Cavity Dilatation Research Articles

Predictors of functional tricuspid regurgitation after successful left-sided valve surgery

Tricuspid regurgitation (TR) is probably the most common and anticipated complication of left-sided heart valve pathology, especially MV disease. Whether preoperative functional TR will regress or progress after successful left-sided valve surgery is unknown. The aim of this study was to identify the predictors of significant TR after successful left-sided valve surgery. A retrospective analysis was performed on a total of 56 patients who underwent left-sided valve surgery (mitral or mitro-aortic-valve surgery). We have excluded patients who had organic TR. All patients had complete clinical examination and echocardiographic studies preoperatively and clinical and echocardiographic follow-up postoperatively. Mean operative age of patients was 49.3 ± 13.7 years with a sex-ratio of 0,8. Tricuspid annuloplasty was associated to left-sided valve surgery in 18 (32%) patients. Postoperatively, significant TR was found in 13 patients (23%) with a mean follow-up of 20.5 ± 33 months. Patients with significant postoperative TR were more often female (83% vs. 48%, P = 0.03), had more often a previous mitral commissurotomy (58% vs. 23%, P = 0.02) and showed a higher prevalence of significant preoperative TR (69% vs. 42%, P = 0.04). Postoperatively, residual pulmonary hypertension ( P = 0.04), dilatation of left atrium ( P = 0.02) and dilatation of right cardiac cavities ( P = 0.01) were significant risk factors for development or progression of TR after surgery. Late onset or progression of functional TR after successful left-sided valve surgery is a significant clinical entity as it displays a great impact on patient prognosis. So, the identification of clinical and echocardiographic predictors of late TR allows an adequate screening of patients that will require tricuspid valve repair at the time of initial left-sided valve surgery.

Гендерные особенности клинического течения и исходов острого коронарного синдрома с подъемом сегмента ST

The aim of the research is to study clinical, hemodynamic, affective disorders in ST-segment elevation acute coronary syndrome (STEACS); to identify gender risk factors affecting the outcomes. Material and methods. The study included 90 males and 90 females with ST-segment elevation acute coronary syndrome. All patients underwent echocardiography, coronary angiography (CAG), and a set of laboratory examinations. Spielberger test, CES-D scales, Morisky-Green test, and Montreal Cognitive Function Scale were uses to study psycho-emotional status of 75 males and females. The treatment was carried out in accordance with current clinical protocols, clinical guidelines and standards. The prognosis was assessed in a year. The results were processed using nonparametric statistics methods. Results. It was revealed that the females, included in the study, were older than males; they more often suffered from coronary artery disease, hypertension, type 2 diabetes, constitutive obesity (before the index event); they more regularly underwent antihypertensive therapy; they more often reached target BP values. There were no differences in features of coronary anatomy, frequency of invasive treatment, but females were significantly more likely to undergo thrombolytic therapy. Males smoked more often; asked for medical help earlier from the onset of anginal syndrome; they were more susceptible to dilatation of the left ventricular cavity. Females more often than males had high and medium level of personal anxiety, as well as high level of situational anxiety. Predictors of worsening prognosis in females are 4-vascular lesion of coronary bed, cardiogenic shock upon admission, decreased hemoglobin, dilatation of the left atrium, decreased cognitive functions, smoking. In males the predictors are: 3-vascular damage, cardiogenic shock, renal failure. Conclusion. It was found that in STEACS there are differences between males and females in several clinical, anatomical and functional characteristics. Risk factors for an unfavorable prognosis are gender specific. The revealed facts can be useful in individualized treatment, rehabilitation and secondary prevention programs.

