139 research outputs found
In silico ischaemia-induced reentry at the Purkinjeventricle interface
This computational modelling work illustrates the influence of hyperkalaemia and electrical uncoupling induced by defined ischaemia on action potential (AP) propagation and the incidence of reentry at the Purkinjeventricle interface in mammalian hearts.
Unidimensional and bidimensional models of the Purkinjeventricle subsystem, including ischaemic conditions (defined as phase 1B) in the ventricle and an ischaemic border zone, were developed by altering several important electrophysiological parameters of the LuoRudy AP model of the ventricular myocyte. Purkinje electrical activity was modelled using the equations of DiFrancesco and Noble. Our study suggests that an extracellular potassium concentration [K](o) 14 mM and a slight decrease in intercellular coupling induced by ischaemia in ventricle can cause conduction block from Purkinje to ventricle. Under these conditions, propagation from ventricle to Purkinje is possible. Thus, unidirectional block (UDB) and reentry can result. When conditions of UDB are met, retrograde propagation with a long delay (320 ms) may re-excite Purkinje cells, and give rise to a reentrant pathway. This induced reentry may be the origin of arrhythmias observed in phase 1B ischaemia.
In a defined setting of ischaemia (phase 1B), a small amount of uncoupling between ventricular cells, as well as between Purkinje and ventricular tissue, may induce UDBs and reentry. Hyperkalaemia is also confirmed to be an important factor in the genesis of reentrant rhythms, since it regulates the range of coupling in which UDBs may be induced.This work was supported: (i) by the European Commission preDiCT grant (DG-INFSO-224381), (ii) by the 'VI Plan Nacional de Investigacion Cientifica, Desarrollo e Innovacion Tecnologica' from the Ministerio de Economia y Competitividad of Spain (grant number TIN2012-37546-C03-01) and the European Commission (European Regional Development Funds - ERDF - FEDER), and (iii) by the Programa de Apoyo a la Investigacioon y Desarrollo (PAID-06-11-2002) de la Universidad Politecnica de Valencia, Programa Prometeo (PROMETEO/2012/030) de la Conselleria d'Educacio Formacio I Ocupacio, Generalitat Valenciana, and (iv) Direccion General de Politica Cientifica de la Generalitat Valenciana (GV/2013/119).Esteban Ramírez, J.; Saiz Rodríguez, FJ.; Romero Pérez, L.; Ferrero De Loma-Osorio, JM.; Trénor Gomis, BA. (2014). In silico ischaemia-induced reentry at the Purkinjeventricle interface. EP-Europace. 16(3):444-451. https://doi.org/10.1093/europace/eut386S44445116
Progresos en cirugía cardiaca
The development of cardiovascular surgery has been accompanied by a series of advances in complementary technology, which has made it possible to carry out safer and less aggressive surgery. In this article there is a review of the latest progress in coronary and valvular surgery, cardiac insufficiency, arrhythmia and the application of extracorporeal circulation in non-cardiac diseases. These advances can serve as the starting point in order to build a future adapted to the needs generated by both patient and diseas
Falso aneurisma aórtico 30 años después de la corrección de una coartación: tratamiento quirúrgico bajo hipotermia profunda
We report a case of a large false aortic aneurysm that had developed in a 43-year-old man who had had coarctation repair 30 years previously. The coarctation repair had been done by inserting an end-to-end Dacron tubular graft which was sutured with silk. The re-operation was successfully performed under deep hypothermic arrest and it was noted that there was complete separation of the graft from both ends and no sutures were visualised. The deep hypothermic technique has considerably improved the ease and safety of this operation. We attribute this complication to the reabsorption of the silk sutures. Patients after coarctectomy with graft material should have regular chest X-rays for life in order to detect false aneurys
Regulation of the Cardiac Na+/K+ ATPase by Phospholemman
Hansraj Dhayan, Rajender Kumar, Andreas Kukol, ‘Regulation of the Cardiac Na+/K+ ATPase by Phospholemman’, in Sajal Chakraborti, Naranjan Dhalla, eds., Regulation of Membrane Na+-K+ ATPase, (Switzerland: Springer, 2016), ISBN 978-3-319-24748-9, eISBN 978-3-319-24750-2.Peer reviewe
Aneurisma de aorta ascendente en pacientes con sustitución valvular aórtica previa
We conclude that an aggressive surgical approach should be adopted in patients with degenerative aortic regurgitation and moderate dilatation of the ascending aorta because of the rapid progression of the aortic disease. We advise complete replacement of the aortic root
Comunicación entre la arteria coronaria derecha y la aurícula derecha
