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ABSTRACT: Abstract Aim of the study: To investigate the surgical result of adult total anomalous pulmonary venous connection (TAPVC). Methods: From March 1997 to March 2011, 12 adult cases of isolated TAPVC, with an average age of 24.9 ± 6.7 years (from 18 to 41 years), underwent surgical repair in our department. All patients suffered from right-sided volume overload with clinical manifestations varying from mild cyanosis to severe heart failure. Results: According to Darling's classification, eight cases were classified as supracardiac type, four as cardiac type. Unobstructed connections were established between the left atrium and the pulmonary common vein in all patients with external cardiac approach in four supracardiac cases, and internal cardiac approach in four cardiac and three supracardiac cases, and Warden technique in one supracardiac patient. Concomitant operations included De Vega's tricuspid annuloplasty in six patients, patent arteriosus ductus closure in two. All patients survived the operation, and postoperative follow-up was 100% complete with a period ranging from 10 months to 14 years. NYHA grade decreased from 2.33 ± 0.49 to 1.08 ± 0.29 (p < 0.01). Three patients had postoperative tricuspid insufficiency. Five patients had cardiac arrhythmia, among two symptomatic cases; one controlled with medication, another received a successful radiofrequency ablation for incision-related atrial flutter. Conclusions: Surgical correction of isolated adult TAPVC can be carried out safely with acceptable long-term outcome. Postoperative tricuspid insufficiency and cardiac arrhythmias may have a negative long-term impact, which should be evaluated preoperatively and managed individually during surgery. (J Card Surg 2012;**:1-4).
Journal of Cardiac Surgery 10/2012; · 0.87 Impact Factor
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Ping Zhu, Ji-Mei Chen,
Hui-Ming Guo,
Xiao-Ping Fan,
Xiao-Shen Zhang,
Rui-Xin Fan,
Shao-Yi Zheng,
Ruo-Bin Wu,
Xue-Jun Xiao,
Huan-Lei Huang,
Xiao-Lan Zhu,
Huai-Pu Liu,
Guang Long,
Yan-Fang Chen,
Jian Zhuang
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ABSTRACT: To investigate the effects of matrine on the vascular smooth muscle cell (VSMC) migration modulated by disturbed flow and their underlying molecular mechanisms in vitro.
Isolated rat aortic VSMCs were grown to confluence on 20- × 80-mm fibronectin-coated glass cover slides, and then, denuded zones were made at the position calculated to be the oscillating flow-reattachment zone and also in the downstream laminar flow region. VSMCs were treated with different doses of matrine (0, 10, 20, 30, and 40 mg/L), or PD98059 (30 μM), ML-7 (10 μM) combined with matrine (40 mg/L) for 30 minutes before and during the experiments. Then, the wounded monolayers were kept under static conditions or were subjected to laminar or disturbed flow for 21 hours or 10 hours. The VSMC migration was assessed by microscopic images. The extracellular signal-regulated kinase 1/2 (ERK1/2) and myosin light chain kinase (MLCK) proteins were determined by Western blot.
Disturbed flow significantly increased phosphorylation of ERK1/2. Selective inhibition of ERK1/2 phosphorylation by inhibitor PD98059 and matrine significantly suppressed VSMC migration under disturbed flow. Disturbed flow significantly enhanced phosphorylation of MLCK, whereas both matrine and PD98059 inhibited the phosphorylation of MLCK under disturbed flow. The complete inhibition of MLCK phosphorylation using the selective MLCK inhibitor ML-7 significantly inhibited VSMC migration under disturbed flow.
Matrine inhibits VSMC migration under disturbed flow, in part, by downregulation of ERK1/2-MLCK signaling pathway.
Annals of Vascular Surgery 02/2012; 26(2):268-75. · 1.03 Impact Factor
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ABSTRACT: A prospective study was conducted to probe into the relationship between arterial oxygen partial pressure (PaO2) and brain injury during cardiopulmonary bypass (CPB) in infants with cyanotic congenital heart disease (CHD).
Enrolled in the study were 45 cyanotic infants, who were less than three years old and underwent corrective cardiac surgery from August 1(st), 2010 to January 31(st), 2011 at Guangdong General Hospital. All the infants had a pulse oxygen saturation (SpO2) lower than 85% and were randomly allocated into three groups by a specific computer program. In controlled group 1 (G1 group), PaO2 levels were controlled at 80 - 120 mm Hg (1 mm Hg = 0.133 kPa) during CPB; in controlled group 2 (G2 group), PaO2 levels at 120 - 200 mm Hg during CPB; while in uncontrolled group (G3 group), PaO2 levels were at 200 - 400 mm Hg during CPB. Blood samples were collected just before starting CPB, at the end of CPB, and at 3 h, 5 h, and 24 h after CPB (T1, T2, T3, T4, T5) for the determination of serum concentrations of protein S100β, neuron specific enolase (NSE), and adrenomedulin (ADM) by ELISA.
