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LMNA-related dilated cardiomyopathy (DCM) is an autosomal-dominant genetic condition with cardiomyocyte and conduction system dysfunction often resulting in heart failure or sudden death. The condition is caused by mutation in the Lamin A/C (LMNA) gene encoding Type-A nuclear lamin proteins involved in nuclear integrity, epigenetic regulation of gene expression, and differentiation. The molecular mechanisms of the disease are not completely understood, and there are no definitive treatments to reverse progression or prevent mortality. We investigated possible mechanisms of LMNA-related DCM using induced pluripotent stem cells derived from a family with a heterozygous LMNA c.357-2A>G splice-site mutation. We differentiated one LMNA-mutant iPSC line derived from an affected female (Patient) and two non-mutant iPSC lines derived from her unaffected sister (Control) and conducted single-cell RNA sequencing for 12 samples (four from Patients and eight from Controls) across seven time points: Day 0, 2, 4, 9, 16, 19, and 30. Our bioinformatics workflow identified 125,554 cells in raw data and 110,521 (88%) high-quality cells in sequentially processed data. Unsupervised clustering, cell annotation, and trajectory inference found complex heterogeneity: ten main cell types; many possible subtypes; and lineage bifurcation for cardiac progenitors to cardiomyocytes (CMs) and epicardium-derived cells (EPDCs). Data integration and comparative analyses of Patient and Control cells found cell type and lineage-specific differentially expressed genes (DEGs) with enrichment, supporting pathway dysregulation. Top DEGs and enriched pathways included 10 ZNF genes and RNA polymerase II transcription in pluripotent cells (PP); BMP4 and TGF Beta/BMP signaling, sarcomere gene subsets and cardiogenesis, CDH2 and EMT in CMs; LMNA and epigenetic regulation, as well as DDIT4 and mTORC1 signaling in EPDCs. Top DEGs also included XIST and other X-linked genes, six imprinted genes (SNRPN, PWAR6, NDN, PEG10, MEG3, MEG8), and enriched gene sets related to metabolism, proliferation, and homeostasis. We confirmed Lamin A/C haploinsufficiency by allelic expression and Western blot. Our complex Patient-derived iPSC model for Lamin A/C haploinsufficiency in PP, CM, and EPDC provided support for dysregulation of genes and pathways, many previously associated with Lamin A/C defects, such as epigenetic gene expression, signaling, and differentiation. Our findings support disruption of epigenomic developmental programs, as proposed in other LMNA disease models. We recognized other factors influencing epigenetics and differentiation; thus, our approach needs improvement to further investigate this mechanism in an iPSC-derived model.

Standard chest tubes (CTs) used to drain retained blood can become occluded from blood clots, leading to ineffective drainage and postoperative complications such as cardiac tamponade. Chest tube clearance strategies (CTCSs) were developed to improve CT patency. Our meta‐analysis compared the safety and efficacy of CTCS versus CT following cardiac surgery. The PubMed/MEDLINE, Embase, Web of Science, and Scopus databases were searched from 1946 to 2023 for studies that compared CTCS to CT. Two investigators independently reviewed, screened, extracted, and assessed the data prior to performing a random effects meta‐analysis using R. The primary outcome was re‐exploration and the secondary outcomes were retained blood syndrome, mortality, blood products, stroke, cardiac arrest, atrial fibrillation, ventilation time, intensive care unit (ICU) time, hospital length of stay, and chest drainage. Five studies (2288 patients) were included. There were two clinical trials (n = 620) and three observational studies (1668 patients). Compared to CT, CTCS had a significant reduction of postoperative atrial fibrillation (risk ratio (RR) 0.80, 95% CI 0.70 to 0.92, I2 = 17%, p < 0.01). There was no significant difference in re‐exploration, retained blood syndrome, hospital length of stay, and ICU length of stay. However, with the addition of four unmatched studies (n = 2583), CTCS was associated with a significant reduction in re‐exploration (RR 0.52, 95% CI 0.37 to 0.73, I2 = 34%, p < 0.01), retained blood syndrome (RR 0.71, 95% CI 0.53 to 0.95, I2 = 72%, p = 0.02), hospital length of stay (mean difference (MD) −0.40, 95% CI −0.78 to −0.01, I2 = 49%, p = 0.04), and chest drainage (MD 0.80, 95% CI 0.70 to 0.92, I2 = 17%, p < 0.01). Drawing from results including the unmatched studies, CTCSs are associated with fewer postoperative complications compared to CT. This was achieved without major differences in chest drainage, supporting the important role of preventing even small accumulations of blood in the pericardial space. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the efficacy and safety of ultrasound (US)-guided microwave ablation (MWA) without artificial ascites (AA) inpatients with sub-cardiac (SC) liver cancers. Methods: This retrospective study included patients with the left lobe and caudate lobe of the liver cancer who underwent US-guided MWA in our institute from January 2020 to December 2022. According to whether the target lesion was located ≤5 mm from the pericardium, patients were divided into the SC group and the non-sub-cardiac (NSC) group. In the SC group, AA was not employed during the ablation procedure. The results of technical success, technical efficiency, local tumour progression (LTP), and major complications were recorded. Results: A total of 79 patients with 87 lesions were enrolled. There were 38 patients with 38 lesions in the SC group and 41 patients with 49 lesions in the NSC group. The median follow-up of all patients was 15 (range, 3-44) months. There was no significant difference in technical success rates (100% vs 100%), technique efficiency rates (100% vs 95.7%), LTP rates (2.63% vs 0%,), and major complication rates (2.63% vs 7.32%) between the SC group and the NSC group (P > .05). No cardiac-related complications occurred. Conclusions: US-guided MWA without AA for SC liver cancers was safe and effective. Advances in knowledge: The clinical prognosis of thermal ablation without AA in the treatment of SC liver cancers is still unclear. The finding of this study provided evidence supporting the efficacy and safety of US-guided MWA without AA for treating this tricky location. [ABSTRACT FROM AUTHOR]

Epicardial adipose tissue (EAT) is a unique fat depot located between the myocardium and the visceral layer of pericardium. It can be further subdivided into pericoronary (PCAT), periatrial (PAAT) and periventricular adipose tissue (PVentAT), each of them exhibiting specific characteristics and association with the underlying tissue. Since no physical barrier separates EAT from the myocardium, this fat tissue can easily interact with the underlying cardiac structure. EAT can be visualized using various imaging modalities. Computed tomography provides not only information on EAT volume, but also on its density. Indeed, EAT density reflected by the recently developed fat attenuation index (FAI) is emerging as a useful index of PCAT inflammation, PAAT inflammation and fibrosis, while the relevance of density of PVentAT is much less known. The emerging data indicates that FAI can be an important diagnostic and prognostic tool in both coronary artery disease and atrial fibrillation. Future studies will demonstrate if it also could be used as a marker of efficacy of therapies and whether FAI PVentAT could indicate ventricular pathologies, such as heart failure. The aim of the review is to present computed tomography derived FAI as an important tool both to study and better understand the epicardial fat and as a potential predictive marker in cardiovascular disorders. Highlights: Epicardial fat (EAT) is located between the myocardium and the pericardium. EAT density, reflected by fat attenuation index (FAI), reflects its characteristics. FAI is emerging as an important diagnostic and prognostic tool in cardiology. [ABSTRACT FROM AUTHOR]

Bioelectronic implants featuring soft mechanics, excellent biocompatibility, and outstanding electrical performance hold promising potential to revolutionize implantable technology. These biomedical implants can record electrophysiological signals and execute direct therapeutic interventions within internal organs, offering transformative potential in the diagnosis, monitoring, and treatment of various pathological conditions. However, challenges remain in improving excessive impedance at the bioelectronic-tissue interface and thus the efficacy of electrophysiological signaling and intervention. Here, we devise orbit symmetry breaking in MXene (a low-cost scalability, biocompatible, and conductive two dimensionally layered material, which we refer to as OBXene), which exhibits low bioelectronic-tissue impedance, originating from the out-of-plane charge transfer. Furthermore, the Schottky-induced piezoelectricity stemming from the asymmetric orbital configuration of OBXene facilitates interlayered charge transport in the device. We report an OBXene-based cardiac patch applied on the left ventricular epicardium of both rodent and porcine models to enable spatiotemporal epicardium mapping and pacing while coupling the wireless and battery-free operation for long-term real-time recording and closed-loop stimulation. [ABSTRACT FROM AUTHOR]

