Nekrošius, Rokas

Introduction: Primary malignant aortic tumors are rare and diagnosis can be difficult due to the variety of clinical manifestations. This malignant disease, which originates in the intima or medial layers of the aorta, presents a complex diagnostic and therapeutic dilemma. Due to their insidious growth and nonspecific symptoms, they are often diagnosed postmortem. Case Presentation: We present the case of a sarcoma of the descending part of thoracic aorta in a 69-year-old man. The initial symptoms were hypertension crisis, chest pain, shortness of breath, and swollen legs. A computed tomography scan of the chest and abdomen revealed an obstructive mass in the thoracic aorta. Treatment consisted of performing prosthesis of the thoracic aorta and removal of thrombi/tumor masses from the thoracoabdominal aorta and iliac artery on both sides, as well as chemotherapy. Conclusion: Aortic sarcoma should be recognized as a potential cause of a large thrombus in the aorta. Palliative procedures, including open aortic replacement, may also serve as alternative treatment options for aortic sarcoma.

Neurological damage remains one of the most common complications after heart surgery under artificial blood circulation conditions. With increasing number of patients with complex surgeries due to aging society, these complications make it important to look for new neuroprotective options. Plant derived extracellular vesicles (PDEVs) contain microRNAs capable of cross-kingdom regulation of gene expression and metabolites with anti-inflammatory, antioxidant activity. PDEVs, can transport both hydrophobic and hydrophilic substances due to their structure and also increases their stability. Unlike mammalian EVs, the use of PDEVs reduces the risk of immunogenicity making them ideal candidates for medical applications. Aim: investigate neuroprotective effects of PDEVs in ischemic model on primary neuronalglial cells (from Wistar rats). Methods: PDEVs were isolated from Rosa Damascena rose buds, cranberry berries, guelder rose berries and blackcurrant berries using Exoplant-Lo kit (Exolitus, Lithuania). Size and concentration of PDEVs were measured using Nanosight NS300 nanotracking analysis (NTA). TRIzol reagent was used to determine total RNA concentration and Bradford method for total protein concentration in PDEVs. Cells were pretreated with PDEVs for 24 hours and then incubated in hypoxic and normoxic conditions for 48h. Cell viability was determined using Hoechst 33258 and propidium iodide stains. Results: only PDEVs from Rosa Damascena rose buds in concentration range of 1109– 1106 particles/ml had neuroprotective effects on mixed neuronal-glial cells in hypoxic conditions. Rosa Damascena PDEVs also contained the highest amount of proteins per particle count and were the largest in size. Summary: nanovesicles from Rosa Damascena rose buds prevented neuronal – glial cell death in ischemia model showing a potential in cardiac surgeries to prevent ischemic brain lesions.

Įžanga. Vainikinių arterijų jungčių suformavimo operacija išlieka viena iš dažniausiai atliekamų širdies operacijų sergantiems vainikinių arterijų (VA) ir kairiojo kamieno (KK) kraujagyslių liga su nusistovėjusia gera simptomine ir prognostine nauda pacientams. Nepaisant didėjančios pacientų rizikos, chirurginio gydymo rezultatai yra gerėjantys, o mirštamumas ir pooperacinių komplikacijų skaičius – mažėjantis. Penkerių ir 10 metų pooperacinis išgyvenamumas yra atitinkamai 85%-95% ir 75% (1). Dabartiniu metu vainikinių arterijų jungčių suformavimo operacija su dirbtine kraujo apytaka yra dažniausia standartinė operacija. Pažangūs techniniai metodikos patobulinimai, kaip dirbtinės kraujo apytakos nenaudojimas, ne-lietimo technikos (,,no-touch“), epiaortinio ultragarsinio skenavimo įdiegimas, jungčių parinkimo strategija, abipusės vidinės krūtinės arterijų, a.radialis panaudojimas, intraoperacinį junčių funkcionavimo įvertinimas, minimaliai invazinės procedūros, robotinė ir hibridinė koronarinė revaskulizacija sudaro techninių metodinių priemonių arsenalą pagerinantį trumpalaikius ir ilgalaikius rezultatus po vainikinių arterijų jungčių suformavimo (2). [...].

