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PubMed | Sun Yat Sen University and Shanghai Institute of Cardiovascular Diseases
Type: Journal Article | Journal: Echocardiography (Mount Kisco, N.Y.) | Year: 2016

To evaluate right ventricular (RV) global and regional systolic function in patients with atrial septal defect (ASD) before and after percutaneous closure using real time three-dimensional echocardiography (RT3DE).RT3DE was performed in 81 patients with ASD within 24 hours before and after percutaneous closure to obtain RV global and regional ejection fraction (EF) in three compartments (inflow, body, and outflow). RV fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), peak tricuspid systolic velocity (S), and pulmonary vascular resistance (PVR) were recorded. Forty matched normal adults were included as controls.When compared with controls, RV global and regional EF were decreased in preclosure patients (P < 0.001). FAC was lower while TAPSE and S were higher in preclosure patients than in controls (P < 0.05). After closure, RV systolic function parameters were all reduced (P < 0.001). Regional EF in the body compartment was the lowest among the three compartments in ASD patients (P < 0.05). Procedural percentage changes of RV global EF and regional EF in the inflow compartment were lower than those of two-dimensional systolic function parameters (P < 0.05). RV global and regional EF in the inflow compartment were negatively correlated with PVR in patients after closure (r = -0.601, -0.543, P < 0.001).RV global and regional systolic functions are impaired in open and closed ASD. RT3DE-derived systolic function parameters are negatively correlated with RV after load. RT3DE has potential value in the evaluation of RV systolic function in patients with ASD.


Li C.G.,Shanghai Institute of Cardiovascular Diseases
Zhonghua xin xue guan bing za zhi | Year: 2011

To evaluate the in-hospital outcome and determinants relating to success rate of percutaneous coronary intervention (PCI) for patients with chronic total occlusion (CTO) using contemporary techniques. A total of 1485 patients with total occluded coronary artery were identified from January 2004 to December 2008 in Zhongshan hospital. Of them, 638 patients were affirmed as CTO and 447 patients underwent PCI. The clinical data and the in-hospital outcome of patients underwent PCI were retrospectively analyzed. Procedure success was achieved in 382 patients (85.5%). Coronary perforation (C-F type dissection or coronary perforation) occurred in 27 patients (6.0%), cardiac tamponade developed in 6 out of the 27 patients, 2 patients (0.4%) received in-hospital repeat revascularization. Two patients (0.4%) died post PCI: one died of acute stent thrombosis and the other one died of refractory heart and respiratory failure.Compared with patients of successful recanalization, patients failure to recanalization were more aged [(62.9 ± 10.4)years vs. (65.9 ± 9.9) years, P < 0.05] and excessive tortuosity (16.2% vs. 38.5%, P < 0.01), absence stump (47.1% vs. 80.0%, P < 0.01) and excessive calcification (36.9% vs. 72.3%, P < 0.01) were more common. Multiple logistic regression analysis revealed that excessive calcification (OR: 3.866, P < 0.01), absence stump (OR: 3.346, P < 0.05) and excessive tortuosity (OR: 3.055, P < 0.01) were independent predictors for the procedural failure. PCI for patients with CTO is safe and effective. Apart from progress on the equipment development, procedural success rates are closely related with the clinical and angiographic features of CTO.


Zhao D.,Fudan University | Wang C.,Fudan University | Hong T.,Fudan University | Pan C.,Shanghai Institute of Cardiovascular Diseases | Guo C.,Fudan University
Journal of Cardiothoracic Surgery | Year: 2012

