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Volume 7
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J. Cardiovasc. Dev. Dis., Volume 7, Issue 4 (December 2020) – 22 articles

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15 pages, 443 KiB  
Review
Coconuts and Health: Different Chain Lengths of Saturated Fats Require Different Consideration
by Susan Hewlings
J. Cardiovasc. Dev. Dis. 2020, 7(4), 59; https://doi.org/10.3390/jcdd7040059 - 17 Dec 2020
Cited by 28 | Viewed by 11756
Abstract
The diet heart hypothesis has driven nutrition recommendations and policy for decades. Recent studies have questioned the hypothesis and sparked great controversy over the assumed connection between saturated fat intake and heart disease. Recent evidence suggests that dietary patterns should be the focus [...] Read more.
The diet heart hypothesis has driven nutrition recommendations and policy for decades. Recent studies have questioned the hypothesis and sparked great controversy over the assumed connection between saturated fat intake and heart disease. Recent evidence suggests that dietary patterns should be the focus of dietary recommendations, not any one food or nutrient. Furthermore, to classify foods as simply saturated fat, polyunsaturated or monounsaturated fats is to ignore the many other potential nutrients and health benefits. Coconut is classified as a saturated fat and therefore listed as a food to limit to reduce heart disease risk. However, different saturated fats, medium-chain or long-chain, act differently metabolically and thus have different health effects. The medium-chain fatty acids predominate in coconut are absorbed differently and have been associated with several health benefits, including improvements in cognitive function and a more favorable lipid profile compared to longer chain fatty acids. Coconuts provide a healthful source of saturated fats and should not be considered the same as foods with longer chain saturated fats. Future recommendations should take this research into consideration. It is the purpose of this review to discuss the research regarding the connection between saturated fat intake, specifically coconut consumption, and health, while focusing on dietary patterns and lifestyle behaviors. Full article
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12 pages, 5627 KiB  
Communication
Sudden Death in Congenital Heart Disease: The Role of the Autopsy in Determining the Actual Cause
by Mary N. Sheppard
J. Cardiovasc. Dev. Dis. 2020, 7(4), 58; https://doi.org/10.3390/jcdd7040058 - 16 Dec 2020
Cited by 4 | Viewed by 3444
Abstract
Congenital heart defects (CHDs) have undergone a large change in epidemiology due to prenatal screening and improved outcomes with surgery and percutaneous procedures. In patients with complex CHD there is an increased risk of sudden cardiac death (SCD) and up to 11% of [...] Read more.
Congenital heart defects (CHDs) have undergone a large change in epidemiology due to prenatal screening and improved outcomes with surgery and percutaneous procedures. In patients with complex CHD there is an increased risk of sudden cardiac death (SCD) and up to 11% of all SCDs in the young occur in people with CHD. It is essential for clinicians to be aware of the risk factors, and for all patients to be followed up in specialised centres. When an SCD occurs, it is important that an autopsy is done and for the pathologist to have an in-depth knowledge of the particular defect and the corrective surgical techniques employed, as well as any complications due to these procedures. Both pathologist and cardiologist should work closely together to explain the cause of death to the family. A terminal cardiac arrhythmia explains many of the SCD cases, often with underlying cardiac fibrosis due to previous procedures. SCD may also be the first presentation of CHD, so great care is required when examining such cases and referral for a detailed expert opinion is recommended in all CHD-SCD cases. Full article
(This article belongs to the Special Issue Leaders in Cardiovascular Research: A special issue dedicated to Professor Robert Anderson)
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22 pages, 1928 KiB  
Review
Biology and Biomechanics of the Heart Valve Extracellular Matrix
by Karthik M. Kodigepalli, Kaitlyn Thatcher, Toni West, Daniel P. Howsmon, Frederick J. Schoen, Michael S. Sacks, Christopher K. Breuer and Joy Lincoln
J. Cardiovasc. Dev. Dis. 2020, 7(4), 57; https://doi.org/10.3390/jcdd7040057 - 16 Dec 2020
Cited by 48 | Viewed by 8472
Abstract
Heart valves are dynamic structures that, in the average human, open and close over 100,000 times per day, and 3 × 109 times per lifetime to maintain unidirectional blood flow. Efficient, coordinated movement of the valve structures during the cardiac cycle is [...] Read more.
