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Post-myocardial infarction ventricular septal rupture (PIVSR) is becoming increasingly rare in the percutaneous coronary intervention era; however, the mortality rates remain high. Surgical repair is the gold standard treatment for PIVSR but is associated with surgical difficulty and high mortality. Therefore, the timing of surgery is controversial (i.e. either undertake emergency surgery or wait for resolution of organ failure and scarring of the infarcted area). Although long-term medical management is usually ineffective, several mechanical circulatory support (MCS) devices have been used to postpone surgery to an optimal timing. Recently, in addition to venous arterial extracorporeal membrane oxygenation (VA-ECMO), new MCS devices, such as Impella (Abiomed Inc., Boston, MA, USA), have been developed. Impella is a pump catheter that pumps blood directly from the left ventricle, in a progressive fashion, into the ascending aorta. VA-ECMO is a temporary MCS system that provides complete and rapid cardiopulmonary support, with concurrent hemodynamic support and gas exchange. When left and right heart failure and/or respiratory failure occur in cardiogenic shock or PIVSR after acute myocardial infarction, ECpella (Impella and VA-ECMO) is often introduced, as it can provide circulatory and respiratory assistance in a shorter period. This review outlines the basic concepts of MCS in PIVSR treatment strategies and its role as a bridge device, and discusses the efficacy and complications of ECpella therapy and the timing of surgery. [Display omitted] • Despite decreasing prevalence, post-myocardial infarction ventricular septal rupture (PIVSR) still has a high mortality rate. • Surgical repair is the standard treatment for PIVSR. • Heart failure due to PIVSR is treated with mechanical circulatory support devices, including Impella. • ECpella can act as a surgical bridge, delaying heart failure due to PIVSR. • This results in delayed surgery allowing for more optimal surgical timing. [ABSTRACT FROM AUTHOR]

Immunoglobulin G4-related inflammatory pseudotumors are usually benign. Such tumors of cardiac origin are extremely rare, with no primary cardiac tumors reported to date. We report a case of a 77-year-old woman, with a medical history of diabetes, hypertension, and hyperlipidemia, who was diagnosed with a malignant cardiac tumor on preoperative imaging and had a confirmed pathological diagnosis of immunoglobulin G4-related inflammatory pseudotumor. She was examined for atherosclerosis obliterans, and coronary computed tomography revealed obstruction of the right coronary artery and a cardiac tumor in the right atrium. A suspected malignant tumor measuring 40 mm (maximum standardized uptake value: 12.2) bordering the right atrium was detected using 18F-fluorodeoxyglucose positron emission tomography. Her tumor was in contact with the heart, making biopsy impossible. She was diagnosed with malignancy on preoperative imaging and underwent tumor resection, tricuspid valve replacement, right atrial and right ventricular plasty, coronary artery bypass, lung resection, and diaphragmatic repair. However, the final pathological diagnosis was immunoglobulin G4-related inflammatory pseudotumor. Preoperative diagnosis of immunoglobulin G4-related inflammatory pseudotumor is extremely difficult; however, if the condition is diagnosed preoperatively, chemotherapy or steroid therapy should be administered, and patients who do not respond to chemotherapy should be considered for surgical treatment. Immunoglobulin G4-associated inflammatory pseudotumor is extremely rare. Preoperative imaging diagnosis of immunoglobulin G4-associated inflammatory pseudotumor is extremely difficult, and pathology with biopsy is the only definitive diagnosis. However, if we could make an accurate preoperative diagnosis, patients should be treated with chemotherapy or steroids, and surgical treatment should be considered for patients who do not respond to chemotherapy or steroids. [ABSTRACT FROM AUTHOR]