Background: Aortic valve replacement (AVR) with a small aortic annulus is always challenging for the cardiac surgeon. In this study, we sought to evaluate the midterm performance of implantation with a 17-mm or 19-mm St. Jude Medical Regent (SJM Regent) mechanical valve in retrospective consecutive cohort of patients with small aortic annulus (diameter ≤ 19 mm).Methods: From January 2008 to April 2011, 40 patients (31 female, mean age = 47.2 ± 5.8 years) with small aortic annulus (≤19 mm in diameter) underwent aortic valve replacement with a 17-mm or 19-mm St. Jude Medical Regent (SJM Regent) mechanical valve. Preoperative mean body surface area, New York Heart Association class, and mean aortic annulus were 1.61 ± 0.26 m 2, 3.2 ± 0.4, and 18 ± 1.4 mm respectively. Patients were divided into two groups, according to the implantation of 17 mm SJM Regent mechanical valve (group 1, n = 18) or 19 mm SJM Regent valve (group 2, n = 22). All patients underwent echocardiography examination preoperatively and at one year post-operation.Results: There were no early deaths in either group. Follow-up time averaged 36 ± 17.6 months. The mean postoperative New York Heart Association class was 1.3 ± 0.6 (p < 0.001). By echocardiography, in group 1, the left ventricular ejection fraction (LVEF), left ventricular fraction shortening (LVFS), and the indexed effective orifice area (EOAI) increased from 43.7% ± 11.6%, 27.3% ± 7.6%, and 0.70 ± 0.06 cm 2/m 2 to 69.8 ± 9.3%, 41.4 ± 8.3%, and 0.92 ± 0.10 cm 2/m 2 respectively (P < 0.05), while the left ventricular mass index (LVMI), and the aortic transvalvular pressure gradient decreased from 116.4 ± 25.4 g/m 2, 46.1 ± 8.5 mmHg to 86.7 ± 18.2 g/m 2 , 13.7 ± 5.2 mmHg respectively. In group 2, the LVEF, LVFS and EOAI increased from 45.9% ± 9.7%, 30.7% ± 8.0%, and 0.81 ± 0.09 cm 2/m 2 to 77.4% ± 9.7%, 44.5% ± 9.6%, and 1.27 ± 0.11 cm 2/m 2 respectively, while the LVMI, and the aortic transvalvular pressure gradient decreased from 118.3 ± 27.6 g/m 2, 44.0 ± 6.7 mmHg to 80.1 ± 19.7 g/m 2, 10.8 ± 4.1 mmHg as well. The prevalence of PPM was documented in 2 patients in Group 1.Conclusions: Patients with small aortic annulus and body surface area, experienced satisfactory clinical improvement after aortic valve replacement with modern SJM Regent bileaflet prostheses. © 2012 Zhao et al.; licensee BioMed Central Ltd.


Sun S.-N.,Fudan University | Sun S.-N.,Central Hospital of Minhang District | Yao Z.-Z.,Central Hospital of Minhang District | Jiang Q.,Shanghai Institute of Cardiovascular Diseases | Gui Y.-H.,Fudan University
Fudan University Journal of Medical Sciences | Year: 2016

Objective: To observe ethanol-induced cardiac phenotypes and identify ethanol-sensitive stages during embryonic development, and to explore the optimal period during which the administration of folic acid can effectively rescue the ethanol-induced heart and outflow tract (OFT) defects and its underlying mechanisms. Methods: Ethanol was administrated to zebrafish embryos in a series of developmental stages (7-12 h) and the abnormal heart and OFT phenotypes were observed after ethanol exposure. The embryos which were given ethanol at 7-12 hpf was defined as ethanol treated group. Administrating folic acid to ethanol-treated zebrafish embryos in different stages (7-12 h) was conducted to rescue the abnormal cardiac defects. The ethanol-treated embryos which were given folic acid at 7-12 hpf was defined as folic acid rescue group. The survival percentage, the malformation percentage, the heart rate and the ventricular shortening fraction (VSF) were recorded. The OFT phenotypes were evaluated using fluorescein micro-angiography. Whole-mount in situ hybridization and Real-time PCR were conducted to analyze the expression of bmp2b and tbx1. Results: Ethanol exposure produced heart and OFT defects, including the abnormal cardiac shapes, the hypogenesis of OFT and the reduced heart rate and VSF. The teratogenic effect of ethanol was observed most obviously at the early embryonic development. Supplementation of folic acid at 7-12 hours post-fertilization partially rescued the developmental defects in ethanol-induced zebrafish embryos. The expressions of bmp2b and tbx1 were reduced in ethanol-treated group, and they were partially recovered after administration of folic acid. Conclusions: Folic acid supplementation can effectively rescue ethanol-induced heart OFT defects, possibly by enhancing the expressions of bmp2b and tbx1. © 2016, Editorial Department of Fudan University Journal of Medical Sciences. All right reserved.


