Search

Objectives The aim of this study was to assess mitral valve (MV) remodeling and strain in patients with secondary mitral regurgitation (SMR) compared with primary MR (PMR) and normal valves. Background A paucity of data exists on MV strain during the cardiac cycle in humans. Real-time 3-dimensional (3D) echocardiography allows for dynamic MV imaging, enabling computerized modeling of MV function in normal and disease states. Methods Three-dimensional transesophageal echocardiography (TEE) was performed in a total of 106 subjects: 36 with SMR, 38 with PMR, and 32 with normal valves; MR severity was at least moderate in both MR groups. Valve geometric parameters were quantitated and patient-specific 3D MV models generated in systole using a dedicated software. Global and regional peak systolic MV strain was computed using a proprietary software. Results MV annular area was larger in both the SMR and PMR groups (12.7 ± 0.7 and 13.3 ± 0.7 cm2, respectively) compared with normal subjects (9.9 ± 0.3 cm2; p Conclusions The MV in secondary MR remodels significantly and similarly to PMR with a resultant larger annular area, leaflet surface area, and leaflet thickness compared with that of normal subjects. Despite these changes, MV strain remains close to or in some instances lower than normal and is significantly lower than that of PMR. Strain determination has the potential to improve characterization of MV mechano-biologic properties in humans and to evaluate its prognostic impact in patients with MR, with or without valve interventions.

Background Patients who refuse allogeneic blood transfusions (alloBT) on the basis of religious doctrine, such as Jehovah's Witnesses (JWs), can pose a challenge when undergoing surgical procedures. During cardiac surgery, special considerations regarding surgical techniques and blood loss minimization strategies can lead to improved outcomes. Limited literature exists to guide the use of four-factor prothrombin complex concentrate (4PCC) in this patient population undergoing cardiac surgery. Study design and methods This retrospective, single-center study evaluated the impact of 4PCC on hemoglobin (Hgb) change from baseline to postoperative nadir within a 7-day period among patients who refused alloBT during cardiac surgery. This study identified patients who refused alloBT from January 2011 to June 2017. Multivariable linear regression was used to control for confounding variables to evaluate the effectiveness of 4PCC. Results During the study timeframe, 79 patients met inclusion criteria, all of whom identified as JWs, and underwent cardiac surgery. Of these, 19 received intraoperative 4PCC. Multivariable linear regression found no difference in Hgb change in patients who received 4PCC vs those who did not. No significant differences were found in mortality, thromboembolic complications, or in-hospital postoperative events. Conclusions In JWs undergoing cardiac surgery who refuse alloBT, intraoperative use of 4PCC was not associated with a difference in Hgb change within 7 days postoperatively when adjusting for confounding variables. In the event of excessive blood loss, the utilization of 4PCC may provide a viable option in JW patients who undergo cardiac surgery where few options exist to mitigate blood loss.

Objective: In this study of women in cardiothoracic anesthesiology, we aimed to characterize demographics, roles in leadership, and perceived professional challenges. Design: A prospective cross-sectional survey of women cardiothoracic anesthesiologists in the United States. Setting: An internet-based survey of 43 questions was sent to women in cardiothoracic anesthesiology. The survey included questions on demographics, leadership, and perceptions of professional challenges including career advancement, compensation, promotion, harassment, and intimidation. Participants: A database of women in cardiothoracic anesthesiology was created via personal contacts and snowball sampling. Interventions: None. Measurements and Main Results: A total of 153 responses were analyzed, for a response rate of 65.1%. Most respondents were at the Clinical Instructor or Assistant Professor rank. Many women perceived that compensation, promotion, authorship, and career advancement were affected by gender. Furthermore, 67% of respondents identified having children as having a negative impact on career advancement. Many women reported experiencing derogatory comments (55.6%), intimidation (57.8%), microaggression (69.6%), sexual harassment (25.2%), verbal harassment (45.2%), and unwanted physical or sexual advances (24.4%). These behaviors were most often from a surgical attending, anesthesia attending, or patient. Conclusion : This survey study of women in cardiothoracic anesthesiology found that many women perceived inequities in financial compensation, authorship opportunities, and promotion; in addition, many felt that their career advancement was impacted negatively by having children. A striking finding was that the majority of women have experienced intimidation, derogatory comments and microaggressions in the workplace.

