pericardiocentesis – ABC CARDIOL

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Research Letter

Intrapericardial Cisplatin Instillation for Malignant Pericardial Effusion: A Single-center Experience

Paulo Medeiros et al. Jorge Rodrigues António Gaspar

Introduction

Heart and pericardium involvement occurs in about 10% of cancer patients, significantly impacting survival. Lung and breast carcinomas, melanoma, and lymphoma are the most common malignant tumors affecting the heart and pericardium. Involvement of the heart is a marker of very poor prognosis, representing end-stage neoplastic disease.

Pericardial decompression via pericardiocentesis results in immediate dyspnea relief and plays an important role in symptomatic treatment. Notwithstanding, the need for multiple procedures in the same patient is not uncommon. During the last decades, reports emerged regarding the utilization of cytotoxic agents for chemical pericardiodesis, but literature is scarce overall, and no systematization document has been published. The authors aimed to assess the recurrence of clinically significant malignant pericardial effusion in patients submitted to pericardiocentesis and cisplatin instillation.

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Artigo Original

Angiotensin-converting enzyme in pericardial fluid: comparative study with serum activity

Roseli Aparecida da Silva Gomes et al. Lívia das Graças Vieito Lombardi Teodoro Isabel Cristina Rezende Lopes Patrícia Alessandra Bersanetti … Adriana Karaoglanovic Carmona Valdemar Hial

BACKGROUND: The characterization of an angiotensin-converting enzyme (ACE) in human pericardial fluid is relevant, considering its role in the angiotensin II release and thus, the role of the pericardium in cardiovascular homeostasis. OBJECTIVE: To isolate and characterize an ACE from human pericardial fluid and to compare the angiotensin I converting activities of the pericardial fluid with that of the serum in patients submitted to cardiovascular surgery. METHODS: The enzyme from human pericardial fluid was purified through chromatographic steps and characterized by polyacrylamide gel electrophoresis (SDS-PAGE), hydrolysis of angiotensin I, bradykinin, Hip-His-Leu and synthetic substrates with internal fluorescence suppression. Lisinopril was used as inhibitor. The ACE activity was measured in blood and pericardial fluid samples of 23 patients submitted to cardiovascular surgery. RESULTS: The purified ACE (MM = 140 kDa), releases angiotensin II, hydrolyses bradykinin and the Hip-His-Leu substrate. The kinetic parameters k cat,(s-1) and k cat/Km (µM-1. s-1) were, respectively: Hip-His-Leu (1.14 and 7 x 10 -4) ; Abz-YRK(Dnp)P-OH (2.60 and 0.77), Abz-LFK(Dnp)-OH (2.77 and 0.36) and Abz-SDK(Dnp)P-OH (1.92 and 0.19). The angiotensin I converting activities (mean ± SD) in the pericardial fluid and in blood, were, respectively: 3.16 ± 0.90 mU x mg -1x min-1 and 0.33 ± 0.11 mU x mg -1x min-1. The difference was significant between the two fluids. CONCLUSION: An ACE that bears great similarity with the somatic enzyme was isolated from human pericardial fluid. The angiotensin I converting activity is higher in the pericardial fluid when compared to the serum activity. These data are important evidence of the role of the pericardial fluid in the metabolism of active peptides.

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Intrapericardial Cisplatin Instillation for Malignant Pericardial Effusion: A Single-center Experience

Introduction

Angiotensin-converting enzyme in pericardial fluid: comparative study with serum activity

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