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- High Creatine Kinase (CK)-MB and Lactate Dehydrogenase in the Absence of Myocardial Injury or Infarction: A Case Report. [Journal Article]
- J Cardiovasc Thorac Res 2014; 6(1):69-70.
Acute myocardial infarction (AMI) is a life threatening condition that needs emergency diagnosis and early treatment in the emergency room. Rapid laboratory testing for creatine kinase (CK)-MB greatly revolutionized the diagnosis and management of acute myocardial infarction. We report a case with chest pain that referred to the emergency department (ED). Laboratory data showed high serum levels of creatine kinase and lactate dehydrogenase. With diagnosis of acute myocardial infarction, he was hospitalized and angiography was performed which showed three vessels disease; the patient was referred to surgical ward for coronary artery bypass graft. Surgery was performed after one week; during the operation there was no sign of infarction over the heart. Our observation suggests that false positive laboratory result may be due to other condition which must be evaluated.
- Echocardiographic investigation of the mechanism underlying abnormal interventricular septal motion after open heart surgery. [Journal Article]
- J Cardiovasc Ultrasound 2014 Mar; 22(1):8-13.
Abnormal interventricular septal motion (ASM) is frequently observed after open heart surgery (OHS). The aim of this study was to investigate the incidence and temporal change of ASM, and its underlying mechanism in patients who underwent OHS using transthoracic echocardiography (TTE).In total, 165 patients [60 ± 13 years, 92 (56%) men] who underwent coronary bypass surgery or heart valve surgery were consecutively enrolled in a prospective manner. TTE was performed preoperatively, at 3--6-month postoperatively, and at the 1-year follow-up visit. Routine TTE images and strain analysis were performed using velocity vector imaging.ASM was documented in 121 of 165 patients (73%) immediately after surgery: 26 patients (17%) presented concomitant expiratory diastolic flow reversal of the hepatic vein, 11 (7%) had inferior vena cava plethora, and 11 (7%) had both. Only 2 patients (1%) showed clinically discernible constriction. ASM persisted 3--6 months after surgery in 38 patients (25%), but only in 23 (15%) after 1 year. There was no difference in preoperative and postoperative peak systolic strain of all segments of the left ventricle (LV) between groups with or without ASM. However, systolic radial velocity (VRad) of the mid anterior-septum and anterior wall of the LV significantly decreased in patients with ASM.Although ASM was common (74%) immediately after OHS, it disappeared over time without causing clinically detectable constriction. Furthermore, we consider that ASM might not be caused by myocardial ischemia, but by the decreased systolic VRad of the interventricular septum after pericardium incision.
- Long-term results of surgical treatment of aortic and mitral regurgitation with enlarged left ventricle. [Journal Article]
- Int J Clin Exp Med 2014; 7(3):709-13.
Mitral valve and aortic valve regurgitation associated with enlarged left ventricle remains difficult to manage and the long-term results following surgical treatment is uncertain. Between April 1988 and September 2000, 82 patients with aortic and mitral regurgitation associated with enlarged left ventricle underwent valve replacement at Anzhen Hospital. The valve disease was rheumatic in origin in 75 patients (91.5%) and congenital in 7 (8.5%). Twenty-eight patients were in New York heart Association Functional (NYHA) class II and 39 in class III and 15 in class IV. Echocardiogram showed severe aortic insufficiency associated with mild to moderate mitral regurgitation in 66 patients and severe mitral regurgitation associated with mild to moderate AI in 16 patients. The mean left ventricular diastole diameter (LVDD) was 77.8 ± 5.2 mm. Valve replacement was performed under hypothermic cardiopulmonary bypass (CPB). Early hospital mortality was 7.3%. Two weeks after surgery the echocardiogram showed a reduction of LVDD. Follow up was completed in 69 patients with mean of 13.5 years. 20 patients were in NYHA class I; 26 in Class II and 3 in Class III and 2 in class IV. The follow-up survival rate was 73.9%, and follow-up mortality was 26.1%. LVDD reduced from 77.8 ± 5.2 mm to 58.3 ± 4.5 mm (P < 0.001). In 24 patients, the LVDD was less than 50 mm. Double valve replacement and/or repair carried out an acceptable early and Long-term clinical outcomes in patients with MR and AI with associated LV great enlargement. Both LVDD and NYHA improved following surgical treatment in survival patients.
- Bubble-free and pulse-free fluid delivery into microfluidic devices. [Journal Article]
- Biomicrofluidics 2014 Jan; 8(1):014102.
The bubble-free and pulse-free fluid delivery is critical to reliable operation of microfluidic devices. In this study, we propose a new method for stable bubble-free and pulse-free fluid delivery in a microfluidic device. Gas bubbles are separated from liquid by using the density difference between liquid and gas in a closed cavity. The pulsatile flow caused by a peristaltic pump is stabilized via gas compressibility. To demonstrate the proposed method, a fluidic chamber which is composed of two needles for inlet and outlet, one needle for a pinch valve and a closed cavity is carefully designed. By manipulating the opening or closing of the pinch valve, fluids fill up the fluidic chamber or are delivered into a microfluidic device through the fluidic chamber in a bubble-free and pulse-free manner. The performance of the proposed method in bubble-free and pulse-free fluid delivery is quantitatively evaluated. The proposed method is then applied to monitor the temporal variations of fluidic flows of rat blood circulating within a complex fluidic network including a rat, a pinch valve, a reservoir, a peristaltic pump, and the microfluidic device. In addition, the deformability of red blood cells and platelet aggregation are quantitatively evaluated from the information on the temporal variations of blood flows in the microfluidic device. These experimental demonstrations confirm that the proposed method is a promising tool for stable, bubble-free, and pulse-free supply of fluids, including whole blood, into a microfluidic device. Furthermore, the proposed method will be used to quantify the biophysical properties of blood circulating within an extracorporeal bypass loop of animal models.