Objectives The aim of this study was to quantitate patient-specific mitral valve (MV) strain in normal valves and in patients with mitral valve prolapse with and without significant mitral regurgitation (MR) and assess the determinants of MV strain. Background Few data exist on MV deformation during systole in humans. Three-dimensional echocardiography allows for dynamic MV imaging, enabling digital modeling of MV function in health and disease. Methods Three-dimensional transesophageal echocardiography was performed in 82 patients, 32 with normal MV and 50 with mitral valve prolapse (MVP): 12 with mild mitral regurgitation or less (MVP − MR) and 38 with moderate MR or greater (MVP + MR). Three-dimensional MV models were generated, and the peak systolic strain of MV leaflets was computed on proprietary software. Results Left ventricular ejection fraction was normal in all groups. MV annular dimensions were largest in MVP + MR (annular area: 13.8 ± 0.7 cm2) and comparable in MVP − MR (10.6 ± 1 cm2) and normal valves (10.5 ± 0.3 cm2; analysis of variance: p Conclusions MVs that exhibit prolapse have higher strain compared to normal valves, particularly in the posterior leaflet. Although higher strain is observed with worsening MR and larger valves and annuli, mitral valve leaflet thickness—and, thus, underlying MV pathology—is the most significant independent determinant of valve deformation. Future studies are needed to assess the impact of MV strain determination on clinical outcome.

The MitraClip procedure is an emerging endovascular technique for treating mitral regurgitation and an attractive alternative for patients who are at high risk for open heart mitral valve repair or replacement. We present the case of a failed redo MitraClip procedure that led to acute right ventricular failure in a patient with homozygous familial hypercholesterolemia and a preexisting secundum atrial septal defect. We highlight the sequelae of the failed redo MitraClip procedure and the anesthetic challenges associated with the emergent redo sternotomy and cardiopulmonary bypass procedure required to replace the mitral valve and repair the tricuspid valve and atrial septal defect.

Human 4-factor prothrombin complex concentrate (4F-PCC) may reduce blood loss during surgery. This case series described perioperative outcomes among 9 patients who refused standard allogeneic blood transfusion, underwent complex cardiac surgery with aortic involvement, and received intraoperative 4F-PCC. Additional intraoperative cointerventions included protamine (n = 9), aminocaproic acid (n = 8), fibrinogen concentrate (n = 6), desmopressin (n = 6), factor VIIa (n = 2), and tranexamic acid (n = 1). Outcomes included postoperative death (n = 1), major postoperative bleeding (n = 1), deep vein thrombosis (n = 2), and ischemic stroke (n = 1). When standard allogeneic blood transfusion is refused, viable hemostasis can be obtained using 4F-PCC during complex cardiac surgeries with a high risk of bleeding.

The protein synthetic and secretory activity of spider tubuliform glands is known to be coordinated with the reproductive stage of the spider. For spiders that produce multiple egg cases, such as the black widow Latrodectus hesperus, this means that the cells that make up the tubuliform gland cycle from minimal to maximal silk protein synthesis and exocytosis as the spider transitions from early vitellogenesis to a gravid state and back. The impact of these transitions on the cells that form the tubuliform gland has yet to be characterized. The entire tubuliform gland undergoes an elastic deformation, doubling in size in response to the accumulation and depletion of egg case silk proteins within its lumen. Similarly, the diversity and organization of organelles within the cytoplasm of the secretory epithelial cells that make up the wall of the tubuliform gland change with the reproductive stage of the spider. Progression of a spider from early to late vitellogenesis is accompanied by decondensed nucleoli and distention of the rough endoplasmic reticulum, markers of protein synthetic activity. The presumed silk proteins that fill the lumen of the tubuliform gland of a gravid spider include a fibrous matrix with homogeneous spherical inclusions. These components are also present within the cytoplasm of the cell; however, only the fibrous material appears to be enclosed by membranous organelles. Transition of the tubuliform gland from peak silk synthesis back to a quiescent state is marked by the appearance of multivesicular bodies and organelles resembling phagophores and autophagosomes, suggestive of a role for autophagy in the process of recovery. The reproducible cellular dynamics of the tubuliform silk gland of the black widow spider makes it a potential model system for study of the regulation of silk gene expression, endomembrane transport, and exocytosis of silk proteins and autophagy.

