Effect of Shengmai Injection (生脉注射液) on Vascular Endothelial and Heart Functions in Patients with Coronary Heart Disease Complicated with Diabetes Mellitus

Objective： To study the effect of Shengmai injection （生脉注射液, SMI） on vascular endothelial and heart functions in coronary heart disease patients complicated with diabetes mellitus （CHD-DM）. Methods： One hundred and twenty patients with CHD-DM, their diagnosis confirmed by coronary arteriography, were equally randomized into a control group treated with conventional treatment and a treated group treated with conventional treatment plus SMI. The changes in blood levels of nitric oxide （NO）, endothelin-1 （ET-1） and angiotensin Ⅱ （Ang Ⅱ）, as well as endothelium-dependent vascular dilating function and heart function in the patients were observed before treatment and after the 3-week treatment. Results： After being treated with SMI for 3 weeks, in the treated group, blood level of NO was raised significantly from 69.8±33.1 μmol/L to 120.1±50.8μmol/L, and ET-1 was lowered from 70.1±32.1 ng/L to 46.2±21.3 ng/L, respectively （P〈0.01）; that of Ang Ⅱ was lowered from 81.3±24.3 ng/L to 50.2±27.3 ng/L （P〈0.01）; brachial arterial post-congestion blood flow increasing rate was raised from 389.4±26.3% to 459.3±27.8% （P〈0.01）; and the improvement in heart function as seen through the ejection fraction （EF） was increased from 44±5% to 68±6% （P〈0.01）, all the changes being more significant than those in the control group （all P〈0.01）. Conclusion： SMI can improve not only the endothelial function in CHD-DM patients, but also heart contraction significantly.

Effects of C2 hemisection on respiratory and cardiovascular functions in rats

High ce rvical spinal co rd injuries induce permanent neuromotor and autonomic deficits.These injuries impact both central respiratory and cardiovascular functions through modulation of the sympathetic nervous system.So far,cardiovascular studies have focused on models of complete contusion or transection at the lower cervical and thoracic levels and diaphragm activity evaluations using invasive methods.The present study aimed to evaluate the impact of C2 hemisection on different parameters representing vital functions(i.e.,respiratory function,cardiovascular,and renal filtration parameters)at the moment of injury and 7 days post-injury in rats.No ventilatory parameters evaluated by plethys mography were impacted during quiet breathing after 7 days post-injury,whereas permanent diaphragm hemiplegia was observed by ultrasound and confirmed by diaphragmatic electromyography in anesthetized rats.Interestingly,the mean arterial pressure was reduced immediately after C2 hemisection,with complete compensation at 7 days post-injury.Renal filtration was unaffected at 7 days post-injury;however,remnant systolic dysfunction chara cterized by a reduced left ventricular ejection fraction persisted at 7 days post-injury.Taken together,these results demonstrated that following C2 hemisection,diaphragm activity and systolic function are impa cted up to 7 days post-injury,whereas the respiratory and cardiovascular systems display vast ada ptation to maintain ventilatory parameters and blood pressure homeostasis,with the latter likely sustained by the remaining descending sympathetic inputs spared by the initial injury.A better broad characterization of the physiopathology of high cervical spinal cord injuries covering a longer time period post-injury could be beneficial for understanding evaluations of putative therapeutics to further increase cardiorespiratory recovery.

Improvement of increased cQTd is associated with heart function in patients with ischemic heart failure

Background Chronic heart failure （CHF） is life-threatening without timely or effective intervention. In this study, we investigated the association between QT dispersion corrected for heart rate （cQTd） and heart function in patients with CHF. Methods From January 2013 to December 2015, we continuously enrolled 240 patients categorized as New York Heart Association functional class （NYHA） III-IV with a left ventricular ejection fraction （LVEF） 〈 40%. Based on the etiology, the patients were divided into a dilated cardiomyopathy （DCM） group （n = 120） and an ischemic cardiomyopathy （ICM） group （n = 120）. Then, based on the cQTd width, the ICM group was divided into two subgroups： a QS group （cQTd ≤60 ms, n = 70） and a QL group （cQTd 〉 60 ms, n = 50）. All patients were examined by echocardiography and 12-lead electrocardiography （ECG） at 1, 3, 6, and 12 months after enrollment. Results After one year of optimized medical treatment, patients in both groups showed significant improvement in LVEF and NYHA classification from baseline. However, the cQTd in the ICM group, especially the QL, was significantly shorter than that in the DCM group at each time point. In addition, the cQTd was negatively correlated with LVEF and 6-min walking test and positively correlated with NYHA class in the ICM group. Conclusions The present findings clearly demonstrate that cQTd is a meaningful parameter for assessing heart function in the follow-up of ICM patients.