ABSTRACT The International System for Serous Fluid Cytopathology (TIS) is intended for reporting cytological specimens from serous cavities: pleural, abdominal and pericardial cavities. TIS is being adopted into practice in cytology laboratories worldwide. In this system, there are six diagnostic categories: non‐diagnostic, negative for malignancy, atypia of undetermined significance, suspicious for malignancy, malignant‐primary and malignant‐secondary. Malignant‐primary category almost always implies malignant mesothelioma and malignant‐secondary usually refers to metastasis from carcinoma but also to involvement of serous cavity by haematolymphoid and other malignancies. When evaluating effusion cytological specimen adequacy, the factors that must be considered are sample volume, cellular content and cellular preservation. In the diagnostic analysis and interpretation, it is helpful to consider systematically all basic cytomorphological components in a sample. The basic components are architecture, cell populations, cell size, cytoplasm, nuclei and background elements. One important requirement for a successful evaluation of an effusion cytological specimen is sufficient clinical and radiological information in a referral. Clinical information may guide ancillary testing. In the present review, we provide a practical and educational approach to reporting serous effusion cytology based on the TIS. [ABSTRACT FROM AUTHOR]

The surgical reconstruction of severe corneal ulcers is a common and crucial component of the clinical practice of veterinary ophthalmology. Numerous surgical techniques are used in dogs for corneal reconstruction, and these techniques may be categorized by the material used to repair the corneal lesion. The first part of the present review described procedures that utilize autogenous ocular tissues, homologous donor tissues, and heterologous donor tissues. In this second part of the review, the categories of biomaterials and keratoprosthetics will be summarized. Biomaterials that are reported for use in dogs include amniotic membrane, porcine urinary bladder acellular matrix, porcine small intestinal submucosa, acellular porcine corneal stroma, and other miscellaneous soft tissue and cartilage grafts (e.g., preserved equine renal capsule, autologous omentum, autologous buccal mucosa membrane, bovine pericardium, and homologous peritoneum). Descriptions of keratoprosthesis surgery in dogs are currently limited, but the use of artificial corneal transplants hold promise for dogs with severe, vision‐compromising corneal disease that is not amenable to other reconstruction techniques. This review describes the results of experimental studies evaluating these graft materials in dogs, and it will summarize the findings and outcomes of the clinical articles published in each material category. Reporting inconsistencies and areas where additional research is required will be highlighted to help guide future studies in this area. A major aim of this review is to help identify potential subjects that could be evaluated in future investigations and that might lead to refinements in clinical practice. [ABSTRACT FROM AUTHOR]

Mesothelial and epicardial cells give rise to various types of mesenchymal cells via epithelial (mesothelial)‐to‐mesenchymal transition during development. However, the genes controlling the differentiation and diversification of mesothelial/epicardial cells remain unclear. Here, we examined Wnt2b expression in the embryonic mesothelium and epicardium and performed lineage tracing of Wnt2b‐expressing cells by using novel Wnt2b‐2A‐CreERT2 knock‐in and LacZ‐reporter mice. Wnt2b was expressed in mesothelial cells covering visceral organs, but the expression was restricted in their subpopulations. Wnt2b‐expressing cells labeled at embryonic day (E) 10.5 were distributed to the mesothelium and mesenchyme in the lungs, abdominal wall, stomach, and spleen in Wnt2b2A‐CreERT2/+;R26RLacZ/+ mice at E13.0. Wnt2b was initially expressed in the proepicardial organ (PEO) at E9.5 and then in the epicardium after E10.0. Wnt2b‐expressing PEO cells labeled at E9.5 differentiated into a small fraction of cardiac fibroblasts and preferentially localized at the left side of the postnatal heart. LacZ+ epicardium‐derived cells labeled at E10.5 differentiated into a small fraction of fibroblasts and smooth muscle cells in the postnatal heart. Taken together, our results reveal novel subpopulations of PEO and mesothelial/epicardial cells that are distinguishable by Wnt2b expression and elucidate the unique contribution of Wnt2b‐expressing PEO and epicardial cells to the postnatal heart. [ABSTRACT FROM AUTHOR]

Calcifying fibrous tumors are rare benign fibrous tumors that rarely occur in the heart. We report a 33-year-old woman who was found to have a benign pericardial tumor on health checkup, which was highly suspected to be a teratoma in clinical and imaging examination. After cardiac tumor resection, histopathological features showed scattered foci of psammoma bodies or calcification among collagenized fibrous connective tissues and foci of inflammatory cell infiltration in the interstitium. The pathological diagnosis was a calcifying fibrous tumor. [ABSTRACT FROM AUTHOR]

Introduction: Spontaneous pneumomediastinum with pneumopericardium is an uncommon clinical entity. Case Study: Here, we report the case of a 23-year-old male with asthma who presented with acute chest pain and shortness of breath after an episode of coughing and sneezing. CT scans of the chest and neck revealed pneumomediastinum and pneumopericardium with extensive subcutaneous emphysema extending into the axilla and neck. Results: The patient was admitted for observation and analgesia. No other interventions were administered. Interval scans performed on day five of the admission demonstrated an interval reduction in the degree of air within the mediastinum, pericardium and subcutaneous tissues, and the patient was subsequently discharged home. Conclusion: This case outlines the presentation, diagnosis, and management of concurrent spontaneous pneumomediastinum and pneumopericardium. [ABSTRACT FROM AUTHOR]

[Display omitted] This work provides a comprehensive characterization of porcine myocardial tissue, combining true biaxial (TBx), simple triaxial shear (STS) and confined compression (CC) tests to analyze its elastic behavior under cyclic loads. We expanded this study to different zones of the ventricular free wall, providing insights into the local behavior along the longitudinal and radial coordinates. The aging impact was also assessed by comparing two age groups (4 and 8 months). Resulting data showed that the myocardium exhibits a highly nonlinear hyperelastic and incompressible behavior. We observed an anisotropy ratio of 2-2.4 between averaged peak stresses in TBx tests and 1-0.59-0.40 orthotropy ratios for normalised fiber-sheet-normal peak stresses in STS tests. We obtained a highly incompressible response, reaching volumetric pressures of 2-7 MPa for perfused tissue in CC tests, with notable differences when fluid drainage was allowed, suggesting a high permeability. Regional analysis showed reduced stiffness and anisotropy (20-25%) at the apical region compared to the medial, which we attributed to differences in the fiber field dispersion. Compressibility also increased towards the epicardium and apical regions. Regarding age-related variations, 8-month animals showed stiffer response (at least 25% increase), particularly in directions where the mechanical stress is absorbed by collagenous fibers (more than 90%), as supported by a histological analysis. Although compressibility of perfused tissue remained unchanged, permeability significantly reduced in 8-month-old animals. Our findings offer new insights into myocardial properties, emphasizing on local variations, which can help to get a more realistic understanding of cardiac mechanics in this common animal model. In this work, we conducted a comprehensive analysis of the passive mechanical behavior of porcine myocardial tissue through biaxial, triaxial shear, and confined compression tests. Unlike previous research, we investigated the variation in mechanical response across the left ventricular free wall, conventionally assumed homogeneous, revealing differences in terms of stiffness and compressibility. Additionally, we evaluated age-related effects on mechanical properties by comparing two age groups, observing significant variations in stiffness and permeability. To date, there has been no such in-depth exploration of myocardial elastic response and compressibility considering regional variations along the wall and may contribute to a better understanding of the cardiac tissue's passive mechanical response. [ABSTRACT FROM AUTHOR]

Background Stent fractures are a rare complication of angioplasties and are an unusual substrate for coronary abscesses. Case summary A 63-year-old patient came into the emergency department for ongoing chest pain. The patient had recently undergone coronary stent implantation, 3 months prior. Computed tomography coronary angiography revealed a coronary abscess and stent fracture, with blood effraction into the pericardium. The patient underwent emergency open-heart surgery to clear the infection and perform coronary artery bypass graft surgery. Post-operative outcome was tentatively favourable. The patient suffered acute kidney injury and required haemodialysis. Discussion Coronary stent fracture is a rare complication which can be life-threatening and which can lead to severe sequelae. [ABSTRACT FROM AUTHOR]

Metastasis to the heart is uncommon compared to other organs, posing notable diagnostic challenges. Incidence in autopsy studies typically ranges between 0.7% and 3.5%. Lung, breast, and hematologiccancers are the main sources of such metastases, leading to varied clinical presentations and severe complications. Postmortem viscera from a 47 year old male with a suspected history of jaundice. Only limited information was available. Gross examination showed a solid mass in the gall bladder with areas of hemorrhage and necrosis, while no other abnormalities were observed in other viscera received. Brain examination showed congested blood vessels, while heart sections exhibited atypical cell deposits in the pericardium and myocardium. Coronary arteries displayed pathological thickening. Lung and liver sections also displayed similar metastatic atypical cell deposits, infiltrating tissue and causing necrosis. Gall bladder examination revealed irregular glandular formations lined with polygonal tumor cells positive for cytokeratin. The final diagnosis based on histomorphological features and immunohistochemistry confirmed gall bladder adenocarcinoma metastasising to the heart, liver and lungs. [ABSTRACT FROM AUTHOR]

