Interventional procedures for atherothrombosis: pathology of retrieved material

The clinical approach to atherosclerotic disease has dramatically changed, thanks to the recent improvements in interventional revascularisation procedures.w1 The mechanical relief of arterial obstruction through the introduction of a catheter into the arterial system to alleviate symptoms and reduce ischaemia and to prevent necrosis has been applied to all the important arterial networks: carotid, coronary and peripheral arteries. Removing the plaque and thrombus through an endovascular catheter without a surgical operation has offered a unique opportunity to obtain and study the retrieved material and to make clinicopathological correlations, thus allowing a better understanding of the atherothrombotic phenomenon. The target of non-surgical percutaneous interventional procedures is to debulk obstructed arteries. This result can be achieved through different approaches and mechanisms

Pathology of the Aorta and Aorta as Homograft

The aorta is not a rigid tube, it is an “organ” with lamellar units, consisting of elastic fibers, extracellular matrix and smooth muscle cells in between as parenchyma. Several diseases may occur in the natural history of the aorta, requiring replacement of both semilunar cusps and ascending aorta. They may be congenital defects, such as bicuspid aortic valve and isthmal coarctation with aortopathy; genetically determined, such as Marfan and William syndromes; degenerative diseases, such as atherosclerosis and medial necrosis with aortic dilatation, valve incompetence and dissecting aneurysm; inflammatory diseases such as Takayasu arteritis, syphilis, giant cell and IgM4 aortitis; neoplasms; and trauma. Aortic homografts from cadavers, including both the sinus portion with semilunar cusps and the tubular portion, are surgically employed to replace a native sick ascending aorta. However, the antigenicity of allograft cells, in the lamellar units and interstitial cells in the cusps, is maintained. Thus, an immune reaction may occur, limiting durability. After proper decellularization and 6 months’ implantation in sheep, endogenous cell repopulation was shown to occur in both the valve and aortic wall, including the endothelium, without evidence of inflammation and structural deterioration/calcification in the mid-term. The allograft was transformed into an autograft

Gender differences in the interrelations between digit ratio, psychopathic traits and life history strategies

The primary purpose of this study was to assess the relationship between prenatal exposure to sex hormones, as measured by digit ratio (2D:4D), and psychopathic personality traits while controlling for the confounding effect of life history strategy. The secondary purpose was to confirm the hypothesis that primary and secondary psychopathy reflect a faster life history strategy. In a nonclinical sample of 137 volunteers, we measured the right and left hand digit ratios, personality traits reflecting primary and secondary psychopathy, and life history strategies. In a hierarchical regression analysis, males with lower levels of prenatal testosterone exposure, as measured by the left hand 2D:4D, scored higher on the subscale measuring primary psychopathy. Neither the right hand 2D:4D nor the left hand 2D:4D were significant predictors of secondary psychopathy. In the female subsample, digit ratios did not correlate with either primary or secondary psychopathy. Males with faster life history strategies scored higher on both primary and secondary psychopathy. By contrast, among the female participants, there was no significant correlation between the life history score and primary psychopathy, and the correlation with secondary psychopathy was significant but relatively weak. These findings suggest that the neurodevelopmental pathways to psychopathy may differ according to sex

The Caged-Ball Prosthesis 60 Years Later: A Historical Review of a Cardiac Surgery Milestone

Sixty years ago, 2 cardiac operations dramatically influenced the survival of patients with valvular heart disease. The replacement of an aortic valve by Dwight Harken and of a mitral valve by Albert Starr with mechanical caged-ball valves, both in 1960, was a true milestone in the history of cardiac surgery and the beginning of a long journey toward prosthetic valve replacement full of expectations, hopes, and dreams fulfilled. Caged-ball prostheses underwent numerous modifications in design and materials to improve reliability and prevent specific mechanical and thrombogenic complications. Clinical and pathologic experience gained during the past 6 decades has enabled the development of safe, durable, and minimally thrombogenic mechanical prostheses

Long-term durability of a st. Jude medical x-cell bioprosthesis.

An 82-year-old female had undergone aortic valve replacement with a 23-mm St. Jude Medical X-Cell porcine bioprosthesis (XCB), a glutaraldehyde-fixed valve subjected to a decellularization process. More than 13 years later, she required a repeated operation because of XCB structural failure. Pathologic examination of an unused XCB as control showed that many interstitial cells were still present in the porcine cusps. The XCB explant exhibited gross mineralization on radiograph, fairly well-preserved fibrosa, lack of interstitial and endothelial cells, scattered empty spaces with plasma insudation, and calcific deposits. Ultrastructural examination revealed calcium deposition on collagen fibers and cell debris. Partial cusp decellularization observed in an XCB was not effective in preventing mineralization and most likely should be associated with other antimineralization treatments as well as methods favoring cell repopulation in vitro or in vivo