Echocardiographic Evaluation of Cardiac Dyssynchrony in Patients with Congestive Heart Failure

The present study investigated the application of echocardiography to evaluation of cardiac dyssynchrony in patients with congestive heart failure（CHF）. A total of 348 consecutive CHF patients who were admitted for cardiac resynchronization（CRT） and presented with low ejection fraction（EF） and wide QRS duration were enrolled in this study, along with 388 healthy individuals. Dyssynchrony was assessed based on filling time ratio（FT/RR）, left ventricular pre-ejection delay（PED）, interventricular mechanical delay（IVMD）, longitudinal opposing wall delay（LOWD） and radial septal to posterior wall delay（RSPWD）. Response to CRT was defined as a ≥15% increase in EF. The results showed that FT/RR was decreased while PED, IVMD, LOWD and RSPWD were increased in the CHF group compared with the control group（P〈0.01）. In the CHF group, FT/RR was negatively correlated with the QRS duration, LV end-diastolic diameter（LVESd）, LV end-diastolic volume（LVEDV） and LV end-systolic volume（LVESV）（P〈0.01）, but positively with the LVEF（P〈0.01）. Additionally, PED, IVMD, LOWD and RSPWD were positively correlated with the QRS duration, LVESd, LVEDV and LVESV（P〈0.01）, but negatively with the LVEF（P〈0.01）. The CHF group was divided into three subgroups according to the varying degrees of LVEF. FT/RR decreased successively from the LVEF-1 group to the LVEF-2 group to the LVEF-3 group, while the PED, IVMD, LOWD and RSPWD successively increased in the same order（P〈0.01）. The CHF group was divided into three subgroups according to the varying degrees of QRS duration, and FT/RR decreased successively in a sequence from the QRS-1 group to the QRS-2 group to the QRS-3 group, while the PED, IVMD, LOWD and RSPWD successively increased in the same order（P〈0.01）. Speckle tracking radial dyssynchrony ≥130 ms was predictive of an EF response in patients in QRS-1 group（78% sensitivity, 83% specificity）, those in QRS-2 group（83% sensitivity, 77% specificity） and in QRS-3 group（89% sensitivity, 79% specificity）. In conclusion, echocardiography is a convenient and sensitive method for evaluating cardiac dyssynchrony in patients with CHF.

THE EFFECT OF ACUTE MYOCARDIUM ISCHEMIC ON HEART FUNCTION OF PREGNANCY RAT

Objective To investigate the effect of acute myocardium ischemic on heart function of pregnancy rat. Methods 13 female SD rats and 6 early pregnancy rats were divided into normal group, unpregnant group with acute myocardial infarction and early pregnant group with acute myocardial infarction. The anterior branch of the left coronary artery was ligated. 3 weeks later, Image 1.31 software was used to measure areas of myocardial infarction, and to evaluate hemodynamics of heart with powerLAB4.12, and cardiac tissues were stained with Massion. Results Compared with unpregnant group with acute myocardial infarction , the early pregnant group with acute myocardial infarction had less myocardial infarction area (28.86% vs. 36.8%),and had a higher left ventricle end systolic pressure, ±dp/dt _ max , and lower left ventricle end diastolic pressure. Massion stain showed the amount of collagen of the lesion was less in the early pregnant group with acute myocardial infarction than that in unpregnant group. Conclusion The early pregnant group with acute myocardial infarction had better heart contractive and diastolic function .

