Zhang Po

ASSA14-03-37 Study of effects of simvastatin on proliferation, migration and adhension of rat smooth muscle progenitor cells

Background To investigate the effects of simvastatin on differentiation and proliferation of rat smooth muscle progenitor cells (SPCs) and identification of compounds that inhibit SPCs differentiation and proliferation for substantial clinical usefulness. Methods Total mononuclear cells (MNCs) were isolated from marrow of rats by Ficoll density gradient centrifugation method, and then plated on fibronectin-coated culture dishes. Fresh isolated MNCs were treated with simvastatin (0.01∼10 μmol/l) or vehicle control for 8 d. SPCs were characterised as adherent cells positive for α-SMA by indirect immunofluorescent staining. After 8 days cultured, attached cells were treated with simvastatin (0.01∼10 μmol/l) or vehicle control for 24 h. The proliferation and migration of SPCs were assayed with 3H-TdR incorporation and modified Boyden chamber assay respectively. SPCs adhesion assay was performed by replating those on fibronectin-coated dishes and counting the adherent cells. Results Simvastatin potently inhibited SPCs outgrowth. The number of SPCs at 8 days was dramatically decreased by simvatatin. At a concentration as low as 0.01 μmol/l, simvastatin significantly reduced 7.5 ± 5.4% of SPCs (0.01 μmol/l simvastatin vs control: 79 ± 5 vs 85 ± 4, n = 5, p < 0.05). Simvastatin also inhibited SPCs proliferation in a dose-dependent manner, simvastatin significantly reduced 5.8 ± 3.1% of SPCs at a concentration as low as 0.01 μmol/l for 24 h (0.01 μmol/l simvastatin vs control: 3833 ± 126 vs 4070 ± 184, n = 5, p < 0.05). In addition, sirolims also inhibited SPCs migratory and adhesive capacity in a concentration-dependent manner. Conclusion Simvastatin could inhibit the differentiation, proliferation and migration of rat smooth muscle progenitor cells.

ASSA14-14-08 Relationship of secundum atrial seplal defect with pulmonary arterial pressure in children less than 5 years old

Background Objective of this study to discover the relationship between secondary atrial septal defect (ASD) and pulmonary arterial pressure (PAP) in children less than 5 years old. Methods Patients whose ages were less than 5 years old were admitted and underwent percutaneous occlusion of ASD with occluder in general anaesthesia with ketamine in General Hospital of Shenyang Military Command from April, 2000 to January, 2011. The patients were divided into different groups according to size of the ASD and PAH. Results 189 patients were concluded, male was 77 cases (40.7 per cent), female was 112 (59.3 per cent), ratio was 1:1.5, mean ages were 4.1 ± 0.9 years old (range from 2 to 5 years), mean weights were 17.2 ± 3.6 kilograms (range from 10.0 to 30.0 kg), mean highs were 104.9 ± 9.2 cm (range from 77 to 135 cm), mean body surface areas (BSA) were 0.71 ± 0.10 m2 (range from 0.46 to 1.02 m2), mean sizes of ASD were 12.6 ± 4.8 mm (range from 5 to 29 mm), mean sizes of ASD modified by BSA were 18.0 ± 7.0 mm/ m2 (range from 5.3 to 38.9 mm/ m2). Mean systolic PAPs were 41.1 ± 8.9 mmHg (range from 15 to 67 mmHg), mean diastolic PAPs were 16.8 ± 6.5 mmHg (range from 3 to 45 mmHg), mean PAPs were 24.9 ± 6.7 mmHg (range from 12 to 48 mmHg). 159 patients (89.4%) had pulmonary arterial hypertension measured by right heart catheterization (RHC), but no patient had PAH by echocardiography. PAPs had no difference in different size ASDs (p >0.05). Conclusions There was no relationship between the sizes of ASD and PAP in children less than 5 years old. PAH maybe been not caused by shunts through ASD.

