A Biomechanical Double Sac (Pericardium-Pebax) for Specially Shaped Artificial Ventricles: A Computerized Study to Evaluate Its Mechanical and Volumetric Properties

Abstract: For original ovoid shaped artificial ventricles. a biomechanical double sac consisting of a biological sac (porcine pericardium) as the blood contact interface and a synthetic sac (Pebax 3533) as the mechanical support to assume systolic-diastolic dynamic constraints was conceived. The volumetric and mechanical properties were assessed with a three-dimensional modeling of Pebax sacs and computerized simulations of their systolic distortions for both right and left ventricular configurations. The stresses and strains of these sacs were represented as quantitative mappings for a maximum end-systolic state and were below the respective threshold values above which the Pebax material is jeopardized for permanent structure impairment. After fatigue tests applied on Pebax strips under the alleged working conditions of Pebax sacs, the material structure was unchanged and maintained its intrinsic mechanical properties. The theoretical maximum stroke volumes were 74.4 cm³ and 62.4 cm for the left and right ventricular configurations, respectively. With these mechanical and volumetric features, the biomechanical double sac concept was considered valid and could be provided for a consequent specific total artificial heart.     

AN AUTOPSY CASE OF PRIMARY ANGIOSARCOMA OF THE PERICARDIUM MIMICKING MALIGNANT MESOTHELIOMA

The pathology of a rare case of primary diffuse angiosarcoma of the pericardium is reported. Grossly, the heart was entirely encased by the pericardial tumor, and the myocardium was only superficially invaded by the tumor. The tumor tissue extended directly to the mediastinum, where the great vessels were embedded in the tumor. A few minute distant metastases were found only in the bilateral lungs and pulmonary hilar lymph nodes. Microscopically, the tumor tissue was composed of malignant cells forming vascular channels admixed with solid areas. Histo- and immunohistochemically, no mesothelial characteristics were evident. Factor VHI-related antigen and Ulex'europaeus I lectin were positive, implying that the tumor was of vascular origin. Grossly, and in part microscopically, this case resembled malignant diffuse mesothelioma, indicating that pericardial angiosarcoma may sometimes mimick malignant mesothelioma. ACTA PATHOL JPN 38: 1345-1351, 1988.     

心包内处理肺静脉根部或切除部分左房在晚期肺癌手术中的应用

目的:探讨切开心包处理肺静脉或切除部分左心房对提高晚期肺癌患者的外科手术切除率及提高手术疗效的作用.方法:对21例晚期肺癌患者施行肺叶或全肺切除时,在心包内处理肺静脉或切除部分左心房.其中左肺下叶切除6例、左全肺切除4例、右肺中下叶切除6例、右肺下叶切除3例、右全肺切除2例.结果:21例均手术顺利;术后并发心律失常2例,肺炎2例,均治愈.本组1年生存率61.9%(13/21)、3年生存率38.1%(8/21),其中2例生存＞5 a.结论:晚期肺癌累及肺静脉根部或左心房时,通过切开心包处理肺静脉或同时切除部分左心房可提高肿瘤的根治率.     

Congenital absence of the pericardium and its relationship to the ligamentum arteriosum

Summary An anatomic and embryologic study of congenital absence of the pericardium and the relationship of the ligamentum arteriosum to this defect was carried out by the authors. A case report is presented to clinically correlate the anatomic and radiologic findings in this anomaly. The authors propose that visualization of the ligamentum arteriosum by computed tomography is a characteristic sign for congenital absence of the left pericardium.

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Absence congénitale de péricarde, ses relations avec le ligament artériel

Résumé Les auteurs ont effectué une étude anatomique et embryologique de l'absence congénitale du péricarde et des relations entre le ligament artériel et cette absence. Ils rapportent une observation à propos de laquelle ils établisent les corrélations cliniques des données anatomiques et radiologiques de cette variation. Ils suggèrent que la visualisation du ligament artériel par tomodensitométrie soit interprétée comme un signe caractéristique de l'absence congénitale du péricarde gauche.

     

Cardiac tamponade due to advanced gastric cancer: case report and review

Introduction and importancePericardial involvement due to gastric cancer is uncommon, especially when it is secondary to direct tumor infiltration. Its manifestation as cardiac tamponade is an exceptional situation that represents a challenge for the treating medical team.Case presentationa case of a patient with advanced gastric cancer with cardiopericardial infiltration, complicated with cardiac tamponade is reported. A narrative review of the diagnostic and therapeutic management was performed.Clinical discussionThere are no well-established diagnostic and therapeutic algorithms.ConclusionsIt is such an exceptional entity that most of the available bibliography is based on case reports or expert opinions. It is a situation with a very bad prognosis.     