DIETARY MAGNESIUM DEFICIENCY INCREASES LEVELS AND FUNCTION OF Giα IN THE RAT HEART AFTER MYOCARDIAL INFARCTION

Magnesium(Mg) is crucial for the function of G proteins which play important roles in mediating the inotropic effects of β adrenergic agonists in the heart and are alteredin heart failure.This study was performed to determine whether or not dietary Mg deficiency alters functional activity and levels of the two major ventricular G proteins, Gia and Gsa in the heart after myocardial infarction(MI).Six week old rats were fed a Mg adequate or deficient diet for 6 weeks.At the end of week 3,MI was induced by coronary artery ligation.A sham operation was performed as control.After surgery,surviving animals were maintained on their assigned diets for another 3 weeks.Then,cardiac function was measured.Severe hypomagnesemia and increased plasma catecholamine level were observed in all animals fed the Mg deficient diet.A significant reduction of ruyocardial Mg concentration accompanied by elevated plasma and myocardial calcium concentrations was observed in MI animals with existing Mg deficiency vs.animals fed the Mg adequate diet.Cardiac function was impaired in MI rats and further reduced in MI rats with existing Mg deficiency. Gia level was not altered by either Mg deficiency or MI alone,but was dramatically elevated in animals with combined Mg deficiency and MI (9. 9±0.7 arbitrary unit.mg-1 protein) as compared to MI alone (5.8±0. 6,P<0.05 )and Mg deficiency alone(6.1± 0.8,P<0.05 ). Gsa level did not differ between groups.Bacal,GppNHp-and forskolin-but not fluoride-, stimulated adenylyl cyclase activity was signifcantly reduced in MI animals with existing Mg deficiency indicating increased functional activity of Gia.The findings suggest that dietary Mg deficiency increases the expression and functional ac tivity of Gia in the heart after MI, while levels and function of Gsa are not compromised during dietary Mg deficiency either with or without MI.

DYNAMIC CHANGES IN Giα2 LEVELS IN THE RAT HEART ASSOCIATED WITH IMPAIRED CARDIACFUNCTION FOLLOWING ACUTE MYOCARDIAL INFA RCTION

Changes in the functional activity and levels of Gsa and Gia in heart failure have been studied predominantly in the end-stage failing heart.The objective of this study was to determine if levels and function of Gsa and Gia2 in rat hearts change over time following acute myocar(lial infarction (MI) and if so,whether the changes in G proteins are associated with changes in heart function.As compared with sham-operated controls, Giα2, level of MI rats did not change at day l,increased by 64% at day 3 (P<0.01) and 55% at day 9 (P< 0.05)accompanied by reduced adenylyl cyclase activity,and returned to control by day 21. By contrast,Gsa level did not change at any time. Cardiac function in MI animals was markedly impaired at days 1,3 and 9 as evidenced by substantial elevation in LVEDP and reduction in +and -dp/dtmax,and partially restored at day 21. The increased Gia2level in MI rats at days 3 and 9 correlated positively to LVEDP(P< 0.05), and negatively to +and -dp/dtmax (p < 0. 01).The results show a three phase dynamic pattern in Gia2 level following acute MI:a lag phase, an increased expression phase associated with marked impairment of heart function,and a late phase in which the expression retums to control level accompanied by partially restored cardlac function.The results suggest that ② in G protein-mediated pathways,cardiac myocytes respond to MI Via regulating the gene expression of the inhibitory pathway, and ② up-regulation of Gia2 levels is related to the severity of impairment in cardiac function.

The value of real-time three-dimensional echocardiography in evaluating left ventricular function for different degrees of heart failure

Objective:To explore the value and feasibility of real-time three-dimensional echocardiography(RT-3DE)in evaluating left ventricular function in patients with different degrees of heart failure.Methods:The 60 heart failure patients in the case group were divided into three subgroups according to the New York Heart Association(NYHA)classification:12 cases of cardiac function gradeⅡ,35 cases of cardiac function gradeⅢ,13 cases of cardiac function grade IV,and the other 30 cases of healthy subjects as control group.Compare the left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular ejection fraction(LVEF),and left ventricular 16,12,and 6 segments reaching the minimum systolic volume time standard deviation standardized value(Tmsv SD%),left ventricular 16,12 and 6 segments reaching the minimum systolic volume time standardized values of the maximum difference(Tmsv DIF%),analysis of the correlation between the above left ventricular function-related parameters and cardiac function grading.Results:(1)There were statistically significant differences in LVEDV and LVESV between each group(p<0.001).There was no statistically significant difference in LVEF between the cardiac function gradeⅡgroup and the control group,and between the grade IV group and the gradeⅢgroup(p=0.094 and 0.246).(2)compared with the control group,all parameters related to RT-3DE evaluation of left ventricular synchronization were prolonged in the case group,and the difference was statistically significant(p<0.001).The differences of Tmsv 16-SD%and Tmsv 16-DIF%in each subgroup of the case group were statistically significant(p<0.001).(3)LVEF was negatively correlated with NYHA classification of cardiac function(rs=-0.779,p<0.001),and LVEDV,LVESV,Tmsv 16-SD%,Tmsv 12-SD%,Tmsv 6-SD%,Tmsv 16-DIF%,Tmsv 12-DIF%,Tmsv 6-DIF%were positively correlated with NYHA function classification,showing strong correlation(rs=0.710,0.785,0.885,0.675,0.605,0.885,0.695,0.622,p<0.001),among them,Tmsv 16-SD%and Tmsv 16-Dif%have the highest correlation.Conclusion:RT-3DE can comprehensively evaluate the impairment of cardiac function.The measured parameters of left ventricular function are strongly correlated with cardiac function classification,which has impo-rtant application value for clinical judgment of the severity of heartfailure.