Management and prognostic of right ventricular extended myocardial infarction: About a Moroccan experience

Myocardial infarction can affect any myocardial territory, however, the isolated right ventricle infarction is exceptional. It is often biventricular with a high mortality of about 30% compared to that of isolated LV (6%). Assess the prevalence of acute myocardial infarction extended to RV, and study the epidemiological, clinical, diagnostic, therapeutic and prognostic. Retrospective and descriptive study conducted in the Cardiology department in CHU Ibn-Rochd in Casablanca. It was conducted on patients admitted in ICU for acute MI extended to the RV, in the period January 2016 to June 2018. Of the 360 patients, who suffered a myocardial infarction in acute phase, 22 patients (6% of all AMI, 23% inferior MI) had an acute MI extended to RV. The average age of our patients was 61 years ranging from 53 to 70 years, with a male predominance. The majority of our patients (81%) have more than 03 cardiovascular risk factors. Chest pain with in physical examination: the jugular turgor, hypotension and bradycardia were the most common clinical signs in our patients. The ECG showed an ST-elevation in right leads (V3R, V4R) and in the inferior territory (DII, DIII and AvF) in all our patients. Dilatation of right cavities and wall motion disorders were the most frequent echocardiographic abnormalities (63% of patients). The most frequent complications were hemodynamic instability (46%) and rhythmic complications (36%). From the therapeutic point, thrombolysis was performed in 18 patients, which 6 patients received an additional angioplasty after failed thrombolysis. Ten patients required vascular filling, and inotropic drugs were used in 4 of our patients. Mortality in our series was 10%. Our series underscores the value of nearly management of patients admitted to the acute phase of MI extended to RV, and the considerable contribution of thrombolysis as a means of revascularization and its positive impact on prognosis.

THE EFFECT OF BETA-BLOCKERS ON A COURSE OF CHRONIC HEART FAILURE IN PATIENTS WITH A LOW TRIIODOTHYRONINE SYNDROME

The aim: The aim is to study the effect of β-ABs in patients with LT3 S on the course of HF. Materials and methods: 354 patients with HF on a background of post-infarction cardiosclerosis were included in the 2-yeared follow-up study. LT3 S was diagnosed at 89 (25.1%) patients. The levels of thyroid-stimulating hormone, free T3f and T4f, and reversible T3 were determined. The echocardioscopy was performed. Results: Patients with HF in combination with LT3 S have a heavier functional class by NYHA, greater dilatation of the left heart cavities, less myocardial contractility, a higher frequency of atrial fibrillation and re-hospitalization. The use of β-ABs in patients with HF without LT3 S leads to a likely decrease in hospitalization frequency, while in patients with LT3 S it has an opposite effect. The frequency of rehospitalization increases with an excess of β-ABs dose > 5 mg (equivalent to bisoprolol). At these patients a decrease in serum T3 level and negative dynamics of parameters of intracardiac hemodynamics are observed. Conclusions: The use of β-ABs in patients with LT3 S leads to an increase in re-hospitalization at a dose over 5.0 mg (equivalent to bisoprolol). In these patients there is a decrease in serum T3, an increase in T4 level; and the ejection fraction decrease; and heart cavities size increase.

Assessment of right ventricular function in patients with closed atrial septal defect

Atrial septal defect is a common congenital heart disease. Residual ventricular dysfunction is one of the late complications after the closure of the atrial septal defect. Assessment of right ventricular function in patients who have undergone atrial septal defect closure either surgically or percutaneously. A descriptive and comparative study of the systolic and diastolic function of the right ventricle(RV) of the 53 patients who underwent an atrial septal defect closure either surgically or percutaneously in the cardiology department of the Sahloul Hospital from May 03, 2000 to May 30, 2016. The assessment of the systolic function of the RV is done by measuring the fractional length shortening of the RV in two-dimensional mode, the tricuspid annular plane systolic excursion (TAPSE) in the time-motion mode and the DTI-derived tricuspid lateral annular systolic velocity wave (S). The assessment of the of the diastolic function of the RV is done by measuring of the tricuspid flow in continuous wave Doppler and pulsed wave Doppler. The echocardiographic study found a decrease in the dilation of the right cavities more pronounced in the percutaneous group (15% versus 34% in respectively percutaneous and surgical group). The Longitudinal systolic function assessed by TAPSE (21 ± 4 mm versus 16 ± 3 mm, in 91.5% and 45.5% of the percutaneous and surgical group, the tricuspid S wave (12.67 ± 2 cm/s versus 10 ± 1.8 cm/s in 91.4% and 60.6% in respectively the percutaneous and surgical group) and the fractional length shortening (45.23 ± 8.35% vs. 45.6 ± 5.6%, in 93.6% and 94% in respectively the percutaneous and surgical group). No significant difference on the diastolic function of the RV between the two groups. Surgery has an important impact on the longitudinal systolic function of RV and the percutaneous closure has the advantage of preserving right ventricular function.

