Approximately 40% of pheochromocytoma and paraganglioma(PPGL) cases are familial, typically presenting earlier with more complex symptoms. This paper synthesizes literature and guidelines to inform on clinical charact...Approximately 40% of pheochromocytoma and paraganglioma(PPGL) cases are familial, typically presenting earlier with more complex symptoms. This paper synthesizes literature and guidelines to inform on clinical characteristics and perioperative care for PPGL. Pheochromocytoma in von Hippel-Lindau(VHL) disease exhibits heightened secretion activity without significant perioperative hemodynamic changes. Tumors in multiple endocrine neoplasia type 2(MEN2) have a stronger endocrine function, which may induce hemodynamic fluctuations during surgery. Therefore, pheochromocytoma screening is essential at all stages of MEN2. Neurofibromatosis type 1(NF1) often presents multisystem lesions and can result in difficult airway. Pheochromocytoma should be evaluated when NF1 patients present hypertension. Pheochromocytoma and paraganglioma type 5 may present multiple lesions of pheochromocytoma or paraganglioma. In summary, hereditary PPGLs may present with severe lesions in other systems, beyond tumor function. A multi-disciplinary team(MDT) approach is often invaluable in perioperative management.展开更多
Heart failure （HF） with preserved ejection fraction （HFpEF） is the most common form of HF in older adults, and is increasing in preva- lence as the population ages. Furthermore, HFpEF is increasing out of proporti...Heart failure （HF） with preserved ejection fraction （HFpEF） is the most common form of HF in older adults, and is increasing in preva- lence as the population ages. Furthermore, HFpEF is increasing out of proportion to HF with reduced EF （HFrEF）, and its prognosis is worsening while that of HFrEF is improving. Despite the importance of HFpEF, our understanding of its pathophysiology is incomplete, and optimal treatment remains largely undefined. A cardinal feature of HFpEF is reduced exercise tolerance, which correlates with symptoms as well as reduced quality of life. The traditional concepts of exercise limitations have focused on central dysfimction related to poor cardiac pump function. However, the mechanisms are not exclusive to the heart and lungs, and the understanding of the pathophysiology of this dis- ease has evolved. Substantial attention has focused on defining the central versus peripheral mechanisms underlying the reduced functional capacity and exercise tolerance among patients with HF. In fact, physical training can improve exercise tolerance via peripheral adaptive mechanisms even in the absence of favorable central hemodynamic function. In addition, the drug trials performed to date in HFpEF that have focused on influencing cardiovascular function have not improved exercise capacity. This suggests that peripheral limitations may play a significant role in HF limiting exercise tolerance, a hallmark feature of HFpEF.展开更多
Objective There are still a high proportion of patients with ST-segment elevation myocardial infarction （STEMI） missing out early reperfusion even in the primary percutaneous coronary intervention （PCI） era. Most ...Objective There are still a high proportion of patients with ST-segment elevation myocardial infarction （STEMI） missing out early reperfusion even in the primary percutaneous coronary intervention （PCI） era. Most of them are stable latecomers, but the optimal time to undergo delayed PCI for stable ones remains controversial. Methods We investigated all STEMI patients who underwent delayed PCI （2-28 days after STEMI） during 2007-2010 in Beijing and excluded patients with hemodynamic instability. The primary outcome was maj or adverse cardiovascular events （MACEs）. Results This study finally enrolled 5,417 STEMI patients and assigned them into three groups according to individual delayed time （Early group, 55.9%; Medium group, 35.4%; Late group, 8.7%）. During 1-year follow-up, MACEs occurred in 319 patients. The incidence of MACEs were respectively 7.1%, 5.6% and 6.7% among three groups. The Medium group had less recurrent myocardial infarction plus cardiac death （hazard ratio, 0.525; 95% confidence interval, 0.294-0.938, P = 0.030） than Late group and less repeat revascularization （hazard ratio, 0.640; 95% confidence interval, 0.463-0.883, P = 0.007） than Early group in pairwise comparisons. We depicted the incidence of major adverse cardiovascular event （MACE） by delayed time as a quadratic curve and found the bottom appeared at day 14. Conclusions The delayed PCI time varied in the real-world practice, but undergoing operations on the second week after STEMI had greater survival benefit and less adverse events for whom without early reperfusion and hemodynamic instability.展开更多
