Search Results (201)

Background: Hydatid disease, caused primarily by Echinococcus granulosus, remains a significant public health challenge in endemic regions. While hepatic (80–85%) and pulmonary (15–20%) involvements are common, multi-organ dissemination involving rare sites such as the pericardium, diaphragm, and mediastinum occurs in less than 0.1–2% of cases. Case presentation: We present a rare case of a 26-year-old male, a farmer for 10 years, with occupational exposure to dogs and horses, with a personal history of multiple surgically treated abdominal cysts in 2016, admitted after abdominal computed tomography revealed liver cysts greater than 5 cm, as well as mediastinal and diaphragmatic cysts. Histopathological examination of the surgically resected hepatic cyst material confirmed echinococcosis. Serology was also positive for echinococcosis. Echocardiography revealed a pericardial cyst, posterior to the left atrium. Under these circumstances, antiparasitic treatment was initiated by an infectious disease specialist, followed by surgical treatment of the abdominal cysts, confirming the final diagnosis of hydatid disease, and subsequently, surgical treatment of the thoracic hydatid cysts was performed. The postoperative course was complicated by bronchial superinfection with Stenotrophomonas maltophilia, identified from bronchial aspirate culture after extended incubation and managed with trimethoprim–sulfamethoxazole. Conclusions: This case underscores the necessity of lifelong surveillance in hydatid disease, the potential role of postoperative antiparasitic therapy in preventing long-term recurrence, and the vital role of a multidisciplinary team in managing complex, disseminated relapses. Full article

Background/Objectives: Epicardial adipose tissue (EAT), a visceral fat depot located between the myocardium and the visceral pericardium, has emerged as a potential imaging biomarker of cardiometabolic dysfunction and cardiovascular health. This study aimed to evaluate whether computed tomography (CT)-derived epicardial adipose tissue volume (EATV) and epicardial adipose tissue density (EATD) may serve as markers of the effects of major cardiovascular disease risk factors. Methods: This cross-sectional study included 105 participants (mean age: 62.12 ± 11.20 years; 58.1% women) examined with coronary computed tomography angiography. Clinical evaluation included anthropometric assessment, blood pressure measurement, laboratory testing, and questionnaire-based smoking status. EAT was assessed using semi-automatic segmentation on a dedicated post-processing workstation, with visual verification and manual correction, when necessary, within an attenuation range of −190 to −30 HU. Two parameters were analyzed: EATV and EATD. Results: EATV was significantly higher in men, participants with overweight/obesity, participants with dyslipidemia, and participants with type 2 diabetes. EATD was significantly lower in participants with overweight/obesity, dyslipidemia, and type 2 diabetes. Both EATV and EATD were associated with the total number of CVRFs. Correlation analysis showed that EATV was positively associated with age (r = 0.20, p = 0.04), BMI (r = 0.54, p = 0.01), fasting glycemia (r = 0.46, p = 0.01), and total CVRF number (r = 0.51, p = 0.01), whereas EATD was negatively associated with age (r = −0.26, p = 0.01), BMI (r = −0.40, p = 0.01), triglycerides (r = −0.44, p = 0.02), fasting glycemia (r = −0.49, p = 0.01), and total CVRF number (r = −0.40, p = 0.01). In regression analysis, older age, higher BMI, male gender, and dyslipidemia were independent risk factors for higher EATV, while dyslipidemia and type 2 diabetes were independent risk factors for lower EATD. Conclusions: Greater exposure to major cardiovascular disease risk factors was associated with higher EAT volume and lower EAT density, supporting the role of EAT as a structural and metabolic marker of the effects of cardiovascular disease risk factors on cardiovascular health. Full article

