Feasibility of epicardial implantation of medtronic 3830 lead in a pediatric patient : case report.

BACKGROUND: High-grade atrioventricular block is the primary reason for epicardial permanent pacemaker implantation during the perioperative period in patients with congenital heart disease. Due to the smaller diameter of venous vessels in children, epicardial permanent pacemaker implantation is usually a preferred choice, we report one pediatric patient who received epicardial permanent pacemaker implantation using a new approach. CASE PRESENTATION: We present the case of a 2-year-old girl who underwent the modified Konno procedure and Pulmonary valvuloplasty surgery and presented after surgery with a High-grade atrioventricular block. At over 20 days after the patient underwent a redo-sternotomy which epicardial permanent pacemaker implantation. Medtronic Model 4965 Capsure Epi ® steroid-eluting unipolar epicardial pacing lead was immobilized on the surface of the right ear. The Medtronic 3830 pacing lead was screwed obliquely and clockwise under direct view from the surface of the right ventricle to the endocardium near the interventricular septum. The patient's recovery was uneventful. CONCLUSION: In this case report, we demonstrate the feasibility and potential benefits of using the Medtronic 3830 lead for epicardial pacing in a pediatric patient with severe cardiac complications following surgery for congenital heart disease. This approach offers a viable alternative to traditional epicardial pacing methods, particularly in complex cases where conventional leads fail to provide stable pacing thresholds.

A review regarding the article 'impact of simulation-based training on transesophageal echocardiography learning: A systemic review and meta-analysis of randomized controlled trials'.

Transesophageal echocardiography (TEE) has emerged as a critical imaging technique for anesthesiologists, enabling them to monitor and detect significant cardiothoracic conditions in both cardiac and noncardiac surgical patients throughout the perioperative period. Given the expanding applications of TEE, its integration into the anesthesiology residency curriculum at an early stage is crucial. This ensures that residents have ample time to develop their TEE skills, thereby facilitating meaningful clinical application post-residency. While studies have demonstrated the successful use of simulators and web-based modules in TEE education, there is currently a lack of educational materials that provide a structured curriculum specifically designed to teach the fundamentals of TEE to residents. Furthermore, simulation training in TEE prior to patient exposure may contribute to enhanced patient safety and comfort. By providing residents with the opportunity to practice their TEE skills in a controlled, risk-free environment, simulation training can help to mitigate the potential risks associated with real-world patient care. TEE has become an indispensable tool for anesthesiologists, and its integration into the residency curriculum is essential. The use of simulation-based training, particularly in a virtual reality setting, offers a promising avenue for enhancing TEE education and fostering the development of competent practitioners.

A review regarding the article 'Semaglutide and heart failure: Updated meta-analysis'.

Individuals afflicted with heart failure (HF) with preserved ejection fraction (HFpEF) often exhibit obesity, a condition that is frequently associated with a pronounced prevalence of symptoms and physical constraints related to HF, alongside detrimental hemodynamic profiles and an elevated susceptibility to adverse cardiac events. The amelioration of health status is a pivotal objective in the management of HF, with extant research suggesting that a considerable number of patients with this condition place equal emphasis on the enhancement of these health dimensions as they do on the prolongation of life. The administration of a weekly subcutaneous dose of 2.4 mg Semaglutide has been observed to yield significant amelioration in symptomatology, physical limitations, and exercise capacity, alongside a reduction in inflammatory markers and a more pronounced reduction in body weight when compared to a placebo in the study's obese HFpEF cohort. Nevertheless, the extent to which these therapeutic benefits of Semaglutide manifest differentially in relation to the baseline severity of health status impairment remains to be elucidated. Additionally, a more nuanced comprehension of the impact of Semaglutide on the comprehensive spectrum of health status parameters, encompassing symptomatology, physical limitations, life quality, and social impediments, is warranted. This includes an assessment of the proportion of patients experiencing deterioration, as well as those attaining minimal, moderate, substantial, and marked improvements within these respective domains.

A review regarding the article 'Comparative efficacy and safety of mitral valve repair versus mitral valve replacement in Rheumatic heart disease: A high-value care systematic review and meta-analysis'.

