Objective\ To understand the effects of serum of patients with rheumatic heart disease and γ interferon on collagen synthesis by valvular fibroblast cultured in vitro, so as to investigate the possible role of transforming growth factor β in genesis of valvular fibrosis and the possibility of γ interferon used to prevent valvular fibrosis in patient with rheumatic heart disease.\ Methods\ Mitral and aortic valve fibroblasts from 5 patients with rheumatic heart disease were cultured in vitro, the cultured ...
Abstract:Objective To observe the expression of calcium-dependent proline-rich tyrosine kinase-2（Pyk2） in myocardium of rheumatic heart disease, the relationship between its role and cardiac fibrosis and clinical significance. Methods The blue myocardium collagen stain were analysed after Masson staining in 30 patients with rheumatic heart disease （RHD group） and 6 normal myocardium specimens （control group）. The contents of hyaluronic acid （HA）, laminin（LN） and type IV collagen（IV-C） were detected by radio-immunity method,and the expressions of Pyk2 protein and messenger ribonucleic acid（mRNA） were explored by immunohistochemistry methods and reverse transcriptase polymerase chain reaction （RT PCR）,then the correlations of these results were statistically analyzed. Results The contents of HA,LN and IV C in RHDgroup increased compared to control group（174.95±76.14μg/L vs. 70.06±15.63μg/L, 153. 86 ± 20. 72μg/L vs. 90.01±14. 11μg/L, 95. 26±7.66μg/L vs. 63. 21±10.62μg/L; P= 0.003, 0. 013, 0. 035）. The Pyk2 absorption and the ratio of Pyk2 mRNA/glyceraldehyde phosphate dehydrogenase （GAPDH） in RHD group were significantly higher than those in control group （0. 325 ± 0. 032 vs. 0.106±0.013, 0.870±0.085 vs. 0.573±0.042; P=0.048, 0.006）.There were positive correlativity between the expression of Pyk2 protein and HA, LN and IV-C （r=0. 611, 0. 743, 0. 829, P〈0. 01）, there were positive correlativity between the expression of Pyk2 mRNA and LN, IV-C （r=0. 794, 0. 766, P〈0.05）. Conclusion Pyk2 may play a key role in the proceeding of cardiac fibrosis in rheumatic heart disease by increasing collagen synthesis in myocardium.
ObjectiveTo summarize the monitoring experiences of blood glucose for patients with rheumatic heart disease combined with diabetes, in order to prevent postoperative complications caused by abnormal blood sugar, relieve pain and promote rehabilitation. MethodsWe reviewed the medical records of the patients with diabetes after heart valve replacement who were admitted to our department from April 2011 to March 2012. Eighty patients were randomly divided into observation group and control group with 40 in each group. Patients in the control group received conventional treatment with subcutaneous insulin injection, while the observation group patients were treated with intravenous insulin pump, and the dose of insulin was adjusted depending on blood glucose levels. Then we compared the postoperative changes in blood glucose level and complications between the two groups. ResultsThe insulin dose, the time of reaching target blood glucose levels, hospital stays and postoperative complication rates were significantly lower in the observation group than the control group (P<0.05). During the one-year follow-up after operations, 2 and 4 patients died respectively in the observation group and the control group, and the difference was not significant (χ2=0.180, P=0.670). ConclusionFor patients with diabetes after heart valve replacements, intravenous insulin pump is better than subcutaneous insulin injection. It can prevent complications, shorten hospital stays, reduce financial burden, and promote prognosis and harmonious doctor-patient relationship.
Objective To estimate the degree of the angle between left principal bronchus and trachea, and it is correlative with the pulmonary function in the patients with rheumatic mitral valve disease. Methods According to various degree of angles between left principal bronchus and trachea,53 patients were divided into three groups, group 1: angle between left principal bronchus and trachea less than 50 degree, group 2: between 50 and 64 degree, group 3: between 65 and 79 degree. The pulmonary function tests,ultrasonic cardiography and left principal bronchus X-ray tomographic film were carried out in three groups before operation. Compare pulmonary function data with different angle between left principal bronchus and trachea in three groups. Results Exception of vital capacity ,residual volume and total lung capacity,the rest markers of lung function showed significant differences (Plt;0.05) in three groups. The correlation of the angle between left principal bronchus and trachea and the ratio of residual volume and total lung capacity among three groups were positively correlative, and the other parameters of lung function were negatively correlative (Plt;0.01). Conclusion The degree of the angle between left principal bronchus and trachea is positively correlative with the extent of pulmonary function impairing.
