Int J Artif Organs. 2025 Jun;48(6):399-405. doi: 10.1177/03913988251346714. Epub 2025 Jun 7.
ABSTRACT
BACKGROUND: Despite veno-venous extracorporeal membrane oxygenation (VV-ECMO) support, hypoxemia may persist due to venous shunting past the ECMO circuit into diseased lungs. Heart rate (HR) control therapy in patients with elevated cardiac output (CO) is one strategy to improve the ratio of ECMO flow to CO and reduce shunting.
METHODS: This retrospective study examined VV-ECMO patients between June 2019 and June 2023 that received ⩾1 HR control agent within 10 days post-cannulation. Efficacy outcomes included trends in hemodynamics, oxygenation, and ventilator and ECMO parameters within 72 h after HR control initiation. Safety outcomes included incidence of hypotension or bradycardia requiring intervention.
RESULTS: Thirty-nine patients were included. The most common HR control strategy was initiation of esmolol infusion with transition to an oral beta-blocker after a median overlap of 6 days. Patients experienced reductions in HR and CO; however, there were no substantial changes in oxygenation parameters. Adverse events were minimal, with only two cases of hypotension requiring intervention.
CONCLUSIONS: While HR control therapy was well tolerated and effectively reduced HR, it did not seem to improve oxygenation. Larger prospective studies should be designed to ascertain the role of HR control strategies in VV-ECMO patients with elevated CO experiencing refractory hypoxemia.
PMID:40481753 | DOI:10.1177/03913988251346714
Regen Med. 2025 May;20(5):181-192. doi: 10.1080/17460751.2025.2514905. Epub 2025 Jun 6.
ABSTRACT
AIMS: To investigate whether direct electric current stimulation, when combined with chemical induction, can enhance the cardiomyogenic differentiation of mesenchymal stem cells (MSCs), offering a potential strategy for cardiac regeneration.
MATERIALS & METHODS: Bone marrow-derived MSCs were subjected to short-term microcurrent stimulation (90 seconds) using an electroporation cuvette with voltages of 1-10 V and pulse parameters of 2 ms at 0.5-2 hz. 5-azacytidine (5-aza) was added as a chemical inducer. In vitro analyses included morphological observation, immunofluorescence staining, qPCR, and flow cytometry. In vivo, pretreated MSCs were injected into a rat myocardial infarction model.
RESULTS: Electrical stimulation enhanced MSC alignment and upregulated cardiomyocyte-specific markers. Gene and protein expression analyses confirmed enhanced differentiation, especially in the combined treatment group. In vivo transplantation resulted in partial restoration of myocardial architecture, though no significant ventricular wall thickening was observed within four weeks.
CONCLUSIONS: This study introduces a dual approach combining electrical and chemical cues to promote cardiomyogenic differentiation in MSCs. The use of a simple electroporation cuvette offers a practical and accessible method, with potential translational relevance for future cardiac repair strategies.
PMID:40476836 | DOI:10.1080/17460751.2025.2514905
Rev Cardiovasc Med. 2025 May 8;26(5):28173. doi: 10.31083/RCM28173. eCollection 2025 May.
