Sepsis is a common complication after severe trauma, infection, shock and major surgery. It has the characteristics of high morbidity, high mortality, and high hospitalization costs. Septic cardiomyopathy is one of the main causes of death in patients with sepsis. This article reviews the pathogenesis and treatment of septic cardiomyopathy. The pathogenesis includes hemodynamics and myocardial changes, mitochondrial fission, cardiomyocyte apoptosis and autophagy, calcium ion imbalance, inflammation mechanism and immune regulation mechanism. The treatment includes conventional treatment, β1 receptor blocker treatment, melatonin, serotonin 3 receptor antagonist, dexmedetomidine and traditional Chinese medicine treatment, etc., aiming to provide a reference for the diagnosis and treatment of septic cardiomyopathy.
Objective To observe the effect of BMSCs on the cardiac function in diabetes mellitus (DM) rats through injecting BMSCs into the ventricular wall of the diabetic rats and investigate its mechanism. Methods BMSCs isolated from male SD rats (3-4 months old) were cultured in vitro, and the cells at passage 5 underwent DAPI label ing. Thirty clean grade SD inbred strain male rats weighing about 250 g were randomized into the normal control group (group A), the DM group (group B), and the cell transplantation group (group C). The rats in groups B and C received high fat forage for 4 weeks and the intraperitoneal injection of 30 mg/kg streptozotocin to made the experimental model of type II DM. PBS and DAPI-labeledpassage 5 BMSCs (1 × 105/μL, 160 μL) were injected into the ventricular wall of the rats in groups B and C, respectively. After feeding those rats with high fat forage for another 8 weeks, the apoptosis of myocardial cells was detected by TUNEL, the cardiac function was evaluated with multi-channel physiology recorder, the myocardium APPL1 protein expression was detected by Western blot and immunohistochemistry test, and the NO content was detected by nitrate reductase method. Group C underwent all those tests 16 weeks after taking basic forage. Results In group A, the apoptosis rate was 6.14% ± 0.02%, the AAPL1 level was 2.79 ± 0.32, left ventricular -dP/dt (LV-dP/dt) was (613.27 ± 125.36) mm Hg/s (1 mm Hg=0.133 kPa), the left ventricular end-diastol ic pressure (LVEDP) was (10.06 ± 3.24) mm Hg, and the NO content was (91.54 ± 6.15) nmol/mL. In group B, the apoptosis rate was 45.71% ± 0.04%, the AAPL1 level 1.08 ± 0.24 decreased significantly when compared with group A, the LVdP/ dt was (437.58 ± 117.58) mm Hg/s, the LVEDP was (17.89 ± 2.35) mm Hg, and the NO content was (38.91±8.67) nmol/mL. In group C, the apoptosis rate was 27.43% ± 0.03%, the APPL1 expression level was 2.03 ± 0.22, the LV -dP/dt was (559.38 ± 97.37) mm Hg/ s, the LVEDP was (12.55 ± 2.87) mm Hg, and the NO content was (138.79 ± 7.23) nmol/ mL. For the above mentioned parameters, there was significant difference between group A and group B (P lt; 0.05), and between group B and group C (P lt; 0.05). Conclusion BMSCs transplantation can improve the cardiac function of diabetic rats. Its possible mechanismmay be related to the activation of APPL1 signaling pathway and the increase of NO content.
Objective To compare the effect of palliative mitral valve surgeries and medication therapies for secondary non-ischemic mitral regurgitation. Methods The clinical data of patients with non-ischemic functional mitral regurgitation treated in our hospital between 2009 and 2019 were retrospectively analyzed. Patients with a left ventricular ejection fraction (LVEF)＜40% underwent a dobutamine stress test, and a positive result was determined when the LVEF improved by more than 15% compared to the baseline value. Positive patients were divided into a surgery group and a medication group. The surgery group underwent surgical mitral valve repair or replacement, while the medication group received simple medication treatment. Follow-up on survival and cardiac function status through outpatient or telephone visits every six months after surgery, and patients underwent cardiac ultrasound examination one year after surgery. The main research endpoint was a composite endpoint of all-cause death, heart failure readmission, and heart transplantation, and the differences in cardiac function and cardiac ultrasound parameters between the two groups were compared. ResultsUltimately 41 patients were collected, including 28 males and 13 females with an average age of 55.5±11.1 years. Twenty-five patients were in the surgery group and sixteen patients in the medication group. The median follow-up time was 16 months, ranging 1-96 months. The occurrence of all-cause death in the surgery group was lower than that in the medication group (HR=0.124, 95%CI 0.024-0.641, P=0.034). The difference between the two groups was not statistically significant in the composite endpoint (HR=0.499, 95%CI 0.523-1.631, P=0.229). The New York Heart Association (NYHA) grade of the surgery group was better (NYHA Ⅰ-Ⅱ accounted for 68.0% in the surgury group and 18.8% in the medication group, P<0.01) as well as the grade of mitral valve regurgitation (87.5% of the patients in the medication group had moderate or above regurgitation at follow-up, while all the patients in the surgery group had moderate below regurgitation, P<0.01). There was no statistical difference in preoperative and follow-up changes in echocardiograph parameters between the two groups (P＞0.05). Conclusion For non-ischemic functional mitral regurgitation, if the cardiac systolic function is well reserved, mitral valve surgery can improve survival and quality of life compare to simple medication therapy.