Double Emergency Pulmonary Embolism and Aortic Dissection: About a Clinical Case

Introduction: Pulmonary embolism and aortic dissection are two formidable cardiovascular emergencies. Their exceptional association has a poor prognosis with very high mortality. The aim of our study was to report the case of a 31-year-old patient with pulmonary embolism associated with De Bakey’s type I aortic dissection, admitted to the cardiology department of Kati University Hospital. Case Presentation: We report the case of a young patient of 31 with no known cardiovascular history, on estrogen-progestogen contraception for 10 years, who consults for a left basal thoracic pain of increasing intensity, a whitish productive cough, hemoptysis and dyspnea stage III. She was admitted to the cardiology department, transthoracic cardiac ultrasound objectified aortic insufficiency, dissection of the aorta, the presence of the intimal flap, the false and the true channel, dilation of the right cavities with HTAP. The chest CT scan revealed bilateral lobar and segmental pulmonary embolism, De Bakey’s type I aortic dissection. Medical treatment was instituted for hemodynamic stabilization at the end of sending her to a center specializing in cardiovascular surgery for better management; unfortunately she succumbed before the preparations for her evacuation were finished. Conclusion: The pulmonary embolism associated with aortic dissection constitutes a medical emergence of rare incidence in a cardiological environment;if the diagnosis was quickly made in our patient, the lack of technical platform made management difficult.

Comparative study between physiological remodeling of the athlete's heart and dilated cardiomyopathies with cardiac MRI

The differential diagnosis between physiological remodeling of the athlete's heart and cardiomyopathies responsible for sudden death is sometimes difficult. Describe the difference between physiological dilatation of cardiac cavities in athletes with pathological dilatation by comparing a group of high-level athletes (athlete group) to a subject group followed for dilated cardiomyopathy (DCM group). We conducted a prospective comparative study including 61 subjects. The group of athletes comprised 31 subjects. The DCM group consisted of 30 subjects. All subjects were paired to age and body surface and had cardiac MRI with late enhancement study. Left ventricular systolic function in MRI by left ventricular ejection fraction (LVEF) study, LV shortening fraction and MAPSE (Mitral annular plane systolic excursion) study were normal in the athlete group and impaired in the DCM group. Left and right ventricular dilatation in the athlete group was proportionate with a ratio of LV tele diastolic volume indexed to RV tele-diastolic volume (LV TDVi/RV TDVi) at 1.1 ± 0.1 versus disproportionate dilatation in the patient DCM group (LV TDVi/RV TDVi) at 2 ± 0.8). The ROC curve was used to identify the threshold value of the LV TDVi/RV TDVi ratio. This threshold value corresponds to 1.21 with a 90% sensitivity and a 90.3% specificity. The correlation between the LV TDVi/RV TDVi ratio and the LV ejection fraction (LVEF) was negative (correlation coefficient = −0.55, P < 0.0001). There is no late enhancement of the myocardium in the athlete group against 30% in the DCM group. Cardiac MRI is a major contributor to the Athlete Heart distinction from the DCM. LV TDVi/RV TDVi ratio represents a discriminating role between a normal proportional adaptation of the two ventricles and a pathological dilatation.

Myocardial remodeling and arterial stiffness depending on aldosterone level in patients with chronic kidney disease and arterial hypertension

