Pulmonary artery injury (PAI) is rare, lethal clinical entity. Traumatic PAI is anatomically classified into transection/rupture/laceration, pseudoaneurysm, dissection and fistula. In addition, traumatic PAI is clinically classified into two major categories: iatrogenic and non-iatrogenic, depending on the mechanism of the trauma. The frequency, clinical symptoms and treatment differ between the two clinical categories. If PAI can be managed appropriately and promptly in patients without cardiac arrest, the patient may be saved, as PAI can be easily controlled with appropriate procedures due to the low pressure in the PA circulation.

Acute coronary syndrome (ACS) comprises a spectrum of disease that includes unstable angina, non-ST-elevation myocardial infarction, and ST-elevation myocardial infarction. Clinical management of patients with ACS has greatly evolved over the last two decades, but ACS remains an important cause of morbidity and mortality in patients with coronary artery disease. This narrative review describes the indication, timing, and approaches to surgical revascularization in the context of ACS. In particular, the review discusses and compares the utilization of off-pump coronary artery bypass grafting (CABG) vs. conventional on-pump CABG. Other surgical interventions, such as totally endoscopic coronary artery bypass and hybrid coronary revascularization, are also reviewed.

We present a case of an aorto-enteric fistula (AEF) with chronic, persistent bleeding from a blind aortic stump managed by endovascular means. This novel approach may have extended the life of a patient who would otherwise have been subject to a high perioperative morbidity or persistent bleeding and death. While our patient ultimately expired, we believe this technique can be considered for temporization in highly-selected patients.

Aim: The aim of the present study was to assess the 10-year cardiovascular disease (CVD) risk and to apply the current recommendations on aspirin use for primary prevention in Korean participants undergoing a medical check-up.

Methods: Adults aged 50 to 69 years were eligible for the study if they did not have a history of atherosclerotic CVD (ASCVD) or stroke. The 10-year CVD risk was calculated using the ASCVD risk estimator (http://tools.acc.org/ASCVD-Risk-Estimator).

Results: A total of 1125 participants were enrolled in this study. The mean age was 57 years, and 32% of the participants were women. Based on the 2016 US Preventive Services Task Force recommendations, aspirin was indicated in 266 (23.6%) participants but only 44 (3.9%) participants were taking aspirin regularly. Among these participants, aspirin was prescribed appropriately in 36% of the participants, suggesting that only 6% of the participants were taking aspirin appropriately and 3.3% of the participants were taking aspirin inappropriately. Logistic regression analysis showed that treatment for hypertension was significantly associated with taking aspirin (odds ratio 7.49; 95% confidence interval 3.62-15.49).

Conclusion: Our study suggested that there may be an opportunity for decreasing the rate of CVD as well as the risk for major bleeds through tailored education on aspirin use.

Depression is one of the most common psychiatric disorders, and has become an epidemic in modern medical practice; notorious for frequently co-occurring with multiple comorbidities, especially cardiovascular disease (CVD), type 2 diabetes mellitus (DM2), and its various risk factors comprised in the metabolic syndrome (MS). Selective serotonin reuptake inhibitors (SSRIs) are the most widely used class of psychotropic drugs in this and many other clinical scenarios; yet their impact on cardiometabolic health has not been elucidated. The objective of this review was to summarize current views on the pharmacology of SSRIs and cardiometabolic risk, as well as available epidemiological evidence regarding its clinical significance. SSRIs appear to intervene in cardiometabolic physiology fundamentally by modulating chronic inflammation, a key pathophysiologic phenomenon in MS, DM2 and CVD. However, the dosing necessary to achieve a beneficial impact in this regard, as well as their clinical correlations, remain controversial. Each SSRI displays a particular profile regarding each of the components of the MS: weight gain seems to be the most common effect of SSRIs, more frequent with paroxetine, followed by citalopram and escitalopram. As a drug class, SSRIs also appear to promote hypercholesterolemia rather uniformly, while fluoxetine and citalopram appear to particularly increase triacylglyceride levels. In contrast, fluvoxamine and paroxetine seem to have the greatest impact on dysglycemia. Lastly, most SSRIs appear to be innocuous or even beneficial regarding blood pressure and high-density lipoprotein cholesterol. Nevertheless, many of these effects may vary significantly upon specific clinical circumstances, especially timing. This topic remains rather unexplored in clinical psychopharmacology, and further, larger-scale epidemiological studies are needed in order to offer improved care in this field.