Protein S100β rose significantly after starting CPB. In group G3, it reached a peak of (699 ± 139) ng/L by the end of CPB, significantly higher than those in groups G1 and G2 [(528 ± 163) ng/L and (585 ± 155) ng/L], and was positively correlated with PaO2 levels (r = 0.526, P < 0.01). NSE levels of group G1 were continuously rising after starting CPB and reached significantly high levels at 3 h or 5 h after CPB [(12.2 ± 3.4) µg/L and (12.3 ± 3.7) µg/L], while those of group G2 rose significantly during CPB [(10.9 ± 4.8) µg/L] and even higher at 3 h or 5 h after CPB [(12.6 ± 5.1) µg/L and (13.2 ± 5.4) µg/L]. NSE levels of group G3 rose significantly during CPB and maintained at a high level [(12.2 ± 5.7) µg/L] afterwards. There was no significant difference in serum ADM concentrations among different time points in each group and among these three groups. All the infants were discharged from the hospital without any obvious nervous symptom and sign.
High PaO2 during CPB in infants with CHD might cause an increase of serum protein S100β and NSE, indicating that brain injury might become worse with a higher PaO2 and might be positively correlated with PaO2 during CPB.
Zhonghua er ke za zhi. Chinese journal of pediatrics 02/2012; 50(2):121-5.
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ABSTRACT: One of the most significant responses to fetal cardiac bypass is severe placental dysfunction characterized by increased vascular resistance. We tested the hypothesis that fetal cardiac bypass triggers the activation of nuclear factor kappa-B (NF-KB), a major regulator of inflammatory response, and that pharmacologic inhibition of NF-KB activation by pyrrolidine dithiocarbamate alleviates fetal cardiac bypass-induced placental dysfunction.
Fifteen pregnant goats at 120 to 140 days' gestation were equally divided into the control group with a sham procedure of fetal sternotomy and cannulation (CG), the fetal bypass group (FB), and the fetal bypass group with 300 mg pyrrolidine dithiocarbamate before sternotomy (FP). Fetal cardiac bypass was performed for 30 minutes. Umbilical arterial flow rate was measured by ultrasonic flowmeter and placental vascular resistance was calculated. Fetal plasma levels of nitric oxide (NO), endothlin-1 (ET-1), 6-keto-prostaglandin F1α (6-K), thromboxane B(2) (TXB2), interleukin 6 (IL-6), and tumor necrosis factor-α (TNF-α) were assayed. IL-6 and TNF-α mRNA were analyzed by real-time polymerase chain reaction. NF-KB activation was evaluated by electrophoretic mobility shift assay.
Placental vascular resistance significantly increased in the FB and FP groups compared with the CG group. Increases in plasma levels of NO were observed in all 3 groups. Plasma levels of ET-1 rose significantly in the FB and FP groups without noticeable difference between them. Plasma levels of 6-K, TXB(2), IL-6, and TNF-α increased significantly in the FB group compared with the CG and FP groups. The transcription levels of IL-6 and TNF-α mRNA in the placental tissues of the FB group were significantly higher than in the FP and CG groups. The amount of activated NF-KB in the placental tissues of the FB group was also significantly higher than that in the FP and CG groups.
Fetal cardiac bypass-induced inflammatory response possibly mediated by NF-KB caused placental dysfunction. Pharmacologic inhibition of NF-KB activation and decrease in the inflammatory response did not alleviate the placental dysfunction.
The Journal of thoracic and cardiovascular surgery 08/2011; 143(2):445-50. · 3.41 Impact Factor
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ABSTRACT: Echocardiography is regarded as a gold standard for measuring hemodynamic values. The ultrasonic cardiac output monitor (USCOM) is a new method for measuring hemodynamics and could provide non-invasive point of care guidance. So far, there are no published USCOM reference values for neonates, nor has USCOM's accuracy been established in this population. We aimed to determine the accuracy and clinical utility of the USCOM in healthy neonates relative to published echocardiographic data, to establish normal hemodynamic parameters that it measures, and to assess the possible role of USCOM as an alternative to echocardiography as a trend monitor.
Right and left heart hemodynamics of 90 normal neonates were measured during circulatory adaptation over the first three days of life using the USCOM and automated oscillotonometry.