Hybrid materials, combining synthetic and biological components, leverage the biocompatibility of biological tissues—even after decellularization—alongside the mechanical strength, durability, and impermeability of synthetic polymers. This study presents the functional assessment of two hybrid conduits developed by coupling decellularized porcine pericardium and decellularized swine intestinal submucosa with a commercial polycarbonate urethane, intended for use as vascular and urinary substitutes, respectively. The response of the hybrid conduits to pulsatile flow was evaluated under physiologically relevant conditions in terms of pressure and flow rate. Their ability to withstand cyclic dilations was assessed using a dedicated image processing method that integrates classical approaches with AI-based segmentation techniques. Mechanical tests were also performed before and after hydrodynamic testing to investigate the potential effects of two different fluids—distilled water and simulated body fluid—on the hybrid materials following cyclic hydrodynamic stimulation. The results demonstrate that hybrid conduits deserve to be subjected to further evaluations to prove their potential use as substitutes in vascular and urological surgical applications. Full article

Objective: Effectively eliminating xenoimmunogenicity and achieving recellularization in cardiac xenografts remains a critical challenge in developing an ideal implantable xenograft. We have previously demonstrated that the removal of major antigens, including Galα1-3Gal (α-Gal) epitope and non-human sialic acid N-glycolylneuraminic acid (Neu5Gc), using α-galactosidase and peptide N-glycosidase F (PNGase-F), enables a synergistic effect with decellularization, significantly reducing the expression of carbohydrate-binding lectins without altering the biomechanical properties of the graft. The aim of this study was to establish an effective method for in vitro recellularization by seeding human mesenchymal stem cells (MSCs) on decellularized cardiac xenografts that had undergone optimal xenoantigen removal using α-galactosidase and PNGase-F. Additionally, this study aimed to evaluate the potential for in vivo recellularization. Methods: Decellularized porcine pericardium scaffolds treated with both enzymes were further modified by forming a fibrin mesh on their surface and within their structure, followed by the attachment of heparin and human vascular endothelial growth factor to the mesh. Subsequently, the scaffolds were seeded with human adipose tissue-derived stem cells for 8 weeks. In vitro recellularization, differentiation, and extracellular matrix remodeling of decellularized and enzyme-treated xenografts were assessed using vimentin, calponin, fibronectin, CD31, VWF, and phalloidin staining. To evaluate the potential for in vivo recellularization, decellularized glutaraldehyde-crosslinked xenografts with anticalcification treatments were seeded with rat bone marrow MSCs and implanted into rats subcutaneously to evaluate cell infiltration and calcification via histology, von Kossa staining, and micro-computed tomography. Results: In decellularized xenografts treated with both enzymes, stronger signals were detected and mesenchymal cell infiltration into the tissue was significantly faster, leading to accelerated recellularization. This recellularization process was more pronounced as time went on, with greater cell infiltration and evidence of cell differentiation. An in vivo study showed that decellularization and anticalcification treatments revealed stronger vimentin staining in histological analysis. The recellularization for our biocompatible scaffolds exhibited a lower degree of calcification compared to the non-recellularized tissue. Conclusions: We successfully developed major xenoantigen-free scaffolds by demonstrating the safety and synergistic effect of α-galactosidase and PNGase-F treatments and proved, for the first time, the effectiveness of recellularization using a human MSC monoculture on xenoantigen-free scaffolds. Furthermore, there was potential for in vivo recellularization of our biocompatible scaffolds seeded with MSCs. Full article

Death rates related to heart failure amount to approximately 50% of deaths globally, and one of the leading causes of heart failure is aortic valve failure, which is treated using prosthetic aortic valves. Porcine pericardium is amongst the materials used to develop a potentially ideal bioprosthetic aortic valve. The mechanical properties of native porcine pericardium are necessary for enhancing a prosthetic aortic valve. The aim of this study was to determine the mechanical properties of porcine pericardium and find optimized material parameters for finite element analysis using five isotropic models. Uniaxial rupture tests were performed using Cellscale biotester to measure the force at rupture, stiffness, and deformation at rupture. Tests were done in circumferential and radial directions, and one-way Anova was used to evaluate different behaviors in both directions. The average coefficient of determination was used to find the model that performed better. Full article

