Aims: We herein report the case of a patient with severe aortic stenosis and a single coronary artery arising from the right sinus of valsalva, who successfully underwent transcatheter aortic valve implantation (TAVI).
Case Presentation: A 86-year-old Caucasian woman was admitted with acute coronary syndrome. Coronary angiography and transthoracic echocardiography revealed the coexistence of single coronary artery and severe aortic stenosis. The patient underwent successful TAVI with Edwards SAPIEN XT valve.
Discussion: Single coronary artery is a rare congenital coronary artery anomaly. Its coexistence with severe aortic stenosis in the context of acute coronary syndrome is even rarer. Knowledge is scarce about feasibility and safety of TAVI in patients with coronary artery anomalies. This procedure is associated with a very low incidence of coronary obstruction, a catastrophic complication in the setting of a single coronary ostium.
Conclusion: This case highlights that TAVI can be safely performed in carefully selected patients with single coronary artery.
A 49-year-old woman has had several episodes of syncope with pallor and diaphoresis since she was 13 years old. She had been diagnosed with rheumatic heart disease and was submitted to mitral and aortic valve replacement for mechanical prosthesis. She was submitted to a tilt table test with presyncope at the 2nd min, progressing to loss of consciousness and bradyarrhythmia followed by asystole. Due to persistent, asystole atropine was administered unsuccessfully. She underwent cardiac massage with recovery to sinus rhythm after 61.5 seconds, without sequelae. After about 2 h, when blood was collected for examination, she presented a new episode of consciousness loss with asystole and prompt response to heart massage. She was submitted to the implant of a dual chamber pacemaker. After a 36-month follow-up, she has not had any new episode of syncope.
Aims: This study was to evaluate cardioprotective effects of extracts of stem barks from Trichilia emetica against cardiotoxicity induced by doxorubicin.
Methodology: This experiment was performed as follows: Group I receives some distilled water; group II receives doxorubicin only. Group III was administered 25 mg/kg b. w. of resveratrol only; Group IV received 25 mg/kg b. w. of resveratrol + doxorubicin. The groups V, VI, VII and VIII received respectively, 100 mg/kg b. w. of ethanolic extract + doxorubicin, 100 mg/kg b. w. of aqueous extract + doxorubicin, 200 mg/kg b. w. of ethanol extract + doxorubicin and 200 mg/kg b. w. of aqueous extract + doxorubicin. The other groups IX, X, XI and XII also received 100 mg/kg b. w. of aqueous extract, 200 mg/kg b. w. of aqueous extract, 100 mg/kg b. w. of ethanol extract and 200 mg/kg b. w. of ethanolic extract respectively. Distilled water, resveratrol and extracts were administered orally for 14 consecutive days. Doxorubicin was administered only on the 13th day by intraperitoneal route. 48 hours after administration of doxorubicin, blood samples were collected for biochemical analyzes: CK-MB, CPK, LDH, transaminases and lipid profile.
Results: Doxorubicin treated rats showed a significant (P˂0.05) increased in activity of creatinine kinase-MB (CK-MB), creatinine phosphokinase (CPK), lactate deshydrogenase (LDH), aspartate aminotransferase (AST), alanine aminotransferase (ALT), triglycerides, total-cholesterol and LDL-cholesterol compared to the control group. The results showed a significant decrease in HDL-cholesterol in comparison with the control group. However, pretreatment of rats with the extracts induced a significant decrease of the same enzymes, Total- Cholesterol, LDL- Cholesterol, triglycerides but also by a significant increase in HDL-cholesterol relative to the group of doxorubicin.
Conclusion: The results suggest that extracts of stem barks from Trichilia emetica possess cardioprotective effect.
Aims: The aim of this study was to detect the abnormalities of left atrial (LA)-left ventricular (LV) coupling using two-dimensional speckle tracking echocardiography in patient with preserved LV ejection fraction.
Methods: A total of 177 asymptomatic patients with preserved LV ejection fraction were studied. Global LV longitudinal peak strain (GLS) and peak LA longitudinal strain during systole (PALS) were measured. The ratio of E/Ea to PALS was used as an index of LA stiffness.
Results: The patients were classified into 2 groups according to the GLS: impaired group (n=81; GLS>-18%) and normal group (n=96; GLS≤-18%). Both GLS and PALS were reduced in the impaired group (p<0.001). LA stiffness was increased in the impaired group (p<0.05). In the normal group, there was no significant correlation between GLS and LA volume index. There was no significant correlation between GLS and LA stiffness. In the impaired group, GLS significantly correlated with correlated with the LA stiffness (r=0.50, p<0.001). Similarly, GLS significantly correlated with LA volume index (r=0.36, p<0.001).
Conclusions: In patients with preserved longitudinal LV systolic function, LA structure and function are preserved. However, LA structure and function are rapidly impaired in patients with reduced longitudinal LV systolic function. LV longitudinal systolic dysfunction may cause the LA wall to become stiffer rapidly.
Aims: Study the role of C-peptide in development of atherosclerosis in late stages of type 2 diabetes in rats.
Methodology: Late stages of type II diabetes were induced by administeration of high fat diet and intraperitoneal injection of a single dose of streptozotocin 35 mg/kg, then rats were divided into 5 groups: 1) control, 2) Diabetic (DM), 3) Diabetic + C-peptide, 4) Diabetic + L-NAME, and 5) Diabetic + C-peptide + L-NAME.
Measurements: At the end of the experiment blood samples were taken for measurement of serum glucose and insulin levels. The arch of the aorta was taken for: Histopathological study and measurement of tissue lipid peroxides (MDA), Bcl-2 (B-cell lymphoma protein 2, apoptotic factor), nitric oxide (NO) and tumor necrosis factor-α (TNF-α).
Results: Aorta of diabetic rats showed severe atherosclerotic changes, and there were significant increase in serum glucose, tissue MDA, and TNF-α alongside there were significant decrease in serum insulin, tissue NO and Bcl-2 as compared to control group. Significant improvement in atherosclerotic changes were observed in Diabetic + C-peptide group which was accompanied with significant decrease in serum glucose, tissue MDA, and TNF-α. There were also significant increase in serum insulin and tissue NO and Bcl-2 as compared to DM group. In DM + L-NAME group, there were severe deterioration of atherosclerotic changes, and there were significant increase in serum glucose, tissue MDA, and TNF-α alongside significant decrease in serum insulin, tissue NO and Bcl-2 as compared to DM group. Although adding L-NAME to DM + C-peptide group abolished increasing in serum insulin level but improvement in atherosclerotic changes and other parameters were still present.
Conclusion: C-peptide has a protective effect against development of atherosclerosis through many mechanisms including hypoglycemic, antioxidant, antiapoptotic, and anti-inflammatory effects. So administration of C-peptide as an adjuvant therapy in late stages of type II diabetes can significantly decrease incidence of vasculopathy.