Objective: To create a deep‐learning automatic segmentation model for esophageal cancer (EC), metastatic lymph nodes (MLNs) and their adjacent structures using the UperNet Swin network and computed tomography angiography (CTA) images and to improve the effectiveness and precision of EC automatic segmentation and TN stage diagnosis. Methods: Attention U‐Net, UperNet Swin, UNet++ and UNet were used to train the EC segmentation model to automatically segment the EC, esophagus, pericardium, aorta and MLN from CTA images of 182 patients with postoperative pathologically proven EC. The Dice similarity coefficient (DSC), sensitivity, and positive predictive value (PPV) were used to assess their segmentation effectiveness. The volume of EC was calculated using the segmentation results, and the outcomes and times of automatic and human segmentation were compared. All statistical analyses were completed using SPSS 25.0 software. Results: Among the four EC autosegmentation models, the UperNet Swin had the best autosegmentation results with a DSC of 0.7820 and the highest values of EC sensitivity and PPV. The esophagus, pericardium, aorta and MLN had DSCs of 0.7298, 0.9664, 0.9496 and 0.5091. The DSCs of the UperNet Swin were 0.6164, 0.7842, 0.8190, and 0.7259 for T1‐4 EC. The volume of EC and its adjacent structures between the ground truth and UperNet Swin model were not significantly different. Conclusions: The UperNet Swin showed excellent efficiency in autosegmentation and volume measurement of EC, MLN and its adjacent structures in different T stage, which can help to T and N stage diagnose EC and will save clinicians time and energy. [ABSTRACT FROM AUTHOR]

Simple Summary: One male adult crested porcupine was found moribund in the province of Siena (Tuscany, Central Italy), and died soon after being recovered by a wildlife rescue service. At necropsy, a rounded nodule was noted on the surface of the heart. Differential diagnoses included abscess, systemic tuberculosis, parasitic cyst, and neoplasia. Histology was performed on the lesion, revealing a cystic formation in the epicardium. The cyst was lined by stratified squamous epithelium and was filled with lamellar keratin without hair shafts. The lesion was diagnosed as an epicardial epidermoid cyst (EC). EC are most commonly found in the skin, both in human and animal patients, although rarely they can occur in various internal organs. However, cardiac EC has not been reported before in animals. To the best of our knowledge, this is the first report of EC in a wild animal species. The crested porcupine (Hystrix cristata) is present in central Italy with an estimated population of 1800 individuals. Despite the local abundance, little data are available on the diseases affecting free-ranging individuals. We describe a case of an epidermoid cyst (EC) in a male adult porcupine found in the municipality of Sovicille, province of Siena (Tuscany). At necropsy, a firm rounded nodule was noted on the left ventricle wall. Histological examination revealed a cystic formation lined by stratified squamous epithelium. The cyst was filled with lamellar keratin, while hair shafts were not present. The adjacent epicardium was infiltrated by lymphoplasmacytic cells in reaction to the rupture of the cyst with the spilling of keratinaceous debris. The lesion was diagnosed as a ruptured epicardial epidermoid cyst. EC are most commonly found in the skin, both in human and animal patients, though infrequently, they can occur in any internal organ. Cardiac EC has not been reported in domestic animals, and this is the first report of EC in a wild animal species. Clinical veterinarians should consider the possibility of similar cardiac lesions in captive subjects since the long lifespan of these rodents could allow the growth of the cyst with the compression of the adjacent tissues. [ABSTRACT FROM AUTHOR]

Simple Summary: Contrast-enhanced computed tomography (CT) is the standard radiologic examination for evaluating mediastinal tumors. In equivocal cases, cine magnetic resonance imaging (cine-MRI) and magnetic resonance imaging (MRI)/T1-weighted spin echo sequences (T1TSE) may be additionally performed. We retrospectively analyzed patients undergoing surgical resection of mediastinal tumors (benign and malignant) with prior CT, cine-MRI, and T1TSE for (re-)evaluation and comparison to the intraoperative findings and postoperative histology reports, which were defined as a gold standard. Unclear CT cases were further investigated. A total of 47 patients were included in the study. Cine-MRI is of crucial benefit in unclear CT findings compared with T1TSE, especially when infiltration into the large central vessels and atria is suspected. Background/Objectives: Contrast-enhanced computed tomography (CT) is the standard radiologic examination for evaluating the extent of mediastinal tumors. If tumor infiltration into the large central thoracic vessels, the pericardium, or the myocardium is suspected, cine magnetic resonance imaging (cine-MRI) can provide additional valuable information. Methods: We conducted a retrospective study of patients with mediastinal tumors who were staged with CT, cine-MRI, and a T1-weighted turbo spin echo (T1TSE) prior to surgical resection. Imaging was re-evaluated regarding tumor infiltration into the pericardium, myocardium, superior vena cava, aorta, pulmonary arteries, and atria and compared with intraoperative findings and postoperative histopathological reports (gold standard). Unclear CT findings were further investigated. Results: Forty-seven patients (29 female and 18 male patients; median age: 58 years) met the inclusion criteria. Cine-MRI was able to predict infiltration of the aorta in 86%, pulmonary arteries in 85%, and atria in 80% of unclear CT cases. Aortic tumor infiltration in unclear CT cases was significantly more often correctly diagnosed with cine-MRI than with T1TSE sequence. Conclusions: Additional cine-MRI is of crucial benefit in unclear CT cases. We recommend performing cine-MRI if infiltration into the large central vessels and atria is suspected. T1TSE sequence is of very limited additional value. [ABSTRACT FROM AUTHOR]

The majority of the cavotricuspid isthmus (CTI) region consists of discretely arranged muscle bundles separated by connective tissue. Heterogeneity in the anatomic arrangement of the muscle bundles results in differences in the endocardial and epicardial activation patterns. We present a case of recurrent atrial flutter (AFL) despite the presence of a complete endocardial CTI block. We found epicardial‐endocardial breakthrough (EEB) sites on the right atrial high septum. In addition, the epicardial excitation confirmed by endocardial activation mapping was detected as far‐field potentials. Radiofrequency ablation was performed at the EEB site. No AFL has recurred for 12 months after the present procedure. [ABSTRACT FROM AUTHOR]

Mutations in GATA6 are associated with congenital heart disease, most notably conotruncal structural defects. However, how GATA6 regulates cardiac morphology during embryogenesis is undefined. We used knockout and conditional mutant zebrafish alleles to investigate the spatiotemporal role of gata6 during cardiogenesis. Loss of gata6 specifically impacts atrioventricular valve formation and recruitment of epicardium, with a prominent loss of arterial pole cardiac cells, including those of the ventricle and outflow tract. However, there are no obvious defects in cardiac progenitor cell specification, proliferation or death. Conditional loss of gata6 starting at 24 h is sufficient to disrupt the addition of late differentiating cardiomyocytes at the arterial pole, with decreased expression levels of anterior secondary heart field (SHF) markers spry4 and mef2cb. Conditional loss of gata6 in the endoderm is sufficient to phenocopy the straight knockout, resulting in a significant loss of ventricular and outflow tract tissue. Exposure to a Dusp6 inhibitor largely rescues the loss of ventricular cells in gata6−/− larvae. Thus, gata6 functions in endoderm are mediated by FGF signaling to regulate the addition of anterior SHF progenitor derivatives during heart formation. [ABSTRACT FROM AUTHOR]

Background: One of the special anatomical structures in sturgeons is the pericardioperitoneal canal (PPC), which has not been studied much. Considering that the presence and absence of this channel and its morphometry have not been investigated in this type of fish, this study was conducted. Objective: The purpose of present study was to obtain a complete understanding about anatomical features and ultrasonography of PPC in the heart of immature beluga species in order to provide standard approaches for performing sonography and echocardiography on this sturgeon species. Methods: Ten immature belugas (Huso huso) were used to perform ultrasonography with Sonosite MicroMaxx ultrasonography machine of ventral approach between two pectoral fins. After performing the steps of ultrasonographic study, gross anatomical studies were also performed, and the morphometric measurement of the canal was also performed. Results: A small PPC was observed, which communicated between the pericardial cavity, and the peritoneal (coelomic) cavity. The cranial part of this channel, which was located immediately after the transverse septum, was on the midline of the body and was seen in midsagittal ultrasonograms. On average, the length of this canal was 3.23 ± 0.05 cm, and its diameter (cranial part) was 0.24 ± 0.04 cm. Conclusions: In the present study on immature beluga, it was observed that the canal is located behind the sinus venosus and is caudoventral to it, though behind the transverse septum. It has been mentioned that this PPC establishes a connection between the pericardial cavity and the peritoneal cavity, so this connection is between the peritoneal cavity and the space between the two layers of the pericardium and has no connection with the pericardial sac (the space where the heart is located). In this study, the anatomical structure and morphometry of the PPC in immature beluga were investigated, and some approaches were presented to observe the canal in ultrasonography. [ABSTRACT FROM AUTHOR]

