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Objective To identify the risk factors for early fluid overload (FO) following repair in the pediatric patients with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) complicated with moderate or severe left ventricular dysfunction (left ventricular ejection fraction [LVEF] ＜50％) and evaluate the effect on clinical outcomes.Methods Forty-three pediatric patients with ALCAPA complicated with moderate or severe left ventricular dysfunction,aged 2-128 months,weighing 4.5-34.5 kg,with New York Heart Association Ⅲ or Ⅳ,undergoing ALCAPA repair,were enrolled in this study.The pediatric patients were divided into FO ≥ 5％ group (n =14) and FO＜5％ group (n =29)according to the FO developed within 24 h after operation.The pediatric Risk,Injury,Failure,Loss,and End-Stage Renal Disease criterion was used to diagnose acute kidney injury developed after operation.Factors including age,height,weight,preoperative LVEF,preoperative biomarkers,operative data,postoperative ventilation time,duration of intensive care unit (ICU) stay and related postoperative clinical outcome parameters were recorded.The risk factors of which P values were less than 0.05 would enter the multivariate logistic regression analysis to stratify the risk factors for FO ≥ 5％ developed within 24 h after operation.The effect of FO≥5％ on postoperative severe acute kidney injury (Injury and Failure),ventilation time,duration of ICU stay and etc.was assessed.Results Fourteen cases developed early postoperative FO≥5％,and the incidence was 33％.The results of the logistic regression analysis showed that lower preoperative LVEF was an independent risk factor for early postoperative FO ≥ 5％ (P＜0.05).Compared with FO＜5％ group,the postoperative ventilation time and duration of ICU stay were significantly prolonged,the number of pediatric patients who developed pulmonary infection and required reintubation was increased,the number of pediatric patients in whom duration of ICU stay was more than 14 days was increased (P＜0.05),and no significant change was found in the other parameters of clinical outcomes in FO ≥ 5％ group (P＞0.05).Conclusion Lower preoperative LVEF is a risk factor for early postoperative FO in pediatric patients with ALCAPA complicated with a moderate or severe left ventricular dysfunction undergoing repair,and it is not helpful for clinical outcomes in pediatric patients when postoperative early FO≥5％ occurs.
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Objective@#To identify the risk factors for early fluid overload(FO)following repair in the pediatric patients with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) complicated with moderate or severe left ventricular dysfunction (left ventricular ejection fraction [LVEF]<50%) and evaluate the effect on clinical outcomes.@*Methods@#Forty-three pediatric patients with ALCAPA complicated with moderate or severe left ventricular dysfunction, aged 2-128 months, weighing 4.5-34.5 kg, with New York Heart Association Ⅲ or Ⅳ, undergoing ALCAPA repair, were enrolled in this study.The pediatric patients were divided into FO≥5% group (n=14) and FO<5% group (n=29) according to the FO developed within 24 h after operation. The pediatric Risk, Injury, Failure, Loss, and End-Stage Renal Disease criterion was used to diagnose acute kidney injury developed after operation. Factors including age, height, weight, preoperative LVEF, preoperative biomarkers, operative data, postoperative ventilation time, duration of intensive care unit(ICU)stay and related postoperative clinical outcome parameters were recorded.The risk factors of which P values were less than 0.05 would enter the multivariate logistic regression analysis to stratify the risk factors for FO≥5% developed within 24 h after operation.The effect of FO≥5% on postoperative severe acute kidney injury (Injury and Failure), ventilation time, duration of ICU stay and etc. was assessed.@*Results@#Fourteen cases developed early postoperative FO≥5%, and the incidence was 33%.The results of the logistic regression analysis showed that lower preoperative LVEF was an independent risk factor for early postoperative FO≥5% (P<0.05). Compared with FO<5% group, the postoperative ventilation time and duration of ICU stay were significantly prolonged, the number of pediatric patients who developed pulmonary infection and required reintubation was increased, the number of pediatric patients in whom duration of ICU stay was more than 14 days was increased (P<0.05), and no significant change was found in the other parameters of clinical outcomes in FO≥5% group (P>0.05).@*Conclusion@#Lower preoperative LVEF is a risk factor for early postoperative FO in pediatric patients with ALCAPA complicated with a moderate or severe left ventricular dysfunction undergoing repair, and it is not helpful for clinical outcomes in pediatric patients when postoperative early FO≥5% occurs.
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Objective To investigate the effects of special anticoagulation method of hybrid coronary revascularization procedure on postoperative bleeding and clinical outcomes.Methods One hundred and forty-one ASA Ⅱ or Ⅲ consecutive patients,aged 35-82 yr,weighing 45-105 kg,undergoing one-stop hybrid coronary revascularization procedure from June 2007 to January 2011 in Fuwai cardiovascular hospital were enrolled and served as Hybrid group.Using propensity score methodology,these patients were matched with another 141 patients who had undergone off-pump coronary artery bypass grafting (OPCAB group) during the same period,selecting from the surgical database.These ASAⅡ or Ⅲ 141 patients,aged 43-80 yr,weighing 47-110 kg,who underwent OPCAB,were served as control subjects.In group Hybrid,the left internal mammary artery was isolated and then 100-120 U/kg heparin was administrated to maintain activated clotting time between 250-300 s,and additional heparin was given if needed.Protamine 1 mg/kg was used to reverse the effect of heparin after anastomosis between left internal mammary artery and left anterior descending branch.Before stent implantation,6000-8000 U heparin and 300 mg clopidogrel were administrated.Activated clotting time was maintained between 200-250 s until the end of operation.Clopidogrel 75 mg/d was taken for at least 12 months after operation.The volume of postoperative chest tube drainage,mechanical ventilation time,length of stay in intensive care unit,postoperative transfusion of allogeneic blood,re-intubation,myocardial damage,acute kidney injury,atelectasis,hydrothorax and thromboembolism were recorded.Results No thromboembolism was observed within the stent during stay in hospital after operation in patients.The volume of chest tube drainage was significantly less,mechanical ventilation time and length of stay in intensive care unit were shorter,the incidence of atelectasis and hydrothorax and transfusion of allogeneic blood requirement were lower in Hybrid group than in OPCAB group (P ＜ 0.05).There was no significant difference in the incidences of re-intubation,myocardio damage,and acute kidney injury between the two groups (P ＞0.05).Conclusion Special anticoagulation method of hybrid coronary revascularization procedure does not increase postoperative bleeding and has a better clinical outcomes during the early period.
