Pre-arterialization of coronary veins prior to retroperfusion of ischemic myocardium: percutaneous closure device

BackgroundChronic coronary retroperfusion to treat myocardial ischemia has previously failed due to edema and hemorrhage of coronary veins suddenly exposed to arterial pressures. The objective of this study was to selectively adapt the coronary veins to become arterialized prior to coronary venous retroperfusion to avoid vascular edema and hemorrhage.Methods and resultsIn 32 animals (Group I = 19 and Group II = 13), the left anterior descending (LAD) artery was occluded using an ameroid occlusion model. In Group I, the great cardiac vein was blocked with suture ligation (Group IA = 11) or with occlusion device (Group IB = 8) to arterialize the venous system within 2 weeks at intermediate pressure (between arterial and venous levels) before a coronary venous bypass graft (CVBG) was implemented through a left internal mammary artery (LIMA) anastomosis. Group II only received the LAD artery occlusion and served as control. Serial echocardiograms showed recovery of left ventricular (LV) function with this adaptation-arterialization approach, with an increase in ejection fraction (EF) in Group I from 38% ± 5% after coronary occlusion to 53% ± 7% eight weeks after CVBG, whereas in Group II the EF never recovered (41% ± 2%–33% ± 7%). The remodeling of the venous system not only allowed restoration of myocardial function when CVBG was implemented but possibly promoted a novel form of “collateralization” between the native arterioles and the newly arterialized venules, which revascularized the ischemic myocardium.ConclusionsThese findings form a potential rationale for a venous arterialization-revascularization treatment for the refractory angina and the “no-option” patients using a hybrid percutaneous (closure device for arterialization)/surgical approach (CVBG) to revascularize the myocardium

Post translational changes to α-synuclein control iron and dopamine trafficking : a concept for neuron vulnerability in Parkinson's disease

Parkinson's disease is a multifactorial neurodegenerative disorder, the aetiology of which remains elusive. The primary clinical feature of progressively impaired motor control is caused by a loss of midbrain substantia nigra dopamine neurons that have a high α-synuclein (α-syn) and iron content. α-Syn is a neuronal protein that is highly modified post-translationally and central to the Lewy body neuropathology of the disease. This review provides an overview of findings on the role post translational modifications to α-syn have in membrane binding and intracellular vesicle trafficking. Furthermore, we propose a concept in which acetylation and phosphorylation of α-syn modulate endocytic import of iron and vesicle transport of dopamine during normal physiology. Disregulated phosphorylation and oxidation of α-syn mediate iron and dopamine dependent oxidative stress through impaired cellular location and increase propensity for α-syn aggregation. The proposition highlights a connection between α-syn, iron and dopamine, three pathological components associated with disease progression in sporadic Parkinson's disease

DONOR-TRANSMITTED CORONARY ATHEROSCLEROSIS

Aim. To estimate opportunities, prospects and safety of using heart transplants from aged donors who are at high risk of coronary atherosclerosis.Materials and methods. Over the period from March 1987 to May 2014450 heart transplantations (HTx) were performed in V.I.Shumakov Federal Research Center of Transplantology and Artifi cial Organs. During the fi rst month after HTx coronarography was made to 152 (37,8%) recipients inorder to exclude/confi rm donor-transmitted coronary atherosclerosis (DTCA) and to identify tactics of treatment. Coronary atherosclerosis was detected among 16 patients (3,6% of total number of HTx), 15 (93,8%) men and 1 (6,2%) women. Mean age of recipients with DTCA at the moment of HTx was 48,3 ± 13,1 years.Results. Hemodynamically relevant coronary atherosclerosis was not detected and percutaneous coronary intervention (PCI) was not made in the group of patients with the mean age of 42,24 ± 8,91 years. Using heart transplants from aged donors is connected with increasing risk of DTCA among the recipients. DTCA-dependent PCI is not connected with coronary mortality. Actuarial survival rate of patients who underwent PCI is comparable with the same one in the total population of HTx recipients and is equal to 87,5% at 5 years and less.Conclusion. Hearts from aged donors (older than 50 years) may be used for HTx with suffi cient level of safety. Due to high level of DTCA using of hearts from such donors is preferable for completing urgent HTx to recipients 1А–В UNOS

