Postoperative cognitive dysfunction (POCD) refers to a complication of neurological dysfunction after surgery, including one or more changes that are significantly lower than those before surgery. The purpose of this study was to review the coping strategies and risk factors of POCD.A systemic research was conducted searching Pubmed, web of science, MEDLINE and other websites with the keywords of cardiac surgery, cognitive impairment and POCD. Multiple factors have been associated with the treatment of POCD, including anesthetic, choice of analgesic drugs, anti-inflammatory drugs, erythropoietin, atherosclerosis, emotional factors, surgical and other factors. Targeted treatments are carried out for risk factors that may affect POCD prevention, such as anesthetic drug prevention, anti-inflammatory drug prevention, and intraoperative prevention and other preventive measures are aimed at reducing the incidence of POCD after cardiac surgery.
术后认知功能障碍(POCD)是指术后神经功能障碍的并发症，包括一种或多种明显低于术前的变化。本研究旨在探讨慢性阻塞性肺疾病的应对策略及危险因素。以心脏外科、认知障碍、POCD等关键词搜索Pubmed、web of science、MEDLINE等网站进行系统研究。多种因素与POCD的治疗有关，包括麻醉、镇痛药物、抗炎药物的选择、促红细胞生成素、动脉粥样硬化、情绪因素、手术等因素。对可能影响POCD预防的危险因素进行针对性的治疗，如麻醉药物预防、抗炎药物预防、术中预防等预防措施，旨在降低心脏手术后POCD的发生率。
{"title":"Research Progress on Coping Strategies of Cognitive Impairment after Cardiac Surgery: A Systematic Review of Literature.","authors":"Yifan Yan, Sandeep Bhushan, Weihao Ding, Chen Ma, Shichuan Peng, Zongwei Xiao","doi":"10.1532/hsf.4395","DOIUrl":"https://doi.org/10.1532/hsf.4395","url":null,"abstract":"Postoperative cognitive dysfunction (POCD) refers to a complication of neurological dysfunction after surgery, including one or more changes that are significantly lower than those before surgery. The purpose of this study was to review the coping strategies and risk factors of POCD.A systemic research was conducted searching Pubmed, web of science, MEDLINE and other websites with the keywords of cardiac surgery, cognitive impairment and POCD. Multiple factors have been associated with the treatment of POCD, including anesthetic, choice of analgesic drugs, anti-inflammatory drugs, erythropoietin, atherosclerosis, emotional factors, surgical and other factors. Targeted treatments are carried out for risk factors that may affect POCD prevention, such as anesthetic drug prevention, anti-inflammatory drug prevention, and intraoperative prevention and other preventive measures are aimed at reducing the incidence of POCD after cardiac surgery.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121403384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tomonori Shirasaka, Nuttapon Arayawudhikul, A. Tantraworasin, Angsu Chartrungsan, Boonsap Sakboon, Jaroen Cheewinmethasiri, H. Kamiya
BACKGROUND It still remains unclear the depth of influence of left ventricular dysfunction on the recovery of patients' physical conditions in the early and midterm period following off-pump coronary artery bypass grafting (OPCAB). METHODS From April 2011 to May 2018, 851 patients underwent OPCAB in our center. All were grouped into two groups: Those whose ejection fraction (EF) was under 35% were defined as the Low EF group (N = 158) and those who maintained EF over 35% were defined as the Faired EF group (N = 693). Preoperatively, there was significant difference in NYHA class (P < 0.001), CCS class (P = 0.038), level of creatinine (P < 0.001), and rate of establishment of IABP (P < 0.001). RESULTS Regarding all-cause death in the early postoperative period, low EF was a not a risk factor in patients (P = 0.52) or in the matched cohort (P = 0.398); however, in the midterm, it was a significant risk factor in patients (HR 2.07, P = 0.016) and in the matched cohort (HR 2.72, P = 0.029). Overall survival at 5 years in the Low EF group was significantly inferior to that of the Faired EF group in all (67.4±4.1% and 86.1±2.9%, P = 0.001) and in the matched cohort (66.5±6.4% vs. 86.5±4.5%, P = 0.008). CONCLUSION OPCAB seems beneficial for patients with LV dysfunction considering the early outcome, however, low EF is a significant risk factor for overall death in the midterm period.