We present a case of a superior mesenteric arteriovenous fistula (SMAVF) diagnosed four years after index Nissen fundoplication and examine the associated imaging, clinical course, and surgical treatment followed by a review of the limited, available literature. From a transbrachial approach, a covered stent was successfully deployed in the superior mesenteric artery to exclude the fistula after confirmation of the site of pathology on both digital subtraction angiography and intravascular ultrasound. Follow-up imaging demonstrated continued exclusion of the anomalous fistula with complete resolution of his symptoms at both his postprocedure and 1-year follow-up visits. SMAVFs are usually encountered secondary to previous surgical dissection or trauma and presents with nondescript abdominal pain making early diagnosis difficult; however, they can be successfully treated with minimally-invasive stent exclusion.

Descending thoracic aortic aneurysm management has gained momentum and became a topic of many debates at international levels since the evolution of endovascular repair. Ruptured descending thoracic aortic aneurysm is a clinical emergency which is associated with high mortality and morbidity rates if not managed properly. Prior to thoracic endovascular aortic repair (TEVAR), open repair (OR) was the gold standard management, however since the evolution of TEVAR, this has changed. Several centers have reported many of their experiences and published that TEVAR can provide equal or even better perioperative outcomes when compared to OR, although the evidences can be of only short term and could be biased at different levels at the time of publication. This review article is aimed to examine current literature evidences behind the use of TEVAR vs. OR and the reported comparative clinical outcomes.

Left ventricle (LV) myocardial infarction may result in changes to the structure of the subvalvular apparatus. This may lead to a functional regurgitation if accompanied by annular dilatation preventing coaptation of leaflets. Scar tissue formation in the left ventricle may also lead to aneurysm of the left ventricle. This can then calcify, making repair of the leaflet technically challenging. We present a case of a mitral valve repair with concomitant repair of left ventricle aneurysm in a 75-year-old gentleman who suffered an ST-segment elevation myocardial infarction to the lateral wall 20 years ago. He presented with breathlessness on minimal activity, severe mitral regurgitation with a posteriorly oriented regurgitant jet and calcification of LV aneurysm on chest X-ray and computed tomography scan. Despite the challenging nature, it is possible to repair a mitral valve with concomitant calcified LV aneurysm formation. Long term outcomes are still unknown for this cohort of patients.

There is an increasing number of patients who have surgery during the active phase of infective endocarditis. Despite the decreasing in-hospital mortality and increasing early intervention rate, optimal timing for surgery remains a difficult decision. For patients with mental illnesses, the choice of valve is another factor to consider as non-adherence may lead to serious adverse events Antipsychotic medications may also alter the metabolism of vitamin K antagonists increasing the risk of stroke or major haemorrhage. We report a case of a 19-year-old man with a history of Ehlers-Danlos syndrome and aortic regurgitation, who required management of aortic valve bacterial endocarditis. This is the first report describing the use of the new RESILIA INSPIRIS valve which has increased durability and does not require anticoagulation.

Posterior reversible encephalopathy syndrome (PRES) is an uncommon neurological syndrome due to autoregulation breakthrough with subsequent predominantly vasogenic oedemain associated with several clinical conditions. It is being increasingly reported in antineoplastic-treated patients. Here we report the case of a 72-year-old man who developed PRES during the second cycle of bortezomib treatment for multiple myeloma. Unlike usual PRES cases, only moderate hypertension was present at symptom onset, supporting the hypothesis that alterations of the vascular endothelium and blood-brain-barrier are the principal pathophysiological mechanisms involved in bortezomib-induced PRES. Prompt recognition of this potentially serious neurological adverse event is paramount to prevent mortality and long-term sequelae.

Bioresorbable stents (BRSs) are regarded as the next-generation medical devices to treat blocked or diseased arteries. The use of BRSs aims to reduce the risk of late stent thrombosis and long-term tissue inflammation associated with permanent metallic stents. BRSs are designed to relieve symptoms immediately and also provide mechanical support for an appropriate time period before they are fully absorbed by human body. To promote clinical adoption of BRSs or even to substitute metallic stents, the mechanical performance of BRSs needs to be thoroughly investigated and quantitatively characterised, especially over the full period of degradation. This paper offers a review of current research status of polymeric BRSs, covering both experimental and modelling work. Review of experimental studies highlighted the effects of stent designs and materials on the behaviour of polymeric BRSs. Computational work was able to simulate crimping, expansion and degradation of polymeric BRSs and the results were useful for performance assessment. In summary, the development of polymeric BRSs is still at an early stage, and further research is urgently required for a better understanding and control of their mechanical performance.

Aim: To determine whether plasmatic biomarkers correlate with ¹⁸fluoro-2-deoxy-D-glucose (FDG) positron emission tomography/computed tomography (PET-CT) and presence of microembolic signals (MES) detected by transcranial Doppler in patients with carotid stenosis.

