Small Interfering RNA Efficiently Suppresses Adhesion Molecule Expression on Pulmonary Microvascular Endothelium

Background. Adhesion molecules are known to influence postoperative organ function, they are hardly involved in the inflammatory response following the ischemia-reperfusion injury. We sought to investigate the potency of small interfering RNAs to suppress adhesion molecule expression in human pulmonary microvascular endothelial cells. Methods. Human lung microvascular endothelial cells were transfected with specific siRNA followed by a stimulation of the cells with an inflammatory cytokine. Adhesion molecule expression was determined by FACS-analysis, and reduction of intracellular mRNA was determined by qRT-PCR. Furthermore, the attachment of isolated neutrophils on the endothelial layer was determined after siRNA transfection. Results. In summary, siRNA transfection significantly decreased the percentage positive cells in a single cocktail transfection of each adhesion molecule investigated. Adhering neutrophils were diminished as well. Conclusion. siRNA might be a promising tool for the effective suppression of adhesion molecule expression on pulmonary microvascular cells, potentially minimizing leukocyte-endothelial depending interactions of a pulmonary allograft

Influence of meteorological conditions on the incidence of spontaneous acute aortic dissection

Die chronobiologische Periodizität kardiovaskulärer Erkrankungen sowie der Einfluss, den meteorologische Bedingungen auf deren Inzidenz nehmen, sind insbesondere für die häufigeren Krankheitsbilder bereits nachgewiesen. Für akute Aortendissektionen wurden ebenfalls jahreszeitliche Schwankungen beschrieben, die weitgehend denen der übrigen kardiovaskulären Erkrankungen entsprechen. Ein Einfluss verschiedener meteorologischer Faktoren – insbesondere von Temperatur und Luftdruck - auf die Inzidenz akuter Aortendissektionen wurde bereits mehrfach untersucht, doch wurden unterschiedliche und teils widersprüchliche Ergebnisse publiziert. De während des 6-jährigen Zeitraums zwischen dem 01.07.2004 und dem 31.06.2010 am Universitätsklinikum Tübingen behandelten Fälle spontaner akuter Aortendissektionen wurden im Hinblick auf eine Korrelation mit den an den Tagen ihres Auftretens sowie definierten Zeiträumen zuvor herrschenden Witterungsbedingungen analysiert. Bei den untersuchten Parametern handelt es sich primär um Temperatur und Luftdruck. Weitere Einflussfaktoren wie die relative Luftfeuchtigkeit, die Niederschlags- sowie die Windverhältnisse wurden als sekundäre Parameter berücksichtigt. Eine Variabilität der Auftretenshäufigkeit von Aortendissektionen im Jahresverlauf konnte nachgewiesen werden. Insbesondere konnte eine Häufung der Aortendissektionen während der kalten Jahreszeit demonstriert werden, was die Ergebnisse bestätigt, die auch von anderen Autoren für die Auftretenshäufigkeit von Aortendissektionen berichtet wurden. Darüber hinaus stimmen die publizierten Ergebnisse mit der jahreszeitlichen Varianz überein, die für verschiedene andere akute kardiovaskuläre Ereignisse nachgewiesen wurde. Auch die negative Korrelation, die die meisten Autoren zwischen akuten kardiovaskulären Ereignissen einschließlich Aortendissektionen und den herrschenden Temperatur- und Luftdruckwerten feststellen konnten, ließ sich anhand der ausgewerteten Daten nachvollziehen. Nicht bestätigen hingegen ließ sich die Hypothese einer Korrelation zwischen dem Auftreten akuter Aortendissektionen und vorangegangenen markanten Temperatur- oder Luftdruckabfällen. Allerdings konnte nachgewiesen werden, dass die maximale Luftdruckdifferenz als Ausdruck der maximalen Amplitude der Luftdruckschwankungen während der den Dissektionen zugeordneten Zeitintervalle größer war, als während der Vergleichszeiträume, was darauf schließen lässt, dass markante Luftdruckschwankungen tatsächlich Einfluss auf das Auftreten akuter Aortendissektionen nehmen könnten. Insgesamt ist aufgrund der Studienlage davon auszugehen, dass meteorologische Einflüsse sich auf das Auftreten von akuten Pathologien der Aorta einschließlich Aortendissektionen auswirken und dass das Wissen über das erhöhte Risiko prädisponierter Patienten, zu bestimmten Jahreszeiten bzw. bei bestimmten Witterungsverhältnissen eine Aortendissektion zu erleiden, auch in Bezug auf prophylaktische Maßnahmen und Therapieentscheidungen eine Rolle spielen könnte.The chronobiological periodicity of cardiovascular events and the influence of meteorological conditions on their incidence have been proven, in particular, for the more common cardiovascular diseases. Seasonal variations in the occurrence of acute aortic dissection largely coinciding with those of other cardiovascular events have also been described. The influence of different meteorological conditions such as, in particular, temperature and atmospheric pressure, on the incidence of acute aortic dissections has been investigated by different authors. The results published, however, are different and contradictory. The cases of spontaneous acute aortic dissections treated at the University Hospital of Tuebingen between 01 July 2004 and 31 June 2010 were investigated with a view to identifying a correlation between their occurrence and the meteorological conditions prevailing on and preceding the date of occurrence. The primary parameters investigated were temperature and atmospheric pressure. Other possible influences such as relative air humidity, precipitation, as well as wind speed and direction were included as secondary parameters. The investigation of the available data showed a seasonal variability of the incidence of aortic dissection. In particular, an increased frequency of occurrence of aortic dissection during the cold season was demonstrated, which confirms the results published by other authors with respect to the incidence of aortic dissections. Additionally, the results published are in keeping with the seasonal variability demonstrated for other acute cardiovascular events. The negative correlation reported by most authors between acute cardiovascular events including aortic dissections and the temperature and atmospheric pressure conditions prevailing at and before the date of their occurrence was confirmed by the data evaluated. The hypothesis of a correlation between the occurrence of acute aortic dissections and significant drops in temperature or atmospheric pressure preceding them was not confirmed. However, it was shown that the maximum atmospheric pressure difference as a measure of the maximum amplitude of the atmospheric pressure variation during the periods preceding dissections exceeded the maximum atmospheric pressure difference during the control intervals, which suggests that significant variations in atmospheric pressure might in fact influence the occurrence of acute aortic dissections. In summary, it may be assumed that meteorological conditions exert an influence on the occurrence of acute aortic pathologies including aortic dissections. Awareness of the increased risk of predisposed patients suffering an aortic dissection during certain seasons of the year or when certain meteorological conditions prevail may play a role when it comes to prophylactic measures and therapy planning

