【摘要】 目的 觀察長期大量酒精攝入對大鼠心肌結構及心肌組織中丙二醛(MDA)、超氧化物歧化酶(SOD)和金屬硫蛋白(MT)含量的影響,探討氧化應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,隨機分為2組,即對照組20只和模型組25只。模型組酒精濃度從5%、10%、20%和30%依次各自由飲1周,然后遞增至36%后以該濃度維持飼喂。對照組每日飲用與模型組酒精同等熱量的葡萄糖水。6個月后,觀察大鼠心肌組織的形態學改變及超微結構的變化,測定心肌組織中MDA、SOD及MT的含量。結果 模型組大鼠心肌細胞排列紊亂、間質充血、炎細胞浸潤、線粒體腫脹、空泡形成、肌絲溶解、核膜不規則和核仁裂解。心肌組織中MDA含量明顯升高(Plt;0.01),SOD活力含量明顯降低(Plt;0.01),MT含量明顯降低(Plt;0.01)。 結論 長期攝入大量酒精可使氧自由基代謝失衡,導致心肌損傷。氧化應激在酒精性心肌病發病機制中發揮著重要的作用。【Abstract】 Objective To observe the effect of longterm 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 Fortyfive 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(Plt;0.01)and the activities of SOD decreased(Plt;001),levels of MT decreased (Plt;0.01) in the cardiac muscular tissues in the model group compared with the control group. Conclusion Longterm 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.
We tried to explore the value of contrast echocardiography (CEcho) on evaluating hypertrophic cardiomyopathy (HCM) with the inferior wall hypertrophy. A total of 114 patients with HCM were investigated. All the patients received CEcho and routine echocardiography (Echo), and 45 of them received cardiac magnetic resonance (CMR) and 47 of them received Holter. The frequency and percentage of inferior wall hypertrophy were analyzed in HCM patients, as well as the structure and function. The results showed that: (1) Inferior wall hypertrophy was detected in 55 patients (48%) by Echo, while 68 patients (60%) by CEcho. (2) There was no significant difference between CMR and CEcho in the measurement of inferior wall at end-diastole and end-systole. Thickness of inferior wall by CEcho tended to be higher than CMR. However, the inferior wall thickness measured by Echo was obviously lower than that by CMR (P < 0.05) and CEcho ( P < 0.05). (3) Bland-Altman plot suggested good consistency between CEcho and CMR in measuring inferior wall thickness. 95% CI of mean differences in inferior wall thickness between CEcho and CMR were smaller in HCM patients as compared with that between Echo and CMR. Unary linear regression analysis showed good degree of fitting between CEcho and CMR. (4) Holter showed that HCM patients with inferior wall hypertrophy were likely to have higher incidence of premature ventricular complexes (PVC) ≥ 500/24 h. We demonstrate that CEcho is rather sensitive in detecting inferior wall hypertrophy. Echo may underestimate the inferior wall thickness. The risk of ventricular premature beats may increase in HCM patients with inferior hypertrophy.
ObjectiveTo analyze the risk factors for pediatric heart transplantation at a single center and its impact on short-term prognosis, providing experience and reference for pediatric heart transplantation. MethodsThe children who underwent heart transplantation from May 2022 to May 2024 at the Seventh Medical Center of Chinese PLA General Hospital were included in this study. We conducted a retrospective analysis of the clinical data of donors and recipients, perioperative conditions, and postoperative complications. The double-lumen venoplasty technique was used for all surgeries. Basiliximab was applied for immune induction during and after the operation (on the 4th day). Tacrolimus+mycophenolate mofetil+prednisolone acetate was used for postoperative immunosuppressive maintenance treatment. According to whether patients had a history of extracorporeal membrane oxygenation (ECMO) installation before surgery, they were divided into an ECMO group and a non-ECMO group. The postoperative ICU stay time, postoperative ventilator assistance time, aortic clamping time, cardiopulmonary bypass time, recipient body surface area, left ventricular ejection fraction, X-ray cardiothoracic ratio, donor heart cold ischemia time, and the weight ratio between donor and recipient were compared between the two groups, and correlation analysis was performed. ResultsA total of 17 children were included, with 10 (58.8%) males and 7 (41.2%) females. Their ages ranged from 7 months to 16 years, with a median age of 11.0 (10.0, 13.0) years. Their weights ranged from 7.0 to 67.5 kg, with an average weight of (41.6±16.7) kg. Of the 17 children, 16 survived post-operation, and 1 died 5 days after the operation. Five patients were ABO incompatible heart transplantations, and 11 patients had a history of ECMO installation before surgery. The left ventricular ejection fraction of the non-ECMO group was higher than that of the ECMO group (t=2.188, P=0.045). The postoperative ICU stay time and postoperative ventilator assistance time (r=0.599, P=0.011), and cardiopulmonary bypass time (r=0.667, P=0.003) were positively correlated. The cardiothoracic ratio was negatively correlated with the postoperative ventilator assistance time (r=?0.527, P=0.030). ConclusionPediatric heart transplantation is an effective treatment method for children with end-stage heart failure. The left ventricular ejection fraction of the recipient may be a predictive factor indicating that the child needs ECMO assistance. Longer extracorporeal circulation time and larger recipient body surface area may affect the surgical process and perioperative prognosis.
