Qianjin Zhong

Strategy of Aortic Root Enlargement in Patients Undergoing Aortic and Mitral Valve Replacement

BACKGROUND This study was undertaken to evaluate the strategy and validity of aortic root enlargement in patients undergoing aortic and mitral valve replacement. METHODS Between January 1999 and December 2008, 78 consecutive patients aged 38.5 +/- 9.4 years underwent aortic root enlargement and double valve replacement at our hospital. The body surface area was 1.4 +/- 0.18 m(2), the aortic annulus diameter was 18.26 +/- 1.34 mm, the aortic orifice area was 0.83 +/- 0.43 cm(2), and the mean aortic transvalvular pressure gradient was 47.5 +/- 35.6 mm Hg. The aortic root enlargement was performed using a Dacron patch lined with autologous pericardium on the basis of either the Nuñez (n = 36) or Manouguian (n = 42) procedure depending on how narrow the aortic root was. RESULTS Mechanical prostheses were implanted in all patients. The mean size of the aortic and mitral valves were 20.5 mm and 25.9 mm, respectively. The postoperative mean indexed effective orifice areas of the aortic and mitral valves were 1.13 +/- 0.14 cm(2)/m(2) and 1.56 +/- 0.17 cm(2)/m(2) (p < 0.01 compared with those preoperatively), respectively. The postoperative mean aortic and mitral transvalvular pressure gradients were 10.7 +/- 2.3 mm Hg and 3.7 +/- 1.6 mm Hg (p < 0.01 compared with those preoperatively), respectively. There were no reoperations for bleeding and no heart block. Valve-related complications included thromboembolism, cerebral hemorrhage, perivalvular leakage, and reoperation. There were 2 deaths, 1 early and 1 late, and survival at 1, 5, and 10 years was 98.7%, 97.4%, and 97.4%, respectively. CONCLUSIONS Aortic root enlargement in patients undergoing double valve replacement can be performed safely to avoid postoperative aortic prosthesis-patient mismatch.

High basal level of autophagy in high-altitude residents attenuates myocardial ischemia-reperfusion injury.

OBJECTIVE Hypoxia can induce autophagy, which plays an important role in cardioprotection. The present study tested the hypothesis that patients with congenital heart disease living at a high altitude could resist ischemia-reperfusion injury better than those at a low altitude, through elevated basal autophagy by chronic hypoxia. METHODS Twelve Tibetan patients residing at a high altitude of >3000 m and 12 Han patients residing at a low altitude of <500 m with simple atrial or ventricular septal defects were prospectively recruited. All patients underwent cardiopulmonary bypass, maintaining a flow rate of approximately 2.4 to 2.8 L/min/m2 and mean arterial pressure of ≥40 to 60 mm Hg. Myocardial ischemia-reperfusion injury between the 2 groups was compared using cardiac troponin I, brain natriuretic peptide, hematoxylin eosin staining, and the terminal deoxynucleotidyl transferase dUTP nick end labeling test. Autophagy-related proteins microtubule-associated protein 1 light chain 3 II (LC3II), Beclin1, and lysosomal-associated membrane protein 2 (LAMP2) and their upstream protein BCL2/adenovirus E1B 19-kDa protein-interacting protein 3 (Bnip3) were evaluated with Western blotting. RESULTS The maximal cardiac troponin I concentration and increasing x-fold of brain natriuretic peptide in the high-altitude group were obviously lower than those in the low-altitude group (3.10±0.77 vs 7.10±2.28 ng/mL and 2.51±0.94 vs 14.66±6.83, respectively). The preoperative and postoperative levels of LC3II, LAMP2, and upstream Bnip3 in the high-altitude group were obviously greater. No difference was found in the Beclin1 level between the 2 groups at baseline or ischemia-reperfusion. CONCLUSIONS Patients living at a high altitude with congenital heart disease resisted ischemia-reperfusion injury during cardiac surgery better than those at a low altitude, possibly through elevated basal autophagy induced by chronic hypoxia.

Risk Factors for Acute Kidney Injury in Patients Undergoing Same Admission Coronary Angiography and Valve Replacement

We investigated risk factors for acute kidney injury (AKI) in patients undergoing same admission coronary angiography (CAG) and valve replacement.

Multiple Thrombosis Caused by Arrhythmogenic Right Ventricular Cardiomyopathy

A 68-year-old man was transferred emergently to our department because of multichamber intracardiac thrombosis. Enhanced computed tomography revealed multichamber thrombosis in the right atrial appendage, right ventricular outlet tract. and left atrial appendage, with localized aneurysm of a much enlarged right ventricle. He underwent thrombectomy and valve repair. Here we report a rare case of arrhythmogenic right ventricular cardiomyopathy with multichamber intracardiac thrombosis.

