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@#Objective To explore and analyze the risk factors for arrhythmia in patients after heart valve replacement. Methods A retrospective analysis of 213 patients undergoing cardiac valve replacement surgery under cardiopulmonary bypass in our hospital from August 2017 to August 2019 was performed, including 97 males and 116 females, with an average age of 53.4±10.5 year and cardiac function classification (NYHA) grade of Ⅱ-Ⅳ. According to the occurrence of postoperative arrhythmia, the patients were divided into a non-postoperative arrhythmia group and a postoperative arrhythmia group. The clinical data of the two groups were compared, and the influencing factors for arrhythmia after heart valve replacement were analyzed by logistic regression analysis. Results There were 96 (45%) patients with new arrhythmia after heart valve replacement surgery, and the most common type of arrhythmia was atrial fibrillation (45 patients, 18.44%). Preoperative arrhythmia rate, atrial fibrillation operation rate, postoperative minimum blood potassium value, blood magnesium value in the postoperative arrhythmia group were significantly lower than those in the non-postoperative arrhythmia group (P<0.05); hypoxemia incidence, hyperglycemia incidence, acidosis incidence, fever incidence probability were significantly higher than those in the non-postoperative arrhythmia group (P<0.05). The independent risk factors for postoperative arrhythmia were the lowest postoperative serum potassium value (OR=0.305, 95%CI 0.114-0.817), serum magnesium value (OR=0.021, 95%CI 0.002-0.218), and hypoxemia (OR=2.490, 95%CI 1.045-5.930). Conclusion Taking precautions before surgery, improving hypoxemia after surgery, maintaining electrolyte balance and acid-base balance, monitoring blood sugar, detecting arrhythmia as soon as possible and dealing with it in time can shorten the ICU stay time, reduce the occurrence of complications, and improve the prognosis of patients.
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Objective To investigate the changes of blood oxygen saturation and heart rate after urgently going to high‐alti‐tude area ,so as to provide a reference for medical rescue in high‐altitude area .Methods Subjects left from the plain area with an al‐titude of 400 m .Blood oxygen saturation and heart rate were measured before departure and after reaching 4 300 m altitude region . Then the subjects were taken to the destination with an altitude of 3 200 m ,at which they received a dynamic continuous monitoring of blood oxygen saturation /heart rate at the 1st day ,2nd day ,3rd day ,4th day ,5th day ,6th day ,7th day after arrival .After adapting to the environment in 3 200 m altitude area for 1 week ,subjects were taken to the 4 300 m altitude region ,at which they were re‐measured blood oxygen saturation and heart rate .Results After entering the areas of 4 300 m altitude and 3 200 m altitude ,the blood oxygen saturation was significantly decreased compared with that in plain area (P 0 .05) .Conclusion The arterial oxygen saturation was de‐creased with the increase of altitude ;the people living in plain areas can preliminarily adapt to the environment at 6th day after reaching 3 200 m altitude regions ;people can better adapt to the high‐altitude environment by shortly living in lower‐altitude areas before re‐entering high‐altitude areas .
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Objective The purpose of this study was to investigate the early outcome of radiofrequency ablation for the treatment of atri-al fibrillation (AF) during concomitant mitral valve replace procedures. Methods From January 2013 to September 2014,43 patients with mitral valvular disease with atrial fibrillation were enrolled in this study. The cases were classified into underwent mitral valve replace surgery concomitant with atrial fibrillation radiofrequency ablation ( RFA group) or underwent only mitral valve replace surgery ( control group) . Re-sults There was no perioperative death and stroke. RFA group’ s time of Cardiopulmonary bypass was more longer than control group. The comparison between RFA and control groups revealed no differences in terms of bleeding,24 hours’ Pleural fluid volume,the mechanical ven-tilation time and time in intensive care unit. One week after the operation,20 cases (87%) in RAF group were sinus rhythm while it was 6 cases(30%) in control group. After a follow-up of one month,RAF group had 78% remaind sinus rhythm while it was 25% in control group. Conclusion Radiofrequency ablation for the treatment of atrial fibrillation ( AF) during concomitant mitral valve replace is safe and effective.