ObjectiveTo explore the effect and safety of surgical treatment for hypertrophic obstructive cardiomyopathy (HOCM) with mitral regurgitation (MR) through right mini-thoracotomy.MethodsFrom January 2008 to June 2018, 54 patients with HOCM and moderate-to-severe MR underwent modified Morrow procedure and edge-to-edge mitral valvuloplasty through right mini-thoracotomy, including 31 males and 23 females, with an average age of 47.1±12.6 years. All patients had systolic anterior motion (SAM) phenomenon. Preoperative left ventricular outflow tract pressure gradient (LVOTPG) was 93.6±32.8 mm Hg, interventricular septum thickness (IVST) was 24.8±2.8 mm.ResultsSurgeries in all patients were completed successfully. No early death or interventricular septal perforation occurred. One (1.9%) patient received permanent pacemaker implantation due to the complete atrial-ventricular block. At discharge, postoperative LVOTPG (18.1±6.2 mm Hg) and IVST (14.5±2.1 mm) were significantly decreased compared with the preoperative values (P<0.05). No MR or SAM was observed in all patients. The follow-up time was 6-132 months, and during this period, no death, MR or SAM occurred. The average LVOTPG was 19.4±5.7 mm Hg, and the average IVST was 14.2±1.5 mm.ConclusionMorrow procedure and edge-to-edge mitral valvuloplasty through right mini-thoracotomy is a safe and effective method for treatment of HOCM with moderate-to-severe MR.
Objective To summarize the surgical treatment strategies and the clinical outcomes of hypertrophic obstructive cardiomyopathy (HOCM) with severe mitral regurgitation. Method We retrospectively analyzed the clinical data of 23 patients of HOCM with severe mitral regurgitation in our hospital from January 2004 through January 2014 year. There were 14 males and 9 females, aged from 15-71(50.2±15.4) years. The preoperative left ventricular outflow tract gradient (LVOTPG) of these patients was 75-161(98.1±19.3) mm Hg. And the septal thickness was 25.8±2.8 mm. All 23 patients had at least moderate mitral regurgitation and systolic anterior motion (SAM). All of them had extend septal myectomy (extend Marrow procedure) and mitral valve repair(MVP),while 4 patients with atrial fibrillation had left atrial ablation and left atrial appendage operation. Results All patients were successfully operated. The left ventricular outflow tract pressure gradient was 16-39(26.9±4.9) mm Hg when the cardiopulmonary bypass stopped and SAM phenomenon was completely eliminated. Except for 2 mitral valve patients with trace amounts of regurgitation, 1 patient with mild regurgitation, the other 20 patients of mitral regurgitation were completely corrected. All patients survived after operation and only 1 patient suffered from transient complete atrioventricular block and then back to normal sinus rhythm. A long-term follow-up from 6 months to 126 months with an average of 53.1±34.9 months showed no late postoperative death. No mitral regurgitation need reoperation. Two patients had mild reflux. Four patients were of trace reflux. The left ventricular outflow tract the maximum pressure gradient was less than 42 mm Hg. The thickness of interventricular septum dropped from preoperative 25.8±2.8 mm to postoperative 14.1±1.3 mm (P<0.001) . No recurrence was noted in the 3 patients with atrial fibrillation. And one patient still had paroxysmal atrial fibrillation. Long term follow-up of the patients' symptoms disappeared or with only mild symptoms. And quality of their life improved significantly. And there was no long-term complication, reoperation, or death. Conclusions The extensive septal myectomy can completely dredge left ventricular outflow tract stenosis and eliminate SAM phenomenon. The mitral valve repair can correct mitral regurgitation. The comprehensive surgical treatment strategy can achieve a good long-term therapeutic effect.
