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肥厚性心肌病合并心尖部室壁瘤致单形性室性心动过速一例

Surgical Treatment for Hypertrophic Obstructive Cardiomyopathy Complicated by Infective Endocarditis

Abstract：?Objective?To analyze surgical procedures and clinical outcomes for patients with hypertrophic obstructive　cardiomyopathy （HOCM） complicated by infective endocarditis.?Methods?We retrospectively analyzed clinical data of 7 patients with HOCM complicated by infective endocarditis who underwent modified Morrow procedure，removal of　intracardiac vegetation，and valve replacement in Fu Wai Hospital from Sep. 2006 to Feb. 2012. There were 5 male patients　and 2 female patients with their mean age of 39.80±13.60 years（ranging 21-55）. Postoperative clinical outcomes were　observed. Preoperative and postoperative left ventricular outflow tract （LVOT） gradients， left atrium （LA） diameter，left　ventricular ejection fraction （LVEF） and heart function were compared.?Results?There was no in-hospital death and　perioperative survival rate was 100% in this group. Bacteria vegetations were multiply detected on the mitral valve leaflet　（7 cases）， aortic valve leaflet （4 cases） and ventricular septum （1 case） with their diameter of 2-19 mm. Blood culture showed Staphylococcus aureus （3 cases），Squirrel aureus （1 case） . Postoperatively， first-degree atrioventricular block　occurred in 2 patients， complete left bundle branch block in 1 patient， left anterior division block in 2 patients， and all these complications were not treated. Postoperative LVOT gradient and LA diameter were significantly lower than preoperative　values （P＜0.05）， and cardiac function was significantly improved in these patients. All the patients underwent transthoracic　echocardiography at a mean follow-up of 13.00±17.19 （1-49） months in outpatient service. The clinical symptoms of all these patients were diminished or significantly ameliorated and their quality of life was considerably improved. All the patients had NYHA classⅠorⅡ without any reintervention or death during follow-up.?Conclusion?Modified Morrow procedure and valve replacement is a good surgical strategy for patients with HOCM complicated by infective endocarditis with satisfactory early and mid-term clinical outcomes.

Ventricular Septal Myotomymyectomy on Hypertrophic Obstructive Cardiomyopathy and the Treatment Strategies during Perioperative Period

Objective To summary the clinical experiences of ventricular septal myotomymyectomy on hypertrophic obstructive cardiomyopathy(HOCM) and investigate the treatment strategies during perioperative period for better clinical results. Methods From October 1996 to June 2009, 62 patients with HOCM underwent surgical treatment. There were 41 male and 21 female, aged 668 years with mean 34.05 years. The ventricular septal myotomymyectomy operation (Morrow operation or modified Morrow operation) was performed through the aortic incision under general anesthesia and hypothermic cardiopulmonary bypass (CPB). The concomitant operations included coronary artery bypass grafting (5 cases), mitral valve replacement (12 cases), mitral valve plasty(9 cases), aortic valve replacement (4 cases), tricuspid valve plasty(2 cases) and ductus arteriosus closure (2 cases). During the perioperative period, the patients were examined by echocardiography or transesophageal echocardiograph(TEE), electrocardiogram or dynamic echocardiogram and chest radiography. Left atrial diameter，left ventricular enddiastolic [CM(159mm]diameter，left ventricular outflow tract (LVOT) pressuregradient，interventricular septal thickness, ejection fraction[CM)](EF), the changes of mitral valve construction and function were evaluated. Results The time of CPB and aortic occlusion were 104.23±47.14 min and 66.76±36.32 min, respectively. The endotracheal intubation time was 13.23±11.76 h and the postoperative intensive care unit(ICU) stay was 42.53±37.41 h. Four patients died and the mortality was 6.45％(4/62). The main causes of death included septic shock complicated with acute renal failure(1 case), refractory arrhythmia, ventricular fibrillation, atrial flutter complicated with severe low cardiac output syndrome (1 case), severe acute renal failure(1 case) and Ⅲ°atrioventricular(AV) block complicated with low cardiac output syndrome(1 case). Postoperative left atrial diameter (34.56±6.45 mm vs.43.46±7.21 mm，t=6.948,P=0.000), left ventricular enddiastolic diameter (37.14±6.31 mm vs.42.03±6.23 mm，t=3.145,P=0.020), LVOT pressure gradient (23.54±17.78 mm Hg vs. 103.84±44.04 mm Hg,t=13.618,P=0.000) and interventricular septal thickness (17.12±5.67 mm vs.26.93±5.23 mm, t=10.694,P=0.000) decreased significantly compared with those before operation. There was no mitral valve regurgitation, or only mild mitral valve regurgitation. No systolic anterior motion(SAM) was found. The main postoperative arrhythmias included complete left bundle branch block, intraventricular block, complete atrioventricular block and atrial fibrillation. All the 58 cases were cured and discharged. Fiftythree cases were followed up for 3 months12 years, and 5 cases were lost. No death, complication and reoperation were found. Symptoms relieved significantly. The cardiac function was in New York Heart Association grade Ⅰ-Ⅱ. The quality of life improved significantly. Conclusion Most patients with HOCM can achieve satisfactory relief of LVOT obstruction and SAM via ventricular septal myotomymyectomy. The main arrhythmias after operation are bundle branch block and atrial fibrillation. Satisfactory effects can be achieved by accurate surgical technique and effective drug treatments.

