Kairiojo plaučio transplantacija žiurkei: eksperimentinio modelio paieškos

Remigijus Sipavičius1, Aleksejus Zorinas1, Dalia Drobelytė2, Rokas Šerpytis2, Vytautas Sirvydis1.1 Vilniaus universiteto Širdies ir kraujagyslių ligų klinikos Širdies chirurgijos centras,Santariškių g. 2, LT-08661 Vilnius2 Vilniaus universiteto Medicinos fakultetas,M. K. Čiurlionio g. 21, LT-03101 VilniusEl. paštas: [email protected] Tikslas Sukurti ar pritaikyti esamus eksperimentinius modelius žiurkėms, tęsiant tyrinėjimus plaučių transplantacijos srityje. Metodai Žiurkėms atliekama kairiojo plaučio autotransplantacija arba ortotopinė transplantacija. Autotransplantacijos atveju atliekama kairiojo plaučio pulmoplegija, plautis paliekamas vietoje konservacijai norimam išemijos laikui. Jam praėjus atkuriama plaučio kraujotaka. Transplantacijos atveju donorui atliekama abiejų plaučių pulmoplegija, jie konservuojami norimą išemijos laiką. Recipientui pašalinamas kairysis plautis. Praėjus išemijos laikui, donoro kairysis plautis persodinamas recipientui, atkuriama plaučio kraujotaka. Rezultatai Atlikta 11 eksperimentų, penki iš jų – sėkmingai. Pagrindinės nesėkmių priežastys buvo broncho ar jo anastomozės plyšimas bei anestetikų perdozavimas. Išvados Esamus eksperimentinius modelius pavyko adaptuoti žiurkėms. Jie taikytini tolesnems plaučių transplantacijos tyrinėjimams. Pagrindiniai žodžiai: plaučių transplantacija, eksperimentinis modelis Left lung transplantation in rat: search for the experimental model Remigijus Sipavičius1, Aleksejus Zorinas1, Dalia Drobelytė2, Rokas Šerpytis2, Vytautas Sirvydis1.1 Vilnius University Clinic of Cardiovascular Diseases, Heart Surgery Centre,Santariškių str. 2, LT-08661 Vilnius, Lithuania2 Vilnius University Faculty of Medicine,M. K. Čiurlionio str. 21, LT-03101 Vilnius, LithuaniaE-mail: [email protected] Objective To design a new or to adapt the existing experimental models of rat lung transplantation. Methods Both left lung autotransplantation and orthotopic transplantation are implemented in rat. At autotransplantation, the left lung is left in situ after pulmoplegia. After a settled ischaemic time the lung perfusion is restored. At transplantation, pulmoplegia is performed in the donor. Lungs are separated and preserved for a settled ischaemic time. The recipient's left lung is removed and the donor's left lung transplantation is performed. The graft's perfusion is restored. Results Eleven experiments were carried out, 5 of them successfully. The main reasons for failure were bronchial anastomosis dehiscence or bronchial tear and anesthetic overdosage. Conclusion Existing experimental models were successfully adapted in rat, capacitating the further lung transplantation research. Key words: lung transplantation, experimental mode

Citomegalovirusinės ligos gastrointes-tininė forma po širdies persodinimo

Aleksejus Zorinas1, Kęstutis Ručinskas1, Saulius Miniauskas1, Radvilė Malickaitė1, Gitana Žemaitytė2, Vytė Valerija Maneikienė2, Vytautas Sirvydis11 Vilniaus universiteto Širdies chirurgijos centras, Santariškių g. 2, LT-08661 Vilnius2 Vilniaus universiteto ligoninės Santariškių klinikų Širdies chirurgijos centras,Santariškių g. 2, LT-08661 VilniusEl paštas: [email protected]; [email protected] Citomegalovirusinis (CMV) virškinimo trakto pažeidimas yra vienas iš klinikinių infekcijos poreiškių pacientams po organų persodinimo. Gastrointestininės CMV formos diagnostika dažnai yra sudėtinga, o padariniai sunkūs. Pristatomas CMV ligos po širdies persodinimo atvejis, diagnostikos ypatumai ir gydymo rekomendacijos. Pagrindiniai žodžiai: širdies persodinimas, citomegalo viruso infekcija Subaortic stenosis and mitral valve anomaly: surgical treatment aspects Aleksejus Zorinas1, Kęstutis Ručinskas1, Saulius Miniauskas1, Radvilė Malickaitė1, Gitana Žemaitytė2, Vytė Valerija Maneikienė2, Vytautas Sirvydis11 Vilnius University, Cardiac Surgery Centre, Santariškių str. 2, LT-08661 Vilnius, Lithuania2 Vilnius University Hospital „Santariškių klinikos“, Cardiac Surgery Centre,Santariškių str. 2, LT-08661 Vilnius, LithuaniaE-mail: [email protected]; [email protected] Cytomegalovirus infection can cause lesions of different organs, including gastrointestinal tract. In transplant patients, CMV infection can be associated with severe consequences. This case details the clinical and diagnostic features of gastrointestinal CMV disease in a patient after heart transplantation, in which treatment resulted in a complete resolution of the symptoms. Key words: heart transplantation, cytomegalovirus infectio

Prognostic value of myocardial fibrosis in severe aortic stenosis:Study protocol for a prospective observational multi-center study (FIB-AS)

