Early Feasibility Study of a Hybrid Tissue-Engineered Mitral Valve in an Ovine Model.

Tissue engineering aims to overcome the current limitations of heart valves by providing a viable alternative using living tissue. Nevertheless, the valves constructed from either decellularized xenogeneic or purely biologic scaffolds are unable to withstand the hemodynamic loads, particularly in the left ventricle. To address this, we have been developing a hybrid tissue-engineered heart valve (H-TEHV) concept consisting of a nondegradable elastomeric scaffold enclosed in a valve-like living tissue constructed from autologous cells.

Generalizable fully automated multi-label segmentation of four-chamber view echocardiograms based on deep convolutional adversarial networks.

A major issue in translation of the artificial intelligence platforms for automatic segmentation of echocardiograms to clinics is their generalizability. The present study introduces and verifies a novel generalizable and efficient fully automatic multi-label segmentation method for four-chamber view echocardiograms based on deep fully convolutional networks (FCNs) and adversarial training. For the first time, we used generative adversarial networks for pixel classification training, a novel method in machine learning not currently used for cardiac imaging, to overcome the generalization problem.

Serial changes of L wave according to heart rates in a heart failure patient with persistent atrial fibrillation.

Mid-diastolic forward flow velocity of transmitral flow (L wave) is known as a marker of diastolic dysfunction and is occasionally observed in patients with fluid retention, low heart rate, and atrial fibrillation (AF). However, how hemodynamic condition affects L wave is still unknown. An 81-year-old woman who underwent implantation of a DDD pacemaker due to complete atrioventricular block 38 years previously suffered from congestive heart failure and was admitted to our hospital.

Reduction in Left Ventricular Ejection Fraction is Associated with Subsequent Cardiac Events in Outpatients with Chronic Heart Failure.

Left ventricular ejection fraction (LVEF) is critical for determining the prognosis and treatment of patients with heart failure (HF). However, the influence of serial LVEF changes in patients with stable chronic HF (CHF) has not yet been completely investigated. We analyzed data of 263 outpatients with CHF from the J-MELODIC study cohort and evaluated the frequency of cardiac events.

Age-related changes in diastolic function in children: Echocardiographic association with vortex formation time.

Background: This study aims to understand the age-related changes in vortex formation time (VFT) index in children, and thus, describe the ranges of VFT in different pediatric age groups with the ultimate goal of assessment of diastolic function.

Methods And Results: Transthoracic echocardiograms in healthy (n = 84) subjects from birth to 20 years were analyzed to compute VFT and diastolic performance. LV apical and short-axis views were used.

Diagnostic and prognostic significance of cardiovascular vortex formation.

Various forms of vortex formation in the cardiovascular system convey valuable information regarding the function of heart and great vessels. The vortex ring that forms during systole in the aortic sinus is the first that was recognized and the asymmetric transmitral vortex ring that forms in the left ventricle during diastole has been most commonly used for diagnosis and follow up of heart failure patients. Adverse vortex interaction in the heart can also occur due to valvular regurgitation and may have energetic consequences to the heart.

Intraventricular Vortex Interaction between Transmitral Flow and Paravalvular Leak.

Paravalvular leak (PVL) is a complication of transcatheter aortic valve replacement. Despite its marked clinical impact, no previous study has reported how PVL affects the intraventricular fluid dynamics. This study aims to delineate vortex interaction between PVL and transmitral flow and the influence of PVL orifice location on intraventricular fluid dynamics using Echocardiographic Particle Image Velocimetry.

A calcified polymeric valve for valve-in-valve applications.

The prevalence of aortic valve stenosis (AS) is increasing in the aging society. More recently, novel treatments and devices for AS, especially transcatheter aortic valve replacement (TAVR) have significantly changed the therapeutic approach to this disease. Research and development related to TAVR require testing these devices in the calcified heart valves that closely mimic a native calcific valve.

Transferrin Receptor 1 in Chronic Hypoxia-Induced Pulmonary Vascular Remodeling.

Background: Iron is associated with the pathophysiology of several cardiovascular diseases, including pulmonary hypertension (PH). In addition, disrupted pulmonary iron homeostasis has been reported in several chronic lung diseases. Transferrin receptor 1 (TfR1) plays a key role in cellular iron transport.

Worsening of proteinuria caused by combination therapy of hypertonic saline and low-dose furosemide for treatment of acute decompensated heart failure with overt diabetic nephropathy.

A combination of hypertonic saline and furosemide has been proposed as a new therapeutic approach for treating acute decompensated heart failure (ADHF). The advantages of this combination have not only been demonstrated in ADHF but also in refractory ascites due to liver cirrhosis. However, the therapeutic effects of this regimen have never been evaluated in ADHF with overt diabetic nephropathy (ODN).

Temporary dietary iron restriction affects the process of thrombus resolution in a rat model of deep vein thrombosis.

Background: Deep vein thrombosis (DVT) is a major cause of pulmonary thromboembolism and sudden death. Thus, it is important to consider the pathophysiology of DVT. Recently, iron has been reported to be associated with thrombotic diseases.

Cardiac remodeling in response to chronic iron deficiency: role of the erythropoietin receptor.