GW24-e2160 Clinical feature of cor triatriatum in 23 cases

Objectives To summarise the data of clinical feature, accompanied abnormities and imaging diagnosis of cor triatriatum in 23 cases enlisted in the study. Methods From January 1993 to June 2005, twenty-three patients, 13 males and 10 females with a mean age of (9.6 ± 10.0) years (range 0.3 from 38 years) were studied. All cases were cor triatriatum laevus. Twenty-one of 23 patients were identified in surgery. Complete cor triatriatum in 15 case and incomplete cor triatriatum in 6. Electrocardiogram show that right unsymmetrical cardial axle was in 18 patients and nomal cardial axle in 4. Eight cases had lung congestion in x-ray. Results Echocardiogram diagnosed 12 in 23 cases before surgery. Heart catheter exam diagnosed 4 in 10 cases. sixteen of 21 cases accompanied other abnormities. Main malformations included atrial septal defeat (n = 14), partial anomalous pulmonary venous drainage (n = 6), pulmonary stenosis (n = 3), persistent left superior vena cava (n = 3). Seven of 21 patients had no atrial septal defeat. Conclusions Cor triatriatum had great variation in clinical feature and complicated other malformations in high ratio. Color doppler imaging has high worthiness of diagnosis of cor triatriatum, but misdiagnosis and missed diagnosis rate is high in cor triatriatum accompanied other malformations. Heart catheter exam have missed diagnosis to cor triatriatum, but have higher diagnosis rate to accompanied abnormities. Surgical exploration is very important in cor triatriatum accompanied other malformations.

GW24-e2161 Expressions of endothelin-1 in primary cultured atrial myocytes after rapid electrical-field stimulation

Objectives To study the expressions of endothelin-1 at early stages of atrial fibrillation in a rapid paced primary cultured atrial myocyte model. Methods Primary rat atrial myocytes were cultured and a rapid paced cell model was established. The polymerase chain reaction (RT-PCR) and Enzyme-Linked Immunosorbent Assay (ELISA) were applied to detect the messenger ribonucleic acid (mRNA) expression and secretion of endothelin-1. Results mRNA expression of endothelin-1 increased after 6 h of rapid pacing and continued to elevate in a time dependent manner. Similarly, changes of endothelin-1 secretion were paralleled. Conclusions Expressions of endothelin-1 increased in early phase of rapid paced atrial myocytes. It implicated the endothelin-1 was implicated in pathological remodelling of atrial fibrillation.

ASSA14-14-05 Initial experience of occluding special type patent ductus arterioses using the Amplatzer vascular plug I

Objectives Occluders licensed for clinical use are not fit for some special Krichenko E patent ductus arterioses (PDA). The Amplatzer vascular plug (Plug) has not been licensed for use for closure of PDA. We report our initial experience to occluding special type PDA with the Plug. Methods Patients referred with small and long Krichenko E PDA 1–3 mm in diameter underwent occlusion using this Plug I, this is a single lobe device of single layer Nitinol mesh for short vessel landing zones. All cases underwent pre-, intra- and post-procedural echocardiography at the completion of the procedure the next day and at a 30-day follow-up visit. Device sizing for device waist diameter and length was based on aortography. Results 26 patients with a median age of 5 years (range 6 months – 32 years) and a median weight of 19 kg (range 7–67 kg) underwent successful PDA closure. The median ductus diameter was 2.2 mm (range 1–3 mm). Both transpulmonary (22/26) and transaortic approaches (4/26) were used. No persistent patency was observed after 24 hours and one month. Conclusions The Plug I Makes it easy to close some Krichenko E PDAs. Smaller delivery catherter profile and symmetric cylindrical device shape allow for use for small and long Krichenko E PDA 1-3 mm in diameter and small patients through transaortic approaches. Broader experience is required to further delineate device and patient selection as well as to document its long-term efficacy and safety.

