Minimally invasive mitral valve surgery: evolution, techniques and outcomes.

Surgical treatment of the mitral valve has evolved considerably since the 1920s. During the mid-1990s new approaches through small incisions have been proposed to access the mitral valve. We herein describe the evolution of mitral surgery, the development of minimally invasive mitral techniques and compare outcomes to a standard sternotomy approach.

Surgical removal of a 'nonretrievable' inferior vena cava filter: a unique case requiring a median sternotomy and cardiopulmonary bypass.

An unsuccessful percutaneous removal of a caval filter that required retrieval through a median sternotomy and cardiopulmonary bypass is reported. Surgical options and techniques are discussed.

Use of an extra-anatomical bypass to the axillary artery to revascularize the subclavian artery during complex aortic surgeries: an alternate option in difficult cases.

Revascularization of the subclavian artery during complex arch surgeries may be challenging. Options include ligation of the subclavian artery with or without in situ revascularization. In cases of complex reoperations of the arch, or in the presence of large arch aneurysms with a leftward displacement of the subclavian artery, in situ revascularization may be difficult or impossible.

"Valve-in-valve" for the treatment of paravalvular leaks following transcatheter aortic valve implantation.

Transcatheter aortic valve implantation (TAVI) is commonly associated with some degree of aortic regurgitation (AR) secondary to the presence of paravalvular leaks. We present the case of an 86-year-old woman diagnosed with severe aortic stenosis who underwent TAVI with a 23-mm Edwards-SAPIEN valve. The procedure complicated with a severe paravalvular leak following TAVI that was unresponsive to balloon postdilation.

Seasonal variations in work-related health effects in swine farm workers.

The aim of the project was to investigate whether there were diminished health effects in swine farm workers during summer compared with winter, as seasonal differences in concentrations of bioaerosols have been reported. Twenty-four workers were visited once during each season. Before and after a work shift, they underwent lung function testing and blood sampling.

Impact of high-fat /low-carbohydrate, high-, low-glycaemic index or low-caloric meals on glucose regulation during aerobic exercise in Type 2 diabetes.

Aims: A decrement in blood glucose (BG) may be observed in patients with Type 2 diabetes (T2DM) when exercise is performed after a meal, in contrast to fasting. We determined the impact of different pre-exercise meal macronutrient compositions with modulation of the glycaemic index (GI) on glucose regulation during exercise in patients with T2DM.

Methods: Using a randomized, single-blind crossover design, 10 sedentary men performed five exercise sessions, once after an overnight fast, and also after each of four test meals, consisting of a high-fat/low-carbohydrate meal, a high-GI meal, a low-GI meal, and a low-calorie meal.

Oxidized low-density lipoprotein, angiotensin II and increased waist cirumference are associated with valve inflammation in prehypertensive patients with aortic stenosis.

Introduction: The progression of aortic stenosis (AS) has been shown to be faster in patients with the metabolic syndrome. We sought to determine the relationships between blood pressure, inflammation, oxidative stress and valvular inflammation in a population of normotensive and prehypertensive patients with AS.

Methods: In this study, 36 male patients (age: 61.

Aging alters PPARgamma in rodent and human adipose tissue by modulating the balance in steroid receptor coactivator-1.

Age is an important risk factor for the development of metabolic diseases (e.g. obesity, diabetes and atherosclerosis).

Effects of exercise in volume overload: insights from a model of aortic regurgitation.

Background: Aortic valve regurgitation (AR) imposes a pathologic volume overload to the left ventricle (LV), whereas aerobic exercise causes physiologic volume overloading. The impact of combining both LV volume overloads (pathologic and physiologic) is unknown. Considering the known beneficial effects of aerobic training on the cardiovascular system, we hypothesized that the positive effects would outweigh the negative ones and that exercise would improve the tolerance of the LV to AR.

Comparison of the hemodynamic performance of percutaneous and surgical bioprostheses for the treatment of severe aortic stenosis.

Objectives: This study was undertaken to compare the hemodynamic performance of a percutaneous bioprosthesis to that of surgically implanted (stented and stentless) bioprostheses for the treatment of severe aortic stenosis.

Methods: Fifty patients who underwent percutaneous aortic valve implantation (PAVI) with the Cribier-Edwards or Edwards SAPIEN bioprosthetic valve (Edwards Lifesciences, Inc., Irvine, California) were matched 1:1 for sex, aortic annulus diameter, left ventricular ejection fraction, body surface area, and body mass index, with 2 groups of 50 patients who underwent surgical aortic valve replacement (SAVR) with a stented valve (Edwards Perimount Magna [SAVR-ST group]), or a stentless valve (Medtronic Freestyle, Medtronic, Minneapolis, Minnesota [SAVR-SL group]).

Rapid pacing technique for preventing ventricular tears during transapical aortic valve replacement.

Background: Transapical aortic valve replacement (TAVR) is emerging as an alternative to surgical aortic valve replacement in high-risk or non-operable patients with aortic stenosis. However, this approach might be associated with major bleeding complications during the removal of the introducer sheath from the left ventricular apex. We describe a simple technique to minimize this complication.

Rosiglitazone-induced heart remodelling is associated with enhanced turnover of myofibrillar protein and mTOR activation.

We investigated cardiac hypertrophy elicited by rosiglitazone treatment at the level of protein synthesis/degradation, mTOR, MAPK and AMPK signalling pathways, cardiac function and aspects of carbohydrate/lipid metabolism. Hearts of rats treated or not with rosiglitazone (15 mg/kg day) for 21 days were evaluated for gene expression, protein synthesis, proteasome and calpain activities, signalling pathways, and function by echocardiography. Rosiglitazone induced eccentric heart hypertrophy associated with increased expression of ANP, BNP, collagen I and III and fibronectin, reduced heart rate and increased stroke volume.