The aim. To analyze the relationship between serum aldosterone levels and myocardial remodeling and changes in elastic properties of arteries in patients with chronic kidney disease (CKD) and hypertension (AH).Materials and methods. A cross-secitonal study of 44 patients (14 men and 30 women, aged 56.0 [52.0; 60.5] years) with CKD and AH who were treated with angiotensine-converting enzyme inhibitors or angiotensine receptor blockers at a stable dose for at least of 3 months was performed. Serum aldosterone levels, elastic properties of the arteries, and transthoracic echocardiography using a standard method were performed. Arterial stiffness was defined as a pulse wave velocity, which was calculated using equation proposed by Arterial Stiffness Society and was measured using a device BAT41-2.Results. In 8 patients (18.2 %) we detected serum aldosterone levels above 90 pg/ml. The proportion of female patients among patients with normal aldosterone levels was significantly higher (P = 0.03). Patients with elevated aldosterone levels had a 5-year higher median age and 10 ml/min lower glomerular filtration rate. Serum aldosterone levels correlated significantly with myocardial structural and functional parameters (left ventricle (LV) end-systolic and end-diastolic dimensions and volumes, LV myocardial mass and LV mass index, thickness of interventricular septum) in men and patients over 55 years of age. Women showed a weak correlation of aldosterone levels with systolic and diastolic blood pressure.Conclusions. An association was found between serum aldosterone levels above 90 pg/ml in patients with CKD and hypertension with dilatation of left ventricular and atrial cavities, and with left ventricular hypertrophy (by LV mass and mass index). This association was stronger for males and for patients aged >55 years. A correlation between aldosterone level and arterial stiffness (augmentation index on the brachial artery and aorta) has only been found in patients over 55 years of age.

Criteria for adverse prognosis for mitral valve prolapse.

On the basis of a survey of 151 patients, diagnostic criteria for an unfavorable prognosis of mitral valve prolapse were revealed according to echocardiography. Transthoracic and transesophageal echocardiography, daily Holter ECG monitoring were performed. Repeated echocardiography was performed in 12-18 months. Statistical analysis of the material allowed us to identify criteria for poor prognosis of mitral valve prolapse according to echocardiography: severe mitral regurgitation, mitral valve leaflet thickness in diastole 6 mm or more, dilatation of the left ventricular cavity, dilatation of the left atrial cavity, dilatation of the mitral ring.

A modern view on the pathogenesis, diagnosis and treatment of alcoholic cardiomyopathy

Dilatation of the left ventricle cavity and its contractility decrease with the subsequent heart failure development against the background of prolonged excessive alcohol consumption is commonly called alcoholic cardiomyopathy (ACM). The direct toxic effect of ethanol and its metabolites on the myocardium, neuroendocrine disorders, other manifestations of alcoholism and a genetic predisposition play a significant role in the development of this pathology. The purpose of this review is to study modern ideas about the mechanisms of development and course of ACM. In particular, special attention is paid to discussing the doses of alcohol necessary for the onset of symptoms and its regression. Actual data are presented in relation to a survey aimed at confirming alcohol abuse and the exclusion of alternative causes of myocardial injury, as well as treating patients and determining the prognosis.

Ultrasound-guided repeat intrauterine balloon dilatation for prevention of adhesions.

Intrauterine adhesions (IUAs) can occur following an invasive intrauterine procedure as a result of the normal healing process of the damaged endometrium/myometrium1. Although several interventions have been proposed for preventing the occurrence of IUAs, such as use of hyaluronic acid gel or polyethylene oxide-sodium carboxymethylcellulose gel, estrogen therapy and use of an intrauterine balloon or intrauterine device, their effectiveness is still uncertain2. The idea of using intrauterine pressure, through injection of saline solution into the uterine cavity, under ultrasound guidance for treating IUAs was first introduced in 20013. Subsequently, the potential therapeutic effect on mild adhesions of intrauterine insertion of a balloon and infusion of a distending medium was reported in 20144. More recently, ultrasound-guided balloon therapy for the treatment of mild IUAs in the outpatient setting was described5, 6. Here, we present a technique for adhesion prophylaxis following intrauterine surgery, based on the hypothesis that use of a balloon for dilatation of the uterine cavity and/or adhesiolysis might be effective using short repeated sequences in the most pivotal period. Before introducing the intrauterine balloon approach, we used hyaluronic acid gel routinely for prevention of IUAs. In our experience, repeat intrauterine balloon therapy can achieve better anatomic results and reduce the need for repeat intervention compared with use of hyaluronic acid gel (Figure 3 and Figure S2). The main disadvantages of the technique are the need for additional appointments and the pain associated with uterine-cavity distension. Although we are optimistic about the value of the method, well-designed studies are needed to evaluate its effectiveness and safety. A randomized controlled trial (RCT) completed recently found that intermittent intrauterine balloon therapy can prevent reformation of IUAs after hysteroscopic adhesiolysis8. Another RCT from the same group, evaluating the efficacy of intrauterine balloon dilatation therapy in adhesion prevention following hysteroscopic myomectomy, is ongoing9. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Intrauterine Fluid Instillation and Transtubal Flow: A Randomized Controlled In vitro Trial Comparing Gel and Water.

