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Milk of calcium (MOC) pericardial effusion (PE) is extremely rare and has rarely been reported. A 78-year-old man was referred to our institution because of breathlessness and bilateral leg edema. Echocardiography revealed mild PE. In addition, abrupt posterior motion of the ventricular septum in early diastole was observed. A non-contrast chest computed tomography revealed a hyperdense PE, with Hounsfield units of 130, suggestive of MOC PE. Right heart catheterization (RHC) revealed that the right ventricular pressure had a dip and plateau pattern. We diagnosed the patient with constrictive pericarditis (CP) with MOC PE. As the right heart failure secondary to CP was refractory to medical therapy, we decided to perform surgical treatment. During pericardiectomy, a highly viscous PE, of which the color was pale and reddish brown, was aspirated. Chemical analysis of the PE revealed a very high calcium content of 39.2 mmol/L. The clinical symptoms secondary to CP improved. RHC performed postoperatively confirmed the disappearance of a dip and plateau pattern in the right ventricular pressure. In conclusion, we experienced a of CP with MOC PE and surgical treatment contributed to the improvement of the clinical symptoms and pericardial constriction secondary to CP. Because constrictive pericarditis (CP) with milk of calcium (MOC) pericardial effusion (PE) can cause severe morbidity and even mortality, the early diagnosis of CP is important in patients suspected of having MOC PE. MOC PE has hyperdensity on computed tomography, so its findings could be helpful in the diagnosis of MOC PE. Pericardiectomy for CP with MOC PE may contribute to the improvement of the clinical symptoms and pericardial constriction secondary to CP. [ABSTRACT FROM AUTHOR]

Tetralogy of Fallot was repaired previously in a preschooler through right ventriculotomy, providing excellent exposure for ventricular septal defect closure and right ventricular outflow tract obstruction relief. Herein, we describe the preschooler as a 50-year-old man with untreated atrial septal defect found at pulmonary valve replacement in the remote period after tetralogy of Fallot repair. It was inferred intraoperatively that the previous tetralogy of Fallot was repaired only through right ventriculotomy, and atrial septal defect closure was performed together with pulmonary valve replacement. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Preventing loss of life in patients with type A acute aortic dissection (AAD) who present with cardiopulmonary arrest (CPA) can be extremely difficult. Thus, we investigated the early outcomes in these patients. METHODS: Patients with type A AAD who were transported to hospitals belonging to the Tokyo Acute Aortic Super-network between January 2015 and December 2019 were considered for this study. We assessed the early mortality of these patients presenting with CPA and also investigated the differences in outcomes between patients with out-of-hospital and in-hospital CPA. RESULTS: A total of 3307 patients with type A AAD were transported, 434 (13.1%) of whom presented with CPA. The overall mortality of patients presenting with CPA was 88.2% (383/434), of which 94.5% (240/254) experienced out-of-hospital CPA and 79.4% (143/180) experienced in-hospital CPA (P < 0.001). Multivariable analysis revealed that aortic surgery [odds ratio (OR), 0.022; 95% confidence interval (CI), 0.008–0.060; P < 0.001] and patient age over 80 years (OR, 2.946; 95% CI, 1.012–8.572; P = 0.047) were related with mortality in patients with type A AAD and CPA. Between in-hospital and out-of-hospital CPA, the proportions of DeBakey type 1 (OR, 2.32; 95% CI, 1.065–5.054; P = 0.034), cerebral malperfusion (OR, 0.188; 95% CI, 0.056–0.629; P = 0.007), aortic surgery (OR, 0.111; 95% CI, 0.045–0.271; P = 0.001), age (OR, 0.969; 95% CI, 0.940–0.998; P = 0.039) and the time from symptom onset to hospital admission (OR, 1.122; 95% CI, 1.025–1.228; P = 0.012) were significantly different. CONCLUSIONS: Patients with type A AAD presenting with CPA exhibited extremely high rates of death. Patient outcomes following in-hospital CPA tended to be better than those following out-of-hospital CPA; however, this difference was not significantly different. To prevent deaths, aortic surgery, when possible, should be considered in patients with type A AAD who sustained CPA. We previously reported a risk analysis for early death in emergency Stanford type A acute aortic dissection (AAD) surgery using the Tokyo Acute Aortic Super (TAAS)-network Registry. [ABSTRACT FROM AUTHOR]

Both the diagnosis and treatment of coronary artery involvement with Takayasu arteritis (TA) are challenging. In this study, we report different clinical scenarios of two TA cases without Typical symptoms of TA that initially presented in the form of acute coronary syndrome (ACS). Patient 1 was a 24-year-old Japanese woman without coronary risk factors who presented with exertional chest pain, dyspnea, and syncope. Invasive coronary angiography (ICA) revealed a considerable lesion of the right coronary artery and the left main trunk. Ventricular fibrillation was observed immediately after the procedure. Despite conventional treatment, she died on day 16. Patient 2 was a 34-year-old Japanese woman without coronary risk factors who developed cardiogenic shock during a treadmill test for exertional chest pain. Coronary computed tomography angiography confirmed severe left main stenosis, presenting as ACS caused by TA. She was started on steroid therapy before coronary artery bypass grafting, resulting in a good postoperative course and no recurrence of chest pain. Therefore, coronary computed tomography angiography likely is useful for the early diagnosis of TA in young women with typical chest symptoms of ACS. It may help in avoiding complications associated with ICA. When young women with a low pre-test probability of coronary artery disease present with typical anginal symptoms, Takayasu arteritis (TA) should be suspected despite the absence of symptoms such as fever, fatigue, or myalgia. Coronary computed tomography angiography is safe for rapid diagnosis and decision-making when patients suspected of having TA initially manifest an unstable condition such as acute coronary syndrome. [ABSTRACT FROM AUTHOR]