Two cases of anomalous communication of the right coronary artery with the right atrium (the so-called coronary artery fistula) are presented. Both were young females in which a continuous murmur was heard during routine examination. The x-ray image was typical, with a huge bulge in the right border similar to that seen in cases of right atrium enlargement. The ECG was normal in both patients. The diagnosis was made during cardiac catheterization and angiocardiography. A slight left-to-right shunt was present and the aneurismatic dilatation of right coronary artery and communication with the right atrium could be documented. In both cases a surgical closure of the defect was performed, both being well after two years and eight months respectively
Tack energy and switchable adhesion of liquid crystal elastomers
The mechanical properties of liquid crystal elastomers (LCEs) make them
suitable candidates for pressure-sensitive adhesives (PSAs). Using the nematic
dumbbell constitutive model, and the block model of PSAs, we study their tack
energy and the debonding process as could be measured experimentally in the
probe-tack test. To investigate their performance as switchable PSAs we compare
the tack energy for the director aligned parallel, and perpendicular to the
substrate normal, and for the isotropic state. We find that the tack energy is
larger in the parallel alignment than the isotropic case by over a factor of
two. The tack energy for the perpendicular alignment can be 50% less than the
isotropic case. We propose a mechanism for reversibly switchable adhesion based
on the reversibility of the isotropic to nematic transition. Finally we
consider the influence of several material parameters that could be used to
tune the stress-strain response
Reduced response to IKr blockade and altered hERG1a/1b stoichiometryin human heart failure
Heart failure (HF) claims 250,000 lives per year in the US, and nearly half of these deaths are sudden and presumably
due to ventricular tachyarrhythmias. QT interval and action potential (AP) prolongation are hallmark proarrhythmic
changes in the failing myocardium, which potentially result from alterations in repolarizing potassium currents.
Thus,we aimed to examinewhether decreased expression of the rapid delayed rectifier potassiumcurrent, IKr, contributes
to repolarization abnormalities in human HF. Tomap functional IKr expression across the left ventricle (LV),
we optically imaged coronary-perfused LV free wall from donor and end-stage failing human hearts. The LV wedge
preparation was used to examine transmural AP durations at 80% repolarization (APD80), and treatment with the
IKr-blocking drug, E-4031, was utilized to interrogate functional expression. We assessed the percent change in
APD80 post-IKr blockade relative to baseline APD80 (ΔAPD80) and found that ΔAPD80s are reduced in failing versus
donor hearts in each transmural region, with 0.35-, 0.43-, and 0.41-fold reductions in endo-, mid-, and epicardium,
respectively (p = 0.008, 0.037, and 0.022). We then assessed hERG1 isoform gene and protein expression levels
using qPCR and Western blot. While we did not observe differences in hERG1a or hERG1b gene expression between
donor and failing hearts, we found a shift in the hERG1a:hERG1b isoform stoichiometry at the protein level. Computer
simulations were then conducted to assess IKr block under E-4031 influence in failing and nonfailing conditions.
Our results confirmed the experimental observations and E-4031-induced relative APD80 prolongationwas greater
in normal conditions than in failing conditions, provided that the cellularmodel of HF included a significant downregulation
of IKr. In humanHF, the response to IKr blockade is reduced, suggesting decreased functional IKr expression.
This attenuated functional response is associated with altered hERG1a:hERG1b protein stoichiometry in the
failing human LV, and failing cardiomyoctye simulations support the experimental findings. Thus, of IKr protein
and functional expression may be important determinants of repolarization remodeling in the failing human LV.We thank the Translational Cardiovascular Biobank & Repository (TCBR) at Washington University for provision of donor/patient records. The TCBR is supported by the NIH/CTSA (UL1 TR000448), Children's Discovery Institute, and Richard J. Wilkinson Trust. We also thank the laboratory of Dr. Sakiyama-Elbert for the use of the StepOnePlus equipment We appreciate the critical feedback on the manuscript by Dr. Jeanne Nerbonne. This work has been supported by the National Heart, Lung & Blood Institute (NHLBI, R01 HL114395). K. Holzem has been supported by the American Heart Association (12PRE12050315) and the NHLBI (F30 HL114310).Holzem, KM.; Gómez García, JF.; Glukhov, AV.; Madden, EJ.; Koppel, AC.; Ewald, GA.; Trénor Gomis, BA.... (2016). Reduced response to IKr blockade and altered hERG1a/1b stoichiometryin human heart failure. Journal of Molecular and Cellular Cardiology. 96:82-92. https://doi.org/10.1016/j.yjmcc.2015.06.008S82929
- …