Impact of female gender and transradial coronary stenting with maximal antiplatelet therapy on bleeding and ischemic outcomes.

Background: Female gender has been associated with poorer outcomes after percutaneous coronary intervention (PCI) and femoral approach. However, no data are available on the impact of gender and transradial PCI with maximal antiplatelet therapy on bleeding and ischemic outcomes.

Methods: In the EArly discharge after Stenting of coronarY arteries (EASY) trial, 1,348 patients with acute coronary syndrome underwent transradial PCI.

Usefulness of coronary fractional flow reserve measurements in guiding clinical decisions in intermediate or equivocal left main coronary stenoses.

The objectives of this study were to evaluate the usefulness of fractional flow reserve (FFR) measurements to guide the clinical decision in patients with intermediate left main coronary artery (LMCA) stenosis and to determine the predictors of major adverse cardiac events (MACE) -- cardiac death, myocardial infarction, coronary revascularization -- in such cases; 142 consecutive patients with intermediate LMCA stenosis (mean percent diameter stenosis 42 +/- 13%) were included. All patients underwent FFR measurement after intracoronary administration of adenosine at a dose > or =30 microg. The clinical decisions were based on FFR as follows: coronary revascularization was recommended if FFR was <0.

Open or minimally invasive esophagectomy: are the outcomes different?

Purpose Of Review: Since the beginning of the 1990s, the use of minimally invasive esophagectomy instead of the open technique has increased. Should this type of approach change the way we manage anesthesia for a patient undergoing esophagectomy for cancer?

Recent Findings: Because valid direct comparisons with open surgery are lacking, one cannot make definitive statements regarding the potential benefits of minimally invasive surgery. Rough comparisons with recent reports on open surgery suggest that reduced mortality, respiratory complications and blood loss, plus a more rapid return to a good quality of life are areas in which minimally invasive surgery might prove superior.

The brain endocannabinoid system in the regulation of energy balance.

The role played by the endocannabinoid system in the regulation of energy balance is currently generating a great amount of interest among several groups of investigators. This interest in large part comes from the urgent need to develop anti-obesity and anti-cachexia drugs around target systems (such as the endocannabinoid system), which appears to be genuinely involved in energy balance regulation. When activated, the endocannabinoid system favors energy deposition through increasing energy intake and reducing energy expenditure.

Primary cardiac Burkitt-like lymphoma of the right atrium.

A 74-year-old man presented for shortness of breath. Echocardiography revealed the presence of a large pericardial effusion with signs of tamponade. A right atrial mass was suspected and later confirmed by transesophageal echocardiography.

Additive action of 11beta-HSD1 inhibition and PPAR-gamma agonism on hepatic steatosis and triglyceridemia in diet-induced obese rats.

Both 11beta-hydroxysteroid dehydrogenase (11beta-HSD1) inhibition and peroxisome proliferator-activated receptor-gamma (PPAR-gamma) agonism reduce liver and plasma lipids in rodents through partly distinct mechanisms. This study aimed to assess their additivity of action on liver and plasma lipids in a model of diet-induced steatosis. Rats were fed an obesogenic diet and were treated either with an 11beta-HSD1 inhibitor (Compound A, 3 mg kg(-1) day(-1)) or rosiglitazone (RSG, 5 mg kg(-1) day(-1)) or both for 6 weeks.

The PPARgamma agonist rosiglitazone enhances rat brown adipose tissue lipogenesis from glucose without altering glucose uptake.

We investigated the mechanisms whereby peroxisome proliferator-activated receptor-gamma (PPARgamma) agonism affects glucose and lipid metabolism in brown adipose tissue (BAT) by studying the impact of PPARgamma activation on BAT glucose uptake and metabolism, lipogenesis, and mRNA levels plus activities of enzymes involved in triacylglycerol (TAG) synthesis. Interscapular BAT of rats treated or not with rosiglitazone (15 mg*kg(-1).day(-1), 7 days) was evaluated in vivo for glucose uptake and lipogenesis and in vitro for glucose metabolism, gene expression, and activities of glycerolphosphate acyltransferase (GPAT), phosphatidate phosphatase-1 (PAP or lipin-1), and diacylglycerol acyltransferase (DGAT).

Depot-specific effects of the PPARgamma agonist rosiglitazone on adipose tissue glucose uptake and metabolism.

We investigated mechanisms whereby peroxisome proliferator-activated receptor gamma (PPARgamma) agonism redistributes lipid from visceral (VF) toward subcutaneous fat (SF) by studying the impact of PPARgamma activation on VF and SF glucose uptake and metabolism, lipogenesis, and enzymes involved in triacylglycerol (TAG) synthesis. VF (retroperitoneal) and SF (inguinal) of rats treated or not for 7 days with rosiglitazone (15 mg/kg/day) were evaluated in vivo for glucose uptake and lipogenesis and in vitro for glucose metabolism, gene expression, and activities of glycerolphosphate acyltransferase (GPAT), phosphatidate phosphatase-1 (or lipin-1), and diacylglycerol acyltransferase. Rosiglitazone increased SF glucose uptake, GLUT4 mRNA, and insulin-stimulated glucose oxidation, conversion to lactate, glycogen, and the glycerol and fatty acid components of TAG.