{"title":"The Influence of Left Ventricular Dysfunction on The Early and Midterm Outcome in The Patients Undergoing Off Pump Coronary Artery Bypass Grafting Assessed by Propensity Matched Score Analysis.","authors":"Tomonori Shirasaka, Nuttapon Arayawudhikul, A. Tantraworasin, Angsu Chartrungsan, Boonsap Sakboon, Jaroen Cheewinmethasiri, H. Kamiya","doi":"10.1532/hsf.4311","DOIUrl":"https://doi.org/10.1532/hsf.4311","url":null,"abstract":"BACKGROUND\u0000It still remains unclear the depth of influence of left ventricular dysfunction on the recovery of patients' physical conditions in the early and midterm period following off-pump coronary artery bypass grafting (OPCAB).\u0000\u0000\u0000METHODS\u0000From April 2011 to May 2018, 851 patients underwent OPCAB in our center. All were grouped into two groups: Those whose ejection fraction (EF) was under 35% were defined as the Low EF group (N = 158) and those who maintained EF over 35% were defined as the Faired EF group (N = 693). Preoperatively, there was significant difference in NYHA class (P < 0.001), CCS class (P = 0.038), level of creatinine (P < 0.001), and rate of establishment of IABP (P < 0.001).\u0000\u0000\u0000RESULTS\u0000Regarding all-cause death in the early postoperative period, low EF was a not a risk factor in patients (P = 0.52) or in the matched cohort (P = 0.398); however, in the midterm, it was a significant risk factor in patients (HR 2.07, P = 0.016) and in the matched cohort (HR 2.72, P = 0.029). Overall survival at 5 years in the Low EF group was significantly inferior to that of the Faired EF group in all (67.4±4.1% and 86.1±2.9%, P = 0.001) and in the matched cohort (66.5±6.4% vs. 86.5±4.5%, P = 0.008).\u0000\u0000\u0000CONCLUSION\u0000OPCAB seems beneficial for patients with LV dysfunction considering the early outcome, however, low EF is a significant risk factor for overall death in the midterm period.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"324 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133991492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND Secondary subaortic stenosis (SSS) is a rare heart disease of the left ventricular outflow tract (LVOT). It usually occurs after cardiovascular correction with or without initial left ventricular outflow tract obstruction (LVOTO). Because most patients with SSS are asymptomatic, many do not realize the need for reoperation until the obstruction worsens. Few studies suggest the characteristics and reasons of SSS without initial SAS. We conducted a retrospective study to describe the characteristics and surgical outcomes of these patients. METHODS In this study, we examined a single-center retrospective cohort of SSS patients without initial SAS undergoing resection from 2010 to 2019. Patients are defined as secondary subaortic obstruction requiring surgery after cardiovascular correction. Demographics, perioperative findings, and clinical data were analyzed. RESULTS Twenty-three patients had undergone secondary cardiac surgery for SSS without initial SAS during 10 years in our center. The median age at operation was 7.3 (4.0-13.5) years. In this study, the most commonly associated cardiac lesions were ventricular septal defect (VSD), atrioventricular septal defect (AVSD), patent ductus arteriosus (PDA), and coarctation arch hypoplasia (COA). The surgical techniques included membranous resection of five patients, fibromuscular resection of 17 patients, and reconstruction of the intraventricular baffle of one patient. The results of surgery in these patients are satisfied. The average LVOT gradient at the last follow up was 14.9 (7.8-26.2) mmHg. There was no operative mortality. Two patients had postoperative complications. The median follow-up period was 2.9 (1.1-4.3) years with one late death. Two patients (8.7%) had recurrence of stenosis. CONCLUSIONS Secondary subaortic stenosis is an uncommon heart disease. The reason is related to several causes, including missed diagnosis, unnoticed abnormalities of LVOT, and further changes of geometric morphology by intracardiac surgery. The results of surgery in these patients are satisfied. However, the recurrence of stenosis is still frequent.
