Transthyretin derived amyloid deposits in the atrium and the aortic valve: insights from multimodality evaluations and mid-term follow up

Abstract Background Recent studies have reported atrial involvement and coexistence of aortic stenosis in transthyretin (ATTR) cardiac amyloidosis (CA). However, pathological reports of extraventricular ATTR amyloid deposits in atrial structures or heart valves are limited, and the clinical implications of ATTR amyloid deposits outside the ventricles are not fully elucidated. Case presentation We report 3 cases of extraventricular ATTR amyloid deposits confirmed in surgically resected aortic valves and left atrial structures, all of which were unlikely to have significant ATTR amyloidosis infiltrating the ventricles as determined by multimodality evaluation including 99mtechnetium-pyrophosphate scintigraphy, cardiac magnetic resonance, endomyocardial biopsy and their mid-term clinical course up to 5 years. These findings suggested that these were extraventricular ATTR amyloid deposits localized in the aortic valve and the left atrium. Conclusions While long-term observation is required to fully clarify whether these extraventricular ATTR amyloid deposits are truly localized outside the ventricles or are early stages of ATTR-CA infiltrating the ventricles, our 3 cases with multimodality evaluations and mid-term follow up suggest the existence of extraventricular ATTR amyloid deposits localized in the aortic valve and left atrial structures

Feasibility Study on Continuous Flow Controlled/Living Anionic Polymerization Processes

A practical microchemical reaction system for keeping process flow at defined conditions, which is one of the key issues of industrial production, was developed. Controlled/living anionic polymerization was chosen as a test reaction because the molecular weight and molecular weight distribution of polymer products are quite sensitive to the relative flow rate of an initiator solution and that of a monomer solution. The polymerization of styrene in THF/hexane was carried out using a flow microreactor system consisting of two T-shaped micromixers and two microtube reactors using Smoothflow pumps at 0 °C. Poly­(styrene) with higher molecular weight such as Mn > 10000 could be synthesized using <i>s</i>-BuLi (Mn = 14 000, <i>M</i>_w/<i>M</i>_n = 1.11). <i>n</i>-BuLi could also be used as an initiator. The continuous operation was performed for 3 h without any problems to obtain ca. 1 kg of the polymer, indicating the feasibility of continuous flow processes for controlled/living anionic polymerization on a relatively large scale