Methods: ¹⁸FDG-PET-CT and MES detection was performed in consecutive patients with 50% to 99% symptomatic or asymptomatic carotid stenosis. Uptake index was defined by a target to background ratio (TBR) between maximum standardized uptake value of the carotid plaque and the average uptake of the jugular veins. The analysis of biomarkers included adhesion molecules [intercellular adhesion molecule (ICAM)-1, vascular cell adhesion molecule 1, P-selectin and E-selectin], interleukins (IL-1, IL-6), chemokines (RANTES, monocyte chemoattractant protein 1), cytokines (tumor necrosis factor α), matrix-metalloproteases (MMP), myeloperoxidase, and lipoprotein-associated phospholipase A2.

Results: There were 54 symptomatic and 57 asymptomatic patients. TBR values were significantly higher in the symptomatic compared to the asymptomatic (median 2.1 vs. 1.8, P = 0.002) and in the MES positive (MES+) compared to the MES negative (MES-) group (MES+, n = 19, median 2.3 and MES-, n = 88, median 1.8, P = 0.01). The best threshold for TBR values was of 1.9. We found a significant correlation between higher ¹⁸FDG uptake (TBR ≥ 1.9) and the plasmatic levels of chemokine RANTES (P = 0.03) and higher levels of ICAM-1 in MES+ patients (P = 0.03). Interestingly MMP-2 levels were more important in patients with lower TBR values (P = 0.02) and MMP-3 and P-selectin in those who were MES- (respectively P = 0.001 and P = 0.009).

Conclusion: In the present study, ICAM-1 was associated with the presence of thrombotically active atherosclerotic plaques, while RANTES mainly correlated with the inflammatory process. MMP-2, MMP-3 and P-selectin levels were more important in patients with stable plaques.

Ischemic heart disease is the leading cause of death with acute coronary syndrome accounting for more than 30% of causes of mortality in the elderly population. The rate of growth of the older segment of the population has increased exponentially and will become more pronounced in the future. Historically, there has been a paucity of clinical trials investigating the challenges and outcomes of more invasive treatment strategies such as percutaneous coronary intervention (PCI) for that very segment of the population. However, the safety, efficacy, and outcomes of PCI in the older population have started to receive more attention, leading to some changes in their trends. There are several factors that make interventional cardiologists more resistant to direct the elderly to PCI. Most of these challenging factors, such as the complexity of coronary lesions, frailty, hematological and vascular changes, are discussed in this review. In addition. more advanced technologies have been introduced to PCI platform such as second- and third-generations stents, several alternative approaches have been adopted like transradial approach and the usage of bivalirudin instead of heparin and GP IIb/IIIa inhibitor, and several imaging modalities have been optimized to assess patients’ outcome and prognosis more accurately. Several recent studies have shown better results when these strategies are adopted. The most recent recommendations regarding performing PCI in the elderly are also discussed in this review.

Acute lung injury (ALI) is a severe progressive disorder that arises from a wide range of causes such as toxins or inflammation, resulting in significant morbidity and mortality. There are no effective therapeutic options apart from mechanical ventilation strategies. While the mechanisms that govern the clinically relevant process of increased endothelial cell (EC) permeability and remodeling associated with ALI are under intense investigation, our knowledge of the processes that determine barrier enhancement or preservation are far from completion. Recently, epigenetic mechanisms have emerged as a major regulator of enduring changes in cell behavior and the therapeutic potential of inhibiting histone deacetylases (HDACs) for the treatment of cardiovascular and inflammatory diseases has gained remarkable attention. Although HDACs have been shown to play an important role in regulating EC barrier function, the involved HDAC subtypes and mechanisms remain undefined. Further investigation of the HDAC signaling may provide therapeutic approaches for the prevention and treatment of ALI.

Aim: The circadian clock is a molecular network that controls the body physiological rhythms. In blood vessels, the circadian clock components modulate vascular remodeling, blood pressure, and signaling. The goal in this study was to determine the pattern of expression of circadian clock proteins in the endothelium, smooth muscle, and adventitia of the vasculature of human and mouse tissues.

Methods: Immunohistochemistry was performed in frozen sections of mouse aorta, common carotid artery, femoral artery, lung, and heart at 12 AM and 12 PM for Bmal1, Clock, Npas2, Per and other clock components. Studies of expression were also assessed in human saphenous vein both by immunoblotting and immunohistochemistry.

Results: In this study, we identified the expression of Bmal1, Clock, Npas, Per1, Cry1, and accessory clock components by immunohistochemical staining in the endothelium, smooth muscle and adventitia of the mouse vasculature with differing temporal and cellular profiles depending on vasculature and tissue analyzed. The human saphenous vein also exhibited expression of clock genes that exhibited an oscillatory pattern in Bmal1 and Cry by immunoblotting.

Conclusion: These studies show that circadian clock components display differences in expression and localization throughout the cardiovascular system, which may confer nuances of circadian clock signaling in a cell-specific manner.