ТРОМБОЗОМ ЛЕВЫХ ОТДЕЛОВ СЕРДЕЧНОГО ТРАНСПЛАНТАТА, РАЗВИВШИМСЯ НА ФОНЕ ПРИМЕНЕНИЯ ВЕНО-АРТЕРИАЛЬНОЙ ЭКСТРАКОРПОРАЛЬНОЙ МЕМБРАННОЙ ОКСИГЕНАЦИИ

We present a case report of a 16-year-old man with venoarterial extracorporeal membrane oxygenation (VA-ECMO) for primary graft failure after orthotopic heart transplantation who developed left atrium and left ventricular thrombosis despite systemic anticoagulation. The surgical thrombectomy was performed and the patient was successfully weaned off the extracorporeal support on the first day thereafter.Представлен клинический случай успешного лечения реципиента сердца с тотальным тромбозом левого предсердия и левого желудочка, развившимся в ранние сроки после трансплантации на фоне применения периферической ВА ЭКМО как метода механической поддержки кровообращения при острой правожелудочковой недостаточности пересаженного сердца. Пациенту успешно выполнили хирургическую тромбэктомию, и ВА ЭКМО прекращена на первые сутки после операции

НАРУШЕНИЕ МАКРОМОЛЕКУЛЯРНОЙ СТРУКТУРЫ КАРДИОМИОЦИТОВ АЛЛОТРАНСПЛАНТАТА СЕРДЦА КАК ПРИЗНАК ХРОНИЧЕСКОГО ОТТОРЖЕНИЯ

Chronic rejection, especially cardiac allograft vasculopathy, is a major limiting factor for long-term transplant survival. This process affects not only the blood vessels, but also cardiomyocytes. However, there are extremely few reports on the evaluation of their macromolecular structure state. The aim of the study was to evaluate the structural proteins of cardiomyocytes (actin, myosin, troponin I, titin, desmin, vinculin) of heart allografts in different periods after the operation (from 6 days to 15 years). Major changes of macromolecular structure were revealed in late period after transplantation (6 months – 15 years). The contribution of humoral immune response in the process of chronic cardiac allograft rejection was observed: in eight of twelve recipients episodes of acute humoral rejection had been repeatedly registered; disorders of the expression of 5 proteins out of 6 characterized were found in recipients with recurrent and persistent antibody-mediated rejection. Хроническое отторжение, и прежде всего болезнь коронарных артерий, является основным лимитирую- щим фактором длительной функции аллотрансплантата сердца. Данный процесс затрагивает не только со- суды, изменениям также подвержены и кардиомиоциты. Однако сообщений, касающихся оценки состоя- ния их макромолекулярной структуры, крайне мало. Целью нашей работы явилось исследование состояния структурных белков кардиомиоцитов (актин, миозин, тропонин I, титин, десмин, винкулин) аллотрансплан- тата сердца в разные периоды после операции (от 6 дней до 15 лет). Основные изменения макромолекуляр- ной структуры выявлены в подгруппе позднего периода (6 мес.–15 лет). Продемонстрирован вклад гумо- рального звена иммунного ответа в процесс хронического отторжения аллотрансплантата сердца: у восьми из двенадцати реципиентов данной подгруппы неоднократно регистрировали эпизоды острого антитело- опосредованного отторжения; нарушения экспрессии пяти белков из шести охарактеризованных были об- наружены у реципиентов с возвратным и персистирующим антителоопосредованным отторжением.