Background:Possible transtubal spillage of malignant cells is a major concern in fluid instillation sonography, as it is in hysteroscopy. This study aims to compare the transtubal flow of gel and saline and validate the clinical hypothesis that application of fluids with higher viscosity causes less spillage.Methods:Randomized controlled in vitro trial comparing gel and saline infusion on 15 tissue specimens after hysterectomy with bilateral salpingectomy. Instillations are performed with saline and gel dyed with a 1% ink solution. Qualitative assessment of tubal spill is investigated as primary outcome. Secondary outcomes are instillation-volume and -pressure, assessed by measuring endometrial cavity dilation at in vitro ultrasound examination and subjective numeric 10-point scoring of the instillation pressure by a dedicated examiner.Results:Tubal flow was more often observed during saline instillation (odds ratio 4.88, P = 0.008). Median subjectively assessed instillation pressures were nine arbitrary units for gel and three for saline (P < 0.001). Tubal flow occurred from 2 cc onward in the saline group versus five cc in the gel instillation group. Cavitary dilation did not differ between both groups.Conclusion:Gel instillation sonography is in vitro associated with less tubal flow and therefore could be a safer diagnostic test compared to saline infusion sonography or hysteroscopy. In vivo studies are necessary to confirm these results.

Echocardiographic parameters in hemodialysis patients

Introduction Cardiovascular morbidity and mortality appears to be higher in patients with end stage renal disease in chronic hemodialysis. Detection of abnormalities in cardiac structure or function allows appropriate therapeutic management. Transthoracic echocardiography (TTE) is a non-invasive, available and reproducible tool that allows the diagnosis of cardiac abnormalities particularly in this population. Methodes We conducted a retrospective study including hemodialysis patients at our dialysis unit and having an echocardiography performed more than 3 months from the beginning of the extrarenal treatment. We selected 31 patients. Resultats obtenus ou attendus The mean age of patients was 51.9 years. Hypertension was found in 83.8 %, diabetes in 22.5 % and coronary event in 25.8%. The electrocardiogram showed repolarization abnormalities in 29%, arhythmia in 16.1% and left ventricular hypertrophy in 22.5%. The mean duration of hemodialysis was 73.1 months. The frequency of hemodialysis was 3 per week in most patients. Echocardiography showed dilatation of the left atrium (LA) in 64.5% and dilatation of the right cavities in 25.8%. Left ventricular (LV) hypertrophy was found in 41.9% with an average thickness of the inter ventricular septum and the posterior wall of 13.43 mm and 10.96 mm respectively. The mean LV end-diastolic pressure was calculated at 49.8 mmHg. Dilated cardiomyopathy was noted in only 3 patients. The kinetic was conserved in 67.7% whereas a total hypokinesia was found in 12.9% and segmental hypokinesia in 19.3%. Valvulopathy was found in 54.8%. Valvular calcifications were noted in 25.8%. 54% of patients had pulmonary arterial hypertension with an average pulmonary arterial systolic pressure of 41.1 mmHg. Pericarditis was found in 32.2%, while 57.2% of patients had previous pericarditis including a patient with a drained tamponade. The inferior vena cava was dilated in 29%. Conclusion Cardiac complications are frequent in hemodialysis population and are dominated by left ventricular hypertrophy and increased preload due to several factors.

