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Objective@#To investigate the safety and efficacy of transcatheter perforation of pulmonary valve by micro-guidewire and balloon dilation in the treatment of neonatal pulmonary atresia with intact ventricular septum (PA-IVS).@*Methods@#The retrospective study included 21 neonates (14 males and 7 females) with PA-IVS who underwent transcatheter micro-guidewire pulmonary valve perforation and balloon dilation in Xinhua Hospital from January 2012 to December 2018. All patients underwent the pulmonary valve perforation by micro-guidewire through the Simmons catheter. During the follow-up period at 1, 3, 6, 12 months postoperatively and annually thereafter, the operative efficacy and the development of the right ventricle (RV) were evaluated by echocardiography. Statistical analyses were performed using t test.@*Results@#A total of 21 neonates with PA-IVS were enrolled, and 13 cases were diagnosed prenatally. The median age of surgery was 6 days, the weight was (3.2±0.5) kg. The balloon/valve ratio was 1.19±0.12, and the RV pressure measured by catheter was (121±33) mmHg (1 mmHg=0.133 kPa) . The immediate postoperative RV pressure was (47±13) mmHg. The median follow-up time was 30 months. All the cases enrolled achieved biventricular circulation without death and serious complications. According to the last follow-up data including 16 cases who were followed up for 1 year or longer, the pulmonary artery transvalvular pressure was (29±15) mmHg. The postoperation ratio of right to left ventricular transverse diameter was significantly higher than that before operation (0.86+0.10 vs. 0.73+0.13, t=-2.96, P=0.006). Compared with preoperative data, the postoperation pulmonary valvular diameter Z-score was significantly higher (-1.41±0.89 vs. -2.83±1.06, t=-3.65, P=0.001) and the tricuspid valvular diameter Z-score was significantly higher (-0.52±0.29 vs. -1.34±0.81, t=-3.55, P=0.001).@*Conclusion@#Transcatheter perforation of pulmonary valve by micro-guidewire and balloon dilation is a safe and effective initial therapy for neonatal PA-IVS.
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Objective To study the clinical features and risk factors of acute pulmonary reperfusion injury after operation in neonates with severe pulmonary stenosis or pulmonary atresia.Method From February 2014 to February 2018,a retrospective analysis was performed in patients with critical pulmonary stenosis or pulmonary atresia who received percutaneous balloon pulmonary valvuloplasty (PBPV) in the neonatal intensive care unit of our hospital.Clinical characteristics,perioperative cardiac structure,hemodynamic data and biochemical results were collected.The neonates were assigned into injury group if they had acute lung reperfusion injury,and non-injury group if not.The risk factors of acute lung reperfusion injury were analyzed using multi-variate Logistic regression model.Result A total of 32 patients (24 prenatal diagnosis and 8 postnatal diagnosis) with severe pulmonary stenosis or pulmonary atresia with intact ventricular septum were enrolled.The main manifestations were dyspnea and cyanosis.Intravenous prostaglandin E was administered to keep the ductus arteriosus open.The age of operation ranged from 1 to 52 days and the median age was 7.5 days.Postoperative acute lung reperfusion injury occurred in 7 cases (21.9％).Preoperative and intraoperative pulmonary valve annulus diameter,balloon diameter,preoperative hemoglobin,hematocrit and blood albumin were significantly lower in the injury group.The operation duration,total length of hospital stay and postoperative duration were longer than in the non-injury group,the differences were statistically significant (P ＜ 0.05).Multi-variate Logistic regression analysis showed that the diameter of pulmonary valve annulus (OR =5.814,95％CI 1.106 ～30.568),preoperative blood albumin (OR =1.361,95％ CI 1.063 ～ 1.742),and hematocrit (OR =1.173,95％ CI 1.010 ～ 1.363) were risk factors of acute lung reperfusion injury,with statistically significant differences (P ＜ 0.05).Conclusion Acute lung reperfusion injury is one of the common complications after the operation of severe pulmonary stenosis or pulmonary atresia.The severity of pulmonary valve annulus stenosis,preoperative hematocrit and blood albumin level may be the risk factors of postoperative acute lung reperfusion injury.