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Objective To observe hypoxia-induced pulmonary arterial endothelial-to-mesenchymal transition and investigate the role of transforming growth factor β1 (TGF-β1) in the process. Methods Pulmonary arterial cells improved by adherence method were cultured in normoxia (containing 21%O2,5%CO2 and 74%N2) or hypoxia (containing 1%O2,5%CO2 and 94%N2) for 1,4,or 7 days,respectively. Endothelial-to-mesenchymal transition was confirmed with morphological observation and expression of α-smooth muscle actin (α-SMA) by immunocytochemistry. Expression of TGF-β1 was evaluated by RT-PCR and Western blot,and α-SMA by Western blot. Results Hypoxia-induced paving-stone-like pulmonary arterial endothelial cells transdifferentiating to polygonal cells with high-expression of α-SMA. TGF-β1 expression was increased significantly after 7 days of hypoxia. TGF-β1 stimulating alone increasedα-SMA expression of pulmonary arterial en-dothelial cells;while,SD-208,inhibitor of TGF-β1,abolished the above effect. Conclusion Hypoxia can induce endothelial-to-mesenchymal transition. And TGF-β1 plays an important role in the process.
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Objective To research ischemic postconditioning on heart function after myocardial ischemia-reperfusion(I/R),and the protective mechanisms. Methods Thirty-two rats were divided into four groups:I/R group ( n = 8 ) , ischemic postconditioning group (n=8),myocardial ischemic postconditioning+ NSC-74859 (STAT3 inhibitor) group(n=8),and control group(n=8). Establish a model of rat to observe changes of the heart rate,LVSP,+dp/dtmax,-dp/dtmax,coronary flow and myocardial enzyme spectrum in each group un-der different conditions. Results Compared with ischemia-reperfusion group,heart rate of the reperfusion period,CK and LDH of coronary ef-fluent in the ischemic postconditioning group were obviously lower,while left ventricular systolic pressure,change of intraventricular pressure, and coronary effluent volume increased obviously. And after inhibition of STAT3 expression,this protective effect decreased significantly. Con-clusion Ischemic postconditioning can provide potent cardioprotective effect in which STAT3 mediates the cardioprotective effects.
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By analyzing the status of Cardiovascular Surgery advanced students,we discussed the characteristics and problems of clinical teaching for advanced students of Cardiovascular Surgery.Strategies of clinical teaching for advanced students of cardiovascular surgery are explored to improve the quality of clinical teaching.
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Objective The present study is to investigate the effect of EPO pretreatment on TNF-? expression in cultured cardiac myocytes with H/R and to explore the possible NF-?B signal transduction mechanism. Methods The model of cultured cardiac myocytes with H/R was established and the cardiac myocytes were divided into 4 groups, including EPO group (treat with EPO 10?U/ml 24?h before H/R), EPO+PDTC group (treat with EPO 10?U/mL and PDTC 5??g/ml 24?h before H/R), PDTC group (treat with PDTC 5??g /ml 24h before H/R) and control group. Change of TNF-? gene expression before and after H/R in cardiac myocytes was detected with RT-PCR and western blot. Change of NF-?B activity before and after H/R in cardiac myocytes was assayed with EMSA. Results Before H/R, there was no significant difference in TNF-? mRNA and protein expression between the 4 groups and after H/R, TNF-? mRNA and protein expression increased significantly in the 4 groups compared to control group before H/R. After H/R, TNF-? mRNA and protein expression was lower in EPO group than in the other 3 groups. Before H/R, NF-?B activity was higher in EPO group than in the other groups. After H/R, NF-?B activity increased significantly in all the 4 groups compared to the control before H/R and NF-?B activity was lower in EPO group than in the other groups. Conclusion EPO pretreatment inhibited the upregulation of TNF-? gene expression after H/R in cardiac myocytes, which might be related to the inhibition of NF-?B activation; EPO pretreatment might inhibit the activation of NF-?B after H/R through the negative feed-back mechanism of NF-?B activation.