Decellularized extracellular matrix (dECM) scaffolds derived from xenogeneic tissues represent promising biomaterials for tissue engineering. In this study, dECM scaffolds were developed and characterized from four ovine tissues—skin, tunica vaginalis, fascia lata, and pericardium—using a detergent-based decellularization protocol to evaluate decellularization efficiency and extracellular matrix (ECM) preservation. Decellularization was performed using a sequential detergent-based protocol with sodium dodecyl sulfate and Triton X-100. Decellularization efficacy and matrix preservation were evaluated through gross examination, histological analysis, scanning electron microscopy (SEM), and residual DNA quantification. Gross inspection revealed increased translucency and reduced pigmentation in decellularized tissues compared with native counterparts, indicating effective cellular removal while maintaining overall tissue architecture. Histological assessment confirmed the complete absence of nuclear and cytoplasmic material, alongside preservation of collagen-rich extracellular matrix organization. SEM analysis demonstrated well-maintained ultrastructural features, including aligned collagen fibers and porous ECM architecture, with complete removal of epithelial and stromal cellular elements. Quantitative analysis revealed approximately 94% reduction in residual DNA content across all decellularized tissues compared with native controls. This study demonstrated that the employed detergent-based protocol reliably produces structurally preserved, acellular scaffolds from multiple ovine tissues. The resulting biomaterials exhibit structural characteristics that support their potential use in tissue engineering applications, pending further functional validation. Full article

Background/Objectives: Trauma management in emergency departments (EDs) requires rapid and reliable diagnostic tools. The Focused Assessment with Sonography in Trauma (FAST) is a bedside ultrasound examination used for the early detection of free fluid in the intraperitoneal cavity, pericardium, and pleural spaces. Expanding FAST use to trained emergency nurses may support timely bedside evaluation in high-demand settings. However, data on agreement with physicians remains limited. This study aimed to evaluate the inter-rater agreement between a trained emergency nurse and physicians in performing FAST and to explore the diagnostic accuracy of nurse-performed FAST compared with computed tomography (CT). Methods: A prospective pilot observational agreement study was conducted between October and December 2023 in the ED of a general hospital in Cyprus. FAST examinations were independently performed by a nurse trained in FAST and by physicians from the radiology department. Four anatomical areas were assessed: right upper quadrant (RUQ), left upper quadrant (LUQ), subxiphoid-pericardial area (SUPH), and suprapubic area (BLADDER). Findings were recorded independently to promote blinding. Diagnostic performance of nurse-performed FAST was explored in a subset of patients undergoing CT. Results: The sample included 68 trauma patients, of whom 58 underwent FAST by both the nurse and the radiologists and were included in the inter-rater agreement analysis. Fluid was detected in four patients (6.9%) in the RUQ area and in one patient (1.7%) in both the LUQ and SUPH regions, while no positive findings were recorded in the BLADDER area. Agreement in the RUQ area was 98.3% (Cohen’s kappa = 0.85, p < 0.001) while agreement was observed in all cases in the SUPH region (100%, Cohen’s kappa = 1.00, p < 0.001), although this finding was based on a single positive case. High observed agreement was also noted in LUQ (98.3%) and BLADDER regions; however, Cohen’s kappa could not be reliably estimated in these regions due to limited variability and the very small number of positive cases. In a subgroup of patients who underwent CT (n = 23), as well as in an additional Trauma Team subgroup (n = 10), diagnostic accuracy estimates were 100% for sensitivity and specificity; however, these estimates were based on a very small number of positive cases (only two positive cases in each subgroup) and were associated with wide confidence intervals. Conclusions: This pilot study suggests that, under specific training conditions, a trained emergency nurse may achieve a high level of agreement with physician assessments when performing FAST. The findings regarding diagnostic accuracy are preliminary and should be interpreted with caution due to the small sample size and low number of positive cases. Further studies with larger samples and multiple operators are required to confirm these findings and to evaluate their clinical implications. Future research is also needed to determine whether nurse-performed FAST may contribute to improved patient safety and emergency department workflow. Full article