{"title":"Surgical Repair of Secondary Subaortic Stenosis in Congenital Heart Disease Without Initial Subaortic Obstruction.","authors":"Yuefeng Cao, Xiangming Fan","doi":"10.1532/hsf.4299","DOIUrl":"https://doi.org/10.1532/hsf.4299","url":null,"abstract":"BACKGROUND\u0000Secondary subaortic stenosis (SSS) is a rare heart disease of the left ventricular outflow tract (LVOT). It usually occurs after cardiovascular correction with or without initial left ventricular outflow tract obstruction (LVOTO). Because most patients with SSS are asymptomatic, many do not realize the need for reoperation until the obstruction worsens. Few studies suggest the characteristics and reasons of SSS without initial SAS. We conducted a retrospective study to describe the characteristics and surgical outcomes of these patients.\u0000\u0000\u0000METHODS\u0000In this study, we examined a single-center retrospective cohort of SSS patients without initial SAS undergoing resection from 2010 to 2019. Patients are defined as secondary subaortic obstruction requiring surgery after cardiovascular correction. Demographics, perioperative findings, and clinical data were analyzed.\u0000\u0000\u0000RESULTS\u0000Twenty-three patients had undergone secondary cardiac surgery for SSS without initial SAS during 10 years in our center. The median age at operation was 7.3 (4.0-13.5) years. In this study, the most commonly associated cardiac lesions were ventricular septal defect (VSD), atrioventricular septal defect (AVSD), patent ductus arteriosus (PDA), and coarctation arch hypoplasia (COA). The surgical techniques included membranous resection of five patients, fibromuscular resection of 17 patients, and reconstruction of the intraventricular baffle of one patient. The results of surgery in these patients are satisfied. The average LVOT gradient at the last follow up was 14.9 (7.8-26.2) mmHg. There was no operative mortality. Two patients had postoperative complications. The median follow-up period was 2.9 (1.1-4.3) years with one late death. Two patients (8.7%) had recurrence of stenosis.\u0000\u0000\u0000CONCLUSIONS\u0000Secondary subaortic stenosis is an uncommon heart disease. The reason is related to several causes, including missed diagnosis, unnoticed abnormalities of LVOT, and further changes of geometric morphology by intracardiac surgery. The results of surgery in these patients are satisfied. However, the recurrence of stenosis is still frequent.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121556327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
OBJECTIVE To summarize the experience in the treatment of repair ventricular septal defect with left superior vena cava (LSVC) through right axillary thoracotomy. To explore the surgical strategy of treating VSD with LSVC through right axillary thoracotomy. METHODS right axillary thoracotomy and median sternotomy were performed in 73 cases of ventricular septal defect with LSVC in our center from 2018 to 2019. Perioperative data and surgical information were analyzed retrospectively. RESULTS There were 54 cases of R-group and 19 cases of S-group with median age of 0.8 years (0.5-1.6years). In the 73 patients, 21(38.9%) were men and 52 (61.1%) women. The operation time of R-group was shorter than S-group, p<0.05. The postoperative drainage in R-group was less than S-group, p<0.05. The mechanical ventilation time was longer in the S-group than in the R-group, p<0.05. There were no deaths, serious complications and readmission in the follow-up 6 months(3-10months). CONCLUSION Right axillary thoracotomy is a safe procedure with excellent cosmetic and clinical results for ventricular septal defect with left superior vena cava. It has the advantages of short operation time, less bleeding and short postoperative time.
{"title":"Experience of repair ventricular septal defect with left superior vena cava through right axillary thoracotomy.","authors":"Yuefeng Cao, Qihua Peng, Junwu Su","doi":"10.1532/hsf.4193","DOIUrl":"https://doi.org/10.1532/hsf.4193","url":null,"abstract":"OBJECTIVE\u0000To summarize the experience in the treatment of repair ventricular septal defect with left superior vena cava (LSVC) through right axillary thoracotomy. To explore the surgical strategy of treating VSD with LSVC through right axillary thoracotomy.\u0000\u0000\u0000METHODS\u0000right axillary thoracotomy and median sternotomy were performed in 73 cases of ventricular septal defect with LSVC in our center from 2018 to 2019. Perioperative data and surgical information were analyzed retrospectively.\u0000\u0000\u0000RESULTS\u0000There were 54 cases of R-group and 19 cases of S-group with median age of 0.8 years (0.5-1.6years). In the 73 patients, 21(38.9%) were men and 52 (61.1%) women. The operation time of R-group was shorter than S-group, p<0.05. The postoperative drainage in R-group was less than S-group, p<0.05. The mechanical ventilation time was longer in the S-group than in the R-group, p<0.05. There were no deaths, serious complications and readmission in the follow-up 6 months(3-10months).\u0000\u0000\u0000CONCLUSION\u0000Right axillary thoracotomy is a safe procedure with excellent cosmetic and clinical results for ventricular septal defect with left superior vena cava. It has the advantages of short operation time, less bleeding and short postoperative time.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122307941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yuntian Sun, Yunlong Fan, Zhaorui Dong, Shixiong Wei, Chao Song