Heart rate showed a significant decline from days one to three, from 126 to 120 (P < 0.001). Systolic, diastolic and mean arterial pressures all increased significantly from 66 to 71 mmHg, 33 to 38 mmHg and 44 to 49 mmHg, respectively (P < 0.001 in each case). Right ventricular cardiac index (RV-CI) showed no change with a mean of 5.07 L × min(-1) × m(-2). Left ventricular cardiac index (LV-CI) declined from 3.43 to 3.00 L × min(-1) × m(-2) (P < 0.001). RV-CI exceeded LV-CI on all three days by a mean of 61%. The systemic vascular resistance index (SVRI), based on LV-CI, increased significantly over the three days from 1083 to 1403 dyne × sec × cm(-5) × m(2) (P < 0.001).
Normal neonatal hemodynamic values, as indicated by USCOM, were established. LV-CI measurement showed excellent agreement with published echocardiographic studies. RV-CI was constant and exceeded LV-CI for all three days of this study. It may be falsely high due to flow velocity measurement errors arising from the pulmonary branch arteries, and may represent a limitation of the USCOM method. The progressive rise of arterial pressure and SVRI despite a declining LV-CI may indicate functional closure of the ductus arteriosus, with the greatest change occurring within the first 24 hours. Evidence of closure of the foramen ovale was not observed.
Chinese medical journal 08/2011; 124(15):2284-9. · 0.86 Impact Factor
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ABSTRACT: Increasing evidence shows that some cardiac defects may benefit from fetal interventions, including fetal cardiac surgery. We attempted to develop an in vivo animal model of fetal cardiopulmonary bypass with cardioplegic arrest.
Operations were performed on 14 pregnant goats. The extracorporeal circulation circuit consisted of a centrifugal pump, silicone tubings with an inner diameter of 6 mm, a roller pump, and a reservoir. The placenta was the sole oxygenator. Cardiopulmonary bypass was maintained at a mean flow rate of 344 ± 68 mL/kg/min, including 30 minutes of cardiac arrest and 15 minutes of reperfusion. Mean arterial blood pressure and heart rate were monitored. Arterial blood samples were analyzed. The pulse index and resistance index of the fetal umbilical artery were monitored.
Experiments were completed in 11 cases (79%), with the fetuses weighing 0.65 to 1.8 kg. Fetal mean arterial blood pressure and heart rate remained stable throughout the experiments. A decrease in partial pressure of oxygen with concomitant increase in carbon dioxide partial pressure was noted, but trends were relatively stable. Metabolic acidosis was recognized during and after cardiac bypass. The pulse index and resistance index of the umbilical artery increased significantly after 2 hours off bypass.
We confirmed the technical feasibility of establishing an in vivo model of fetal cardiac bypass with cardioplegic arrest. This fetal goat model provides reproducible data and is suitable to study clinically relevant problems related to fetal cardiopulmonary bypass, myocardial protection, and hemodynamics.
The Journal of thoracic and cardiovascular surgery 07/2011; 142(6):1562-6. · 3.41 Impact Factor
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Ping Zhu,
Yu-Guan Wen, Ji-Mei Chen,
Jian Zhuang,
Zhi-Ling Zhou,
Shao-Yi Zheng,
Ruo-Bin Wu,
Xue-Jun Xiao,
Cong Lu,
Rui-Xin Fan,
Hui-Ming Guo,
Xiao-Ping Fan
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ABSTRACT: A sensitive and rapid method was developed for quantification of olprinone in human plasma utilizing liquid chromatography tandem mass spectrometry (LC-MS/MS). An aliquot of 1 mL plasma sample was extracted with ethyl acetate-dichloromethane. Separation of olprinone and the milrinone (internal standard, IS) from the interferences was achieved on a C(18) column followed by MS/MS detection. The analytes were monitored in the positive ionization mode. Multiple reaction monitoring using the transition of m/z 251 → m/z 155 and m/z 212 → m/z 140 was performed to quantify olprinone and IS, respectively. The method had a total chromatographic run time of 3 min and linear calibration curves over the concentration range of 0.5-60 ng/mL. The lower limit of quantification (LLOQ) was 0.5 ng/mL. The intra- and inter-day precisions were less than 16.3% for low QC level, and 7.1% for other QC levels, respectively. The intra- and inter-day relative errors were ranged between -12.2% and 3.7% for three QC concentration levels. The validated method was successfully applied to the quantification of olprinone concentration in human plasma after intravenous (i.v.) administration of olprinone at a constant rate of infusion of 2 μg/(kg min) for 5 min in order to evaluate the pharmacokinetics.