ТРАНСМИССИВНЫЙ АТЕРОСКЛЕРОЗ КОРОНАРНЫХ АРТЕРИЙ ТРАНСПЛАНТАТА

Aim. To estimate opportunities, prospects and safety of using heart transplants from aged donors who are at high risk of coronary atherosclerosis.Materials and methods. Over the period from March 1987 to May 2014450 heart transplantations (HTx) were performed in V.I.Shumakov Federal Research Center of Transplantology and Artifi cial Organs. During the fi rst month after HTx coronarography was made to 152 (37,8%) recipients inorder to exclude/confi rm donor-transmitted coronary atherosclerosis (DTCA) and to identify tactics of treatment. Coronary atherosclerosis was detected among 16 patients (3,6% of total number of HTx), 15 (93,8%) men and 1 (6,2%) women. Mean age of recipients with DTCA at the moment of HTx was 48,3 ± 13,1 years.Results. Hemodynamically relevant coronary atherosclerosis was not detected and percutaneous coronary intervention (PCI) was not made in the group of patients with the mean age of 42,24 ± 8,91 years. Using heart transplants from aged donors is connected with increasing risk of DTCA among the recipients. DTCA-dependent PCI is not connected with coronary mortality. Actuarial survival rate of patients who underwent PCI is comparable with the same one in the total population of HTx recipients and is equal to 87,5% at 5 years and less.Conclusion. Hearts from aged donors (older than 50 years) may be used for HTx with suffi cient level of safety. Due to high level of DTCA using of hearts from such donors is preferable for completing urgent HTx to recipients 1А–В UNOS.Цель: оценить вклад трансмиссивного атеросклероза коронарных артерий трансплантата в непосредственный исход трансплантаций и определение перспективности использования трансплантатов с предсуществующим коронарным атеросклерозом.Материалы и методы. В ФГБУ «ФНЦ трансплантологии и искусственных органов имени академика В.И. Шумакова» с марта 1987 г. по май 2014 г. выполнено 450 трансплантаций сердца (ТС). В пределах первого месяца после ТС 152 (37,8%) реципиентам была выполнена коронарография для исключения/подтверждения трансмиссивного атеросклероза коронарных артерий трансплантата (ТАКАТ) и определения тактики лечения. Поражение коронарных артерий было выявлено у 16 пациентов (3,6% от общего количества трансплантаций), 15 (93,8%) мужчин и 1 (6,2%) женщины. Средний возраст реципиентов с ТАКАТ на момент выполнения ТС составил 48,3 ± 13,1 года.Результаты. В группе пациентов, у которых не было выявлено гемодинамически значимого поражения коронарного русла и чрескожное коронарное вмешательство (ЧКВ) не выполнялось, средний возраст донора составил 42,24 ± 8,91 года, в группе с ТАКАТ и последующей ЧКВ – 47,94 ± 5,38 года (р = 0,013). Использование трансплантатов от возрастных доноров сопряжено с повышенным риском ТАКАТ у реципиентов. Выполнение ЧКВ по поводу ТАКАТ не сопровождается коронарогенной летальностью. Актуриальная выживаемость пациентов, перенесших ЧКВ по поводу ТАКАТ, сопоставима с таковой в общей популяции реципиентов и на сроке до 5 лет составляет 87,5%.Заключение. Сердца от возрастных доноров (старше 50 лет) могут быть с достаточной степеньюбезопасности использованы для трансплантации. Ввиду высокого риска ТАКАТ использование таких трансплантатов предпочтительно при выполнении ургентных трансплантаций у реципиентов статуса 1А–В UNOS

EVALUATION OF THE MACROMOLECULAR STRUCTURE OF CARDIAC MYOCYTES IN PATIENTS WITH VARIOUS FORMS OF CARDIOMYOPATHY

Assessing the condition of the structural proteins of cardiomyocytes in patients with various forms of cardiomyo- pathy (49 samples) revealed changes characteristic for dilated cardiomyopathy, as well as common disorders of the molecular structure, developing, regardless of the etiology of the disease

SUCCESSFUL TREATMENT OF A RECIPIENT WITH MASSIVE THROMBOSIS OF HEART TRANSPLANT LEFT CHAMBERS DURING EXTRACORPOREAL MEMBRANE OXYGENATION

We present a case report of a 16-year-old man with venoarterial extracorporeal membrane oxygenation (VA-ECMO) for primary graft failure after orthotopic heart transplantation who developed left atrium and left ventricular thrombosis despite systemic anticoagulation. The surgical thrombectomy was performed and the patient was successfully weaned off the extracorporeal support on the first day thereafter