Background Amoebiasis is a prevalent infection in the tropics and can sometimes present as liver abscess. Cardiac tamponade is an uncommon complication of ruptured amoebic liver abscess requiring urgent pericardiocentesis, which has a high success rate, but procedural complications can include injury to cardiac chambers, abdominal viscera, and even death. This case underscores the approach to diagnose and manage an unintended visceral puncture during pericardiocentesis, which is a rare but life-threatening complication. Case summary A 41-year-old male presented with intermittent fever over 2 months and chest pain for 15 days. Echocardiography revealed a significant pericardial effusion causing cardiac tamponade. In an emergency setting, percutaneous pericardiocentesis was attempted to drain the effusion. However, the pigtail inadvertently punctured a sizable liver abscess. Consequently, another pigtail was inserted into the pericardial cavity to successfully drain the effusion. Patient was discharged on Day 12 and is doing well at 6 months follow-up. Discussion A previously undiagnosed case of a ruptured amoebic liver abscess presented with the uncommon complication of cardiac tamponade, necessitating emergency pericardiocentesis, which inadvertently led to the cannulation of the liver abscess. This case underscores the significance of image-guided pericardiocentesis in minimizing procedural complications. This case also highlights the intricacies of addressing accidental visceral puncture during pericardiocentesis, specially involving the liver. It also underscores the need to consider the possibility of a ruptured amoebic liver abscess when anchovy sauce-like pus is drained from pericardial cavity, especially in high epidemiologically prevalent country like India. [ABSTRACT FROM AUTHOR]

Background Intracardiac masses are historically treated with surgery. As percutaneous technologies continue to evolve, non-surgical techniques for mass removal may become options. We present a case of a woman with a large right atrial mass that was percutaneously removed en bloc without surgery. Case summary A 77-year-old woman presents with a 40 mm right atrial mass. The mass was increasing in size, and she preferred to avoid surgical removal. The tumour was removed percutaneously from the femoral vein using a large suction cannula in combination with transection of the stalk using an electrified snare. The case was complicated by a haemopericardium that was treated successfully by injecting a haemostatic matrix into the pericardial space. The pathology returned papillary fibroelastoma. Discussion The TEXAS technique used to remove the right atrial mass in this case is a modification of a previously described technique (SEATTLE procedure). Using this method, we were able to remove a 40 mm tumour from the right atrium without surgery. This is the largest reported intracardiac tumour that has been removed en bloc percutaneously. Percutaneous removal of right atrial tumours appears feasible, although this may be limited to smaller tumours based on the results of our case. [ABSTRACT FROM AUTHOR]

Mechanical mismatch between native aortas and aortic grafts can induce graft failure. This study aims to compare the mechanical and microstructural properties of different graft materials used in aortic repair surgeries with those of normal and dissected human ascending aortas. Five types of materials including normal aorta (n = 10), dissected aorta (n = 6), human pericardium (n = 8), bovine pericardium (n = 8) and Dacron graft (n = 5) were collected to perform uniaxial tensile testing to determine their material stiffness, and ultimate strength/stretch. The elastin and collagen contents in four tissue groups except for Dacron were quantified by histological examinations, while the material ultrastructure of five material groups was visualized by scanning electron microscope. Statistical results showed that three graft materials including Dacron, human pericardium and bovine pericardium had significantly higher ultimate strength and stiffness than both normal and dissected aortas. Human and bovine pericardia had significantly lower ultimate stretch than native aortas. Histological examinations revealed that normal and diseased aortic tissues had a significantly higher content of elastic fiber than two pericardial tissues, but less collagen fiber content. All four tissue groups exhibited lamellar fiber ultrastructure, with aortic tissues possessing thinner lamella. Dacron was composed of densely coalesced polyethylene terephthalate fibers in thick bundles. Aortic graft materials with denser fiber ultrastructure and/or higher content of collagen fiber than native aortic tissues, exhibited higher ultimate strength and stiffness. This information provides a basis to understand the mechanical failure of aortic grafts, and inspire the design of biomimetic aortic grafts. [ABSTRACT FROM AUTHOR]

Abstract Background Pericardiectomy due to constrictive pericarditis is usually safe procedure. There was a rare event of thrombosis after pericardiectomy, which was mainly accounted by low-cardiac-output syndrome. Case presentation Here, we report the case undergoing pericardiectomy after constrictive pericarditis, with fatal cerebral thrombosis after pericardiectomy confirmed by endovascular mechanical thrombectomy. Even though recanalization was completed and suggestive decompressive craniectomy was in preparation, the patient still died for cerebral hernia due to severe edema. The causes of cerebral thrombosis after pericardiectomy in this case was accounted by the persistence of nonpliable pericardium encasing the left ventricular wall limited local myocardium motor, pro-coagulable state due to thermal transmission during decortication like radiofrequency ablation under the condition of postoperative atrial fibrillation and rapid ventricular rates precipitated the information of mural thrombus in cardiac cavity and migration into the main branch of the aortic arch. Conclusion The protocol of prompt aggressive anticoagulation prophylaxis would be vigilantly recommended for the patients undergoing pericardiectomy.

Purpose: To compare the outcomes of maxillary horizontal alveolar ridge augmentation in the esthetic area, using either pericardium membrane or titanium mesh, clinically, radiographically, and histologically. Materials and Methods: A randomized clinical study was performed on 20 patients with insufficient edentulous ridge width. Subjects were equally allocated into two groups. For both groups, autogenous tenting bone blocks were harvested from the symphysis area. Bone block was covered by an equal mixture (1:1) of particulate graft of inorganic bovine bone and autogenous bone matrix. The barrier membrane used in group 1 (PM) was bovine pericardium membrane, and in group 2 (TM), it was titanium mesh. Results: Both groups had a clinically statistically significant difference in buccopalatal alveolar ridge dimension between baseline and after 4 months. Radiographically, at both intervals, there was no significant difference in 3D volume between both groups. Within both groups, there was a significant volume increase postoperatively. Histologically, the PM group had a lower area fraction of the mean value of newly formed bone than the TM group, yet the difference was not significant. The PM group had a higher mean osteocyte count than the TM group, but again, the difference was not significant. Conclusion: Guided bone regeneration using either pericardium membrane or titanium mesh is a reliable treatment for horizontal augmentation of insufficient maxillary alveolar ridge width. No significant differences between both treatment modalities were noticed clinically and histologically. However, percentage change in radiographic volumetric measurements using TM was significantly higher than that of PM. [ABSTRACT FROM AUTHOR]

Agenesis of pericardium is a rare finding resulting from alterations during embryologic formation. It is a congenital cardiac anomaly commonly asymptomatic. Cardiac magnetic resonance is actually considered the gold standard for diagnosis of pericardium agenesis. This report details the case of a 24-year-old woman who came to our clinic.

Background Congenital absence of the pericardium (CAP) is a rare cardiac abnormality. As pericardial defects are usually asymptomatic, most cases are diagnosed during surgery or on autopsy. The patient in this case was found to have CAP during thoracoscope. Case We present the unusual case of a 69-year-old patient with CAP who experienced sudden ventricular arrhythmia and developed ventricular fibrillation during left upper lobectomy. Surgical operations, the lateral decubitus position, and other external stimuli may be important risk factors for ventricular fibrillation. The patient regained sinus rhythm soon after intrathoracic cardiac compression and pharmacological treatment, including lidocaine spray (2%, 10 ml) administered to the heart surface. The surgery was then completed without any additional instances of ventricular arrhythmia. Conclusions Patients with CAP are more susceptible to cardiac-related adverse events during thoracotomy or thoracoscopy. Treatment of ventricular arrhythmias that occur during lung resection in patients with CAP should be emphasized.

Congenital complete absence of the pericardium is a rare condition, often difficult to diagnose due to its incidental discovery or nonspecific clinical manifestations. Instrumental investigations commonly used as initial approaches, such as chest radiography and electrocardiogram, are often insufficient. Echocardiography is an imaging technique that is used for the initial evaluation of pericardial diseases. However, echocardiography does not offer a physiological anatomical delineation of the pericardium and can be affected by operator dependency, acoustic and nontraditional imaging windows. Therefore, accurate imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI) are required for correct diagnosis. We present a case of a symptomatic patient with complete pericardial agenesis diagnosed on angio-CT. This case can contribute to highlighting the importance of CT as a comprehensive imaging method in diagnosis, despite MRI being the gold standard in pericardial disease assessment.

