Background: Partial anomalous pulmonary venous connection (PAPVC) occurs when at least one pulmonary vein drains into the right atrium or its tributaries rather than the left atrium, most commonly connecting with the superior vena cava (SVC). The Warden procedure involves transecting the SVC proximal to the uppermost connection of the pulmonary vein followed by proximal SVC reattachment to the right atrial appendage. However, descending thoracic aortic homograft replacement for SVC translocation has recently been introduced as a modified technique. Aims: This commentary aims to discuss the recent study by Said and colleagues who reported their experiences with 6 PAPVC cases undergoing a modified Warden procedure using thoracic aortic homograft SVC translocation. Methods: A comprehensive literature search was performed using multiple electronic databases in order to collate the relevant research evidence. Results: The Warden procedure is associated with a 10% incidence of SVC obstruction with many requiring reintervention. Meanwhile, using the aortic homograft for SVC translocation, Said et al. observed no SVC obstructions. In addition, this modified technique does not require anticoagulation and has demonstrated an improvement in long-term SVC patency. Nevertheless, it can be considered an expensive procedure. Moreover, since the thoracic aortic homograft utilised is biological tissue, only long-term follow-up will determine whether calcification and graft degeneration is an issue. Conclusion: It can be concluded that the modified Warden procedure is a safe and effective method to reconstruct the systemic venous drainage into the right atrium when a direct anastomosis under tension might be prone to re-stenosis.
The authors performed a detailed retrospective analysis of diabetic patients undergoing isolated coronary artery bypass graft surgery (CABG) aiming to investigate the association of the preoperative Glycosylated hemoglobin with occurance of postoperative atrial fibrillation. Altough statistical analysis showed a weak relationship between HbA1c values of 9.06% or above and PoAF, they concluded that serum level of HbA1c could not be used as a predictor for the development of PoAF. But there are many questions to be asked and answers to be found.
Prolonged Remission in Multiple Relapsed MLL-rearranged Infant B-ALL with Inotuzumab OzogamicinAkhila Lattupally MD1, Adonis Lorenzana MD1, Gregory Anthony Yanik MD2, Danielle Bell MD1,31. Ascension St. John Children’s Hospital, Detroit, Michigan, United States.2. C.S. Mott Children’s Hospital – University of Michigan, Ann Arbor, Michigan, United States.3. Children’s Hospital of Michigan, Detroit, Michigan, United States.Corresponding Author: Akhila Lattupally MDAddress: 22101 Moross Rd, PB2, Suite 70, Detroit, Michigan 48236Phone: 469-468-7978Fax: 313-343-4756Email:Akhila.Lattupally@ascension.orgWord Count: Main text: 841 wordsNumber of Tables: 0 Number of Figures: 0 Number of Supporting Information Files: 0Running Title: Remission in Infant ALL with Inotuzumab Ozogamicin.Keywords: Infant Leukemia, ALL Relapse, Immunotherapy
The management of patients with transposition complex in combination with an interrupted aortic arch (IAA) presents a technical challenge to the surgeon to decide which is the best approach to correct both defects. This is a rare disorder and with significant variation in anatomic arrangements deciding on the ideal surgical repair. Over time a single-stage approach to repair has become standard.
Kawasaki Disease (KD) is a systemic vasculitis of small and medium arteries, preferably affecting coronary arteries. It is one of the most frequent causes of acquired heart disease in children. Despite being comprehensively studied, its etiopathogenesis is not totally explained. The surgical procedures usually become necessary during the late follow-up and may be coronary artery bypass grafting, cardiac defibrillator implantation with or without cardiac resynchronization therapy, or cardiac transplantation.
Mitral regurgitation in Barlow disease may still be challenging to be repaired . Most often it involves the posterior leaflet . Many techniques and concepts are currently available ; the main goal being to restore a good surface of coaptation . Basic principles such a thorough analysis is still required whatever the approach to assess excess tissue height , width and prolapse . Nowadays it seems that two different ways of treating mitral prolapse coexist : the non resection one and the resection one .Both will be discussed and analysed . Similarly the use of artificial chordae seem to have a preponderant role to support the free edge and correct a prolapse . Native secondary chord transfer are easy and reliable but seem abandoned by many . Anterior leaflet prolapse is also dealt with and fewer options are available to address this leaflet . Then commissural prolapse is mentioned . It is an important area of the valve which should deserve better treatment than commissuroplasty . Finally a special entity will be described ; mitro annular disjonction . The approach is not or no longer an issue as only good long term results are important in an era where per cutaneous therapy is the only non invasive technique .