- Atypical Wernicke's syndrome sans encephalopathy with acute bilateral vision loss due to post-chiasmatic optic tract edema. [Journal Article]
- Ann Indian Acad Neurol 2014 Jan; 17(1):103-5.
A middle aged male presented with acute bilateral vision loss, 4 weeks after undergoing gastric bypass surgery for gastric carcinoma. He had normal sensorium, fundoscopy, normal pupillary reaction to light, but had mild opthalmoparesis and nystagmus with ataxia. Magnetic resonance imaging of the brain revealed post-chiasmatic optic tract edema along with other classical features of Wernicke's syndrome. Thiamine supplementation leads to complete resolution of clinical as well as imaging findings. In appropriate clinical settings, a high index of suspicion and early treatment are essential for managing Wernicke's syndrome even in patients with atypical clinical and imaging presentation.
- Three-dimensional CFD/MRI modeling reveals that ventricular surgical restoration improves ventricular function by modifying intraventricular blood flow. [JOURNAL ARTICLE]
- Int j numer method biomed eng 2014 Apr 21.
Surgical ventricular restoration (SVR) is designed to normalize distorted ventricular shape and size in patients with left ventricular (LV) dysfunction and akinetic and dyskinetic segments. This study is aimed to quantify the characteristics of LV as a pump for a case before and after SVR, which is followed by coronary artery bypass grafting (CABG). We hypothesize that SVR+CABG improves heart flow. A patient with heart failure had magnetic resonance (MR) scans before and 4 months after SVR. LV endocardial geometries were semi-automated segmented and reconstructed using our customized algorithm. The arbitrary Lagrangian-Eulerian formulation of Navier-Stokes equations was solved to derive the flow patterns and calculate pressure differences in LV. After SVR, LV ejection fraction increased from 34% to 48% in patient but was still lower than normal (70%). Second, LV vortices were stronger than pre-surgery but still weaker than normal. The maximum pressure differences between ventricular base and apex increased from 180 to 400 Pa during diastole, from 252 to 560 Pa during systole, respectively. As anticipated, SVR reduced LV volumes and augmented LV ejection fraction. Three-dimensional CFD/MRI modeling suggests that improved diastolic and systolic ventricular function after SVR is associated with changes in intraventricular blood flow. Copyright © 2014 John Wiley & Sons, Ltd.
- A new Adamts9 conditional mouse allele identifies its non-redundant role in interdigital web regression. [JOURNAL ARTICLE]
- Genesis 2014 Apr 20.
ADAMTS9 is the most conserved member of a large family of secreted metalloproteases having diverse functions. Adamts9 null mice die before gastrulation, precluding investigations of its roles later in embryogenesis, in adult mice or disease models. We therefore generated a floxed Adamts9 allele to bypass embryonic lethality. In this mutant, unidirectional loxP sites flank exons 5 through 8, which encode the catalytic domain, including the protease active site. Mice homozygous for the floxed allele were viable, lacked an overt phenotype, and were fertile. Conversely, mice homozygous for a germ-line deletion produced from the floxed allele by Cre-lox recombination did not survive past gastrulation. Hemizygosity of the deleted Adamts9 in combination with mutant Adamts20 led to cleft palate and severe white spotting as previously described. Previously, Adamts9 haploinsufficiency combined with either Adamts20 or Adamts5 nullizygosity suggested a cooperative role in interdigital web regression, but the outcome of deletion of Adamts9 alone remained unknown. Here, Adamts9 was conditionally deleted in limb mesoderm using Prx1-Cre mice. Unlike other ADAMTS single knockouts, limb-specific Adamts9 deletion resulted in soft-tissue syndactyly (STS) with 100% penetrance and concurrent deletion of Adamts5 increased the severity of STS. Thus, Adamts9 has both non-redundant and cooperative roles in ensuring interdigital web regression. This new allele will be useful for investigating other biological functions of ADAMTS9. © 2014 Wiley Periodicals, Inc.
- The Influence of the Metabolic Syndrome on Atrial Fibrillation Occurrence and Outcome after Coronary Bypass Surgery: A 3-Year Follow-up Study. [JOURNAL ARTICLE]
- Thorac Cardiovasc Surg 2014 Apr 21.
Background We sought to investigate the influence of the metabolic syndrome (MS) on new-onset postoperative atrial fibrillation (POAF), and occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) in a period of 3 years after isolated coronary artery bypass grafting (CABG) surgery. Methodology The study included 460 patients who underwent the first CABG operation without baseline atrial fibrillation. The MS was defined by the presence of three or more Adult Treatment Panel (ATP)-American Heart Association (AHA)- National Heart, Lung, and Blood (NHLB) Institute criteria. POAF was diagnosed by continuous electrocardiographic monitoring during the first 48 to 72 hours after CABG. All the patients were followed up for at least 3 years after surgery. Results The MS and its criteria were significantly associated with POAF and MACCE occurrence in the 3-year period after isolated CABG surgery. Among the MS risk factors, hypertension, abdominal obesity, and the increased fasting glucose level were independently associated with both POAF and MACCE onset in the observed patients. Individuals with four or five MS criteria have similar risk of POAF or MACCE as individuals with three MS criteria. In the 3-year period of follow-up, the MS was proven to be associated with MACCE occurrence, independently of hypertension, diabetes, and obesity defined by body mass index. Conclusions The MS and its criteria significantly increased risk of POAF and MACCE in a 3-year period. The MS, irrespective of hypertension, diabetes, and obesity, was associated with POAF and MACCE in the patients who underwent CABG.