EFFECT OF ELECTROACUPUNCTURE OF THE HEART MERIDIAN ACUPOINTS ON ISCHEMIC CARDIAC FUNCTION IN THE RABBIT

Subjective: To observe the effect of electroacupuncture (EA) of acupoints of the Heart Meridian and Lung Meridian on ischemic cardiac systolic ability for analyzing the relative specific relationship between the Heart Meridian and the heart. Methods: Acute myocardial ischemia (AMI) was produced by intravenous infusion of pituitrin (40 u + 5% glucose injection 500 ml, 60 drips/min) in the rabbit. Left intraventricular pressure (LVP), maximal rising velocity of LVP (dp/dt max), isovolumetric pressure (IP) and end-diastolic pressure (EDP) of the left cardiac ventricle were used as the indexes. Three points of Heart Meridian [HM, from 'Shenmen' (HT 7) to 'Lingdao' (HT 4)] and the three points of Lung Meridian [LM, from 'Taiyuan' (LU 9) to 'Lieque' (LU 7)] were punctured with filiform needles and stimulated with hand-manipulation and electrically with ZY2-1 EA Therapeutic Apparatus. 30 rabbits anesthetized with urethane (1 g/kg) were randomly and evenly divided into control group, HM group and LM group. Result-s: The effects of EA of HM points were evidently superior to those of EA of LM points in promoting the recovery of both AMI-induced decrease of LVP and dp/dtmax, and AMI-induced increase of IP and EDP. Conclusion: Acupoints of Heart Meridian has a relatively specific connection with the heart in comparison with those of Lung Meridian; and the Heart Meridian is a functional whole.

RELEASE OF SERUM TROPONIN I AND ITS RELATIONSHIP TO MULTIFACTORS FOLLOWING OPEN HEART SURGERY IN CHILDREN

Objective To be released specifically after myocardial damage. The goal of this study was to measure serum cardiac troponin I levels after open heart surgery in children, and to evaluate relevance between TnTi and perioperative multi-factors. Methods Fifty-seven consecutive pediatric patients undergoing elective correction of congenital heart diseases were divided into group A （ TOF, n =31 ） and group B （ VSD, n =26）. Blood sampies were drawn preoperatively, 5min（ T0 ） , 6h（ T6 ） , 12h（ T12 ） , 24h（ T24 ） , 48h（ T48 ） , 72h（ T72 ） after removal of aortic cross clamping. Myocardial protection consisted of moderate systemic hypothermia （ 30℃- 32℃ ）, cold crystalloid cardioplegia and topical cooling. Demographic information, cardiac defect, repair procedure, duration of bypass （ CPBT） , cross-clamping time （ CCT） , clinical score for cardiac function, electrocardiographic changes and outcomes were recorded. Results Compared with the baseline value, serum concentration of troponin I peaked at T0 （ P 〈 0. 01 ）, and fell to normal level at T72 （ P 〉 0. 05 ）. Peak CTnI was 118 and 55 times higher than the baseline value, respectively in group A and group B. There was a positive correlation between peak CTnI and CPBT, CCT （ r = 0. 51 ; P 〈 0. 01 ）, myocardial operative injury after ventriculotomy and muscle resection （ r = 0. 35, P 〈0. 01 ）. Also the peak CTnl value was correlated to the clinical score for cardiac function （r = -0. 52; P 〈0. 01）. 2.3μg/L was a cutoff value which was highly predictive for postoperative recovery and inotropic support. Conclusion Postoperative serum troponin I is a highly specific and sensitive marker for myocardial ischemia and injury; therefore, its measurement may contribute to the assessment of recovery and outcome after open heart surgery.