Aortic valve stenosis (AS) represents the most prevalent valvular defect worldwide. It is a progressive disease with a long latency interval and a poor prognosis after symptoms present. According to current European Society of Cardiology guidelines, transcatheter aortic valve implantation (TAVI) is recommended in all patients with severe symptomatic AS and a predicted survival longer than one year, who are not suitable for surgical valve replacement. Despite these recommendations, several studies over the past few years suggest extending these indications towards lower risk AS populations. Otherwise, current available operative risk scores such as Society of Thoracic Surgeons score and EuroSCORE, may offer an incomplete risk assessment; in this setting, the Heart Team plays a crucial role in defining the most appropriate therapeutic strategy in patients with AS. In this review, we aim to discuss the current and future indications for TAVI, analyzing available literature according to patients’ profile risk (high/mid/low risk) and other specific conditions (valve-in-valve, bicuspid valve and pure aortic regurgitation).

Most of axillo-subclavian artery injuries are due to violence. Iatrogenic injuries to such vessels are relatively rare. We hereby present the first report of pigtail catheter insertion for right upper chest wall hematoma drainage resulting in penetration of axillary artery and pseudoaneurysm formation. A 39-year-old male victim of motor vehicle accident developed right upper chest wall hematoma after initial conservative treatment. Subsequent admission was arranged and pigtail catheter drainage was performed under sonography guidance. The procedure caused penetrating injury to his right axillary artery with pseudoaneurysm formation. Endovascular repair and stent placement were performed. The patient was discharged within 2 weeks without significant sequelae. Non-catheterization procedure caused penetration of axillary artery was rarely seen in published reports. Our report described a case of axillary artery penetration resulted by pigtail catheter insertion which was never seen. We wish to emphasize on the jeopardy of non-vascular procedure on penetrating nearby vessels because of anatomical proximity.

Aim: Renin, a component of the Renin-Angiotensin-Aldosterone System (RAAS), is produced in the juxtaglomerular cells of the kidney. It is an important factor for the regulation of blood pressure and electrolyte balance and encoded by the REN gene. Recent studies suggest that the RAAS is a regulator of kidney functions. Individuals with REN variants have been associated with high blood pressure. We substantiated the hypothesis that genetic variants of REN gene have significant association with prevalence of nephropathy and in the development of nephropathy in type 2 diabetes mellitus (T2DM).

Methods: We enrolled to the study 718 consecutive subjects who were registered patients in two individual hospitals in Kolkata city, India. They consisted of 246 (34.26%) T2DM patients without nephropathy cases, 168 (23.40%) type 2 diabetes with nephropathy cases (T2DNH) and 304 (42.34%) healthy controls. Genotypes were assayed with genomic DNA for two known variants of the REN gene, i.e., rs16853055 and rs41317140 using sequencing methods.

Results: Association between the REN gene variants and prevalence of T2DM and T2DNH was tested. A significant association of T2DNH and variant rs41317140 was obtained and it was evident that the rs41317140 (C>T) shows a significant difference between T2DM and T2DNH (X² = 4.92; P = 0.03; OR = 0.6162; 95% CI: 0.4006-0.948). The results from the multiple model test that additive model predicted the association at genotype level and shows a significant difference between T2DM and T2DNH (OR = 0.6067; P = 0.03). There was no significant association between T2DNH or T2DM and variant rs16853055.

Conclusion: Thus, it is concluded that a genetic variant of the REN gene should have a significant impact on the onset of type 2 diabetic nephropathy.

Considering the plethora of literature about surgical revascularization, this review aims to discuss the most recent studies about the effects of total arterial coronary artery bypass graft (TACABG) compared with CABG that involves venous graft (VCABG) in patients with multivessel coronary artery disease. Patients were sampled from published papers that studied various aspects involving TACABG or VCABG. Resulting samples were used to compare the complexity and 5 years’ outcomes of TACABG to VCABG in the revascularization of coronary arteries. TACABG provides a better prognosis with average all-cause mortality within 5 years of 5.35% as compared to VACABG with average of all-cause mortality within 5 years of 9.1%. Furthermore, assumption of deep sternal wound infection from TACABG, especially when bilateral internal thoracic arteries were used, is very technique-dependent, as reports have been showing that the rate of such infection to occur is less than 1%. TACABG was concluded to wield a better prognosis within both short- and long- terms, although more research need to be done to prove its use in left main disease.