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Objective To evaluate the cardiac function of fetuses with aortic arch anomalies using spatio -temporal image correlation (STIC). Methods Thirty - two fetuses with aortic arch anomalies in Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from March 2015 to October 2016,were included. These fetuses were divided into 2 groups according to hemodynamics:obstructive lesion group(17 cases)and non - obstructive lesion group(15 cases). Comparative analysis of cardiac function of these fetuses was conducted in light of gestational age - matched normal fetuses separately using fetal echocardiography and STIC. The indexes were obtained,which in-cluded diameter of great arteries,left ventricular end diastolic dimension(LVDD),right ventricular end diastolic dimen-sion(RVDD),right ventricular end systolic transverse diameter(RVDS),left ventricular end systolic transverse diame-ter(LVDS),fractional shortening (FS),left ventricular end - diastolic volume(LVEDV),right ventricular end - dias-tolic volume (RVEDV),left ventricular end - systolic volume (LVESV),right ventricular end - systolic volume (RVESV),stroke volume(SV)and ejection fraction(EF)were obtained. Comparison was made between the groups. Results Cardiac function of fetuses with aortic arch anomalies was within normal range,however,FS and EF were lower in these fetuses than those of normal ones,specifically,the development of aorta was worse in fetuses with obstruc-tive lesions (all P < 0. 05). In these fetuses,RVEDV was larger than that of normal fetuses. EDV and SV were larger in the right ventricle(RV)than those of the left ventricle(LV)[RVEDV vs. LVEDV:(1. 681 ± 0. 725)mL vs. (1. 181 ± 0. 565)mL,SV of RV vs. SV of LV:(1. 020 ± 0. 436)mL vs. (0. 643 ± 0. 299)mL],and the differences were all sta-tistically significant(t = - 2. 246,P = 0. 032;t = - 2. 939,P = 0. 006);and EF was higher in RV[EF of RV vs. EF of LV:(61 ± 5)％ vs. (54 ± 5)％],and the difference was statistically significant(t = - 3. 708,P = 0. 001). Meanwhile, aorta and pulmonary artery were both smaller in fetuses with non - obstructive lesions than those of normal fetuses,and the differences were all statistically significant(all P < 0. 05). There were no significant differences between these fetu-ses and normal fetuses in LVDD,LVDS,RVDD,RVDS or RVDD/ LVDD,and there was no significant difference be-tween LV and RV in volumic indices (all P > 0. 05). Conclusions Small aorta and ventricular disproportion may appear in fetuses with aortic arch obstruction. Though ventricular systolic function is within normal range,FS and EF are lower in aortic arch anomaly fetuses than those in normal fetuses. Aortic arch anomalies may have influence on fetal car-diac function.
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Objective To explore and analyze the effects of ω-3 polyunsaturated fatty acid(PUFA)on oxidative stress and Toll like receptor-4(TLR4)and tumor necrosis factor alpha(TNF-α)in rats with acute lung injury(ALI)induced by lipopolysaccharide (LPS).Methods 120 healthy adult Wistar rats(clean grade;weight,180-240 g)were randomly divided into control group and ob-servation group,60 rats in each group,rats in the control group were randomly divided into untreated group,6 h group(LPS injec-tion),and 24 h group(LPS injection),20 rats in each group.The rats in the observation group were randomly divided into untreated group,6h group(PUFA+LPS injection),and 24 h group(PUFA+LPS injection),20 rats in each group.The relative expression of Superoxide Dismutase(SOD)before treatment,6 h after treatment and 24 h after treatment,Malondialdehyde(MDA),intercellular cell adhesion molecule-1(ICAM-1),TNF-α,and TLR4 in two groups were observed.Results The difference of SOD levels before and after treatment in the two groups of rats was statistically significant(P<0.05),the difference of SOD levels before treatment in the two groups of rats was not statistically significant(P> 0.05).As the processing time went on,the level of SOD in the two groups of rats decreased,but the decrease of the rats in the observation group was lower than that of the control group,and the difference was statistically significant(P<0.05),the difference of MDA level before and after treatment in two groups of rats was statistically significant(P<0.05).As the processing time went on,The level of MDA in the two groups of rats increased,but the increase of the rats in the observation group was significantly lower than that of the control group,and the difference was statistical-ly significant(P<0.05).The difference of ICAM-1 level before and after treatment in the two groups of rats was statistically signif-icant(P<0.05).As the processing time went on,the levels of ICAM-1 and TNF-alpha in the two groups increased,but the increase of the rats in the observation group was significantly lower than that in the control group,the difference was statistically significant (P<0.05).The relative expression of TLR4 in the lung tissue of the observation group was significantly lower than that of the control group(P<0.05).Conclusion PUFA could effectively reduce the oxidative stress and inflammation in ALI rats induced by LPS,which may contribute to the treatment of ALI.
