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Sun Y.,National Center for Cardiovascular Disease
Chinese Journal of Pathology | Year: 2014

Objective: To study the clinical and pathologic features of primary cardiac inflammatory myofibroblastic tumor.Methods: A total of 4 patients with primary cardiac inflammatory myofibroblastic tumor were encountered during the period from 1993 to 2013 in National Center for Cardiovascular Disease. The clinical features, imaging findings and outcomes of the 4 patients were evaluated. ALK protein expression and ALK gene status were studied using the archival tumor tissues.Results: There were 1 female and 3 male patients. The age of patients ranged from 5 months to 30 years (mean =16 years). The tumor was located in right ventricle (n = 2), right atrium (n = 1) or pericardium (n = 1). Histologic patterns included 2 cases of fibrous histiocytoma type, 1 case of granulomatous type and 1 case of sclerosing type. Immunohistochemical study showed that 2 cases expressed ALK protein. Fluorescence in-situ hybridization however did not reveal any ALK gene rearrangement.Conclusions: Inflammatory myofibroblastic tumor of the heart is rarely encountered and easily misdiagnosed. It carries distinctive clinical and pathologic features. ALK protein expression is helpful in arriving at the correct diagnosis.

Jilaihawi H.,Cedars Sinai Heart Institute | Wu Y.,Chinese Academy of Sciences | Yang Y.,Chinese Academy of Sciences | Xu L.,National Center for Cardiovascular Diseases | And 11 more authors.
Catheterization and Cardiovascular Interventions | Year: 2015

Objectives We sought to describe the morphological characteristics of aortic valve disease in a Chinese population presenting for transcatheter aortic valve replacement (TAVR). Background Racial and regional differences are known to exist in aortic stenosis (AS), but limited data exist comparing the specific anatomical variations between populations. Methods Patients were prospectively evaluated in a Chinese population presenting for TAVR in the Venus A-Valve trial, the first trial evaluating TAVR in China. A systematic anatomical assessment protocol employed contrast-enhanced computed tomography (CT) in all the cases. Results A total of 120 consecutive patients were studied. Of these, 61 (50.7%) were patients with tricuspid, 57 (47.5%) bicuspid, and 2 (1.7%) unicuspid valve morphologies. Of the 57 cases with bicuspid valve, 31 (54.4%) had no raphe (Sievers classification, type 0) and 26 (45.6%) were of raphe type. Although the incidence of bicuspid valve morphology was more than a third in the northern Chinese population, this was lower than the eastern Chinese population (P = 0.035), in whom the incidence was more than half. A comparison of tricuspid morphologies in China versus a Western series of 229 consecutive patients undergoing TAVR assessed with CT showed a threefold excess of leaflet calcium burden in China, with a leaflet calcium volume of 421 mm3 (IQR, 188-688 mm3) versus 142 mm3 (IQR, 58-267 mm3). Conclusions Patients presenting for TAVR in China have a very high frequency of bicuspid valve morphology. Even in tricuspid disease, there are clear differences to Western patients, with a high calcium burden, which presents challenges for TAVR in this population (ClinicalTrials.gov NCT01683474). © 2015 Wiley Periodicals, Inc.

Li L.,Capital Medical University | Wang Z.-W.,National Center for Cardiovascular Disease | Li J.,Capital Medical University | Ge X.,Capital Medical University | And 5 more authors.
Europace | Year: 2014

Aims: An association between obstructive sleep apnoea (OSA) and atrial fibrillation (AF) has been established. However, studies on the role of OSA in AF recurrence after catheter ablation have yielded conflicting results, and the effect of OSA treatment by continuous positive airway pressure (CPAP) on the success rate of AF catheter ablation is indeterminate. The aim of this meta-analysis was to investigate the rate of AF recurrence after catheter ablation in patients with AF with or without OSA and to evaluate the relationship between CPAP therapy and AF recurrence. Methods and results: We performed an online search and identified five studies involving 3743 patients with AF. Patients with OSA had a 31% greater risk of AF recurrence after catheter ablation than did patients without OSA [relative ratio (RR) = 1.31, P = 0.00], and this risk increased by 57% in patients with OSA not undergoing CPAP therapy (RR = 1.57, P = 0.00). However, CPAP users had a risk of AF recurrence similar to that of patients without OSA (RR = 1.25, P = 0.37), and this similarity was maintained even after the removal of study heterogeneity (RR = 0.99, P = 0.39). Conclusion: Obstructive sleep apnoea was associated with AF recurrence after catheter ablation. The efficacy of catheter ablation for AF was similar between patients without OSA and patients with OSA undergoing CPAP treatment. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014.