Rheumatic heart disease remains a major cause of cardiovascular death worldwide. Limited real-world nationwide data are available to compare the long-term outcomes between mitral valve repair and replacement in rheumatic heart disease. For patients with RHD, MVP is the superior choice of surgical intervention owing to better long-term survival, reduced incidence of early mortality and thromboembolic events. However, it entails higher chances of re-operation at follow-up at four, eight and twelve years. Although feasible, surgeons may opt for MVR in patients with a worse prognosis. Whereas degenerative mitral repair for severe MR has been proven superior to replacement, the optimal operative strategy for mitral RHD remains unclear. In developing countries, mitral RHD commonly develops in young patients, predominantly consists of MR rather than MS, and occurs more frequently than in the United States. In addition, the predominant MR etiology (rather than MS), relatively early intervention in the RHD timeline, and variation in Carpentier MR types among developing world populations further make these rheumatic MVs more amenable to repair than replacement. Patients should be carefully selected for mitral valve repair because of its higher reoperation rate, particularly those with previous percutaneous transvenous mitral commissurotomy. Careful assessment of anterior leaflet mobility/calcification to determine mitral repair or replacement was associated with improved outcomes. This decision-making strategy may alter the threshold for rheumatic mitral replacement in the current valve-in-valve era.

A review regarding the article 'Mineralocorticoid receptor antagonists in heart failure with reduced ejection fraction: a network meta-analysis of 32 randomized trials'.

Heart failure (HF) is a prevalent clinical syndrome characterized by significant morbidity and is often precipitated by impaired left ventricular myocardial function. The condition can be categorized into two primary forms based on the ejection fraction (EF): Heart failure with preserved ejection fraction (HFpEF) and Heart failure with reduced ejection fraction (HFrEF). Evidence-based treatments for HF have been instrumental in reducing morbidity and mortality, particularly in patients with HFrEF. Mineralocorticoid receptor antagonists (MRAs) represent a cornerstone in the pharmacological management of HF, with a strong indication for use in HFrEF. Notably, pharmacological nuances exist among MRAs, which may influence therapeutic decision-making for individual patients. Moreover, MRAs have been shown to enhance heart rate variability and improve cardiac sympathetic nervous system function in HF patients. Spironolactone, an MRA, has been a pivotal agent in the clinical management of HFrEF since its introduction. However, its use has been tempered by certain side effects, including gynecomastia and hyperkalemia, leading to considerable discontinuation rates among patients. To address these challenges, numerous randomized clinical trials (RCTs) have been conducted to assess the efficacy and safety profiles of alternative steroidal and non-steroidal MRAs. Eplerenone, a steroidal MRA introduced subsequent to spironolactone, has demonstrated efficacy with a more favorable side effect profile.

A review regarding the article 'Targeting inflammatory signaling pathways with SGLT2 inhibitors: Insights into cardiovascular health and cardiac cell improvement'.

Sodium-glucose co-transporter 2 (SGLT2) inhibitors have emerged as a novel category of blood glucose-lowering drugs in clinical recommendations for a wide range of diseases. SGLT2 inhibitors are promising anti-inflammatory agents by acting either indirectly via improving metabolism and reducing stress conditions or via direct modulation of inflammatory signaling pathways. The SGLT2 inhibitors empagliflozin and dapagliflozin better vascular function and avert vascular aging by decreasing the reactive oxygen species (ROS) content and increasing nitric oxide bioavailability, respectively. It was discovered that ipragliflozin has the ability to prevent dysfunction of the endothelium, and this effect was connected with oxidative stress. According to published data, SGLT2 inhibitors may delay vascular aging and arrest the development of endothelial dysfunction in animal models of type 2 diabetes (T2D) by reducing inflammation, oxidative stress, and glucose toxicity and increasing the survival of hyperglycemic endothelial cells. The adenosine monophosphate-activated protein kinase (AMPK) molecule plays a vital role in the regulation of bioenergy metabolism and is pivotal in our understanding of diabetes mellitus and other metabolic disorders. It has been hypothesized that SGLT2 inhibitors may indirectly affect AMPK to reduce mammalian target of rapamycin (mTOR) activity. Numerous studies have demonstrated that SGLT2 inhibitors can activate AMPK by restoring the AMP/ATP balance in favor of AMP, which is assumed to be the mechanism by which these medications have positive effects on the cardiac structure and microvessel.

Tricuspid valve detachment for ventricular septal defect closure: A meta-analysis of existing evidence.