Few data exist on mitral valve (MV) deformation during systole in humans. 3D echocardiography allows for dynamic MV imaging, enabling digital modeling of MV function in health and disease. 3D transesophageal echocardiography was performed in 32 patients with normal MV, and 48 with mitral valve

6 p., AIM.To determine the association between gross motor function and nutritional status inchildren with cerebral palsy (CP) residing in an urban area in a developing country. METHOD.We conducted a cross-sectional study in 177 children (ages 2–12y, 59.3% male) witha diagnosis of CP who were attending rehabilitation centres in Bucaramanga, Colombia(2012–2013). A physiotherapist evaluated patients using the Gross Motor FunctionClassification System (GMFCS, levels I to V). Nutritional status was evaluated by nutritionistsand classified according to the World Health Organization growth charts. We used linear andmultinomial logistic regression methods to determine the associations. RESULTSThere were 39.5%, 6.8%, 5.6%, 16.4%, and 31.6% patients classified in levels I to Vrespectively. The mean adjusted differences for weight-for-age, height-for-age, BMI-for-age,and height-for-weight z-scores were significantly larger for children classified in levels II to Vcompared with those in level I. The children classified in levels IV and V were more likely tohave malnutrition (adjusted odds ratio [OR] 5.64; 95% confidence interval [CI] 2.27–14.0) andstunting (OR 8.42; 95% CI 2.90–24.4) than those classified in GMFCS levels I to III. INTERPRETATIONStunting and malnutrition are prevalent conditions among paediatric patientswith CP, and both are directly associated with higher levels of gross motor dysfunction.

Elizabeth Herrera-Saldivar1, Antonio Yanez2,6,7,8, David Banuelos3, Constantino Gil4,8 and Lilia Cedillo4,5,7 1Posgrado en Ciencias Ambientales, Instituto de Ciencias, Benemerita Universidad Autonoma de Puebla (B.U.A.P.) 2Facultad de Estomatologia, B.U.A.P. 3Centro Medico Nacional Gral. Manuel Avila Camacho, Instituto Mexicano del Seguro Social I.M.S.S. Hospital de Especialidades San Jose, Puebla 4Centro de Investigaciones en Ciencias Microbiologicas del Instituto de Ciencias, B.U.A.P. 5Vicerrectoria de Extension y Difusion de la Cultura, B.U.A.P. 6Cuerpo Academico de Ciencias Basicas 7Profesor con Perfil Deseable PROMEP 8Programa Integral de Fortalecimiento Institucional PIFI Mexico

Background Identification of mitral regurgitation (MR) mechanism and pathology are crucial for surgical repair. The aim of the present investigation was to evaluate the comparative accuracy of real-time three-dimensional (3D) transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) with two-dimensional (2D) TEE and TTE in diagnosing the mechanism of MR compared with the surgical standard. Methods Forty patients referred for surgical mitral valve repair were studied; 2D and 3D echocardiography with both TTE and TEE were performed preoperatively. Two independent observers reviewed the studies for MR pathology, functional or organic. In organic disease, the presence and localization of leaflet prolapse and/or flail were noted. Surgical findings served as the gold standard. Results There was 100% agreement in identifying functional versus organic MR among all four modalities. Overall, 2D TTE, 2D TEE, and 3D TEE performed similarly in identifying a prolapse or a flail leaflet; 3D TEE had the best agreement in identifying anterior leaflet prolapse, and it also showed an advantage for segmental analysis. Three-dimensional TTE was less sensitive and less accurate in identifying flail segments. Conclusion All modalities were equally reliable in identifying functional MR. Both 2D TEE and 3D TEE were comparable in diagnosing MR mechanism, while 3D TEE had the advantage of better localizing the disease. With current technology, 3D TTE was the least reliable in identifying valve pathology.

6 p., The link between inflammation, obesity, and cardiovascular disease (CVD) has been described in adult populations but few data are available with respect to children. The aim of this study was to describe the inter-relationships between adiposity, C-reactive protein (CRP) plasma concentrations, and blood pressure levels in a Hispanic pediatric population. Methods We included 325 schoolchildren (mean age, 10.0 years) selected from the school population of Bucaramanga, Colombia. Blood pressure, lipid profile, glucose, and CRP plasma concentration were measured using standard procedures. Body mass index (BMI) was used for evaluating the children’s nutritional condition. Correlation coefficients were calculated for all the variables using Spearman’s test. Results As expected, a positive correlation was found between BMI and systolic blood pressure (SBP) in both genders, and between CRP and SBP levels in boys. After a multivariate regression analysis, the association between adiposity and blood pressure remained significant, whereas the CRP concentrations were no longer associated with SBP. Conclusions The results obtained in our study of Hispanic school-age children show that adiposity is correlated with CRP concentrations and SBP values as has been earlier described in Caucasian populations. However, we failed to find a significant relationship between low-grade inflammation and SBP levels. Further studies are needed in order to explore alternative pathophysiological mechanisms linking obesity and high blood pressure in children and to define the impact of these associations on the cardiovascular risk of our pediatric population.