The Spectrum of Congenital Heart Disease with Transposition of the Great Arteries from the Cardiac Registry of the University of Padua

Transposition of the great arteries (TGA) is a cardiac condition in which the arterial trunks arise from the inappropriate ventricle: the aorta from the right ventricle and the pulmonary trunk from the left ventricle [discordant ventriculo-arterial (VA) connection]. In complete TGA the discordant VA connection is associated with situs solitus or inversus and concordant atrioventricular (AV) connection. The hemodynamic consequence of these combined connections is that systemic and pulmonary circulations function in parallel rather than in series.The presence of situs solitus or inversus associated with both AV and VA discordant connections characterizes a different anatomical complex known as corrected TGA. In these hearts, the double discordance at AV and VA level permits a normal sequence of the blood flow from the right atrium to the pulmonary artery and from the left atrium to the aorta. The systemic and pulmonary circulation in these hearts functions regularly in series and the blood sequence is physiologically corrected. Thus the term transposition, either complete or corrected, identifies two precise, different anatomical complexes, both characterized by VA discordance. However among congenital heart disease (CHD), there are other anatomical complexes with discordant VA connection in the setting of isomeric atrial situs (right or left) or of univentricular AV connections (double inlet or absent connections). In these latter conditions, the term transposition is still necessary to stress that the great arteries are transposed in relation to the ventricular septum (aorta from the right ventricle and pulmonary trunk from the left ventricle) but certainly does not figure out the anatomical complexes named complete or corrected transposition.We reviewed the hearts with discordant VA connection of our Anatomical Collection, consisting of 1640 specimens with CHD, with the aim to discuss the anatomy and the frequency of the anatomical variants of TGA and to clarify terminology and classification. The knowledge of the precise anatomy of these malformations results really important for clinical diagnosis and surgical planning

Complete Transposition of Great Arteries With Dominant Left Ventricle

We report the case of an adult patient, affected by complete transposition of great arteries with ventricular septal defect, who survived until 68 years of age without surgery, thanks to the presence of a common atrium and pulmonary stenosis. (Level of Difficulty: Advanced.

Coronary Arteries: Normal Anatomy With Historical Notes and Embryology of Main Stems

Anatomy of subepicardial coronary arteries became a topic of investigation at autopsy in Florence (Italy) by Banchi in the early twentieth century, with the discovery of dominant and balanced patterns. Thereafter, in the 60's of the same century Baroldi in Milan did post-mortem injection with spectacular three-dimensional casts. Later Sones at the Cleveland Clinic introduced selective coronary arteriography for in vivo visualization of coronary arteries. In the present chapter we show these patterns, as well as normal variants of origin and course with questionable risk of ischemia, like myocardial bridge as well as origin of the left circumflex coronary artery from the right sinus with retroaortic course. As far as embryology, the coronary arteries and veins are epicardial in origin and finally connect the former with the aorta, and the latter with the sinus venosus. At the time of spongy myocardium, intramural blood supply derives directly by the ventricular cavities, whereas later, at the time of myocardial compaction, vascularization originates from the subepicardial network. The connection of the subepicardial plexus with the aorta occurs with prongs of the peritruncal ring, which penetrate the facing aortic sinuses. Septation of truncus arteriosus is not responsible for the final position of the coronary orifices. Infact in transposition of the great arteries coronary ostia are regularly located within facing sinuses of the anterior aorta

Guaraná (Paullinia cupana) improves the proliferation and oxidative metabolism of senescent adipocyte stem cells derived from human lipoaspirates

AbstractCellular senescence is a limiting factor in the proliferative expansion and quality of adult mesenchymal stem cells, often making them unviable in regenerative clinical practice. In vitro supplementation by antioxidant food extract of senescent mesenchymal stem cells could reverse these undesirable characteristics. To evaluate this hypothesis, senescent adipocyte-mesenchymal cells (ASCs) obtained from human lipoaspirates were exposed at different concentrations of hydro-alcoholic guaraná (Paullinia cupana) extract for 72h. After the incubation, we performed a proliferative assay. Oxidative stress indicators and antioxidant enzymes (biochemical activity and gene expression by qRT-PCR analysis) in these senescent cells were also evaluated. In senescent cells exposed to guaraná at 5mg/g concentration increased cellular proliferation occurred compared to untreated senescent cells (79.1±15.7%). Concomitantly, a decrease in several oxidative stress indicators was observed in senescent cells treated with guaraná. A genomic effect of guaraná exposure was observed when the modulation of antioxidant enzymes genes was analyzed. The results described here suggest that the food extract supplementation could reverse the initial senescence processes in ASCs. These results have potential application in regenerative medicine