Epicardial adipose tissue (EAT) is a fat reservoir close to the myocardium and visceral pericardium. It has special anatomical and physiological characteristics. The volume and deposition site of EAT are closely related to the occurrence and development of atrial fibrillation (AF). This article discusses the connotation of the traditional Chinese medicine theory, " yang transforming qi and yin shaping up the body", and holds that the essence of abnormal accumulation of EAT is " yang transforming qi deficiency and yin constituting form too much". Yin pathogen gradually accumulates, local yin and yang imbalance occurs, and abnormal secretion occurs. With the extension of time, the intrinsic yang heat is accompanied and becomes increasingly exuberant. Finally, yin is difficult to control yang, resulting in EAT infiltrating normal tissues, inducing and promoting the occurrence and progression of AF. Under the guidance of this theory, when distinguishing the amount of yin and yang between the body and EAT, considering the ability of " yang transforming qi" and " yin constituting form" in the whole and part, the method of supporting yang and eliminating yin should be reasonably selected. At the beginning of the disease, it is mainly to restore " yang transforming qi". By avoiding the accumulation of evil from the yin, it dissipates the body of the yin that has become. When the disease progresses, it is necessary to " eliminate pathogenic factor", supplemented by different treatment methods such as eliminating dampness, activating qi, and promoting blood circulation. Furthermore, the whole course of the disease should take care of the patient's deficiency, pay attention to strengthening yang and tonifying the healthy qi, and eliminate yin and evil promptly to improve clinical efficacy. [ABSTRACT FROM AUTHOR]

Ischemic heart disease (IHD) is a prevalent cardiovascular condition that remains the primary cause of death due to its adverse ventricular remodelling and pathological changes in end‐stage heart failure. As a complex pathologic condition, it involves intricate regulatory processes at the cellular and molecular levels. The immune system and cardiovascular system are closely interconnected, with immune cells playing a crucial role in maintaining cardiac health and influencing disease progression. Consequently, alterations in the cardiac microenvironment are influenced and controlled by various immune cells, such as macrophages, neutrophils, dendritic cells, eosinophils, and T‐lymphocytes, along with the cytokines they produce. Furthermore, studies have revealed that Gata6+ pericardial cavity macrophages play a key role in regulating immune cell migration and subsequent myocardial tissue repair post IHD onset. This review outlines the role of immune cells in orchestrating inflammatory responses and facilitating myocardial repair following IHD, considering both macro and micro views. It also discusses innovative immune cell‐based therapeutic strategies, offering new insights for further research on the pathophysiology of ischemic heart disease and immune cell‐targeted therapy for IHD. [ABSTRACT FROM AUTHOR]

The cardiac computed tomography (CT) practice guidelines provide an updated review of the technological improvements since the publication of the first Canadian Association of Radiologists (CAR) cardiac CT practice guidelines in 2009. An overview of the current evidence supporting the use of cardiac CT in the most common clinical scenarios, standards of practice to optimize patient preparation and safety as well as image quality are described. Coronary CT angiography (CCTA) is the focus of Part I. In Part II, an overview of cardiac CT for non-coronary indications that include valvular and pericardial imaging, tumour and mass evaluation, pulmonary vein imaging, and imaging of congenital heart disease for diagnosis and treatment monitoring are discussed. The guidelines are intended to be relevant for community hospitals and large academic centres with established cardiac CT imaging programs. [ABSTRACT FROM AUTHOR]

An 80‐year‐old man with a history of Bence‐Jones potein (BJP) λ‐type multiple myeloma (MM), which had been in remission for 16 years, was examined for shortness of breath and was found to have bilateral pleural and pericardial effusions. A pleural fluid test and a pleural biopsy under local anaesthesia performed by a previous physician failed to make the diagnosis. Despite diuretic therapy, his condition necessitated frequent thoracentesis. The patient was referred to our hospital and thoracoscopic pleural and pericardial biopsies performed under general anaesthesia revealed λ‐type AL amyloidosis, indicating a relapse of MM. Despite drug therapy for MM, the patient died from aspiration pneumonia. The case underscores the importance of considering amyloidosis in differential diagnoses for refractory effusions, especially in patients with a history of MM, even after long‐term remission. [ABSTRACT FROM AUTHOR]

Pericardial diseases have gained renewed clinical interest, leading to a renaissance in the field. There have been many recent advances in pericardial diseases in both multimodality cardiac imaging of diagnoses, such as recurrent, transient constrictive and effusive-constrictive pericarditis, and targeted therapeutics, especially anti–interleukin (IL)-1 agents that affect the inflammasome as part of autoinflammatory pathophysiology. There remains a large educational gap for clinicians, leading to variability in evaluation and management of these patients. The latest pericardial imaging (American Society of Echocardiography, European Association of Cardiovascular Imaging) and clinical guidelines (European Society of Cardiology) are >8-10 years of age and may not reflect current practice. Recent clinical trials involving anti–IL-1 agents in recurrent pericarditis, including anakinra (AIRTRIP), rilonacept (RHAPSODY), and goflikicept have demonstrated their efficacy. The present document represents an international position statement from world leaders in the pericardial field, focusing on novel concepts and emphasizing the role of multimodality cardiac imaging as well as new therapeutics in pericardial diseases. • The spectrum of pericardial disorders encompasses pericardial inflammation, effusion, constriction, masses, and congenital anomalies. • MMI plays important an role in the diagnosis, prognostication, and surveillance of pericardial diseases. • Recent advances in biologic therapies, including rilonacept, necessitate IGT strategies to manage pericardial diseases. [Display omitted] [ABSTRACT FROM AUTHOR]

Applied to the epicardium in-vivo , regenerative cardiac patches support the ventricular wall, reduce wall stresses, encourage ventricular wall thickening, and improve ventricular function. Scaffold engraftment, however, remains a challenge. After implantation, scaffolds are subject to the complex, time-varying, biomechanical environment of the myocardium. The mechanical capacity of engineered tissue to biomimetically deform and simultaneously support the damaged native tissue is crucial for its efficacy. To date, however, the biomechanical response of engineered tissue applied directly to live myocardium has not been characterized. In this paper, we utilize optical imaging of a Langendorff ex-vivo cardiac model to characterize the native deformation of the epicardium as well as that of attached engineered scaffolds. We utilize digital image correlation, linear strain, and 2D principal strain analysis to assess the mechanical compliance of acellular ice templated collagen scaffolds. Scaffolds had either aligned or isotropic porous architecture and were adhered directly to the live epicardial surface with either sutures or cyanoacrylate glue. We demonstrate that the biomechanical characteristics of native myocardial deformation on the epicardial surface can be reproduced by an ex-vivo cardiac model. Furthermore, we identified that scaffolds with unidirectionally aligned pores adhered with suture fixation most accurately recapitulated the deformation of the native epicardium. Our study contributes a translational characterization methodology to assess the physio-mechanical performance of engineered cardiac tissue and adds to the growing body of evidence showing that anisotropic scaffold architecture improves the functional biomimetic capacity of engineered cardiac tissue. Engineered cardiac tissue offers potential for myocardial repair, but engraftment remains a challenge. In-vivo , engineered scaffolds are subject to complex biomechanical stresses and the mechanical capacity of scaffolds to biomimetically deform is critical. To date, the biomechanical response of engineered scaffolds applied to live myocardium has not been characterized. In this paper, we utilize optical imaging of an ex-vivo cardiac model to characterize the deformation of the native epicardium and scaffolds attached directly to the heart. Comparing scaffold architecture and fixation method, we demonstrate that sutured scaffolds with anisotropic pores aligned with the native alignment of the superficial myocardium best recapitulate native deformation. Our study contributes a physio-mechanical characterization methodology for cardiac tissue engineering scaffolds. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: This systematic review investigates the diagnostic value of ultrasound in the evaluation of torso injuries following a penetrating trauma. Methods: We searched PubMed, Scopus, and WOS databases for related original articles until May 7, 2023, and extracted data related to diagnostic performance. The bivariate model and hierarchic summary receiver operating characteristic (HSROC) approach were used to calculate pooled diagnostic values. Cochrane Q test and I-squared were performed to evaluate heterogeneity. We assessed heterogeneity with meta-regression. Results: Seventeen studies were included, which involved a total number of 1866 patients. According to meta-analysis, sonography demonstrated a pooled sensitivity of 56% (45–67%) and specificity of 96% (94–97%), positive likelihood ratio (LR +) of 13.66 (8.03–23.23), and negative likelihood ratio (LR-) of 0.45 (0.35–0.59) for detecting abdominal injuries. In pericardial penetrating trauma, pooled sensitivity was 100% (45–100%), pooled specificity was 99% (96–100%), LR + was 136.7 (24.8–752.3), and LR- was 0.00 (0.00–1.22). For thoracic penetrating trauma, pooled sensitivity was 99% (93–100%) and specificity was 100% (98–100%). Conclusions: Sonography demonstrated promising diagnostic value in the initial assessment of torso penetrating trauma, particularly in the thoracic and pericardial regions. However, the sensitivity of sonography is limited in abdominal penetrating trauma and a combination with other imaging modalities should be considered in these cases. [ABSTRACT FROM AUTHOR]