Introduction. Atherotic vascular disease is the leading cause of death and disability in Lithuania. Coronary, carotid and leg arteries are the most often affected vessels. Multiple disease locations increase the risk of cardiovascular events as well as mortality compared with patients having multiple risk factors only. Peripheral arterial disease patients being those with the highest cardiovascular mortality rate. This case report presents a relatively young man who was diagnosed with excessive atherosclerosis of coronary, carotid and peripheral arteries. Case statement. A 61 year old male patient was admitted to Kaunas Clinics Cardiology department because of stable angina pectoris. The patient had a previous history of intermittent claudication, arterial hypertension, deep vein thrombosis, pneumonia, COVID-19 and smoking. An ultrasonography showed lowered left ventricle ejection fraction. Coronary angiography revealed multiple stenoses in the coronary arteries requiring coronary artery bypass surgery. Bilateral lower limb angiography revealed complete occlusion of the left iliac and right inguinal arteries. Ultrasonography of the neck showed total occlusion of both internal carotid arteries with very good extra/intra collaterals through ophthalmic arteries. Both vertebral arteries were compensatory dilated without stenosis. A decision was made to perform coronary artery bypass surgery with postponing of lower limb revascularisation. During the first postoperative day an urgent right endarterectomy and arterioplasty of the right femoral artery due to acute right lower limb was performed. After the surgery reperfusion syndrome was observed in the right calf and urgent reconstructive surgery using axillofemoral shunt was done. The surgery was successful, however, the patient's condition deteriorated. The postoperative course was complicated by cardiogenic shock, renal failure, metabolic disorders, and ischaemia of lower limbs. The patient died of multiorgan dysfunction syndrome 4 days after the initial cardiac revascularization surgery. Discussions. Severe atherosclerotic vascular disease has been identified as an independent risk factor for high postoperative mortality in patients undergoing coronary artery bypass surgery. Moreover, life expectancy is substantially reduced in patients with more than one atherothrombotic event and peripheral arterial disease. Conclusion. This case report highlights a case of outspread atherosclerosis and coronary artery bypass surgery which resulted in a fatal outcome.

Neurological complications are one of the main causes of morbidity and mortality during cardiac surgery characterized by acute ischemic brain lesions, ischemic stroke and inflammation [1]. Existing prevention of ischemic damage (artificial oxygenation and cooling) are insufficient to prevent the damage. Extracellular vesicles (EVs) are nanosized double membraned particles containing cell metabolites, microRNAs, proteins and other substances found in the cells. They are involved in intracellular communication and can pass through blood-brain barrier. Although there is plenty of research done on mammalian EVs, plant derived extracellular vesicles (PDVs) are more scalable and sustainable in comparison [2]. PDVs also exert anti-inflammatory, anti-oxidant, anti-fungal and antimicrobial activity. They contain bioactive metabolites and microRNAs capable of cross-kingdom regulation of gene expression [3]. Unique biological cargo and permeability makes PDVs a good tool for medical applications and might be used during and after cardiac surgery to reduce cerebral damage caused by ischemia. The aim of this research was to test the neuroprotective effects of PDVs in an ischemic model on mixed neuron-glial cell cultures. For this study, nanovesicles from Rosa Damascena rose buds, cranberries, blueberries, guelder rose, and nettle were isolated using the Exoplant-Lo kit (Exolitus). The Nanosight 300 was used to determine the size and concentration of nanovesicles (nanotracking analysis NTA). RNA concentration was determined using Trizol reagent. Protein concentration was determined using the Bradford method. Primary mixed neuron-glial cell culture was obtained from 5-7 days old Wistar rats. Cells were pretreated with PDVs for 24 hours and then transferred into hypoxic conditions (CO2 5%, O2 2%, N2 95%) for 48h. The percentage of live cells was evaluated with fluorescence microscopy using live/dead fluorescent dyes. Results indicated that size of obtained nanovesicles was in a range of 50 - 250 nm depending on source plant. PDVs contained significant concentrations of RNA and proteins complying with data found in literature. A range of nanovesicles derived from Rosa Damascena rose buds (11010 – 1107 particles/ml) had neuroprotective effects on mixed neuronal-glial cell cultures in an ischemic model, while other PDVs had no or toxic effects at higher doses. In summary, PDVs from Rosa Damascena rose buds prevented cell death in neuronal-glial cells during hypoxia, showing a potential use during cardiac surgeries in order to prevent neurological damage. Also the differences between plant source can highly impact effects of PDVs, as some plant PDVs can have adverse effects depending on concentration.

