Papillary fibroelastoma of the aortic wall with partial occlusion of the right coronary ostium.

Papillary fibroelastomas are the most common cardiac valve tumors, although they represent less than 10% of all cardiac tumors. These benign tumors are increasingly incidentally discovered as the result of the widespread use of echocardiography. After a definitive diagnosis has been made, surgical resection is strongly advocated due to the risk of cardioembolic complications.

Endothelial NOS is required for SDF-1alpha/CXCR4-mediated peripheral endothelial adhesion of c-kit+ bone marrow stem cells.

In the era of intravascular approaches for regenerative cell therapy, the underlying mechanisms of stem cell migration to non-marrow tissue have not been clarified. We hypothesized that next to a local inflammatory response implying adhesion molecule expression, endothelial nitric oxide synthase (eNOS)-dependent signaling is required for stromal- cell-derived factor-1 alpha (SDF-1alpha)-induced adhesion of c-kit+ cells to the vascular endothelium. SDF-1alpha/tumor necrosis factor-alpha (TNF-alpha)-induced c-kit+-cell shape change and migration capacity was studied in vitro using immunohistochemistry and Boyden chamber assays.

Minimizing cardiopulmonary bypass attenuates myocardial damage after cardiac surgery.

The standard heart-lung machine is deemed a major trigger of systemic inflammatory reactions, potentially inducing organ failure. The strict reduction of blood-artificial surface and blood-air contact might represent meaningful improvements of the extracorporeal technology with respect to organ preservation. In this study, we assessed perioperative myocardial damage by using a novel minimal extracorporeal circuit (MECC) and a conventional cardiopulmonary bypass (CPB) system.

Effects of poly-2-methoxyethylacrylate (PMEA)-coating on CPB circuits.

Objectives: In this study, the immuno- and neuroprotective effect of a novel cardiopulmonary bypass coating was investigated.

Design: Thirty nine patients scheduled for elective coronary artery bypass grafting were randomly assigned to either PMEA-coated (n = 19) or non-coated CPB circuits (n = 20). Pericardial suction blood was separated and retransfused only if needed at the end of operation.

Pericardial suction blood separation attenuates inflammatory response and hemolysis after cardiopulmonary bypass.

Objectives: Retransfusion of pericardial suction blood (PSB) is critically considered under the aspect of the biocompatibility of the cardiopulmonary bypass (CPB). We investigated various indicators of inflammation and blood cell activation associated with CPB and re-transfusion of PSB during cardiac surgery.

Design: Thirty-five patients undergoing elective coronary artery bypass grafting were prospectively randomized into two groups.

Circulating endothelial cells demonstrate an attenuation of endothelial damage by minimizing the extracorporeal circulation.

Objective: Detachment of endothelial cells may represent serious injury of the endothelium after cardiopulmonary bypass. We investigated whether the extent of endothelial injury is related to the type of cardiopulmonary bypass system used (conventional or minimized) and determined circulating endothelial cells as well as von Willebrand factor and soluble thrombomodulin.

Methods: Twenty patients scheduled for elective coronary bypass grafting were randomly assigned to either the minimal extracorporeal circulation system or the standard cardiopulmonary bypass.

Evaluation of coated oxygenators in cardiopulmonary-bypass systems and their impact on neurocognitive function.

Introduction: Coronary artery bypass graft surgery (CABG) using cardiopulmonary bypass (CPB) is assumed to be associated with a decline of neurocognitive functions. This study was designed to analyse the neurocognitive function of patients with coronary heart disease before and after CABG and to determine possible protective effects of oxygenator surface coating on neurological outcome.

Methods: Forty patients scheduled for selective CABG were prospectively randomized into two groups of 20 patients each according to the type of hollow-fibre membrane oxygenator used.

Placement of a left ventricular assist device in a patient with dextrocardia.

Dextrocardia most commonly presents in the setting of situs inversus, but it may occur as an isolated anomaly with normal position of the abdominal organs. Herein we present a 54-year-old man with ischemic cardiomyopathy and dextrocardia with normal position of the abdominal organs who presented with an exacerbation of congestive heart failure requiring inotropic support as well as mechanical ventilation. An implantable, wearable left ventricular assist device was placed in this patient to allow for ambulation and eventual discharge home.

Organ-specific regulation of pro-inflammatory molecules in heart, lung, and kidney following brain death.

Background: Nonspecific inflammatory events following brain death may increase the intensity of the immunological host response. The present study investigated the course of pro-inflammatory molecules in heart, lung, kidney, and plasma after brain death induction.

Materials And Methods: Brain death was induced in five pigs by inflation of an intracranial Foley catheter and five pigs were sham-operated as controls.

Plasma neurohormone levels correlate with left ventricular functional and morphological improvement in LVAD patients.

Objective: Brain natriuretic peptide (BNP) and endothelin-1 (ET-1) have been shown to be markers of left ventricular (LV) function. To determine the feasibility of using serial assays of these neurohormones in the assessment of cardiac status in the left ventricular assist device (LVAD) setting, we examined the relationship between LV function, myocardial morphology, and plasma levels of these hormones in LVAD recipients.

Methods: Plasma BNP and ET-1 levels were serially assayed in 19 end-stage congestive heart failure (CHF) patients before and after LVAD implantation with various devices (i.

Role of mast cells and their mediators in failing myocardium under mechanical ventricular support.

Background: Mast cells have been implicated in tissue remodeling and fibroblast stimulation. We explored the effect of mechanical support by left ventricular assist device (LVAD) in failing myocardium and looked into grade and distribution of interstitial fibrosis, mast cell density, mast cell phenotypes and basic fibroblast growth factor (bFGF) expression pre- and post-LVAD.

Methods: Myocardial tissue was obtained from 20 patients with end-stage cardiomyopathy at the time of LVAD implantation and LVAD removal and from 7 donor hearts not used for transplantation.

Interaction between isolated human myocardial mast cells and cultured fibroblasts.

Introduction: Previously, we reported an increase in interstitial collagen and total mast-cell numbers in heart failure versus normal myocardium. A secondary increase, primarily in chymase-negative mast cells, occurred following LVAD support compared to matched pre-LVAD tissue samples and was associated with a decrease in interstitial collagen and bFGF. To further elucidate the changes in interstitial collagen, we investigated the direct interaction between mast cells, isolated from failing myocardium with or without previous LVAD support, and human fibroblasts in a coculture model.