Congenital left main coronary artery aneurysm

Left main coronary artery aneurysm (LMCAA) is an uncommon coronary abnormality seen in 0.1% of patients during routine diagnostic coronary angiographies. The most common etiology is atherosclerosis in acquired cases. However, it can also be a congenital malformation. We present the case of a 26 year-old female with a large LMCAA. She was diagnosed with tetralogy of Fallot initially. (Cardiol J 2011; 18, 4: 430–433

True-scale biomimetic multi-generation airway platforms of the human bronchial epithelium for in vitro cytotoxicity screening

Lung exposure to inhaled particulate matter may injure the epithelial tissue and lead to a loss of function in affected regions via inflammation for example. Screening for the critical contaminate concentrations may provide essential information towards damage assessment and epithelial healing. To date, most approaches have typically relied on traditional in vitro well plate assays or alternatively in vivo animal experiments. Yet, such methods manifest some outstanding disadvantages such as the inability to capture physiological flow and aerosol deposition characteristics as well as significant differences in anatomy, immune system and inflammatory responses compared to humans. The advent of organ-on-chip platforms has shown promising results to reconcile many such drawbacks. In an attempt to provide an attractive in vitro gateway to monitor airway health, we discuss here a novel biomimetic platform which emulates the bronchial epithelium of a human upper airway, allowing to study organ-level characteristics in a homeostatic cellular microenvironment. This device reconstitutes a multi-generation pulmonary epithelial airway environment, capturing realistic respiratory transport phenomena and critical cellular barrier functions at an air-liquid interface (ALI), in analogy to the bronchial lumen. As a proof of concept, we demonstrate its feasibility for in vitro based assays by exposing the device to cytotoxic aerosolized particles under respiratory flow conditions. Subsequently, we investigate the cytotoxic effects of these particles including cellular viability, cytokine and mucus secretion as a function of local particle deposition patterns. Ultimately, our bronchial airway models are intended to provide off-the-shelf in vitro kits geared for the end-user interested in a wide range of broader biological assays that may be attractive for cytotoxicity and drug screening. Please click Additional Files below to see the full abstract

A failed case of percutaneous septal closure of fenestrated atrial septal defect

A patient presenting with a history of palpitation and exertional dyspnea was initially diagnosed with two separate secundum-type atrial septal defects by transesophageal echocardiography. Subsequent transesophageal echocardiography, after failure of closure with two separate closure devices, showed another defect and an ongoing left to right shunt. During surgery, more defects were observed. The defects were successfully repaired using pericardial patch without incident. (Cardiol J 2011; 18, 1: 92-93

Microfluidic acini-on-chip platforms as a tool to study bacterial lung exposure

Bacterial invasion of the respiratory system leads to complex immune responses involving many cell types. In the alveolar regions, the first line of defense includes the alveolar epithelium, secreted surfactant, alveolar lining fluid and alveolar macrophages. The epithelium consists of alveolar type I and type II cells. Both cell types are known to have immuno-modulatory functions characterized by the secretion of pro-inflammatory cytokines. Epithelial in vitro models offer attractive platforms to investigate biological functionality, but have typically relied on traditional well plate assays that come short of mimicking the complexity of the airway environment and do not capture physiological flows or relevant anatomical features. In the last decade, microfluidics have gained significant momentum in laying the foundations for constructing in vitro models that mimic physiologically-relevant organ functions. Here we propose to use acinus-on-chip platforms that mimic more closely native acinar microflows at true scale in a multi-generation alveolated tree. Acinar chips are cultured with human Alveolar Epithelial Lentivirus immortalized (hAELVi) cells at an air-liquid interface (ALI); such cells show alveolar type I like characteristics and maintained barrier function, leading to high trans-epithelial electrical resistance (TEER) in analogy to primary cells harvested from human tissue. To model bacterial infection, i.e. a strong stimulator of the innate arm of the immune system, lipopolysaccharides (LPS) will be used. LPS is a major outer surface membrane protein expressed on Gram-negative bacteria. The alveolar epithelium is exposed to LPS-laden aerosols and cell response is monitored mainly by secretion of pro-inflammatory cytokines. Our acinus-on-chip allows quantitative on-line measurements of alveolar barrier function, absorption kinetics and immunologically relevant responses, giving further insight to the role played by type I alveolar cells in lung immunity. Please click Additional Files below to see the full abstract