Heart valves are dynamic structures that, in the average human, open and close over 100,000 times per day, and 3 × 109 times per lifetime to maintain unidirectional blood flow. Efficient, coordinated movement of the valve structures during the cardiac cycle is mediated by the intricate and sophisticated network of extracellular matrix (ECM) components that provide the necessary biomechanical properties to meet these mechanical demands. Organized in layers that accommodate passive functional movements of the valve leaflets, heart valve ECM is synthesized during embryonic development, and remodeled and maintained by resident cells throughout life. The failure of ECM organization compromises biomechanical function, and may lead to obstruction or leaking, which if left untreated can lead to heart failure. At present, effective treatment for heart valve dysfunction is limited and frequently ends with surgical repair or replacement, which comes with insuperable complications for many high-risk patients including aged and pediatric populations. Therefore, there is a critical need to fully appreciate the pathobiology of biomechanical valve failure in order to develop better, alternative therapies. To date, the majority of studies have focused on delineating valve disease mechanisms at the cellular level, namely the interstitial and endothelial lineages. However, less focus has been on the ECM, shown previously in other systems, to be a promising mechanism-inspired therapeutic target. Here, we highlight and review the biology and biomechanical contributions of key components of the heart valve ECM. Furthermore, we discuss how human diseases, including connective tissue disorders lead to aberrations in the abundance, organization and quality of these matrix proteins, resulting in instability of the valve infrastructure and gross functional impairment. Full article
(This article belongs to the Special Issue Mitral Valve Development and Disease)
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18 pages, 12048 KiB  
Review
Angiogenesis in the Avian Embryo Chorioallantoic Membrane: A Perspective on Research Trends and a Case Study on Toxicant Vascular Effects
by Warren Burggren and Maria Rojas Antich
J. Cardiovasc. Dev. Dis. 2020, 7(4), 56; https://doi.org/10.3390/jcdd7040056 - 5 Dec 2020
Cited by 13 | Viewed by 4738
Abstract
The chorioallantoic membrane (CAM) of the avian embryo is an intrinsically interesting gas exchange and osmoregulation organ. Beyond study by comparative biologists, however, the CAM vascular bed has been the focus of translational studies by cardiovascular life scientists interested in the CAM as [...] Read more.
The chorioallantoic membrane (CAM) of the avian embryo is an intrinsically interesting gas exchange and osmoregulation organ. Beyond study by comparative biologists, however, the CAM vascular bed has been the focus of translational studies by cardiovascular life scientists interested in the CAM as a model for probing angiogenesis, heart development, and physiological functions. In this perspective article, we consider areas of cardiovascular research that have benefited from studies of the CAM, including the themes of investigation of the CAM’s hemodynamic influence on heart and central vessel development, use of the CAM as a model vascular bed for studying angiogenesis, and the CAM as an assay tool. A case study on CAM vascularization effects of very low doses of crude oil as a toxicant is also presented that embraces some of these themes, showing the induction of subtle changes in the pattern of the CAM vasculature growth that are not readily observed by standard vascular assessment methodologies. We conclude by raising several questions in the area of CAM research, including the following: (1) Do changes in patterns of CAM growth, as opposed to absolute CAM growth, have biological significance?; (2) How does the relative amount of CAM vascularization compared to the embryo per se change during development?; and (3) Is the CAM actually representative of the mammalian systemic vascular beds that it is presumed to model? Full article
(This article belongs to the Special Issue Comparative Developmental Cardiovascular Biomechanics and Bioengineering)
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17 pages, 2925 KiB  
Article
The Needle in the Haystack—Searching for Genetic and Epigenetic Differences in Monozygotic Twins Discordant for Tetralogy of Fallot
by Marcel Grunert, Sandra Appelt, Paul Grossfeld and Silke R. Sperling
J. Cardiovasc. Dev. Dis. 2020, 7(4), 55; https://doi.org/10.3390/jcdd7040055 - 2 Dec 2020
Cited by 11 | Viewed by 3429
Abstract
Congenital heart defects (CHDs) are the most common birth defect in human with an incidence of almost 1% of all live births. Most cases have a multifactorial origin with both genetics and the environment playing a role in its development and progression. Adding [...] Read more.
Congenital heart defects (CHDs) are the most common birth defect in human with an incidence of almost 1% of all live births. Most cases have a multifactorial origin with both genetics and the environment playing a role in its development and progression. Adding an epigenetic component to this aspect is exemplified by monozygotic twins which share the same genetic background but have a different disease status. As a result, the interplay between the genetic, epigenetic and the environmental conditions might contribute to the etiology and phenotype. To date, the underlying causes of the majority of CHDs remain poorly understood. In this study, we performed genome-wide high-throughput sequencing to examine the genetic, structural genomic and epigenetic differences of two identical twin pairs discordant for Tetralogy of Fallot (TOF), representing the most common cyanotic form of CHDs. Our results show the almost identical genetic and structural genomic identity of the twins. In contrast, several epigenetic alterations could be observed given by DNA methylation changes in regulatory regions of known cardiac-relevant genes. Overall, this study provides first insights into the impact of genetic and especially epigenetic factors underlying monozygotic twins discordant for CHD like TOF. Full article
(This article belongs to the Special Issue Leaders in Cardiovascular Research: A Special Issue Dedicated to Professor Adriana Gittenberger-De Groot)
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33 pages, 2728 KiB  
Review
The Intrinsic Cardiac Nervous System and Its Role in Cardiac Pacemaking and Conduction
by Laura Fedele and Thomas Brand
J. Cardiovasc. Dev. Dis. 2020, 7(4), 54; https://doi.org/10.3390/jcdd7040054 - 24 Nov 2020
Cited by 50 | Viewed by 12232
Abstract
The cardiac autonomic nervous system (CANS) plays a key role for the regulation of cardiac activity with its dysregulation being involved in various heart diseases, such as cardiac arrhythmias. The CANS comprises the extrinsic and intrinsic innervation of the heart. The intrinsic cardiac [...] Read more.
