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Objective To investigate the aberrant expression of long non-coding RNA(lncRNA) in chronic thromboembolic pulmonary hypertension,and explore the lncRNA role in pathogenesis of CTEPH.Methods A total of 5 pulmonary artery endarterium tissue of CTEPH patients and 5 pulmonary artery endarterium tissue of healthy controls were collected.Using high-throughput gene microarray technology to detect two groups of lncRNA and mRNA expression spectrum,build lncRNA-mRNA express network,Pathway and GO analysis to explore the gene function.Results Differential expression of 185 lncRNA was observed in the CTEPH tissues compared with healthy control tissues.Further analysis identified 464 regulated enhancerlike lncRNA and overlapping,antisense or nearby mRNA pairs.Coexpression networks were subsequently constructed and investigated.The expression levels of the lncRNA,NR_036693,NR_027783,NR_033766 and NR_001284,were significantly altered.Gene ontology and pathway analysis demonstrated the potential role of lncRNA in the regulation of central process,including inflammatory response,response to endogenous stimulus and antigen processing and presentation.Conclusion Differentially expressed lncRNA may exert a partial role in CTEPH,the results of this study will help in the future about diagnosis and treatment of CTEPH.
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Objective To retrospectively analysis whether the existence of deep vein thrombosis(DVT) in chronic thromboembolic pulmonary hypertension (CTEPH)) has an influence on the efficacy of pulmonary thromboendarterectomy.Methods The data of 75 patients with CTEPH having undergone PTE in Beijing Chaoyang Hospital from Sep 2004 to Mar 2016 were retrospectively reviewed.We classified them into two different groups which were DVT (+)group (32) and DVT (-) group (43) according to the present of DVT.Clinical data,hemodynamics,blood gas analysis and so on of both groups were compared.Results There were 1 patient died after PEA surgery in DVT(+)group and 7 patients died after PEA surgery in DVT (-) group(3.1％ vs 16.3％,P =0.033).The incidence of severe pulmonary reperfusion injury and the neurological disorders postoperatively in DVT(-) group was significantly higher than that in DVT(+) group (46.5 ％ vs 21.9％,P =0.028;32.6％ vs 12.5％,P =0.044).Compared with DVT(+) group,the content of C-react protein (CRP) was higher in DVT (-) group [(0.9 ± 0.7) mg/dl vs (0.5 ± 0.4) mg/dl,P =0.005].Furthermore,DVT(-) group had a significantly greater proportion of Jamieson Ⅲ or V than DVT(+) group,while the cardiopulnonary bypass time [(289.8 ± 54.3) min vs (259.8 ±45.5) min,P=0.014],aorta cross clamp time[(137.3 ±31.6) min vs(119.5±29.3) min,P=0.015] and deep hypothermia circulatory arrest were significantly longer in DVT(-) group than in DVT(+) group.Postoperative hemodynamics and blood gas index were obvious improved in both groups,but the postoperative pulmonary artery systolic pressure (PAPS) [(59.6 ± 17.9) mmHg vs (48.5 ± 9.7) mmHg,P =0.001],the pulmonary vascular resistance (PVR) [(30.44 ± 22.97) kPa · S · L-1 vs (18.34 ±8.09) kPa · S · L 1,P =0.002] in DVT(-) group were significantly higher than those in DVT(+) group.In addition,the incidence of residual pulmonary hypertension in DVT(-) group was significantly higher than in DVT(+) group.Conclusion Pulmonary thromboendarterectomy for patients with CTEPH results in significant pulmonary hemodynamic improvement with favorable outcomes of heart and lung function.The recovery of the PAPS,PVR in patients with DVT are significantly better than those in patients without DVT,and the incidence of postoperative complication is significantly lower in patients with DVT.