Cerebral cavernous malformations (CCM) are manifested by microvascular lesions characterized by leaky endothelial cells with minimal intervening parenchyma predominantly in the central nervous system predisposed to hemorrhagic stroke, resulting in focal neurological defects. Till date, three proteins are implicated in this condition: CCM1 (KRIT1), CCM2 (MGC4607), and CCM3 (PDCD10). These multi-domain proteins form a protein complex via CCM2 that function as a docking site for the CCM signaling complex, which modulates many signaling pathways. Defects in the formation of this signaling complex have been shown to affect a wide range of cellular processes including cell-cell contact stability, vascular angiogenesis, oxidative damage protection and multiple biogenic events. In this review we provide an update on recent advances in structure and function of these CCM proteins, especially focusing on the signaling cascades involved in CCM pathogenesis and the resultant CCM cellular phenotypes in the past decade.

Hypertension remains a leading risk factor of cardiovascular (CV) events and disease in the general population. The prevalence of hypertension is present in developed and developing countries and according to various assessments may fluctuate between 30% to 90% with considerable regional differences. Hypertension influences CV risk and mortality rate through target organ damages that affect vasculature particularly endothelium. Endothelial dysfunction is an independent risk factor of CV complications. Recent studies have shown that a decreased number and altered function of circulating endothelial progenitor cells (EPCs) may be a powerful marker of endothelial dysfunction with possible predictive value. The aim of this review is to update the current evidence of the role of endothelial progenitor cell dysfunction in impaired vascular reparation and CV risk in hypertension. The review discusses the interrelation between EPC dysfunction and traditional CV risk factors, such as hypertension, dyslipidemia, obesity, prediabetes/diabetes mellitus. It has been speculated that EPC dysfunction could appear prior to hypertension and represents an appropriate hypertensive phenotype with exaggerated CV risk. However, the predictive value of EPC dysfunction in hypertensive patients is not established and requires to be investigated in large clinical controlled trials.

Transcatheter aortic valve implantation (TAVI) has become in the last years a primary therapeutic tool in order to treat percutaneously severe aortic stenosis in frail patients with multiple comorbidity and a high surgical risk. In almost all cases, the complexity of patients who are candidates for TAVI is also reflected in challenging access sites. This vascular issue addresses the invasive play of constantly evolving devices and resulting complications have a considerable impact on patient morbidity and mortality. For this reason, the study and the choice of the different access site require the attention and experience of the operators to reach the most reliable and feasible vascular approach for a real procedural success.

Aim: Immunosuppression has evolved since the first successful orthotopic heart transplant 50 years ago. Currently, calcineurin inhibitors lie at the focal point of the immunosuppressive regimen. However, these drugs exhibit a variety of side effects, including hyperglycaemia. This in turn compounds the risk of cardiovascular disease. There is conflict around which calcineurin inhibitor, tacrolimus or ciclosporin, is more likely to induce diabetes.

Methods: A retrospective analysis of data from 52 patients who had received a heart transplantation at the Scottish heart transplant unit between January 2011 and August 2017. All patients received a combination immunosuppressive regimen consisting of mycophenolate mofetil, corticosteroids and either tacrolimus or ciclosporin. Fasting glucose levels were compared every 3 months after transplantation for a year. HbA1c was collected and compared at one interval during follow-up postoperatively. Statistical analysis was achieved using Students t-test for continuous variables and Chi-squared test for categorical variables.

Results: The drug regimens remained unchanged in the two cohorts over the study period. The fasting glucose of tacrolimus treated patients was higher over the 12-month period compared to ciclosporin treated patients (7.3 ± 1 vs. 5.9 ± 0.5, P = 0.017). The results were significantly higher in the tacrolimus group at 9 months (P = 0.013). In contrast to these findings, HbA1c of the tacrolimus group was lower than the ciclosporin group, although there was no significant difference (38 ± 11.4 vs. 43 ± 1.3, P = 0.104).

Conclusion: This study suggests a relationship between tacrolimus and rising fasting glucose among heart transplant population. However, a longer follow-up and control of confounding variables is required to denote the long-term impact of immunosuppression related diabetes in heart transplant patients.

Into the scientific community, consensus about the emerging concept of “the fetal origin of adult diseases” is growing. It sustains that the parental (of the two parents) adversities, and the related external influences, during the intra-utero/perinatal life of each eutherian mammal organism, human included, can permanently set the structure and functionality of specific body systems (i.e., immune, endocrine, nervous and cardiovascular systems), predisposing them to early ageing and disease during adulthood. The pulmonary circulation system also appears to be one of its targets. Established evidence supports the strong association between developmental programming and pulmonary arterial remodeling and dysfunction. Here, a revised overview of this topic is reported, by stressing the efforts and advances in identifying the molecular and cellular mechanisms and pathways involved.