The cardiac autonomic nervous system (CANS) plays a key role for the regulation of cardiac activity with its dysregulation being involved in various heart diseases, such as cardiac arrhythmias. The CANS comprises the extrinsic and intrinsic innervation of the heart. The intrinsic cardiac nervous system (ICNS) includes the network of the intracardiac ganglia and interconnecting neurons. The cardiac ganglia contribute to the tight modulation of cardiac electrophysiology, working as a local hub integrating the inputs of the extrinsic innervation and the ICNS. A better understanding of the role of the ICNS for the modulation of the cardiac conduction system will be crucial for targeted therapies of various arrhythmias. We describe the embryonic development, anatomy, and physiology of the ICNS. By correlating the topography of the intracardiac neurons with what is known regarding their biophysical and neurochemical properties, we outline their physiological role in the control of pacemaker activity of the sinoatrial and atrioventricular nodes. We conclude by highlighting cardiac disorders with a putative involvement of the ICNS and outline open questions that need to be addressed in order to better understand the physiology and pathophysiology of the ICNS. Full article
(This article belongs to the Special Issue Leaders in Cardiovascular Research: A special issue dedicated to Professor Robert Anderson)
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12 pages, 3874 KiB  
Communication
A Bioengineered Neuregulin-Hydrogel Therapy Reduces Scar Size and Enhances Post-Infarct Ventricular Contractility in an Ovine Large Animal Model
by Jeffrey E. Cohen, Andrew B. Goldstone, Hanjay Wang, Brendan P. Purcell, Yasuhiro Shudo, John W. MacArthur, Amanda N. Steele, Michael J. Paulsen, Bryan B. Edwards, Chiaka N. Aribeana, Nicholas C. Cheung, Jason A. Burdick and Y. Joseph Woo
J. Cardiovasc. Dev. Dis. 2020, 7(4), 53; https://doi.org/10.3390/jcdd7040053 - 17 Nov 2020
Cited by 8 | Viewed by 3266
Abstract
The clinical efficacy of neuregulin (NRG) in the treatment of heart failure is hindered by off-target exposure due to systemic delivery. We previously encapsulated neuregulin in a hydrogel (HG) for targeted and sustained myocardial delivery, demonstrating significant induction of cardiomyocyte proliferation and preservation [...] Read more.
The clinical efficacy of neuregulin (NRG) in the treatment of heart failure is hindered by off-target exposure due to systemic delivery. We previously encapsulated neuregulin in a hydrogel (HG) for targeted and sustained myocardial delivery, demonstrating significant induction of cardiomyocyte proliferation and preservation of post-infarct cardiac function in a murine myocardial infarction (MI) model. Here, we performed a focused evaluation of our hydrogel-encapsulated neuregulin (NRG-HG) therapy’s potential to enhance cardiac function in an ovine large animal MI model. Adult male Dorset sheep (n = 21) underwent surgical induction of MI by coronary artery ligation. The sheep were randomized to receive an intramyocardial injection of saline, HG only, NRG only, or NRG-HG circumferentially around the infarct borderzone. Eight weeks after MI, closed-chest intracardiac pressure–volume hemodynamics were assessed, followed by heart explant for infarct size analysis. Compared to each of the control groups, NRG-HG significantly augmented left ventricular ejection fraction (p = 0.006) and contractility based on the slope of the end-systolic pressure–volume relationship (p = 0.006). NRG-HG also significantly reduced infarct scar size (p = 0.002). Overall, using a bioengineered hydrogel delivery system, a one-time dose of NRG delivered intramyocardially to the infarct borderzone at the time of MI in adult sheep significantly reduces scar size and enhances ventricular contractility at 8 weeks after MI. Full article
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5 pages, 1435 KiB  
Case Report
Early Basal Cuspal Tear of a Porcine Bioprosthetic Mitral Valve Causing Massive Mitral Regurgitation
by Muhammed Tamim, Christos Alexiou, Yaser AlKadi, Mohsen S. Mahmoud and Fatema Qaddoura
J. Cardiovasc. Dev. Dis. 2020, 7(4), 52; https://doi.org/10.3390/jcdd7040052 - 6 Nov 2020
Viewed by 2292
Abstract
Although porcine mitral bioprostheses provide predictably good long-term outcomes, unexpected leaflet tears leading to abrupt haemodynamic changes may occur. Here, we report on a patient who was presented with acute dyspnea due to a cuspal tear of a porcine bioprosthetic mitral valve causing [...] Read more.
Although porcine mitral bioprostheses provide predictably good long-term outcomes, unexpected leaflet tears leading to abrupt haemodynamic changes may occur. Here, we report on a patient who was presented with acute dyspnea due to a cuspal tear of a porcine bioprosthetic mitral valve causing severe mitral regurgitation. Her condition was subsequently complicated by a systemic infection, probably pneumonia, and was successfully managed with an urgent redo-mitral valve replacement. Full article
(This article belongs to the Special Issue Mitral Valve Development and Disease)
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13 pages, 1100 KiB  
Review
Muscularization of the Mesenchymal Outlet Septum during Cardiac Development
by Maurice J. B. van den Hoff and Andy Wessels
J. Cardiovasc. Dev. Dis. 2020, 7(4), 51; https://doi.org/10.3390/jcdd7040051 - 4 Nov 2020
Cited by 6 | Viewed by 3282
Abstract
After the formation of the linear heart tube, it becomes divided into right and left components by the process of septation. Relatively late during this process, within the developing outflow tract, the initially mesenchymal outlet septum becomes muscularized as the result of myocardialization. [...] Read more.