Granulocyte-macrophage colony stimulating factor improves cardiac function in rabbits following myocardial infarction

Objective: To investigate the therapeutic potency of recombinant human Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF) in a rabbit myocardial infarction model. Methods: A myocardial infarction was created by the ligation of the major ventricular branch of the left coronary artery in rabbits. After myocardial infarction, the animals were randomly assigned to GM-CSF treatment group, untreated groups and sham-operated group. The rabbits of the treated group were injected into GM-CSF by subcutaneous administration, 10 μg/kg/day, once a day for 5 days. The untreated and sham-operated group received a equal saline in the same manner as treated group. Six weeks later echocardiography and haemodynamic assessment were undertaken to assesse cardiac function. The size of the infarct region of the heart were also studied. Results: The untreated group exhibited significant higher left ventricle end-diastolic pressure, higher central venous pressure, and with significant lower mean blood pressure, lower peak first derivative of left ventricle pressure (dP/dt) than the sham group. Also, Rabbits in untreated group display significant systolic dysfunction shown by the decreased ejection fraction, diastolic dysfunction shown by increasing in the ratio of E wave to A wave (E/A), and display left ventricle enlargement. However, GS-CSF singnificantly prevented heart dysfunction, left ventricle enlargement, and reduced infarct size in treatment group. Conclusion: Administration GM-CSF after cardiac infarction can improve heart function. These findings indicate the technique may be a novel and simple therapeutic method for ischemic myocardium.

Hemodynamic changes in depressive patients

Objective: This study is aimed at exploring the relationship between hemodynamic changes and depressive and anxious symptom in depression patients. Methods: The cardiac function indices including the left stroke index (LSI), ejection fraction (EF), heart rate (HR), diastolic pressure mean (DPM), systolic pressure mean (SPM), left ventricle end-diastolic volume (LVDV), effective circulating volume (ECV), resistance total mean (RTM) and blood flow smooth degree (BFSD) were deter-mined in 65 patients with major depressive disorders and 31 healthy normal controls. The clinical symptoms were assessed with Hamilton depression scale (HAMD) and Hamilton anxiety scale (HAMA). Results: In patients with depression without anxiety, LSI, EF, LVDV, DPM, SPM, ECV, BFSD were significantly lower than those in controls, while RTM was higher than that in controls. Patients with comorbidity of depression and anxiety showed decreased LVDV, ECV, BFSD, and increased HR in comparison with the controls. The anxiety/somatization factor score positively correlated with LSI, EF, LVDV, but negatively correlated with RTM. There was negative correlation between retardation factor score and DPM, SPM, LVDV. Conclusion: The study indicated that there are noticeable changes in left ventricle preload and afterload, blood pressure, peripheral resistance, and microcirculation in depressive patients, and that the accompanying anxiety makes the changes more complicated.

Systemic-to-pulmonary artery pressure ratio as a predictor of patient outcome following liver transplantation

AIM To assess the value of the mean systemic-to-pulmonary artery pressure(MAP/m PAP) ratio for predicting outcomes following orthotopic liver transplant(OLT). METHODS A retrospective data analysis was performed and data(mean arterial blood pressure, mean pulmonary artery pressure and Cardiac Index) were collected at several points during OLT. Outcomes evaluated were duration of postoperative endotracheal intubation [ET; minutes after intensive care unit(ICU) arrival], length of ICU stay, total hospitalization and frequency of immediate postoperative complications. A total of 91 patients were included in the data analysis. Based on the intraoperative course of the MAP/m PAP ratio, 2 hemodynamic responses were identified: Group 1(MAP/m PAP ratio increase during anhepatic period with postreperfusion recovery, n = 66); and Group 2(MAP/m PAP ratio with no change during anhepatic period or decreased without recovery, n = 25). RESULTS The main finding was that the lack of increased MAP/m PAP ratio in the anhepatic period was associated with:(1) longer intubation times; and(2) prolonged ICU stays and total hospitalization time, when compared to patients with an increase in MAP/m PAP ratio during the anhepatic period. CONCLUSION The data from this retrospective study should raise awareness to the mean systemic to pulmonary artery pressure ratio as a potential indicator for poor outcome after OLT. Further prospective studies are needed for validation.