Angiomatosis in the Head and Neck—3 Case Reports

Angiomatosis is a diffuse vascular lesion which involves a large segment of the body in a contiguous fashion involving multiple tissues (e.g. subcutis, muscle, bone, adipose tissue etc.) in different planes. Such lesions usually present in the first two decades of life with female predilection and are commonly seen in lower extremities. It clinically mimics hemangioma or vascular malformation and its surgical removal is difficult because of its infiltrative nature and thus has high recurrence rate (90%). Therefore a precise histopathological diagnosis of angiomatosis is important to achieve a curative resection. Histopathologically it consists of proliferating blood vessels of varying caliber, infiltrating into the soft tissues. Proliferating capillaries are seen within or adjacent to major vessels. Few cases are reported in head and neck region. This article highlights three unusual cases of angiomatosis reported as benign lesions, in rare sites such as the malar region (predominantly infiltrating the adipose tissue), within the masseter (predominantly infiltrating the muscle) and in the mandible (infiltrating the bone). Histopathological differential diagnosis is also discussed

The association of functional mitral regurgitation and anemia in patients with non-ischemic dilated cardiomyopathy

Background: We investigated the association between anemia and functional mitral regurgitation (MR) in non-ischemic dilated cardiomyopathy (DCM) patients with sinus rhythm and normal renal function. Methods: Sixty non-ischemic DCM patients with sinus rhythm and left ventricular ejection fraction < 40% were recruited. Functional MR was quantified with the proximal isovelocity surface area method. MR was graded according to the mitral regurgitant volume (Reg Vol) or effective regurgitant orifice (ERO) area. The clinical, biochemical and echocardiographic correlates of functional MR severity were investigated in patients with DCM. Results: Hemoglobin degrees were significantly different between various MR levels (mild MR 13.9 &#177; 1.7 mg/dL, moderate MR 12.3 &#177; 1.5 mg/dL, moderate to severe MR 10.8 &#177; 0.9 mg/dL). Receiver operating characteristic (ROC) analysis was performed to assess the utility of hemoglobin levels to predict moderate or severe functional MR. A hemoglobin level less than 12.5 mg/dL predicted moderate or high MR with 80% sensitivity and 58% specificity (AUC: 0.789, 95% CI: 0.676&#8211;0.901, p < 0.0001). Logistic regression analysis was performed to determine the independent predictors of moderate or severe levels of MR. The left atrium diameter (OR: 19.3, 95% CI: 1.4-27.1, p = 0.028) and presence of anemia (OR: 11.9, 95% CI: 1.22-42.5, p = 0.0045) were independent predictors of moderate or severe functional MR. Conclusions: The presence of anemia and enlarged left atrium are independent predictors of moderate or severe functional MR in non-ischemic DCM patients with normal renal function. Hemoglobin levels less than 12.5 mg/dL should alert the physician for the presence of moderate or severe MR in patients with DCM. (Cardiol J 2010; 17, 3: 274-280

Red cell distribution width and its relationship with global longitudinal strain in patients with heart failure with reduced ejection fraction: a study using two-dimensional speckle tracking echocardiography

   Background: Red cell distribution width (RDW) is a measurement of size variability of the red blood cells and has been shown to be a powerful predictor of prognosis in heart failure (HF). Recently, global longitudinal strain (GLS) emerged as a more accurate marker of left ventricular (LV) systolic function. Aim: We aimed to assess the relationship between RDW and standard echocardiographic parameters and LV global strain measured by two-dimensional (2D) speckle tracking echocardiography in patients with HF with reduced EF (HFrEF). Methods: Fifty-nine HF patients with an EF &lt; 50%, and 40 age-matched controls with normal EF were included in the study. Standard and 2D strain imaging examinations were performed. Blood tests including RDW were scheduled on the same day as the echocardiographic study. Results: Left atrial volume index, LV end-systolic and end-diastolic dimensions, and E/A and E/e’ ratios were higher and LVEF together with LV GLS were significantly lower in the HFrEF group. RDW showed positive correlations with log B-type natri­uretic peptide (r = 0.45, p = 0.0001), left atrial volume index (r = 0.38, p = 0.001), LV end-diastolic dimensions (r = 0.37, p = 0.001), and E/e’ (r = 0.33, p = 0.005) and negative correlations with haemoglobin (r = –0.54, p = 0.0001), LVEF (r = –0.27, p = 0.004) and finally LV GLS (r = –0.41, p = 0.001). HFrEF patients were divided into two groups based on the median RDW value. Patients with higher than median RDW had significantly lower GLS despite similar EF. Conclusions: Elevated RDW is associated with poorer LV deformation assessed by speckle tracking echocardiography in HF patients with similar EF. Therefore, the degree of anisocytosis could be used as an additional marker to identify these high-risk patients as well as improve treatment strategy