Objective To evaluate the clinical and follow-up results of the surgical treatment for hypertrophic obstructive cardiomyopathy associated with aortic stenosis. Methods We retrospectively analyzed the clinical data of the patients with hypertrophic obstructive cardiomyopathy plus aortic stenosis in our hospital from February 2008 to October 2015. There were 4 males and 3 females aged 55.6 ± 7.5 years. All the patients were received concomitant aortic valvulopasty at the time of modified extended Morrow procedure. Echocardiographic data and major complications were recorded through the outpatient clinic and telephone. Results The postoperative ventricular septal thickness, left ventricular outflow tract gradient and aortic gradient were significantly lower than those in preoperation with statistical differences (P<0.05). During the mean follow-up 25.6 ± 28.2 months period, 1 patient died of cerebral hemorrhage, 1 patient was implanted a permanent pacemaker, and 1 patient had a postoperative new-onset atrial fibrillation. All patients had a satisfied prosthetic valve function and the left ventricular outflow tract gradient. The patient's symptoms and heart function significantly improved postoperatively. Conclusion For patients with hypertrophic obstructive cardiomyopathy associated with moderate to severe aortic stenosis, concomitant aortic valvulopasty at the time of modified extended Morrow procedure is an appropriate and effective treatment, which can significantly alleviate the clinical symptoms, and improve quality of life with a satisfied prognosis.
Objective To analyze the long-term outcome of modified Morrow surgery (interventricular septal cardiomyectomy) in the treatment of hypertrophic obstructive cardiomyopathy (HOCM) in children. Methods The clinical data of the children with HOCM (aged≤14 years) who underwent modified Morrow surgery from January 2010 to August 2022 in Guangdong Provincial People's Hospital were retrospectively analyzed, including changes in hospitalization status, perioperative period, and long-term 15-lead electrocardiogram and echocardiography. Results A total of 29 patients were collected, including 22 males and 7 females, aged 10.00 (5.00, 12.00) years. Five (17.9%) patients had New York Heart Association (NYHA) heart function grade Ⅲ or Ⅳ. Ventricular septal cardiomyectomy was performed in all patients. All 29 patients survived and their cardiac function recovered after operation. Before discharge, right bundle branch block was observed in 2 patients and left bundle branch block in 6 patients. After surgery, in the left ventricular septal cardiomyectomy, the left atrial diameter decreased (P＜0.001), left ventricular end-systolic diameter increased (P=0.009), the peak pressure gradient of left ventricular outflow tract decreased (P＜0.001), and the thickness of ventricular septum decreased (P＜0.001). The systolic anterior motion of mitral valve disappeared and mitral regurgitent jet area decreased (P＜0.001). The flow velocity and peak pressure gradient of right ventricular outflow tract also decreased in the patients who underwent right ventricular septal cardiomyectomy. The average follow-up of the patients was 69.03±10.60 months. All the patients survived with their NYHA cardiac function grading Ⅰ or Ⅱ. No new-onset arrythmia event was found. Echocardiography indicated that the peak pressure gradient of the left ventricular outflow tract remained low (P<0.001). Moderate mitral regurgitation occurred in 2 patients, and left ventricular outflow tract obstruction with moderate mitral regurgitation occurred in 1 patient after simple right ventricular septal cardiomyectomy. Conclusion Right ventricular or biventricular obstruction is frequent in the children with HOCM and they usually have more symptoms before surgery. Modified Morrow surgery can effectively relieve outflow tract obstruction and improve their cardiac function. The long-term outcome is satisfactory. However, the posterior wall of the left ventricle remains hypertrophic. Also, there is an increased risk of a conduction block.
目的:本文通過研究白介素23受體(IL-23R)基因多態性與擴張型心肌病(DCM)的相關性,探討DCM患者的免疫遺傳學發病機制. 方法:采用PCR-RFLP方法測定DCM患者和正常對照者IL-23R基因rs7517847位點的單核苷酸多態性. 用卡方檢驗比較病例組與對照組之間基因型頻率和等位基因頻率的統計學差異。結果:IL-23R基因rs7517847位點單核苷酸多態基因型和等位基因頻率在DCM組與正常對照組之間無差異。結論:本研究未發現IL-23R基因rs7517847位點多態性與DCM相關。