Acute respiratory distress syndrome (ARDS) is the most common cause of acute respiratory failure. Extensive researches have been conducted for the pathophysiology of this disease, but the mortality rate remains high. Previous studies have found that catecholamines play an important role in acute lung injury, and newly discover prompted that upregulation of phagocyte-derived catecholamines augmented the acute inflammatory response in acute lung injury which provides a new way of thinking. In the current review, we describe the mechanism of the phagocyte-derived catecholamines augmenting the acute lung injury.
Pulmonary hypertension is a disease characterized by pulmonary artery pressure increased, with or without small artery pathological change, which ultimately leads to right heart failure or even death. Pulmonary hypertension seriously threatens to human health, however, the pathogenesis of pulmonary hypertension is unclear. Previous studies have found that bone morphogenetic protein (BMP) signaling system played an important role in the progress of pulmonary hypertension. In the current review, we describe the mechanism of BMP4 in the development of pulmonary hypertension.
Pulmonary hypertension due to left heart disease (PH-LHD) is the most common in various types of pulmonary hypertension. Although there are many treatments for pulmonary hypertension, it may be harmful when we adopt treatment without detrimental diagnosis and classification of pulmonary hypertension. Therefore, it is very crucial to have accurate diagnosis and classification of pulmonary hypertension before making treatment decisions. However, there are still some difficulties in the classification of pulmonary hypertension in clinical work. It is a great challenge with limited treatment to solve the PH-LHD which often has complicated pathophysiological mechanisms of precapillary and postcapillary pulmonary hypertension. Here, we review the research status of PH-LHD.
Pulmonary hypertension is a kind of progressive pulmonary vascular diseases in which there is excessive vasoconstriction and abnormal pulmonary vascular remodeling, and then a gradual increase in pulmonary arterial pressure, and it eventually leads to right ventricular failure and even death. The pathogenesis of pulmonary hypertension is still uncertain, but some studies suggest that Hippo pathway or some components of the Hippo pathway may be involved in the progress of pulmonary hypertension. In this review, we describe the mechanism of the Hippo pathway or some components of the Hippo pathway in the progress of pulmonary hypertension.
Transcatheter aortic valve replacement (TAVR) has been confirmed to be safety and efficacy for high-risk elderly aortic stenosis, and the clinical effect of TAVR for medium and low-risk aortic stenosis is not worse than that of surgery. The development of surgical techniques and instruments has made cardiologists attempt to broaden the surgical indications. Many elderly and high-risk patients with pure native aortic regurgitation have been treated “off label” with similar techniques, completing artificial valve replacement, restoring valve function and improving the prognosis. However, due to the high requirements of surgical techniques and surgical complications, there is a lack of randomized controlled studies to confirm its safety and effectiveness. Unlike aortic stenosis, native aortic regurgitation presents unique challenges for transcatheter valves. In this article, the authors review current advances in the treatment of aortic valve regurgitation with TAVR.
Hypertrophic obstructive cardiomyopathy (HOCM) is a relatively common hereditary cardiomyopathy, which is featured by asymmetric myocardial hypertrophy and dynamic left ventricular outflow tract (LVOT) obstruction. Other than septal hypertrophy, mitral valve abnormalities are also quite common in HOCM patients, and they also contribute to systolic anterior motion of the mitral leaflets and LVOT obstruction. Septal myectomy is believed as the standard surgical treatment for HOCM, but whether to perform mitral valve procedures at the same time of myectomy is still debatable. In this article, we thoroughly explained the mitral valve abnormalities in HOCM patients and their surgical corrections. Besides, we also explained the controversies over mitral valve procedures based on the current clinical studies.