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Objective To summarize experiences in surgical treatments of 18 patients suffered from Ebstein's anomaly with intracardiac repair and bi-directional cavopulmonary shunt from January 1999 to June 2003. Methods Of 18 patients, 10 male (55.6%) and 8 female (44.4%), mean age was (18.47?13.85) years old (range from 9 months～54 years old),and mean weight of body (36.09?19.78) kg (range from 8.5～80.0 kg). All patients were in type II of Ebstein's anomaly according to WANG (Zenwei's) classification, while 15 (83.3%) were in type B, and 3 (16.7%) in type C according to Carpentier's classification. Danielson repair of Ebstein's malformation and other intracardiac repair were performed on all patients, followed by bi-directional cavopulmonary anastomosis, on pump with heart beating. Results There was no death, and no severe heart dysfunction and refractory low cardiac output in all patients postoperatively. No reoperation for residual or recurrent tricuspid incompetence was required in all patients. At follow-up of 13 (72.2%) patients ranging from 1 to 53 months, 12 patients were in New York Heart Association ((NYHA)) class I, 1 in class II. Four were with 1 grade, 2 with 2 grades tricuspid regurgitation. The patency of bi-directional cavopulmonary anastomoses was verified by echocardiography. Conclusion Ventricular unloading added to intracardiac repair appears to be effective to improve left and right ventricular function and tricuspid valve performance in Ebstein's anomaly with moderate or massive tricuspid dysfunction and physiological right ventricular outlet tract obstruction.
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Objective: To investigate the role of thrombus precursor protein (TPP) in the monitoring of anticoagulation after mechanical heart valve replacement. Methods: TPP and INR were compared between the coagulant group and control group. In the coagulant group, TPP and INR were also compared between the patients with atrial fibrillation and the patients without atrial fibrillation. The relationship between TPP levels and INR levels in 60 cases of anticoagulated patients was analyzed by linear regression. Results: It was found that the anticoagulant therapy could effectively decrease the level of TPP and increase the level of INR. In the anticoagulant group, the patients with atrial fibrillation had higher TPP level than other patients. No significant relationship was found between TPP levels and INR levels. TPP level in the patients with bleeding complications was far lower than 6 ?g/ml. Conclusion: TPP is a very valuable monitoring marker assisting INR. Patients with atrial fibrillation may require higher anticongulant intensity. INR and TPP should be tested at the same time in the patients receiving oral anticoagulation after mechanical heart valve replacement.
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Objective To investigate the roles of the expressions of B cell lymphoma-2 (bcl-2) and Bcl-assosiated X (bax) in the pulmonary vascular remodeling (PVR) of pulmonary arterial hypertension (PAH) secondary to left-right shunt congenital heart disease (CHD).Methods A total of 80 SPF SD rats were randomly divided into 8 groups,shunt groups (SⅠ,SⅡ,SⅢ and SⅣ) and control groups (CⅠ,CⅡ,CⅢ and CⅣ).PAH rat model was established in the shunt groups by left-to-right shutting,and the control groups received sham operation.The rats from Ⅰ,Ⅱ,Ⅲ and Ⅳ groups were sacrificed in 4,8,12 and 16 weeks after operation.Mean pulmonary arterial pressure (mPAP) was recorded.Pathologic observations were made to assess pulmonary vascular remodeling.Their lung tissues were detected by in situ hybridization histochemistry (ISHH) technique and Western blotting for bcl-2 and bax.And apoptosis of pulmonary artery smooth muscle cells (PSMCs) and endothelial cells (ECs) were also detected by TUNEL.Results After 12 weeks or 16 weeks shunt,following indexes of the shunt groups were significantly higher than the control groups (P
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Objective To evaluate the efficiency of emergency surgery to consecutive 258 infants suffering with critical congenital heart diseases (CHD). Methods From January 2006 and February 2009,emergency surgery was performed within 24 h after definite diagnosis on 258 children with critical congenital heart diseases,including 150 males (58.1%) and 108 females (41.9%),with a mean age of (7.5?4.3) months (ranging from 6 d to 11 months),at a mean weight of (5.5?3.3) kg (ranging from 2.1 to 9.5 kg). Complications such as refractory pneumonia,heart failure,repeated episodes of hypoxic spells,kidney dysfunction,liver dysfunction,severe anaemia or growth retardation were found in 233 infants (90.2%). Totally 246 (95.3%) of them were operated on CPB with heart arrested,and 12 (4.7%) with patent ductus arteriosus and operated off pump. Results This group of patients had a stage-one corrective rate of 92.3%,and a total curative rate of 96.9%. In infants operated with heart arrested and with heart beating,the duration of cardiopulmonary bypass was 105.00?38.71 min and (71.89?27.78) min respectively,postoperative ventilation duration was (16.5?9.3) h,intensive care unit (ICU) staying duration was (98.5?33.6) h. After operation,low cardiac output syndrome occourred with a rate of 6.9% and severe complications of major organs with a rate of 12.9%. Of 8 (3.1%) dead infants,7 were diagnosed with complicated CHD. Five died of low cardiac output syndrome,1 of arrhythmia,1 of respiratory failure and 1 of arrhythmic heart. Conclusion Emergency surgical treatment should be performed as soon as definite diagnosis for critical infants with congenital heart disease. Heart failure,respiratory failure,liver dysfunction,severe anaemia and infection are not contraindications to surgical treatment. However,complex anomalies and younger age are considered to be the most risk factors for surgery of infants with CHD.
