Prognostic value of myocardial fibrosis in severe aortic stenosis:Study protocol for a prospective observational multi-center study (FIB-AS)

BACKGROUND: Adverse cardiac remodeling with a myocardial fibrosis as a key pathophysiologic component may be associated to worse survival in aortic stenosis (AS) patients. Therefore, with the application of advanced cardiac imaging we aim to investigate left ventricular myocardial fibrosis in severe AS patients undergoing aortic valve replacement (AVR) and determine its impact with post-intervention clinical outcomes. METHODS: In a prospective, observational, cohort study patients with severe AS scheduled either for surgical or transcatheter AVR will be recruited from two tertiary heart centers in Denmark and Lithuania. All patients will receive standard of care in accordance with the current guidelines and will undergo additional imaging testing before and after AVR: echocardiography with deformation analysis and cardiovascular magnetic resonance (CMR) with T1 parametric mapping. Those undergoing surgical AVR will also have a myocardial biopsy sampled at the time of a surgery for histological validation. Patients will be recruited over a 2-year period and followed up to 2 years to ascertain clinical outcomes. Follow-up CMR will be performed 12 months following AVR, and echocardiography with deformation analysis will be performed 3, 12, and 24 months following AVR. The study primary outcome is a composite of all-cause mortality and major adverse cardiovascular events. DISCUSSION: Despite continuous effort of research community there is still a lack of early predictors of left ventricular decompensation in AS, which could improve patient risk stratification and guide the optimal timing for aortic valve intervention, before irreversible left ventricular damage occurs. Advanced cardiac imaging and CMR derived markers of diffuse myocardial fibrosis could be utilized for this purpose. FIB-AS study is intended to invasively and non-invasively assess diffuse myocardial fibrosis in AS patients and investigate its prognostic significance in post-interventional outcomes. The results of the study will expand the current knowledge of cardiac remodeling in AS and will bring additional data on myocardial fibrosis and its clinical implications following AVR. ETHICS/DISSEMINATION: The study has full ethical approval and is actively recruiting patients. The results will be disseminated through scientific journals and conference presentations. TRIAL REGISTRATION: ClinicalTrials.govNCT03585933. Registered on 02 July 2018

Chirurginių minimaliai invazyvių prieširdžių virpėjimo gydymo būdų palyginimas

This was an observational, retrospective study of 127 patients (79% males; mean age, 52±10 years [range, 23–75 years]) who underwent minimally invasive standalone surgical ablation of paroxysmal, persistent and longstanding persistent AF from 2008 to 2015. Mean follow-up was 60±21 months. Three different devices have been used for the ablation: Cardioblate® Gemini® surgical ablation system; Medtronic, Inc., Minneapolis, MN, USA; COBRA Adhere XL™ ablation system, Estech, Inc, California, CA, USA; AFx FLEX 10 microwave ablation system, Guidant, AFx, Fremont, CA, USA. The absence of arrhythmia was confirmed at 3, 6, and 12 months, and annually thereafter, with 24-hour Holter monitoring. The mean duration of preoperative AF was 6.5±5.4 years. Six (5%) patients had a paroxysmal AF, and 19 patients (15%) had a long-standing persistent AF. Mean left atrial diameter was 4.3±0.8 cm. There were two postoperative strokes (2%) and three conversions to median sternotomy (2.4%). Permanent pacemakers were implanted in 10 (8 %) patients. There were no intra- or postoperative deaths. At 1, 2, 3, 4, and 5 years postoperatively, freedom from AF was 70%, 48%, 41%, 38%, 34%, 32% of patients, respectively. The best results were achieved then bipolar ablation device (Cardioblate® Gemini® surgical ablation system;) was used (χ2=12,521. p=0.0004). At 1, 2, 3, 4, and 5 years postoperatively, freedom from AF was 73%, 58%, 48%, 44%, 42%, 42% of patients, respectively if bipolar ablation device was used.The failure to achieve pulmonary vein isolation (“exit” block) was the only independent predictor of long-term recurrence of AF (HR −3 [95%CI 1,858 to 8,586], p = 0,001). Conclusions: In the present series, the efficacy of epicardial surgical ablation was similar to that reported previously. The rate of arrhythmia recurrence increased over time. Achieving pulmonary vein isolation is essential to AF elimination