ASSA13-17-8 Interventional Therapy of Combined Congenital Heart Disease

Objective To evaluate the interventional therapeutic strategy and effect of one-stage interventional therapy of 109 patients’ with combined congenital heart idsease. Methods From June 2000 to October 2012, 109 cases with combined congenital heart disease underwent one-stage interventional therapy. There are 38 males and 71 females ranging from 1 to 56 years old (13.8 +/- 14.6). All patients had been diagnosed by X-ray, ECG, echocardiogram, right heart catheterization and cardiac angiography before the interventional therapy. There were 12 cases with Atrial septal defect (ASD) and patent ductus arteriosus (PDA), 39 cases with ASD and pulmonary valvular stenosis (PS), 25 cases with ASD and ventricular septal defect, 1 case with ASD and mitral valve stenosis (MS), 23 cases with VSD and PDA, 8 cases with PDA and PS, 1 case with ASD and PDA and PS. The interventional therapeutic sequence was percutaneous balloon pulmonary valvuloplasty (PBPV) or percutaneous balloon mitral valvuloplasty, VSD closure, PDA closure, ASD closure in turn. And to evaluate the therapeutic effect by echocardiogram, cardiac angiography or cardiac chamber piezometry after procedure immediately. All patients were enforced X-ray, ECG, echocardiogram on 2d, 1, 3 and 6 months after operation for the follow-up. Results All patients were treated successfully. No complications occurred during the procedure. No residual shunt and dislocation of the devices were found. In the patients with PS, the systolic gradient pressure across the pulmonary valve decreased meet a criterion after operation. In 1 case with ASD and mitral valve, the mitral valve orifice areas increased markably after procedure. During the period of follow-up, the enlarged chambers heart were diminished progressively and all the occluders fixed wel1, X-ray examination showed that pulmonary vascularity diminished significantly, and there was no severe complication in all patients by echocardiogram. Conclusions Though the operation is more difficult and the interventional technic is more skillful, but multiple transcatheter interventions in the same session are feasible, safe and effective with satisfactory good results. However, a satisfactory result can be obtained from suitable indications by TTE before operation, proper algorithm of procedures and standardised manipulations.

ASSA13-17-1 Clinical Analysis of Treatment For 1149 Cases of Membranous Ventricular Septal Defect by Interventional Therapy in Children

Objective To assess the characteristics and clinical experience of treatment for paediatric ventricular septal defect by interventional therapy. Methods We collected 1149 children with VSD who received interventional therapy from 2001 June to 2012 February. There were 578 males and 571 females, age 2.5–16 (6.8 ± 3.1) years old and weight 8–54 (24.7 ± 10.6) kg. III-IVsystolic regurgitant murmur could be heard at left sternal border between 3–4 intercostal space, pulmonic second sound enhanced or split. UCG showed the diameter of VSD was 2–8 (4.3 ± 1.1) mm. Left ventricular angiography showed the left ventricular surface is 4 ∼ 20 (6.38 ± 3.17) mm, right ventricular surface is 3 ∼ 10 (3.81 ± 1.75) mm and the distance from upper VSD margin to aortic valve is 0 ∼ 6 (2.67 ± 1.61) mm. 464 patients combined with membranous ventricular septal aneurysm, 15 patients combined with patent ductus arteriosus, 16 patients combined with atrial septal defect and 4 patients combined with muscular VSD. Results The closure was successful conducted in 1125 patients and the success rate was 98.2%. The diameters of occluder were 4–16 (7.56 ± 2.12) mm. The patients who combined with PDA or ASD, VSD was firsted closed and then PDA or ASD. The patients combined with muscular VSD received occlusion simultaneously. 1061 patients (94.3%) had no shunt instantly, 38 patients (3.4%) had a small shunt and 26 patients (2.3%) had a trace of shunt. 1 cases of postoperative occluder shedding and the occluder was removed and patient received surgical repair of ventricular septal defect. 11 cases of postoperative III degree AVB, 1 patient underwent surgical operation and the rest recovered. 1 patient had III degree AVB 3 years after the occlusion and returned to normal after treatment. 75 cases of complete left bundle branch block, 3 patients did not recovered in the follow up and the rest became normal or not complete left bundle branch block. 1 cases of postoperative hematuria and the symptom disappeared after treatment. Conclusions Strictly indications, standardised operation, proficient skill are the keys to reduce complications and improve the success rate in interventional therapy of VSD. Occlusion of paediatric membrane VSD is a safe, reliable, effective treatment. But its long-term efficacy still need long-term follow-up.