ABSTRACT
Once considered the "forgotten valve and ventricle", the tricuspid valve and right ventricle are now recognized as critical structures with significant clinical and prognostic implications. Growing evidence has highlighted that tricuspid regurgitation (TR) and right heart failure are not merely secondary phenomena that resolve following the treatment of left-sided heart disease. Instead, TR and right heart failure contribute to adverse outcomes and increased mortality if left untreated. This paradigm shift has fueled extensive clinical research, leading to a deeper understanding of the pathophysiology of TR and right ventricular (RV) dysfunction. Additionally, advancements in cardiovascular imaging have facilitated early detection, risk stratification, and innovative therapeutic approaches for TR and right heart failure. This article explores the evolving landscape of tricuspid valve disease, emphasizing the importance of early recognition and the role of emerging imaging technologies in improving patient outcomes. Thanks to progress in imaging technology, especially echocardiography, as well as cardiac magnetic resonance and cardiac computer tomography, enhanced studies can be conducted on the tricuspid valve pathology to delineate the various mechanisms involved in TR and RV dysfunction and offer patients a tailored medical, as well as surgical and transcatheter therapies. These unparalleled technological advances would not be possible without the hard work of physicians, scientists, surgeons, interventional cardiologists, and echocardiographers worldwide, despite the many challenges they experience daily and in every procedure. Many patients with TR present at an advanced stage of disease progression, often with severe regurgitation and clinical manifestations associated with poor outcomes. Additionally, a significant proportion of these patients have either undergone previous open-heart surgery for left-sided valvular disease or are considered high-risk surgical candidates due to multiple comorbid conditions. In recent years, transcatheter therapy has emerged as a viable alternative for this high-risk population, offering a less invasive option for those previously deemed "inoperable". This breakthrough has transformed the therapeutic landscape for valvular heart disease, particularly for TR, providing new hope and improved outcomes for patients who were once left with limited treatment options.
PMID:40475749 | PMC:PMC12135663 | DOI:10.31083/RCM28173
Prehosp Emerg Care. 2025 Jun 23:1-6. doi: 10.1080/10903127.2025.2517154. Online ahead of print.
ABSTRACT
This case report highlights the importance of prehospital point-of-care ultrasound (POCUS) when acute aortic dissection is suspected. At 2:09 pm the local emergency medical services (EMS) received a call from a small town in Lombardy, Italy, reporting that a 54-years-old man had collapsed while lifting weights in a fitness club. Response teams found him lying on the floor, fully responsive and very pale; he was a lean man, with no allergies, no home therapy and no significant past medical history. He had had a transient facial paralysis and complained of dizziness and mild chest discomfort. During physical examination he became suddenly hypotensive (60/30 mmHg). The electrocardiogram showed a sinus rhythm, 80 beats per minute (bpm) and unaltered T wave and ST segment. The POCUS showed a dilated aortic root with intimal flap and small pericardial effusion. A diagnosis of Type A acute aortic dissection was made on the spot. The EMS dispatch center identified the closest hospital with available cardiothoracic surgery and provided a full report of the patient's condition, diagnosis and initial treatment. At 3:10 pm, the patient entered the emergency room and a rapid transthoracic ultrasound confirming the diagnosis was performed in the presence of the cardiac anesthetist and cardiothoracic surgeon. The patient was agitated, tachycardic (110 bpm) and hypotensive (50/30 mmHg). Upon stabilization with intravenous norepinephrine and fluids, a computed tomographic angiogram was performed demonstrating a Stanford Type A aortic dissection with intimal flap starting from the bulb/valvular plane and extending to the origin of supra-aortic trunks down to the left common iliac artery. At 4.00 pm the patient was ready for surgery; he underwent successful ascending aorta replacement with a regular postoperative course and no signs of neurological damage. On post-operative day eight he was referred to an inpatient cardiac rehabilitation facility and later discharged home. At prehospital level, POCUS is feasible and may provide key diagnostic findings in some threatening medical (non-trauma-related) conditions that are normally diagnosticated only once the patient has reached the hospital. In addition, this report highlights a perfect interaction between out-of-hospital medical personnel, dispatch center and in-hospital multidisciplinary health staff.
PMID:40472335 | DOI:10.1080/10903127.2025.2517154
Eur Heart J. 2025 Jun 5:ehaf363. doi: 10.1093/eurheartj/ehaf363. Online ahead of print.
NO ABSTRACT
PMID:40471673 | DOI:10.1093/eurheartj/ehaf363
J Am Heart Assoc. 2025 Jun 17;14(12):e040150. doi: 10.1161/JAHA.124.040150. Epub 2025 Jun 5.