BACKGROUND Stanford type A aortic dissection (TAAD) is the most common cause of death caused by aortic disease in the Chinese mainland. Patients suffering TAAD need immediate surgical treatment [Pompilio 2001; Di Eusanio 2003; Ueda 2003; Li 2013; Afifi 2016; Zhou 2019; Zhou 2021]. Emergency aortic arch replacement is difficult and risky. The prognosis following surgery varies depending on the different surgical approaches [Pompilio 2001; Kazui 2002; Di Eusanio 2003; Ueda 2003; Moon 2009; Li 2013; Afifi 2016; Zhou 2019; Zhou 2021]. Aortic arch replacement includes total-arch replacement (Sun's operation) and hemi-arch replacement. The comparative analysis of learning curves between the two procedures has not been systematically studied. In this study, we studied and analyzed the learning curves of total-arch replacement and hemi-arch replacement using cumulative sum (CUSUM) analysis. METHODS From January 2013 to December 2019, a total of 139 Stanford TAAD operations were performed by the same surgeon and two assistants, including 61 cases of hemi-arch replacement and 78 cases of total-arch replacement. Baseline information, including preoperative conditions, intraoperative related data and postoperative prognosis, were collected. Descriptive statistics and CUSUM were used to analyze the total operation time, cardiopulmonary bypass (CPB) time, aortic clamping (AC) time, operative mortality, incidence of postoperative complications, postoperative intensive care unit (ICU) time, hospital stay, and postoperative drainage volume. RESULTS A total of 139 patients with TAAD (age 48.8 ± 12.3, male, 107, female, 32) underwent emergency aortic arch replacement. A total of 61 patients (43.9%) underwent hemi-arch replacement, and 78 patients (56.1%) underwent total-arch replacement. The total time, cardiopulmonary bypass (CPB) time, and aortic clamping (AC) time of hemi-arch operation were 434.2 ± 137.0 minutes, 243.3 ± 87.2 minutes, and 157.0 ± 60.2 minutes. The total, CPB, and AC times of total-arch operation were 747.8 ± 164.3 minutes, 476.4 ± 121.6 minutes, and 238.5 ± 67.6 minutes. The mortality of hemi-arch operation was 3.3%, and that of total-arch operation was 6.4%. The incidence of complications after hemi-arch operation was 11.3%, and that after total-arch operation was 46.2%. The ICU time and hospital stay after hemi-arch surgery were 7.3 ± 4.4 days and 27.2 ± 16.2 days, respectively, and the ICU time and total hospital stay after total-arch surgery were 7.2 ± 5.9 days and 24.0 ± 10.3 days, respectively. The total drainage volume after hemi-arch operation was 2182.4 ± 1236.4 ml, and that after total-arch operation was 2467.3 ± 1385.7 ml. According to CUSUM analysis, the same cardiovascular surgery team seems to have different learning curves in the time of two operations. CUSUM analysis of intraoperative and postoperative indicators shows that after a certain period of professional and systematic cardiovascular surgery training, aortic hemi-arc
{"title":"Learning Curve of Aortic Arch Replacement Surgery in Chinese Mainland with Stanford Type A Aortic Dissection.","authors":"Yuntian Sun, Yunlong Fan, Zhaorui Dong, Shixiong Wei, Chao Song","doi":"10.1532/hsf.4399","DOIUrl":"https://doi.org/10.1532/hsf.4399","url":null,"abstract":"BACKGROUND\u0000Stanford type A aortic dissection (TAAD) is the most common cause of death caused by aortic disease in the Chinese mainland. Patients suffering TAAD need immediate surgical treatment [Pompilio 2001; Di Eusanio 2003; Ueda 2003; Li 2013; Afifi 2016; Zhou 2019; Zhou 2021]. Emergency aortic arch replacement is difficult and risky. The prognosis following surgery varies depending on the different surgical approaches [Pompilio 2001; Kazui 2002; Di Eusanio 2003; Ueda 2003; Moon 2009; Li 2013; Afifi 2016; Zhou 2019; Zhou 2021]. Aortic arch replacement includes total-arch replacement (Sun's operation) and hemi-arch replacement. The comparative analysis of learning curves between the two procedures has not been systematically studied. In this study, we studied and analyzed the learning curves of total-arch replacement and hemi-arch replacement using cumulative sum (CUSUM) analysis.\u0000\u0000\u0000METHODS\u0000From January 2013 to December 2019, a total of 139 Stanford TAAD operations were performed by the same surgeon and two assistants, including 61 cases of hemi-arch replacement and 78 cases of total-arch replacement. Baseline information, including preoperative conditions, intraoperative related data and postoperative prognosis, were collected. Descriptive statistics and CUSUM were used to analyze the total operation time, cardiopulmonary bypass (CPB) time, aortic clamping (AC) time, operative mortality, incidence of postoperative complications, postoperative intensive care unit (ICU) time, hospital stay, and postoperative drainage volume.