Tohru Takaseya

Obstruction of St. Jude Medical Valves in the Aortic Position: Plasma Transforming Growth Factor Type Beta 1 in Patients With Pannus Overgrowth

The study investigated the hypothesis that plasma transforming growth factor type beta 1 (TGF-beta1) initiated pannus overgrowth in cases with aortic prosthetic valve dysfunction (PVD). Patients with obstruction of an aortic St. Jude Medical valve in 26 cases (PVD group) and without obstruction in 48 cases (control group) were studied. Plasma TGF-beta1, the intensity of the prothrombin time-international normalized ratio (PT-INR), and the interruption of an oral anticoagulant medicine were conducted. Plasma TGF-beta1 levels in the PVD group (87.7 +/- 29.2 ng/mL) were significantly higher (P < 0.05) than in the control group (73.7 +/- 25.2 ng/mL). The interruption of an oral anticoagulant medicine in 54% of the PVD group versus 12% of the control group was identified (P < 0.001). The mean value of the PT-INR in the PVD group (1.75 +/- 0.30) and control group (1.75 +/- 0.30) was not significantly different (P = 0.82). In conclusion, elevated levels of plasma TGF-beta1 may play a role in pannus overgrowth.

Antiinflammatory effects of colforsin daropate hydrochloride, a novel water-soluble forskolin derivative

BACKGROUNDnTo evaluate the effects of colforsin daropate hydrochloride (colforsin), a water-soluble forskolin derivative, on hemodynamics and systemic inflammatory response after cardiopulmonary bypass, we conducted a prospective randomized study.nnnMETHODSnTwenty-nine patients undergoing coronary artery bypass grafting were randomized to receive either colforsin treatment (colforsin; n = 14) or no colforsin treatment (control; n = 15). Administration of colforsin (0.5 microg.kg(-1).min(-1)) was started after induction of anesthesia and was continued for 6 hours. Perioperative cytokine and cyclic adenosine monophosphate levels, hemodynamics, and respiratory function were measured serially.nnnRESULTSnMarked positive inotropic and vasodilatory effects were observed in patients receiving colforsin. Interleukin 1beta, interleukin 6, and interleukin 8 levels after cardiopulmonary bypass were significantly (p < 0.05) lower in the colforsin group. Plasma levels of cyclic adenosine monophosphate increased significantly (p < 0.05) in the colforsin group, and the levels correlated inversely (r = -0.56, p = 0.002) with the respiratory index after cardiopulmonary bypass.nnnCONCLUSIONSnIntraoperative administration of colforsin daropate hydrochloride had potent inotropic and vasodilatory activity and attenuated cytokine production and respiratory dysfunction after cardiopulmonary bypass. The results indicate that the technique can be a novel therapeutic strategy for the systemic inflammatory response associated with cardiopulmonary bypass.

Inflammatory activity of degenerated Freestyle valve 17 years after ROSS procedure

The Ross operation provides favorable earlyto mid-term clinical results, such as excellent durability, hemodynamic performance, and survival. However, little is known about the long-term morphological, pathological, and molecular changes. A 74-year-male admitted to our hospital for exertional dyspnea, who had undergone the ROSS procedure for aortic regurgitation at the age of 57. The right ventricular outflow tract (RVOT) was reconstructed with a porcine valved conduit, Medtronic Freestyle valve (27 mm). During 17 years after the procedure, the patient received radiofrequency catheter ablation for atrial tachycardia at the age of 70 and 72. Trans-thoracic echocardiography revealed the enlargement of rightsided chamber size with pulmonary stenosis and severe tricuspid regurgitation of trans-pulmonary artery valve peak velocity of 3.3 m/s, suggesting a structural deterioration of the Freestyle valve. Computed tomographic angiography (CTA) showed eccentrically thickened wall and cusp calcification at the Freestyle valve (Figure 1A, white arrows). 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) combined with CTA demonstrated the intense FDG uptake in the thickened wall and prosthetic valve leaflets (Figure 1A, red arrows), suggesting the inflammatory reaction of the Medtronic Freestyle valve. Therefore, we decided to reconstruct the RVOT with a new Medtronic Freestyle valve (27 mm). No pannus, tear or prolapse, but marked tissue degeneration, was observed on the porcine cusps. Histological examination of the resected Freestyle valve using immunohistochemical analysis with CD68 antibody revealed magnitude of inflammation in the valvular leaflet and root corresponded to FDG uptake (Figure 1B). As presented in the patient, inflammatory mechanism may be involved in the structural valve degeneration of bioprosthesis. FDG-PET/CT, which is able to detect inflammatory activity, may be a useful modality to monitor prosthetic valve failure noninvasively.