同种异体原位心脏移植六例

目的总结6例行原位心脏移植术患者的外科治疗经验。方法采用Shumway和Stanford方法行心脏移植,供心保护采用经主动脉根部灌注4℃心脏停搏液;术后免疫抑制治疗采用环孢素A、骁悉和强的松联合治疗,根据血环孢素A浓度及心内膜活检调整环孢素A用量。结果6例患者均康复,无手术及术后死亡,术后未发生超急性或急性排斥反应。结论受者-供者选择、供心保护、吻合技术、合理应用免疫抑制剂和围术期并发症的处理是手术成功的关键。

EFFECT OF BMSCs TRANSPLANTATION ON CARDIAC FUNCTION OF DIABETES MELLITUS RATS

Objective To observe the effect of BMSCs on the cardiac function in diabetes mellitus (DM) rats through injecting BMSCs into the ventricular wall of the diabetic rats and investigate its mechanism. Methods BMSCs isolated from male SD rats (3-4 months old) were cultured in vitro, and the cells at passage 5 underwent DAPI label ing. Thirty clean grade SD inbred strain male rats weighing about 250 g were randomized into the normal control group (group A), the DM group (group B), and the cell transplantation group (group C). The rats in groups B and C received high fat forage for 4 weeks and the intraperitoneal injection of 30 mg/kg streptozotocin to made the experimental model of type II DM. PBS and DAPI-labeledpassage 5 BMSCs (1 × 105/μL, 160 μL) were injected into the ventricular wall of the rats in groups B and C, respectively. After feeding those rats with high fat forage for another 8 weeks, the apoptosis of myocardial cells was detected by TUNEL, the cardiac function was evaluated with multi-channel physiology recorder, the myocardium APPL1 protein expression was detected by Western blot and immunohistochemistry test, and the NO content was detected by nitrate reductase method. Group C underwent all those tests 16 weeks after taking basic forage. Results In group A, the apoptosis rate was 6.14% ± 0.02%, the AAPL1 level was 2.79 ± 0.32, left ventricular -dP/dt (LV-dP/dt) was (613.27 ± 125.36) mm Hg/s (1 mm Hg=0.133 kPa), the left ventricular end-diastol ic pressure (LVEDP) was (10.06 ± 3.24) mm Hg, and the NO content was (91.54 ± 6.15) nmol/mL. In group B, the apoptosis rate was 45.71% ± 0.04%, the AAPL1 level 1.08 ± 0.24 decreased significantly when compared with group A, the LVdP/ dt was (437.58 ± 117.58) mm Hg/s, the LVEDP was (17.89 ± 2.35) mm Hg, and the NO content was (38.91±8.67) nmol/mL. In group C, the apoptosis rate was 27.43% ± 0.03%, the APPL1 expression level was 2.03 ± 0.22, the LV -dP/dt was (559.38 ± 97.37) mm Hg/ s, the LVEDP was (12.55 ± 2.87) mm Hg, and the NO content was (138.79 ± 7.23) nmol/ mL. For the above mentioned parameters, there was significant difference between group A and group B (P lt; 0.05), and between group B and group C (P lt; 0.05). Conclusion BMSCs transplantation can improve the cardiac function of diabetic rats. Its possible mechanismmay be related to the activation of APPL1 signaling pathway and the increase of NO content.

Atorvastatin for Dilated Cardiomyopathy Complicating Chronic Heart Failure: A Meta-Analysis

Objective　To systematically assess the effectiveness and safety of atorvastatin in patients with dilated cardiomyopathy (DCM) complicating chronic heart failure (CHF). Methods　Databases including PubMed, The Cochrane Library, EMbase, CNKI, CBM, and VIP were searched from inception to November 2011 to collect randomized controlled trials (RCTs) on atorvastatin for DCM accompanied with CHF. According to the inclusion criterion, relevant articles were screened. Then we extracted data, assessed quality, and performed meta-analysis using RevMan 5.0. Results　A total of 11 RCTs involving 648 patients were included. The result of meta-analyses showed that compared with the control group at the sixth month after treatment, in the atorvastatin group, left ventricular ejection fraction (LVEF) obviously (MD=3.92, 95%CI 1.93 to 5.92, P=0.000 1) and 6-minute walk distance (MD=13.15, 95%CI 5.47 to 20.83, P=0.000 8) increased. Besides, serum level of CRP obviously decreased in the atorvastatin group (MD=1.91, 95%CI 3.03 to 0.79, P=0.000 9). Conclusion　Current evidence indicates that atorvastatin, based on routine treatment, can improve cardiac function to some extent, increase LVEF, and reduce serum levels of inflammatory markers for patients with DCM complicating CHF. Therefore, atorvastatin is likely to be a safe and effective drug for non-ischemic cardiomyopathy due to DCM, which still has to be proved by more large-scale and high-quality clinical trials.