ABSTRACT
BACKGROUND: Multiple valvular heart disease correlates with poor outcomes following transcatheter aortic valve replacement. Previous studies have focused on mitral regurgitation (MR) or tricuspid regurgitation (TR) individually, without comparing their long-term effects. The impact of staged transcatheter edge-to-edge repair (TEER) remains unclear. We aimed to assess the prevalence and effects of severe multiple valvular heart disease (sMVHD) and evaluate the impact of staged TEER on outcomes.
METHODS: Patients were recruited from 4 transcatheter aortic valve replacement centers. The primary cohort included 2823 patients to evaluate the prevalence of sMVHD. All patients were screened for additional valvular interventions; those undergoing TEER for severe MR (n=147) or TR (n=59) were included.
RESULTS: Concomitant sMVHD was observed in 369 patients, with 208 having severe MR and 161 having severe TR. The 1-year mortality rate was higher in patients with sMVHD compared with the overall cohort (9.0 versus 5.2 per 100 person-years; P<0.01). Severe TR was associated with the highest 1-year mortality rate, followed by severe MR and no or mild multiple valvular heart disease (13.3 versus 6.4 versus 3.9 per 100 person-years; P<0.01). This difference persisted over 5 years (P<0.01). Patients undergoing staged TEER showed a reduced 1-year mortality rate compared with conservative management (4.1 versus 12.1 per 100 person-years; P<0.001). This trend continued over 5 years (P<0.001). Severe TR was independently associated with an increased mortality rate (hazard ratio, 1.79 [95% CI, 1.17-2.74]; P<0.01).
CONCLUSIONS: Persistent sMVHD was associated with an increased mortality rate following transcatheter aortic valve replacement, with severe TR posing a higher risk than severe MR. Staged TEER was associated with improved outcomes and warrants consideration in sMVHD.
PMID:40470661 | DOI:10.1161/JAHA.124.040150
Cureus. 2025 Jun 4;17(6):e85315. doi: 10.7759/cureus.85315. eCollection 2025 Jun.
ABSTRACT
Perioperative cardiogenic shock can be fatal, and assisted circulation with an Impella percutaneous ventricular support pump catheter (Abiomed, Danvers, MA, USA) is useful in patients with severely compromised cardiac function. However, we report a case in which an Impella implanted preoperatively deepened its position during off-pump coronary artery bypass grafting decannulation. This change in position caused the Impella to interfere with the posterior mitral valve leaflet and led to severe mitral regurgitation and difficulty with intraoperative circulatory control. In patients without significant left ventricular enlargement, the heart team should discuss the risk of interference with the mitral valve and inhalation failure during decannulation. In such cases, other forms of assisted circulation, such as intra-aortic balloon pumping or cardiopulmonary bypass, should be considered.
PMID:40469888 | PMC:PMC12134815 | DOI:10.7759/cureus.85315
Emerg Med Australas. 2025 Jun;37(3):e70073. doi: 10.1111/1742-6723.70073.
ABSTRACT
Extracorporeal cardiopulmonary resuscitation (ECPR) is a time-critical, resource-intensive intervention used in select cases of refractory cardiac arrest. Its success depends on rapid initiation, streamlined workflows, and coordination across multidisciplinary teams. This article outlines the phases of ECPR, key resuscitation modifications, and inclusion criteria. It also provides practical guidance on equipment, personnel roles, environmental setup, and post-initiation priorities.
PMID:40468856 | DOI:10.1111/1742-6723.70073
J Med Case Rep. 2025 Jun 4;19(1):265. doi: 10.1186/s13256-025-05292-1.
ABSTRACT
BACKGROUND: Mitral blood cyst with atrial septal aneurysm is a unique instance of rare occurrence in medical literature. It is crucial for the discipline of cardiology to address the special difficulties that come with diagnosing and treating these two diseases together. The goal of this case report is to provide a comprehensive overview of the clinical presentation, diagnostic challenges, and treatment strategies for this uncommon cardiac disease in a resource-limited setting.