Dipeptidyl peptidase 4 (DPP-4) is a novel adipokine and may be involved in the association between adipose tissue and metabolic syndrome. We investigated DPP-4 and adiponectin levels in the serum, subcutaneous adipose tissue (SAT), and epicardial adipose tissue (EAT), and their relationship with preoperative factors, as well as comparing the DPP-4 levels in SAT and EAT with and without DPP-4 inhibitors. This study included 40 patients (25 men, age 67.5 ± 13.8 years). The serum adipokine, DPP-4, and adiponectin levels in SAT and EAT were measured using ELISA and Western blotting. The DPP-4 and adiponectin levels were significantly higher in the SAT than in the EAT. The serum DPP-4 and DPP-4 activity levels had no correlation with the DPP-4 levels in the SAT and EAT, but the DPP-4 levels in the SAT and EAT had a positive correlation. The DPP-4 levels in the SAT were positively correlated with atherosclerosis, diabetes mellitus, DPP-4-inhibitor use, and fasting blood glucose. The DPP-4 levels in the EAT showed a negative correlation with eGFR and a positive correlation with atrial fibrillation. The DPP-4 activity in the serum had a lower tendency in the group taking DPP-4 inhibitors than in the group not taking them. DPP-4 inhibitors may suppress angiogenesis and adipose-tissue hypertrophy. [ABSTRACT FROM AUTHOR]

This article evaluates the frictional performance of different bearing grease formulations in full rolling bearings and a ball-on-disc rig and subsequently assesses whether the ball-on-disc test results can be used to predict the grease performance in actual bearings. A selection of custom-made greases with systematically varied formulations as well as their base oils were tested. Bearing torque was measured in two different cylindrical roller thrust bearings and a thrust ball bearing. The same lubricants were tested with ball-on-disc tribometers, a mini traction machine (MTM) to measure friction and an optical elastohydrodynamic (EHD) rig to measure film thickness. Both lithium complex and diurea greases were observed to produce lower friction than their base oils within the low speed, low nominal lambda ratio region, whereas the greases and oils had the same friction at high nominal lambda ratio values. These relative trends were the same in full bearing and single-contact MTM tests. The reduction in friction was seen to be related to the level of film thickness enhancement provided by greases at lower speeds, which leads to an increase in the effective lambda ratio and hence reduced friction. By extracting the sliding torque component from the overall measured bearing torque, a plot of the friction coefficient against the effective lambda ratio was produced encompassing all bearing and single-contact tests and all lubricants and test conditions. This plot was seen to follow a general shape of a master Stribeck curve, indicating that the numerical values of the friction coefficient from ball-on-disc and full bearing tests overlap and can be related to each other using this approach over the range of conditions employed here. Thus, single-contact ball-on-disc tests can provide a fast and economical way of establishing the frictional performance of bearing greases in full bearings in terms of both relative performance rankings and quantitative values of bearing frictional power losses. [ABSTRACT FROM AUTHOR]

The article presents a case study of an 84-year-old male with increasing dyspnea on exertion, and was diagnosed with ventricular septal defect.

The article describes the case of a 38-year-old male with type A aortic dissection with intimal intussusception.

Background: We examined the safety and efficacy of acceleration training (AT) in patients immediately after cardiac surgery., Methods and Results: This randomized controlled study included patients who underwent open-heart surgery using cardiopulmonary bypass. Of these patients, 31 received regular cardiac rehabilitation (CR) and 39 received AT in addition to regular CR (AT group). AT was provided using a vibration platform (Power Plate ® Pro7 TM and Power plate ® personal; Performance Health System, Chicago, IL, USA). The AT group performed 5 static resistance training sessions: squats, wide stance squats, toe stands, banded squats, and front lunges. Each vibration session lasted 30 s. We evaluated the short physical performance battery, anterior mid-thigh thickness, maximum voluntary isometric contraction of the knee extensors, and serum intercellular adhesion molecule (ICAM-1) and vascular cell adhesion molecule (VCAM-1) concentrations as indicators of endothelial function. The observation period was during hospitalization and lasted approximately 20 days. No adverse events occurred during AT. Ultrasound revealed a significantly lower reduction in muscle mass at discharge in the AT group. No significant differences were observed in ICAM-1 and VCAM-1 concentrations between the 2 groups preoperatively, postoperatively, or at discharge., Conclusions: AT is considered safe and effective for patients immediately after open-heart surgery. AT, along with regular CR, may prevent skeletal muscle mass loss, muscle weakness, and physical function loss immediately after open-heart surgery.