Background and Objectives: The combination of aortic valve stenosis (AS) and ischemic heart disease (IHD) is quite common and is associated with myocardial fibrosis (MF). The purpose of this study was to evaluate the association between the histologically verified left ventricular (LV) MF and its geometry and function in isolated AS and AS within IHD groups. Materials and Methods: In a single-center, prospective trial, 116 patients underwent aortic valve replacement (AVR) with/without concomitant surgery. The study population was divided into groups of isolated AS with/without IHD. Echocardiography was used, and LV measurements and aortic valve parameters were obtained from all patients. Myocardial tissue was procured from all study patients undergoing elective surgery. Results: There were no statistical differences between isolated AS and AS+IHD groups in LV parameters or systolic and diastolic functions during the study periods. The collagen volume fraction was significantly different between the isolated AS and AS+IHD groups and was 7.3 ± 5.6 and 8.3 ± 6.4, respectively. Correlations between MF and left ventricular end-diastolic diameter (LVEDD) (r = 0.59, p = < 0.001), left ventricular mass (LVM) (r = 0.42, p = 0.011), left ventricular ejection fraction (LVEF) (r = −0.67, p < 0.001) and an efficient orifice area (EOA) (r = 0.371, p = 0.028) were detected in isolated AS during the preoperative period; the same was observed for LVEDD (r = 0.45, p = 0.002), LVM (r = 0.36, p = 0.026), LVEF (r = −0.35, p = 0.026) and aortic annulus (r = 0.43, p = 0.018) in the early postoperative period; and LVEDD (r = 0.35, p ≤ 0.05), LVM (r = 0.43, p = 0.007) and EOA (r = 0.496, p = 0.003) in the follow-up period. In the group of AS and IHD, correlations were found only with LV posterior wall thickness (r = 0.322, p = 0.022) in the follow-up period. Conclusions: Histological MF in AS was correlated with LVM and LVEDD in all study periods. No correlations between MF and LV parameters were found in aortic stenosis in the ischemic heart disease group across all study periods.

Introduction Cardiac surgery frequently leads to complications like cerebral injury. One of various manifestations of perioperative cerebral injury is ischemic brain lesions or even ischemic stroke. Recent findings report that as many as 45% of patients who have undergone cardiac surgery have new ischemic brain lesions. (1) Accordingly, it is important to search for substances that can effectively reduce the damage caused by ischemia. Extracellular vesicles (EVs) are involved in intracellular communication and due to its permeability, transport various biological cargo through blood-brain barrier. Lately, interest in plant - derived extracellular vesicles increased, as they are more sustainable and scalable alternative than mammalian derived EVs. (2) Plant derived nanovesicles contain bioactive metabolites, proteins with antifungal and antimicrobial activity and microRNAs capable of regulating gene expression in animal cells. (3) Permeability, biological activity and biocompatibility makes plant derived nanovesicles a good tool for medical applications and might be used during and after cardiac surgery to reduce cerebral damage caused by ischemia.

Introduction: Patient-prosthesis mismatch (PPM) has been associated with numerous short- and long-term adverse events. This study aimed to evaluate the effect of PPM on early postoperative results after aortic valve replacement (AVR) in daily practice. Methods: In this single-centre retrospective study, 150 non-consecutive patients from March 2019 to January 2020 with clinically indicated AVR with/without concomitant surgery were analysed. The study protocol included operative mortality, complication rate, and pre- and postoperative echocardiographic data. PPM was considered severe with indexed effective orifice area at <0.65 cm2 /m2 , moderate at 0.65–0.85 cm2 /m2 and none at >0.85 cm2 /m2 . Results: Moderate PPM was observed in 16 patients (10.6%). No patient had severe PPM. PPM was not related to early mortality (r=0.40, p=0.630), intra- (r=−0.076, p=0.352) and postoperative (r=−0.0134, p=0.102) events. Conclusion: In this study, moderate PPM was a frequent finding after AVR, whereas severe PPM was not observed. PPM did not affect the early results after AVR. A long-term follow-up study in a large patient population is required to assess the actual influence of residual PPM.