CASE PRESENTATION: This is a case involving a 50-year-old Ethiopian female patient referred to our hospital for cardiac evaluation. She presented with intermittent palpitation to a nearby health center, which was diagnosed as rheumatic heart disease, for which she was on intramuscular benzathine penicillin injection on a monthly basis. Otherwise, she had no history suggestive of acute rheumatic fever and no chest pain, body swelling, orthopnea, or paroxysmal nocturnal dyspnea, historically or on current presentation. Evaluations revealed that her chest was clear and resonant with good air entry, and flat jugular venous pressure, but she had a grade III pansystolic murmur best heard at the apex that radiates to the left axilla. No other pertinent physical examination findings were discovered. Echocardiographic evaluation revealed a tiny cyst at the apex of posterior mitral valve leaflet with interatrial septal bulging into the right atrium.
CONCLUSION: Cardiac blood cysts are an uncommon congenital cardiac condition that can lead to stroke and other potentially fatal consequences, especially if they are situated on the mitral valve. With improved specialists and low-risk procedures, surgical removal is advised. Given the patient's state, a proper diagnosis was therefore essential to provide her with accessible management options in this setting while she waits for a definitive surgical treatment in case the need arises.
PMID:40468408 | PMC:PMC12139344 | DOI:10.1186/s13256-025-05292-1
J Cardiothorac Surg. 2025 Jun 4;20(1):259. doi: 10.1186/s13019-025-03493-9.
ABSTRACT
BACKGROUND: There is no solid evidence on the clinical benefits of blood cardioplegia or Custodiol™ in procedures other than coronary artery bypass grafting. We aimed to compare mortality and the risk of major cardiovascular events in patients undergoing valve or aortic surgery.
METHODS: This retrospective single-center study included patients who underwent valve or ascending aortic surgery between 2016 and 2024. The sample was divided based on the type of cardioplegia for myocardial protection: Custodiol™ or blood cardioplegia. The comparison of outcomes between the two groups was adjusted using propensity score.
RESULTS: 2909 patients were included, with 1426 (49%) receiving Custodiol™. In a propensity score-matched analysis that included 930 pairs, we observed higher perioperative mortality in the blood cardioplegia group (5.3% vs. 2.9%, p = 0.014) and worse long-term survival (p = 0.004). In an IPTW analysis, we confirmed significant differences in favor of Custodiol™ for early mortality (-2.2%, 95% CI -4; -0.4), long-term mortality (2.6 years, 95% CI 2.1; 3.2), and renal failure (-4.7%, 95% CI -7.9; -1.6), and low cardiac output syndrome requiring mechanical circulatory support (-2.2%, 95% CI -3.6;-0.9), but a higher siks of postoperative denovo atrial fibrillation (6.8%, 95% CI 2.5;11).
CONCLUSIONS: In this retrospective study including patients undergoing on-pump valve and aortic surgery, Custodiol™ compared to blood cardioplegia was associated with lower short- and medium-term mortality, although no robust evidence was found for differences in other clinical events.
PMID:40468334 | PMC:PMC12135263 | DOI:10.1186/s13019-025-03493-9
Curr Cardiol Rev. 2025 Jun 3. doi: 10.2174/011573403X353597250515051547. Online ahead of print.
ABSTRACT
INTRODUCTION: This study aimed to assess the association of renal impairment (RI) severity on short and mid-term outcomes in patients undergoing cardiac surgery for infective endocarditis (IE).
METHODS: Patients undergoing cardiac surgery for IE between January 2010 and October 2022 were included. They were stratified based on preoperative renal function into four groups: Normal (N: Creatinine clearance (CrCl) >85mL/min), moderate RI (M: CrCl 51-85mL/min), severe RI (S: CrCl ≤50mL/min), and haemodialysis-dependent (H). Each group was compared with group N. Survival analysis was performed using Kaplan-Meier curves.