Abstract： Objective To determine the influence of preoperative atrial fibrillation （AF） on midterm and longterm clinical outcomes of patients after mitral valve replacement （MVR）. Methods We retrospectively analyzed clinical data of 1 029 patients who underwent MVR with or without tricuspid valve repair in Changhai Hospital， Second Military Medical University， from January 2000 to December 2005. According to the exclusion criteria， 621 patients were selected and divided into two groups depending on presence of preoperative AF. Those 395 patients with preoperative AF belonged to the AF group， including 134 males and 261 females with their average age of 51.1±11.5 years. Those 226 patients with preoperative sinus rhythm （SR） were in the SR group， including 82 males and 144 females with their average age of 48.2±14.1 years. Early postoperative outcomes， midterm and longterm mortality and morbidity of the two groups were compared. Results During 10 years of follow-up， there was no statistical difference in early postoperative mortality and morbidity between the two groups， but the incidence of late thromboembolism was significantly higher in AF group than that in SR group ［0.9‰ （31 patients/33 984 patient-months） vs. 0.4‰ （9 patients/21 151 patient-months）， χ2=4.26， P=0.039］. Ten-year survival rate in patients in AF group was significantly lower than that in SR group （83.2% vs. 92.7%， χ2=10.26， P=0.002）. Multivariate analysis identified preoperative AF ［HR=2.878， 95% CI （1.166，4.129）］， low left ventricular ejection fraction ［HR=0.948， 95% CI （0.917，0.981）］ ， and old age ［HR=1.073， 95% CI （1.038，1.109）］ as independent risk factors for late mortality after MVR. Apart from its influence on patient survival rate and incidence of thromboembolism， preoperative AF also had an adverse effect on left ventricular function， right ventricular function and tricuspid regurgitation. Conclusion AF is an independent risk factor for poor prognosis after MVR. Prognosis after MVR might be improved if surgery could be performed early when patients have predictive signs of AF such as multiple premature atrial contractions or left atrium enlargement.
Abstract： Objective To explore the association between transforming growth factor-β receptor typeⅡ (TGFBR2) gene rs6785358 and rs764522 polymorphisms and rheumatic heart disease (RHD) in Chinese Han People. Methods The research design was a case-control study. A total of 207 patients who were hospitalized in Nanjing First Hospital Affiliated to Nanjing Medical University between October 2008 and January 2011 with RHD served as RHD group while 225 age and gender matched healthy adults as control group. Polymerase chain reaction-restriction length polymorphism (PCR-RFLP) technique was used to determine TGFBR2 gene rs6785358 and rs764522 polymorphisms. Results The frequencies of genotype AA, AG and GG of rs6785358 in RHD group and control group were 72.0%, 25.1%, 2.9% and 68.9％, 28.0％, 3.1％,respectively. There was no significant difference in the distribution of genotype frequencies for rs6785358 between RHD group and control group（χ2=0.50，P=0.78）. The frequencies of allele A and G of rs6785358 in RHD group and control group were 84.5％, 15.5％ and 82.9％, 17.1％,respectively. There was no significant difference in the distribution of allele frequencies for rs6785358 between RHD group and control group（χ2=0.43，P=0.51）. The frequencies of genotype CC, CG and GG of rs764522 in RHD group and control group were 77.3%, 21.3%, 1.4% and 75.6％, 21.3％, 3.1％, respectively. There was no significant difference in the distribution of genotype frequencies for rs764522 between RHD group and control group（χ2=1.33，P=0.51）. The frequencies of allele C and G of rs764522 in RHD group and control group were 87.9％, 12.1％ and 86.2％, 13.8％,respectively. There was no significant difference in the distribution of allele frequencies for rs764522 between RHD group and control group（χ2=0.55，P=0.46）. Further analysis by sex stratification showed that no statistical significance was detected in the distribution of genotype and allele frequencies for rs6785358 or rs764522 between RHD patients and controls. Conclusion TGFBR2 gene rs6785358 and rs764522 polymorphisms are not associated with RHD in Chinese Han people.