CLINICAL AND INSTRUMENTAL ASSESSMENT OF MORPHO-FUNCTIONAL CONDITION OF THE HEART AND VASCULATURE IN COMORBIDITY OF ARTERIAL HYPERTENSION AND DIABETES MELLITUS TYPE 2

The aim of this study was to investigate the heart and common carotid arteries (CCA) morphological and functional condition and the lipid spectrum in patients with arterial hypertension (AH) and type 2 diabetes mellitus (DM-2).Material and methods. The study included 144 patients with varying degrees of AH, 103 had AH without DM-2 (AH subgroup) and 41 patients with AH and DM-2 (AH+DM-2 subgroup). In all investigated patients the blood plasma lipid profile, echocardiographic examination of the heart and ultrasound Doppler examination of the CCA were carried out. The results. Significant differences between the AH and AH+DM-2 subgroups were discovered, which confirmed the significant effect of DM-2 on various parameters of the cardiovascular system. The lipid profile in the above mentioned subgroups has not significant differences, but some separated indices (TG, VLDL) in the AH+DM-2 subgroup were comparatively higher and HDL level lower comparing to AH subgroup. Marked changes in echocardiographic parameters, such as lowering of left ventricle (LV) ejection fraction (EF), significant increase of interventricular septum and LV posterior wall thickness, high frequency of LV hypertrophy detection, diastolic dysfunction, diffuse hypokinesis and dilatation of the heart cavities in the AH+DM-2 subgroup were confirmed. A significant rise of CCA intima-media thickness also was found in the AH+DM-2 in comparison with AH subgroup, which proved the essential role of comorbidity of AH and DM-2 in the heart and vessels remodeling. The conclusion. The results of the study confirm the role and significance of comorbidity of AH with DM-2 in the development of the cardiovascular system pathological changes.

Dynamics of Indicators of Structural and Functional State of the Heart in the Post-Infarction Period Depending on the Presence of Decompensated Heart Failure

Echocardiographic indicators in decompensated heart failure demonstrate a high prevalence of structural and hemodynamic abnormalities. In the patients with decompensated heart failure in the early and late post-infarction period, echocardiographic indicators were found to significantly differ from those recorded in the patients without heart failure. Thus, reduced ejection fraction, increased end-diastolic volume and end-diastolic dimension indicate left ventricular systolic dysfunction and left ventricular cavity dilation. Since echocardiography of the heart and the pulmonary artery enables real-time estimation of cardiac filling, signs of systolic dysfunction and pulmonary congestion, it may serve as a predictor of decompensated heart failure development in the early and late post-infarction period.&#x0D; The objective of the research was to determine the main echocardiographic indicators in terms of rapid monitoring of deterioration in the main parameters of left ventricular overload for early diagnosis of decompensated heart failure, as well as structural and geometric remodeling of left ventricular myocardium in the early and late post-infarction period.&#x0D; Materials and methods. There were examined 160 patients with acute myocardial infarction. Depending on the development of decompensated heart failure in the early and late post-infarction period, the patients were divided into two subgroups being homogeneous by age and gender.&#x0D; Results. The results obtained indicated significant hemodynamic changes in the patients with decompensated heart failure in the post-infarction period. They included significantly lower values of ejection fraction indicating left ventricular systolic dysfunction and the signs of left ventricular cavity dilation as evidenced by the increase in left ventricular end-diastolic volume and end-diastolic dimension. The tendency for an increase in left ventricular posterior wall thickness and interventricular septal thickness, as well as left ventricular myocardial mass, left ventricular myocardial mass index and left ventricular radius to wall thickness ratio indicated concentric left ventricular remodeling.&#x0D; Conclusions. Modern management of patients with decompensated heart failure should be guided by an objective value of left ventricular ejection fraction as it plays a key role in selecting management strategy for this cohort of patients since a significant reduction in this parameter indicates cardiac decompensation. Pulmonary artery pressure and concentric left ventricular hypertrophy play a significant role in cardiac failure development as well.

OPTIMIZATION OF ACUTE MYOCARDITIS TREATMENT

Aim. This paper is aimed at investigating the possibility of preventing an adverse outcome of acute viral myocarditis by means of optimal pharmacotherapy without the use of surgical treatment methods.Results. We describe a clinical case of acute viral myocarditis in a 60-year old female patient. According to the conducted echocardioscopy, the dilatation of the heart cavities and the complete insufficiency of the mitral and tricuspid valves were identified. A cumulative effect of the chosen optimal pharmacotherapy, which included an angiotensin converting enzyme inhibitor, a beta-blocker, a mineralocorticoid receptor antagonist and a loopback diuretic with neurohumoral properties taken in optimal doses, allowed congestion signs to be rapidly eliminated, a reverse remodeling of the heart to be achieved and the heart size to be returned normal values. The double blockade of aldosterone receptors using eplerenone and torasemide prevented both the development of fibrosis in the myocardium and the formation of irreversible dilated cardiomyopathy.Conclusion. The application of antiviral and immunomodulatory therapy, along with the maximum possible doses of drugs used to treat chronic heart failure, allowed the patient’s cardiohemodynamic parameters to be returned to normal values. A timely combination therapy should be used to avoid the formation of dilated cardiomyopathy, thus improving the prognosis of the disease.

