Ventricular constraint in dilated cardiomyopathy: A new, compliant textile mesh exerts prophylactic and therapeutic properties

BackgroundDilated cardiomyopathy is associated with a progressive decrease in cardiac function, leading to end-stage heart failure. We aimed to stop this process by mechanically constraining the heart with a new, compliant textile mesh.MethodsIn 16 male Munich minipigs (50 ± 7 kg), dilated cardiomyopathy with congestive heart failure was induced through 4 weeks of rapid ventricular pacing (220 beats/min). In the early-mesh group (n = 8), a polyvinylidene fluoride mesh was positioned around both ventricles before pacing was started. In the other group (n = 8), experimental dilated cardiomyopathy through rapid pacing was induced (no mesh). After mesh grafting, rapid pacing was continued (late mesh).ResultsRapid pacing in the no-mesh group (control group) significantly decreased both systolic (cardiac output, peak systolic pressure, and the derivative of pressure increase [dP/dtmax]) and diastolic (minimum rate of pressure rise [dP/dtmin] and left ventricular end-diastolic pressure) variables, whereas these variables remained almost unchanged in the early-mesh group. In the late-mesh group the passive-elastic constraint not only prevented further deterioration but even exerted reverse remodeling to some extent (dP/dtmax and left ventricular end-diastolic pressure, P < .05).ConclusionsVentricular constraint with the new mesh seems to be a prophylactic and therapeutic option in cardiac insufficiency caused by ventricular dilation. This passive-elastic cardioplasty induced reverse remodeling of dilated hearts and significantly improved diastolic and systolic ventricular function

Autonomic arousal in children of parents with and without social anxiety disorder: a high‐risk study

Objective Autonomic hyperarousal in social situations is considered a genetic vulnerability factor for social anxiety disorder (SAD), but so far it is unstudied in children at risk for developing SAD. We examined autonomic activity during socially stressful tasks in children of mothers and fathers with and without lifetime SAD to reveal possible biological mechanisms of intergenerational transmission of SAD. Methods One hundred ten children aged 4.5 years were asked to sing a song in front of an audience and watch back their performance in the presence of that audience. Heart rate (HR), heart rate variability (HRV), electrodermal activity (EDA), and blushing (cheek blood flow and temperature) were measured in anticipation of, during, and after the tasks. Both parents’ lifetime SAD status was assessed, and both parents reported about their own and their child's social anxiety symptoms. Results Children of parents with lifetime SAD blushed more during the socially challenging tasks than children of parents without SAD. Moreover, children of parents with more social anxiety symptoms showed increased EDA throughout the tasks. Finally, more blushing, increased EDA, and reduced HRV were associated with greater child social anxiety. Conclusions This study adds to the current knowledge on the intergenerational transmission of SAD by providing evidence that children at risk for SAD are characterized by excessive blushing in socially challenging situations. The findings also demonstrate that heightened autonomic activity is a characteristic of social anxiety already during early childhood. Hence, autonomic hyperarousal, and blushing in particular, is likely to play an etiological role in the development of SAD