Background Ruptured sinus of Valsalva (RSOV) is a rare disorder, which usually involves the right coronary sinus (RCS) or the non-coronary sinus (NCS) and ruptures usually into the right-sided chambers. Involvement of the left coronary sinus (LCS) and multiple sinuses, rupture into the left ventricle (LV), and dissecting aneurysm of the interventricular septum (IVS) have all been scarcely reported. Case summary A 24-year-old male presented with complaints of exertional fatigue, palpitations, and chest pain with signs of aortic run-off like wide pulse pressure, collapsing pulse along with cardiomegaly, and a diastolic murmur. Echocardiography revealed sinus of Valsalva aneurysms (SOVAs) involving both the RCS and LCS with RCS aneurysm dissecting the IVS and rupturing into the LV and another multilobulated aneurysm from LCS rupturing into the LV. Findings were confirmed on computed tomography (CT) aortogram, and the patient underwent successful surgical repair. Discussion Sinus of Valsalva aneurysm is a rare disorder which usually ruptures into the right-sided chambers. The involvement of multiple sinuses and rupture into the IVS is extremely rare (<2%). Aneurysm dissecting the IVS can lead to complete heart block (CHB) and sudden death. Involvement of the LCS is reported in <5% cases of RSOV, and rupture of such an aneurysm into the pericardial space may lead to cardiac tamponade and can also lead to sudden death. Clinical examination, electrocardiogram, chest X-ray, 2D echocardiography, and CT all help in the diagnosis. Treatment involves surgical repair of the defect. [ABSTRACT FROM AUTHOR]

During heart development, the embryonic ventricle becomes enveloped by the epicardium, which adheres to the outer apical surface of the heart. This is concomitant with onset of ventricular trabeculation, where a subset of cardiomyocytes lose apicobasal polarity and delaminate basally from the ventricular wall. Llgl1 regulates the formation of apical cell junctions and apicobasal polarity, and we investigated its role in ventricular wall maturation. We found that llgl1 mutant zebrafish embryos exhibit aberrant apical extrusion of ventricular cardiomyocytes. While investigating apical cardiomyocyte extrusion, we identified a basal-to-apical shift in laminin deposition from the internal to the external ventricular wall. We find that epicardial cells express several laminin subunits as they adhere to the ventricle, and that the epicardium is required for laminin deposition on the ventricular surface. In llgl1 mutants, timely establishment of the epicardial layer is disrupted due to delayed emergence of epicardial cells, resulting in delayed apical deposition of laminin on the ventricular surface. Together, our analyses reveal an unexpected role for Llgl1 in correct timing of epicardial development, supporting integrity of the ventricular myocardial wall. [ABSTRACT FROM AUTHOR]

Collagen-based membranes are class III-medical devices widely used in dental surgical procedures to favour bone regeneration. Here, we aimed to provide biophysical and biochemical data on this type of devices to support their optimal use and design/manufacturing. To the purpose, four commercial, non-crosslinked collagen-based-membranes, obtained from various sources (equine tendon, pericardium or cortical bone tissues, and porcine skin), were characterized in vitro. The main chemical, biophysical and biochemical properties, that have significant clinical implications, were evaluated. Membranes showed similar chemical features. They greatly differed in morphology as well as in porosity and density and showed a diverse ranking in relation to these latter two parameters. Samples highly hydrated in physiological medium (swelling-ratio values in the 2.5–6.0 range) and, for some membranes, an anisotropic expansion during hydration was, for the first time, highlighted. Rheological analyses revealed great differences in deformability (150-1500kPa G') also alerting about the marked variation in membrane mechanical behaviour upon hydration. Samples proved diverse sensitivity to collagenase, with the cortical-derived membrane showing the highest stability. Biological studies, using human-bone-derived cells, supported sample ability to allow cell proliferation and to prompt bone regeneration, while no relevant differences among membranes were recorded. Prediction of relative performance based on the findings was discussed. Overall, results represent a first wide panel of chemical/biophysical/biochemical data on collagen-based-membranes that 1) enhances our knowledge of these products, 2) aids their optimal use by providing clinicians with scientific basis for selecting products based on the specific clinical situation and 3) represents a valuable reference for optimizing their manufacturing. [ABSTRACT FROM AUTHOR]

Background: The current study presents a novel and precise surgical technique for complete reconstruction of the aortic valve using glutaraldehyde-treated autologous pericardium in a patient with aortic valve disease and endocarditis. The technique aims to provide a more effective and reproducible method for aortic valve repair, with the goal of improving outcomes and quality of life for patients with aortic valve disease. Case presentation: A 35-year-old Iranian male with aortic valve disease and endocarditis underwent aortic valve reconstruction surgery. Preoperative echocardiography showed a degenerative aortic valve with severe regurgitation, reduced left ventricular ejection fraction, and specific aortic root dimensions. The surgical technique involved precise measurements and calculations to design the size and shape of the new aortic valve cusps using autologous pericardium, with the goal of optimizing coaptation and function. The surgeon calculated the intercommissural distance based on the aortic annulus diameter to determine cusp size and shape. He tailored the pericardial cusps to have a height equal to 80% of the coaptation margin length. Detailed suturing techniques were used to ensure proper alignment and coaptation of the new cusps. Intraoperative evaluation of the valve function using suction and transesophageal echocardiography showed good coaptation and minimal residual regurgitation. At the 3-year follow-up, the patient had a well-functioning aortic valve with only trivial leak and was in satisfactory clinical condition. Conclusions: Glutaraldehyde-treated autologous pericardium is a validated leaflet alternative, and the causes of its failure are late annular dilatation and other technique breakdowns. Current evidence reveals that aortic valve reconstruction with glutaraldehyde-treated autologous pericardium is associated with many advantages with the potential to improve patient outcomes and quality of life. Further clinical studies are warranted to evaluate the long-term durability and efficacy of this approach. [ABSTRACT FROM AUTHOR]

BACKGROUND: The second heart field is crucial for the development of the embryonic heart. Abnormal development of the second heart field can result in multiple cardiac malformations. After Cx43 gene knockout, reduced formation and proliferation of cells of the second heart field can be observed, but the specific reason remains unclear. OBJECTIVE: (1) To determine whether β-catenin, Smo and Cx43 were co-expressed in the second heart field and the endoderm, we observed the expression patterns of these proteins. (2) To explore whether Cx43 interacts with the Wnt/β-catenin pathway or the Shh pathway in the development of the second heart field. METHODS: Serial paraffin sections of the mouse embryos at embryonic days 10-12 were selected for immunohistochemical staining, hematoxylin-eosin staining and immunofluorescence staining. The primitive gut of mouse embryos at embryonic day 11 was separated for western blot assay and co-immunoprecipitation. RESULTS AND CONCLUSION: (1) Cx43 and Isl1 were co-expressed in some mesenchymal cells on the ventral side of the foregut and dorsal wall of the pericardial cavity of mouse embryos at embryonic days 10-12; Isl1 positive cells increased while Cx43 positive cells increased. (2) Cx43 and β-catenin were co)expressed in the ventral part of the endoderm at embryonic days 10-12. (3) Cx43 and Smo were co-expressed in the endoderm at embryonic days 10-12. (4) The co-immunoprecipitation results confirmed that there was an interaction between Cx43 and β-catenin, which suggested that Cx43 interacted with β-catenin to participate in the development of the second heart field. [ABSTRACT FROM AUTHOR]