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Objective To evaluate the feasibility,validity and safety of pulmonary endarterectomy for patients with chronic thromboembolic pulmonary hypertension.Methods 50 patients undertook pulmonary endarterectomy operations were enrolled in this study.Of them,38 were males (76％),the average age was (43.35 ± 12.51) years,23 patients had deep venous thrombosis.Obvious pulmonary hypertension and hypoxemia were observed in all patients.Bilateral pulmonary endarterectomy was performed under cardiopulmonary bypass with profound hypothermic circulatory arrest.Preoperative systolic pulmonary artery pressure was(104.16 ± 16.95) mmHg,pulmonary vascular resistance was(129.68 ± 50.88) kPa · s · L-1,central venous pressure was (14.91 ± 4.88) mmHg,and cardiac output was (3.28 ± 1.04) L/min.Results The average time of cardiopulmonary bypass was(294.37 ± 94.01) min,aortic cross clamp time was(127.93 ± 35.57) min,circulatory arrest time was(34.30 ±21.74) min.Post-operative mechanical ventilation time was (97.24 ±70.53) hours,and the ICU stay was (9.52 ± 12.96) days.There were 4 patients that died after PEA surgery for postoperative residual pulmonary hypertension of reperfusion pulmonary edema.Post-operation,all patients had significant decrease in systolic pulmonary artery pressure (54.11 ± 16.86) mmHg and pulmonary vascular resistance(20.55 ± 15.17) kPa · s · L-1,and central venous pressure (9.00 ± 3.09) mmHg,and great improvement in cardiac output (5.75 ± 1.48) L/min.6-months follow-up showed that the cardiac function of 44 (95.7 ％) cases returned to NYHA class Ⅰ or Ⅱ,with great improvement in computed tomography pulmonary angiography.All patients go back to normal work and physical exercise at 1-year follow-up.Conclusion Conclusions According the successful experience of surgery for CTEPH patients,pulmonary endarterectomy for patients with CTEPH results in significant pulmonary hemodynamic improvement,with favorable outcomes of heart and lung function in short and middle time follow-up.
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Objective Hypothyroidism may have adverse effects on the post-operative outcomes. We evaluated the outcomes of coronary artery bypass grafting (CABG) in patients who had both coronary artery disease (CAD) and hypothyroidism.Methods Among 1347 patients undergoing CABG between September 2002 and June 2009, hypothyroidism was diagnosed in 21 patients (Group A, with 6 men and 15 women) and treated with thyroxin replacement therapy. The average age of patients in group A was(60.4 ± 10.2). Hypothyroidism was identified with tests for thyroid functions. CABG in 4 patients was performed with extracorporeal circulation, three of them received on-pump beating heart CABG, and in 17 patients was performed with off pump CABG( OPCAB). CABG was performed following the improvement of FT3, FT4 and TSH with the use of levothyroxine for all patients in group A Twenty patients with CAD in the absence of hypothyroidism ( group B) served as control, 4 of these patients underwent CABG with extracorporeal circulation. Data of thyroid function and hemodynamics pre-, post- and during operation were analyzed. Results Serum thyroid hormones, such as FT3, were measured with sensitive and specific radioimmunoassays peri-operatively. In the patients receiving CABG without extraorporeal circulation, the mean serum FT3 concentrations were ( 1. 39 ± 0. 36 ) pg/ml pre-operatively and ( 1.29 ± 0. 32 ) pg/ml post-operatively ( P = 0.18 ) for 17 cases in group A, and were (2.28 ±0.36)pg/ml and (2.19 ±0.34) pg/ml respectively (P =0.24)for 16 cases in Group B. In the patients receiving CABG with extracorporeal circulation, the mean serum FT3 concentrations were( 1.53 ±0.51 )pg/ml pre-operatively and (0.85 ± 0.40) pg/ml post-operatively ( P = 0. 04 ) for 4 cases in group A, and were ( 2.08 ± 0.24) pg/ml vs. ( 1.96 ±0. 26) pg/ml ( P = 0. 26 ) for 4 cases in group B. The CIs of patients in group A and group B were ( 2.7 ± 1.4)L · min-1 · m-2 vs. (2.8 ±1.5) L · min-1 · m-2, P=0.53). One patients with severe hypothyroidism and underwent CABG with extracorporeal circulation in Group A died of refractory bradycardia after failure in heart resuscitation. Twenty survivors in group A underwent coronary artery bypass on-beating heart. All survivors had improvement in cardiac function during 2to 30 months of follow-up, their preoperative ejection fraction (EF) was 0.48 ± 0.17 and follow-up EF was 0.55 ± 0. 21. All 20 patients in group B were alive. There was no significant difference between group A and B in hemodynamics, prognosis, duration of hospitalization [( 12.2 ±4.7 ) day vs. ( 10. 1 ± 3.9 ) day, P = 0.17], time to extubation [( 17.6 ± 9. 1 ) h vs.(15.1 ± 13.7) h, P =0.12]. Conclusion CABG in patients with both CAD and hypothyroidism is relatively safe. Proper peri-operative nanagement, combined with on-beating heart techniques of CABG, may decrease the operation risks. Off pump CABG had little effect on serum concentrations of FT3. Peri-operative thyroid replacement therapy was critical for patients with hypothyroidism. Patients with severe hypothyroidism who underwent CABG with extracorporeal circulation were at high risk.