As a novel treatment modality, transcatheter aortic valve replacement (TAVR) is widely used for patients with severe aortic valve stenosis who have high surgical risk worldwide. However, this promising alternative procedure has different types of complication risks including, cerebrovascular events, vascular complications, bleeding, coronary obstruction, myocardial infarction, valve regurgitation, valve malpositioning or migration, conduction disturbances and acute kidney injury which may occur during and/or after the procedure. These complications may be seen up to one third of the patients and some of them may need urgent surgical intervention and may have a higher risk of death. For preventing and overcoming these complications, pre-procedural evaluation of the patient by an effective “heart team” which consists of cardiologists, cardiac surgeons, radiologists and anesthesiologists in equal proportion is needed. Estimating the potential difficulties and complications, deciding the interventions to be performed in case of any complication may increase the success of the procedure and save the patients’ lives. In this article, we reviewed the possible complications of the TAVR procedure and described rescue procedures in case of complications, in the context of the literature.

Aim: To evaluate activity of oxidative stress (OS) as marker of vascular aging in different age groups of patients with combined course of arterial hypertension (HT) and type 2 diabetes mellitus (T2DM).

Methods: 126 patients (average age 57.8 ± 6.2 years) with stage II HT and compensated T2DM were divided into 2 subgroups: 2a (n = 59) - aged 45-60 years; 2b (n = 97) - aged 61-75 years; 30 patients with isolated stage II HT (comparison group), 20 practically healthy individuals (control group). The activity of antioxidative [glutathione peroxidase, sulfhydryl groups (SH-groups)] and oxidative [malonic dialdehyde (MDA)], 8-hydroxy-2-deoxyguanosine (8-OH-dG) systems in blood serum, were studied.

Results: A significant increase in MDA levels (P < 0.05) and SH-groups (P < 0.05) compared with healthy volunteers was observed. Patients in 2b group had lower MDA values than in 2a (6.25 ± 0.33 μmol/L, 7.07 ± 0.44 μmol/L, respectively, P > 0.05). In the 2b group, in comparison with 2a patients, a decrease in thiol status was observed (P > 0.05). The level of 8-OH-dG was increased in patients with HT and T2DM, but there was also an age-associated increase in the average 8-OH-dG in the 2b group.

Conclusion: The age-associated changes in the OS in comorbid course of HT and T2DM did not have significant differences. Nevertheless, the presence of correlations between various indexes that are included in the concept of “vascular aging” and indicators of oxidant-antioxidant systems in different age groups allows us to make an assumption about the significant influence of the oxidative status on the status of vascular age, especially in the older age group persons.

Aortic valve replacement (AVR) is the current standard treatment for severe aortic stenosis, nonetheless, many patients are not suitable to AVR because of high risk related to advanced age, impaired cardiac function, or comorbidities. Given these considerations, transcatheter aortic valve replacement or implantation (TAVR or TAVI) has emerged in the last decade as an alternative to surgery and has become the treatment of choice for severe aortic stenosis in patients with prohibitive surgical risk. In the context of this kind of hybrid procedure, the anesthesiologist plays a central role because the choice of anesthetic technique is strongly related to clinical features of the patients and technical considerations, which must be discussed collegially with the surgeons. The choice of anesthesiologic management is different among hospitals, but it is generally based on preoperative comorbidities, procedural approach used for TAVR and even hospital logistic. Some centers used to perform TAVR under general anesthesia (GA), some else under local anesthesia plus sedation (LAS), some of them start their TAVR program under GA, but convert in LAS when the team get enough experience. Also, anesthesiologists involved in TAVR procedures must be part of a “heart team”, and should be confident with anesthesia for cardiovascular surgery, mechanical circulatory support, and with transesophageal echocardiography. The aim of this article is to provide a general overview about anesthetic techniques in TAVR and to evaluate pathways for future researches.

Pathological vascular remodeling is observed in various cardiovascular diseases including pulmonary hypertension (PH), a disease of unknown etiology that has been characterized by pulmonary artery vasoconstriction, right ventricular hypertrophy, vascular inflammation, and abnormal angiogenesis in pulmonary circulation. G protein-coupled receptors (GPCRs) are the largest family in the genome and widely expressed in cardiovascular system. They regulate all aspects of PH pathophysiology and represent therapeutic targets. We overview GPCRs function in vasoconstriction, vasodilation, vascular inflammation-driven remodeling and describe signaling cross talk between GPCR, inflammatory cytokines, and growth factors. Overall, the goal of this review is to emphasize the importance of GPCRs as critical signal transducers and targets for drug development in PH.