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Objective To explore the impact of prenatal diagnosis on the early treatment and short and medium term outcome of neonatal pulmonary atresia with intact ventricle septum (PA/IVS) or critical pulmonary stenosis with intact ventricle septum (CPS/IVS). Methods According to the case-control method, twenty-eight neonates with (PA/IVS) or (CPS/IVS) who had percutaneous pulmonary balloon valvuloplasty (PBPV) surgery indications, were divided into the prenatal diagnosis group (n?=?15) and the postnatal diagnosis group (n?=?13). The prenatal diagnosis group was diagnosed in fetal period and the intervention program was since developed . The postnatal diagnosis group was referred from other hospitals, and the intervention program was developed after conifrmation of the diagnosis. All the neonates accepted the PBPV surgery after the hemodynamic parameters stable. All neonates were followed-up at 1 month, 3 months, 6 months, 1 year, and 2 years after surgery. Clinical situations, echocardiography results, and interventional cardiology measurements were compared between two groups. Result The average age and weigh was 7.53?±?3.18 days and 3102.32?±?708.40 g respectively at the time of PBPV surgery in 28 neonates. Among them, 9 neonates were PA/IVS and 19 neonates were CPS/IVS. The mean follow-up time was 18.8?±?5.22 months and there were no death. The ages at admission and at the ifrst treatment were signiifcantly younger in the prenatal diagnosis group than those in the postnatal diagnosis group (P??0.05). Conclusion Prenatal diagnosis is helpful for the early intervention in neonates with PA/IVS and CPS/IVS, and can reduce the complications after surgery.
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Objective To evaluate regional right ventricular function by ultrasonic strain rate imaging in postoperative children with conotruncal defects(CTD). Methods All 27 postoperative CTD children had magnetic resonance imaging evaluation of right ventricular end-diastolic volume and end-systolic volume to calculate right ventricular ejection fraction (RVEF). The ultrasonic parameters of peak systolic strain rate (SRs), peak early diastolic strain rate (SRe), peak late diastolic strain rate(SRa) and strain (S) were obtained at the basal,middle and apical segment in curve of right ventricular anterior wall in 27 postoperative CTD children and 27 normal children. The correlation between SRs,S and RVEF were evaluated. Results Compared with healthy children,SRs,S,SRe,SRa were significantly reduced in postoperative CTD children (P ＜ 0.01 ), there were different distribution rules between postoperative CTD children and normal children,and all indexes had no statistical descrepancy among the basal, middle and apical segment ( P ＞0.05). SRs in basal segment of the right ventricular anterior wall correlated well with RVEF ( r = 0.89,P ＜ 0. 01 ). Conclusions Regional right ventricular function still was reduced in postoperative CTD children, and could be accurately evaluated by ultrasonic strain rate imaging.
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Objective:To construct eukaryotic expression plasmids of pneumocystis carinii p55-v3 and p55-v0 antigenic genes and to identify their expression in COS-7 cells at mRNA level.Methods:Pneumocystis carinii total RNA was used as the template to amplify p55-v3 and p55-v0 antigenic gene by RT-PCR.The products were connected to pTA2 vector and then cloned in pVAX1 eukaryotic expression vector to construct recombinant plasmids as pVAX-p55-v3 and pVAX-p55-v0.After propagated in E.coli DH5α,the recombinant plasmids were transfected into COS-7 cells.After 24 h incubation,the RT-PCR was performed to identify the mRNA expression of p55-v3 and p55-v0 antigenic gene.Results:The recombinant plasmids were qualified by restrictive endonuclease digestion and sequencing.And when compared with that in GenBank,the homology of p55-v3 antigenic gene was 99.9% in nucleotides and 100% in amino acid.The homology between p55-v0 antigenic gene and the one reported previously in nucleotide and amino acid seguence were 99.8% and 100%.The results of RT-PCR confirmed that p55-v3 and p55-v0 antigenic genes were transfected into COS-7 cells successfully and the genes were expressed in the cells.Conclusion:In this study,the recombinant plasmids of pVAX-p55-v3 and pVAX-p55-v0 are conducted successfully and expressed in the COS-7 cells,which provide a basis for clarification of immunologic function of p55-v3 and study of DNA vaccine.