RESULTS: A total of 487 patients (N: 198; M: 154; S: 96; H: 39) were included. Mean age 55.92 ± 14.60 years, 375 (77%) males. Groups M, S, and H vs N demonstrated more atrial fibrillation [17 (11.0%), 20 (20.8%), 6 (15.4%) vs 8 (4.0%); p<0.05]. Groups S and H vs. N had increased incidence of left ventricular ejection fraction <50% [43 (44.8%), 22 (56.4%) vs 43 (21.7%); p<0.001] and preoperative cardiogenic shock [16 (16.7%), 13 (33.3%) vs 9 (4.5%); p<0.001]. The need for postoperative haemodialysis was 21 (13.6%) in M and 23 (23.0%) in S vs. 13 (6.6%) in N (p<0.05). In-hospital mortality was 13 (8.4%), 21 (21.9%), and 11 (28.2%) vs. 12 (6.1%) (p=0.388, <0.001, <0.001), and mortality at a mean of 69.1months was 49 (31.8%), 46 (46.9%), 30 (76.9%) vs. 49 (24.7%) (p=0.142, <0.001, <0.001) in groups M, S, H vs. N, respectively.
CONCLUSIONS: The incidence of renal impairment in patients with IE undergoing surgery remains high. Early and mid-term outcomes of those with severe RI and haemodialysis dependence are significantly worse.
PMID:40464179 | DOI:10.2174/011573403X353597250515051547
Open Forum Infect Dis. 2025 May 12;12(6):ofaf287. doi: 10.1093/ofid/ofaf287. eCollection 2025 Jun.
ABSTRACT
BACKGROUND: The 2023 Duke-International Society for Cardiovascular Infectious Diseases (ISCVID) guideline included Enterococcus faecalis as a typical infective endocarditis (IE) organism irrespective of the primary source and setting of infection. Universal echocardiogram for E. faecalis bacteremia is resource-intensive. Our aim was to develop a risk score that can be applied at the time of bacteremia.
METHODS: We conducted a retrospective cohort study utilizing a territory-wide electronic database and included all inpatients (age ≥18) between 2009 and 2019 who had at least 1 blood culture positive for E. faecalis. A multistep machine learning algorithm was employed to generate the risk score.
RESULTS: A total of 2535 distinct E. faecalis bacteremia episodes were analyzed. The percentage of IE was 3.39% (86/2535). The Machine Learning-derived Enterococcus faecalis Infective Endocarditis Risk (MEFIER) score was developed based on history of valvular heart disease (28 points), history of congenital heart disease (14 points), presence of cardiac implantable electronic device (12 points), age (≥18 to <43 years: 3 points; ≥43 to <65 years: 6 points), male gender (2 points), community onset (11 points), and abnormal levels of hemoglobin (16 points), albumin (3 points), and platelets (1 point). With a threshold of ≥32 indicating high risk for IE, the MEFIER score demonstrated an area under the receiver operating characteristic curve of 0.79 (95% CI, 0.72-0.88) and a negative predictive value of 0.98 (95% CI, 0.97-0.99).
CONCLUSIONS: The MEFIER score is a unique tool to stratify IE patients with E. faecalis bacteremia, boasting a negative predictive value of 98%, to guide use of echocardiography in these patients.
PMID:40463831 | PMC:PMC12131156 | DOI:10.1093/ofid/ofaf287
Lung. 2025 Jun 4;203(1):68. doi: 10.1007/s00408-025-00822-6.
ABSTRACT
Poor or worsening functional status of lung transplant (LTx) candidates is a key risk factor for waitlist and post-transplant mortality. As more critically ill adults and children are listed for LTx, the use of extracorporeal membrane oxygenation (ECMO) as bridge to LTx is also increasing. Sustaining optimal functional status while on the waitlist to LTx is crucial for LTx candidates as deterioration in functional status can negatively impact pre- and post-LTx outcomes. We conducted an analysis of the United Network for Organ Sharing Registry which showed that most patients (70%) on ECMO successfully bridged to LTx. The majority had severely limited functional status at the time of waitlisting but 96% of adults requiring ECMO on the waitlist for LTx either maintained or improved functional status from the time of waitlist to the time of LTx while all children on ECMO maintained or improved their functional status. With continuing medical and technical advances, the use of ECMO may also evolve to improve LTx candidates' functional status.
