Zhigang Song

Changhai Hospital, Shanghai, Shanghai, Shanghai Shi, China

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Publications (8)22.77 Total impact

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    ABSTRACT: Calcific aortic valve disease is an active process involving a wide range of pathologic changes. Valve interstitial cells are the most prevalent cells in the heart valve and maintain normal valve structure and function. MicroRNAs (miRNAs) are essential posttranscriptional modulators of gene expression, and miRNA-30b is a known repressor of bone morphogenetic protein 2-mediated osteogenesis. We hypothesized that miRNA-30b is a multifunctional regulator of aortic valve interstitial cells during calcification. To determine the role of miRNA-30b in calcific aortic valve disease, we evaluated miRNA expression in human calcific aortic valve leaflets obtained intraoperatively. Furthermore, human valve interstitial cells were evaluated with regard to miRNA-30b expression and osteogenesis by quantitative real-time polymerase chain reaction, Western blotting, flow cytometry, and alkaline phosphatase assays. In this study, we demonstrated that miRNA-30b attenuates bone morphogenetic protein 2-induced osteoblast differentiation by targeting Runx2, Smad1, and caspase-3. Transfection of a mimic of miRNA-30b led to decreases in alkaline phosphatase activity and expressions of Runx2, Smad1, and caspase-3. Furthermore, dual luciferase reporter assays confirmed that Runx2, Smad1, and caspase-3 are direct targets of miRNA-30b. We demonstrated a remarkable role of miRNA-30b in calcific aortic valve disease as a regulator of human aortic valvular calcification and apoptosis through direct targeting of Runx2, Smad1, and caspase-3. Targeting of miRNA-30b could serve as a novel therapeutic strategy to limit progressive calcification in aortic stenosis.
    The Journal of thoracic and cardiovascular surgery 08/2013; · 3.41 Impact Factor
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    ABSTRACT: OBJECTIVE: For acute type A dissection without an intimal tear in the arch, the optimal surgical strategy is unknown. The present study was designed to clarify the issue by comparing the early and late outcomes of proximal (PR) and extensive repair (ER). METHODS: From January 2002 to June 2010, 331 patients with acute type A dissection were treated surgically at our institute. Of these 331 patients, 197 were identified without an arch tear on the preoperative imaging examination and by intraoperative inspection. Of these 197 patients, 74 underwent proximal repair, including the aortic root, ascending aortic, or hemiarch repair, and 88 underwent extensive repair, including proximal repair, total arch replacement and a stented elephant trunk technique. The perioperative variables and late results were statistically analyzed. RESULTS: No significant difference was found in the rates of early mortality and morbidity between the 2 groups, despite the shorter duration of circulatory arrest in the PR group. During long-term follow-up (mean, 55.7 ± 33.1 months; maximum, 129), the overall survival rate in the whole cohort was 100%, 90.8%, and 71.1% at 1, 5, and 8 years, respectively. No difference was found in survival between the 2 groups (P > .05). However, complete thrombosis of the false lumen in the proximal descending aorta was achieved in 100% of the ER group and 24.6% of the PR group (P < .001). For patients with a patent false lumen in the PR group, distal anastomosis leakage and unclosed small intimal tears were identified in 53.3% and 35.6% patients, respectively. The reintervention rate was also lower in the ER group than in the PR group (4.9% vs 15.9%, P < .05) during follow-up. Moreover, the reintervention rate for patients with Marfan syndrome was 9.5% in the ER group and 38.5% in the PR group (P < .05). CONCLUSIONS: For patients with acute type A dissection without an intimal tear in the arch, extensive repair could promote the occlusion of distal false lumen and decrease the reintervention rate without increasing the operative risk.
    The Journal of thoracic and cardiovascular surgery 06/2013; · 3.41 Impact Factor
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    ABSTRACT: OBJECTIVE: We have reviewed the medical histories of 4 patients who underwent operations between November 2004 and February 2011 at Changhai Hospital for cardiac papillary fibroelastoma. METHODS: Diagnosis was demonstrably suggested by echocardiography. Tumor locations were mitral valve (1), left atrium (1), and aortic valve (2). Indications for operation were previous cerebrovascular accident for the mitral tumor, incidental apopsychia and giant mobile mass for the left atrium, ingravescent chest tightness and palpitations for the first aortic tumor, and severe regurgitation of aortic valve for the second aortic tumor. The study was approved by the Changhai Hospital Ethics Committee, and the consent from the patients or their immediate family was obtained. RESULTS: Surgical excision with necessary valve replacement operations was performed in all cases. All patients had uneventful postoperative recoveries. No evidence of regurgitation or recurrence was seen on echocardiography at follow-up. CONCLUSIONS: Despite their histologically benign aspect, cardiac papillary fibroelastomas should be removed because of potential embolic complications.