After the formation of the linear heart tube, it becomes divided into right and left components by the process of septation. Relatively late during this process, within the developing outflow tract, the initially mesenchymal outlet septum becomes muscularized as the result of myocardialization. Myocardialization is defined as the process in which existing cardiomyocytes migrate into flanking mesenchyme. Studies using genetically modified mice, as well as experimental approaches using in vitro models, demonstrate that Wnt and TGFβ signaling play an essential role in the regulation of myocardialization. They also show the significance of the interaction between cardiomyocytes, endocardial derived cells, neural crest cells, and the extracellular matrix. Interestingly, Wnt-mediated non-canonical planar cell polarity signaling was found to be a crucial regulator of myocardialization in the outlet septum and Wnt-mediated canonical β-catenin signaling is an essential regulator of the expansion of mesenchymal cells populating the outflow tract cushions. Full article
(This article belongs to the Special Issue Leaders in Cardiovascular Research: A special issue dedicated to Professor Robert Anderson)
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21 pages, 755 KiB  
Review
The Mesenchymal Cap of the Atrial Septum and Atrial and Atrioventricular Septation
by Ray Deepe, Emily Fitzgerald, Renélyn Wolters, Jenna Drummond, Karen De Guzman, Maurice J.B. van den Hoff and Andy Wessels
J. Cardiovasc. Dev. Dis. 2020, 7(4), 50; https://doi.org/10.3390/jcdd7040050 - 4 Nov 2020
Cited by 10 | Viewed by 3816
Abstract
In this publication, dedicated to Professor Robert H. Anderson and his contributions to the field of cardiac development, anatomy, and congenital heart disease, we will review some of our earlier collaborative studies. The focus of this paper is on our work on the [...] Read more.
In this publication, dedicated to Professor Robert H. Anderson and his contributions to the field of cardiac development, anatomy, and congenital heart disease, we will review some of our earlier collaborative studies. The focus of this paper is on our work on the development of the atrioventricular mesenchymal complex, studies in which Professor Anderson has played a significant role. We will revisit a number of events relevant to atrial and atrioventricular septation and present new data on the development of the mesenchymal cap of the atrial septum, a component of the atrioventricular mesenchymal complex which, thus far, has received only moderate attention. Full article
(This article belongs to the Special Issue Leaders in Cardiovascular Research: A special issue dedicated to Professor Robert Anderson)
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16 pages, 6142 KiB  
Review
Anatomy of Mitral Valve Complex as Revealed by Non-Invasive Imaging: Pathological, Surgical and Interventional Implications
by Laura Anna Leo, Vera Lucia Paiocchi, Susanne Anna Schlossbauer, Elisa Gherbesi and Francesco F. Faletra
J. Cardiovasc. Dev. Dis. 2020, 7(4), 49; https://doi.org/10.3390/jcdd7040049 - 4 Nov 2020
Cited by 5 | Viewed by 5221
Abstract
Knowledge of mitral valve (MV) anatomy has been accrued from anatomic specimens derived by cadavers, or from direct inspection during open heart surgery. However, today two-dimensional and three-dimensional transthoracic (2D/3D TTE) and transesophageal echocardiography (2D/3D TEE), computed tomography (CT) and cardiac magnetic resonance [...] Read more.
Knowledge of mitral valve (MV) anatomy has been accrued from anatomic specimens derived by cadavers, or from direct inspection during open heart surgery. However, today two-dimensional and three-dimensional transthoracic (2D/3D TTE) and transesophageal echocardiography (2D/3D TEE), computed tomography (CT) and cardiac magnetic resonance (CMR) provide images of the beating heart of unprecedented quality in both two and three-dimensional format. Indeed, over the last few years these non-invasive imaging techniques have been used for describing dynamic cardiac anatomy. Differently from the “dead” anatomy of anatomic specimens and the “static” anatomy observed during surgery, they have the unique ability of showing “dynamic” images from beating hearts. The “dynamic” anatomy gives us a better awareness, as any single anatomic arrangement corresponds perfectly to a specific function. Understanding normal anatomical aspects of MV apparatus is of a paramount importance for a correct interpretation of the wide spectrum of patho-morphological MV diseases. This review illustrates the anatomy of MV as revealed by non-invasive imaging describing physiological, pathological, surgical and interventional implications related to specific anatomical features of the MV complex. Full article
(This article belongs to the Special Issue Mitral Valve Development and Disease)
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8 pages, 700 KiB  
Article
Assessment of D-Shaped Annulus of Mitral Valve in Patients with Severe MR Using Semi-Automated 4-Dimensional Analysis: Implications for Transcatheter Interventions
by N. Mai Vo, Suzanne E. van Wijngaarden, Nina Ajmone Marsan, Jeroen J. Bax and Victoria Delgado
J. Cardiovasc. Dev. Dis. 2020, 7(4), 48; https://doi.org/10.3390/jcdd7040048 - 1 Nov 2020
Cited by 3 | Viewed by 3054
Abstract
The development of transcatheter mitral valve replacement therapies requires accurate post-processing analysis tools to provide D-shaped mitral annulus dimensions from 3-dimensional (3D) data. The agreement between two semi-automated, software packages to process 3D transesophageal echocardiography (TEE) data for the measurement of the mitral [...] Read more.