ObjectiveTo analyze the long-term efficacy and its influencing factors in the treatment of the permanent atrial fibrillation(AF) using monopolar radiofrequency ablation during concomitant cardiac valve replacement surgery with rheumatic heart disease. MethodsClinical data of the 116 patients with rheumatic heart disease and permanent AF who underwent modified maze procedure using monopolar radiofrequency ablation and concomitant cardiac valve replacement in the affiliated hospital of Qingdao university from October 2004 to December 2010 were collected and retrospectively analyzed, including 43 males and 73 females with their age of 50.5±7.5 years. Electrocardiogram (ECG) with 12-lead and echocardiography data, as well as the related complications, cardiac function and life quality were collected at the time of the immediately after the operation, discharge from hospital, 3 months, 6 months, 1 year postoperatively and every year after the operation. Patients were divided into eliminating group of AF (including sinus rhythm and nodal rhythm) and AF group according to the results of the ECG at the time of the ending follow-up. In the eliminating group of AF, there were 52 patients (16 males, 36 females) with their age of 48.4±7.3 years, and in the AF group, there were 50 patients (22 males, 28 females) with their age of 51.9±7.1 years. Analyzed the difference of the related factors between the two groups using statistical methods and tried to find the factors affecting the long-term clinical efficacy of the operation. ResultsThree patients died in hospital (one died of the hemolysis, acute renal insufficiency and hyperkalemia. One died of the multiple organ dysfunction syndrome caused by the acute renal insufficiency. And the other one died of the multiple organ dysfunction syndrome caused by the repetitive ventricular tachycardia and ventricular fibrillation on the day of the automatic discharge). Three patients died during the follow-up (one died after the reoperation because of the perivalvular leakage in other hospital, and the causes of death in the two others could not be catched). One patient occurred cerebral embolism, and the other one occurred cerebral hemorrhage in the af group during the follow-up. There was statistical significance between two group at the aspects of age, preoperative AF duration, preoperative left atrium diameter, time of the cardiopulmonary bypass and time of the cross-clamp ascending aorta. In multivariate analysis, age and preoperative left atrium diameter are risk factors affecting the long-term efficacy. ConclusionThe treatment of the permanent atrial fibrillation using monopolar radiofrequency ablation concomitant cardiac valve replacement with rheumatic heart disease is effective and has good long-term efficacy. The factors of affecting the long-term clinical efficacy are the patient's age and the diameter of left atrium.
Objective To explore the impact of recombinant human growth hormone （rhGH） on T lymphocyte subsets in patients with rheumatic heart disease during the perioperative period of heart valve replacement. Methods A total of 65 patients with rheumatic valvular heart disease who received heart valve replacement in Department of Cardiothoracic Surgery of Xiangyang Central Hospital from June 1， 2011 to March 31， 2012 were enrolled in this double-blind randomized controlled clinical study. All the patients were divided into 2 groups by random number produced by SAS software：the trial group and the control group. There were 35 patients in the trial group including 19 males and 16 females with their average age of 50.57 years， and 30 patients in the control group including 16 males and 14 females with their average age of 49.87 years. Apart from routine cardiac glycosides， diuretics， glucose-insulin-potassium solution， and postoperative anti-infective therapy， patients in the trial group also received subcutaneously injection of rhGH 5 U （1 ml）daily from 1 day before surgery to 3 days after surgery， and patients in the control group received subcutaneously injection of normal saline 1 ml as placebo. Peripheral venous blood samples were taken in the morning 2 days before surgery and 1 st， 3 rd， 7 th day after surgery respectively. Percentages of CD3+， CD4+， CD8+ were examined timely by flow cytometry and CD4+ /CD8+ ratio was calculated. Results In the control group， percentages of CD3+， CD4+ and CD4+ /CD8+ ratio on the 1st， 3rd， 7th postoperative day were significantly lower than preoperative levels， and percentages of CD8+ on the 1st and 3rd postoperative day were significantly lower than preoperative level （P＜0.05）. In the trial group， percentages of CD3+， CD4+， and CD8+ on the 1st and 3rd postoperative day were significantly lower than preoperative levels（P＜0.05）， while percentages of CD3+， CD4+， and CD8+ on the 7th postoperative day were not statistically different from preoperative levels （P＞0.05）; CD4+ /CD8+ ratio on the 1st postoperative day was significantly lower than preoperative level （P＜0.05）， while CD4+ /CD8+ ratios on the 3rd and 7th postoperative day were not statistically different from preoperative level （P＞0.05）. There was no statistical difference in preoperative T lymphocyte subsets between the trial group and the control group （P＞0.05）. The percentages of CD4+ and CD4+/CD8+ ratio in the trial group were significantly higher than those of the control group on the 1st postoperative day （P＜0.05）， while the percentages of CD3+ and CD4+ and CD4+ /CD8+ratio in the trial group were significantly higher than those of the control group on the 3rd and 7th postoperative day（P＜0.05）. Conclusion Use of rhGH can significantly increase T lymphocyte subsets expression， enhance body cellular immunity， and improve postoperative recovery of patients with rheumatic valvular heart disease during the perioperative period of heart valve replacement.