To design novel heart valve bioprostheses, it is extremely important to predict leaflet failure and fatigue for 10–20 years, as the aortic valve opens and closes approximately 40 million times per year. Most studies devoted to aortic valve leaflets mechanical tests employ uniaxial or biaxial tests, which do not fully and explicitly describe the time-dependent biomechanical behavior of this tissue. The aim of this study was to evaluate the viscoelastic response of porcine pericardium using biaxial tensile tests. Biaxial creep tests were performed on a biaxial test machine to evaluate the circumferential and axial behavior of the porcine pericardium under creep testing, and biaxial stress relaxation was used to complement creep. The results showed that the creep behavior was the same in both directions after 1 s, 60 s, 300 s, 900 s, and 1800 s. After 30 min of creep, deformation in the circumferential and radial directions was 3303 $\times {10}^{-6}$ and 5192.9 $\times {10}^{-6}$, respectively. Stress relaxation tests showed the same behavior as creep. At stress relaxation test after 30 min, the pericardium deformation in the circumferential and radial directions was 15.28 kPa and 9.6 kPa, respectively. The Prony series with Levenberg–Marquardt as the optimizer was used to obtain material parameters to use for finite element analysis. The data obtained during such tests can be employed in numerical FSI simulations of novel aortic valve bioprosthesis long-term performance in a patient’s body. Full article

Ectopic liver is a rare anomaly characterized by the presence of hepatic tissue outside its normal anatomical location without continuity with the main liver. Reports of this condition are sporadic in human medicine, and cases in veterinary species remain limited. This condition may arise as a congenital developmental defect or as a consequence of prior traumatic injury leading to fragmentation and displacement of hepatic tissue. This case study describes an incidental intrathoracic ectopic liver identified in a 6-year-old male cat that died of acute suppurative bacterial pneumonia. Necropsy revealed a well-demarcated, encapsulated, large mass within the middle of the caudal mediastinum, unattached to the diaphragm, lungs, or pericardium. Cytologic and histopathologic examinations confirmed the presence of hepatic tissue with preserved lobular architecture. No evidence of previous trauma or diaphragmatic defects was present, supporting the congenital origin. The accompanying severe bacterial pneumonia was unrelated to the mediastinal mass. This study highlights the diagnostic challenges associated with intrathoracic ectopic liver, which can mimic neoplastic or inflammatory masses. Awareness of this entity is essential for accurate diagnosis. Given the documented risk of malignant transformation in ectopic hepatic tissue, surgical excision and histopathological assessment should be considered whenever such lesions are detected. Full article

Pericardial cysts (PCs) are rare, benign congenital abnormalities that are encountered as mediastinal lesions. Despite their rarity, they remain clinically important due to their potential to mimic other mediastinal or cardiac pathologies and their capacity, in select cases, to cause significant complications. PCs are typically identified incidentally on imaging studies such as chest x-ray or transthoracic echocardiography, as most patients remain asymptomatic throughout their lives. When symptoms do occur, they are often nonspecific and related to compression of adjacent structures. Serious complications—including infection, rupture, and, rarely, cardiac tamponade—have been reported, underscoring the importance of accurate diagnosis and appropriate follow-up. Definitive characterization of PCs is best achieved using advanced imaging modalities such as cardiac computed tomography or cardiac magnetic resonance imaging, which help differentiate PCs from other mediastinal masses. While many PCs remain stable or even regress spontaneously, intervention may be warranted for symptomatic patients, enlarging cysts, or when the diagnosis remains uncertain. Therapeutic options include percutaneous aspiration, which carries a risk of recurrence, and surgical resection, which offers definitive treatment with excellent outcomes. This review provides a comprehensive overview of the etiology, clinical manifestations, diagnostic evaluation, differential diagnosis, complications, and management strategies for PCs. Full article