TITLE PAGE Title: Letter to the Editor: Early experience of aortic surgery during the COVID-19 pandemic in the United Kingdom: A multicenter studyArticle type: Letter to the editorCorrespondence : 1. Sara AlzagloolContact: +962797244907 Email: Sarah97.email@example.comInstitute: Al-Bashir HospitalAddress: Al Bashir Hospital، Ossamah Ben Zeid St. 261, Amman, JordanCo-authors : 2. Osama Al-JaiuossiContact: +962788003306 Email: Osamaeyad@ymail.comInstitute: Al-Bashir HospitalAddress: Al Bashir Hospital، Ossamah Ben Zeid St. 261, Amman, JordanWords count: 480Conflict of interest: NoneFunding: NoneAcknowledgement: NoneDeclaration: None
Saltwater- and freshwater environments have opposing physiological challenges, yet, there are fish species that are able to enter both habitats during short time-spans, and as individuals they must therefore adjust quickly to osmoregulatory contrasts. In this study, we conducted an experiment to test for plastic responses to abrupt sainity changes in two poplulations of threespine stickleback, Gasterosteus aculeatus, representing two ecotypes (freshwater and ancestral saltwater). We exposed both ecotypes to abrupt native (control treatment) and non-native salinities (0 and 30‰) and sampled gill-tissue for transcriptomic analyses after six hours exposure. To investigate genomic responses to salinity, we analysed four different comparisons; one for each ecotype (in their control and exposure salinity; 1 and 2), one between ecotypes in their control salinity (3), and the fourth comparison included all transcripts identified in (3) that did not show any expressional changes within ecotype in either the control or the exposed salinity (4). Abrupt salinity transfer affected the expression of 10 and 1530 transcripts for the saltwater and freshwater ecotype, respectively, and 1314 were differentially expressed between the controls, including 502 that were not affected by salinity within ecotype (fixed expression). In total, these results indicate that factors other than genomic expressional plasticity are important for osmoregulation in stickleback, due to the need for opposite physiological pathways to survive the abrupt change in salinity.
Title Page:Title : Letter To the Editor: Outcomes of Preoperative Antiplatelet Therapy in Patients With Acute Type A Aortic DissectionArticle Type : Letter To The EditorCorrespondence : 1. Sandhya KumariContact no: +92-3321346164 Email: firstname.lastname@example.orgInstitute: Ziauddin University KarachiAddress: Bungalow Number 7/2, 26th Street, Tauheed Commercial Area, Phase 5 Defence Karachi.ORCID: 0000-0001-8842-8738Co-Author : 2. Roomi RajaContact No: +92-3342946940 Email: Romirajagoindani@yahoo.comInstitution: Ziauddin University KarachiAddress: Hemilton Courts Block G-1 Flat 408 Near Teen Talwar Clifton KarachiORCID: 0000-0001-9104-3644Word Count : 340Conflict of interest : NoneAcknowledgement : NoneDeclaration : NoneDisclosure : NoneFunding : NoneDear Editor,We have, in recent times, read with great interest the article entitled “ Outcomes of Preoperative Antiplatelet Therapy in Patients With Acute Type A Aortic Dissection” by Xuan Jiang MD et al.1 We highly appreciate the author’s efforts towards this highly sensitive topic and it needs to be applauded by the readers.We acknowledge the primary conclusion of the article that patients receiving antiplatelet therapy before having surgery for acute type A aortic dissection is associated with increased mortality and increased need for blood transfusions. However, some concerns appear, disturbing the validity of the study.Even though the authors have highlighted the use of multiple different antiplatelet drugs before the surgery such as ticagrelor, clopidogrel and aspirin, there remains some factors that made an impact on the findings. Firstly, the authors should have considered the patients who are on Dual antiplatelet therapy because mortality and blood transfusion rate in patients using dual antiplatelet therapy is higher as compared to a single antiplatelet drug user.2 Secondly, the authors should have widened their inclusion criteria and could have included patients with preoperative characteristic such as cardiac tamponade and lower systolic blood pressure, like the study of 2014 included these two as variables and found increased prevalence of mortality associated with these variables.3Thirdly, the authors should have classified the patients using Debakey class 1,2 and Penn class A,B,C classifications. For example, a study in 2019 stated that the patients who experienced major bleeding were associated with Debakey class 1 and higher Penn class.4 Lastly, the authors should have taken into consideration some measures while transferring a patient to the ICU to minimize the mortality rate. For example, a study of 2022 stated that patients on new oral anticoagulants required norepinephrine and other inotropic agents while transferring to ICU as compared to patients taking warfarin (Coumadin).5In last, additional new studies should be conducted on patients receiving antiplatelet therapy before undergoing mitral valve surgery so that incidents leading to mortality goes down and prognosis becomes better.References:1- Jiang X, Khan F, Shi E, Fan R, Qian X, Zhang H, Gu T. Outcomes of preoperativeantiplatelet therapy in patients with acute type A aortic dissection. J Card Surg. 2022Jan;37(1):53-61. doi: 10.1111/jocs.16080. Epub 2021 Oct 17. PMID: 34657299.2- Chemtob RA, Moeller-Soerensen H, Holmvang L, Olsen PS, Ravn HB. OutcomeAfter Surgery for Acute Aortic Dissection: Influence of Preoperative AntiplateletTherapy on Prognosis. J Cardiothorac Vasc Anesth. 