Objective: Anemia is a common comorbidity of patients with heart failure, and iron deficiency is known as one of the causes of anemia in heart failure. Recent studies have shown that iron deficiency alone, without overt anemia, is associated with poor outcomes in patients with heart failure. Thus, to minimize the mortality in patients with heart failure, it is important to understand the link between iron deficiency and cardiac function.

Association between renal iron accumulation and renal interstitial fibrosis in a rat model of chronic kidney disease.

Iron accumulation is associated with the pathophysiology of chronic kidney disease (CKD). Renal fibrosis is a final common feature that contributes to the progression of CKD; however, little is known about the association between renal iron accumulation and renal interstitial fibrosis in CKD. Here we investigate the effects of iron chelation on renal interstitial fibrosis in a rat model of CKD.

Iron restriction inhibits renal injury in aldosterone/salt-induced hypertensive mice.

Excess iron is associated with the pathogenesis of several renal diseases. Aldosterone is reported to have deleterious effects on the kidney, but there have been no reports of the role of iron in aldosterone/salt-induced renal injury. Therefore, we investigated the effects of dietary iron restriction on the development of hypertension and renal injury in aldosterone/salt-induced hypertensive mice.

Association of dietary iron restriction with left ventricular remodeling after myocardial infarction in mice.

Several epidemiologic studies have reported that body iron status and dietary iron intake are related to an increased risk of acute myocardial infarction (MI). However, it is completely unknown whether dietary iron reduction impacts the development of left ventricular (LV) remodeling after MI. Here, we investigate the effect of dietary iron restriction on the development of LV remodeling after MI in an experimental model.

Hemodynamic response to sildenafil in patients with decompensated congestive heart failure can be predicted by deceleration time of transmitral flow.

Aim: How sildenafil acutely provides hemodynamic alterations in patients with decompensated congestive heart failure remains unknown. The aim of this study was to investigate whether myocardial and/or hemodynamic conditions affect hemodynamic response to sildenafil in patients with decompensated heart failure.

Methods And Results: Twenty-five consecutive patients with decompensated congestive heart failure were enrolled.

Combination of hypertonic saline and low-dose furosemide is an effective treatment for refractory congestive heart failure with hyponatremia.

Hyponatremia often associates with heart failure. Although severe salt restriction is generally recommended in heart failure treatment, it may promote hyponatremia which is a risk factor for increased morbidity and mortality in heart failure patients. Therefore, it is not yet clear whether correction of hyponatremia is an effective treatment in congestive heart failure with hyponatremia.

Intravenous salt supplementation with low-dose furosemide for treatment of acute decompensated heart failure.

Background: Theoretically, salt supplementation should promote diuresis through increasing the glomerular filtration rate (GFR) during treatment of acute decompensated heart failure (ADHF) even with low-dose furosemide; however, there is little evidence to support this idea.

Methods And Results: This was a prospective, randomized, open-label, controlled trial that compared the diuretic effectiveness of salt infusion with that of glucose infusion supplemented with low-dose furosemide in 44 consecutive patients with ADHF. Patients were randomly administered 1.

Increased renal iron accumulation in hypertensive nephropathy of salt-loaded hypertensive rats.

Although iron is reported to be associated with the pathogenesis of chronic kidney disease, it is unknown whether iron participates in the pathophysiology of nephrosclerosis. Here, we investigate whether iron is involved in the development of hypertensive nephropathy and the effects of iron restriction on nephrosclerosis in salt- loaded stroke-prone spontaneously hypertensive rats (SHRSP). SHRSP were given either a normal or high-salt diet for 8 weeks.

Treatment of collateral channel perforation during percutaneous coronary intervention for chronic total occlusion with retrograde approach.

We describe one case of septal and two cases of epicardial collateral channel perforation during percutaneous coronary intervention by the retrograde approach for chronic total occlusion. After coil embolization of the channel perforation area, additional treatments were required in all three cases to stop bleeding. All three cases required injection of autologous clots, with one case also requiring subsequent injection of fibrin glue.

Predictive factors for successful weaning from percutaneous cardiopulmonary support in patients with cardiogenic shock complicating acute myocardial infarction.

Background And Purpose: Percutaneous cardiopulmonary support (PCPS) is useful in the rescue of patients who have experienced severe cardiogenic shock. We investigated the predictive factors of survival among patients with cardiogenic shock requiring PCPS.

Methods And Subjects: We enrolled 29 patients (21 men and 8 women, 73 ± 10 years old) with circulatory collapse complicating acute myocardial infarction (AMI) requiring PCPS.

Effect of elevated left ventricular diastolic filling pressure on the frequency of left atrial appendage thrombus in patients with nonvalvular atrial fibrillation.

We investigated the relation between left ventricular diastolic dysfunction and left atrial appendage (LAA) thrombus in patients with atrial fibrillation (AF). We performed transesophageal echocardiography to examine LAA thrombus or spontaneous echo contrast (SEC) and to measure LAA emptying flow velocity in consecutive 376 patients with AF. We estimated diastolic filling pressure as the ratio of early transmitral flow velocity (E) to mitral annular velocity (e') on transthoracic echocardiogram.