Backgrounds Pulmonary arterial hypertension （PAH） was previously considered an illness that affects mostly the young, but now it is also increasingly recognized in the elderly. The aim of this study was to compare t...Backgrounds Pulmonary arterial hypertension （PAH） was previously considered an illness that affects mostly the young, but now it is also increasingly recognized in the elderly. The aim of this study was to compare the features of elderly versus younger patients diagnosed with PAH, and to define the prognostic factors which affect their long-term survival. Methods In this prospective, single center study, the clinical, echocardiographic, hemodynamic characteristics, and the outcomes of younger （18-65 years） and elderly （〉 65 years） patients with definitive diagnosis of precapillary PAIl were compared. Results A total of 119 patients were analyzed in this study; 43 were elderly （mean age： 71.5 ± 5.5 years）, while 76 were non-elderly （mean age 44.5 ±15.2 years）. During the mean follow-up duration of 26.8 ±25.0 months, 43 deaths occurred, 17 of which were among the elderly group, with 28 among non-elderly group. Comparison of baseline parameters showed that 6 min walking distance, hemoglobin levels, pulmonary artery pressures and pulmonary vascular resistance were significantly lower; and estimated glomerular filtration rate, body mass index, E/e＇ and pulmonary capillary wedge pressure were significantly higher in the elderly group than in the younger group. Survival analysis demonstrated that the independent predictors of death were tricuspid plane annular systolic excursion （TAPSE; HR： 1.272, 95% CI： 1.079-1.499, P = 0.004） and uric acid （HR： 1.291, 95% CI： 1.042-1.600, P = 0.019） in the elderly group. In contrast, in the non-elderly group, higher brain natriuretic peptide （HR： 1.002, 95% CI： 1.001-1.004, P 〈 0.001） and higher right atrial pressure （HR： 1.128, 95% CI： 1.026-1.241, P = 0.013） values were the only parameters associated with mortality. Conclusions Our data suggest that elderly PAH patients have a unique clinical and hemodynamic profile, with totally different prognostic markers compared to younger PAH patients.展开更多
Objective To examine the effects of exogenously administered intermedin （IMD,adrenomedullin-2） on arterial blood pressure,cardiac function and the cardiovascular IMD receptor system in spontaneously hypertensive ra...Objective To examine the effects of exogenously administered intermedin （IMD,adrenomedullin-2） on arterial blood pressure,cardiac function and the cardiovascular IMD receptor system in spontaneously hypertensive rats （SHRs） as well as to investigate the associated mechanisms.Methods Thirteen week-old male rats were divided in Wistar Kyoto （WKY） group （n =12）,SHR group （n =12）,IMD group （SHRs infused with IMD 1-47 500 ng/kg per hour,n =12）,and ADM group （SHRs infused with adrenomedullin 500 ng/kg per hour,n =12）.Results A two-week continuous administration of low dose IMD 1-47 via mini-osmotic pumps markedly reduced blood pressure,the maximal rates of increase and decrease of left-ventricle pressure development （LV ± dp/dtmax）,left ventricular systolic pressure and heart rate in SHRs.Furthermore,IMD also inhibited protein over-expression of cardiovascular IMD receptors,myocardial Receptor Activity-Modifying Proteins （RAMP1 and RAMP2）,aortic RAMP1,RAMP2,RAMP3,and calcitonin receptor-like receptor （CRLR）;suppressed up-regulation of aortic RAMP1,RAMP2,RAMP3 and CRLR gene expression; and markedly elevated the mRNA abundance of myocardial atrial natriuretic peptide （ANP） and myocardial brain natriuretic peptide （BNP）.Additionally,IMD 1-47 administration in SHRs increased aortic cAMP concentration and reduced myocardial cAMP concentration.Conclusion These findings support the speculation that IMD,as a cardiovascular active peptide,is involved in blood pressure reduction and cardiac function amelioration during hypertension.The mechanism underlying this effect may involve IMD binding of a receptor complex formed by RAMPs and CRLR,and consequential regulation of cAMP levels and other cardiovascular active factors,such as ANP and BNP.展开更多
To investigate the dynamic changes of serum vascular endothelial growth factor(VEGF) levels in a rat model of acute myocardial infarction. Materials and methods.Eighty eight adult male Sprague Dawley rats weighing app...To investigate the dynamic changes of serum vascular endothelial growth factor(VEGF) levels in a rat model of acute myocardial infarction. Materials and methods.Eighty eight adult male Sprague Dawley rats weighing approximately 270 g were used in this study. Eighty rats were subjected to left coronary artery ligation, with 8 rats for each different duration of infarct. Eight sham operated animals in which the left coronary artery was surgically exposed without ligation were used as controls. Blood samples were drawn from the right atrium before (sham animals) and 1,3,6,12,24 h and 2,3,5,7,14 d after myocardial infarction. The concentrations of serum VEGF were measured by a sensitive enzyme linked immunosorbent assay with a rabbit polyclonal antibody specific for VEGF. Results. In the 8 control animals, the mean concentration of serum VEGF was 66.99±17.83 pg/ml. Six hours after myocardial infarction, the level of serum VEGF significantly increased to 125.68±28.07 pg/ml (P<0.01 vs. sham controls), and reached a peak (240.61±70.63 pg/ml. P<0.01 vs. sham animals) at 24 h after ligation and then decreased gradually over the remaining 2 weeks. However, the level remained significantly elevated for 14 d (107.64±30.13pg/ml, P<0.01 vs. sham controls). Conclusion. The present study shows that the levels of serum VEGF are markedly increased until 14 d in the rat model of acute myocardial infarction. The increased serum VEGF level may play an important role in the angiogenesis associated with myocardial infarction.展开更多