2017 Apr;31(2):569-574. doi:10.1053/j.jvca.2016.10.007. Epub 2016 Oct 11. PMID: 28017673.3- Hansson EC, Dellborg M, Lepore V, Jeppsson A. Prevalence, indications andappropriateness of antiplatelet therapy in patients operated for acute aortic dissection:associations with bleeding complications and mortality. Heart. 2013 Jan;99(2):116-21. doi: 10.1136/heartjnl-2012-302717. Epub 2012 Oct 9. PMID: 23048167.4- Hansson EC, Geirsson A, Hjortdal V, Mennander A, Olsson C, Gunn J, et al.Preoperative dual antiplatelet therapy increases bleeding and transfusions but notmortality in acute aortic dissection type a repair [Internet]. OUP Academic. OxfordUniversity Press; 2019: doi: org/10.1093/ejctz/ezy469. Epub 2019 january 16.5- Sromicki J, Van Hemelrijck M, Schmiady MO, Krüger B, Morjan M, Bettex D, VogtPR, Carrel TP, Mestres CA. Prior intake of new oral anticoagulants adversely affectsoutcome following surgery for acute type A aortic dissection. Interact CardiovascThorac Surg. 2022 Jun 15;35(1):ivac037. doi: 10.1093/icvts/ivac037. PMID:35258082; PMCID: PMC9252133.
Geobacter species have great application potential in remediation processes and electrobiotechnology. In all applications, understanding the metabolism will enable target-oriented optimization of the processes. The typical electron donor and carbon source of the Geobacter species is acetate, while fumarate is the usual electron acceptor. Here, we could show that depending on the donor/acceptor ratio in batch cultivation of G. sulfurreducens different product patterns occur. With a donor/acceptor ratio of 1:2.5 malate accumulated as an intermediate product but was metabolized to succinate subsequently. At the end of the cultivation, the ratio of fumarate consumed and succinate produced was approximately 1:1. When fumarate was added in excess, malate accumulated in the fermentation broth without further metabolization. After the addition of acetate to stationary cells, malate concentration decreased immediately and additional succinate was synthesized. Finally, it was shown that also resting cells of G. sulfurreducens could efficiently convert fumarate to malate without an additional electron donor. Overall, it was demonstrated that by altering the donor/acceptor ratio, targeted optimization of the metabolite conversion by G. sulfurreducens can be realized.
Over the last few years cardiac changed radically and so has the average age of the heart disease population progressively increased. Mitral valve surgery has a significant margin for progress in conservative vs replacement strategy. Mitral disease due to insufficiency in the elderly population has historically suffered from lower repair rates but deficiency alone should not limit repair operations in a specialized environment ensuring good survival.
Background: The management of aortic arch pathologies represents a great challenge and is associated with high rates of mortality and morbidity. A superior endovascular approach via thoracic endovascular aortic repair (TEVAR) has been introduced to treat arch pathologies with specifically designed endografts. This approach was shown to benefit patients who are deemed ‘high risk’ for undergoing OSR as it is a greatly less invasiveness option and thus, yields lower rates of morbidity and mortality. Aims: This commentary aims to discuss the recent study by Tan et al. which reports original data on the neurological outcomes after endovascular repair of the aortic arch using the RELAY™ Branched device. Methods: We carried out a literature search on multiple electronic databases including PubMed, Ovid, Google Scholar, Scopus and EMBASE in order to collate research evidence on the neurological outcomes of endovascular aortic arch repair with TEVAR. Results: Tan and colleagues showed through their original clinical data that the RELAY™ Branched device has a high rate of technical success and favourable neurological outcomes. There were no reported neurological deficits in patients who received the triple-branched RELAY™ Branched device. Conclusion: The RELAY™ Branched endograft is well-established for candidates for aortic arch endovascular repair with favourable neurological outcomes. Multiple considerations can help control the incidence of stroke following endovascular repair. These include optimization of the supra-aortic vessels’ revascularization, weighting the embolic risk in patients with atheromatous disease, and careful preoperative assessment to select the best candidates for arch endovascular repair