Background: Sacubitril/valsartan, being both a neprilysin inhibitor and angiotensin receptor blocker, exhibits a renin-angiotensin-aldosterone system (RAAS) inhibitory effect. However, no study has investigated the administration of sacubitril/valsartan in patients early after surgery using cardiopulmonary bypass., Methods and Results: This was a prospective observational study of 63 patients who underwent open heart surgery and were treated with sacubitril/valsartan. No serious adverse events occurred. Among the 63 patients, sacubitril/valsartan was discontinued in 13 due to hypotension (n=10), renal dysfunction (n=2), and dizziness (n=1). Atrial natriuretic peptide concentrations increased significantly from Day 3 of treatment (P=0.0142 vs. Postoperative Day 1) and remained high thereafter. In contrast, plasma renin activity was significantly suppressed from Day 3 onwards (P=0.00206 vs. Postoperative Day 1). A decrease in creatinine concentrations and an increase in the estimated glomerular filtration rate were observed on Day 3; this improvement in renal function was not observed in the historical control group, in which patients did not receive sacubitril/valsartan. New postoperative atrial fibrillation was less frequent in the study group compared with the historical control (12.7% vs. 38.0%; P=0.0034)., Conclusions: Sacubitril/valsartan administration was safe immediately after open heart surgery in patients without postoperative hypotension. It enhanced serum atrial natriuretic peptide concentrations and suppressed RAAS activation.

Spermatozoa released from Sertoli cells must be transported to the epididymis. However, the mechanism of the luminal flow in seminiferous tubules has remained unclear to date. Therefore, in this study, we investigated luminal flow and movements in the seminiferous tubules by three-dimensional analysis and in vivo imaging. Serial 5-μm-thick mouse testicular sections at 50-µm-intervals were prepared and stained by Periodic Acid-Schiff-hematoxylin. After three-dimensional reconstruction of the seminiferous tubules, the localization of the released spermatozoa and the stages observed in the sections were recorded in each reconstructed tubule. Luminal movements in the seminiferous tubules were observed by in vivo imaging using a fluorescent-reporter mouse and two-photon excitation microscopy system. Spermatozoa without contact to the seminiferous epithelium were not accumulated toward the rete testis. Additionally, such spermatozoa were found on their way not only to the most proximal rete testis but also a more distant rete testis from any stage VIII seminiferous epithelia. In vivo imaging demonstrated that the direction of the flagella of spermatozoa attached to the seminiferous epithelium was repeatedly reversed. The epithelium at the inner curve of the seminiferous tubule was shaken more actively and had fewer spermatozoa attached compared with the epithelium at the outer curve. Our results hence suggest that the luminal flow in the seminiferous tubules is repeatedly reversed and that this physical force helps spermatozoa to be released from Sertoli cells. In brief: Spermatozoa are released from Sertoli cells and flow in the seminiferous tubule to the rete testis. Our results suggest that the luminal flow in the tubules is repeatedly reversed and that this physical force helps spermatozoa release from the Sertoli cells.

Background: Limited studies have assessed the factors affecting prognosis in hemodialysis (HD) patients who undergo surgical aortic valve replacement with a bioprostheses (SAVR-BP). This study aimed to evaluate the outcomes of HD patients who had undergone SAVR-BP for aortic stenosis (AS) and identify the risk factors for mortality., Methods: This retrospective study included 57 HD patients who had undergone SAVR-BP for AS between July 2009 and December 2020. Multivariate logistic regression was used to predict factors associated with mid-term outcomes and death or survival. Kaplan - Meier curves were also generated for mid-term survival., Results: The in-hospital mortality rate was 8.8%, and the 5-year mortality rate was 42.1%. The independent predictors of 5-year mortality were preoperative age (hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.175-2.083, p = 0.002), hyperlipidemia (HR, 0.02; 95% CI, 0.002-0.297, p = 0.004), left ventricular diastolic diameter (HR, 1.74; 95% CI, 1.142-2.649, p = 0.010), left ventricular systolic diameter (HR, 0.61; 95% CI, 0.392-0.939, p = 0.025), and Japan SCORE (HR, 1.28; 95% CI, 1.052-1.563, p = 0.014). The postoperative predictors included intensive care unit stay (HR, 1.11; 95% CI, 1.035-1.194, p = 0.004) and albumin level (HR, 0.38; 95% CI, 0.196-0.725, p = 0.003)., Conclusions: The 5-year prognosis of HD patients undergoing SAVR may be improved by early diagnosis (before the occurrence of LV hypertrophy/enlargement) and nutritional management with oral intake to alleviate postoperative hypoalbuminemia. Registration number of clinical studies: UMIN000047410., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Author(s).)

