A-Ghr is involved in cardiac function and has little effect on their physique in infants with CHD.
The outcome of stent implantation for pulmonary vein stenosis (PVS) in children remains poor. Several reports describe placing drug-eluting stents to treat PVS, but their effectiveness remains unknown. In this study, three bare-metal stents (BMSs) and three sirolimus-eluting stents (SESs) were implanted in 1-month-old pigs. The pigs were killed 8 weeks later to compare in-stent stenosis rates. The extent of neointimal thickness, as measured by injury score, was significantly less in the SES group than in the BMS group (injury score 1: BMS 0.351 + or - 0.033 vs SES 0.226 + or - 0.031 mm; P < 0.01; injury score 2: BMS 1.232 + or - 0.244 vs SES 0.609 + or - 0.208 mm; P < 0.01). The pathologic findings showed confluence of inflammatory cells around the stent wires in BMS-treated areas and granuloma formation. Granuloma formation was not seen with SES. The degree of in-stent stenosis was significantly reduced in the SES group, suggesting that the use of drug-eluting stents is an effective treatment for PVS. Because of the small sample size and the considerable variation in injury scores and balloon-to-vein ratios, future studies with larger samples are necessary.
No specific parameter that reflects the progress in liver fibrosis was identified in this study. The possibility exists that type IV collagen reflects the degree of hepatic congestion.
Background: Studies have reported that heparin and exercise may alleviate myocardial ischemia in patients with Kawasaki disease (KD).Moreover, exercise alone can alleviate ischemic heart disease, e.g., cardiac rehabilitation in adult coronary disease. Exercise induces secretion of some growth factors and improves endothelial function. We found that exercise may play a role in physiologically increasing the diameter of the coronary artery(CA) in KD patients with history of coronary aneurysm. Clinical course: We report the case of a 9-year-old boy who had been admitted to our hospital at 6 months of age. He had long-term fever, rash, peripheral edema, conjunctivitis, and strawberry tongue and was diagnosed with KD. We treated him with a high dose of gamma globulin and pulse therapy. Despite these treatments, he developed coronary aneurysms on both sides. In the left descending artery (LAD), the aneurysmal diameter was 8 mm. We initiated treatment with warfarin and aspirin and performed angiography twice in the acute phase and at one year after admission, followed by magnetic resonance coronary angiography every 6 months. At 6 years of age, the aneurysmal changes disappeared. We stopped warfarin and started regular exercise on a weekly basis (1 hour of running and 2 hours of baseball). After initiation of exercise,echocardiography showed that LAD diameter increased from 2.8 mm to 3.5 mm. At 9 years of age, we performed angiography and intravascular ultrasound (IVUS) to determine whether this increase in diameter was due to recurrent aneurysmal change or physiological change. The diameter of the LAD was 3.5 mm (>+2 SD of normal). IVUS showed that there was a small amount of endothelial hypertrophy but no irregularity, calcification, or thrombus. Thus, we concluded that this dilatation was not an inflammatory change but a physiological change. Conclusion: Regular exercise may play a role in improving CA lesions through arterial dilatation and improvement of endothelial function.
Background: Kawasaki Disease (KD)-related coronary artery aneurysm results in stenotic lesions due to thrombus formation and intimal thickening. In its acute phase, KD may follow an acute course due to thrombotic occlusion leading to myocardial infarction. On the other hand, in the convalescent phase, it does not follow a rapid course due to the development of collateral circulation and often occurs with chest pain. In this study, we retrospectively analyzed the following variables in patients who underwent bypass surgery: clinical course until initiation of surgical treatment, indication of surgical treatment. Subjects and Methods: The subjects were 15 patients who underwent coronary artery bypass graft (CABG) surgery at our hospital (male:female ratio, 8:7; age, 24-58 years; mean age, 38.3 years). In these subjects, we examined the age at onset, period until initiation of surgical treatment, presence or absence of symptoms, radiographic findings, indications for surgical treatment, and operative methods. Results: The age at onset of KD was between 6 months and 12 years. For 3 patients, KD was not diagnosed in childhood and the diagnosis was based on calcification and chest radiography findings. The period from onset to surgical treatment ranged 7-42 years (mean, 25.6 years). Most of the subjects underwent surgical treatment during adulthood. Radiography showed bilateral lesions in 14 patients, complete occlusion of the right coronary artery in 5 patients, and calcification in 4 patients. Collateral circulation developed in all subjects who underwent surgical treatment during adulthood. Although exertional chest pain was observed in 9 patients, no patient required emergency CABG. Surgical treatment involving the bilateral inferior mesenteric arteries was performed in 14 patients. In 2 patients, a bulky mass was resected from the right coronary artery. Conclusion: The mean age at surgery was approximately 40 years. There were many subjects in whom the time elapsed since disease onset was long, which was presumably attributed to the development of collateral circulation. Therefore, it is necessary to examine such patients using diagnostic imaging or stress myocardial scintigraphy even if they are asymptomatic.
Background:Stenotic changes after stent implantation for coarctation of the aorta remain a major problem. There are only a few studies examining pathological vascular changes of the great arteries after stenting in the pediatric population.Aim:Using immunohistochemistry, we investigated the involvement of chronic inflammation in in─stent stenosis of abdominal great arteries after stent implantation in juvenile pigs.Methods: Five pigs, aged 4─5 weeks with body weights ranging from 8─10 kg, were used for this study. Stents were implanted in the abdominal great artery. Abdominal arteries with stents were later collected and stained with hematoxylin and eosin. Immunological staining was also performed for the intima, using vascular endothelial growth factor (VEGF) , interleukin─8( IL─8) , cyclooxygenase 2(COX─2)and peroxisome proliferators activated receptor gamma(PPAR c) antibodies.Results:Only one of five samples showed stenotic change due to neointimal proliferation.Neutrophil recruitment in the neointima was confirmed by H & E stain at the site of stenosis. VEGF, IL─8, COX─2 and PPAR c expressions in the neointima were also increased at the site of stent implantation compared with those in normal tissue.Conclusion: Our data suggest that chronic inflammation is involved in the pathogenesis of in─ stent stenosis after stent implantation. Management of inflammation may be important to prevent stenotic change after stenting in pediatric cardiology.
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