Wang Y.,Fudan University | Wang Y.,Shanghai Institute of Cardiovascular Diseases | Gong X.,Fudan University | Gong X.,Shanghai Institute of Cardiovascular Diseases | And 6 more authors.
Physiological Research | Year: 2011

The objective of this study was to find out the implication of QRS duration in dogs with rapid pacing-induced heart failure. Sixteen Beagle dogs were implanted with transvenous cardiac pacemakers and underwent rapid right ventricular pacing for 3 weeks at 260 bpm to induce heart failure. Dogs were divided into two groups according to the QRS duration: 9 with normal QRS duration (<100 ms) and 7 with prolonged QRS duration (≥100 ms). Cardiac systolic function and size was analyzed by real time 3-dimensional echocardiography and left ventricular dyssynchrony was assessed by speckle tracking strain imaging. Congestive heart failure developed 3 weeks after rapid right ventricular pacing. Dogs with prolonged QRS duration showed more extensive radial strain and circumferential strain dyssynchrony than dogs with normal QRS duration. At the end of 4-week recovery, greater improvement of left ventricular ejection fraction and left ventricular end-systolic volume was detected in dogs with normal QRS duration. The findings suggested that left ventricular dyssynchrony, indicated by a prolonged QRS duration, predicted an unsatisfying recovery in dogs with rapid pacinginduced heart failure. QRS duration had the potential to be a prognostic indicator for dogs with heart failure. © 2011 Institute of Physiology.


Guo C.,Fudan University | Guo C.,Shanghai Institute of Cardiovascular Diseases | Zhu K.,Fudan University | Zhu K.,Shanghai Institute of Cardiovascular Diseases | And 4 more authors.
Journal of Cardiothoracic Surgery | Year: 2013

A 57-year-old Chinese male patient presented with Standford type A aortic dissection with an aberrant right subclavian artery (ARSA). At operation, the ascending aorta was replaced by a mono-branch vascular prosthesis with the branch bypassing to the ARSA; the triple-branched stent graft was inserted into the true lumen of the arch and proximal descending aorta (covering the origin of the ARSA) with each sidearm graft being positioned into the aortic branches; and then its proximal end was sutured to mono-branched vascular prosthesis. Follow-up computed tomography angiography showed false lumen of the dissection disappeared with satisfactory position of the triple-branched stent graft. © 2013 Guo et al.; licensee BioMed Central Ltd.


Zhao D.,Fudan University | Zhao D.,Shanghai Institute of Cardiovascular Diseases | Wang C.-S.,Fudan University | Wang C.-S.,Shanghai Institute of Cardiovascular Diseases | And 4 more authors.
Experimental and Clinical Cardiology | Year: 2014

Aim: To evaluate the effectiveness and safety of recombinat human B-type natriuretic peptide (rhBNP) in patients undergoing cardiac surgery. Methods: This was a retrospective case-control study conducted between April 2011 and October 2013. Patients who received rhBNP after surgery were included in the rhBNP group; those who received nitroglycerin (NIT) were included in the control group. Intra- and inter-group comparisons were made for perioperative mortality, hemodynamic function evaluated by Doppler echocardiography, plasma N-terminal brain natriuretic peptide precursor (NT-proBNP), cardiac troponin T (cTnT), and creatine kinase MB (CK-MB) levels as well as adverse events. Results: Overall, 166 patients (83/group), aged 38 to 76 years, were evaluated. The perioperative mortality was 2.4% in the rhBNP group and 3.6% in the NIT group (p=0.68). There were significant pre- to post-treatment changes in hemodynamic function including left ventricular ejection fraction (LVEF), left ventricular shortening fraction (FS), cardiac index (CI) and plasma NT-proBNP, cTnT and CK-MB in both groups, and significant betweengroup differences in favor of the rhBNP group. No serious drug-related adverse events occurred in either group. Conclusion: Compared with NIT, rhBNP may improve hemodynamic function in patients undergoing cardiac surgery with no serious drug-related side effects. A randomized controlled trial with long-term follow-up is required to confirm these findings.


Ma J.,Fudan University | Ma J.,Shanghai Institute of Cardiovascular Diseases | Qian J.,Fudan University | Qian J.,Shanghai Institute of Cardiovascular Diseases | And 10 more authors.
European Journal of Medical Research | Year: 2014