Factors influencing survival of patient with in-hospital ventricular fibrillation： experience of a single center

Objective To evaluate the factors influencing the outcome of patients who suffered in-hospital ventricular fibrillation （IHVF）. Methods Data of patients with IHVF in a single center were collected. Clinical characteristics of patients were compared between those survived （n=112） and those died （n=94）, and those with IHVF occurred in inpatient ward and in emergency center. Multiple logistic regression analysis was used to identify factors associated with survival. Results There were 206 events in the analysis. The most common underlying disease was coronary artery disease （CAD）, especially acute myocardial infarction （AMI）. On multiple logistic regression analysis, independent predictors for failure to survive were higher NYHA class （odds ratio 1.7, 95% CI, 1.3-2.2, P〈 0.001）, lower serum potassium concentration （ [K＋] ） （odds ratio, 2.9, 95% CI, 1.9-4.3, P--0.007） and adrenaline usage （odds ratio, 25, 95% CI 11.5-55.1, P〈 0.001）. Emergency group have better NYHA class （P = 0.012）, lower [K-] （P 〈 0.001） than in inpatient ward group. Hypokalemia （serum potassium level 〈4.5 mmol/L） was found in all patients with AMI in emergency group. In AMI sub-group, 56.9% of IHVF events occurred within the first day after AMI, and decreasing within 2 weeks. Patients with fight coronary artery as infarction related artery （IRA） oRen （8/9, 88.9~,5） had bmdycardia （R-R interval 〉 ls） before the occurrence of IHVF, while those with left anterior descending artery as IRA often showed tachycardia （R-R interval 〈 0.6s） （8/12, 66.7%）. Conclusion The most common disease causing IHVF is CAD. Keeping [K＋] above 4.5mmol/1 could prevent on-setting IHVF, especially to AMI patients. The worse heart function is associated with higher rate of IHVF and worse pmgnosis （J Geriatr Cardio12010; 7：21-24）.

Assessment of Non-Contact Measurement Using a Microwave Sensor to Jugular Venous Pulse Monitoring

The jugular venous pulse (JVP) waveform provides an insight into right heart function, and its assessment is important in patients with heart failure. However, the conventional pulse-transducer (contact) method for monitoring this waveform is not frequently used because it requires a high degree of skill. The aim of this study was to confirm the effectiveness of a prototype non-contact system that employs microwave radar (24 GHz, 7 mW;non-contact system) for JVP measurement. Experiments were conducted on eight healthy male volunteers (21.88 ± 0.99 years). JVP measurements were compared between the conventional contact method and the proposed non-contact method. Change in JVP waveform was measured in response to an angle of reclining in five steps from the supine position to 75° of elevation. The obtained JVP measurements were similar between the two methods. Because in the non-contact method the faint pulsation of the JVP is not suppressed by the pressure of a sensor placed on the skin, the prototype microwave radar system is particularly suitable for evaluating the JVP waveform.

Results of Fontan in Patients with Apicocaval Juxtaposition or/and Separated Hepatic Venous Drainage

Objective:Modifications of the Fontan operation,which are also known as total cavopulmonary connection(TCPC),are widely applied for patients with functionally univentricular hearts(FUH).Herein,we summed up the different surgical pathways and clinical outcomes in FUH patients with apicocaval juxtaposition(ACJ)or/and separated hepatic venous(SHV)drainage.Methods:Between January 2009 and December 2019,123 patients who undergone TCPC in our institute were included in this retrospective study.We have included 70 patients with ACJ(Group 1)and 53 patients with SHV(Group 2).Moreover,Group 2 included 17 cases combing with ACJ(32.1%).In Group 1,three different TCPC methods were conducted.While 45 cases were conducted with the extracardiac conduit-TCPC(EC-TCPC)method,24 cases used the intracardiac conduit-TCPC(IC-TCPC)method,and only one case used the lateral tunnel-TCPC(LT-TCPC).In Group 2,four TCPC methods were conducted on patients.Forty cases used the EC-TCPC-common open technique,6 cases with IC-TCPC technique,4 cases with LT-TCPC,and 3 cases with intra-extracardiac conduit-TCPC(IEC-TCPC).Results:There were 7 patients in Group 1 and 14 patients in Group 2 who required early re-operation during hospitalization(p<0.05).Postoperative mean pulmonary artery pressure(mPAP)greater than 15 mmHg emerged as a predictor for early re-operation(p<0.01)and early death(p<0.001)in univariate analysis.Conclusions:TCPC can be performed in these patients and shows beneficial results.Under the Fontan principle of connecting systemic venous to the pulmonary vasculature unimpededly,surgeons should carefully evaluate three components when choosing for the surgical technique:The distance between inferior vena cava(IVC)and the apex;the site of the vertebrae relative to the ACJ;the distance between ACJ and SHV if coexisting.However,the technique should be altered when the postoperative mPAP was greater than 15 mmHg.

