ObjectiveTo investigate the efficacy of intravenous infusion of recombinant human brain natriuretic peptide in rheumatic heart valves patients with cardiorenal syndrome preoperatively, the function and operational results before and after treatment were compared. MethodsA randomized, single-blind, and controlled study was conducted in 60 patients characterized of rheumatic heart valves patients in our hospital from March 2012 through March 2015. There were 24 males and 36 females at average age of 52.1±8.9 years (ranged from 35-73 years). Their left ventricular ejection fraction was less than 40% and plasma creatinine was mildly or moderately raised. They were recruited into an experiment group and a control group by random digital table. The control group received continuous intravenous Dopamine and Nitroglycerin based anti-heart failure treatment (n=30). The experimental group received additional recombinant human brain natriuretic peptide for 48 hours without bolus (at a dose of 0.006 μg·kg-1·min-1, n=30). The levels of the biomarkers for cardiac and renal function between before and after treatment were compared. ResultsIn the experiment group, treatment with recombinant human brain natriuretic peptide for 48 hours had lower level of plasma NT-proBNP than the baseline level with a statistical difference (88.6±55.1 pg/ml vs. 55.0±47.6 pg/ml, P=0.014), lower level of high sensitivity creative reaction protein than the baseline level with a statistical difference (2.79±1.27 mg/l vs. 1.39±0.79 mg/l, P=0.000), more 24 hours urine output than the baseline level with a statistical difference (1 464.0±348.3 ml vs. 1 223.0±279.9 ml, P=0.005), lower level of serum cystatin-C than the baseline level with a statistical difference (0.25±0.14 mg/l vs. 0.08±0.07 mg/l, P=0.000), higher inotrope requirement within three days after operation (2.52±1.30 mg·kg-1·min-1 vs.3.36±1.15 mg·kg-1·min-1, P=0.011), less ICU stay days (4.5±1.2 days vs. 5.3±1.6 days, P=0.03). There were no statistical differences between the experiment group and the control group after treatment in cardiac function class, left ventricular ejection fraction, left ventricular end-diastolic diameter, creatinine, chest tube drainage volume, and intra-aortic balloon pumping use. ConclusionIntravenous injection of recombinant human brain natriuretic peptide in the patients with rheumatic valve disease combined with cardiorenal syndrome before operation can decrease systemic inflammation reaction and cardiac and renal function injury, and enhance operational recovery.
ObjectiveTo investigate the perioperative change of parathyroid hormone (PTH) and its effect on cardiac function in patients with rheumatic heart disease.MethodsFrom January 2018 to June 2019, 76 patients were randomly divided into calcium supplement group (n=39) and control group (n=37). Mitral valve replacement was performed in both groups with cardiopulmonary bypass (CPB). Blood gas was measured immediately and every 6 h within 24 h after CPB. The patients in the calcium supplement group were given 1 g of calcium gluconate when hypocalcemia occurred, while the control group received no calcium supplementation. Values of radial arterial blood PTH and calcium ion (Ca2+) were measured in the two groups before operation (T1), at 30 min after starting CPB (T2), immediately after stopping CPB (T3), at 24 h after operation (T4), and at 48 h after operation (T5), respectively.ResultsThere were 71 patients enrolled in this study finally, including 38 in the calcium supplement group and 33 in the control group. The PTH values of patients in the two groups gradually increased, reached the peak at T3 time-point, then began to recover gradually. There was no significant difference between the two groups at T1, T2 or T3 time-point (P>0.05), while there were significant differences at T4 and T5 time-points (P<0.05). The Ca2+ values of the two groups gradually decreased after CPB, and gradually increased after blood ultrafiltration. There was no significant difference between the two groups at T1 or T3 time-point (P>0.05), while there were significant differences at T2, T4 and T5 time-points (P<0.05). The postoperative 24-hour values of ejection fraction (EF) and cardiac troponin T (cTnT) and the 72-hour total amount of epinephrine used in the calcium supplement group were (42.66±4.18)%, (1 881.17±745.71) ng/L, and (3.04±0.86) mg, respectively, and those in the control group were (40.76±3.39)%, (2 725.30±1 062.50) ng/L, and (4.69±1.37) mg, respectively. There were statistically significant differences in EF, cTnT and the 72-hour total amount of epinephrine used between the two groups (P<0.05). Values of PTH at T4 and T5 time-points were respectively negatively correlated with postoperative 24-hour value of EF (r=-0.324, P=0.006; r=-0.359, P=0.002), positively correlated with postoperative 24-hour value of cTnT (r=0.238, P=0.046; r=0.248, P=0.037) and the 72-hour total amount of epinephrine used (r=0.324, P=0.006; r=0.383, P=0.001).ConclusionsHyperparathyroidism occures after CPB, and calcium supplementation could relieve the hyperparathyroidism. Hyperparathyroidism may be related to postoperative cardiac insufficiency.