Background: Carbohydrate antigen 125 (CA125) is a proteolytic fragment of MUC-16 that is increased in heart failure (HF) and associated with inflammation, fluid overload, and worse adverse events. Our main objective was to study the expression of CA125 on epicardium and its association with inflammation, adipogenesis, and fibrosis. Methods: Epicardial fat biopsies and blood were obtained from 151 non-selected patients undergoing open heart surgery. Immunohistochemistry, ELISA, or real-time PCR were used for analyzing protein or mRNA expression levels of CA125 and markers of inflammatory cells, fibroblasts, and adipocytes. Epithelial or stromal cells from epicardium were isolated and cultured to identify CA125 and its association with the adipogenesis and fibrosis pathways, respectively. Results: The median age was 71 (63–74) years, 106 patients (70%) were male, and 62 (41%) had an established diagnosis of HF before surgery. The slice of epicardial fat biopsy determined a positive and colorimetric staining on the epithelial layer after incubating with the CA125 M11 antibody, providing the first description of CA125 expression in the human epicardium. Epicardial CA125 showed a strong and positive correlation with markers of inflammation and fibrosis in the epicardial fat tissue while exhibiting a negative correlation with markers of the adipogenesis pathway. This relationship remained significant after adjusting for potential confounders such as a prior HF diagnosis and plasma CA125 levels. Conclusion: Epicardial cells express CA125, which is positively associated with inflammatory and fibroblast markers in epicardial adipose tissue. These results suggest that CA125 may be biologically involved in HF progression (transition from adipogenesis to fibrosis). Highlights: This is the first time that CA125 was identified on human epicardium biopsies and primary culture of epithelial cells was performed. This is a promising tool for understanding the pathophysiological mechanisms association between CA-125 and HF progression. [ABSTRACT FROM AUTHOR]

This review explores the significance of pericardial dissection in cardiac surgery for managing congenital heart disease (CHD). The procedure often results in intrapericardial adhesion formation, impacting outcomes and increasing hospitalization costs. The focus is on the bovine pericardium (BP) scaffold and its compatibility with mesenchymal stem cells (MSCs) seeding. Various pericardial substitutes have been utilized to achieve complete closure without inducing rapid cardiac constriction. Successful substitutes must prevent adhesions between the chest wall/lung and pericardium, minimizing the risk of injury during resternotomy. The review emphasizes the promising application of BP scaffolds, particularly when seeded with MSCs, facilitating differentiation into mesothelial cells. Different methodologies are discussed for optimal MSCs seeding in BP scaffolds, suggesting a positive outlook for expanding the use of bovine pericardium in cardiac surgery. The review highlights the extensive use of bovine pericardium as a xenograft in vascular applications, supported by theoretical evidence, with potential for further enhancement through MSC seeding, indicating promising prospects for tissue engineering and regenerative medicine advancements. [ABSTRACT FROM AUTHOR]

The search for optimal material for aortic infection reconstruction is ongoing. Our study presents the early and mid-term results of surgeon-constructed porcine pericardial tubes in the in-situ reconstruction of abdominal aortic infections, focusing on the safety as well as the durability of surgeon-created tubes. We performed a retrospective analysis of 8 patients treated for native aortic (n = 3) and aortic graft infections (n = 5) with surgeon-created tubes made of porcine pericardium patch (8 × 14 cm NO-REACT Ⓡ, BioIntegral Surgical Inc., Mississauga, ON, Canada). There were 7 males and 1 female, aged 68.5 (±4.8 years). Three patients had an aorto-enteric fistula. Technical success was obtained in all patients. Thirty-day mortality was 12.5% (n = 1). Mid-term follow-up was 12 months (2–63 months). One-year mortality was 37.5% (n = 3). Reintervention rate was 28.5% (n = 2). False aneurysm rate in the follow-up was 14.2% (n = 1). Surgeon-constructed porcine pericardial tubes seem to be a promising alternative as a replacement for native as well as graft-related abdominal aortic infections. The mid-term durability is encouraging, once the infection is controlled in cases with successful fistula repair and in native aortic infections patients. Further observations on larger groups, in longer follow-ups are necessary to confirm these preliminary observations. [ABSTRACT FROM AUTHOR]

Introduction. One of the most common pathologies of the pericardium is pericarditis, which can present as acute, subacute or chronic pericarditis, pericardial effusion, cardiac tamponade or constrictive pericarditis. However, it is a rare condition in the pediatric population. Methods. A series of cases of patients with pericarditis who were taken to pericardiotomy, pericardial drainage and anterior partial pericardiectomy, between July 2014 and June 2023 is presented. Demographic and clinical variables were collected, microbiological isolates and the management received were evaluated. Results. A total of 12 patients underwent minimally invasive surgical management; of these, 58% belonged to indigenous communities and lived in rural areas. Half had associated pneumonia. In most cases, no microbiological isolation was obtained. Conclusion. The need for surgical management is determined by the impact on the hemodynamic variables related to the effusion and pericardial compromise. Partial pericardiectomy by thoracoscopy is an alternative in these cases. [ABSTRACT FROM AUTHOR]

Objective: To describe the unique finding and treatment of a dog with cardiac herniation due to traumatic pericardial rupture. Case Summary: A 6.5‐year‐old entire male Yorkshire Terrier was presented for further management after being hit by a car. Despite suspected significant intrathoracic trauma at that time, the patient regained hemodynamic stability and had orthopedic surgery to correct a right iliac fracture. The patient was readmitted to the hospital 12 days following the initial visit due to considerable respiratory difficulty after accidentally being dropped several feet. Thoracic radiographs revealed an unusual severe mediastinal shift to the left with an atypical position of the cardiac silhouette against the left lateral thoracic wall. Due to the severe respiratory compromise of the patient and newly developed pneumothorax, an exploratory thoracotomy was recommended, where a complete rupture of the pericardium was identified, with secondary left‐sided prolapse of the heart. Other more common intrathoracic injuries (ie, lung perforation, rib fractures) were also identified and partially repaired. The patient recovered successfully and was discharged 4 days postoperatively. New or Unique Information Provided: This is the first case report in the veterinary literature of traumatic pericardial rupture and cardiac herniation. According to human case descriptions, this is a rare and often fatal occurrence, which can be significantly challenging to diagnose preoperatively or antemortem. Emergency veterinary clinicians should be aware of this rare but important complication of blunt thoracic trauma. Surgical intervention may be necessary in cases with suspected or confirmed entrapment of great vessels or cardiac chambers, although these abnormalities were not present in this case. [ABSTRACT FROM AUTHOR]

Background: Effusive-constrictive pericarditis (ECP) is an uncommon clinical syndrome characterized by the coexistence of pericardial effusion and constriction involving the visceral pericardium. This differs from constrictive pericarditis, which presents with thickening of the pericardium without effusions. Specific diagnostic criteria of ECP include the failure of right atrial pressure to decrease by 50% or reach a new level below 10 mmHg after normalization of intrapericardial pressure. Case Report: We present the case of a 32-year-old obese man with multiple comorbidities who initially presented with flulike symptoms and pleural effusion with development of constrictive-like symptoms. Despite undergoing numerous pericardiocentesis and appropriate medical management, the patient's condition failed to improve, leading to the likely diagnosis of effusive-constrictive pericarditis. Cultures of pericardial fluid revealed E. faecium, which required multiple antimicrobial therapy. Despite infection, the exact etiology of ECP remained unknown and likely idiopathic. Common causes of ECP include idiopathic, tuberculosis, cardiac surgery complications, radiation, or neoplasia. Ultimately, the patient underwent a pericardiectomy involving the visceral and parietal pericardium, resulting in hemodynamic stability and resolution of symptoms. Conclusions: This case highlights the challenges in diagnosing and managing ECP, emphasizing the importance of considering surgical intervention in refractory cases. ECP initially presents as a pericardial effusion, often addressed through pericardiocentesis; however, in a small subset of patients, sustained symptoms and altered hemodynamics persist following pericardiocentesis, necessitating further evaluation and management. The success of pericardiectomy in our patient highlights the potential efficacy of surgical intervention in improving outcomes for patients with ECP. [ABSTRACT FROM AUTHOR]

Background: Congenital absence of pericardium is a rare cardiac disorder with a reported incidence of less than 1 in 10,000. Although most of the cases are of little clinical significance, some of them are associated with serious complications, including risk of herniation and strangulation or coronary artery compression. Detailed Case Description: We report a case of a 36-year-old male referred for routine cardiovascular examination. He had a medical history of a heart murmur since childhood. Electrocardiogram (ECG) revealed sinus rhythm, normal axis, poor R-wave progression in the precordial leads and repolarization abnormalities with negative T waves in leads V1–V4. On 2D transthoracic echocardiography (TTE), an unusual heart position was noted with poor image quality from the standard acoustic windows. The parasternal long axis view gave the impression of right ventricular dilatation. The findings raised the suspicion of left to right shunt and possible atrial septal defect. For further evaluation, the patient was referred for cardiac magnetic resonance which demonstrated complete left-sided absence of the pericardium. Discussion: Due to indistinct and atypical symptoms and lack of clinical awareness, pericardial congenital absence is frequently misdiagnosed. Patients may complain of atypical chest pain. Patient's history and physical examination are often nonspecific. In cases with complete pericardial absence, ECG findings may include right axis deviation, right bundle block and sinus bradycardia. Echocardiography findings are also not characteristic, but some may raise the clinical suspicion of this diagnosis. The imaging modalities of choice are computed tomography and cardiac magnetic resonance. Treatment depends on the type of defect and clinical symptoms. [ABSTRACT FROM AUTHOR]