Objective To summary the clinical experiences of ventricular septal myotomymyectomy on hypertrophic obstructive cardiomyopathy(HOCM) and investigate the treatment strategies during perioperative period for better clinical results. Methods From October 1996 to June 2009, 62 patients with HOCM underwent surgical treatment. There were 41 male and 21 female, aged 668 years with mean 34.05 years. The ventricular septal myotomymyectomy operation (Morrow operation or modified Morrow operation) was performed through the aortic incision under general anesthesia and hypothermic cardiopulmonary bypass (CPB). The concomitant operations included coronary artery bypass grafting (5 cases), mitral valve replacement (12 cases), mitral valve plasty(9 cases), aortic valve replacement (4 cases), tricuspid valve plasty(2 cases) and ductus arteriosus closure (2 cases). During the perioperative period, the patients were examined by echocardiography or transesophageal echocardiograph(TEE), electrocardiogram or dynamic echocardiogram and chest radiography. Left atrial diameter，left ventricular enddiastolic [CM(159mm]diameter，left ventricular outflow tract (LVOT) pressuregradient，interventricular septal thickness, ejection fraction[CM)](EF), the changes of mitral valve construction and function were evaluated. Results The time of CPB and aortic occlusion were 104.23±47.14 min and 66.76±36.32 min, respectively. The endotracheal intubation time was 13.23±11.76 h and the postoperative intensive care unit(ICU) stay was 42.53±37.41 h. Four patients died and the mortality was 6.45％(4/62). The main causes of death included septic shock complicated with acute renal failure(1 case), refractory arrhythmia, ventricular fibrillation, atrial flutter complicated with severe low cardiac output syndrome (1 case), severe acute renal failure(1 case) and Ⅲ°atrioventricular(AV) block complicated with low cardiac output syndrome(1 case). Postoperative left atrial diameter (34.56±6.45 mm vs.43.46±7.21 mm，t=6.948,P=0.000), left ventricular enddiastolic diameter (37.14±6.31 mm vs.42.03±6.23 mm，t=3.145,P=0.020), LVOT pressure gradient (23.54±17.78 mm Hg vs. 103.84±44.04 mm Hg,t=13.618,P=0.000) and interventricular septal thickness (17.12±5.67 mm vs.26.93±5.23 mm, t=10.694,P=0.000) decreased significantly compared with those before operation. There was no mitral valve regurgitation, or only mild mitral valve regurgitation. No systolic anterior motion(SAM) was found. The main postoperative arrhythmias included complete left bundle branch block, intraventricular block, complete atrioventricular block and atrial fibrillation. All the 58 cases were cured and discharged. Fiftythree cases were followed up for 3 months12 years, and 5 cases were lost. No death, complication and reoperation were found. Symptoms relieved significantly. The cardiac function was in New York Heart Association grade Ⅰ-Ⅱ. The quality of life improved significantly. Conclusion Most patients with HOCM can achieve satisfactory relief of LVOT obstruction and SAM via ventricular septal myotomymyectomy. The main arrhythmias after operation are bundle branch block and atrial fibrillation. Satisfactory effects can be achieved by accurate surgical technique and effective drug treatments.
ObjectiveTo compare clinical outcomes between modified and traditional Morrow procedures for the treatment of hypertrophic obstructive cardiomyopathy (HOCM). MethodsForty-two HOCM patients undergoing surgical correction in Beijing Anzhen Hospital between January 2005 and July 2011 were recruited in this study. According to different surgical techniques, all the patients were divided into 2 groups. In traditional Morrow procedure group, there were 16 patients including 13 males and 3 females with their age of 49±15 years. In modified Morrow procedure group, there were 26 patients including 14 males and 12 females with their age of 40±18 years. Preoperative and postoperative echocardiography were performed to compare ventricular septal thickness (VST), left ventricular outflow tract velocity (LVOTV)and left ventricular outflow gradient (LVOG)between the 2 groups. ResultsVST, LVOTV and LVOG of HOCM patients were significantly reduced after both traditional and modified Morrow procedure. There was statistical difference in preoperative and postoperative VST (23.10±3.64 mm vs. 17.38±4.39 mm), LVOTV (433.08±101.68 mm/s vs. 248.46±101.88 mm/s)and LVOG (78.57±40.16 mm Hg vs. 4.29±21.52 mm Hg)in traditional Morrow procedure group (P < 0.05). There was statistical difference in preoperative and postoperative VST (25.04±47.05 mm vs. 18.38±6.55 mm, P < 0.05), LVOTV (414.83±83.33 mm/s vs. 159.72±60.84 mm/s, P < 0.05)and LVOG (77.94±29.16 mm Hg vs. 17.56±9.39 mm Hg, P < 0.05)in modified Morrow procedure group (P < 0.05). Preoperative and postoperative difference in LVOG of modified Morrow procedure group was more significant than that of traditional Morrow procedure group (74.25±27.91 mm Hg vs. 34.63±30.66 mm Hg, P < 0.05). ConclusionModified Morrow procedure is superior to traditional Morrow procedure in reducing postoperative LVOG for HOCM patients.
