ABSTRACT
Objective This study was designed to evaluate the effect of obesity on late survival after aortic valve replacement(AVR) in patients with implantation of small aortic prosthesis(size≤21).Methods From January 1998 through December 2008,307 patients in a single center in china underwent primary AVR with smaller prosthesis survive the 30 days of surgery.Patients were defined as normal if body mass index (BM1) ＜ 24.0 kg/m2,as overweight if BMI 24.0-27.9 kg/m2,and as obesity if BMI≥28.0 kg/m2.Data of New York Heart Association(NYHA) Functional class,effective orifice area index (EOAI),left ventricular mass index(LVMI),left ventricular ejection fraction(LVEF) were got at the 3rd month(M),6th M,1 st year(Y),3rd Y,5th Y,8th Y after operation respectively.Results At multivariable analysis,obesity was independent factor of later mortality [hazard ratio (HR):1.62 ; P =0.01].Obesity group and overweight group had poor survival (P ＜0.001)and higher proportion of NYHA Function Ⅲ/Ⅳ (P ＜ 0.01) in long-term compared to normal group.EOAI were lower and LVMI were higher in obesity group and overweight group,but LVEF have no significant difference.Conclusion Obesity is associated with increased late mortality after AVR in patients with implantation of small aortic prosthesis.Obesity and overweight may also affect the NYHA function in long term.EOAI should be improved where possible as it may reduce late mortality and improve life quality in such patients.
ABSTRACT
Objective Calcification and graft failure may occur in aortic valved homografting as a result of immune rejection. This study was designed to examine the effects of immunosuppression in reducing immune rejection response and preventing calcification in rat aortic valved homograft(AVH). Methods Animals were randomly assigned into 3 test groups and 1 control group. SD-Wistar rats in the test groups received AVH of cryopreservation (group A), received AVH of cryopreservation followed by CsA treatment (group B), and received AVH preconditioned with monoclonal antibody against dendritic cells (DcmAb) diluted in 1:5 and cryopreserved then were treated with DcmAb postoperatively (group C), respectively. Rats in the control group(group D) were Wistar→Wistar.Rat AVH with myocardial cuff were transplanted into the abdominal aorta of rats. The rats were sacrificed in batchs at 2, 4, 8, 12 and 16 weeks postoperatively. Blood samples were obzained for detecting the expression of TCR-αβ, CD28. The AVH specimens were obtained for observing the change of endotheliocyte and smooth muscle cells with light and electron microscopes. At the same time, calcium contents of AVH tissues after transplantation were measured. Results As compared with the control group, the expression of TCR-αβ and CD28 in test groups was increased significantly at each time point(P<0.01) and reached peaks 2 to 4 weeks after operation, then gradually reduced and was closed to the level of controls at 12 weeks. Calcium contents of AVH tissues in the test groups was increased gradually since 4 weeks and reached the peak 12 to 16 weeks after operation. No significant difference in calcium level was found in the control group over 5 different periods (P>0.05). Calcium contents of AVH tissues at 4 and 8 weeks postoperatively were (2856±79)μg/g and (3587±168)μg/g in the groups with cryopreservation;(2518±73)μg/g,(3237±187)μg/g in the CsA treatment group;(2176±210)μg/g, (3089±176)μg/g in the DCmAb treatment group; (860±60) μg/g, (870±50) μg/gin the control group. Conclusion The immunosuppressive treatment had substantial effects on AVH calcification as a result of reduction in immune rejection response and delay in the development of calcification.
ABSTRACT
Objectives:To study the pathological behavior and the value of transforming growth factor β1(TGF-β1) in predicting prognosis in pulmonary hypertension associated with congenital heart disease. Methods:Lung tissues from 29 patients with congenital heart diseases associated with pulmonary hypertension were examined by surgical biopsy of the lung. All samples were examined for the expression and localization of TGF-β1 by immunohistochemical technique with anti-TGF-β1 antibody. Results:Twenty-six out of 29 showed positive staining of intracellular endotheliocyte TGF-β1(89.65%),16 samples showed extracellular matrix TGF-β1 staining(55.17%).Statistically, there was significant difference between Ⅰ～Ⅱ and Ⅲ～Ⅵ pathological degrees in extracellular matrix(P<0.05). Conclusions: TGF-β1 plays an important biological role in the formation of pulmonary hypertension after congenital heart disease. It is conductive in predicting prognosis.