Effect of Chronic Alcohol Cardiomyopathy Oxidative Stress in Rats

【摘要】 目的 观察长期大量酒精摄入对大鼠心肌结构及心肌组织中丙二醛(MDA)、超氧化物歧化酶(SOD)和金属硫蛋白(MT)含量的影响,探讨氧化应激在酒精性心肌病大鼠中的作用。 方法 雄性健康SD大鼠45只,随机分为2组,即对照组20只和模型组25只。模型组酒精浓度从5%、10%、20%和30%依次各自由饮1周,然后递增至36%后以该浓度维持饲喂。对照组每日饮用与模型组酒精同等热量的葡萄糖水。6个月后,观察大鼠心肌组织的形态学改变及超微结构的变化,测定心肌组织中MDA、SOD及MT的含量。结果 模型组大鼠心肌细胞排列紊乱、间质充血、炎细胞浸润、线粒体肿胀、空泡形成、肌丝溶解、核膜不规则和核仁裂解。心肌组织中MDA含量明显升高(Plt;0.01),SOD活力含量明显降低(Plt;0.01),MT含量明显降低(Plt;0.01)。 结论 长期摄入大量酒精可使氧自由基代谢失衡,导致心肌损伤。氧化应激在酒精性心肌病发病机制中发挥着重要的作用。【Abstract】 Objective To observe the effect of longterm and large quantities of alcohol intake on myocardial structure of rats and the content of malondialdehyde (MDA), superoxide dismutase (SOD) and metallothionein (MT) in myocardium tissue. To study the effect of oxidative stress on the rats with alcoholic cardiomyopathy. Methods Fortyfive male and healthy SD rats were randomly divided into the control group (20 rats) and model group (25 rats).The alcoholic concentrate in model group was increased from 5%,10%,20% to 30% every week, and maintain free drinking mass concentration of 36% alcohol. The control group drink the same calories of glucose water. Six months later, the myocardial tissues were observed both in light microscope and electron microscope .The level of MDA、SOD and MT were tested in myocardium tissue. Results In the model rats, the cells of myocardial disarray, interstitial congestion, inflammatory cell infiltration, mitochondrial swelling, vacuole formation, melt filaments, irregular nuclear membrane and nucleolus cracking. The content of MDA incresed(Plt;0.01)and the activities of SOD decreased(Plt;001),levels of MT decreased (Plt;0.01) in the cardiac muscular tissues in the model group compared with the control group. Conclusion Longterm intake of large amounts of alcohol can break the balance of oxygen free radicals, which leading to the damage of myocardial. Oxidative stress plays an important role in the etiopathogenesis of alcoholic cardiomyopathy.

老年高血压性肥厚型心肌病临床分析

【摘要】 目的 探讨老年高血压性肥厚型心肌病的临床特征，以提高其诊断率。 方法 对1999年1月-2009年12月收治11例患者的临床表现、超声心动图检查和诊治经过进行回顾性分析，总结经验。 结果 所有患者均符合老年高血压性肥厚型心肌病的超声诊断标准:显著的心肌肥厚、左心室缩小、左心室收缩功能超常，舒张功能明显降低。但临床表现不一，医生对其认识不足。 结论 高血压病导致心脏受累，直至发展为高血压性肥厚型心肌病的病程长，病情隐匿，且患者多合并其他心脏疾病，导致临床诊断困难，甚至误诊、延误治疗。目前对其治疗措施有限，如何早期发现，早期治疗是下一步研究重点。

曲美他嗪治疗缺血性扩张型心肌病疗效观察

【摘要】　目的　总结曲美他嗪在缺血性扩张型心肌病患者心功能改善方面的作用。　方法　2007年1月-2009年12月随机将61例患者分为二组，观察组给予常规药物治疗加用曲美他嗪，对照组给予常规治疗，通过心功能及左心室射血分数两个方面来评估治疗效果。　结果　观察组较对照组显著增加左室射血分数，并能改善患者心功能分级。　结论　缺血性扩张型心肌病患者可以很好地耐受较长期的曲美他嗪治疗，同时心功能也得到改善。

Association between Interleukin-23 Receptor Gene Polymorphisms and Dilated Cardiomyopathy

目的:本文通过研究白介素23受体(IL-23R)基因多态性与扩张型心肌病(DCM)的相关性,探讨DCM患者的免疫遗传学发病机制. 方法:采用PCR-RFLP方法测定DCM患者和正常对照者IL-23R基因rs7517847位点的单核苷酸多态性. 用卡方检验比较病例组与对照组之间基因型频率和等位基因频率的统计学差异。结果:IL-23R基因rs7517847位点单核苷酸多态基因型和等位基因频率在DCM组与正常对照组之间无差异。结论:本研究未发现IL-23R基因rs7517847位点多态性与DCM相关。