We evaluated the impact of donor age on the efficacy of myocardial cellular therapy for ischemic cardiomyopathy. Characteristics of smooth muscle cells (SMC), bone marrow stromal cells (MSCs), and skeletal muscle cells (SKMCs) from young, adult, and old rats were compared in vitro. Three weeks after coronary ligation, 3.5 million SMCs (n = 11) or MSCs (n = 9) from old syngenic rats or culture medium (n = 6) were injected into the ischemic region. Five weeks after implantation, cardiac function was assessed by echocardiography and the Langendorff apparatus. In the in vitro study, the numbers and proliferation of MSCs from fresh bone marrow and SKMCs from fresh tissue but not SMCs were markedly diminished in old animals (P < 0.05 both groups). SKMCs from old animals did not reach confluence. After treatment with 5-azacytidine (azacitidine), the myogenic potential of old MSCs was decreased compared with young MSCs. In the in vivo study, both SMC and MSC transplantation induced significant angiogenesis compared with media injections (P < 0.05 both groups). Transplantation of SMCs but not MSCs prevented scar thinning (P = 0.03) and improved ejection fraction and fractional shortening (P < 0.05). Load-independent indices of cardiac function in a Langendorff preparation confirmed improved function in the aged SMC group (P = 0.01) but not in the MSC group compared with the control group. In conclusion, donor age adversely impacts the efficacy of cellular therapy for myocardial regeneration and is cell-type dependent. SMCs from old donors retain their ability to improve cardiac function after implantation into ischemic myocardium. myocardial infarction; aging

We evaluated the impact of donor age on the efficacy of myocardial cellular therapy for ischemic cardiomyopathy. Characteristics of smooth muscle cells (SMC), bone marrow stromal cells (MSCs), and skeletal muscle cells (SKMCs) from young, adult, and old rats were compared in vitro. Three weeks after coronary ligation, 3.5 million SMCs (n = 11) or MSCs (n = 9) from old syngenic rats or culture medium (n = 6) were injected into the ischemic region. Five weeks after implantation, cardiac function was assessed by echocardiography and the Langendorff apparatus. In the in vitro study, the numbers and proliferation of MSCs from fresh bone marrow and SKMCs from fresh tissue but not SMCs were markedly diminished in old animals (P < 0.05 both groups). SKMCs from old animals did not reach confluence. After treatment with 5-azacytidine (azacitidine), the myogenic potential of old MSCs was decreased compared with young MSCs. In the in vivo study, both SMC and MSC transplantation induced significant angiogenesis compared with media injections (P < 0.05 both groups). Transplantation of SMCs but not MSCs prevented scar thinning (P = 0.03) and improved ejection fraction and fractional shortening (P < 0.05). Load-independent indices of cardiac function in a Langendorff preparation confirmed improved function in the aged SMC group (P = 0.01) but not in the MSC group compared with the control group. In conclusion, donor age adversely impacts the efficacy of cellular therapy for myocardial regeneration and is cell-type dependent. SMCs from old donors retain their ability to improve cardiac function after implantation into ischemic myocardium. [ABSTRACT FROM AUTHOR]

: BackgroundAutologous cell transplantation may restore viable muscle after a myocardial infarction. We compared the effect of three cell types or an angiotensin-converting enzyme (ACE) inhibitor on preservation of ventricular function after cardiac injury.: MethodsA uniform transmural myocardial scar was created in adult rats by cryoinjury. Three weeks later the rats were randomly assigned to one of four blinded treatments: transplantation with 5 × 106 aortic smooth muscle cells (SMC, n = 12), ventricular heart cells (VHC, n = 13), skeletal muscle cells (SKC, n = 13) or culture medium alone (control, n = 11). The ACE inhibitor group (n = 8) received enalapril (1.0 mg/kg per day), also beginning 3 weeks after cryoinjury. Five and 12 weeks after transplantation, left ventricle (LV) function was assessed in a Langendorff apparatus, and histologic and immunohistological evaluation of the LV scars was performed.: ResultsAt 5 weeks, greater scar elastin content and better LV function was noted with cell transplantation or ACE inhibitor therapy compared with control rats (p < 0.05). Twelve weeks after transplantation, cell-transplanted rats still had greater elastin content and better LV function than control rats, although elastin content and LV function had declined in ACE inhibitor-treated animals to levels below those observed in control rats (p < 0.05).: ConclusionsTransplantation of SMC, VHC, and SKC preserved ventricular function equivalent to the effects of an ACE inhibitor. Muscle cell transplantation, but not ACE inhibitor therapy, continues to be effective later after cryoinjury. No differences were detected between the muscle cells. [Copyright &y& Elsevier]