BACKGROUND: Adverse cardiac remodeling with a myocardial fibrosis as a key pathophysiologic component may be associated to worse survival in aortic stenosis (AS) patients. Therefore, with the application of advanced cardiac imaging we aim to investigate left ventricular myocardial fibrosis in severe AS patients undergoing aortic valve replacement (AVR) and determine its impact with post-intervention clinical outcomes. METHODS: In a prospective, observational, cohort study patients with severe AS scheduled either for surgical or transcatheter AVR will be recruited from two tertiary heart centers in Denmark and Lithuania. All patients will receive standard of care in accordance with the current guidelines and will undergo additional imaging testing before and after AVR: echocardiography with deformation analysis and cardiovascular magnetic resonance (CMR) with T1 parametric mapping. Those undergoing surgical AVR will also have a myocardial biopsy sampled at the time of a surgery for histological validation. Patients will be recruited over a 2-year period and followed up to 2 years to ascertain clinical outcomes. Follow-up CMR will be performed 12 months following AVR, and echocardiography with deformation analysis will be performed 3, 12, and 24 months following AVR. The study primary outcome is a composite of all-cause mortality and major adverse cardiovascular events. DISCUSSION: Despite continuous effort of research community there is still a lack of early predictors of left ventricular decompensation in AS, which could improve patient risk stratification and guide the optimal timing for aortic valve intervention, before irreversible left ventricular damage occurs. Advanced cardiac imaging and CMR derived markers of diffuse myocardial fibrosis could be utilized for this purpose. FIB-AS study is intended to invasively and non-invasively assess diffuse myocardial fibrosis in AS patients and investigate its prognostic significance in post-interventional outcomes. The results of the study will expand the current knowledge of cardiac remodeling in AS and will bring additional data on myocardial fibrosis and its clinical implications following AVR. ETHICS/DISSEMINATION: The study has full ethical approval and is actively recruiting patients. The results will be disseminated through scientific journals and conference presentations. TRIAL REGISTRATION: ClinicalTrials.govNCT03585933. Registered on 02 July 2018

Sternotomy closure using negative pressure wound therapy after heart transplantation

Background: Deep sternal wound infection (DSWI) after orthotopic heart transplantation (OHT) is not a common but known complication and carries high mortality and morbidity rates. This report identifies a successful management strategy for recurrent DSWI, and it is a valuable addition to the medical literature supporting the management of sternal wound infections (SWI) along with negative pressure wound therapy (NPWT). Case presentation: This report describes the successful management of recurrent DSWI after OHT in a 52-year-old patient. We performed secondary sternotomy closure along with NPWT for the immunosuppressed patient. Conclusion: Our case demonstrates that a combination of reduced immunosuppression, adequate antimicrobial treatment, and NPWT can effectively treat complicated DSWI

Surgical vs. catheter-based paravalvular mitral valve leak closure (trans apical approach). Early results. Single center experience

Following surgical mitral valve replacement paravalvular leaks may occur in up to 17% of patients. A significant fraction of these patients present with a symptoms of heart failure and/or anaemia. Conventional surgical clo- sure is associated with increased morbidity and mortal- ity. Alternative transcatheter closure has been developed and being introduced into the clinical practice with a reasonable success. More evidence is needed to compare the efficacy and safety between surgical and catheter- based paravalvular mitral valve leak closure

Three-dimensional analysis of the tricuspid annular geometry in healthy subjects and in patients with different grades of functional tricuspid regurgitation

Abstract Background Accurate sizing of the tricuspid valve annulus is essential for determining the optimal timing of tricuspid valve (TV) intervention. Two-dimensional (2D) echocardiography has limitations for comprehensive TV analysis. Three-dimensional (3D) imaging of the valve provides a better understanding of its spatial anatomy and enables more accurate measurements of TV structures. Objectives The study aimed to analyze tricuspid annulus (TA) parameters in normal heart and in different grades of functional tricuspid regurgitation (TR); to compare TA measurements obtained by 2D and 3D echocardiography. Methods One hundred fifty-five patients (median age 65 years, 57% women) with normal TV and different functional TR grades underwent 2D and 3D transthoracic echocardiography. The severity of TR was estimated using multiparametric assessment according to the guidelines. Mid-systolic 3D TA parameters were calculated using TV dedicated software. The conventional 2D systolic TA measurements in a standard four-chamber view were performed. Results In mid-systole, the normal TA area was 9.2 ± 2.0 cm2 for men and 7.4 ± 1.6 cm2 for women. When indexed to body surface area (BSA), there were no significant differences in the 3D parameters between genders. The 2D TA diameters were smaller than those measured in 3D. The ROC curve analysis identified that all 3D TA parameters can accurately differentiate between different functional TR grades. Additionally, the optimal cut-off values were identified for each TA parameter. Conclusions Gender, body size, and age have an impact on the TA parameters in healthy subjects. 2D measurements are smaller than 3D parameters. The reference values for 3D metrics according to TR severity can help in identifying TA dilation and distinguishing between different functional TR grades. Graphical Abstrac

A Rare Case of Primary Purulent Pericarditis Caused by <i>Streptococcus constellatus</i>

Background: Bacteria-caused acute pericarditis is a very rare entity. It is usually associated with an underlying infection or compromised immune system. Primary purulent pericarditis in a previously healthy individual is highly unexpected; therefore, it is likely to have a delayed diagnosis and poor outcomes. Case: We report a case of an adult immunocompetent patient with primary bacterial pericarditis caused by a member of the commensal oral flora Streptococcus constellatus. The patient presented with septic shock and cardiac tamponade, and was further complicated with constrictive pericarditis, which was successfully treated with pericardiectomy. Conclusions: Bacterial pericarditis is a fulminant disease with a high mortality and complication rate. Fast recognition and prompt therapy are required to achieve a full recovery