Journal of pharmaceutical and biomedical analysis 01/2011; 54(1):198-202. · 2.45 Impact Factor
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ABSTRACT: A sensitive and rapid method based on liquid chromatography- tandem mass spectrometry (MS-MS) was developed for the determination of olopatadine in human plasma. Sample preparations were carried out by protein precipitation with the addition of acetonitrile followed by liquid-liquid extraction with ethyl acetate/dichloromethane after internal standard (IS, amitriptyline) spiked. After evaporation to dryness, the resultant residue was reconstituted in mobile phase. Separation of olopatadine and IS from the interferences was achieved on a C(18) column followed by MS-MS detection. The analytes were monitored in the positive ionization mode with a TurboIonspray source. Multiple reaction monitoring using the transition of m/z 338 → 165 and m/z 278 → 91 was performed to quantify olopatadine and IS, respectively. The method had a total chromatographic run time of 3.5 min and linear calibration curves over the concentration range of 0.2-100 ng/mL. The lower limit of quantification was 0.2 ng/mL. For each QC concentration level the intra- and interday precisions were less than 11.4%, and relative errors ranged between -6.40% and 9.26%. The validated method was successfully applied to the quantification of olopatadine concentration in human plasma after administration of olopatadine at an oral dose of 5 mg in order to evaluate the pharmacokinetics.
Journal of analytical toxicology 01/2011; 35(2):113-8. · 2.02 Impact Factor
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Ping Zhu, Ji-mei Chen,
Shu-zhen Chen,
Cheng Zhang,
Shao-yi Zheng,
Guang Long,
Ji Chen,
Zhi-ling Zhou,
Rui-xin Fan,
Xiao-ping Fan,
Yan-fang Chen,
Jian Zhuang
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ABSTRACT: To investigate the effect of matrine on proliferation of vascular smooth muscle cells (VSMCs) and elucidate the underlying mechanisms.
Rat aortic VSMCs were cultured in medium supplemented with 10% fetal bovine serum and treated with various concentrations (0, 5, 10, 15, and 20 mg/L) of matrine for 72 h. VSMCs proliferation and cell cycle profiling were assessed using a methylene blue incorporation assay and flow cytometry, respectively. The underlying protein signaling mechanisms were determined using Western blot analysis of the expression levels of cell cycle regulatory genes, including p53, p21, p27, cyclin D1, cyclin E, cyclin-dependent kinase 2 and 4 (cdk2, cdk4), and phosphorylated Rb. The involvement of p21 and p27 pathways was further determined using small interfering RNA (siRNA) knockdown.
Matrine inhibited VSMC proliferation in a dose-dependent manner by promoting G(1) arrest. The G(1) arrest was accompanied by up-regulation of p53 and p21 protein levels, and down-regulation of cyclin D1/cdk4, cyclin E/cdk2 and phosphorylated Rb protein levels. Matrine did not affect p27 expression. Furthermore, the anti-proliferative effect of matrine was abolished by silencing of p21, but not by silencing of p27.
Our data indicate that matrine has an inhibitory effect on VSMC proliferation via up-regulation of the p53/p21 signaling pathway and modulation of other cell cycle regulatory genes.
Acta Pharmacologica Sinica 10/2010; 31(10):1329-35. · 1.95 Impact Factor
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ABSTRACT: Our objective was to evaluate the early and midterm outcomes of palliative arterial switch operation in which a ventricular septal defect was not closed or repaired with a fenestrated patch in patients with transposition of the great arteries, ventricular septal defect, and severe pulmonary vascular obstructive disease.
Between March 2000 and September 2009, the palliative arterial switch operation was performed in 21 patients with a mean age of 3.7 years (range, 0.5-15). Mean preoperative values for systolic pulmonary arterial pressure and systemic arterial oxygen saturation were 91 mm Hg and 69%, respectively. Eighty-one percent of the patients were in New York Heart Association functional class III or IV preoperatively.
Early mortality was 14.3%. Mean follow-up was 4.0 years (maximum 9.5 years). Regression of pulmonary arterial pressure occurred in 8 patients (44% of the early survivors). Three of the 8 fenestrations were closed interventionally. Mean postoperative systemic arterial oxygen saturation increased significantly to 93% (P < .001). One late death occurred 3 months after surgery. All the long-term survivors (n = 17) were in New York Heart Association functional class I or II (P < .001).
The palliative arterial switch operation significantly improved the quality of life and possibly life expectancy in patients with transposition of the great arteries, ventricular septal defect, and severe pulmonary vascular obstructive disease. Postoperative pulmonary vascular resistance might be reversible in some patients. Closing the ventricular septal defect with a fenestrated patch, which can be easily closed nonsurgically later on, might contribute to a safer postoperative recovery.