Background: The objective of this study was to evaluate changes in left ventricular ejection fraction (LVEF) and left ventricular remodeling after coronary microembolization (CME) and to investigate the protective effects of methylprednisolone (MTP). Methods. CME was induced by injection of microspheres (42 μm Dynospheres) into left anterior descending artery of mini swine. The animals were divided into two groups. Group 1 (n = 9) received 120,000 microspheres and Group 2 (n = 7) received 120,000 microspheres following intravenous administration of 30 mg/kg MTP. Contrast-enhanced magnetic resonance imaging (CeMRI) was performed at baseline, 6 h after intervention, and 1 week later. Results: In Group 1, LVEF was significantly decreased at 6 h but recovered 1 week. This was accompanied by continuing left ventricular remodeling. In Group 2, LVEF remained unchanged at all assessment times. LVEF measured at 6 h and 1 week after CME in Group 1 and Group 2 was 0.39 ± 0.06 and 0.44 ± 0.04, and 0.44 ± 0.04 and 0.48 ± 0.03, respectively (Both P >0.05). Hyperenchancement at the anterior wall of the left ventricle was shown by MRI at 6 h in Group 1 but not in Group 2. The hyperenhanced area in Group 1 was 7.77 ± 1.49% of left ventricular mass. Conclusions: The consequence of CME is left ventricular dilation with preserved LVEF. Pretreatment with MTP appears to have a cardioprotective effect on left ventricular remodeling. © 2014 Ma et al.; licensee BioMed Central Ltd.


PubMed | Shanghai Institute of Cardiovascular Diseases
Type: Journal Article | Journal: Zhonghua xin xue guan bing za zhi | Year: 2012

To determine the expression of TREM-1 (triggering receptor expressed on myeloid cells-1) in macrophages after coxsackievirus B3 (CVB3) infection and the cardiomyocytes viability after culturing with supernatant of macrophages in the absence and presence of TREM-1 inhibitor LP-17 to explore if TREM-1 is involved in the pathogenesis of CVB3 infection induced inflammation and cardiomyocytes injury.TREM-1 mRNA and TREM-1 and DAP-12 protein expression in macrophages were detected by Real-time PCR at 0, 1, 4, 8 and 12 h and by Western blot at 0, 16, 24 and 48 h post CVB3 infection. TNF- secretion of macrophages was measure by ELISA, vitality and the apoptosis degree of cardiomyocytes was assessed by CCK8 and Annexin V-FITC after the cardiomyocytes were cultured with the supernatant of macrophages in normal control group, CVB3 infection group and LP-17 pretreated CVB3 infection group.TREM-1 mRNA expression was significantly upregulated at 4, 8, and 12 h (peaked at 8 h) and TREM-1 protein expression was significantly upregulated at 16 and 24 h and returned to baseline level at 48 h after CVB3 infection. The protein expression of DAP-12, a direct downstream signaling molecule of TREM-1, also significantly increased at 24 and 48 h post CVB3 infection (P < 0.01). Level of macrophages secreted TNF- post CVB3 infection was significantly reduced in LP-17 pretreated cells (P < 0.01), LP-17 pretreatment also significantly improved viability and significantly reduced apoptosis of cardiomyocytes cultured with supernatant of CVB3 infected macrophages (P < 0.01).TREM-1 might be an important mediator post CVB3 infection and a major player on inducing excess macrophages-related inflammation and resulting in an indirect injury to cardiomyocytes.


PubMed | Shanghai Institute of Cardiovascular Diseases
Type: Journal Article | Journal: Zhonghua xin xue guan bing za zhi | Year: 2011

To evaluate the in-hospital outcome and determinants relating to success rate of percutaneous coronary intervention (PCI) for patients with chronic total occlusion (CTO) using contemporary techniques.A total of 1485 patients with total occluded coronary artery were identified from January 2004 to December 2008 in Zhongshan hospital. Of them, 638 patients were affirmed as CTO and 447 patients underwent PCI. The clinical data and the in-hospital outcome of patients underwent PCI were retrospectively analyzed.Procedure success was achieved in 382 patients (85.5%). Coronary perforation (C-F type dissection or coronary perforation) occurred in 27 patients (6.0%), cardiac tamponade developed in 6 out of the 27 patients, 2 patients (0.4%) received in-hospital repeat revascularization. Two patients (0.4%) died post PCI: one died of acute stent thrombosis and the other one died of refractory heart and respiratory failure.Compared with patients of successful recanalization, patients failure to recanalization were more aged [(62.9 10.4)years vs. (65.9 9.9) years, P < 0.05] and excessive tortuosity (16.2% vs. 38.5%, P < 0.01), absence stump (47.1% vs. 80.0%, P < 0.01) and excessive calcification (36.9% vs. 72.3%, P < 0.01) were more common. Multiple logistic regression analysis revealed that excessive calcification (OR: 3.866, P < 0.01), absence stump (OR: 3.346, P < 0.05) and excessive tortuosity (OR: 3.055, P < 0.01) were independent predictors for the procedural failure.PCI for patients with CTO is safe and effective. Apart from progress on the equipment development, procedural success rates are closely related with the clinical and angiographic features of CTO.

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