Background: Right ventricular outflow tract (RVOT) reconstruction is frequently performed for pediatric patients with pulmonary valve anomalies, yet optimal techniques remain debated. The equine pericardium offers a promising substrate for pulmonary valve reconstruction but has been understudied in pulmonary valve reconstruction. This study evaluated a novel technique using the equine pericardium to create a cylinder bicuspid pulmonary valve for RVOT reconstruction. Methods: In this retrospective cohort study, 17 pediatric patients (median age: 10 months; 53% male) underwent RVOT reconstruction with equine pericardium between 2023 and 2024. The valve was fashioned from a patch of equine pericardium into a cylinder to create a functionally bicuspid valve. The height of the cylinder ranged from 1.5–2 cm. The diameter was measured around a Hegar dilator corresponding to a valve size z-score of +3. The outcomes included the degree of postoperative pulmonary regurgitation, RVOT pressure gradients, postoperative complications, and reinterventions. Results: Postoperatively, the median peak RVOT pressure gradient decreased significantly from 70 mmHg (IQR: 65–90) to 25 mmHg (IQR: 20–40; p < 0.001). Mild pulmonary regurgitation persisted in one patient (5.9%). Five patients had mild right ventricular dysfunction (29.41%). At a median 3-month follow-up (IQR: 1–8), 17.7% (n = 3) underwent cardiac catheterization. There was no postoperative mortality. Conclusions: Cylinder bicuspid pulmonary valve reconstruction using the equine pericardium effectively reduces RVOT obstruction while maintaining pulmonary valve competence and demonstrates acceptable short-term safety. Having a competent pulmonary valve after repairing the hypoplastic pulmonary valve annulus is very promising; however, the small cohort and limited follow-up preclude definitive conclusions about long-term durability. Larger prospective studies with longer follow-up periods are needed to validate this technique for RVOT reconstruction. Full article

Background/Objectives: Entelon150^® (Vitis vinifera seed extract), losartan, and rosuvastatin have been shown to be effective in reducing calcification and inflammation of bovine pericardium implants. However, no study has compared the effects of the drugs on bioprosthetic heart valve (BHV). This study aimed to compare the anti-calcification and anti-inflammatory effects of each drug in a rat model. Methods: Twenty-eight female Sprague-Dawley rats (two weeks old) were implanted with BHV leaflets in the dorsal subcutis. They were divided into control, losartan (10.3 mg/kg/day), rosuvastatin (2 mg/kg/day), and Entelon150^® (30.8 mg/kg/day) groups. Eight weeks later, the calcium level and inflammatory cell infiltration in the BHV leaflets as well as the expression levels of IL-6, osteopontin, and BMP-2 in the surrounding tissues were measured. Results: Losartan-, Entelon150^®-, and rosuvastatin-treated groups showed a decrease in the calcium content as compared to the control group in the order. A reduction in the inflammatory cell infiltration was observed in the treatment groups (losartan > Entelon150^® > rosuvastatin) as compared to that in the control group. The treatment groups showed a decrease in IL-6, OPN, and BMP-2 expression levels as compared to the control group in the following order: Entelon150^® > losartan > rosuvastatin. Conclusions: The calcification of the BHV leaflets and inflammation of the surrounding tissues in treatment groups were lower than those in the control group and were comparable to each other. Entelon150^® showed comparable anti-inflammatory and anti-calcification effects and may represent a potential therapeutic candidate for prolonging BHV durability, although further validation is required. Full article

Cantrell syndrome (CS) is a rare congenital disorder involving defects in the thoraco-abdominal midline, the diaphragm, the pericardium, the sternum and the heart. Since the initial description of the syndrome, 165 well-documented cases in humans have been reported, demonstrating substantial heterogeneity ranging from complete pentalogy to partial or atypical variants. A systematic review classified body wall defects and associated anomalies into nine categories, which are fully described in the manuscript. The categories include midline defects (UThAb, SUThAb, UAb, SUAb, SUICD, and UH), lateral defects (ThLAb and StLAb), and special cases. Each case was reassessed for umbilical cord status, body wall morphology, cardiac anomalies and additional malformations. Midline defects predominated (153 out of 165 cases, 92.7%), with supraumbilical variants being the most frequent. Umbilical hernias formed a distinct subgroup of ten cases. Lateral defects were uncommon (9 cases, 5.5%) and typically presented as thoracogastroschisis or lateral thoracoabdominoschisis. These defects were often associated with normal umbilical cords. Cardiac anomalies were universal, with ventricular and atrial septal defects being the most common findings. Reclassification revealed that many cases originally labeled as ‘classic pentalogy of Cantrell’ were more accurately classified as partial or atypical forms. This unified framework improves epidemiological understanding and diagnostic precision. From a One Health perspective, it underscores CS as a shared developmental vulnerability across mammalian species. Full article