The development of transcatheter mitral valve replacement therapies requires accurate post-processing analysis tools to provide D-shaped mitral annulus dimensions from 3-dimensional (3D) data. The agreement between two semi-automated, software packages to process 3D transesophageal echocardiography (TEE) data for the measurement of the mitral valve annulus dimensions was evaluated. 3DTEE data of patients with moderate–severe mitral regurgitation (MR) were postprocessed with semi-automated, vendor-independent (VI) software and vendor-specific (VS) software. Both post-processing software provided key measurements for the selection of transcatheter valve prosthesis size: annulus area, annulus circumference and the septal-to-lateral distance of the annulus. The intertrigonal distance was provided only by the VS software. The inter- and intra-observer agreements were assessed with Bland–Altman analysis. Of 105 patients (63.8 ± 11 years, 66% male) with MR, 28 had secondary MR, 45 fibroelastic deficiency, and 32 Barlow’s disease. Using VS software, the dimensions for the overall population were 16.1 ± 4.6 cm2 for annulus area, for circumference 14.4 ± 1.9 cm, intertrigonal distance 3.4 ± 0.5 cm and septal-to-lateral distance 3.8 ± 0.6 cm. Similar dimensions were obtained using VI software: 15.7 ± 4.6 cm2 for annulus area, 14.5 ± 2.0 cm for circumference, and 4.1 ± 0.6 cm for septal-to-lateral distance. The inter- and intra-observer agreement for both software programs was excellent. In conclusion, current post-processing software programs for 3DTEE data of the mitral valve annulus provide good reproducibility of key measurements to select the transcatheter prosthesis size. Full article
(This article belongs to the Special Issue Mitral Valve Development and Disease)
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17 pages, 4596 KiB  
Review
Assessing Myocardial Architecture: The Challenges and Controversies
by Peter Agger and Robert S. Stephenson
J. Cardiovasc. Dev. Dis. 2020, 7(4), 47; https://doi.org/10.3390/jcdd7040047 - 29 Oct 2020
Cited by 6 | Viewed by 3249
Abstract
In recent decades, investigators have strived to describe and quantify the orientation of the cardiac myocytes in an attempt to classify their arrangement in healthy and diseased hearts. There are, however, striking differences between the investigations from both a technical and methodological standpoint, [...] Read more.
In recent decades, investigators have strived to describe and quantify the orientation of the cardiac myocytes in an attempt to classify their arrangement in healthy and diseased hearts. There are, however, striking differences between the investigations from both a technical and methodological standpoint, thus limiting their comparability and impeding the drawing of appropriate physiological conclusions from the structural assessments. This review aims to elucidate these differences, and to propose guidance to establish methodological consensus in the field. The review outlines the theory behind myocyte orientation analysis, and importantly has identified pronounced differences in the definitions of otherwise widely accepted concepts of myocytic orientation. Based on the findings, recommendations are made for the future design of studies in the field of myocardial morphology. It is emphasised that projection of myocyte orientations, before quantification of their angulation, introduces considerable bias, and that angles should be assessed relative to the epicardial curvature. The transmural orientation of the cardiomyocytes should also not be neglected, as it is an important determinant of cardiac function. Finally, there is considerable disagreement in the literature as to how the orientation of myocardial aggregates should be assessed, but to do so in a mathematically meaningful way, the normal vector of the aggregate plane should be utilised. Full article
(This article belongs to the Special Issue Leaders in Cardiovascular Research: A special issue dedicated to Professor Robert Anderson)
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10 pages, 912 KiB  
Article
Predictive Value of Pre-Operative 2D and 3D Transthoracic Echocardiography in Patients Undergoing Mitral Valve Repair: Long Term Follow Up of Mitral Valve Regurgitation Recurrence and Heart Chamber Remodeling
by Gloria Tamborini, Valentina Mantegazza, Marco Penso, Manuela Muratori, Laura Fusini, Sarah Ghulam Ali, Claudia Cefalù, Gianpiero Italiano, Valentina Volpato, Paola Gripari, Enrico G. Caiani, Marco Zanobini and Mauro Pepi
J. Cardiovasc. Dev. Dis. 2020, 7(4), 46; https://doi.org/10.3390/jcdd7040046 - 20 Oct 2020
Cited by 7 | Viewed by 2692
Abstract
The “ideal” management of asymptomatic severe mitral regurgitation (MR) in valve prolapse (MVP) is still debated. The aims of this study were to identify pre-operatory parameters predictive of residual MR and of early and long-term favorable remodeling after MVP repair. We included 295 [...] Read more.
