- Inflammation and pericarditis: Are neutrophils actors behind the scenes? [Review]
- JCJ Cell Physiol 2018 Nov 11
- The morbidity of acute pericarditis is increasing over time impacting on patient quality of life. Recent clinical trials focused especially on clinical aspects, with a modest interest in pathophysiol...
The morbidity of acute pericarditis is increasing over time impacting on patient quality of life. Recent clinical trials focused especially on clinical aspects, with a modest interest in pathophysiological mechanisms. This narrative review, based on papers in English language obtained via PubMed up to April 2018, aims at focusing on the role of the innate immunity in pericarditis and discussing future potential therapeutic strategies impacting on disease pathophysiology. In developed countries, most cases of pericarditis are referred to as idiopathic, although etiological causes have been described, with autoreactive/lymphocytic, malignant, and infectious ones as the most frequent causes. Apart the known impairment of the adaptive immunity, recently a large body evidence indicated the central role of the innate immune system in the pathogenesis of recurrent pericarditis, starting from similarities with autoinflammatory diseases. Accordingly, the "inflammasome" has been shown to behave as an important player in pericarditis development. Similarly, the beneficial effect of colchicine in recurrent pericarditis confirms that neutrophils are important effectors as colchicine, which can block neutrophil chemotaxis, interferes with neutrophil adhesion and recruitment to injured tissues and abrogate superoxide production. Anyway, the role of the adaptive immune system in pericarditis cannot be reduced to a black or white issue as mechanisms often overlap. Therefore, we believe that more efficient therapeutic strategies have to be investigated by targeting neutrophil-derived mediators (such as metalloproteinases) and disentangling the strict interplay between neutrophils and platelets. In this view, some progress has been done by using the recombinant human interleukin-1 receptor antagonist anakinra.
- Doses of radiation to the pericardium, instead of heart, are significant for survival in patients with non-small cell lung cancer. [Journal Article]
- RORadiother Oncol 2018 Nov 08
- CONCLUSIONS: PCE was associated with both heart and pericardial doses. The significance of pericardial dosimetric parameters, but not heart chamber parameters, on survival suggests the potential significance of radiation damage to the cranial region of pericardium.
- Integrating point-of-care ultrasound in the ED evaluation of patients presenting with chest pain and shortness of breath. [Journal Article]
- AJAm J Emerg Med 2018 Oct 30
- CONCLUSIONS: In evaluation of patients with CP and SOB, POCUS is a highly feasible diagnostic test which can assist in narrowing down the differential diagnoses. In patients with a normal thoracic ultrasound, the added value of a CXR may be minimal.
- Transesophageal echocardiography and fluoroscopy for percutaneous closure of atrial septal defects: A comparative study. [Journal Article]
- MMedicine (Baltimore) 2018; 97(43):e12891
- The aim of the study was to compare transesophageal echocardiography (TEE) and fluoroscopy for percutaneous atrial septal defect (ASD) closure.This was a retrospective analysis of children who underw...
The aim of the study was to compare transesophageal echocardiography (TEE) and fluoroscopy for percutaneous atrial septal defect (ASD) closure.This was a retrospective analysis of children who underwent percutaneous ASD closure. The procedure was guided by TEE without fluoroscopy in 130 patients (TEE group) and by fluoroscopy in 163 patients (fluoroscopy group). Baseline demographic/clinical characteristics were recorded. Patients were followed until hospital discharge. Outcomes were procedure duration, peri/postoperative complications, hospital stay, and costs.The TEE and fluoroscopy groups showed no significant differences in age (71.7 ± 40.7 vs 62.5 ± 38.8 months), male/female ratio (54/76 vs 66/97), weight (22.0 ± 12.0 vs 20.1 ± 9.0 kg), ASD diameter (9.9 ± 4.2 vs 9.3 ± 3.9 cm), distances to the superior vena cava (13.4 ± 4.6 vs 13.3 ± 4.2 cm), inferior vena cava (13.4 ± 4.3 vs 13.9 ± 4.1 cm) and atrial septal roof (12.1 ± 4.0 vs 12.3 ± 3.2 cm), or atrial septal size (38.2 ± 6.2 vs 39.4 ± 26.6 cm); distance to the mitral valve was greater in the TEE group (13.2 ± 4.4 vs 11.3 ± 3.9 cm; P < .001). The TEE and fluoroscopy groups showed no significant differences in occlusion device size (14.3 ± 4.6 vs 13.8 ± 4.0 cm) or sheath size (8.7 ± 1.8 vs 8.7 ± 0.9 cm), but procedure duration was shorter in the TEE group (21.5 ± 14.6 vs 28.6 ± 10.9 minutes; P < .001). Postoperative fever (>38°C) occurred less frequently in the TEE group than in the fluoroscopy group (0.8% vs 9.2%; P < .001); there were no significant differences for the other complications. No patient had postoperative residual shunt, occlusion device shedding/displacement, or pericardial effusion. The TEE group had longer hospital stay (3.2 ± 0.6 vs 2.9 ± 0.6 days; P < .001) and higher procedure cost (29,687 ± 4218 vs 28,530 ± 1668 CNY (China Yuan); P = .002) than the fluoroscopy group.TEE-guided percutaneous ASD closure can be used as an alternative to fluoroscopy-guided procedures and avoids the use of radiation or contrast agents.