\u0000\u0000\u0000RESULTS\u0000A total of 139 patients with TAAD (age 48.8 ± 12.3, male, 107, female, 32) underwent emergency aortic arch replacement. A total of 61 patients (43.9%) underwent hemi-arch replacement, and 78 patients (56.1%) underwent total-arch replacement. The total time, cardiopulmonary bypass (CPB) time, and aortic clamping (AC) time of hemi-arch operation were 434.2 ± 137.0 minutes, 243.3 ± 87.2 minutes, and 157.0 ± 60.2 minutes. The total, CPB, and AC times of total-arch operation were 747.8 ± 164.3 minutes, 476.4 ± 121.6 minutes, and 238.5 ± 67.6 minutes. The mortality of hemi-arch operation was 3.3%, and that of total-arch operation was 6.4%. The incidence of complications after hemi-arch operation was 11.3%, and that after total-arch operation was 46.2%. The ICU time and hospital stay after hemi-arch surgery were 7.3 ± 4.4 days and 27.2 ± 16.2 days, respectively, and the ICU time and total hospital stay after total-arch surgery were 7.2 ± 5.9 days and 24.0 ± 10.3 days, respectively. The total drainage volume after hemi-arch operation was 2182.4 ± 1236.4 ml, and that after total-arch operation was 2467.3 ± 1385.7 ml. According to CUSUM analysis, the same cardiovascular surgery team seems to have different learning curves in the time of two operations. CUSUM analysis of intraoperative and postoperative indicators shows that after a certain period of professional and systematic cardiovascular surgery training, aortic hemi-arc","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128294100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
It's your first day as the surgery resident working in the cardiac surgery intensive care unit (ICU) and you are accepting the hand-off of a cardiac surgery patient that your senior resident has brought up from the operating room for admission to the ICU. During the handoff, your resident colleague tells you that the patient is 'oozing a lot and that the operating team, after a diligent search for bleeding sites, does not believe that the oozing is 'surgical.' She announces that your job will, therefore, be to stop the ongoing oozing, while, of course, being alert to the possible development of tamponade physiology.
{"title":"All Bleeding Stops, Eventually (But: The Sooner The Better!).","authors":"C. Tribble, L. Pham, N. Teman","doi":"10.1532/hsf.4507","DOIUrl":"https://doi.org/10.1532/hsf.4507","url":null,"abstract":"It's your first day as the surgery resident working in the cardiac surgery intensive care unit (ICU) and you are accepting the hand-off of a cardiac surgery patient that your senior resident has brought up from the operating room for admission to the ICU. During the handoff, your resident colleague tells you that the patient is 'oozing a lot and that the operating team, after a diligent search for bleeding sites, does not believe that the oozing is 'surgical.' She announces that your job will, therefore, be to stop the ongoing oozing, while, of course, being alert to the possible development of tamponade physiology.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121691014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND Aortic valve stenosis (AS) disease is the most common valvular disease in developed countries. The pathology of AS is complex, and its main processes include calcification of the valve stroma and involve genetic factors, lipoprotein deposition and oxidation, chronic inflammation, osteogenic transition of cardiac valve interstitial cells, and active valve calcification. The aim of this study was to identify potential genes associated with AS. METHODS Three original gene expression profiles (GSE153555, GSE12644, and GSE51472) were downloaded from the Gene Expression Omnibus (GEO) database and analyzed by GEO2R tool or 'limma' in R to identify differentially expressed genes (DEGs). Functional enrichment was analyzed using the ClusterProfiler package in R Bioconductor. STRING was utilized for the Protein-Protein Interaction (PPI) Network construct, and tissue-specific gene expression were identified using BioGPS database. The hub genes were screened out using the Cytoscape software. Related miRNAs were predicted in Targetscan, miWalk, miRDB, Hoctar, and TarBase. RESULTS A total of 58 upregulated genes and 20 downregulated genes were screened out, which were mostly enriched in matrix remodeling and the immune system process. A module was thus clustered into by PPI network analysis, which mainly involved in Fc gamma R-mediated phagocytosis, Osteoclast differentiation. Ten genes (IBSP, NCAM1, MMP9, FCGR3B, COL4A3, FCGR1A, THY1, RUNX2, ITGA4, and COL10A1) with the highest degree scores were subsequently identified as the hub genes for AS by applying the CytoHubba plugin. And hsa-miR-1276 was finally identified as potential miRNA and miRNA-gene regulatory network was constructed using NetworkAnalyst. CONCLUSIONS Our analysis suggested that IBSP, NCAM1, MMP9, FCGR3B, COL4A3, FCGR1A, THY1, RUNX2, ITGA4, and COL10A1 might be hub genes associated with AS, and hsa-miR-1276 was potential miRNA. This result could provide novel insight into pathology and therapy of AS in the future.