Left ventricular non-compaction cardiomyopathy and left ventricular assist device: a word of caution

BACKGROUND: In patients with left ventricular non-compaction (LVNC), implantation of a left ventricular assist device (LVAD) may be performed as a bridge to transplantation. In this respect, the particular characteristics of the left ventricular myocardium may represent a challenge. CASE PRESENTATION: We report a patient with LVNC who required urgent heart transplantation for inflow cannula obstruction nine months after receiving a LVAD. LVAD parameters, echocardiography and examination of the explanted heart suggested changes of left ventricular configuration brought about by LVAD support as the most likely cause of inflow cannula obstruction. CONCLUSIONS: We conclude that changes experienced by non-compacted myocardium during LVAD support may give rise to inflow cannula obstruction and flow reduction. Presence of LVNC mandates tight surveillance for changes in LV configuration and LVAD flow characteristics and may justify urgent transplantation listing status

Restrictive surgical approach to palliate angina in a patient with coronary three vessel disease and biventricular metastatic hepatocellular carcinoma

Abstract Background Metastatic cardiac tumors may cause different symptoms including angina, symptoms of heart failure and/or arrhythmia. In patients with concomitant coronary artery disease, it may be difficult to distinguish between angina caused by metastases to the heart, for example, by stealing perfusion from the coronary arteries, and angina caused by coronary stenosis. Identifying the origin of the symptoms is, however, essential for designing appropriate surgical strategies. Case presentation A 69-year-old male with multifocal recurrence of a hepatocellular carcinoma (HCC) presented with increasing ventricular arrhythmia and angina several weeks after posterior myocardial infarction and PCI of the RCA culprit lesion during which two further lesions present in the distal RCX and a posterolateral branch, and a chronically occluded LAD had not been addressed. MRI showed a large metastatic tumor infiltrating the walls of both ventricles as well as the interventricular septum. His debilitating symptoms were attributed to steal phenomena and/or perivascular compression caused by the metastatic tumor rather than the remaining coronary lesions, and he was offered a restrictive surgical approach consisting of debulking of the metastasis with an option for subsequent coronary intervention. The palliative surgical procedure resulted in a reduction of the tumor mass by half and sufficiently reduced the patient’s symptoms so that further coronary intervention was not required. Conclusions Palliative surgery for metastases to the heart may benefit patients, provided that the origin of symptoms is identified correctly. It goes without saying that in a palliative setting, surgery should be limited to treating symptoms rather than performing extensive procedures addressing, for example, coronary artery or valve disease. Interventional cardiac procedures addressing not only CAD but also valve disease may supplement palliative tumor surgery

