Initial results of the second order chordal-cutting procedure for chronic ischemic mitral regurgitation / 中华胸心血管外科杂志

Objective To discuss and evaluate the safty and outcome of the second order chordal-cutting.Methods From Aug 2015 to Mar 2017,9 chronic IMR patients underwent chordal-cutting procedure,in addition to myocardial revascularization and undersized mitral annuloplasty.The indication was the presence of increased tethering of the anterior leaflet,with a bending angle (BA) ＜ 145° and the coaptation depth (CD) less than 10 mm.Pre-and post-procedure clinical data including left ventricular ejection fraction(LVEF),mitral regurgitation grade,New York Heart Association (NYHA) class and dimension of the left ventricle were compared.Results There was no perioperative death.No patient was lost to follow-up.MR grade decreased from 2.89 ± 0.60 preoperatively to 0.56 ± 0.70 postoperatively.The New York Heart Association class decreased from 2.78 ± 0.70 preoperatively to 1.33 ± 0.50 postoperatively.The BA increased from (136.22 ± 4.55) °preoperatively to (174.22 ± 3.15) °postoperatively.The coaptation depth decreased from (8.59 ± 0.46) mm preoperatively to (1.54 ± 0.68) mm postoperatively.LVEF increased from 0.49 ± 0.07 preoperatively to 0.57 ± 0.05 postoperatively.The diastolic and systolic diameters of left ventricle decreased from (62.78 ± 5.24)mm to (53.67 ± 2.99)mm and(44.11 ± 4.62) mm to(37.22 ± 3.27) mm,respectively.Conclusion In selected chronic IMR patients with a BA ＜ 145 ° and coaptation depth less than 10 mm,second order chordal-cutting can be a good surgical option,and is related to less MR return or persistence,improved LVEF,and lower New York Heart Association class.

Initial results of the second order chordal-cutting procedure for chronic ischemic mitral regurgitation / 中华胸心血管外科杂志

Objective@#To discuss and evaluate the safty and outcome of the second order chordal-cutting.@*Methods@#From Aug 2015 to Mar 2017, 9 chronic IMR patients underwent chordal-cutting procedure, in addition to myocardial revascularization and undersized mitral annuloplasty. The indication was the presence of increased tethering of the anterior leaflet, with a bending angle (BA)<145° and the coaptation depth (CD) less than 10 mm. Pre- and post-procedure clinical data including left ventricular ejection fraction(LVEF), mitral regurgitation grade, New York Heart Association (NYHA) class and dimension of the left ventricle were compared.@*Results@#There was no perioperative death. No patient was lost to follow-up. MR grade decreased from 2.89 ± 0.60 preoperatively to 0.56 ± 0.70 postoperatively. The New York Heart Association class decreased from 2.78 ± 0.70 preoperatively to 1.33 ± 0.50 postoperatively. The BA increased from (136.22 ± 4.55)°preoperatively to (174.22 ± 3.15)°postoperatively. The coaptation depth decreased from (8.59 ± 0.46) mm preoperatively to (1.54 ± 0.68) mm postoperatively. LVEF increased from 0.49±0.07 preoperatively to 0.57±0.05 postoperatively. The diastolic and systolic diameters of left ventricle decreased from (62.78 ± 5.24 )mm to (53.67 ± 2.99)mm and( 44.11 ± 4.62)mm to( 37.22 ± 3.27)mm, respectively.@*Conclusion@#In selected chronic IMR patients with a BA<145° and coaptation depth less than 10 mm, second order chordal-cutting can be a good surgical option, and is related to less MR return or persistence, improved LVEF, and lower New York Heart Association class.

Exercise preconditioning attenuates pressure overload-induced pathological cardiac hypertrophy: potential role of HSF1 and NF-κB p65 signaling / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the effect of exercise preconditioning (EP) on pressure overload-induced pathological cardiac hypertrophy and explore related mechanisms.</p><p><b>METHODS</b>Ten-week-old male Sprague-Dawley rats (n = 80) were randomly divided into four groups via random number table method: sham, TAC, EP + sham and EP + TAC. Two EP groups were subjected to 4 weeks of treadmill training, and followed by sham and TAC operations. Eight weeks after the surgery, mean arterial pressure (MAP), cardiac morphology, mRNA expressions of the B-type natriuretic peptide (BNP) and heat shock protein (HSP) 70 and protein expression of the BNP, heat shock transcription factor 1 (HSF1), HSP70, nuclear factor κB (NF-κB) p65, and interleukin-2 (IL-2) were examined.</p><p><b>RESULTS</b>(1) Pathological cardiac hypertrophy index: eight weeks after TAC, MAP, heart size, HW/BW, cross-sectional area of the cardiomyocytes (CSA) and mRNA and protein expressions of BNP in the LV were all significantly higher in the TAC and EP + TAC groups than respective sham groups (all P < 0.05). HW/BW, CSA, and mRNA and protein expressions of BNP in the LV were significantly lower in EP + TAC group than in TAC group (all P < 0.05). (2) mRNA and protein expressions of HSF1 and HSP70 and nuclear HSF1 levels were significantly downregulated post TAC, however, EP treatment significantly increased the expression of HSF1 and nuclear HSF1 levels in TAC rats (all P < 0.05). (3) mRNA and protein expressions of NF-κB p65 and IL-2 were significantly increased in the TAC and EP + TAC groups compared with the respective sham groups (all P < 0.05), which were significantly downregulated in EP + TAC group compared to TAC group (all P < 0.05).</p><p><b>CONCLUSIONS</b>EP could effectively reduce the cardiac hypertrophic responses induced by TAC possibly through upregulating the expressions of HSF1 and HSP70 and inhibiting the expression of NF-κB p65 and its nuclear translocation.</p>

Exercise Preconditioning Improving the Pathological Cardiac Hypertrophy in Pressure Over-loaded Rats / 中国循环杂志

Objective: To explore the effect of exercise preconditioning (EP) on pathological cardiac hypertrophy and heart failure (HF) in pressure over-loaded experimental rats. Methods:A total of 60 SD rats at the age of 6 weeks were randomly divided into 3 groups, n=20 in each group. Sham-operation group, Transverse aortic constriction (TAC) group and EP + TAC group. The cardiac function and structure were evaluated by echocardiography, patholgical changes and HF biomarkers were examined for EP effect at 4 and 8 weeks after TAC. Results:Compared with Sham-operation group, the cardiac function and structure had obvious changes in the other 2 groups. Compared with TAC group, the ejection fraction in EP+ TAC group increased 15%, the heart weight index and left ventricular weight index decrease 15.7%and 20%respectively at 8 weeks after TAC, all P Conclusion: EP may improve cardiac pathological hypertrophy in pressure over-loaded rats at the early stage, and delay the heart failure process.