Aim. Aortic valve diseases are associated with myocardial fibrosis. The relationship between severity of myocardial fibrosis and left ventricular mass reduction (LVMR) after aortic valve replacement (AVR) still needs to be elucidated. Methods. In a single-center, retrospective trial, 130 patients underwent AVR with/without concomitant surgery. The study population was divided by etiology into aortic stenosis (AS) and aortic regurgitation (AR) groups. LV end-diastolic diameter, LV septal and posterior thicknesses, LV mass, and aortic annulus were obtained in all study patients. Left ventricular mass regression index (iLVMR) was found by the difference between preoperative iLVM and follow-up iLVM. iLVMR in months was calculated by divided iLVMR on the number of months before follow-up visit. Myocardial tissue was embedded in paraffin, and sectioned into 4 µm slices for histological staining (picrosirius red) and scanning. The fraction of myocardial volume occupied by collagen tissue was determined. Results. The left ventricular remodeling of AS and AR patients is presented in Table 3. There was significant LV mass reduction in both aortic valve disease groups in the follow-up period (AS group, p < 0.001; AR group, p < 0.05). The number of LVH cases decreased in both groups in the follow-up period (AS group, p < 0.001; AR group, p < 0.05). In Post-AVR period the ejection fraction of LV did not improve in the AS group, compare to AR group (p<0.05). In both groups number of patients with impaired LV EF was increased in Post-AVR period, but not significantly. Moreover, the LV septal thickness, and iLVEDD significantly decreased in the AS group (p<0.001 and p<0.001), compared to the AR group (p=NS, p<0.05). We did not found correlations between MF and LVM in preoperative, and follow-up periods for AS and AR groups. Moreover, MF did not correlate significantly to iLVMR and iLVMR in months. A significant correlation exists in AS patients between MF and preoperative iLVEDD (r = 0.21, p = 0.04). Conclusion. The LVM reduction was observed in both AS and AR groups. LVM of AS group recovered more quickly than that of AR group. In our study MF does not affect LVM regression. Large cohort of patients with myocardial biopsies and long-term follow-up are needed to access the impact of the MF on the LVMR.

Background and objectives: The aims of this study were to investigate changes in the hemodynamics associated with di erent types of aortic prostheses and to evaluate patient-prosthesis mismatch (PPM) at rest and after exercise. Materials and Methods: We retrospectively analyzed 150 patients who presented with indications for aortic valve replacement (AVR) with/without concomitant surgery from March 2019 to January 2020. The study population included 90 (60%) men and 60 (40%) women (mean age, 67.33 10.22 years; range, 37–88 years). Echocardiography data such as peak and mean transprosthetic pressure gradients (Gmax, Gmean), velocity (V), e ective orifice area (EOA), and indexed EOA (iEOA) were derived at rest and after exercise at baseline and before discharge. The study patients performed the six-minute walk test (6MWT) on the 5th–7th postoperative day. Results: Stented tissue valves showed excellent performance at rest and after exercise in comparison with mechanical valves, which showed favorable hemodynamics at rest only. At the time of discharge, moderate PPM was observed in 7/74 patients (9.5%) at rest and 5/98 (3.3%) patients after exercise. None of the patients showed severe PPM. EOA and iEOA were not significantly di erent between the groups. However, the stented group showed more pronounced changes in EOA and iEOA after exercise, whereas the changes in the mechanical valve group did not reach significance. Conclusions: In the early postoperative period, mechanical valves and stented valves showed favorable resting hemodynamics. The PPM rate measured after exercise was lower than that at rest.