BACKGROUND: Ventricular septal defect (VSD) is one of the most common congenital cardiac defects. However, in some cases, VSD sites are difficult to expose due to obstruction from chordal attachments and leaflets of the tricuspid valve (TV). To systematically review the efficacy and safety of tricuspid valve detachment, (TVD) versus conventional surgical repair (non-TVD) in the treatment of ventricular septal defect (VSD). This article is aimed to compare the many outcomes from existing studies and provide evidence regarding the necessity of performing TVD. METHODS: We searched the following databases: PubMed via NCBI, the Cochrane Central Register of Controlled Trials (no date restriction), Medline via Ovid (from 1966 to May 2020); Embase via Ovid (no date restriction), and China National Knowledge Infrastructure for studies comparing the efficacy of TVD and other surgical techniques in VSD repair. Cardiopulmonary bypass time, Cross-clamp time; postoperative complications including residual defect, postoperative atrioventricular block, implantation of pacemakers, tricuspid regurgitation; length of stay (LOS), length of intensive care unit (ICU) stay were analyzed. RESULTS: Only nine studies were included after selection, including seven retrospective cohort studies, one respective cohort study, and one prospective observational study, a patient pool of 1404 patients with 374 underwent TVD and 1030 underwent non-TVD procedures, met the inclusion criteria. Meta analysis has drawn to the following conclusions. First, TVD prolongs CPB time (MD = 7.75, 95% confidence interval [CI] = 2.60-12.89, p = .003) and cross-clamp time (MD = 7.77, 95% CI = 4.76-10.78, p < .001) compared with non-TVD techniques in VSD repair surgeries. Second, no significant difference exists in LOS, length of ICU stay, postoperative atrioventricular block, implantation of pacemakers, incidence of ≥mild tricuspid valve regurgitation (TR) postoperatively and at discharge, as well as the incidence of ≥small residual VSD after surgery and during follow-up (all p ＞ .05). Third, application of TVD increases the risk of TR during follow-up (odds ratio [OR] = 2.42, 95% CI = 1.55-3.76, p < .001). CONCLUSION: VSD closure using TVD technique results in longer CPB and cross-clamp time, and increases risk of TR during follow-up. TVD provides equally viable and safe alternative in treating VSD.

The Relationship between Blood Groups and Aortic Dissection.

BACKGROUND: Plenty of diseases have been found having associations with blood types, especially cardiovascular diseases. The purpose of this study was to clarify whether there is a relationship between blood groups and acute aortic dissection. We also further studied the distribution of blood groups in different types of acute aortic dissection. METHODS: A total of 291 patients diagnosed with acute aortic dissection from 2011 to 2018 were enrolled and analyzed retrospectively in this study. The control group consisted of 582 patients who received plastic surgery at West China hospital from 2011 to 2018. First, we analyzed the distribution of blood groups between the study group and the control group, including the ABO, Rh, O and non-O groups. Then, we further divided the study group into two groups by the type of acute aortic dissection to determine if there was difference in blood groups between the two types of acute aortic dissection. RESULTS: The analysis of the distribution of ABO blood groups (p = 0.302) and Rh blood groups (p = 0.502) did not reveal statistically significant differences. There were no statistically significant differences in the distributions of ABO blood groups and Rh blood groups in different types of acute aortic dissection. CONCLUSIONS: Our study did not prove the incidence of acute aortic dissection, or the type of acute aortic dissection had a relationship with common blood groups.

Management of a giant aortic root aneurysm in a young patient with Marfan syndrome: a case report.

INTRODUCTION: Marfan syndrome (MFS) is a common heritable connective tissue disease involving multiple organs. Even though the clinical manifestations of MFS can be various, aortic root aneurysm is estimated as one of the most serious complications. We herein describe an individualized treatment decision-making process for a 23-year-old male with MFS, suffering from a giant but stable aortic root aneurysm which is extremely rare at his age. CASE: The patient, a 23-year-old male with a family history of MFS, presented to our cardiovascular department because of progressive exertional chest distress, fatigue and occasional precordial pain. Physical examinations revealed 190.5 cm of height, high myopia, and a diastolic murmur at the aortic valve area. Laboratory examinations for systemic vasculitis and infectious diseases were negative. Transthoracic echocardiography and enhanced thoracic computed tomography (CT) scan revealed the existence of a giant aortic root aneurysm (125.1 mm in short-axis), severe aortic valve regurgitation, cardiac dilatation (LV; 99 mm in diastolic diameter) and a poor ejection fraction (EF; 18%). Considering the risk of rupture or dissection of the dilated aortic root, we performed Bentall procedure based on the results of multidisciplinary team discussion and intraoperative exploration. Postoperative thoracic CT scan revealed a normal sized reconstructed aortic root, and the patient was discharged uneventfully 7 days later. CONCLUSION: It is extremely rare to report such a giant aortic root aneurysm in a young patient. In the treatment decision-making process, the patient's specific situation should be taken into consideration. A mechanical Bentall procedure seems to be an acceptable option for some selected cases.