Functional Cardiological Changes Resulting from Thoracoscopic Thoracic Sympathectomy: Systematic Review

Hyperhidrosis is a condition resulting from a systemic sympathetic hyperactivity. The gold standard treatment is the resection or surgical ablation of the paravertebral sympathetic chain: the endoscopic thoracoscopic sympathectomy (ETS). Non-cardiac thoracic surgeries carry a considerable incidence of pathological postoperative cardiac events, raising attention to possible worsen cardiac functional capacity after the resection of a pair of thoracic sympathetic ganglia. The aim of this study is to investigate literature evidences of postoperative cardiovascular functional changes on patients submitted to ETS as treatment for hyperidrosis. This is a systematic review of the literature. Clinical studies published between January 1999 and April 2019 were analyzed. The PICO strategy was used to construct the question of systematic reviews research. The process of selecting articles was organized according to PRISMA Diagram. The search in electronic databases resulted in seven articles, of which one was excluded for being out of scope of the research, leaving six articles. All studies showed a pattern of heart rate (HR) reduction after endoscopic thoracic sympathectomy. It was suggested a relation between the extension of the procedure and the presence of cardiac functional alterations. There was an improvement in myocardial physical conditioning and maintenance of functional capacity. To elucidate the real mechanisms involved in the maintenance of myocardial function, and even its improvement, it is necessary to develop further studies that directly evaluate them.

Effect of Metoprolol on Cardiac Function and Prognosis in Patients with Dilated Cardiomyopathy

Objective:To investigate the effect of metoprolol on cardiac function and prognosis in patients with dilated cardiomyopathy.Methods:100 patients with dilated cardiomyopathy treated in our hospital from January 2018 to December 2019 were randomly divided into control group(n=50)and observation group(n=50).The control group was treated with conventional methods,and the observation group was treated with conventional methods and metoprolol for 6 months.The cardiac function[left ventricular ejection fraction(LVEF),stroke volume(SV),cardiac output(CO)]and prognosis[Glasgow Outcome Scale(GOS)score]of the two groups before and at the end of 6 months of intervention were compared,and the incidence of adverse reactions of the two groups were compared.Results:After 6 months of treatment,the levels of LVEF,SV and CO in the two groups were higher than before treatment,and the comparison level between the observation group and the control group was higher,the difference was statistically significant(P<0.05);After 6 months of treatment,the GOS score of the observation group was higher than that of the control group,and the difference was statistically significant(P<0.05);There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion:Metoprolol can improve the cardiac function and prognosis of patients with dilated cardiomyopathy,without increasing the incidence of adverse reactions.

Heart rate variability and its response to thyroxine replacement therapy in patients with hypothyroidism

Objective To analyze heart rate variability (HRV)and its changes with thyroxine treatment in patients with hypothyroidism. Methods HRV was analyzed using 24-hour electrocardiographic recording in 38 patients with hypothyroidism and 21 normal controls. The changes in HRV were evaluated for the 18 hypothyroid patients after 3 months of thyroxine therapy.Results The time domain measurements of HRV in hypothyroid patients were much lower than those in the control group. As to HRV frequency domain, the high frequency power was significantly higher, but the ratio of low frequency power to frequency power for hypothyroid patients was lower than in the controls. These abnormal changes of HRV measurements in hypothyroid patients were improved after treatment with thyroxine and were associated with recovery of serum concentrations of FT3 and FT4. Conclusions Patients with hypothyroidism often have autonomic neuropathies with a higher level of vagal tone. These abnormalities could be partly improved by thyoxine therapy.