The “ideal” management of asymptomatic severe mitral regurgitation (MR) in valve prolapse (MVP) is still debated. The aims of this study were to identify pre-operatory parameters predictive of residual MR and of early and long-term favorable remodeling after MVP repair. We included 295 patients who underwent MV repair for MVP with pre-operatory two- and three-dimensional transthoracic echocardiography (2DTTE and 3DTTE) and 6-months (6M) and 3-years (3Y) follow-up 2DTTE. MVP was classified by 3DTTE as simple or complex and surgical procedures as simple or complex. Pre-operative echo parameters were compared to post-operative values at 6M and 3Y. Patients were divided into Group 1 (6M-MR < 2) and Group 2 (6M-MR ≥ 2), and predictors of MR ≥ 2 were investigated. MVP was simple in 178/295 pts, and 94% underwent simple procedures, while in only 42/117 (36%) of complex MVP a simple procedure was performed. A significant relation among prolapse anatomy, surgical procedures and residual MR was found. Post-operative MR ≥ 2 was present in 9.8%: complex MVP undergoing complex procedures had twice the percentage of MR ≥ 2 vs. simple MVP and simple procedures. MVP complexity resulted independent predictor of 6M-MR ≥ 2. Favorable cardiac remodeling, initially found in all cases, was maintained only in MR < 2 at 3Y. Pre-operative 3DTTE MVP morphology identifies pts undergoing simple or complex procedures predicting MR recurrence and favorable cardiac remodeling. Full article
(This article belongs to the Special Issue Mitral Valve Development and Disease)
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11 pages, 2619 KiB  
Article
Effect of Evolocumab on Lipoprotein(a) and PCSK9 in Healthy Individuals with Elevated Lipoprotein(a) Level
by Olga Afanasieva, Marat V. Ezhov, Elena Klesareva, Oksana Razova, Uliana Chubykina, Mane Egiazaryan, Ekaterina Sherstyuk, Marina Afanasieva, Elena Utkina and Sergei Pokrovsky
J. Cardiovasc. Dev. Dis. 2020, 7(4), 45; https://doi.org/10.3390/jcdd7040045 - 15 Oct 2020
Cited by 10 | Viewed by 3407
Abstract
Background and aims: The aim of this study was to investigate the influence of a single injection of Evolocumab on the dynamics of Lp(a), fractions of apoB100-containing lipoproteins, PCSK9, and their complexes in healthy individuals with elevated Lp(a) levels. Methods: This open-label, 4-week [...] Read more.
Background and aims: The aim of this study was to investigate the influence of a single injection of Evolocumab on the dynamics of Lp(a), fractions of apoB100-containing lipoproteins, PCSK9, and their complexes in healthy individuals with elevated Lp(a) levels. Methods: This open-label, 4-week clinical study involved 10 statin-naive volunteers with Lp(a) >30 mg/dL, LDL-C < 4.9 mmol/L, and a moderate risk of cardiovascular events. The concentrations of Lp(a), lipids, PCSK9, circulating immune complexes (CIC), and plasma complexes of PCSK9 with apoB100-containing lipoproteins (Lp(a)–PCSK9 and LDL–PCSK9) were measured before and each week after Evolocumab (MABs) administration. Results: After a single dose injection of 140 mg of MABs, the median concentration of PCSK9 in serum increased from 496 to 3944 ng/mL; however, the entire pool of circulating PCSK9 remained bound with MABs for 2–3 weeks. LDL-C level decreased significantly from 3.36 mmol/L to 2.27 mmol/L during the first two weeks after the injection. Lp(a) concentrations demonstrated multidirectional changes in different patients with the maximal decrease on the second week. There were no positive correlations between the changes in levels of Lp(a), LDL-C, and TC. The change in the amount of circulating complex of PCSK9–Lp(a) was significantly less than of PCSK9–apoB100 (−5% and −47% after 1 week, respectively). Conclusions: A single administration of monoclonal antibodies against PCSK9 (Evolocumab) in healthy individuals with hyperlipoproteinemia(a) resulted in a decrease of Lp(a) of 14%, a 5% decrease in PCSK9–Lp(a), a 36% reduction of LDL-C, a 47% decrease in PCSK9–apoB100 and a tenfold increase in total serum PCSK9 concentration. Full article
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15 pages, 2034 KiB  
Review
An Appreciation of Anatomy in the Molecular World
by Bjarke Jensen, Vincent M. Christoffels and Antoon F. M. Moorman
J. Cardiovasc. Dev. Dis. 2020, 7(4), 44; https://doi.org/10.3390/jcdd7040044 - 15 Oct 2020
Cited by 5 | Viewed by 3313
Abstract
Robert H. Anderson is one of the most important and accomplished cardiac anatomists of the last decades, having made major contributions to our understanding of the anatomy of normal hearts and the pathologies of acquired and congenital heart diseases. While cardiac anatomy as [...] Read more.
Robert H. Anderson is one of the most important and accomplished cardiac anatomists of the last decades, having made major contributions to our understanding of the anatomy of normal hearts and the pathologies of acquired and congenital heart diseases. While cardiac anatomy as a research discipline has become largely subservient to molecular biology, anatomists like Professor Anderson demonstrate anatomy has much to offer. Here, we provide cases of early anatomical insights on the heart that were rediscovered, and expanded on, by molecular techniques: migration of neural crest cells to the heart was deduced from histological observations (1908) and independently shown again with experimental interventions; pharyngeal mesoderm is added to the embryonic heart (1973) in what is now defined as the molecularly distinguishable second heart field; chambers develop from the heart tube as regional pouches in what is now considered the ballooning model by the molecular identification of regional differentiation and proliferation. The anatomical discovery of the conduction system by Purkinje, His, Tawara, Keith, and Flack is a special case because the main findings were never neglected in later molecular studies. Professor Anderson has successfully demonstrated that sound knowledge of anatomy is indispensable for proper understanding of cardiac development. Full article
(This article belongs to the Special Issue Leaders in Cardiovascular Research: A special issue dedicated to Professor Robert Anderson)
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10 pages, 12854 KiB  
Review
A Rare Presentation of Common Arterial Trunk with Intact Ventricular Septum
by Diane E. Spicer and Thora S. Steffensen
J. Cardiovasc. Dev. Dis. 2020, 7(4), 43; https://doi.org/10.3390/jcdd7040043 - 12 Oct 2020
Cited by 4 | Viewed by 3366
Abstract
Common arterial trunk is a rare anomaly on its own, but with an intact ventricular septum it is extremely rare. An unexpected finding at autopsy prompted a review of the literature and a review of the developmental considerations associated with the outflow tracts. [...] Read more.