[Effects of Continuous Training on the Induction of Atrial Fibrillation in a Rabbit Model].

OBJECTIVE: This study was aimed to assess mechanisms underlying continuous training induced atrial fibrillation (AF) in an animal model. METHODS: Healthy New Zealand rabbits were divided into three groups ( n=12 each): control group (C), moderate intensity group (M), and high intensity group (H). The intensity of continuous training was adjusted according to the treadmill speed. After 12 weeks of training, with a Langendorff perfusion system, AF was induced by S1S2 stimulation and the incidence was recorded. Changes in atrial kir2.1, kir2.2, type Ⅰ and Ⅲ collagen protein mRNA expressions were assessed by quantitative real-time PCR. Masson staining was used to assess the extracellular collagen volume fraction (CVF) . RESULTS: After 12 weeks, comparing with group C, groups M and H had greater ( P<0.05): CVF, incidence of AF ( P<0.05, also between Groups H and M), and atrial inward rectifier potassium current/channel (IK 1) . In Group H, kir2.1, kir2.2, type Ⅰ and Ⅲ collagen protein mRNA expressions in the left atrium were increased ( P<0.05, compared with Groups C and M). CONCLUSION: Long-term and high-intensity treadmill running could increase AF incidence in rabbits.

Influence of Continuous Training on Atrial Myocytes IK1 and IKAch and on Induction of Atrial Fibrillation in a Rabbit Model.

BACKGROUND: Elucidation of mechanisms underlying continuous training-related atrial fibrillation (AF) may inform formulation of novel therapeutic approaches and training method selection. This study was aimed at assessing mechanisms underlying continuous training-induced AF in an animal model. METHODS: Healthy New Zealand rabbits were divided into three groups (n=8 each), namely, control (C), and moderate intensity (M), and high intensity (H) continuous training according to treadmill speed. Atrial size andintrinsic and resting heart rates were measured by transthoracic echocardiography before, and 8 and 12 weeks after training. Using a Langendorff perfusion system, AF was induced by S1S2 stimulation and the induction rate was recorded. Atrial IK1 and IKAch ion current densities were recorded using whole-cell patch-clamp technique in isolated atrial myocytes. Changes in atrial Kir2.1, Kir2.2, Kir3.1, and Kir3.4 mRNA expression were assessed by reverse transcriptase-coupled polymerase chain reaction. RESULTS: After 8 and 12 weeks, Groups M and H vs. Group C had greater (all P < 0.05) atrial anteroposterior diameter; greater incidence of AF (60% and 90% vs. 45%, respectively; P < 0.05, also between Groups H and M); and greater atrial IKAch current density. In Group H, Kir2.1 and Kir2.2 mRNA expression in the left and right atria was increased (P < 0.05, vs. Groups C and M) as was left atrial Kir3.1 and Kir3.4 mRNA expression (P < 0.05, vs. Group C). CONCLUSION: In a rabbit model, continuous training enlarges atrial diameter leading to atrial structural and electrical remodeling and increased AF incidence.

Exploration and optimization of processes for key intermediates of phosphorodiamidate morpholino oligonucleotides / 军事医学

Objective To explore and optimize the processes for synthesis of key intermediates of phosphorodiamidate morpholino oligonucleotides-7'-hydroxy-N-trityl morpholino nucleoside monomer in order to contribute to the research of phosphorodiamidate morpholino oligonucleotides antisense nucleotides.Methods With N-benzoylcytidine,guanosine and 5-methyluridine as starting materials,the ribose was modified to morpholino and the key chemical groups were protected to obtain 7'-hydroxy-N-trityl morpholino nucleoside monomer.Results Compounds N4-benzoyl-7'-hydroxy-N-trityl morpholinocytidine,N2-benzoyl-7'-hydroxy-N-trityl morpholinoguanosine and 7'-hydroxy-N-trityl morpholinothymidine were synthesized.The synthetic processes were optimized as well.The structures of all the intermediates and title compounds were characterized.Conclusion The synthetic processes of 7'-hydroxy-N-trityl morpholino nucleoside monomers have been optimized,which can be employed to prepare title compounds on a large scale.