Background: Cardiovascular surgery in older patients with sarcopenia has high rates of major complications, long hospital stays, readmissions, and discharge transfers. However, the factors that influence the length of hospital stay are unknown. This study aimed was to identify the predictors of the prolonged hospital stay in patients with sarcopenia after cardiovascular surgery., Methods: A total of 192 patients scheduled for cardiac surgery were enrolled in this retrospective observational study. Sarcopenia was diagnosed preoperatively. Clinical data from the preoperative, intraoperative, and perioperative periods were evaluated to determine the factors influencing the length of hospital stay., Results: The sarcopenia and non-sarcopenia groups differed significantly in age; body mass index; renal function; intubation time; transfusion of red blood cells; hospital transfer; and hemoglobin, brain natriuretic peptide, and albumin levels. Sarcopenia was the most significant factor influencing prolonged postoperative hospital stay, as well as prolonged intubation time. In the sarcopenia group, albumin levels and cardiopulmonary bypass time were the significant factors affecting hospital stay., Conclusions: Sarcopenia was the most significant factor associated with prolonged postoperative hospital stay in patients who underwent cardiac surgery. In addition, improving sarcopenia, nutritional status, and shortening cardiopulmonary bypass time appear to shorten the hospital stay in patients with sarcopenia who underwent cardiovascular surgery., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Author(s).)

A 73-year-old woman presented with severe dyspnea. Type A acute aortic dissection with cardiac tamponade was suspected by plain computed tomography (CT). She was referred to our hospital with cardiogenic shock. In our hospital, contrast-enhanced CT revealed a ruptured aortic arch aneurysm and cardiac tamponade, which is a rare and potentially fatal clinical crisis. The left pulmonary artery was compressed by a hematoma, and there was no aortic dissection. Emergent aortic arch replacement under moderate hypothermia with selective cerebral perfusion was successfully performed. A saccular aneurysm at the lesser curvature of the aortic arch ruptured into the pericardial cavity. Her postoperative course was uneventful, and she was discharged home on the 39th postoperative day.

A 64-year-old woman was diagnosed with dilatation of the pulmonary artery and pulmonary valve stenosis approximately 10 years ago. At the age of 63, she developed hemoptysis and was referred to our hospital. The pulmonary trunk was enlarged to 63 mm with moderate pulmonary valve insufficiency. The transpulmonary valve pressure gradient was 25 mmHg;thus, surgery was performed. A median sternotomy revealed a markedly dilated pulmonary trunk growing into the pericardial cavity. After opening the patient's pulmonary trunk to check the pulmonary valve, a thickened and shortened quadricuspid valve was observed. We replaced the pulmonary valve with a bioprosthetic valve and used a vascular prosthesis to reconstruct the pulmonary artery. The postoperative course was uneventful, and she was discharged 22 days after the surgery. Histopathological examination of the pulmonary artery aneurysm wall revealed cystic medial necrosis.

A 66-year-old man was diagnosed with pacemaker pocket infection in the upper abdominal area. His generator was removed with partial resection of the epicardial leads, and a new device was reimplanted in his left prepectoral area. The abdominal wound was left open, and debridement was performed for several times. After the wound was cured, he complicated a chest pain and was diagnosed with residural epicardial pacemaker lead infection. He underwent complete removal of infected epicardial pacemaker leads and omentopexy under extracorporeal circulation via resternotomy. Postoperative course was uneventful. There was no sign of reinfection during the two-year follow-up.

A male patient underwent radiation therapy for hypopharyngeal cancer and esophageal cancer at the age of 58 years without recurrence. At the age of 63 years, he started to experience fatigue, numbness of the left upper limb and dizziness. The symptom gradually worsened and he was admitted to our hospital for further investigation. By computed tomography scan and angiography, the subclavian artery (SCA) occlusion and a patent left vertebral artery with retrograde flow were revealed( subclavian steal syndrome). Subclavian artery occlusion could not be recanalized by percutaneous transluminal angioplasty. He underwent carotid-subclavian bypass. His symptoms clearly improved. Postopertive course was uneventful and no further symptoms developed after surgery.