Objective To observe early and intermediate-term clinical outcomes of tricuspid valvuloplasty withannuloplasty ring for the treatment of secondary tricuspid regurgitation （TR） of patients with rheumatic heart disease. MethodsFrom December 2009 to September 2011, 41 patients with rheumatic heart disease underwent left-side heart valve replacementand concomitant tricuspid valvuloplasty with annuloplasty ring in Sichuan Jianyang People’s Hospital. There were 12 males and 29 females with their mean age of 49 （21-67） years. Preoperatively, there were 38 patients with atrial fibrillation, 13 patients with left atrial thrombus; 2 patients with trivial TR, 5 patients with mild TR, 11 patients with moderate TR, and 23 patients with severe TR. Twenty-eight patients received mitral valve replacement and 13 patients received mitral and aortic valve replacement. All the patients were followed up every 3 months at the outpatient department, and received color Doppler echocardiography examination to observe TR degree at the 6th postoperative month. Results Postoperative heart function improved by 2-3 class in all the patients. There were 39 patients with New York Heart Association (NYHA) classⅠorⅡ postoperatively, and postoperative heart function was significantly better than preoperative heart function（P＜0.05）. All the patients were followed up for 6-27 months, and there was no death during follow-up. Color Doppler echocardiography at the 6th postoperative month showed that TR degrees were significantly decreased than preoperative TR degrees. There were 39 patients with trivial or mild TR during follow-up, which was significantly different with preoperativeTR degree （P＜0.05）. Right ventricle dimension decreased from preoperative 20 mm to 17 mm during follow-up, which were statistically different （P＜0.05）. Conclusion Early and intermediate-term clinical outcomes of tricuspid valvuloplasty with annuloplasty ring for the treatment of TR are satisfactory, while further evaluation for its long-term outcome is needed.
Objective To evaluate the clinical effects of bi-polar radiofrequency ablation (BRFA) for the surgical treatment of atrial fibrillation (AF) in rheumatic heart disease (RHD) patients. Methods We involved 96 RHD patients who underwent valve replacement in Department of Cardiovascular Surgery, West China Hospital from July 2014 through May 2015. There were 74 patients with AF, 22 in sinus rhythm. All patients with AF were fully informed of BRFA, in which 40 of the 74 patients received while the other 34 patients refused. The 40 patients with AF who received BRFA were classified into a treatment group and the other 34 patients were classified into a control group. The 20 patients with sinus rhythm were classified into a blank group as well. The clinical effect and quality of life of the patients were analyzed. Results Left atrial diameter (LAD), pulmonary arterial systolic pressure (PASP), and conversion rate of sinus rhythm at discharge, maintenance rate of sinus rhythm during follow-up in patients with AF were significantly higher than those in the patients in sinus rhythm. No difference was found in terms of survival rate, mortality, major complications among the three groups. The treatment group experienced higher scores in physical functioning (PF), role-physical (RP), general health (GH), vitality (VT), social functioning (SF), mental health (MH), physical component summary (PCS), mental component summary(MCS) and total score compared with the control group both at postoperative 3-month and 6-month . At postoperative 12-month, the treatment group experienced higher scores in PF, RP, GH, PCS, and total score compared with the control group. Conclusion AF would enhance the negative impact on structure remodeling in RHD patients. BRFA is beneficial for the conversion and maintaining of sinus rhythm in RHD patients and the decreasing of LAD & PASP parameter as well. BRFA is more beneficial for the improvement of quality of life in RHD patients with AF during one-year follow-up.