Preeclampsia (PE) is characterized by disturbed extravillous trophoblast migration toward uterine spiral arteries leading to increased uteroplacental vascular resistance and by vascular dysfunction resulting in reduced systemic vasodilatory properties. Its pathogenesis is mediated by an altered bioavailability of nitric oxide (NO) and tissue damage caused by increased levels of reactive oxygen species (ROS). Furthermore, superoxide (O₂⁻) rapidly inactivates NO and forms peroxynitrite (ONOO⁻). It is known that ONOO⁻ accumulates in the placental tissues and injures the placental function in PE. In addition, ROS could stimulate platelet adhesion and aggregation leading to intravascular coagulopathy. ROS-induced coagulopathy causes placental infarction and impairs the uteroplacental blood flow in PE. The disorders could lead to the reduction of oxygen and nutrients required for normal fetal development resulting in fetal growth restriction. On the other hand, several antioxidants scavenge ROS and protect tissues against oxidative damage. Placental antioxidants including catalase, superoxide dismutase (SOD), and glutathione peroxidase (GPx) protect the vasculature from ROS and maintain the vascular function. However, placental ischemia in PE decreases the antioxidant activity resulting in further elevated oxidative stress, which leads to the appearance of the pathological conditions of PE including hypertension and proteinuria. Oxidative stress is defined as an imbalance between ROS and antioxidant activity. This review provides new insights about roles of oxidative stress in the pathophysiology of PE.

The left and right atria serve as buffer chambers to control the flow of venous blood for ventricular filling. If an atrium is absent, blood does not flow effectively into the ventricle, leading to venous blood retention and low cardiac output. The importance of atrial function has become increasingly recognized, because left atrial (LA) function contributes to cardiac performance, and loss of LA function is associated with heart failure. LA volume change has been used for LA function assessment in experimental and clinical studies. In conjunction with LA pressure, the LA pressure–volume relationship provides a better understanding of LA mechanics. LA strain measurement by speckle tracking echocardiography was introduced to evaluate three components of LA function as a (booster) pump, reservoir and conduit. Furthermore, increasing evidence supports the theory that LA reservoir strain has prognostic utility in various cardiac diseases. In this review, we summarize LA contribution to maintain cardiac performance by evaluating LA function with echocardiography according to our experiences and previous reports. Furthermore, we discuss LA dysfunction in challenging cardiac diseases of cardiac amyloidosis and adult congenital heart disease.

Background: Coil occlusion has been widely indicated for the closure of patent ductus arteriosus (PDA). Although many reports have shown the efficacy and safety of coil occlusion, the long-term outcome in patients remains controversial. Here, we analyzed the long-term outcome of coil occlusion in patients with PDA in Japan. Methods and Results: We collected the longitudinal data of patients who underwent coil occlusion between 1995 and 2009. A total of 310 coil occlusions were performed in 298 patients with PDA. The median minimum duct diameter was 1.4mm. Successful coil occlusion was achieved in 286 patients (96.0%), and total adverse events were seen in only 28 cases (9.0%). The median follow-up period was 50 months. The occlusion rates at 1 month, 6 months, 1 year, 2 years and 5 years were 90.1%, 94.4%, 97.4%, 97.8% and 97.8%, respectively. Patients with a large PDA (≥4mm) showed a higher rate of residual leakage than those with a small (<2mm) or moderate (2-4mm) PDA (P=0.004). Patients who underwent this procedure in the early study period also showed a higher rate of residual leakage than those in the late study period. Conclusions: Coil occlusion is an effective procedure for patients with PDA. Our data indicate that the long-term outcome is promising without any adverse events. (Circ J 2011; 75: 407-412)