Introduction: Congenital structural anomalies of the pulmonary artery in children, encompassing defects such as pulmonary atresia (PA), pulmonary stenosis (PS), pulmonary artery hypoplasia, and tetralogy of Fallot (ToF), pose significant challenges in pediatric cardiac surgery due to impaired blood flow in pulmonary circulation. Traditional options for conventional repair—including autologous materials such as the native pericardium and synthetic materials such as artificial patches—have limitations including a lack of growth potential and vulnerability to restenosis over time. ProxiCor^® patches, based on the extracellular matrix (ECM), have emerged as biologically compatible substitutes capable of fostering tissue regeneration. The primary outcomes of this study were the safety (absence of patch-related complications such as restenosis, dilation, aneurysm, infection, or thrombosis) and feasibility (intraoperative handling and surgical success) of ProxiCor^® for pulmonary artery and right ventricular outflow tract (RVOT) reconstruction in a single-center pediatric cohort. Secondary outcomes included mortality, postoperative complications (prolonged mechanical ventilation > 72 h, need for continuous renal replacement therapy (CRRT), and intensive care unit (ICU) and hospital stay), and qualitative echocardiographic assessment of vessel patency during follow-up. Patients and methods: A retrospective analysis was conducted in 25 consecutive pediatric patients who underwent pulmonary artery or RVOT reconstruction with ProxiCor^® at the Department of Pediatric Cardiac Surgery in Poznań (Poland) between the years 2023 and 2024. Surgical techniques, clinical outcomes, and follow-up data were assessed using transthoracic echocardiography (TTE). Results: The median age was 224 (Q1–Q3: 124–362) days, and median weight was 4.2 (Q1–Q3: 2.8–8.5) kg. Procedures targeted repairs of the main pulmonary artery (MPA), right pulmonary artery (RPA), left pulmonary artery (LPA), and RVOT. Diagnoses included tetralogy of Fallot (ToF), pulmonary artery stenosis (PS), pulmonary atresia (PA), pulmonary artery hypoplasia, and anomalous left coronary artery from the pulmonary artery (ALCAPA). The mortality rate stood at 8% (2/25), stemming from multiorgan failure and hemorrhagic stroke, unrelated to the patch. Over a median observation period of 483 (Q1–Q3: 363–584) days, no patch-related complications (e.g., restenosis or dilation) arose. The median hospitalization time was 22 (Q1–Q3: 8.5–38.5) days. Conclusions: ProxiCor^® ECM patches appear to be safe and feasible for use in pulmonary artery and RVOT reconstruction, with favorable early outcomes. However, the small cohort size, lack of a control group, and limited mid- to long-term echocardiographic data preclude definitive conclusions about long-term outcomes or comparative effectiveness. Full article

The physiological relevance of in vitro models is limited because conventional two-dimensional cell culture systems are unable to replicate the structural and functional complexity of native tissues. Extracellular matrix (ECM)-mimetic hydrogels have become important platforms for tissue engineering applications. This work developed hybrid hydrogels that mimic important biochemical and mechanical characteristics of cardiac tissue by combining decellularized bovine pericardium-derived (dBP) ECM, gellan gum (GG), and spermine (SPM). Although dBP offers tissue-specific biological cues, processing compromises its mechanical integrity. This limitation was overcome by adding GG, whose ionic gelation properties were optimized using DMEM and SPM. The hydrogels’ mechanical, biological, physicochemical, and structural characteristics were all evaluated. Under physiologically simulated conditions, the formulations showed quick gelation and long-term stability; scanning electron microscopy revealed an interconnected, ECM-like porous microarchitecture. While uniaxial compression testing provided Young’s modulus values comparable to native myocardium, rheological analysis revealed a concentration-dependent increase in storage modulus with increasing SPM content. H9C2 cardiomyoblasts were used in cytocompatibility studies to confirm that cell viability, morphology, and cytoskeletal organization were all preserved. All of these findings support the potential application of dBP−GG−SPM hydrogels in advanced in vitro cardiac models by showing that they successfully replicate important characteristics of cardiac ECM. Full article