Dilated cardiomyopathy (DCM) is a highly prevalent disease which has multiple clinical manifestations and pathological features. With the characteristics of multi-sequence and multi-parameter, cardiac magnetic resonance imaging (MRI) can accurately assess the morphology, function and tissue characterization of heart, and provide comprehensive information for diagnosis of DCM. This review focuses on the sequences and clinical applications of MRI evaluation in DCM in order to provide additional information for clinical diagnosis, treatment and prognosis.
ObjectiveTo explore the association between preoperative, perioperative parameters, especially estimated glomerular filtration rate (eGFR) and postoperative atrial fibrillation (POAF) after modified extended Morrow procedure.MethodsA total of 300 hypertrophic obstructive cardiomyopathy (HOCM) patients who underwent modified extended Morrow procedure in our hospital from January 2012 to March 2018 were collected. There were 197 (65.67%) males and 103 (34.33%) females with an average age of 43.54±13.81 years. Heart rhythm was continuously monitored during hospitalization. The patients were divided into a POAF group (n=68) and a non-POAF group (n=232). The general data, perioperative parameters and echocardiographic results were collected by consulting medical records for statistical analysis. Univariate and multivariate logistic regression models were used to analyze the risk factors for POAF.ResultsOverall incidence of POAF during hospitalization was 22.67% (68/300). Compared with patients without POAF, patients with POAF were older, had higher incidence of chest pain and syncope, lower level of preoperative eGFR, higher body mass index and heart function classification (NYHA), larger preoperative left atrial diameter and left ventricular end diastolic diameter, and longer ventilator-assisted time, ICU stay and postoperative hospital stay. Age, heart function classification (NYHA)≥Ⅲ, hypertension, syncope history and eGFR were independent risk factors for POAF. Receiver operating characteristic curve analysis showed that the area under the curve of eGFR was 0.731 (95%CI 0.677-0.780, P<0.001), and the sensitivity and specificity were 82.4% and 57.8%, respectively.ConclusionIncreased age, high preoperative heart function classification (NYHA), hypertension, preoperative syncope history and decreased eGFR are independent risk factors for POAF in HOCM patients who underwent surgical septal myectomy. Preoperative decreased eGFR can moderately predict the occurrence of POAF after modified extended Morrow procedure.
Abstract：?Objective?To analyze surgical procedures and clinical outcomes for patients with hypertrophic obstructive cardiomyopathy （HOCM） complicated by infective endocarditis.?Methods?We retrospectively analyzed clinical data of 7 patients with HOCM complicated by infective endocarditis who underwent modified Morrow procedure，removal of intracardiac vegetation，and valve replacement in Fu Wai Hospital from Sep. 2006 to Feb. 2012. There were 5 male patients and 2 female patients with their mean age of 39.80±13.60 years（ranging 21-55）. Postoperative clinical outcomes were observed. Preoperative and postoperative left ventricular outflow tract （LVOT） gradients， left atrium （LA） diameter，left ventricular ejection fraction （LVEF） and heart function were compared.?Results?There was no in-hospital death and perioperative survival rate was 100% in this group. Bacteria vegetations were multiply detected on the mitral valve leaflet （7 cases）， aortic valve leaflet （4 cases） and ventricular septum （1 case） with their diameter of 2-19 mm. Blood culture showed Staphylococcus aureus （3 cases），Squirrel aureus （1 case） . Postoperatively， first-degree atrioventricular block occurred in 2 patients， complete left bundle branch block in 1 patient， left anterior division block in 2 patients， and all these complications were not treated. Postoperative LVOT gradient and LA diameter were significantly lower than preoperative values （P＜0.05）， and cardiac function was significantly improved in these patients. All the patients underwent transthoracic echocardiography at a mean follow-up of 13.00±17.19 （1-49） months in outpatient service. The clinical symptoms of all these patients were diminished or significantly ameliorated and their quality of life was considerably improved. All the patients had NYHA classⅠorⅡ without any reintervention or death during follow-up.?Conclusion?Modified Morrow procedure and valve replacement is a good surgical strategy for patients with HOCM complicated by infective endocarditis with satisfactory early and mid-term clinical outcomes.
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.