    Journal of Cardiothoracic Surgery 04/2013; 8(1):65. · 0.90 Impact Factor
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    ABSTRACT: OBJECTIVES The study aimed to assess the long-term follow-up of patients with an autologous pericardial aortic valve (APAV) replacement and to analyse in vivo histopathological changes in implanted APAVs.METHODS From 1996 to 1997, 15 patients (mean age, 34 years) underwent aortic valve replacement with the glutaraldehyde-treated autologous pericardium. All patients were followed up after discharge. The excised APAVs were processed for haematoxylin-eosin, Victoria blue-van Gieson and immunohistochemical staining.RESULTSThe mean clinical follow-up was 11.43 ± 4.50 years. APAV-related in-hospital and late mortalities were both 0%. Five (33%) patients required reoperation because of a prolapse of the right coronary cusp (n = 1), infective endocarditis (n = 1) or fibrocalcific degeneration (n = 3). Freedom from endocarditis, fibrocalcific degeneration and reoperation at the end of follow-up was 93, 80 and 67%, respectively. The remaining 10 patients were alive and well with a mean New York Heart Association class of 1.10 ± 0.32 and normally functioning aortic valves (peak pressure gradient: 7.70 ± 3.41 mmHg; mean pressure gradient: 1.79 ± 0.64 mmHg). Histopathology revealed that (i) a thin factor VIII-positive layer (endothelialization) was found on all non-endocarditis APAVs; (ii) pericardial cells in all APAVs were positive for α-smooth muscle actin (myofibroblast phenotype) and some cells in the fibrocalcific APAVs were positive for alkaline phosphatase (osteoblast phenotype) and (iii) an elastic band was found in 3 cases (in vivo >9 years).CONCLUSIONSAPAV replacement is a procedure with a low mortality. APAVs adapt to new environmental demands by producing an elastic band and by endothelialization, whereas myofibroblast/osteoblast transdifferentiation seems to be responsible for the fibrocalcification of APAVs.
    Interactive Cardiovascular and Thoracic Surgery 11/2012; · 1.11 Impact Factor
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    ABSTRACT: Recent data from human and animal studies have shown an upregulated expression of advanced glycosylation end product-specific receptor (RAGE) in human atherosclerotic plaques 1 and in retina, messangial, and aortic vessels, suggesting an important role of RAGE in the pathogenesis of atherothrombotic diseases. In the past few years, the relationship between RAGE polymorphisms (-429T/C, -374T/A, and G82S) and coronary heart disease (CHD) has been reported in various ethnic groups; however, these studies have yielded contradictory results. PubMed, ISI web of science, EMBASE and the Chinese National Knowledge Infrastructure databases were systematically searched to identify relevant studies. Data were abstracted independently by two reviewers. A meta-analysis was performed to examine the association between RAGE polymorphisms and susceptibility to CHD. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. A total of 17 studies including 4343 patients and 5402 controls were involved in this meta-analysis. Overall, no significant results were observed for -429T/C (OR  = 1.01, 95% CI: 0.92-1.12, P  = 0.78), -374T/A (OR  = 1.11, 95% CI: 0.98-1.26, P  = 0.09) and G82S (OR  = 1.12, 95% CI: 0.86-1.45, P  = 0.41) polymorphism. In the stratified analyses according to ethnicity, sample size, CHD endpoint and Hardy-Weinberg status, no evidence of any gene-disease association was obtained. This meta-analysis demonstrates that there is no association between the RAGE -429T/C, -374T/A and G82S polymorphisms and CHD.
