The involvement of oral bacteria in the pathogenesis of cardiovascular diseases has been the focus of attention in many studies, and several periodontal pathogens have been detected in diseased cardiovascular lesions, suggesting relationships between oral microorganisms and cardiovascular diseases. However, no information is available regarding the involvement of cariogenic pathogens such as Streptococcus mutans. The presence of oral streptococcal species and periodontitis-related bacteria in 35 heart valve and 27 atheromatous plaque clinical specimens, as well as 32 dental plaque specimens from the same subjects, was analyzed using a PCR method. Furthermore, broad-range PCR with DNA sequencing analysis was employed to identify the bacterial species in those samples. Streptococcus mutans was frequently detected in the heart valve (69%) and atheromatous plaque (74%) specimens, while other bacterial species, including those related to periodontitis, were detected with much lower frequencies. The bacterial composition in cardiovascular tissues was found to be markedly distinct from that in dental plaque, with only a limited number of species, including S. mutans, in the cardiovascular regions shown to have possibly originated from the oral cavity. Semiquantitative assay results revealed that S. mutans was detected in significant quantities in the heart valve (40%) and atheromatous plaque (48%) specimens, whereas the quantities of all other tested bacterial species, including several related to periodontitis, were negligible in the cardiovascular samples. These results indicate that S. mutans is a possible causative agent of cardiovascular disease.Accumulated evidence suggests that oral bacterial pathogens are associated with several kinds of systemic diseases, such as infective endocarditis (IE), cardiovascular diseases, bacterial pneumonia, low birth weight, and diabetes mellitus (12). Those associations are speculated to be initiated by transient or prolonged bacteremia caused by oral infection: i.e., from professional dental treatments and daily oral care practices such as tooth brushing and flossing, as well as from food chewing, which possibly induces dissemination of oral bacteria into the bloodstream (21). Oral streptococcal species are major components of the oral microflora that are known to occasionally cause bacteremia and IE (13). Streptococcus mutans, a major pathogenic agent of dental caries, has also been isolated from the blood of patients with IE, strongly suggesting a close relationship of the pathogen with IE (5, 23, 24).The recent development of several molecular techniques has enabled prompt identification of targeted bacterial species in specimens with significantly improved specificity and sensitivity. PCR methods using primers constructed with a species-specific nucleotide alignment are widely used for the detection of specific species. In addition, broad-range eubacterial PCR with amplification of bacterial DNA and subsequent direct sequencing is considered to be a reliable diagnostic tool ...

In patients with paroxysmal AF related to aortic valve disease and/or coronary artery disease, a dilated left atrium (≥45 mm) was associated with inferior AF- and event-free survival after PVI, accompanied by persistent abnormalities in cardiac and haemodynamic function. These findings may assist patient selection for PVI during AVR and/or CABG.

The RMA procedure partially relieved leaflet tethering, evidenced by decreased tethering distances and IPMD; the latter was the main determinant of MR. These beneficial effects might be mainly attributed to post-RMA reverse LV remodeling, potentially offsetting the negative effect of augmented posterior leaflet angle in selected patients.

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Background-Restrictive mitral annuloplasty (RMA) often leads to reverse left ventricular (LV) remodeling in patients with advanced cardiomyopathy and functional mitral regurgitation. However, the mechanism responsible for its favorable effects on LV ejection performance has been poorly understood. We evaluated systolic wall stress using cineangiographic multidetector computed tomography (MDCT) and our developed software system to assess stress-shortening relations before and after RMA. Methods and Results-Twenty-four patients with dilated cardiomyopathy underwent 64-row MDCT before and 2 months after RMA. All patients underwent stringent downsizing annuloplasty with a semirigid complete ring. Reconstructed images were used to calculate LV end-diastolic index (EDVI) and end-systolic volume index (ESVI), LV ejection fraction, and regional and global end-systolic wall stress (ESS). After RMA, LVEDVI and LVESVI decreased from 151Ϯ52 to 131Ϯ53 mL/m 2 (Pϭ0.0001) and from 114Ϯ48 to 92Ϯ50 mL/m 2 (Pϭ0.0001), respectively. Global ESS decreased from 157Ϯ43 to 139Ϯ50 kdyne/cm 2 (Pϭ0.01), and LV ejection fraction improved from 27Ϯ8.0 to 33Ϯ13% (Pϭ0.0007). There were significant correlations between change in LVEDVI and LVESVI (rϭ0.88, PϽ0.0001) and change in LVESVI and global ESS (rϭ0.68, Pϭ0.0002). Moreover, the magnitude of increase in LV ejection fraction significantly correlated with the degree of reduction in global ESS (rϭϪ0.61, Pϭ0.002). Patients without significant reverse LV remodeling had significantly higher preoperative and postoperative global ESS than those with it. Conclusions-Our study suggests that decrease in afterload after reduction in volume overload was responsible for postoperative reverse LV remodeling process after RMA.