Objective To evaluate the clinical effects of bi-polar radiofrequency ablation (BRFA) for the surgical treatment of atrial fibrillation (AF) in rheumatic heart disease (RHD) patients. Methods We involved 96 RHD patients who underwent valve replacement in Department of Cardiovascular Surgery, West China Hospital from July 2014 through May 2015. There were 74 patients with AF, 22 in sinus rhythm. All patients with AF were fully informed of BRFA, in which 40 of the 74 patients received while the other 34 patients refused. The 40 patients with AF who received BRFA were classified into a treatment group and the other 34 patients were classified into a control group. The 20 patients with sinus rhythm were classified into a blank group as well. The clinical effect and quality of life of the patients were analyzed. Results Left atrial diameter (LAD), pulmonary arterial systolic pressure (PASP), and conversion rate of sinus rhythm at discharge, maintenance rate of sinus rhythm during follow-up in patients with AF were significantly higher than those in the patients in sinus rhythm. No difference was found in terms of survival rate, mortality, major complications among the three groups. The treatment group experienced higher scores in physical functioning (PF), role-physical (RP), general health (GH), vitality (VT), social functioning (SF), mental health (MH), physical component summary (PCS), mental component summary(MCS) and total score compared with the control group both at postoperative 3-month and 6-month . At postoperative 12-month, the treatment group experienced higher scores in PF, RP, GH, PCS, and total score compared with the control group. Conclusion AF would enhance the negative impact on structure remodeling in RHD patients. BRFA is beneficial for the conversion and maintaining of sinus rhythm in RHD patients and the decreasing of LAD & PASP parameter as well. BRFA is more beneficial for the improvement of quality of life in RHD patients with AF during one-year follow-up.
Abstract： Objective To explore the association between transforming growth factor-β receptor typeⅡ (TGFBR2) gene rs6785358 and rs764522 polymorphisms and rheumatic heart disease (RHD) in Chinese Han People. Methods The research design was a case-control study. A total of 207 patients who were hospitalized in Nanjing First Hospital Affiliated to Nanjing Medical University between October 2008 and January 2011 with RHD served as RHD group while 225 age and gender matched healthy adults as control group. Polymerase chain reaction-restriction length polymorphism (PCR-RFLP) technique was used to determine TGFBR2 gene rs6785358 and rs764522 polymorphisms. Results The frequencies of genotype AA, AG and GG of rs6785358 in RHD group and control group were 72.0%, 25.1%, 2.9% and 68.9％, 28.0％, 3.1％,respectively. There was no significant difference in the distribution of genotype frequencies for rs6785358 between RHD group and control group（χ2=0.50，P=0.78）. The frequencies of allele A and G of rs6785358 in RHD group and control group were 84.5％, 15.5％ and 82.9％, 17.1％,respectively. There was no significant difference in the distribution of allele frequencies for rs6785358 between RHD group and control group（χ2=0.43，P=0.51）. The frequencies of genotype CC, CG and GG of rs764522 in RHD group and control group were 77.3%, 21.3%, 1.4% and 75.6％, 21.3％, 3.1％, respectively. There was no significant difference in the distribution of genotype frequencies for rs764522 between RHD group and control group（χ2=1.33，P=0.51）. The frequencies of allele C and G of rs764522 in RHD group and control group were 87.9％, 12.1％ and 86.2％, 13.8％,respectively. There was no significant difference in the distribution of allele frequencies for rs764522 between RHD group and control group（χ2=0.55，P=0.46）. Further analysis by sex stratification showed that no statistical significance was detected in the distribution of genotype and allele frequencies for rs6785358 or rs764522 between RHD patients and controls. Conclusion TGFBR2 gene rs6785358 and rs764522 polymorphisms are not associated with RHD in Chinese Han people.