Common arterial trunk is a rare anomaly on its own, but with an intact ventricular septum it is extremely rare. An unexpected finding at autopsy prompted a review of the literature and a review of the developmental considerations associated with the outflow tracts. The case presented was an intrauterine fetal death at 37 weeks gestation. At autopsy, the only anatomic abnormalities were pulmonary dominant common arterial trunk with an intact ventricular septum, ventriculo-arterial septal defect, coarctation and widely patent arterial duct. A review of the literature and the developmental concepts related to the outflow tracts of the developing heart demonstrate the rare nature of this particular variation of common arterial trunk. Full article
(This article belongs to the Special Issue Leaders in Cardiovascular Research: A special issue dedicated to Professor Robert Anderson)
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19 pages, 3754 KiB  
Review
Embryonic Mouse Cardiodynamic OCT Imaging
by Andrew L. Lopez III, Shang Wang and Irina V. Larina
J. Cardiovasc. Dev. Dis. 2020, 7(4), 42; https://doi.org/10.3390/jcdd7040042 - 4 Oct 2020
Cited by 13 | Viewed by 5407
Abstract
The embryonic heart is an active and developing organ. Genetic studies in mouse models have generated great insight into normal heart development and congenital heart defects, and suggest mechanical forces such as heart contraction and blood flow to be implicated in cardiogenesis and [...] Read more.
The embryonic heart is an active and developing organ. Genetic studies in mouse models have generated great insight into normal heart development and congenital heart defects, and suggest mechanical forces such as heart contraction and blood flow to be implicated in cardiogenesis and disease. To explore this relationship and investigate the interplay between biomechanical forces and cardiac development, live dynamic cardiac imaging is essential. Cardiodynamic imaging with optical coherence tomography (OCT) is proving to be a unique approach to functional analysis of the embryonic mouse heart. Its compatibility with live culture systems, reagent-free contrast, cellular level resolution, and millimeter scale imaging depth make it capable of imaging the heart volumetrically and providing spatially resolved information on heart wall dynamics and blood flow. Here, we review the progress made in mouse embryonic cardiodynamic imaging with OCT, highlighting leaps in technology to overcome limitations in resolution and acquisition speed. We describe state-of-the-art functional OCT methods such as Doppler OCT and OCT angiography for blood flow imaging and quantification in the beating heart. As OCT is a continuously developing technology, we provide insight into the future developments of this area, toward the investigation of normal cardiogenesis and congenital heart defects. Full article
(This article belongs to the Special Issue Comparative Developmental Cardiovascular Biomechanics and Bioengineering)
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17 pages, 9955 KiB  
Article
Cauterization as a Simple Method for Regeneration Studies in the Zebrafish Heart
by Papa K. Van Dyck, Natasha Hockaden, Emma C. Nelson, Alyssa R. Koch, Kamil L. Hester, Neil Pillai, Gabrielle C. Coffing, Alan R. Burns and Pascal J. Lafontant
J. Cardiovasc. Dev. Dis. 2020, 7(4), 41; https://doi.org/10.3390/jcdd7040041 - 3 Oct 2020
Cited by 8 | Viewed by 5773
Abstract
In the last two decades, the zebrafish has emerged as an important model species for heart regeneration studies. Various approaches to model loss of cardiac myocytes and myocardial infarction in the zebrafish have been devised, and have included resection, genetic ablation, and cryoinjury. [...] Read more.
In the last two decades, the zebrafish has emerged as an important model species for heart regeneration studies. Various approaches to model loss of cardiac myocytes and myocardial infarction in the zebrafish have been devised, and have included resection, genetic ablation, and cryoinjury. However, to date, the response of the zebrafish ventricle to cautery injury has not been reported. Here, we describe a simple and reproducible method using cautery injury via a modified nichrome inoculating needle as a probe to model myocardial infarction in the zebrafish ventricle. Using light and electron microscopy, we show that cardiac cautery injury is attended by significant inflammatory cell infiltration, accumulation of collagen in the injured area, and the reconstitution of the ventricular myocardium. Additionally, we document the ablation of cardiac nerve fibers, and report that the re-innervation of the injured zebrafish ventricle is protracted, compared to other repair processes that accompany the regeneration of the cauterized ventricle. Taken together, our study demonstrates that cautery injury is a simple and effective means for generating necrotic tissue and eliciting a remodeling and regenerative response in the zebrafish heart. This approach may serve as an important tool in the methods toolbox for regeneration studies in the zebrafish. Full article
(This article belongs to the Special Issue Zebrafish Heart Development, Regeneration, and Disease Modelling)
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18 pages, 2547 KiB  
Review
In Full Force. Mechanotransduction and Morphogenesis during Homeostasis and Tissue Regeneration
by Vasiliki Tsata and Dimitris Beis
J. Cardiovasc. Dev. Dis. 2020, 7(4), 40; https://doi.org/10.3390/jcdd7040040 - 1 Oct 2020
Cited by 14 | Viewed by 4536
Abstract
The interactions of form and function have been the focus of numerous studies in the context of development and more recently regeneration. Our understanding on how cells, tissues and organs sense and interpret external cues, such as mechanical forces, is becoming deeper as [...] Read more.