背景:主动脉瓣狭窄(AS)是发达国家最常见的瓣膜疾病。AS的病理复杂，其主要过程包括瓣膜间质钙化，涉及遗传因素、脂蛋白沉积氧化、慢性炎症、心脏瓣膜间质细胞成骨转化、活动性瓣膜钙化等。本研究的目的是确定与AS相关的潜在基因。方法从gene expression Omnibus (GEO)数据库中下载三个原始基因表达谱(GSE153555、GSE12644和GSE51472)，使用GEO2R工具或R中的“limma”进行分析，鉴定差异表达基因(deg)。使用R Bioconductor中的ClusterProfiler包分析功能富集。利用STRING构建蛋白-蛋白相互作用(Protein-Protein Interaction, PPI)网络，利用BioGPS数据库鉴定组织特异性基因表达。利用Cytoscape软件筛选中心基因。在Targetscan、miWalk、miRDB、Hoctar和TarBase中预测了相关mirna。结果共筛选出58个上调基因和20个下调基因，这些基因主要富集在基质重塑和免疫系统过程中。因此，通过PPI网络分析聚类成一个模块，主要涉及Fc γ r介导的吞噬作用、破骨细胞分化。随后，通过CytoHubba插件鉴定出10个程度得分最高的基因(IBSP、NCAM1、MMP9、FCGR3B、COL4A3、FCGR1A、THY1、RUNX2、ITGA4和COL10A1)为as的枢纽基因。最终确定hsa-miR-1276为潜在miRNA，并利用NetworkAnalyst构建miRNA-基因调控网络。结论通过分析发现，IBSP、NCAM1、MMP9、FCGR3B、COL4A3、FCGR1A、THY1、RUNX2、ITGA4、COL10A1可能是与AS相关的枢纽基因，hsa-miR-1276可能是潜在的miRNA。该结果可为今后AS的病理和治疗提供新的思路。
{"title":"Bioinformatic-based Identification of Genes Associated with Aortic Valve Stenosis.","authors":"Chaona Song, Shixiong Wei, Yunlong Fan, Shengli Jiang","doi":"10.1532/hsf.4263","DOIUrl":"https://doi.org/10.1532/hsf.4263","url":null,"abstract":"BACKGROUND\u0000Aortic valve stenosis (AS) disease is the most common valvular disease in developed countries. The pathology of AS is complex, and its main processes include calcification of the valve stroma and involve genetic factors, lipoprotein deposition and oxidation, chronic inflammation, osteogenic transition of cardiac valve interstitial cells, and active valve calcification. The aim of this study was to identify potential genes associated with AS.\u0000\u0000\u0000METHODS\u0000Three original gene expression profiles (GSE153555, GSE12644, and GSE51472) were downloaded from the Gene Expression Omnibus (GEO) database and analyzed by GEO2R tool or 'limma' in R to identify differentially expressed genes (DEGs). Functional enrichment was analyzed using the ClusterProfiler package in R Bioconductor. STRING was utilized for the Protein-Protein Interaction (PPI) Network construct, and tissue-specific gene expression were identified using BioGPS database. The hub genes were screened out using the Cytoscape software. Related miRNAs were predicted in Targetscan, miWalk, miRDB, Hoctar, and TarBase.\u0000\u0000\u0000RESULTS\u0000A total of 58 upregulated genes and 20 downregulated genes were screened out, which were mostly enriched in matrix remodeling and the immune system process. A module was thus clustered into by PPI network analysis, which mainly involved in Fc gamma R-mediated phagocytosis, Osteoclast differentiation. Ten genes (IBSP, NCAM1, MMP9, FCGR3B, COL4A3, FCGR1A, THY1, RUNX2, ITGA4, and COL10A1) with the highest degree scores were subsequently identified as the hub genes for AS by applying the CytoHubba plugin. And hsa-miR-1276 was finally identified as potential miRNA and miRNA-gene regulatory network was constructed using NetworkAnalyst.\u0000\u0000\u0000CONCLUSIONS\u0000Our analysis suggested that IBSP, NCAM1, MMP9, FCGR3B, COL4A3, FCGR1A, THY1, RUNX2, ITGA4, and COL10A1 might be hub genes associated with AS, and hsa-miR-1276 was potential miRNA. This result could provide novel insight into pathology and therapy of AS in the future.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127168103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Total anomalous pulmonary venous drainage (TAPVD) is caused by the absence of the congenital connection between the pulmonary vein and left atrium. This causes blood drainage into the right atrium, resulting in poor development of the left atrium and increasing the burden for the right atrium. It is accompanied by an atrial septal defect. TAPVD mostly is diagnosed during the fetal period and rarely is reported in adults. Atrial fibrillation (AF), a common arrhythmia, originates primarily from the joint of the pulmonary vein and left atrium, whereas AF originating from the right atrium has not been documented. Herein, we report the case of a 45-year-old male diagnosed with TAPVD accompanied by AF. After the correction of TAPVD and radiofrequency ablation (RFA) for AF performed under general anesthesia and cardiopulmonary bypass, the patient returned to normal sinus rhythm and showed no AF recurrence during two years of follow up.
