A case report of left ventricular lead implantation via total three-dimensional transseptal puncture after tricuspid valve replacement

BackgroundVentricular lead implantation is relatively difficult for patients with bradyarrhythmia after tricuspid valve replacement. Right atrial (RA) abnormalities often occurred in patients with tricuspid valve disease; conventional coronary sinus (CS) lead implantation is not easy to operate. Therefore, it is necessary to develop a safe method for implanting LV endocardial leads in patients after tricuspid valve replacement.Case presentationA 76-year-old Asian woman who had been implanted with a metal tricuspid valve replacement 4 years ago was admitted to the Department of Cardiology for pacemaker implantation due to transient blackout related to persistent atrial fibrillation with long pauses. The patient's family rejected the surgical placement of an epicardial LV lead. Therefore, we first intended to operate LV lead implantation through the CS; however, the orifice of the CS was virtually difficult to seek. Ultimately, we utilized total 3-dimensional (T3D) transseptal puncture (TSP) under the guidance of the CARTO 3 system; thus, we implanted the LV endocardial lead, which contributed to the accurate puncture of the central fossa ovalis and ensured the safety of TSP in the case of RA enlargement. Meanwhile, the CARTO 3 system contributed to the localization of the LV lead to the LV free wall during implantation. All the intraoperative and postoperative pacemaker parameters were favorable; no intraoperative or postoperative complications occurred.ConclusionsThis case report may provide a novel surgical approach for LV lead implantation in patients who underwent tricuspid valve replacement or patients who may benefit from cardiac resynchronization therapy but failed to implant CS lead

Glycine tomentella Hayata inhibits IL-1β and IL-6 production, inhibits MMP-9 activity, and enhances RAW264.7 macrophage clearance of apoptotic cells

<p>Abstract</p> <p>Background</p> <p>To assess the effects of <it>Glycine tomentella </it>Hayata (GTH), a traditional herbal medicine for treatment of rheumatic diseases on the expression of the proinflammatory cytokines and on the clearance of apoptotic cells by macrophages.</p> <p>Methods</p> <p>RAW264.7 cells were cultured with lipopolysaccharide (LPS) in the presence or absence of ethanol extract of GTH. The expression of proinflammatory cytokines IL-1β, IL-6, and TNF-α, and inducible nitric oxide synthase (iNOS) and transglutaminase 2 (TG2) were assayed by reverse transcriptase-polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay (ELISA). Matrix metalloproteinase (MMP)-2 and MMP-9 were assayed by gelatin zymography. For detecting uptake of apoptotic cells, RAW264.7 cells were cultured with carboxyfluorescein diacetate (CFDA)-stained apoptotic cells and assayed by flow cytometry.</p> <p>Results</p> <p>The major components of GTH analyzed by high-performance liquid chromatography (HPLC) chromatogram were daidzein (42.5%), epicatechin (28.8%), and naringin (9.4%).</p> <p>GTH treatment inhibited the expression of proinflammatory cytokines IL-1β, IL-6 and MMP-9 but did not affect the expression of TNF-α and iNOS. GTH significantly enhanced the expression of TG2 and the clearance of apoptotic cells by RAW264.7 macrophages.</p> <p>Conclusions</p> <p>GTH inhibits proinflammatory cytokine secretion and MMP-9 activity, enhances apoptotic cell uptake and up-regulates TG2 expression. Our data show that GTH might have beneficial effects on rheumatic diseases.</p