- Two case reports of neonatal autoantibody-associated congenital heart block. [Journal Article]
- MMedicine (Baltimore) 2018; 97(45):e13185
- CONCLUSIONS: Autoimmune CHB is a severe, potentially life-threatening disorder associated with passive transfer of maternal anti-Sjogren's syndrome A/Ro and anti-Sjogren's syndrome B/La autoantibodies. Mothers who are positive for these autoantibodies are recommended to have serial echocardiography and obstetric ultrasonography from the early second trimester. Newborns should be delivered at an early stage of gestation if there is evidence of pericardial effusion, ascites, increasing ventricular ectopy, reduced ventricular shortening fraction, or AV valve regurgitation. Aggressive medical management after birth should be coupled with pacemaker implantation in infants who do not respond to medical therapies alone.
- Large Unilateral Pleural Effusion with Pacemaker-associated Post-cardiac Injury Syndrome. [Journal Article]
- CCureus 2018 Jul 08; 10(7):e2946
- Post-cardiac injury syndrome (PCIS) as a delayed complication of permanent pacemaker implantation has rarely been reported in the literature. A 67-year-old man who recently underwent a dual chamber p...
Post-cardiac injury syndrome (PCIS) as a delayed complication of permanent pacemaker implantation has rarely been reported in the literature. A 67-year-old man who recently underwent a dual chamber permanent pacemaker implantation came to the hospital for increasing dyspnea and chest discomfort. A diagnosis of pericarditis was made, and the patient was discharged on ibuprofen therapy. He presented to our facility a month later with worsening dyspnea and chest discomfort despite recommended therapy. A computerized tomography (CT) scan of the chest revealed a large right-sided pleural effusion, requiring chest tube placement and drainage. A pleural fluid analysis revealed exudative effusion with elevated pH. The pleural fluid analysis was negative for infectious etiology. A perforation of the atrial wall was considered given the proximity of the atrial pacer lead and overlying pericardial effusion. However, no conclusive evidence of cardiac chamber perforation was found on echocardiogram or CT scan. A pacemaker interrogation was normal. A repeat CT scan showed the resolution of pleural effusion, and the chest tube was discontinued. A possible explanation for the absence of predominant pericardial findings may be the previous use of non-steroidal anti-inflammatory therapy.
- Tetralogy of Fallot in the Current Era. [Journal Article]
- STSemin Thorac Cardiovasc Surg 2018 Nov 02
- CONCLUSIONS: Although the 15-year outcome of the transatrial-transpulmonary approach in terms of postoperative complications and mortality rates is excellent, the high incidence of moderate and severe PR is worrisome. Valve sparing surgery was associated with a substantially lower incidence of PR, yet was surgically not possible in the majority of patients.
- Right Ventricular Septal Pacing Using a Thin Lumenless Pacing Lead and Delivery System with a Deflectable Catheter. [Journal Article]
- IHInt Heart J 2018 Nov 05
- The SelectSecure™ lead system (SSLS), which is composed of a thin lumenless, active-fixation lead and a deflectable catheter, is approved for use in Japan. This study aimed to evaluate the long-term ...
The SelectSecure™ lead system (SSLS), which is composed of a thin lumenless, active-fixation lead and a deflectable catheter, is approved for use in Japan. This study aimed to evaluate the long-term clinical outcomes of right ventricular (RV) septal pacing with the SSLS along with the system's safety and electrical performance. A total of 129 patients were divided into the following 3 groups: the RV septal pacing with the SSLS group (SSP, n = 21); the RV septal pacing with the conventional lead group (Septal, n = 77); and the RV apical pacing with the conventional lead group (Apical, n = 31). All lead-related complications and pacing parameters during follow-up were compared among the groups. The clinical outcome was heart failure-associated hospitalization. The SSP and Septal groups showed significantly shorter paced QRS duration than the Apical group. During the follow-up for a mean of 49.5 ± 13.1 months, no lead-related complications occurred in any of the groups. A case of pericardial effusion occurred in the SSP group, but cardiac tamponade did not occur, and it spontaneously resolved. The ventricular pacing threshold after the follow-up period was higher in the SSP group than in the other 2 groups. There was no difference in the primary heart failure hospitalization among the 3 groups. The SSLS could be effective in producing a narrow QRS width with RV septal pacing, but its pacing threshold was higher than conventional leads in the chronic phase.
- Bedside Ultrasonography in the Management of Penetrating Cardiac Injury Caused by a Nail Gun. [Journal Article]
- JEJ Emerg Med 2018 Oct 30
- Injuries from nail guns are a unique type of penetrating trauma seen in emergency departments (EDs), rising in prevalence in the United States. These devices can lead to life-threatening injuries tha...
Injuries from nail guns are a unique type of penetrating trauma seen in emergency departments (EDs), rising in prevalence in the United States. These devices can lead to life-threatening injuries that require rapid diagnosis to help guide management.
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- Cardiac tamponade induced by dabrafenib and trametinib combination therapy for melanoma: Case report. [Journal Article]
- MMedicine (Baltimore) 2018; 97(44):e12751
- CONCLUSIONS: This is the first documented report of pericardial effusion and cardiac tamponade induced by Dabrafenib and Trametinib. Cardiac toxicity of BRAF/MEK inhibitors is rare but clinicans must monitor for treatment emergent adverse effects.