{"title":"Surgical Treatment of Total Anomalous Pulmonary Venous Drainage with Atrial Fibrillation in an Adult: A Case Report and Literature Review.","authors":"Jun Xiang, Shuliang Wei","doi":"10.1532/hsf.4313","DOIUrl":"https://doi.org/10.1532/hsf.4313","url":null,"abstract":"Total anomalous pulmonary venous drainage (TAPVD) is caused by the absence of the congenital connection between the pulmonary vein and left atrium. This causes blood drainage into the right atrium, resulting in poor development of the left atrium and increasing the burden for the right atrium. It is accompanied by an atrial septal defect. TAPVD mostly is diagnosed during the fetal period and rarely is reported in adults. Atrial fibrillation (AF), a common arrhythmia, originates primarily from the joint of the pulmonary vein and left atrium, whereas AF originating from the right atrium has not been documented. Herein, we report the case of a 45-year-old male diagnosed with TAPVD accompanied by AF. After the correction of TAPVD and radiofrequency ablation (RFA) for AF performed under general anesthesia and cardiopulmonary bypass, the patient returned to normal sinus rhythm and showed no AF recurrence during two years of follow up.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"74 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125188644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mingkui Zhang, Zhengjie Zhang, Hui Xue, L. Fan, Yan-qiong Wen
BACKGROUND Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic cardiomyopathy characterized by microvascular ischemia and myocardial fibrosis. Microvessels play an important role in myocardial fibrosis in HOCM. However, the changes of myocardial microvessels and myocardial fibrosis in pediatric and adult patients with HOCM remain unclear. This study was to investigate the changes in myocardial microvessel density (MVD) and myocardial fibrosis in pediatric and adult patients with HOCM. METHODS We analyzed the changes in MVD and myocardial fibrosis in myectomy left ventricular (LV) septal wall specimens in 12 adult patients and five pediatric patients with HOCM. Control myocardium from the LV septal wall was collected at autopsy of 5 adults and 4 pediatric individuals, who died of non-cardiac causes. RESULTS There was no significant difference in MVD between pediatric HOCM patients and control subjects (706.4±187.5 vs. 940.2±491.1, P > 0.05), but the myocardial fibrosis area ratio was significantly increased in HOCM than in control subjects (10.6±3.5 vs. 4.9±1.2, P < 0.01). MVD was significantly reduced, and myocardial fibrosis area ratio was significantly higher in adult HOCM patients than in control subjects (i.e. 523.3± 209.4 vs. 845.7±260.7, P < 0.05; 12.8±5.1 vs. 4.4±1.3, P < 0.05). There was no significant difference in MVD and myocardial fibrosis between pediatric and adult HOCM patients (706.4±187.5 vs. 523.3±209.4, P > 0.05; 10.6±3.5 vs. 12.8±5.1, P > 0.05). Conclusions: Pediatric and adult patients with HOCM have high myocardial fibrosis. The present findings suggest that myocardial microvascular density lesions contribute to myocardial fibrosis during childhood.