Zhang H.,National Center for Cardiovascular Disease | Zhang H.,Chinese Academy of Sciences | Zhang H.,National Center for Cardiovascular Diseases | Gong D.-X.,National Center for Cardiovascular Disease | And 6 more authors.
European Heart Journal | Year: 2012

Aims About 40 of East Asians carry an aldehyde dehydrogenase-2 (*)2 (ALDH2 (*)2) allele, and the influence of the ALDH2 (*)2 allele on human cardioprotection has not been studied. This study was designed to evaluate the effect of ALDH2 (*)2 allele on cardioprotection of patients with congenital heart diseases after open-heart surgery.Methods and resultsThe right atrial appendage was harvested before performing cardiopulmonary bypass in cyanotic and acyanotic congenital heart disease groups (n 20 per group). Tissues were assayed to determine the impact of cyanosis on metabolic remodelling. A prospective cohort of Tetralogy of Fallot (TOF) patients (n 118) was recruited to investigate the influence of the ALDH2 (*)2 allele on cardioprotection after surgical repair. Myocardium samples were dissected after cardioplegia. ALDH2 activity, oxidative stress and glutathione (GSH) levels, and activating transcription factor-4 (ATF4) were analysed. After genotyping and grouping, all of the experimental and clinical results were compared between ALDH2 (*)2 carriers and non-carriers.Cyanosis inhibited ALDH2 activity and led to aldehyde accumulation in ALDH2 (*)2 carriers. This accumulation in turn increased expression of ATF4 and resulted in larger myocardium GSH pools. The differences in ALDH2 activity and GSH level between carriers and non-carriers disappeared during cardioplegic arrest, and more aldehydes accumulated in the non-carriers. Consequently, ALDH2 (*)2 carriers showed lower postoperative troponin I, inotrope score, and shorter postoperative length of ICU and hospital stay. Conclusions ALDH2 (*)2 carriers with cyanotic congenital heart disease were associated with an induced metabolic remodelling phenotype and a compensatory myocardium GSH pool. When ALDH2 activity was impaired during open-heart surgery, this larger GSH pool could lead to unexpectedly better cardioprotection. This may aid in the prediction of cardioprotection outcomes and identification of individualized cardioprotective strategies. © 2012 The Author.

Ritter P.,Bordeaux University Hospital Center | Duray G.Z.,Medical Center | Steinwender C.,Johannes Kepler University | Soejima K.,Kyorin University | And 16 more authors.
European Heart Journal | Year: 2015

Aims Permanent cardiac pacing is the only effective treatment for symptomatic bradycardia, but complications associated with conventional transvenous pacing systems are commonly related to the pacing lead and pocket. We describe the early performance of a novel self-contained miniaturized pacemaker. Methods and results Patients having Class I or II indication for VVI pacing underwent implantation of a Micra transcatheter pacing system, from the femoral vein and fixated in the right ventricle using four protractible nitinol tines. Prespecified objectives were >85% freedom from unanticipated serious adverse device events (safety) and <2 V 3-month mean pacing capture threshold at 0.24 ms pulse width (efficacy). Patients were implanted (n = 140) from 23 centres in 11 countries (61% male, age 77.0 ± 10.2 years) for atrioventricular block (66%) or sinus node dysfunction (29%) indications. During mean follow-up of 1.9 ± 1.8 months, the safety endpoint was met with no unanticipated serious adverse device events. Thirty adverse events related to the system or procedure occurred, mostly due to transient dysrhythmias or femoral access complications. One pericardial effusion without tamponade occurred after 18 device deployments. In 60 patients followed to 3 months, mean pacing threshold was 0.51 ± 0.22 V, and no threshold was ≥2 V, meeting the efficacy endpoint (P < 0.001). Average R-wave was 16.1 ± 5.2 mV and impedance was 650.7 ± 130 ohms. Conclusion Early assessment shows the transcatheter pacemaker can safely and effectively be applied. Long-term safety and benefit of the pacemaker will further be evaluated in the trial. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.

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