PMID:40467879 | DOI:10.1007/s00408-025-00822-6
Braz J Cardiovasc Surg. 2025 Jun 4;40(4):e20240237. doi: 10.21470/1678-9741-2024-0237.
ABSTRACT
OBJECTIVE: A variety of cardioplegia techniques with different components are implemented to ensure myocardial protection, in addition to keeping the operationa field immobile and free of blood during cardiac surgery. The implemented cardioplegia has unwanted negative effects on other end organs. In this study, our aim was to compare the effects of Del Nido cardioplegia and blood cardioplegia solutions on postoperative intensive care duration, drainage, and renal functions for patients undergoing cardiopulmonary bypass and bypass graft operations.
METHODS: Selections were made from patients undergoing elective bypass graft operations in our clinic from January 1, 2022 to December 31, 2023. Patients were randomly selected, retrospectively assessed, and divided into two groups - De Nido group (Group 1) and blood cardioplegia group (Group 2). Comparisons were made between these groups in terms of intensive care duration, drainage, and renal functions.
RESULTS: The study included 120 patients. The Del Nido cardioplegia group included 60 patients, with 60 patients in the blood cardioplegia group. Comparisons between the groups found that the aortic cross-clamping duration was significantly high in Group 1 (P = 0.014). The noradrenaline dose given to Group 1 was high (P = 0.004). In terms of renal injury, significant degree of elevation was present in Group 1 (P = 0.027). The longer aortic cross-clamping duration in Group 1 may be assessed as a determinant factor for noradrenaline dose and acute kidney injury.
CONCLUSION: This study concluded that it willbe appropriate to choose the cardioplegia method by performing broader meta-analysis studies and minimizing limiting factors.
PMID:40464404 | PMC:PMC12135678 | DOI:10.21470/1678-9741-2024-0237
Int J Pharm. 2025 Jun 1;681:125786. doi: 10.1016/j.ijpharm.2025.125786. Online ahead of print.
ABSTRACT
Myocardial Infarction (MI) is still a leading cause of mortality, and current treatments primarily focus on symptom alleviation and blood flow restoration, with limited capacity for myocardial repair. Exosomes, key mediators of intercellular communication, have demonstrated potential to promote myocardial regeneration but exhibit limited cardiac-targeting efficiency due to rapid accumulation in other organs. To overcome this limitation, we designed targeted nanobubbles (TNBCD81-cRGD) loaded with exosomes derived from adipose-derived stem cells (ADSCs) in this study. These ADSCs were genetically modified through viral transfection to secrete exosomes with high expression of stromal cell-derived factor 1α (SDF-1α), which was upregulated in the infarcted region and promotes stem cell homing via the SDF-1α-CXCR4 axis. The nanobubbles, modified with anti-CD81 antibodies and cRGD, enabled efficient targeting of ischemic myocardium under Low-Intensity Pulsed Ultrasound (LIPUS) irradiation. Our study demonstrated that the combination of targeted nanobubbles, ADSC-derived exosomes with high SDF-1α expression, and LIPUS irradiation enhanced exosome retention in the heart, improved therapeutic efficacy, and promoted myocardial repair. This approach holds potential for advancing exosome-based therapies in myocardial infarction treatment.
PMID:40460966 | DOI:10.1016/j.ijpharm.2025.125786
Cell Prolif. 2025 Jun 3:e70070. doi: 10.1111/cpr.70070. Online ahead of print.