    PLoS ONE 01/2012; 7(12):e50790. · 3.53 Impact Factor
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    ABSTRACT: The left subclavian artery (LSA) is usually difficult to manipulate in total aortic arch replacement procedures if it is displaced by huge false lumens in the ascending aorta or right hemiarch. We summarize our experience of selectively ligating the deeply located LSA in total aortic arch replacement and stented "elephant trunk" implantation procedures for Stanford type A aortic dissection. Data of 29 patients with deep LSA undergoing total arch replacement and stented "elephant trunk" implantation from January 2008 to June 2010 were reviewed. The LSA was ligated because of the difficult exposure (21 males, 8 females, age 19 to 55). Collateral circulation of the circle of Willis and bilateral vertebral arteries were assessed thoroughly by preoperative imaging and intraoperative observations. If collateral circulation was sufficient, LSA was ligated; if insufficient, an additional bypass graft was created from the ascending aorta to the left axillary artery. Twenty-eight patients survived the operation with 1 early death. Postoperative blood pressures were lower in the left arm than in the right (78±17.3 vs 126±3.7 mm Hg, p<0.01), but oxygen saturation, skin temperature, and strength of the left hand were normal. The surviving patients have been followed for 16.6±9.0 months (6 to 36) and none had symptoms of LSA steal syndrome or arm ischemia. Ligation of the LSA after strict evaluation of collateral circulation could be safe for type A dissection patients if the exposure is insufficient, and this method can simplify the operation significantly.
    The Annals of thoracic surgery 11/2011; 93(1):110-4. · 3.45 Impact Factor
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    ABSTRACT: To clarify the role of glutathione S-transferases (GSTs; GSTM1 and GSTT1) status in susceptibility to coronary heart disease (CHD), a meta-analysis of published studies was performed. A total of 19 studies including 8020 cases and 11 501 controls were included in this meta-analysis. In a combined analysis, the relative risks for CHD of the GSTM1 null and GSTT1 null polymorphisms were 1.47 [95% confidence interval (CI): 1.08-2.01] and 1.26 (95% CI: 0.90-1.75), respectively. Three potential sources of heterogeneity including ethnicity, source of control and sample size of study were also assessed. However, no significant association was found in stratified analyses. By pooling data from eight studies (2909 cases and 3745 controls) that considered combinations of GSTT1 and GSTM1 genotypes, a statistically significant increased risk for CHD [odds ratio (OR = 2.38, 95% CI: 1.03-5.48)] was detected for individuals with combined deletion mutations in both genes compared with positive genotypes. Results from the meta-analysis of five studies on GSTs stratified according to smoking status showed an increased risk for individuals with null genotype (OR = 2.21, 95% CI: 1.24-3.92 for GSTM1 and OR = 3.29, 95% CI: 1.49-7.26 for GSTT1) versus non-null genotypes. This meta-analysis suggests that the GSTM1 null genotype may slightly increase the risk of CHD and that interaction between unfavourable GSTs genotypes may exist.
    Mutagenesis 03/2010; 25(4):365-9. · 3.50 Impact Factor
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    ABSTRACT: Surgical repair of pathologic tricuspid valve disease often fails because of severe anatomic distortion of the valve apparatus, particularly in patients with rheumatic heart disease. This usually leads to tricuspid valve replacement despite the associated prosthesis-related complications. This study examines our experience of tricuspid valve repair with autologous pericardium for organic rheumatic tricuspid valve disease. From 1996 to 2007, 31 patients underwent repairs for rheumatic tricuspid valve disease characterized by retracted leaflets and inadequate leaflet area. The patients, aged 14 to 56 years, had a mean New York Heart Association (NYHA) class of 2.9 +/- 0.6. All patients presented with severe tricuspid regurgitation and coexisting left-sided heart valve disease. Glutaraldehyde-treated autologous pericardial patch was used to augment tricuspid valve leaflets. Other techniques were applied as needed, including commissurotomy, leaflet mobilization, annuloplasty, and prosthetic ring implantation. Concomitant operations included left-sided valve replacement in all, and left atrial thrombus removal in 3 patients. Follow-up duration was 4 to 126 months. No deaths or late reoperations occurred. All patients demonstrated clinical improvements on follow-up. Echocardiographic studies before hospital discharge showed less than mild tricuspid regurgitation in all patients. The most recent echocardiographic follow-up showed no tricuspid regurgitation in 10 patients (32.3%), trivial regurgitation in 12 (38.7%), mild regurgitation in 8 (25.8%), and moderate regurgitation in 1 (3.2%). In selected patients, organic rheumatic tricuspid valve disease can be treated with pericardial patch to augment the retracted leaflets in combination with other techniques. Follow-up reveals excellent tricuspid valve function.
    The Annals of thoracic surgery 04/2009; 87(3):726-30. · 3.45 Impact Factor