Abstract:Objective To observe the expression of calcium-dependent proline-rich tyrosine kinase-2（Pyk2） in myocardium of rheumatic heart disease, the relationship between its role and cardiac fibrosis and clinical significance. Methods The blue myocardium collagen stain were analysed after Masson staining in 30 patients with rheumatic heart disease （RHD group） and 6 normal myocardium specimens （control group）. The contents of hyaluronic acid （HA）, laminin（LN） and type IV collagen（IV-C） were detected by radio-immunity method,and the expressions of Pyk2 protein and messenger ribonucleic acid（mRNA） were explored by immunohistochemistry methods and reverse transcriptase polymerase chain reaction （RT PCR）,then the correlations of these results were statistically analyzed. Results The contents of HA,LN and IV C in RHDgroup increased compared to control group（174.95±76.14μg/L vs. 70.06±15.63μg/L, 153. 86 ± 20. 72μg/L vs. 90.01±14. 11μg/L, 95. 26±7.66μg/L vs. 63. 21±10.62μg/L; P= 0.003, 0. 013, 0. 035）. The Pyk2 absorption and the ratio of Pyk2 mRNA/glyceraldehyde phosphate dehydrogenase （GAPDH） in RHD group were significantly higher than those in control group （0. 325 ± 0. 032 vs. 0.106±0.013, 0.870±0.085 vs. 0.573±0.042; P=0.048, 0.006）.There were positive correlativity between the expression of Pyk2 protein and HA, LN and IV-C （r=0. 611, 0. 743, 0. 829, P〈0. 01）, there were positive correlativity between the expression of Pyk2 mRNA and LN, IV-C （r=0. 794, 0. 766, P〈0.05）. Conclusion Pyk2 may play a key role in the proceeding of cardiac fibrosis in rheumatic heart disease by increasing collagen synthesis in myocardium.
Objective To evaluate the correlation of TNF-α G308A polymorphism and rheumatic heart disease (RHD) using meta-analysis. Methods Databases including PubMed, EMbase, CNKI and WanFang Data were searched to collect case-control study on the correlation of TNF-α G308A polymorphism and RHD, published from January 1990 to June 2011. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data and evaluated the methodological quality of the included studies. Then meta-analysis was performed using RevMan 5.1 and SPSS 16.0. Results A total of 5 studies were included, involving 539 RHD cases and 624 controls. The results of meta-analysis according to recessive genetic model of TNF-α G308A showed that there were significant differences in RHD risk between the AA genotype carriers and the GA+GG genotype carries (OR=5.06, 95%CI 2.15 to 11.89, P=0.0002), the same as the results of meta-analysis calculated according to dominant genetic model (OR=3.14, 95%CI 1.05 to 9.38, P=0.04). Conclusion Current evidence shows that TNF-α G308A polymorphism is related to RHD, and the AA genotype carriers tend to face an increasing RHD risk. This conclusion still needs to be further proved by more high-quality and large-scale clinical trials.