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Objective To evaluate the effects of sevoflurane postconditioning on ischemia-reperfusion injury in chronically-infarcted rat hearts.Methods Left anterior descending coronary artery was ligated to induce myocardial infarction in male Sperague-Dawley rats.Six weeks later,chronically-infarcted hearts were isolated and passively perfused in a Langendorff apparatus.Eighty chronically-infarcted hearts were randomized into 8 groups (n =10 each)∶ Ⅰ-Ⅷ groups.In group Ⅰ,hearts were continously perfused with Krebs-Henseleit (K-H) solution for 90 min.In group Ⅱ,hearts were subjected to 30 min of global ischemia,followed by 60 min of reperfusion.In groups Ⅲ to Ⅵ,hearts were exposed to 30 min of global ischemia,specific phosphatidylinositol-3-kinase (PI3K) inhibitor LY294002 15 μmol/L and mitogen-activated extracellular regulated kinase 1/2 (MEK1/2) inhibitor PD98059 20 μmol/L,0.02％ dimethyl sulfoxide,and K-H solution saturated with 3％ sevoflurane were administered,respectively,during the first 15 min of reperfusion,followed by perfusion with plain K-H solution for 45 min.In groups Ⅶ and Ⅷ,hearts were exposed to 30 min of global isehemia,K-H solution saturated with 3％sevoflurane was given during the first 15 min of reperfusion,LY294002 15 μmol/L and PD98059 20 μmol/L were simultaneously administered,respectively,followed by perfusion with plain K-H solution for 45 min.Coronary flow (CF),left ventricular developed pressure (LVDP),± dp/dt,left ventricular end-diastolic pressure (LVEDP) and heart rate (HR) were recorded after 20 min of equilibration (baseline,T0),immediately before ischemia (T1),and at 15,30 and 60 min of reperfusion (T2-4).The concentrations of lactate dehydrogenase (LDH) and creatine kinase-MB (CK-MB) in the collected coronary effluent were determined at T0 and T4.Acute myocardial infarct size was determined at T4.Left ventricular tissue samples were collected at T2 to measure the phosphorylation of protein kinase B/Akt (PKB/Akt),and extracellular regulated kinase 1/2 (ERK1/2) and degree of mitochondrial permeability transition pore (rnPTP) opening.Results Compared with group Ⅰ,LVDP,± dp/dt,HR and CF were significantly decreased,LVEDP was increased,the acute myocardial infarct size was enlarged,and the concentrations of LDH and CK-MB in the coronary effluent and degree of mPTP opening were increased during reperfusion in groups Ⅱ-Ⅷ (P ＜ 0.05).LVDP,± dp/dt,HR and CF were significantly higher,LVEDP was lower,the acute myocardial infarct size was smaller,the concentrations of LDH and CK-MB in the coronary effluent were lower,the phosphorylation of PKB/Akt and ERK1/2 was higher,and the degree of mPTP opening was lower during reperfusion in group Ⅵ than in group Ⅱ (P ＜ 0.05).Conclusion Sevoflurane postconditioning protects chronically-infarcted rat hearts against ischemia-reperfusion injury by activating PI3K-PKB/Akt and MEK1/2-ERK1/2 and inhibiting mPTP opening.
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Objective To investigate the effects of O-GlcNAc modification on gintamine (Glu)-induced heat shock protein 70 (HSP70) expression in LPS-treated rat cardiomyocytes.Methods Primary cultures of neonatal rat cardiomyocytes were randomly divided into 6 groups:group Ⅰ control(group C);group Ⅱ Glu;group Ⅲ LPS;group Ⅳ Glu+LPS;group Ⅴ Glu+LPS+Alloxan and group Ⅵ Gln+LPS+PUGNAc.In group C double distilled water 25 μl was added.In group Ⅱ-Ⅵ the cells were exposed to the sanle concentrations of Glu (5 mmol/L)and LPS(4 μg/ml) except Alloxan (an inhibiter of O-linked β-N-acetyl glucosamine transferase/OGT) (1 mmol/L) and PUGNAc (an inhibitor of O-linked β-N-acetyl glucosaminidase/OGA)(100μmol/L).After being incubated for 6 h,cardiomyocyte viability,O-GlcNAc modification level and HSP70 expression level were measured.Results There was no significant difference in cell viability among the six groups.The levels of O-GlcNAc modification and HSP70 expression were significantly higher in group Ⅱ-Ⅵ than in group Ⅰ,were significantly higher in group Ⅳ and group Ⅵ than in group Ⅲ,were significantly lower in group Ⅴ and higher in group Ⅵ than in group Ⅳ.Conclusion O-GlcNAc modification may be involved in Glu-induced HSPT0 expression in LPS-treated cardiomyocytes.