The reactivated adult epicardium produces epicardium-derived cells (EPDCs) via epithelial-mesenchymal transition (EMT) to benefit the recovery of the heart after myocardial infarction (MI). SMARCA4 is the core catalytic subunit of the chromatin re-modeling complex, which has the potential to target some reactivated epicardial genes in MI. However, the effects of epicardial SMARCA4 on MI remain uncertain. This study found that SMARCA4 was activated over time in epicardial cells following MI, and some of activated cells belonged to downstream differentiation types of EPDCs. This study used tamoxifen to induce lineage tracing and SMARCA4 deletion from epicardial cells in Wt1-CreER;Smarca4 fl/fl ;Rosa26-RFP adult mice. Epicardial SMARCA4 deletion reduces the number of epicardial cells in adult mice, which was related to changes in the activation, proliferation, and apoptosis of epicardial cells. Epicardial SMARCA4 deletion reduced collagen deposition and angiogenesis in the infarcted area, exacerbated cardiac injury in MI. The exacerbation of cardiac injury was related to the inhibition of generation and differentiation of EPDCs. The alterations in EPDCs were associated with inhibited transition between E -CAD and N-CAD during the epicardial EMT, coupled with the down-regulation of WT1, SNAIL1, and PDGF signaling. In conclusion, this study suggests that Epicardial SMARCA4 plays a critical role in cardiac injury caused by MI, and its regulatory mechanism is related to epicardial EMT. Epicardial SMARCA4 holds potential as a novel molecular target for treating MI. [Display omitted] • Lineage tracing and SMARCA4 deletion in epicardial cells were achieved using Wt1-CreER;Smarca4fl/fl;Rosa26-RFP mice. • Epicardial SMARCA4 deletion exacerbated cardiac injury in myocardial infarction. • Epicardial SMARCA4 deletion inhibited the generation and differentiation of EPDCs in myocardial infarction. • The effects of Epicardial SMARCA4 deletion on EPDCs were related to the obstruction of epicardial EMT. [ABSTRACT FROM AUTHOR]

Objectives: In this study, we aimed to analyze the layer-specific strain values obtained by speckle tracking echocardiography (STE) method in the determination of subclinical cardiac dysfunction in rheumatoid arthritis (RA) patients. Patients and methods: Between February 2019 and October 2019, a total of 63 female RA patients (mean age: 51.82±6.07 years; range, 40 and 65 years) who had a confirmed diagnosis were included. Thirty-one age-matched female healthy individuals (mean age: 50.71±5.37 years; range, 40 and 65 years) were selected as the control group. The patients were divided into three groups according to the duration of disease as <5 years, 5-10 years and >10 years. The Disease Activity Score in 28 joint - C-reactive protein (CRP) was used to determine disease activation. The standard assessment included complete serum CRP, anti-cyclic citrullinated peptide, rheumatoid factor, N-terminal pro B-type natriuretic peptide (NT-proBNP), and homocysteine. Global longitudinal strain (GLS) analysis was performed with STE. Results: The NT-proBNP values were found to be higher in RA patients compared to the control group (p=0.044). In terms of conventional echocardiographic parameters, a significant difference between E/A and E/E' ratios was observed (p<0.001 and p=0.015). Endocardium, transmural, and epicardium GLS values obtained by STE were found to be lower in RA patients (p<0.05). The left ventricular (LV) GLS values worsened, as the duration of disease increased (p<0.05). There was a significant correlation between RA disease activity and LV GLS values, showing that increasing levels of disease activity was associated with worse LV GLS (r=0.583, p<0.01 and r=0.681, p<0.01 and r=0.689, p<0.01 for endocardium, transmural and epicardium, respectively). Conclusion: Our study results suggest that the layer-specific GLS values obtained by STE decrease in RA patients. [ABSTRACT FROM AUTHOR]

In complex cardiovascular surgical reconstructions, conduit materials that avoid possible large-scale structural deformations should be considered. A fundamental mode of mechanical complication is torsional buckling which occurs at the anastomosis site due to the mechanical instability, leading surgical conduit/patch surface deformation. The objective of this study is to investigate the torsional buckling behavior of commonly used materials and to develop a practical method for estimating the critical buckling rotation angle under physiological intramural vessel pressures. For this task, mechanical tests of four clinically approved materials, expanded polytetrafluoroethylene (ePTFE), Dacron, porcine and bovine pericardia, commonly used in pediatric cardiovascular surgeries, are conducted (n = 6). Torsional buckling initiation tests with n = 4 for the baseline case (L = 7.5 cm) and n = 3 for the validation of ePTFE (L = 15 cm) and Dacron (L = 15 cm and L = 25 cm) for each are also conducted at low venous pressures. A practical predictive formulation for the buckling potential is proposed using experimental observations and available theory. The relationship between the critical buckling rotation angle and the lumen pressure is determined by balancing the circumferential component of the compressive principal stress with the shear stress generated by the modified critical buckling torque, where the modified critical buckling torque depends linearly on the lumen pressure. While the proposed technique successfully predicted the critical rotation angle values lying within two standard deviations of the mean in the baseline case for all four materials at all lumen pressures, it could reliably predict the critical buckling rotation angles for ePTFE and Dacron samples of length 15 cm with maximum relative errors of 31% and 38%, respectively, in the validation phase. However, the validation of the performance of the technique demonstrated lower accuracy for Dacron samples of length 25 cm at higher pressure levels of 12 mmHg and 15 mmHg. Applicable to all surgical materials, this formulation enables surgeons to assess the torsional buckling potential of vascular conduits noninvasively. Bovine pericardium has been found to exhibit the highest stability, while Dacron (the lowest) and porcine pericardium have been identified as the least stable with the (unitless) torsional buckling resistance constants, 43,800, 12,300 and 14,000, respectively. There was no significant difference between ePTFE and Dacron, and between porcine and bovine pericardia. However, both porcine and bovine pericardia were found to be statistically different from ePTFE and Dacron individually (p < 0.0001). ePTFE exhibited highly nonlinear behavior across the entire strain range [0, 0.1] (or 10% elongation). The significant differences among the surgical materials reported here require special care in conduit construction and anastomosis design. [ABSTRACT FROM AUTHOR]

Objectives: To use pericardial adipose tissue (PAT) radiomics phenotyping to differentiate existing and predict future heart failure (HF) cases in the UK Biobank. Methods: PAT segmentations were derived from cardiovascular magnetic resonance (CMR) studies using an automated quality-controlled model to define the region-of-interest for radiomics analysis. Prevalent (present at time of imaging) and incident (first occurrence after imaging) HF were ascertained using health record linkage. We created balanced cohorts of non-HF individuals for comparison. PyRadiomics was utilised to extract 104 radiomics features, of which 28 were chosen after excluding highly correlated ones (0.8). These features, plus sex and age, served as predictors in binary classification models trained separately to detect (1) prevalent and (2) incident HF. We tested seven modeling methods using tenfold nested cross-validation and examined feature importance with explainability methods. Results: We studied 1204 participants in total, 297 participants with prevalent (60 ± 7 years, 21% female) and 305 with incident (61 ± 6 years, 32% female) HF, and an equal number of non-HF comparators. We achieved good discriminative performance for both prevalent (voting classifier; AUC: 0.76; F1 score: 0.70) and incident (light gradient boosting machine: AUC: 0.74; F1 score: 0.68) HF. Our radiomics models showed marginally better performance compared to PAT area alone. Increased PAT size (maximum 2D diameter in a given column or slice) and texture heterogeneity (sum entropy) were important features for prevalent and incident HF classification models. Conclusions: The amount and character of PAT discriminate individuals with prevalent HF and predict incidence of future HF. Clinical relevance statement: This study presents an innovative application of pericardial adipose tissue (PAT) radiomics phenotyping as a predictive tool for heart failure (HF), a major public health concern. By leveraging advanced machine learning methods, the research uncovers that the quantity and characteristics of PAT can be used to identify existing cases of HF and predict future occurrences. The enhanced performance of these radiomics models over PAT area alone supports the potential for better personalised care through earlier detection and prevention of HF. Key Points: •PAT radiomics applied to CMR was used for the first time to derive binary machine learning classifiers to develop models for discrimination of prevalence and prediction of incident heart failure. •Models using PAT area provided acceptable discrimination between cases of prevalent or incident heart failure and comparator groups. •An increased PAT volume (increased diameter using shape features) and greater texture heterogeneity captured by radiomics texture features (increased sum entropy) can be used as an additional classifier marker for heart failure. [ABSTRACT FROM AUTHOR]