Abstract: Objective To observe the longterm condition of patients after mitral valve replacement with or without mild aortic valve regurgitation (AR) and discuss whether treatment of AR is necessary during the course of mitral valve replacement. Methods From March 1999 to April 2004, 88 patients who underwent mitral valve replacement (with or without mild AR before surgery) in West China Hospital of Sichuan University were followed up for 5 years or more. The patients were divided into two groups according to whether they had mild AR based on the result of preoperative echocardiography examination. In the AR group, there were 35 patients including 7 males and 28 females aged 49.26±11.87. By the New York Heart Association (NYHA) grading system before surgery, 4 patients were classified as Class Ⅱ, 26 Class Ⅲ and 5 Class Ⅳ. In the nonAR group, there were 53 patients including 7 males and 46 females aged 48.59±10.22. Using the NYHA grading system before surgery, we found there were 7 patients with Class Ⅱ cardiac function, 39 Class Ⅲ and 7 Class Ⅳ. After operation, all patients were followed up regularly and 5 years after surgery, patients were examined by echocardiography again. Results The followup period ranged from 5 to 9 years (6.39±1.26). There was no statistical difference in gender (P=0.394), age (P=0.841), preoperative cardiac function (P=0.960) and cardiac rhythm (P=0.732) between the two groups. For the AR group, after operation, NYHA heart function, left ventricle ejection fraction (LVEF) and left ventricle fraction shortening (LVFS) significantly increased or improved(Plt;0.05). In the nonAR group, after operation, NYHA heart function and LVEF significantly improved (Plt;0.05), while LVFS had no significant change (Pgt;0.05). Left [CM(159mm]ventricular dimensions (LVD) and aortic dimensions between the two groups had no significant difference afteroperation (Pgt;0.05). There was no significant difference in the number of AR cases before and after surgery (Pgt;005) in the AR group, while there was a significant difference in the nonAR group (Plt;0.05). Conclusion For patients with mild AR who underwent mitral valve surgery 5 to 9 years ago, there is little change in their AR condition. There is no need to treat mild AR preventively during the course of mitral valve replacement.
ObjectiveTo summarize the monitoring experiences of blood glucose for patients with rheumatic heart disease combined with diabetes, in order to prevent postoperative complications caused by abnormal blood sugar, relieve pain and promote rehabilitation. MethodsWe reviewed the medical records of the patients with diabetes after heart valve replacement who were admitted to our department from April 2011 to March 2012. Eighty patients were randomly divided into observation group and control group with 40 in each group. Patients in the control group received conventional treatment with subcutaneous insulin injection, while the observation group patients were treated with intravenous insulin pump, and the dose of insulin was adjusted depending on blood glucose levels. Then we compared the postoperative changes in blood glucose level and complications between the two groups. ResultsThe insulin dose, the time of reaching target blood glucose levels, hospital stays and postoperative complication rates were significantly lower in the observation group than the control group (P<0.05). During the one-year follow-up after operations, 2 and 4 patients died respectively in the observation group and the control group, and the difference was not significant (χ2=0.180, P=0.670). ConclusionFor patients with diabetes after heart valve replacements, intravenous insulin pump is better than subcutaneous insulin injection. It can prevent complications, shorten hospital stays, reduce financial burden, and promote prognosis and harmonious doctor-patient relationship.