ABSTRACT
Metabolic disorders could cause dysregulated glucose and lipid at the systemic level, but how inter-tissue/organ communications contribute to glucolipotoxicity is difficult to dissect in animal models. To solve this problem, myocardium and nerve tissues were modelled by 3D engineered heart tissues (EHTs) and neural organoids (NOs), which were co-cultured in a generalised medium with normal or elevated glucose/fatty acid contents. Morphology, gene expression, cell death and functional assessments detected no apparent alterations of EHTs and NOs in co-culture under normal conditions. By contrast, NOs significantly ameliorated glucolipotoxicity in EHTs. Transcriptomic and protein secretion assays identified the extracellular matrix protein versican as a key molecule that was transferred from NOs into EHTs in the high-glucose/fatty acid condition. Recombinant versican protein treatment was sufficient to reduce glucolipotoxicity in EHTs. Adeno-associated virus-delivered versican overexpression was sufficient to ameliorate cardiac dysfunction in a murine model of diabetic cardiomyopathy. These data provide the proof-of-concept evidence that inter-tissue/organ communications exist in the co-culture of engineered tissues and organoids, which could be systemically studied to explore potential pathological mechanisms and therapeutic strategies for multi-organ diseases in vitro.
PMID:40459298 | DOI:10.1111/cpr.70070
Bioact Mater. 2025 May 2;50:585-602. doi: 10.1016/j.bioactmat.2025.04.017. eCollection 2025 Aug.
ABSTRACT
It remains a significant challenge to reactivate the cell cycle activity of adult mammalian cardiomyocytes (CMs). This study created a hypo-immunogenic human induced pluripotent stem cell (hiPSC) line using clustered regularly interspaced palindromic repeats (CRISPR)/Cas9 gene editing to knockout β2-microglobulin in hiPSCs (B2MKOhiPSCs) for manufacturing nanovesicles (B2MKOhiPSC-NVs). Approximately 9500 B2MKOhiPSC-NVs were produced from a single B2MKOhiPSC. Proteomic analyses indicated that, compared to B2MKOhiPSCs, the cargos of B2MKOhiPSC-NVs were enriched in spindle and chromosomal proteins, as well as proteins that regulate the cell cycle and scavenge reactive oxygen species (ROS). When administrated to hiPSCs derived CMs (hiPSC-CMs), B2MKOhiPSC-NVs reduced lactate dehydrogenase leakage and apoptosis in hypoxia-cultured hiPSC-CMs through activating the AKT pathway, protected hiPSC-CMs from H2O2-induced damage by ROS scavengers in the NV cargo, increased hiPSC-CM proliferation via the YAP pathway, and were hypoimmunogenic when co-cultured with human CD8+ T cells or delivered to mice. Furthermore, when B2MKOhiPSC-NVs or 0.9 % NaCl were intramyocardially injected into mice after cardiac ischemia/reperfusion injury, cardiac function and infarct size, assessed 4 weeks later, were significantly improved in the B2MKOhiPSC-NV group, with increased mouse CM survival and cell cycle activity. Thus, the proteins in the B2MKOhiPSC-NV cargos convergently activated the AKT pathway, scavenged ROS to protect CMs, and upregulated YAP signaling to induce CM cell cycle activity. Thus, B2MKOhiPSC-NVs hold great potential for cardiac protection and regeneration.
PMID:40453695 | PMC:PMC12124652 | DOI:10.1016/j.bioactmat.2025.04.017
J Tehran Heart Cent. 2024 Oct;19(4):283-288. doi: 10.18502/jthc.v19i4.17615.
ABSTRACT
Mixed atrial septal defects (ASDs) involving inferior vena cava (IVC)-type sinus venosus and secundum types and mixed partial anomalous pulmonary, systemic, and hepatic venous drainage are rare. We describe a 3-year-old acyanotic boy who presented with a large mixed inferior sinus venosus and secundum-type ASD. He exhibited an abnormal connection between the right upper pulmonary vein and the right atrium. Additionally, the IVC and a hepatic vein drained abnormally into the left atrium. The patient also had valvular and supravalvular pulmonary stenosis, as well as a small patent ductus arteriosus. The ASD was surgically closed using a pericardial patch, positioned lower than usual to reroute the IVC and hepatic vein flow into the right atrium. The surgery was successful, with no residual lesions or complications. The patient recovered without issues and was discharged smoothly. At the 6-month follow-up, the child's cardiac examination and oxygen saturation were normal. Furthermore, echocardiography confirmed normal drainage of the systemic and hepatic veins into the right atrium.