Treatment of aortic and peripheral prosthetic graft infections with bovine pericardium

ObjectiveGraft infections are rare but serious complications of vascular operations. The aim of this study was to evaluate the results of in situ reconstruction with bovine pericardium in infected aortic and peripheral vessel fields.MethodsA retrospective cohort study was conducted with a focus on the treatment of infected grafts with bovine pericardium. We retrospectively reviewed 19 consecutive patients with prosthetic graft infections and in situ repair with bovine pericardium. All operations were done between March 2015 and January 2018. No other materials were used. Excision of the infected graft, radical débridement of the infected tissue, and in situ reconstruction with bovine pericardium were applied in all patients. Short-term outcomes including primary patency, freedom of reinfection, mortality, and complication rates were analyzed.ResultsBovine pericardium was used in 19 patients (84% male) with a median age of 70 years (range, 56-84 years) to reconstruct the descending aorta (n = 1), abdominal aorta (n = 5), iliac artery (n = 4), and femoral artery (n = 9). Graft infections were observed in all patients (one thoracic endovascular aneurysm repair, three infrarenal endovascular aneurysm repairs, two open aortic repairs, four iliac-femoral reconstructions, and nine femoral reconstructions including two closure device infections after coronary angiography). Ten patients (53%) had a complication perioperatively and postoperatively. The 30-day mortality was 10.5%; the total mortality rate after 1 year was 32%. There was no reinfection after bovine reconstruction observed in our cohort. Graft occlusions were detected in two cases during follow-up (median, 6 months; range, 1-47 months).ConclusionsBovine pericardium reconstruction shows a good short-term outcome after aortic or peripheral graft infections. It is associated with good patency, low reinfection rate, and acceptably low early mortality rate. It can be a good therapeutic option in prosthetic graft infections when in situ repair with a prosthetic (even soaked) or autologous vein or homograft is not recommended or is not possible.     

Pericardite – apresentação e características numa população pediátrica

Introduction

Pericarditis is an inflammation of the pericardium. It may be infectious or secondary to a systemic disease. The aim of this study was to analyze the clinical findings, course, treatment and follow‐up of children diagnosed with pericarditis at our center.

心外膜脂肪厚度、CT值及Syntax评分与冠心病的关系

目的探讨心外膜脂肪厚度、CT值及心脏外科与介入治疗狭窄冠脉研究(Syntax)评分与冠心病的关系。 方法选取2017年2月至2018年10月就诊于临沂市兰陵县人民医院心血管内科,经冠状动脉造影检查确诊的冠心病患者,共69例作为研究组,另选同期正常健康体检者60例作为对照组。两组均行冠状动脉CT血管成像(CTA)检查,比较心外膜脂肪厚度及CT值。分析冠心病患者造影结果,计算Syntax评分,比较不同水平Syntax评分冠心病患者心外膜脂肪厚度及CT值差异。 结果研究组患者甘油三酯[(1.62±0.68)mmol/L]、总胆固醇[(5.12±1.83)mmol/L]水平明显高于对照组[(1.50±0.53)mmol/L,(4.90±1.20)mmol/L](t＝4.60,3.82;均P<0.05);研究组高密度脂蛋白胆固醇[(1.49±0.43)mmol/L]和低密度脂蛋白胆固醇[(2.45±0.63)mmol/L]水平与对照组[(1.50±0.55)mmol/L,(2.50±0.55)mmol/L]比较,均差异无统计学意义(t＝0.55,0.34;均P>0.05)。研究组心外膜脂肪厚度[(12.30±2.66)mm]高于对照组[(9.50±1.85)mm](t＝8.60,P<0.01);研究组心外膜脂肪CT值[(-98.60±15.66)HU]高于对照组[(-70.55±9.82)HU](t＝19.36,P<0.01);低积分组冠心病患者心外膜脂肪厚度[(11.30 ± 2.20)mm]、心外膜脂肪CT值[(-90.60±9.55)HU]、平均Syntax评分[(-17.32±8.42)分]低于高积分组冠心病患者[(14.50±2.76)mm、(-115.30±13.36)HU、(-30.44±9.19)分],均差异有统计学意义(t＝6.42,9.58,21.15;均P<0.01)。 结论心外膜脂肪厚度、CT值可能影响冠心病患者Syntax评分结果,可作为患者病情评估的参考指标,有推广价值。     

Anthropomorphic simulator for minimally invasive epicardial access procedures

We have developed a prototype, in?vitro anthropomorphic model for simulating pressure-guided, subxiphoid access procedures done to enable minimally invasive epicardial cardiac procedures including treatments for ventricular tachycardia. Life-size replicas of the heart and lungs were modelled using anatomically accurate surrogates. The dynamic pressure–frequency profiles of simulated pericardial fluid surrounding the water-pumped replica heart were measured and validated against previously acquired human intrapericardial pressure observations (Pearson's r?=?0.88, p?<?0.001). In replicating access procedures for approaching and entering the pericardial space, the system produced physiologically appropriate pressure measurements at each intermediate point along the needle's insertion pathway. Details of construction and performance are presented and discussed.