Age-dependent cardioprotective action of meldonium on heart remodeling under the experimental hypoosmolar hyperhydration

Background: Chronic water overload leads to a remodeling of the internal organs, in particular the heart. The reaction of the organism to the influence of the damaging factors varies depending on age. Therefore, the complex treatment of diseases, which results in a positive water balance, requires the prescription of cardioprotectors.The aim of our study was the determination of morphological changes of the heart of rats of different age under the influence of hypoosomolar hyperhydration and an attempt to correct the detected changes by means of meldonium.&#x0D; Material and Method:The experiment was conducted on 36 laboratory male rats of two age groups: young (3 months old), and old (22 months old).Modeling of severe degree ofhypoosmolarhyperhydration was by the introduction of 10 ml distilled water three times a day and synthetic analogue of antidiuretic hormone «Minirin» (Ferring) 2 times a day at a dose of 0.01 mg without meldonium (first experimental series) and with the parallel introduction of meldonium (second experimental series). We analyzed organometric and histomorphometric data to study the features ofthe heart remodeling.&#x0D; Results: The organometric study indicated a uniform increase in the weight of the ventricles and a significant dilatation of the right ventricular cavity in young ratsof the first experimental series, and there was a predominant increase in the weight of the right ventricle and uniform dilatation of the cavities of both ventricles in old animals of the same series. The histomorphometric study has determined increasing in the diameter of cardiomyocytes and their nuclei in both age groups. We observed increasing in the relative amount of cardiomyocytes and vessels, and decreasing in relative amount of connective tissue in young rats. In contrast, there was decreasing in relative amount of cardiomyocytes and vessels, and increasing in the relative amount of connective tissue in old animals. The meldonium administration positively acts on the right ventricle, slowing its dilatation in young rats of the second experimental series and its hypertrophy in old rats. Moreover, the diameter of cardiomyocytes in both age groups is significantly increased, but meldonium stabilizes the diameter of the nuclei of cardiomyocytes. Also meldonium increases in the relative amount of vessels in 3-month age rats.&#x0D; Conclusions: The use of meldonium to correct the morphofunctional state of myocardium in rats under the influence of severe degree of Hypoosmolar hyperhydration significantly reduces the damaging effect of water overload on the myocardium of young animals, and to a lesser extent, on the myocardium of animals of old age. The positive effect of meldonium on the heart of experimental rats is to enhance myocardial vascularization, slowing the growth of the weight of the chambers of the heart, and slowing the dilation of ventricular cavities.&#x0D; Bangladesh Journal of Medical Science Vol.18(2) 2019 p.395-401

Exceptional intrarenal pseudomembranous.

We report the case of a 51-year-old patient, known as hypertensive and type 2 diabetic, admitted to emergency for acute pyelonephritis. She suffered from low back pain in a feverish context. A Uro-scanner showed the presence of a 12mm pyelic renal calculus and a calycal calculus of 6mm diameter responsible for a moderate dilation of left pyelocalictic cavities. First, we performed drainage with a double J probe. Then, in a second step, the left ureteroscopy allowed partial laser fragmentation. The presence of a suspect soft magma prompted us to stop the procedure. After performing a hydatid serology that has returned negative, a laparoscopic left pyelotomy allowed the progressive externalization of the suspect magma. It presented with a greenish, fibrinous, semi-solid shell completely molding the pyelon and the pyelocalicielles cavities. The introduction of the flexible cystoscope through a trocar at the end of the procedure allowed us to check the complete cleaning of the excretory cavities. The anatomopathological study is back in favor of a weakly eosinophilic acellular material with some polyhedral crystals and some inflammatory elements. There were no signs of malignancy. The patient did not present any postoperative complication and did not present a recurrence.

