Search

Indications for transcatheter valve implantation have been extended to treat native valve aortic regurgitation in case of disproportionate risk for open surgery. Transcatheter aortic valves are also an attractive alternative in patients who refuse blood transfusions. We report the successful off-label implantation of a self-expandable transcatheter valve in a Jehovah's Witness with prior replacement of the ascending aorta for Type A dissection, residual severe aortic regurgitation and refractory heart failure.

Objective: Post-infarction ventricular remodelling has been graded (I—III) according to the loss of systolic left ventricular silhouette curvaturechanges.Althoughsurgicalventricularrestoration(SVR)hasbeenextendedtotypeIIIischaemiccardiomyopathy,theresultsareless satisfactory. We sought to identify geometric and functional predictors of late outcome after SVR. Methods: Among 144 patients who underwent SVR since 1998, a subgroup of 31 patients (age: 65.2 7.6 years) was analysed. Inclusion criteria were: type III cardiomyopathy, no associated procedure except coronary artery bypass grafting, prior anterior infarction, absent-to-2+ mitral regurgitation, elective operation, follow-up 18 months (mean: 44 26; longest: 96 months). Probability of events was estimated with the Kaplan—Meier method. A Cox multivariable regression model was constructed selecting eight potential predictors of four adverse events: death, cardiac death, recurrent heart failure (New York Heart Association class III or IV) and left ventricular re-remodelling, defined as a 25% increase of end-systolic volume index after SVR, or an end-systolic volume index 50 mlm 2 . Results: Early and late mortality were zero and 6% (2/31 patients, one cardiacrelated death). NYHA class and all echocardiographic functional variables significantly improved early after SVR. Freedom (standard error (SE)) from heart failure was 97% 3%, 93% 5%, 77% 11% and 64% 15%, whereas freedom from left ventricular re-remodelling was 97% 3%, 80% 8%, 60% 12% and 39% 15%, respectively, 1, 3, 5 and 7 years after SVR. Multivariable analysis identified baseline mitral regurgitation degree and sphericity index as independent predictors of recurrent heart failure (p = 0.025; hazard ratio (HR) = 7.80 (95% confidence intervals (CIs): 1.29—47.19)) and left ventricular re-remodelling (p = 0.047; HR = 2.84 (95% CIs: 1.01—7.95)). Both predictors also correlated with a higher recurrence of end-systolic volume index 50 mlm 2 at late follow-up.Conclusions: Despite advanced cardiomyopathy, SVR determines left ventricular volume reduction and improved systolic function. Baselineabsent-to-moderate mitral regurgitation and a more spherical left ventricular geometry predict a less favourable clinical and functional outcome, suggesting a possible rationale for wider indications for combined correction of 2+ mitral regurgitation and undersizing of the mitral annulus, particularly in patients with sphericity index 0.75. # 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Since 2000, the International Criminal Tribunal for the former Yugoslavia (ICTY) has been devising a ‘Completion Strategy’, commonly understood as a plan to wind down its trial and appellate activities. Crucial to this comprehensive plan is, however, that the winding down of the Tribunal's activities should be accomplished while simultaneously upholding the international rule of law, preventing impunity and widely sharing the Tribunal's institutional knowledge and jurisprudence. The author, President of the ICTY, explains that the Tribunal, from its inception, was established to exercise primacy only for a short period and because of the inability of local judiciaries to deliver justice or ensure a future of peace to the region. In view of the principle of complementarity, which fully applies to the ICTY, the Tribunal is therefore transferring cases and investigative material to local institutions. Moreover, the Tribunal has amended its Rules of Procedure and Evidence to allow direct petition by local actors to modify protective measures and thereby receive confidential material from the Tribunal's archives. Through these and other measures, the ICTY has adopted a strategy of ‘continued legacy building’ in the region of the former Yugoslavia that will faciliate the growth of local institutional capacity to handle the numerous cases that remain to be prosecuted and tried effectively. Thus, in its essence, the ‘Completion Strategy’ is an unprecedented attempt to contribute to the development of the rule of law, both in the region of the former Yugoslavia and beyond.

Oviduct epithelial cells are important for the nourishment and survival of ovulated oocytes and early embryos, and they respond to the steroid hormones estrogen and progesterone. Endocrine-disrupting polyhalogenated aromatic hydrocarbons (PHAH) are environmental toxins that act in part through the ligand-activated transcription factor arylhydrocarbon receptor (AhR; dioxin receptor), and exposure to PHAH has been shown to decrease fertility. To investigate effects of PHAHs on the oviduct epithelium as a potential target tissue of dioxin-type endocrine disruptors, we have established a novel telomerase-immortalized oviduct porcine epithelial cell line (TERT-OPEC). TERT-OPEC exhibited active telomerase and the immunoreactive epithelial marker cytokeratin but lacked the stromal marker vimentin. TERT-OPEC contained functional estrogen receptor (ER)-alpha and AhR, as determined by the detection of ER-alpha- and AhR-specific target molecules. Treatment of TERT-OPEC with the AhR ligand 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) resulted in a significant increase in the production of the cytochrome P-450 microsomal enzyme CYP1A1. Activated AhR caused a downregulation of ER nuclear protein fraction and significantly decreased ER-signaling in TERT-OPEC as determined by ERE-luciferase transient transfection assays. In summary, the TCDD-induced and AhR-mediated anti-estrogenic responses by TERT-OPEC suggest that PHAH affect the predominantly estrogen-dependent differentiation of the oviduct epithelium within the fallopian tube. This action then alters the local endocrine milieu, potentially resulting in a largely unexplored cause of impaired embryonic development and female infertility.