The interactions of form and function have been the focus of numerous studies in the context of development and more recently regeneration. Our understanding on how cells, tissues and organs sense and interpret external cues, such as mechanical forces, is becoming deeper as novel techniques in imaging are applied and the relevant signaling pathways emerge. These cellular responses can be found from bacteria to all multicellular organisms such as plants and animals. In this review, we focus on hemodynamic flow and endothelial shear stress during cardiovascular development and regeneration, where the interactions of morphogenesis and proper function are more prominent. In addition, we address the recent literature on the role of extracellular matrix and fibrotic response during tissue repair and regeneration. Finally, we refer to examples where the integration of multi-disciplinary approaches to understand the biomechanics of cellular responses could be utilized in novel medical applications. Full article
(This article belongs to the Special Issue Comparative Developmental Cardiovascular Biomechanics and Bioengineering)
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15 pages, 2084 KiB  
Article
Left Ventricular Noncompaction Is More Prevalent in Ventricular Septal Defect Than Other Congenital Heart Defects: A Morphological Study
by Laís Costa Marques, Gabriel Romero Liguori, Ana Carolina Amarante Souza and Vera Demarchi Aiello
J. Cardiovasc. Dev. Dis. 2020, 7(4), 39; https://doi.org/10.3390/jcdd7040039 - 25 Sep 2020
Cited by 6 | Viewed by 3339
Abstract
Left ventricular noncompaction (LVNC) is a condition characterized by prominent ventricular trabeculae and deep intertrabecular recesses and has been described as a possible substrate for arrhythmias, thromboembolism, and heart failure. Herein, we explored the prevalence of LVNC morphology among hearts with congenital heart [...] Read more.
Left ventricular noncompaction (LVNC) is a condition characterized by prominent ventricular trabeculae and deep intertrabecular recesses and has been described as a possible substrate for arrhythmias, thromboembolism, and heart failure. Herein, we explored the prevalence of LVNC morphology among hearts with congenital heart defects (CHD). We examined 259 postnatal hearts with one of the following CHD: isolated ventricular septal defect (VSD); isolated atrial septal defect (ASD); atrioventricular septal defect (AVSD); transposition of the great arteries (TGA); isomerism of the atrial appendages (ISOM); Ebstein’s malformation (EB); Tetralogy of Fallot (TF). Eleven hearts from children who died of non-cardiovascular causes were used as controls. The thickness of the compacted and non-compacted left ventricular myocardial wall was determined and the specimens classified as presenting or not LVNC morphology according to three criteria, as proposed by Chin, Jenni, and Petersen. Normal hearts did not present LVNC, but the CHD group presented different percentages of LVNC in at least one diagnostic criterium. The prevalence of LVNC was respectively, according to Chin’s, Jenni´s and Petersen´s methods: for VSD—54.2%, 35.4%, and 12.5%; ASD—8.3%, 8.3%, and 8.3%; AVSD—2.9%, 2.9%, and 0.0%; TGA—22.6%, 17%, and 5.7%; ISOM—7.1%, 7.1%, and 7.1%; EB—28.6%, 9.5%, and 0.0%; TF—5.9%. 2.9%, and 2.9%. VSD hearts showed a significantly greater risk of presenting LVNC when compared to controls (Chin and Jenni criteria). No other CHD presented similar risk. Current results show some agreement with previous studies, such as LVNC morphology being more prevalent in VSDs. Nonetheless, this is a morphological study and cannot be correlated with symptoms or severity of the CHD. Full article
(This article belongs to the Special Issue Leaders in Cardiovascular Research: A special issue dedicated to Professor Robert Anderson)
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27 pages, 4447 KiB  
Review
New Concepts in the Development and Malformation of the Arterial Valves
by Deborah J. Henderson, Lorraine Eley and Bill Chaudhry
J. Cardiovasc. Dev. Dis. 2020, 7(4), 38; https://doi.org/10.3390/jcdd7040038 - 24 Sep 2020
Cited by 18 | Viewed by 5023
Abstract
Although in many ways the arterial and atrioventricular valves are similar, both being derived for the most part from endocardial cushions, we now know that the arterial valves and their surrounding structures are uniquely dependent on progenitors from both the second heart field [...] Read more.
Although in many ways the arterial and atrioventricular valves are similar, both being derived for the most part from endocardial cushions, we now know that the arterial valves and their surrounding structures are uniquely dependent on progenitors from both the second heart field (SHF) and neural crest cells (NCC). Here, we will review aspects of arterial valve development, highlighting how our appreciation of NCC and the discovery of the SHF have altered our developmental models. We will highlight areas of research that have been particularly instructive for understanding how the leaflets form and remodel, as well as those with limited or conflicting results. With this background, we will explore how this developmental knowledge can help us to understand human valve malformations, particularly those of the bicuspid aortic valve (BAV). Controversies and the current state of valve genomics will be indicated. Full article
(This article belongs to the Special Issue Leaders in Cardiovascular Research: A special issue dedicated to Professor Robert Anderson)
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