Results of comparing transthoracic device closure and surgical repair with right infra-axillary thoracotomy for perimembranous ventricular septal defects

OBJECTIVES Transthoracic device closure (TTDC) and surgical repair with right infra-axillary thoracotomy (SRRIAT) are two main alternative minimally invasive approaches for restrictive perimembranous ventricular septal defect (VSD); however, few studies have compared them with each other in terms of effectiveness and cost. METHODS Patients with perimembranous VSD undergoing TTDC or SRRIAT from January 2012 to July 2013 were reviewed in a comparative investigation between the two procedures. RESULTS Success from the procedures was achieved in 30 TTDC (30/33, 91%) and 96 SRRIAT patients (100%). Operation duration in the TTDC group was significantly shorter than that of the SRRIAT group (115.8 ± 43.8 vs 175.6 ± 41.3 min, P < 0.01). The total perioperative drainage, use of red blood cells, mechanical ventilation time, stay in the intensive care unit and hospital stay for the TTDC group were significantly less than those in the SRRIAT group. No deaths or complete atrioventricular block occurred in either group. One SRRIAT patient accepted a second surgery for residual shunt. TTDC costs slightly more than SRRIAT (40270.6 ± 2741.3 renmingbi [RMB] vs 32964.5 ± 8221.6 RMB, P < 0.01). CONCLUSIONS Both TTDC and SRRIAT showed excellent outcomes and cosmetic appearance for suitable VSD candidates. Although its costs were higher, TTDC had the advantages over SRRIAT of a short operation duration and intensive care unit stay and fewer days in the hospital.

Anti-inflammatory effect of erythropoietin pretreatment on cardiomyocytes with hypoxia/reoxygenation injury and the possible mechanism.

OBJECTIVE To investigate the anti-inflammatory effect of erythropoietin (EPO) pretreatment on cardiomyocytes exposed to hypoxia/reoxygenation injury (H/R) and explore the possible mechanism. METHODS The cultured neonatal rats?ventricular cardiomyocytes were divided randomly into 4 groups, control group (C group), EPO pretreatment group (E group), EPO and pyrrolidine dithiocarbamate (PDTC) pretreatment group (EP group) and PDTC pretreatment group (P group). After 24 hours?pretreatment, the cardiomyocytes were exposed to H/R. After pretreatment and H/R, the expression of tumor necrosis factor-alpha(TNF-alpha) gene in all the groups was detected by RT-PCR and Western blot. The nuclear factor-kappa B (NF-kappa B) activity was detected by electrophoretic mobility shift assay (EMSA) and the inhibitor-kappa B alpha (I-kappa B alpha) protein level was detected by Western blot. RESULTS The decrement of I-kappa B alpha protein and the increasing NF-kappa B activity were found in cardiomyocytes pretreated with EPO before H/R compared to other groups (t equal to 3.321, 4.183, P less than 0.01). However, after H/R, NF-kappa B activity and expression of TNF-alphagene were significantly reduced, I-kappa B alpha protein expression was increased in cardiomyocytes of E group compared to other groups (t=3.425, 3.687, 3.454, P less than 0.01). All theses changes caused by EPO pretreatment were eliminated by the intervention of PDTC (an antagonist to NF-kappa B) during pretreatment. CONCLUSIONS EPO pretreatment can inhibit the activation of NF-kappa B and upregulation of TNF-alpha gene in cardiomyocytes exposed to H/R through a negative feedback of NF-kappa B signaling pathway, and thus produces the anti-inflammatory effect. This might be one of the ways EPO produces the anti-inflammatory effect.

High Takeoff of the Right Coronary Artery Associated with Ventricular Septal Defect, Right Aortic Arch, and Bridging Bronchus

We report a case of a 14‐year‐old female with abnormally high takeoff of the right coronary artery (RCA) that was associated with a ventricular septal defect, right aortic arch, and bridging bronchus. During surgery, an exceptionally high takeoff of the RCA was discovered. Postoperative computed tomography confirmed the presence of the associated right aortic arch with anomalous branching pattern, and bridging bronchus. doi: 10.1111/jocs.12379 (J Card Surg 2014;29:829–831)

Mechanism of genistein regulating the differentiation of vascular smooth muscle cells into osteoblasts via the OPG/RANKL pathway

Objective The present study aimed to investigate the mechanism of genistein, a tyrosine kinase inhibitor, regulating the differentiation of vascular smooth muscle cells (VSMCs) into osteoblasts via the OPG/RANKL (Osteoprotegerin/Receptor Activator of Nuclear Factor-κB Ligand) pathway. Methods The mouse VSMCs were isolated, purified and cultured. We constructed the LV5-Tnfrsf11b overexpression lentiviral vector and LV3-OPG-309 interference lentiviral vector. The OPG overexpression was induced and the growth of VSMCs infected with the lentiviral vector was observed. The VSMC calcification and control group were treated with different doses of genistein. The mRNA and protein expression levels of OPG, α-SM-actin (smooth muscle actin), ALP (alkaline phosphatase) and OPN (osteopontin) were detected in VSMCs after treatment using RT-PCR and Western Blot. Result We induced OPG overexpression and performed lentiviral vector infection of the VSMCs to suppress OPG expression, respectively, which was followed by treatment with genistein. The results showed that the relative expression of OPG was the highest in the VSMC calcification +genistein +OPG overexpression-inducing treatment group. It was the lowest in the VSMC calcification +OPG expression-suppressing treatment group. The relative expression of ALP was the highest in the VSMC calcification +OPG expression-suppressing treatment group, and the lowest in the VSMCs+genistein treatment group. Conclusion OPG gene plays an important regulatory role in the growth of VSMCs, by suppressing the calcification of VSMCs. Genistein could regulate the differentiation of VSMCs into osteoblasts via the OPG/RANKL pathway in a dose-dependent manner.