The Asia Pacific Heart Journal最新文献

Background: The Rashkind Umbrella device has proven effective in closing small to moderate size patent ductus arteriosus. A comparable early occlusion rate was also seen in PDA occlusion using Gianturco coils. This study addresses the long-term outcome of both techniques in a single centre. Methods: Review was undertaken of 522 patients with PDA who underwent transcatheter occlusion before January 1997; 244 patients (mean: age 8.0±6.7 years, weight 21.8±12.9 kg, PDA size 3.2±1.0 mm) were intended to receive the Rashkind Umbrella device and the remaining 278 patients (mean: age 6.4±5.6 years, weight 18.6±11.2 kg, PDA size 2.5±1.0 mm) would receive Gianturco coils. Deployment failure occurred in 8 patients (3%) and 6 (2%) during the initial learning curve of the Rashkind Umbrella and Gianturco coil, respectively. In the Rashkind Umbrella group, haemolysis occurred in 6, device embolisation in 3, and 1 patient died from anaesthetic sequelae. Peripheral pulmonary embolisation of coils occurred in 7 patients and all were successfully retrieved. Results: Results were analysed from 228 and 258 patients who had successful Rashkind Umbrella device and Gianturco coil deployment respectively. All had completed at least 1 year follow-up. They were evaluated clinically for residual ductal murmur and echocardiographically for a residual ductal shunt and presence of pulmonary artery or aortic obstruction. The Rashkind Umbrella group had significantly higher residual shunt compared to the Gianturco coil group at various stages of follow-up (p<0.05), 40% v 22% at 24 hours, 29% v 7% at 3 months, 25% v 4% at 6 months and 22% v 3% at 1 year. In 57 patients, a reocclusion procedure during the study period was undertaken to effect immediate complete occlusion. Mild left pulmonary artery stenosis (velocity<2 m/s) was noted in 6 patients who had multiple coils and one who had a 17 mm Rashkind Umbrella device. Conclusions: Transcatheter occlusion of PDA using the Gianturco coil is safer and more effective than the Rashkind Umbrella device. It has become the first choice for treating small to moderate size native PDA at our institution.

Background: With a shift in geographical focus to include the Pacific rim, and with the Journal's scope now broadened to embrace cardiology, the Editorial Board of the APHJ wished to obtain the views of the wider readership on the Journal format and style. Aim: To determine the views of readers in the evolving process of structuring the Journal and to stimulate discussion about the future role of the APHJ. Method. Subscribers were asked anonymously by questionnaire for their views on the subjects and styles of articles currently published by the Journal. Results: One-hundred and two replies were received (a response rate of 15%). The main subjects of interest were, in order of importance: cardiology, cardiac surgery, thoracic surgery and basic research, these being a reflection of the professional interests of the responders. Cardiologists were interested primarily in articles on general clinical cardiology, followed by interventional cardiology and clinical research. Cardiothoracic surgeons showed an overwhelming primary interest in cardiac surgery, followed by thoracic surgery and clinical research, a reflection of the higher response rate from cardiac compared with thoracic surgeons. Interests in basic research were in physiology, followed by atherosclerosis, pharmacology and molecular biology. Conclusion: The most popular styles of articles for all disciplines were reviews by experts, followed by original research papers and scientific editorials. These, in turn, were more highly favoured than professional editorials, how-to-do-it articles and case reports. The Editorial Board has taken heed of these views and is now using this information in setting the Journal style for the future.

Background: Acute cardiac rupture is a life-threatening complication of acute myocardial infarction. Traditional methods of surgical treatment by infarctectomy with mattress suture repair are associated with a high mortality. Recently, new approaches involving an onlay patch without infarctectomy have been introduced with promising results. Our previous experimental work showing that the recently infarcted myocardium recovers poorly after aortic cross-clamping and cardioplegic arrest suggested that repair of rupture using ventricular fibrillation is preferable. Methods and Results: We report 4 consecutive patients who have been successfully treated using a technique involving an onlay patch of pericardium secured with glue and a circumferential suture. In 2 cases it was possible to complete the repair without cross-clamping the aorta. Conclusion: Ventricular rupture can be successfully repaired using an onlay patch and repair can be accomplished without the use of cross-clamping or cardioplegia.

The participation of reactive oxygen species in different cardiovascular pathologic conditions is widely recognised. One of these situations is the Ischaemia-reperfusion phenomenon where the role of oxygen free radicals (OFR) has been of particular interest. Ischaemia-reperfusion is a common phenomenon in the clinical setting and is observed in thrombolytic therapy, percutaneous transluminal coronary angioplasty (PTCA) and open-heart surgery. Several experimental and clinical studies strongly suggest that antioxidants may ameliorate reperfusion injury during open-heart surgery. In this regard, the following substances have been used: mannitol, deferoxamine, vitamin E, allopurinol and coenzyme Q₁₀. In PTCA procedures, the presence of an oxidative stress after reperfusion was also shown by several authors, but up to now, only probucol demonstrated efficacy in reducing restenosis after these techniques.

One of the most important hallmarks of the aged heart is altered calcium homeostasis, possibly due to age-associated alterations in several major calcium cycling processes involved in cardiac excitation-contraction coupling. During ageing, the magnitude of the L-type Ca²⁺ channel current (I_Ca,L) becomes significantly increased in parallel with the enlargement of cardiac myocytes, resulting in an unaltered I_Ca,L density. Since the inactivation of I_Ca,L is slowed, and the action potential duration is prolonged, the net Ca²⁺ influx during each action potential is increased in cells of senescent myocardium relative to cells of adult control. While neither mRNA nor protein levels of the sarcoplasmic reticulum (SR) Ca²⁺ release channel (ryanodine receptor) significantly change with advancing adult age, the mRNA abundance and the density of SR Cat+ pump decrease with ageing and are associated with a diminished SR Ca²⁺ sequestration rate in the aged heart. In addition, cardiac chronotropic and inotropic responses to β-adrenergic receptor stimulation are also reduced with advancing age. The multiple changes in Ca cycling that occur during ageing result in an augmented Cat+ influx, slowed SR Ca²⁺ sequestration and prolonged durations of the Ca_i transient and contraction. These alterations which prolong electromechanical systole may be construed as an adaptation in that they prolong the force-bearing capacity of the senescent cells following excitation. This is helpful with respect to maintaining the cardiac function in the aged heart. However, they also increase the risk of Ca²⁺ overload and Cat²⁺-dependent arrhythmias during stress in the senescent heart. Although reduced (3-adrenergic responses with ageing contribute to diminished contraction reserve, these may be viewed in part, as adaptive, in that they protect against Ca²⁺ overload during stress.