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Left ventricular pseudoaneurysm after myocardial infarction detected by cardiac MRI.

ABSTRACT: Left ventricular free wall rupture (LVFWR) is a grave complication of acute myocardial infarction. Acutely, it has an extremely high rate of mortality, especially if undetected. Chronically, there is paucity of data on how to manage the pathology, especially if detected as an incidental finding. We present a unique case of initially undetected LVFWR in a patient who presented with repeated chest pain. Cardiac MRI enabled the diagnosis and localisation of the original site of LVFWR and provided highly relevant volume calculations. Measurement of both absolute and virtual volumes indicated that aneurysm resection, including the original site of rupture, was surgically feasible without reducing postoperative stroke volume.

SUBMITTER: Orsborne C

PROVIDER: S-EPMC4248130 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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Left ventricular pseudoaneurysm after myocardial infarction detected by cardiac MRI.

Orsborne Christopher C Schmitt Matthias M

BMJ case reports 20141125

Left ventricular free wall rupture (LVFWR) is a grave complication of acute myocardial infarction. Acutely, it has an extremely high rate of mortality, especially if undetected. Chronically, there is paucity of data on how to manage the pathology, especially if detected as an incidental finding. We present a unique case of initially undetected LVFWR in a patient who presented with repeated chest pain. Cardiac MRI enabled the diagnosis and localisation of the original site of LVFWR and provided h ...[more]

PMID: 25425353

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Project description:We report a genome-wide survey of early responses of the mouse heart transcriptome to acute myocardial infarction (AMI). For three regions of the left ventricle (LV), namely ischemic/infarcted tissue (IF), the surviving LV free wall (FW) and the interventricular septum (IVS), 36,899 transcripts were assayed at six time points from 15 min to 48 h post-AMI in both AMI and sham surgery mice. For each transcript, temporal expression patterns were systematically compared between AMI and sham groups, which identified 515 AMI-responsive genes in IF tissue, 35 in the FW, 7 in the IVS, with three genes induced in all three regions. Using the literature, we assigned functional annotations to all 519 nonredundant AMI-induced genes and present two testable models for central signaling pathways induced early post-AMI. First, the early induction of 15 genes involved in assembly and activation of the activator protein-1 (AP-1) family of transcription factors implicates AP-1 as a dominant regulator of earliest post-ischemic molecular events. Second, dramatic increases in transcripts for arginase 1 (ARG1), the enzymes of polyamine biosynthesis and protein inhibitor of nitric oxide synthase (NOS) activity indicates that NO production may be regulated, in part, by inhibition of NOS and coordinate depletion of the NOS substrate, L-arginine. ARG1 was the single most highly induced transcript in the database (121-fold in IF region) and its induction in heart has not been previously reported. Keywords: heart attack, mouse, time course, regional responses We report temporal and regional changes in steady state mRNA levels in the mouse LV following a surgically-induced AMI. Three regions of the infarcted LV were surveyed: IF, FW and IVS. For each region, mRNA levels were assayed at t=0 and six time points after occlusion of the left anterior descending coronary artery (t = 15 min, 1 h, 4 h, 12 h, 24 h, 48 h). As control, an identical time course was carried out in the mouse LV after sham surgery in which the suture was passed under the artery, but not ligated. For sham surgical mice and naïve mice (t=0), the IVS and the LV free wall were harvested and assayed. The AMI and sham time courses were repeated for a total of two independent repetitions of the experiment. For each repetition, 96 GeneChips were hybridized. Thus, for two repetitions, 192 GeneChips (2 x 96) were hybridized. In addition, the naïve time point was assayed a second time during Repetition 1 for six additional GeneChips (two tissues x three chips). The overall total number of samples is 198 GeneChips (192 + 6). Total RNA was isolated from each individual tissue sample. Equal weights of total RNA from 4-10 mice were combined for each LV region, time point and treatment. Copy RNA mixtures were synthesized from each total RNA pool and hybridized to the Affymetrix GeneChip set MG U74 v2 (A, B, and C) that carries 36,899 probe sets. The global normalization of fluorescence emissions for the 198 GeneChips used in this study and their conversion to relative transcript concentrations measured in relative fluorescence units (RFU) was conducted using Robust Multi-array Averaging (RMA; www.bioconductor.org). Each of the 198 Accessions is titled as follows: time point / treatment / tissue, repetition, GeneChip. The additional assays of naïve mice in Repetition 1 are labeled “Naive2”.

Dataset Information

Left ventricular pseudoaneurysm after myocardial infarction detected by cardiac MRI.

Publications

Left ventricular pseudoaneurysm after myocardial infarction detected by cardiac MRI.

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