PMID:40454352 | PMC:PMC12126196 | DOI:10.18502/jthc.v19i4.17615
Catheter Cardiovasc Interv. 2025 Jun 2. doi: 10.1002/ccd.31579. Online ahead of print.
ABSTRACT
BACKGROUND: Behcet's, a systemic autoimmune vasculitis, often leads to cardiovascular complications sunch as valvular damage and aortic root pseudoaneurysms. Concurrent involvement of all four cardiac valves is exceptionally rare, posing significant surgical challenges due to tissue fraagility, inflammatory destruction, and high reoperation risks.
OBJECTIVE: To describe a tailored surgical strategy for quadruple replacement in a Behcet's syndrome patient with extensive valvular lesions, aortic root pseudoaneurysm, and prior mechanical valve failure, emphasizing techniques to address anatomical complexity and enable future transcatheter interventions.
METHODS: A 51-year-old female with Behcet's syndrome and prior aortic/pulmonary valve replacements underwent reoperation for aortic root pseudoaneurysm, paravalvular leaks, severe mitral/tricuspid regurgitation, and pulmonary valve thrombosis. Key techniques include three parts, firstly, radical debridement of necrotic tissue and annular enlargement (aortic: 20-25mm; mitral: 25-29mm). Second, modified "chimney" Commando-Bentall hybrid procedure with a tongue-shaped vascular path to reconstruct the aorto-mitral curtain and reinforce the aortic root. Third, "Sandwich" technique for aortic root reconstruction to minimize paravalvular leakage.
RESULTS: The surgery was successful, with uneventful recovery and discharge on postoperative day 30. Six-month follow-up confirmed patient survival, stable valve function, and no recurrent leaks. Dual annular enlargement facilitated larger protheses, reducing patient-prothesis mismatch and preserving options for future transcatheter valve im plantation (TAVI).
CONCLUSIONS: This cases highlights the feasibility of combining annular enlargement, root reinforcement, and bioprosthetic valve replacement in Behcet's syndrome with pan-valvular involvement. The hybrid chimney-Bentall technique and meticulous root reconstruction address inflammatory tissue vulnerability while enabling future minimally invasive interventions. This approach optimizes immediate outcomes and long-term durability in complex autoimmune-associated valvulopathies.
PMID:40452468 | DOI:10.1002/ccd.31579
Lancet Respir Med. 2025 May 30:S2213-2600(25)00122-5. doi: 10.1016/S2213-2600(25)00122-5. Online ahead of print.
ABSTRACT
When conventional cardiopulmonary resuscitation (CCPR) cannot restore spontaneous circulation, the initiation of venoarterial extracorporeal membrane oxygenation during refractory cardiac arrest-known as extracorporeal CPR (ECPR)-might restore circulation and adequate tissue oxygenation. ECPR could substantially improve survival with favourable functional recovery. However, the complexity and time-sensitive nature of the intervention, high costs, resource demands, considerable risks, and complications restrict the availability of ECPR. Patient age and comorbidities, timely and effective CCPR, and time-to-ECPR are major contributors to the outcome of patients. The primary goal of ECPR is full recovery of the patient, but in some cases, transition to a long-term ventricular assist device or heart transplantation can be additional options for survival. In patients diagnosed with brain death or, according to local regulation, in those with irreversible post-anoxic brain damage, organ donation is possible after ECPR. Ongoing research aims to assess the efficacy of ECPR versus continued CCPR and uncover key prognostic indicators.
PMID:40456239 | DOI:10.1016/S2213-2600(25)00122-5