Vascular remodeling defines cancer growth and aggressiveness. Although cancer cells produce pro-angiogenic signals, the fate of angiogenesis critically depends on the cancer microenvironment. Composition of the extracellular matrix (ECM) and tumor inflammation determine whether a cancer will remain dormant, will be recognized by the immune system and eliminated, or whether the tumor will develop and lead to the spread and metastasis of cancer cells. Thrombospondins (TSPs), a family of ECM proteins that has long been associated with the regulation of angiogenesis and cancer, regulate multiple physiological processes that determine cancer growth and spreading, from angiogenesis to inflammation, metabolic changes, and properties of ECM. Here, we sought to review publications that describe various functions of TSPs that link these proteins to regulation of cancer growth by modulating multiple physiological and pathological events that prevent or support tumor development. In addition to its direct effects on angiogenesis, TSPs have important roles in regulation of inflammation, immunity, ECM properties and composition, and glucose and insulin metabolism. Furthermore, TSPs have distinct roles as regulators of remodeling in tissues and tumors, such that the pathways activated by a single TSP can interact and influence each other. The complex nature of TSP interactions and functions, including their different cell- and tissue-specific effects, may lead to confusing results and controversial conclusions when taken out of the context of interdisciplinary and holistic approaches. However, studies of TSP functions and roles in different systems of the organism offer an integrative view of tumor remodeling and a potential for finding therapeutic targets that would modulate multiple complementary processes associated with cancer growth.

One of the notable advances in modern day medicine is organ transplantation. None more so than the heart. A complex interaction between physiology, surgery and immunology that spanned decades, involving the hard work of many pioneers in their fields. We revisit the contributions of the pioneers as well as marvel at the paradigm shifts in medicine that have made heart transplantation safe and reproducible with in excess of 3000 transplants done yearly today.

Type 2 diabetes mellitus (DM) is a risk factor for the progression of cardiovascular mortality, exacerbated by the development of chronic renal failure secondary to diabetic nephropathy, which requires long-term hemodialysis (LTH). However, in the case of LTH cardiovascular mortality exceeds that in the general population, especially in patients with diabetes. The identification of risk factors for the progression of atherosclerosis and vascular calcification in patients with DM on LTH is of great importance for finding a more effective approach to the prevention of cardiovascular mortality in a given cohort of patients. The presented review contains analysis of current literature data on the evaluation of both traditional and non-traditional risk factors for cardiovascular morbidity in order to improve the effectiveness of therapeutic and diagnostic tactics.

Aim: The aim of the study was to perform a comparative evaluation of the use of various methods of reconstructive assistance in the repair of the femoral-tibial segment in patients with peripheral arterial disease.

Methods: Two hundred and fifty-three patients with atherosclerotic lesions of arteries below the inguinal ligament were examined and revascularized. According to the type of reconstruction performed, the patients were divided into 3 groups: 98 patients underwent open operative interventions; 116 patients underwent endovascular interventions; 39 had hybrid reconstructions performed.

Results: Minor blood loss, and stability of hemodynamics in the perioperative context positively characterize hybrid effects. The time spent in the resuscitation department and the shorter hospitalization of patients after hybrid revascularization methods were revealed in comparison with open methods. The absence of dangerous complications and the primary patency of the operated segment in the early postoperative period, approaching 100%, characterize hybrid techniques as an effective method of treating patients with infrainguinal arterial disease.

Conclusion: Hybrid technologies are characterized by a shorter duration of surgical intervention, a low amount of blood loss and a lower incidence of complications in the early periods. The primary patency of the operated segment after hybrid techniques was higher than after open and endovascular surgical interventions.

Vascular smooth muscle cells (VSMCs) are the predominant cell type in the arterial wall and normally adopt a quiescent, contractile phenotype to regulate vascular tone. In the arterial wall, VSMCs are exposed to multiple mechanical cues, including stretch and matrix stiffness, which regulate VSMC contraction. However, during ageing and in vascular disease, such as atherosclerosis, hypertension and vascular calcification, the arterial wall stiffens and VSMC contraction contributes to this process. VSMCs display remarkable plasticity and changes in their mechanical environment promote VSMCs to adopt a proliferative, synthetic phenotype. VSMC phenotypic modulation is associated with altered expression of contractile proteins that generate actomyosin-based force. However, our understanding of precise mechanisms whereby altered mechanical landscape and mechanotransduction influence VSMC contraction remains limited. In this review, we discuss the present literature describing how VSMCs sense and respond to changes in their mechanical environment and how these changes influence VSMC contraction.

Aim: Assessment of the possibility of the fixed-dose combination of lisinopril + amlodipine + rosuvastatin (Equamer) to achieve further angioprotection in patients with arterial hypertension and high pulse wave velocity (PWV) despite the previous combination antihypertensive therapy (AHT).

Methods: The 24-week open-label multi-center observational study involved 60 patients who received dual combination AHT for 6 months. All patients underwent 24 h blood pressure (BP) monitoring, applanation tonometry (determination of the augmentation index and central BP), measurement of the pulse wave velocity and laboratory tests [blood lipids, fasting glucose test, homeostasis model assessment of insulin resistance (HOMA-IR), leptin, ultra-sensitive C-reactive protein (us-CRP)] before and after switching to the fixed-dose combination of lisinopril + amlodipine + rosuvastatin (Equamer).

