of the patients. Urinary tract infections were not observed. The perineal groove resolved spontaneously in 87.9% of cases.
CONCLUSION: AA is a benign anatomical variant that does not increase the risk of constipation or urinary tract infections. Given the observed association with congenital heart disease, cardiac evaluation should be considered when clinically indicated.
PMID:40957958 | DOI:10.1007/s00383-025-06196-3
JACC Basic Transl Sci. 2025 Sep 16;10(10):101324. doi: 10.1016/j.jacbts.2025.101324. Online ahead of print.
ABSTRACT
Although the prevalence of aortic regurgitation (AR), which causes eccentric remodeling and valvular heart disease (VHD), is increasing, suitable animal research models remain lacking. To address this issue, we established the first efficient, real-time visualized minimally invasive aortic regurgitation surgery mouse model by performing echocardiography-guided aortic valve tear using a modified insulin needle. The clinically relevant features of this AR model were verified by multimodal analysis, and feature genes closely associated with AR-induced VHD were obtained by time series analysis in conjunction with weighted gene co-expression network analysis. The results may provide comprehensive insights into the mechanistic study and potential therapeutic targets of AR-induced VHD.
PMID:40956257 | PMC:PMC12481893 | DOI:10.1016/j.jacbts.2025.101324