Identification of factors influencing cumulative long-term radiation exposure in patients undergoing EVAR

Patients who undergo endovascular repair of aortic aneurysms (EVAR) require life-long surveillance because complications including, in particular, endoleaks, aneurysm rupture, and graft dislocation are diagnosed in a certain share of the patient population and may occur at any time after the original procedure. Radiation exposure in patients undergoing EVAR and post-EVAR surveillance has been investigated by previous authors. Arriving at realistic exposure data is essential because radiation doses resulting from CT were shown to be not irrelevant. Efforts directed at identification of factors impacting the level of radiation exposure in both the course of the EVAR procedure and post-EVAR endovascular interventions and CTAs are warranted as potentially modifiable factors may offer opportunities to reduce the radiation. In the light of the risks found to be associated with radiation exposure and considering the findings above, those involved in EVAR and post-EVAR surveillance should aim at optimal dose management

Giant right atrial myxoma: A rare cause of cardiovascular collapse

We report the case of a patient with a giant right atrial myxoma that remained clinically silent until it almost completely obliterated the right atrium, prolapsed into the right ventricle and obstructed the tricuspid valve inflow. This case illustrates the importance of rapid surgical intervention in the setting of acute heart failure caused by tumor masses obliterating heart valves or cardiac chambers

Kinetics of circulating endothelial progenitor cells in patients undergoing carotid artery surgery

Aim: Endothelial progenitor cells (EPCs) are primitive cells found in the bone marrow and peripheral blood (PB). In particular, the potential of EPCs to differentiate into mature endothelial cells remains of high interest for clinical applications such as bio-functionalized patches for autologous seeding after implantation. The objective of this study was to determine EPCs’ kinetics in patients undergoing carotid artery thromboendarterectomy (CTEA) and patch angioplasty. Methods: Twenty CTEA patients were included (15 male, mean age 76 years). PB samples were taken at 1 day preoperatively, and at 1, 3, and 5 days postoperatively. Flow cytometric analysis was performed for CD34, CD133, KDR, and CD45. Expression of KDR, SDF-1α, and G-CSF was analyzed by means of enzyme-linked immunosorbent assay. Results: Fluorescence-activated cell sorting analysis revealed 0.031%±0.016% (% of PB mononuclear cells) KDR+ cells and 0.052%±0.022% CD45-/CD34+/CD133+ cells, preoperatively. A 33% decrease of CD45–/CD34+/CD133+ cells was observed at day 1 after surgery. However, a relative number (compared to initial preoperative values) of CD45-/CD34+/CD133+ cells was found on day 3 (82%) and on day 5 (94%) postoperatively. More profound upregulated levels of CD45–CD34+/CD133+ cells were observed for diabetic (+47% compared to nondiabetic) and male (+38% compared to female) patients. No significant postoperative time-dependent differences were found in numbers of KDR+ cells and the concentrations of the cytokines KDR and G-CSF. However, the SDF-1α levels decreased significantly on day 1 postoperatively but returned to preoperative levels by day 3. Conclusion: CTEA results in short-term downregulation of circulating EPCs and SDF-1α levels. Rapid return to baseline levels might indicate participation of EPCs in repair mechanisms following vascular injury

Acute heart failure due to giant left atrium: remote ECLS implantation for interhospital transfer and bridging to decision

Remote extracorporeal life support (ECLS) implantation and mobile ECLS are increasingly applied to enable the treatment of patients with refractory heart failure at specialized care centers. Giant left atrium (GLA) is a rare cause but may lead to acute and devastating heart failure