Transplantation of Cardiac Mesenchymal Progenitor Cell Sheets for Myocardial Vascularization after an Infarction (Experimental Study)

Purpose. To develop a method of producing tissue-engineered constructs (TECs) on the basis of resident mesenchymal progenitor cells (MPC) of the human heart and to assess the effect of TECs transplantation on regenerative processes in the heart using a model of myocardial infarction in rats.Materials and methods. Human resident MPCs were isolated from the right atrial auricle of CAD patients. A similar protocol was used to obtain MPCs from Wistar rats. The MPC immunophenotype was determined by cytofluorometry. Corresponding TECs were obtained on the basis of MPC sheets of human and rats' hearts. Myocardial infarction in rats was induced by ligation of the anterior descending coronary artery followed by TEC transplantation. Euthanasia was performed 30 days after the transplantation. Histological examination of the implant and vascularization cells, morphometric analysis, tracking of the MPC differentiation ability, determination of the content of growth factors by solid-phase ELISA were carried out. Statistical evaluation of the significance of differences was performed using the Statistica 8.0 software package.Results. The analysis of the obtained cell constructs showed that they consisted of several layers of cells interacting with each other by means of connexin 43 and were characterized by good cell viability as a part TECs. The number of vessels in the peri-infarction area under the transplant from the MPC was significantly higher than that in the reference group with signs of differentiation of cardiac MPCs transplanted into endothelial vascular cells.The increased vascularization was combined with an increase in the area of viable myocardial sites and a decrease in LV cavity dilation. Analysis of the cardiac MPC secretion products showed that they produce the most important growth factors and cytokines that regulate angiogenesis and migration of stem cells.Conclusion. The strategy of using epicardial TEC transplantation based on MPC sheets seems to be a rational approach for effective delivery of viable stem/progenitor cells to the damaged myocardium. The use of TEC helps to reduce or temporarily eliminate the effect of factors that contribute to progressive heart dysfunction by local paracrine exposure and activation of the revascularization processes in the affected zone.

Effect of bone flap reduction on unilateral acute subdural hematoma under intracranial pressure monitoring

Objective To investigate the effect of bone flap reduction on unilateral acute subdural hematoma (ASDH) under intracranial pressure monitoring. Methods A retrospective case control study was conducted to analyze the clinical data of 139 patients with unilateral ASDH admitted to the First Affiliated Hospital of Xinjiang Medical University from July 2014 to December 2017. There were 84 males and 55 females, aged 19-87 years (mean, 53 years). At the time of admission, the Glasgow Coma Score (GCS) was 3-5 points in 63 patients and 6-8 points in 76. There were 40 patients with unilateral cavity dilation and 16 cases with bilateral pupil dilation. According to the different surgical methods, the patients were divided into study group (n=61) and control group (n=78). The study group removed the cranial hematoma under cranial pressure monitoring and determined whether to perform bone flap reduction according to the actual intracranial pressure. The control group was treated with craniotomy hematoma removal and standard large bone decompressed craniectomy (DC). The success rate of bone flap reduction in the study group was recorded. The complications at postoperative 3 months and the Glasgow Outcome Score (GOS) at postoperative 6 months were compared. Results All patients were followed up for 1-6 months, average 5.5 months. In the study group, 23 patients underwent bone flap reduction, and the bone flap reduction rate was 38%. At postoperative 3 months, the study group showed better efficacy in subdural effusion (9 ∶25), hydrocephalus (7 ∶19), and brain swelling in the skull defect area(5 ∶18) than the control group (P<0.05). Based on the GOS at 6 months after operation, in the study group, 25 patients were with good results, nine with moderate disability, 10 with heavy disability, seven with plant survival, and 10 died; in the control group, six patients were with good results, 21 with moderate disability, 15 with heavy disability, 10 with plant survival, and 26 died. The number of patients with good prognosis (good and moderate disability) and the number of deaths in the study group were statistically different from those in the control group (P<0.05). Conclusion In the treatment of unilateral ASDH, bone flap reduction under intracranial pressure monitoring can reduce the incidence of complications and improve the life quality of patients. Key words: Intracranial pressure; Hematoma, subdural, acute; Reconstructive surgical procedure