ASSA14-14-07 Expressions of endothelin-converting enzyme in primary cultured atrial myocytes after rapid electrical-field stimulation

Background To study the expressions of endothelin-converting enzyme (ECE2) at early stages of atrial fibrillation in a rapid paced primary cultured atrial myocyte model. Methods Primary rat atrial myocytes were cultured and a rapid paced cell model was established. The atrial cells were divided into five groups with pacing durations within 0 to 24 h. The polymerase chain reaction (RT-PCR) and Western blot (WB) were applied to detect the messenger ribonucleic acid (mRNA) and proteins expression of ECE2. Results mRNA expression of ECE2 increased after 3 h of rapid pacing and continued to elevate in a time dependent manner. Similarly, changes of ECE2 protein were paralleled with mRNA expression. Conclusion Expressions of ECE2 increased in early phase of rapid paced atrial myocytes. It implicated the ECE2 and endothlin-1 was implicated in pathological remodelling of atrial fibrillation.

ASSA13-17-6 The Usefullness of Echocardiogram in Predicting Post-Procedural Pulmonary Artery Pressure in Patients with Patent Ductus Arteriosus and Severe Pulmonary Arterial Hypertension

Background Patent ductus arteriosus (PDA) is one of the commonest congenital heart defects which are prone to be complicated with pulmonary arterial hypertension (PAH). Objective The present study aims to assess the usefullness of echocardiogram in predicting post-procedural pulmonary artery pressure after transcatheter closure of PDA with severe PAH. Methods A cohort of patients with PDA and severe PAH undergoing transcatheter closure of PDA were included in this study. Patients with isolated PDA, cardiac function ≤NYHA class II, systolic pulmonary arterial pressure (sPAP) ≥70mmHg and pulmonary capillary wedge pressure ≤15mmHg and those who underwent cardiac catheterization under local anaesthesia were included in this study. After PDA was completely closed, pulmonary arterial pressure and aortic pressure were re-measured. According to post-closure sPAP, patients were divided into three groups: patients with sPAP<40mmHg (group A), from 40 to 70mmHg (group B) and > 70 mmHg (group C) after PDA closure. Differences in baseline parameters of echocardiogram and the correlations between these parameters and the decrease (%) in mean PAP were analysed. Results A total of 63 patients (49 females) aged from 10 to 60 years were recruited into this study. There was no significant differences in the age (P > 0.05) and the size of PDA (P > 0.05) between groups. The left atrium diameter indexes (35.96 ± 6.60 vs 31.17 ± 6.85 vs 22.24 ± 3.47 mm/m²; P < 0.05) and the left ventricular end diastolic volume indexes (279.45 ± 89.42 vs 162.88 ± 54.13 vs 60.94 ± 9.87 ml/m²; P < 0.05) decreased significantly from group A to group C. The left ventricular diameter/right ventricular diameter ratio in group C (1.86 ± 0.38) was less than that in group A (4.29 ± 1.85; P < 0.05) and group B (3.18 ± 1.21; P < 0.05) but had no significant difference between group A and group B. Linear regression analysis showed a significant correlation between the decrease in pulmonary artery mean pressure and the baseline of left ventricular end diastolic volume index (P < 0.05). Conclusions In patients with PDA and severe PAH, the baseline echocardiographic parameters are capable of predicting the outcome of transcatheter PDA closure. The decrease in pulmonary artery mean pressure after device closure is well correlated with the baseline left ventricular end diastolic volume index.