Comparison of minimally invasive epicardial ablation methods of atrial fibrillation treatment

This is an observational, retrospective study of 127 patients (79 % males; mean age 52 ± 10 years [range, 23–75 years]) who underwent minimally invasive standalone surgical ablation of paroxysmal, persistent and longstanding persistent AF from 2008 to 2015. Mean follow-up was 60±21 months. Three different devices have been used for the ablation: Cardioblate® Gemini® surgical ablation system; Medtronic, Inc., Minneapolis, MN, USA; COBRA Adhere XL™ ablation system, Estech, Inc, California, CA, USA; AFx FLEX 10 microwave ablation system, Guidant, AFx, Fremont, CA, USA. The absence of arrhythmia was confirmed at 3, 6, and 12 months, and annually thereafter, with 24-hour Holter monitoring. The mean duration of preoperative AF was 6.5 ± 5.4 years. Six (5%) patients had a paroxysmal AF, and 19 patients (15%) had a long-standing persistent AF. Mean left atrial diameter was 4.3±0.8 cm. There were two postoperative strokes (2 %) and three conversions to median sternotomy (2.4%). Permanent pacemakers were implanted in 10 (8%) patients. There were no intra- or postoperative deaths. At 1, 2, 3, 4, and 5 years postoperatively, freedom from AF was 70%, 48%, 41%, 38%, 34%, 32% of patients, respectively. The best results were achieved then bipolar ablation device (Cardioblate® Gemini® surgical ablation system;) was used (χ2 = 12,521, p = 0.0004). At 1, 2, 3, 4, and 5 years postoperatively, freedom from AF was 73%, 58%, 48%, 44%, 42%, 42% of patients, respectively if bipolar ablation device was used.The failure to achieve pulmonary vein isolation (“exit” block) was the only independent predictor of long-term recurrence of AF (HR −3 [95 % CI 1,858 to 8,586], p = 0,001). Conclusions: In the present series, the efficacy of epicardial surgical ablation was similar to that reported previously. The rate of arrhythmia recurrence increased over time. Achieving pulmonary vein isolation is essential to AF elimination

Sternotomy closure using negative pressure wound therapy after heart transplantation

Background: Deep sternal wound infection (DSWI) after orthotopic heart transplantation (OHT) is not a common but known complication and carries high mortality and morbidity rates. This report identifies a successful management strategy for recurrent DSWI, and it is a valuable addition to the medical literature supporting the management of sternal wound infections (SWI) along with negative pressure wound therapy (NPWT). Case presentation: This report describes the successful management of recurrent DSWI after OHT in a 52-year-old patient. We performed secondary sternotomy closure along with NPWT for the immunosuppressed patient. Conclusion: Our case demonstrates that a combination of reduced immunosuppression, adequate antimicrobial treatment, and NPWT can effectively treat complicated DSWI

Surgical vs. catheter-based paravalvular mitral valve leak closure (trans apical approach). Early results. Single center experience

Following surgical mitral valve replacement paravalvular leaks may occur in up to 17% of patients. A significant fraction of these patients present with a symptoms of heart failure and/or anaemia. Conventional surgical clo- sure is associated with increased morbidity and mortal- ity. Alternative transcatheter closure has been developed and being introduced into the clinical practice with a reasonable success. More evidence is needed to compare the efficacy and safety between surgical and catheter- based paravalvular mitral valve leak closure

Histone deacetylase inhibitor suberoylanilide hydroxamic acid improves energetic status and cardiomyogenic differentiation of human dilated myocardium-derived primary mesenchymal cells