The Journal of thoracic and cardiovascular surgery 10/2010; 140(4):845-9. · 3.41 Impact Factor
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ABSTRACT: To analyze the changes in the cardiac function after St. Jude Regent mechanical valve replacement and assess the prosthesis-patient matching.
From October 2007 to March 2009, 44 patients received implantation of 17 mm St. Jude aortic prostheses in our hospital. The patients were followed up for clinical symptoms, signs, electrocardiogram (ECG), echocardiogram and cardiac functions, and the results were compared with those of randomly selected 44 patients receiving 21 mm St. Jude aortic prostheses.
In 17 mm St Jude Medica Regent valve group, 8 patients presented with ECG ST segment changes, 3 complained of chest tightness, 3 had occasional chest pain and discomfort, and 8 had grade II and 4 grade III cardiac function. In 21 mm St Jude Medical Regent valve group, 6 patients had ECG ST segment changes, 2 complained of chest tightness, 2 reported occasional chest pain and discomfort, 11 had grade II and 2 grade III cardiac function. No significant differences were found in these indices between the two groups (P=0.32). Compared with those before operation, the two groups showed significant improvements in the left ventricular end-diastolic diameter, left ventricular posterior wall thickness, left ventricular mass index, and aortic pressure gradient (P<0.05). A significant increase in the left ventricular ejection fraction occurred 6-12 months after operation, but without statistical difference between the two groups (P>0.05).
For underweight patients (<60 kg) and those with small body surface area (<1.6 cm(2)), 17 mm St. Jude Medical Regent valve prosthesis may produce good therapeutic effect, and some indices are even close to those after placement of 21 mm St. Jude Medical Regent valve prosthesis. No obvious prosthesis-patient mismatch occurs after the placement of the 17 mm valve prosthesis and aortic valve ring expansion is not necessary.
Nan fang yi ke da xue xue bao = Journal of Southern Medical University 04/2010; 30(4):799-801.
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ABSTRACT: OBJECTIV: To summarize the experience with surgical treatment of constrictive pericarditis.
A retrospective analysis of the post-operative clinical data was conducted in 128 surgical patients with chronic constrictive pericarditis.
Two early postoperative death occurred in this group due to severe low cardiac output syndrome, with the mortality rate of 1.57%. The postoperative complications included low cardiac output syndrome (13.2%), arrhythmia (7.02%), acute renal insufficiency (3.9%), respiratory insufficiency (3.1%), wound infection (2.3%), postoperative chest bleeding (1.6%) and cerebral infarction (0.78%). Relapse occurred in one case because of incomplete pericardial resection.
Constrictive pericarditis should be confirmed as soon as possible with actively surgery, and the extent of pericardial resection should be decided according to the individual conditions. Complete untethering of the diseased pericardium should be performed with active prevention of postoperative complications.
Nan fang yi ke da xue xue bao = Journal of Southern Medical University 03/2010; 30(3):535-7.
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European Heart Journal 06/2008; 29(20):2488. · 10.48 Impact Factor
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ABSTRACT: To analyze 68 pediatric cases with functional univentricle heart who underwent bidirectional Glenn procedure during from April 1998 to December 2005.
There were 47 males and 21 females in this group, aged from 5 months to 14 years old and weighed from 6.7 to 30.0 kg. Among them, 39 cases were received bidirectional Glenn procedure on the right side, 13 cases on the left side and 16 cases on both sides. Three cases had the pulmonary artery banded; one case had the pulmonary artery ligated;one case had the original A-P shunt cut off; six cases had the PDA ligated; four cases had the MAPCAs cut off; one case had TAPVC corrected contemporarily; two cases of PAPVC were also corrected; four cases had the atrial-ventricular valve repaired.
Three cases died. The mortality was 4.4%. The mean post-operative pressure of super vena cava was (15.9 +/- 2.4) mm Hg (1 mm Hg = 0.133 kPa), higher than the pre-operative one (8.3 +/- 1.8) mm Hg (P < 0.01). The mean post operative SpO(2) was (89.3 +/- 4.2)%, higher than the pre-operative one (78.4 +/- 6.0)% (P < 0.01).
Bidirectional Glenn procedure is of satisfied effect on surgical treatment for functional univentricle heart. The persistent forward flow from pulmonary artery should be reserved in bidirectional Glenn procedure.
Zhonghua wai ke za zhi [Chinese journal of surgery] 06/2007; 45(12):812-4.