Pregnancy complicated by aortic root aneurysm in patients with Marfan syndrome is one of the main causes of termination of pregnancy or even death in pregnant women. A very small number of pregnant women require cardiac surgery to preserve pregnancy under extracorporeal circulation, and all surgeries use aortic root replacement. We reported a 30-year-old patient with severe aortic regurgitation combined with giant aortic root aneurysm and Marfan syndrome in mid-pregnancy. Valve-sparing root replacement using reimplantation technology was performed via a multidisciplinary cooperation model. This not only achieved the patient’s desire to continue pregnancy but also avoided the anticoagulation and bleeding complications brought by mechanical valve replacement, reduced pregnancy risks and improved long-term quality of life. Postoperative echocardiography showed trace aortic regurgitation, aortic valve coaptation height of 0.6 cm, effective height of 1.1 cm, maximum aortic flow velocity of 1.4 m/s, mean transvalvular pressure gradient of 4.4 mm Hg, and satisfactory clinical results.
ObjectiveTo evaluate the feasibility and safety of Remodeling+Ring (modified Yacoub) for patients with aortic root aneurysm. MethodsThe clinical data of patients who underwent modified Yacoub surgery at West China Hospital of Sichuan University from July 2020 to May 2023 were retrospectively analyzed. ResultsFour male patients were enrolled, with an average age of 47.3±10.3 years and body surface area of 1.9±0.2 m2. One patient had a complication of bicuspid aortic valve. Aortic valve regurgitation was mild in three patients and moderate in one patient. Preoperative New York Heart Association (NYHA) heart function was gradeⅠin one patient and gradeⅡin three patients, and the body surface area was 1.9±0.2 m2. The maximum diameter of the aortic sinus was 59.3±8.1 mm. All four patients recovered and were discharged without a second thoracotomy. No postoperative complications such as brain injury, infection, respiratory failure or renal insufficiency occurred. During the follow-up of 17.0±13.1 months, two patients showed no regurgitation of the aortic valve, two patients exhibited mild regurgitation. Three patients had a heart function of gradeⅠ and one patient of gradeⅡ. ConclusionModified Yacoub technique is safe and effective for patients with aortic root aneurysm.
Objective To investigate the early safety and efficacy of transapical transcatheter aortic valve implantation (TAVI) for high-risk elderly patients with pure aortic valve insufficiency. Methods A prospective multicenter clinical study of domestic J-valveTM TAVI for high-risk native non-calcified aortic valve insufficiency was conducted from April 2014 to May 2018, and the early postoperative results were analyzed. A total of 82 patients were enrolled, including 62 patients from West China Hospital, Sichuan University, 16 patients from Zhongshan Hospital, Fudan University, and 4 patients from Beijing Fuwai Hospital, National Center for Cardiovascular Diseases. There were 55 males and 27 females. The age was 61-90 (73.8±6.3) years. The logistic EuroSCORE was 10.0%-44.4% (17.5%±8.1%). All patients underwent TAVI using J-ValveTM system. Clinical evaluation and echocardiography were performed preoperatively and 1 month postoperatively. Multislice spiral CT was reviewed before discharge. Results Three patients were transferred to thoracotomy for cardiopulmonary bypass operation, and 1 patient had decreased cardiac function due to leakage of the valve 1 week after surgery. The overall technical and procedural success rate was 95.1% and 93.9%, respectively. During hospitalization, 1 patient died of moderate pericyclosis complicated with multiple organ failure, and 1 patient died of pulmonary infection. Six (7.6%) patients received pacemaker implantation due to new onset Ⅲ° atrioventricular block. Echocardiographic follow-up showed paravalvular leak was observed in the few of patients, mild paravalvular leak was in 13 patients on the 30th day. Two patients showed moderate paravalvular leak. Left ventricular end-diastolic volume decreased from 197.7±66.8 mL (pre-TAVI) to 147.2±53.3 mL (30-day post-TAVI) (P<0.05). Mean pressure gradient was 9.5±4.1 mm Hg (30-day post-TAVI). Conclusion This multicenter study demonstrates that TAVI with the J-Valve system for the treatment of pure aortic regurgitation is associated with sustained clinical and functional cardiovascular benefits in high-risk patients with symptomatic aortic regurgitation early-term follow-up. Our results further support that TAVI with the specific designed J-Valve system is an acceptable alternative therapy for high-risk patients with pure AR. Our result demonstrates good early-term durability and preserved hemodynamic function. The procedure appears to offer an adequate and lasting resolution for selected patients with pure aortic regurgitation.