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Objective To observe the localization and expression of hepatocyte growth factor(HGF),c-Met and Caspase-3 in pulmonary arterioles during the formation process of pulmonary arterial hypertension(PAH) induced by left to right shunt in rats,and explore the effect of HGF and c-Met in the formative process of PAH.Methods Eighty male SD rats(aged 4-5 weeks) were randomly divided into control group and shunt group(40 each).Rats in shunt group underwent right common carotid artery-external jugular vein shunt with cannulation to reproduce PAH model of left to right shunt,and animals in control group only received sham operation.Pulmonary hemodynamic and pathologic examination were performed 4,8,12 and 16 weeks after operation in both groups,while the expression of HGF,c-Met and Caspase-3 proteins in pulmonary arterioles were determined by immunohistochemisty at the above time points.Results Pulmonary artery systolic pressure(PASP),mean pulmonary arterial pressure(mPAP) and the ratio of pulmonary to systemic circulation flow(Qp/Qs) were obviously increased in rats with A-V shunt compared with controls at all time points after operation(P
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Objective To improve intracardiac operation skil ls on bea-ting-heart with mild hypothermic cardiopulmonary bypass (On pump beating-heart technique), and to review the clinical experience in 1 032 c ases. Methods A total of 1 032 cases of intracardiac operatio ns on pump beating-heart from November 1997 to September 2000 were reviewed. Of them, 714 cases were congenital heart diseases (CHD), and 318 cases were valvul ar heart diseases (VHD). The technique was improved by establishing simultaneous left atrium and ventricle suction and integrating sequential de-airing procedu re. Results The operative mortality was 2.33% (24/1 032), the m ortality was 2.7% (19/714) in cases with CHD, and 1.6% (5/318) in those with VHD. There was no pati ent complicated with systemic air embolism or permanent atrioventricular conduct ion block. Conclusion Results suggested that intracardiac procedures on pump beating-heart with mild hypothermic cardiopnlmonary bypass is safe and available in patients with CHD or VHD. It might extenuate the heart and lung injury by hypothermia and ischemia-reperfusion during cardiopulmonary bypass. Cardiac conducting block might be prevented during operation.
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Objective To compare the clinical efficiency of intracardiac procedures on traditional cardioplegic arrested-heart and on-pu mp beating-heart for congenital heart disease (CHD) with severe pulmonary hyper tension. Methods Among all 153 cases, 95 cases underwent operat ions on cardioplegic arrested-heart, while 58 on-pump beating-heart. In arres ted-heart group, 79 cases with ventricular septal defect (VSD), 13 with atria l septal defect (ASD) and 3 with patent ductus arteriosus (PDA) were examined whi le in beating-heart group, 43 cases with VSD, 10 with ASD, and 5 with PDA were examined. Results There were 12 cases of operative death (12.6%) and 8 of tracheotomy (8.4%) in heart arrested group. No operative death and tracheotomy in beating-heart group. 141 patients were followed up for 3 months to 10 year s with good recovery. There were 2 cases of right heart function failure six yea rs later in arrested-heart group. Conclusion Results sugges t that on-pump beating-heart technique is superior to traditional cardiopl egic arrested-heart for CHD with severe pulmonary hypertesion. The cause might be t hat on-pump beating-heart intracardiac operation is more effective in cardio pulmon ary protection.