{"title":"Microvascular Rarefaction and Myocardial Fibrosis in Hypertrophic Obstructive Cardiomyopathy: A Histopathological Comparison of Pediatric and Adult Patients.","authors":"Mingkui Zhang, Zhengjie Zhang, Hui Xue, L. Fan, Yan-qiong Wen","doi":"10.1532/hsf.4277","DOIUrl":"https://doi.org/10.1532/hsf.4277","url":null,"abstract":"BACKGROUND\u0000Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic cardiomyopathy characterized by microvascular ischemia and myocardial fibrosis. Microvessels play an important role in myocardial fibrosis in HOCM. However, the changes of myocardial microvessels and myocardial fibrosis in pediatric and adult patients with HOCM remain unclear. This study was to investigate the changes in myocardial microvessel density (MVD) and myocardial fibrosis in pediatric and adult patients with HOCM.\u0000\u0000\u0000METHODS\u0000We analyzed the changes in MVD and myocardial fibrosis in myectomy left ventricular (LV) septal wall specimens in 12 adult patients and five pediatric patients with HOCM. Control myocardium from the LV septal wall was collected at autopsy of 5 adults and 4 pediatric individuals, who died of non-cardiac causes.\u0000\u0000\u0000RESULTS\u0000There was no significant difference in MVD between pediatric HOCM patients and control subjects (706.4±187.5 vs. 940.2±491.1, P > 0.05), but the myocardial fibrosis area ratio was significantly increased in HOCM than in control subjects (10.6±3.5 vs. 4.9±1.2, P < 0.01). MVD was significantly reduced, and myocardial fibrosis area ratio was significantly higher in adult HOCM patients than in control subjects (i.e. 523.3± 209.4 vs. 845.7±260.7, P < 0.05; 12.8±5.1 vs. 4.4±1.3, P < 0.05). There was no significant difference in MVD and myocardial fibrosis between pediatric and adult HOCM patients (706.4±187.5 vs. 523.3±209.4, P > 0.05; 10.6±3.5 vs. 12.8±5.1, P > 0.05). Conclusions: Pediatric and adult patients with HOCM have high myocardial fibrosis. The present findings suggest that myocardial microvascular density lesions contribute to myocardial fibrosis during childhood.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133470212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND Scapulothoracic dissociation (STD) is a rare, life-threatening injury, usually resulting from high energy and leading to poor clinical outcomes and high incidence of disability. This case and a review of the literature aimed to highlight the early diagnosis and management of STD. CASE PRESENTATION A 61-year-old man was injured in a motorcycle accident, when he took a sudden turn and fell from his motorcycle. He was admitted to the emergency department of Changsha Central Hospital. Based on the computed tomography (CT) and digital subtraction angiogram (DSA) findings, the patient was diagnosed as follows: right scapulothoracic dislocation syndrome, right subclavian artery rupture, right subclavian vein rupture, right clavicular fracture, right multiple rib fractures, and right lung contusion and laceration. An expanded polytetrafluoroethylene interposition graft was implemented in the right subclavian artery to re-establish continuity of the subclavian artery. Surgery was performed to repair thoracic deformity, and active rehabilitation therapy also was implemented after surgery. The patient was discharged from the hospital and recovered well with grade 4 muscle strength in his right arm. CONCLUSIONS Physicians should be vigilant for STD in all patients with shoulder girdle injury. DSA could be recommended for patients with unstable hemodynamics. Early diagnostic image tests and individualized management should be implemented, according to the patient's condition.
{"title":"A Case Report of Scapulothoracic Dissociation and Literature Review.","authors":"Fengning Tang, Yong Long, Changluo Li, Ning Ding","doi":"10.1532/hsf.4109","DOIUrl":"https://doi.org/10.1532/hsf.4109","url":null,"abstract":"BACKGROUND\u0000Scapulothoracic dissociation (STD) is a rare, life-threatening injury, usually resulting from high energy and leading to poor clinical outcomes and high incidence of disability. This case and a review of the literature aimed to highlight the early diagnosis and management of STD.\u0000\u0000\u0000CASE PRESENTATION\u0000A 61-year-old man was injured in a motorcycle accident, when he took a sudden turn and fell from his motorcycle. He was admitted to the emergency department of Changsha Central Hospital. Based on the computed tomography (CT) and digital subtraction angiogram (DSA) findings, the patient was diagnosed as follows: right scapulothoracic dislocation syndrome, right subclavian artery rupture, right subclavian vein rupture, right clavicular fracture, right multiple rib fractures, and right lung contusion and laceration. An expanded polytetrafluoroethylene interposition graft was implemented in the right subclavian artery to re-establish continuity of the subclavian artery. Surgery was performed to repair thoracic deformity, and active rehabilitation therapy also was implemented after surgery. The patient was discharged from the hospital and recovered well with grade 4 muscle strength in his right arm.\u0000\u0000\u0000CONCLUSIONS\u0000Physicians should be vigilant for STD in all patients with shoulder girdle injury. DSA could be recommended for patients with unstable hemodynamics. Early diagnostic image tests and individualized management should be implemented, according to the patient's condition.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"77 2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133470712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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