Results: According to the office BP measurements, switching the patients from the dual combinations to the fixed-dose combination of lisinopril + amlodipine + rosuvastatin has resulted in a further decrease of 14.3% in systolic BP (SBP) and 18.5% in diastolic BP (DBP). According to the 24 h BP monitoring data, the SBP has decreased by 16.1% and the DBP by 21.8%. The combination of lisinopril + amlodipine + rosuvastatin has reduced the SBP by 14.4%, the augmentation index by 14.5% and the central SBP by 8.1% (P < 0.01 vs. baseline). The fixed-dose combination of lisinopril + amlodipine + rosuvastatin has provided a 44%-decrease in low-density lipoproteins, a 36.1%-decrease in triglycerids and a 10.3%-increase in high-density lipoproteins (P < 0.01 vs. baseline). The use of the fixed-dose combination of lisinopril + amlodipine + rosuvastatin has provided a definite decrease in the insulin resistance, as well as levels of us-CRP and leptin.

Conclusions: The fixed-dose combination of lisinopril + amlodipine + rosuvastatin provides improved BP control, better vessel elasticity indicators (augmentation index, PWV, central BP), boosts the lipid and carbohydrate metabolism and helps to reduce the inflammation and leptin resistance in patients who initially received a dual combination AHT.

This article summarizes the current research on endoscopic technique of radial artery harvesting as a graft for coronary artery bypass grafting (CABG) surgery. Based on the available data, we reviewed various grafts available for CABG. Radial artery as a graft in CABG surgery has recently gained popularity. We sought to investigate the impact of radial artery harvesting techniques on clinical outcomes. Endoscopic harvest approach was found to be feasible in all patients when performed by skillful surgeon while local arm complications were found to be infrequent. However, when compared to open approach for harvest, it takes longer but provides higher patient satisfaction and cosmetic result.

Aim: Endarterectomy has been shown to be an effective adjunct in treating diffusely diseased coronary arteries. Reconstruction of endarterectomized coronaries has been done by various techniques. We compare early results of left internal mammary artery (LIMA) patch to saphenous vein patch in left anterior descending artery (LAD) reconstruction.

Methods: We prospectively followed 30 patients with diffusely diseased LAD from January 2016 to January 2018. Patients were followed up clinically, by echocardiogram and CT coronary angiography.

Results: Twenty-seven patients were males (90%). The mean age was 59.23 ± 7.98. Twenty-two patients (73.3%) had a LIMA onlay patch. The mean length of patch reconstruction was greater in the saphenous vein group than LIMA group (8.31 ± 1.16 cm vs. 5.64 ± 0.73 cm, P < 0.001). Postoperative myocardial infarction occurred in 1 patient from the LIMA group (4.5%) and 1 patient in the saphenous vein patch group (12.5%). Operative mortality occurred in 1 patient belonging to the LIMA group. Mean time of follow up was 17.59 ± 6.34 months. CT coronary angiography showed a patency rate of 93.1%.

Conclusion: Results of reconstruction by LIMA and saphenous vein patch are comparable in short-term follow up.

A 28-year old male sustaining a penetrating injury to the subxiphoid area presented to the emergency department fully conscious and haemodynamically stable. The CT scan revealed a localized infero-posterior pericardial collection. Emergency surgery was planned to evacuate the collection and assess the extent of injury. Intraoperative transoesophageal echocardiogram demonstrated severe tricuspid regurgitation due to transection of the papillary muscle, as well as a ventricular septal defect. Tricuspid repair with reconstruction of the papillary muscle, closure of the ventricular septal defect (VSD) and the right ventricular laceration was performed. Mitral regurgitation secondary to chordae rupture was identified following de-airing maneuvers, and subsequently underwent repair. Traumatic VSD and lesions of the mitral and tricuspid valves causing insufficiency have been reported before. They have been described in isolation or as combination of two lesions but never the combination of the three of them as described in this case.

Nowadays, there are numerous studies demonstrating that volatile anesthetics reduce mortality and morbidity with a cardio-protective effect. The mechanisms involved in protecting perioperative cardiac ischemic damage provided by desflurane and sevoflurane are not fully known. Volatile anesthetics are commonly used in cardiac surgery. This mini-review aims to summarize the mechanism of action for cardio-protection of volatile anesthetics and discuss the potential therapeutic implications. Human studies have shown that volatile anesthetics can reduce mortality, but also the use of mechanical ventilation in cardiac patients, especially coronary artery bypass grafting. In contrast, total intravenous anesthesia has not shown any significant benefit compared to halogenated agents. Volatile anesthetics are among the few drugs that affect survival in the perioperative period. In addition, they can be administered in areas other than cardiac surgery due to their cardioprotective effects, which may add future perspectives in their use.