BACKGROUND: In this study the effect of histone deacetylase (HDAC) inhibitor suberoylanilide hydroxamic acid (SAHA) on the energetic status and cardiomyogenic differentiation of human healthy and dilated myocardium-derived mesenchymal stromal cells (hmMSC) have been investigated. METHODS: The hmMSC were isolated from the healthy and dilated post-operation heart biopsies by explant outgrowth method. Cell proliferation, HDAC activity, mitochondrial membrane potential, and level of adenosine triphosphate (ATP) were evaluated. The effect of SAHA on mitochondrial parameters has been investigated also by Seahorse XF analyzer and cardiomyogenic differentiation was confirmed by the expression of transcription factor NK2 Homeobox 5 (Nkx2.5), cardiac troponin T and alpha cardiac actin at gene and protein levels. RESULTS: Dilated myocardium-derived hmMSC had almost 1.5 folds higher HDAC activity compared to the healthy cells and significantly lower mitochondrial membrane potential and ATP level. HDAC class I and II inhibitor SAHA improved energetic status of mitochondria in dilated myocardium-isolated hmMSC and increased expression of cardiac specific proteins during 14 days of exposure of cells to SAHA. CONCLUSIONS: HDAC inhibitor SAHA can be a promising therapeutic for dilated cardiomyopathy (DCM). Dilated hmMSC exposed to SAHA improved energetic status and, subsequently, cardiomyogenic differentiation. Data suggest that human dilated myocardium-derived MSC still have cardio tissue regenerative potential, which might be stimulated by HDAC inhibitors

Aspects of Juvenile Criminality in Lithuania

Juvenile criminality in Lithuania is still increasing though not so rapidly. Society is troubled by the decreasing age of criminals and brutalization of the nature of crimes. Children commit crimes for various reasons (objective and subjective). Lawyers and sociologists are of the opinion that there are plenty enough of factors which can influence criminal behaviour. The factors are following: disengagement of children and teenagers; insufficient control of a family and upbringing institutions; infringement of children rights; considerable property and social differentiation of a family; world-view formed by the media; influence of informal groups; violence in a family; poverty; prevailing illusion of impunity; alcoholism, etc. Therefore disharmony and instability in families and total neglect of their children upbringing are the main reasons stimulating juvenile crime. Environment where children grow and people who communicate and spend leisure time with them have great influence too. The aim of the article is to review juvenile criminality and its reasons in Lithuania

Mitral valve repair with a device for artificial chordal implantation at 2 years

Objectives: This study examines the early and midterm safety, efficacy, and durability of mitral valve repair for primary mitral regurgitation (MR) using the ChordArt device (CoreMedic) for chordal replacement. Methods: Five patients with symptomatic severe primary degenerative MR due to isolated central posterior leaflet prolapse/flail were treated with the ChordArt device in a transseptal surgical approach and followed prospectively with periodical clinical and echocardiographic assessments for 2 years. Results: Reduction of MR immediately after the implantation of artificial chords was achieved in all patients showing no or trace MR (<1+/4+). In all patients, MR <1+ was maintained during 24 months of follow-up. No dehiscence, detachment, or dislocation of the implanted ChordArt devices was observed. Transthoracic echocardiography showed that left ventricle end diastolic diameter significantly decreased during the whole follow-up period in comparison to baseline condition, especially at discharge and 1-month follow-up. Left ventricle end systolic diameter also significantly decreased during the whole follow-up period in comparison to baseline condition. Left atrial volume significantly decreased during the follow-up period in comparison to discharge. No major adverse events, as defined per protocol, were observed during the intervention or during the follow-up period. Conclusions: The ChordArt device allows successful treatment of primary degenerative MR due to posterior mitral leaflet prolapse or flail, with a good safety profile and promising immediate clinical and echocardiographic benefits that are confirmed up to 24 months

A Rare Case of Primary Purulent Pericarditis Caused by <i>Streptococcus constellatus</i>

Background: Bacteria-caused acute pericarditis is a very rare entity. It is usually associated with an underlying infection or compromised immune system. Primary purulent pericarditis in a previously healthy individual is highly unexpected; therefore, it is likely to have a delayed diagnosis and poor outcomes. Case: We report a case of an adult immunocompetent patient with primary bacterial pericarditis caused by a member of the commensal oral flora Streptococcus constellatus. The patient presented with septic shock and cardiac tamponade, and was further complicated with constrictive pericarditis, which was successfully treated with pericardiectomy. Conclusions: Bacterial pericarditis is a fulminant disease with a high mortality and complication rate. Fast recognition and prompt therapy are required to achieve a full recovery