Alkylphenolic compounds are a widespread family of xenoestrogens. High concentrations of these substances are present in sewage sludge that is spread on arable land and pasture as fertilizer. Because of their known endocrine system-disrupting activity, alkylphenols represent a potential risk for the reproductive health of farm animals. In this study, the impact of p-tert-octylphenol (OP) on the developmental competence of bovine oocytes was evaluated. Endocrine activity of OP was investigated for its effect on estrogen receptors α and β (ERα and ERβ) and progesterone receptor (PR) mRNA levels. Cumulus-oocyte complexes (COCs) were exposed during in vitro maturation to serial concentrations of OP (1–0.0001 μg/ml) and were compared with vehicle-treated controls and a group of COCs treated with 17β-estradiol (E2). A dose-related decrease in the percentage of oocytes that completed maturation after 24 h and in oocyte fertilization competence was observed at doses of OP as low as 0.01 μg/ml. Groups tre...

Surgical revascularization for postinfarction cardiogenic shock carries 20-50% mortality. Beating-heart techniques have been favoured, but their impact on the avoidance of additional myocardial injury is unknown. Ten consecutive patients with postinfarction cardiogenic shock, unsuitable anatomy for percutaneous coronary intervention (Syntax score 34.0±7.5; triple-vessel disease, 10/10; left main stenosis, 5/10), and no associated cardiac procedure, were selected for salvage/emergent on-pump beating-heart coronary bypass surgery. Remote muscle was sequentially substrate-enhanced reperfused through the grafts after construction of distal anastomoses. Early/late mortality, preoperative/peak postoperative enzyme release, and baseline/pre-discharge ventricular function were analysed. One early death occurred. Patients received 2.9±0.6 grafts, always employing the left internal mammary artery. Cardiopulmonary bypass duration was 140±62 min. Left ventricular ejection fraction (29.4±5.8 vs. 37.5±8.3%), wall motion score index (2.10±0.29 vs. 1.86±0.28), and end-systolic volume index (42.1±11.5 vs. 33.1±14.0 ml/m(2)) acutely improved (P≤0.001), whereas functional mitral regurgitation decreased from 1.4±0.8 to 0.8±0.4 (P=0.051). Total creatine kinase levels significantly increased (P=0.017), but myocardial band isoenzyme did not (P=0.18). After 3.1±1.4 years, eight patients are alive and seven are free of recurrent heart failure. Satisfactory functional outcome can be achieved with beating-heart on-pump revascularization for postinfarction cardiogenic shock. Perioperative enzyme releases and ventricular functional variables may suggest reduced perioperative myocardial injury.

The optimal surgical management of simultaneous abdominal aortic aneurysm and cardiac disease remains a major challenge in case of larger aneurysms and severe cardiac disease. In case of symptomatic aneurysms or impending rupture, a single-stage combined operation is the most widely accepted procedure. We report the successful use of closed-chest cardiopulmonary bypass, with femoral venous and axillary arterial peripheral cannulation, to support cardiac function on the beating heart during resection of a giant abdominal aortic aneurysm and ischaemic cardiomyopathy. One month later, the patient underwent a second-stage deferred cardiac operation, consisting of triple coronary bypass grafting, undersized mitral annuloplasty and epicardial left ventricular lead implantation for cardiac resynchronisation therapy.

Despite a decline in the last three decades, postinfarction ventricular free wall rupture still complicates more than 3% of acute ST-elevation myocardial infarctions and remains a surgical challenge. TachoSil ® (Nycomed, Zurich, Switzerland) is an equine collagen patch coated with human fibrinogen and human thrombin, which has recently been used for haemostasis in cardiovascular surgery, but its potential usefulness in free wall rupture has not been reported. Initial clinical experience with an on-pump sutureless technique without cardioplegia, using wide TachoSil ® patching to achieve free wall rupture repair, has been described.

1010-7940/$ — see front matter # 2009 European Association for Cardio-Thoracic doi:10.1016/j.ejcts.2009.06.036 Listerial endocarditis is uncommon, but potentially destructive. Fifteen years after mitral valve replacement, a 67-year-old male without co-morbidities developed hyperacute shock (white blood cell count = 38.750 ml ) following a mildly febrile period with normal echocardiograms. Trans-oesophageal echocardiography showed a flail prosthesis (Fig. 1). Surgery consisted of valve re-replacement and pericardial annular reinforcement.