Objective To explore the impact of recombinant human growth hormone （rhGH） on T lymphocyte subsets in patients with rheumatic heart disease during the perioperative period of heart valve replacement. Methods A total of 65 patients with rheumatic valvular heart disease who received heart valve replacement in Department of Cardiothoracic Surgery of Xiangyang Central Hospital from June 1， 2011 to March 31， 2012 were enrolled in this double-blind randomized controlled clinical study. All the patients were divided into 2 groups by random number produced by SAS software：the trial group and the control group. There were 35 patients in the trial group including 19 males and 16 females with their average age of 50.57 years， and 30 patients in the control group including 16 males and 14 females with their average age of 49.87 years. Apart from routine cardiac glycosides， diuretics， glucose-insulin-potassium solution， and postoperative anti-infective therapy， patients in the trial group also received subcutaneously injection of rhGH 5 U （1 ml）daily from 1 day before surgery to 3 days after surgery， and patients in the control group received subcutaneously injection of normal saline 1 ml as placebo. Peripheral venous blood samples were taken in the morning 2 days before surgery and 1 st， 3 rd， 7 th day after surgery respectively. Percentages of CD3+， CD4+， CD8+ were examined timely by flow cytometry and CD4+ /CD8+ ratio was calculated. Results In the control group， percentages of CD3+， CD4+ and CD4+ /CD8+ ratio on the 1st， 3rd， 7th postoperative day were significantly lower than preoperative levels， and percentages of CD8+ on the 1st and 3rd postoperative day were significantly lower than preoperative level （P＜0.05）. In the trial group， percentages of CD3+， CD4+， and CD8+ on the 1st and 3rd postoperative day were significantly lower than preoperative levels（P＜0.05）， while percentages of CD3+， CD4+， and CD8+ on the 7th postoperative day were not statistically different from preoperative levels （P＞0.05）; CD4+ /CD8+ ratio on the 1st postoperative day was significantly lower than preoperative level （P＜0.05）， while CD4+ /CD8+ ratios on the 3rd and 7th postoperative day were not statistically different from preoperative level （P＞0.05）. There was no statistical difference in preoperative T lymphocyte subsets between the trial group and the control group （P＞0.05）. The percentages of CD4+ and CD4+/CD8+ ratio in the trial group were significantly higher than those of the control group on the 1st postoperative day （P＜0.05）， while the percentages of CD3+ and CD4+ and CD4+ /CD8+ratio in the trial group were significantly higher than those of the control group on the 3rd and 7th postoperative day（P＜0.05）. Conclusion Use of rhGH can significantly increase T lymphocyte subsets expression， enhance body cellular immunity， and improve postoperative recovery of patients with rheumatic valvular heart disease during the perioperative period of heart valve replacement.
Abstract： Objective To determine the influence of preoperative atrial fibrillation （AF） on midterm and longterm clinical outcomes of patients after mitral valve replacement （MVR）. Methods We retrospectively analyzed clinical data of 1 029 patients who underwent MVR with or without tricuspid valve repair in Changhai Hospital， Second Military Medical University， from January 2000 to December 2005. According to the exclusion criteria， 621 patients were selected and divided into two groups depending on presence of preoperative AF. Those 395 patients with preoperative AF belonged to the AF group， including 134 males and 261 females with their average age of 51.1±11.5 years. Those 226 patients with preoperative sinus rhythm （SR） were in the SR group， including 82 males and 144 females with their average age of 48.2±14.1 years. Early postoperative outcomes， midterm and longterm mortality and morbidity of the two groups were compared. Results During 10 years of follow-up， there was no statistical difference in early postoperative mortality and morbidity between the two groups， but the incidence of late thromboembolism was significantly higher in AF group than that in SR group ［0.9‰ （31 patients/33 984 patient-months） vs. 0.4‰ （9 patients/21 151 patient-months）， χ2=4.26， P=0.039］. Ten-year survival rate in patients in AF group was significantly lower than that in SR group （83.2% vs. 92.7%， χ2=10.26， P=0.002）. Multivariate analysis identified preoperative AF ［HR=2.878， 95% CI （1.166，4.129）］， low left ventricular ejection fraction ［HR=0.948， 95% CI （0.917，0.981）］ ， and old age ［HR=1.073， 95% CI （1.038，1.109）］ as independent risk factors for late mortality after MVR. Apart from its influence on patient survival rate and incidence of thromboembolism， preoperative AF also had an adverse effect on left ventricular function， right ventricular function and tricuspid regurgitation. Conclusion AF is an independent risk factor for poor prognosis after MVR. Prognosis after MVR might be improved if surgery could be performed early when patients have predictive signs of AF such as multiple premature atrial contractions or left atrium enlargement.