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Objective To compare the effects of mild hypothe rmic cardiopulmonary bypass (CPB) and moderate hypothermic cardiopulmonary bypas s in pediatric cardiac surgery. Methods A total of 118 cas es of less than 3 years of age that had undergone open heart surgery were review ed, in which 46 patients received moderate hypothermic CPB(group 1) and 72 patie nts received mild hypothermic CPB(group 2). The CPB duration, incidence of low c ardiac output and postoperative concentration of CK-MK, etc, were compared with each other betwee n the two groups. Results Duration of bypass and postoperative mechanical respiratory assistance of group 2 was shorter than that of group 1 ( P<0.05). Transfusion requirements, incidence of low cardiac output syndrome, concentration of CK-ME and percentage of metabolic acidosis were lower in grou p 2 than in group 1 (P<0.05), while the index of oxygenation was higher in g roup 2(P<0.05). Conclusion The mild hypothermic CPB is saf er and more effective and therefore is superior to moderate hypothermic CPB in p ediatric cardiac surgery.
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Objective To introduce the technique of mitral v alve replacements in beating heart, and review the clinical experience in 234 ca ses of operation. Methods A total of 234 patients of mitral val ve replacement in beating heart with mild hypothermic extracorporeal circulation (30～32 ℃) were reviewed. Results The procedures underwe nt fluently and only 2(0.85%) died early postoperatively. No low cardiac output , arrhythmia and cer ebral embolism complications was found. Conclusion Results sugg ested that mitral valve replacement in beating heart is a safe and available method and is good in extenuating myocardial and pulmonary i njury from ischemia-reperfusion and deep hypothermia.
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Objective To investigate the relationship betwee n tricuspid insufficiency (TI) and the function of the right ventricle, degree o f pulmonary vascular pathological change in patients with rheumatic heart diseas e so as to provide the indication of operation for treating TI. Methods 41 cases of rheumatic heart disease with TI accompanying with bicuspid pathological changes were reviewed. Correlation analysis was done between the s everity of TI and the right ventricular size(RVS), pulmonary artery pressure(PAP ), pulmonary artery resistance(PAR) etc. Results It was found t hat the size of the right ventricle, PAP, PAR were positively correlated to th e degree of TI. Tricuspid annuloplasty should be carried out in patients with RV D>40 mm, PAR >48 kPa*s/L, PAP>8 kPa. Conclusion TI resulted ma inly from insufficient function of the right ventricle and marked patholog ical changes of the pulmonary blood vessels. Doppler echocardiography evaluation for the function of right ventricle and pathological condition of pulmonary blo od vessels might be of significant in deciding whether tricuspid annuloplasty sh ould be performed simutaneously in patients of bicuspid valve replacement.
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objective To study the expression of CD44v3 and CD44v6 and its relationship with lymph node metastasis in non small cell lung cancer (NSCLC). Methods Specimens (lung tissues) from 52 c ases of NSCLS and 12 normal lung tissue were used to detect the expression of CD 44v3 and CD44v6 by immunohistochemical method (SP method) and flow cytometry, co rrelation was analysed between the expression of CD44v3 or CD44v6 a nd lymph node metastasis of the lung cancer. Results CD44v3 and CD44v6 were not, or weakly expressed in all normal lung tissues from 12 cases. In contrast, the expression levels of CD44v3 and CD44v6 were obviously higher in lung cancer than that in normal tissue(P<0.05). The expression of CD44v 3 and CD44v6 were much higher in patients with lymph node metastasis than those without lymph node metastasis(P<0.05). Conclusion ① CD44v3 and CD44v6 are expressed with different degree in NSCLC. ②There is a close rel ationship between high expression of CD44v6 and lymph node metastasis, and CD44v 6 may be a co-marker for predicting the potentiality of lymph node metastasis i n lung cancer.
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Objective To study the relationship between ? 1-aderenergic receptor (? 1-AR) and cardiac function in hypoxic newborn guinea-pig myocardia undergoing ischemic reperfusion, and the effects of St. Thomas Hospital cardioplegic solution Ⅱ (STS) and cold blood cardioplegia (CBC) on the ? 1-AR and cardiac function. Methods Normobaric hypoxic guenia-pig model and isolated perfused working heart preparation were established. Cardiac functions were recorded by a multichannel biologic signal analyzer. Myocardial ? 1-AR density (B max ) and affinity (K d) were investigated by radial ligand binding. Results Significant decrease of B max was found in hypoxic newborn guinea-pig myocardia suffering from hypothermic (20 ℃)-ishemic reperfusion (P0.05). Conclusion The impairment of cardiac function in hypoxic newborn guinea-pig undergoing myocardial ischemic reperfusion might be associated with the decline of B max , but not with K d. Different effects of STS and CBC on cardiac function may result from their different influences on B max .