Background Endomyocardial biopsy （EMB） is an important tool when patients with inflammatoric cardiomyopathy （DCMi） are evaluated. We aimed to assess the clinical profile of elderly patients with DCMi on EMB. Metho...Background Endomyocardial biopsy （EMB） is an important tool when patients with inflammatoric cardiomyopathy （DCMi） are evaluated. We aimed to assess the clinical profile of elderly patients with DCMi on EMB. Methods Retrospective study of all consecutive patients hospitalized from January 2007 to December 2011 with clinical suspicion of DCMi undergoing EMB. Patients with evidence of DCMi on EMB （Group 1 〉 70 years, n = 85; Group 3 〈 70 years; n = 418） were compared to patients of the same age group without evi- dence of DCMi on EMB （Group 2 〉 70 years, n = 45; Group 4 〈 70 years; n = 147）. Results Among 24,275 patients treated at our institu- tion during the study period, 695 had clinical suspicion of DCMi and underwent EMB; 503 （2.1%） patients had DCMi on EMB. There were more male patients in Group 1, mean age was 74 ~ 2.8 years, mean ejection fraction was 38% q- 14%. On presentation, signs of hemody- namic compromise （NYHA functional class IIUIV, low cardiac output/index, and low cardiac power index） were more frequent in Group 1. EMB revealed viral genome in 78% of the patients, parvovirus B 19 （PVB） was frequently encountered in both age groups （Group 1： 69.4% vs. Group 2： 59.6%）; detection of more than one viral genome was more frequent in Group 1 （21.2% vs. 11.2%; P = 0.02） whereas the extent of immune response was significantly lower in individuals with advanced age. Conclusions In patients 〉 70 years with DCMi on EMB signs of hemodynamic compromise, detection of multiple viral genomes together with an overall lower extent of immune response were more frequently observed.展开更多
Objective:To determine whether long-term survival(>10 years) after heart transplantation is possible and identify complications influencing long-term survival.Methods:We analyzed clinical outcomes in the group of 2...Objective:To determine whether long-term survival(>10 years) after heart transplantation is possible and identify complications influencing long-term survival.Methods:We analyzed clinical outcomes in the group of 21 patients who had undergone heart transplantation at the Second Affiliated Hospital of Harbin Medical University since 1992 and 4 of them survived more than 10 years.Results:Nine patients are still alive with normal left ventricular function,and 4 of them have survived more than 10 years.The longest survival patient has lived more than 18 years after transplantation,whose survival is the longest in China and in Asia.We have also found that there has been a high incidence of complications,such as rejection episodes during the first 6 months,and transplant vasculopathy in the long-term survival patients.Conclusion:Long-term survivors maintain normal hemodynamic function of their allografts,and long-term survival following cardiac transplantation is possible.Aggressive preventive and therapeutic measures are essential to limit the risk factors for development of complications such as rejection episodes and transplant vasculopathy,and enable long-term survival after cardiac transplantation.展开更多
This ten-year retrospective study was designed to examine the morbidity and mortality of three cases of Cantrell＇s syndrome between 1998 and 2008. The three patients showed different degrees of Cantrell＇s pentalogy ...This ten-year retrospective study was designed to examine the morbidity and mortality of three cases of Cantrell＇s syndrome between 1998 and 2008. The three patients showed different degrees of Cantrell＇s pentalogy including abdominal ectopia cordis, thoracic-abdominal ectopia cordis and left ventricular diverticulum. Of the three, the 5-month-old boy suffering from complicated congenital heart disease with abdominal ectopia cordis received a successful single stage repair and reconstruction of the abdominal wall. The 33-week-old premature girl with thoracic-abdominal ectopia cordis underwent two stage correction of tetraology of Fallot. The 4-year-old girl underwent ectomy of left ventricular diverticulum and thoracoabdominal wall repair. Twenty-four to thirty-five months follow-up were satisfactory. We hold that two-stage repair are technically feasible for Cantrell＇s syndrome, especially for those with complex congenital heart diseases. Post-operative ventilatory support and multiple post-operative care should be prolonged. Malnutrition, infection and arrhytbmia are central problems in medical care and surgery should be considered if there was progressive heart failure or hemodynamic instability.展开更多
Objective： To determine the effect of antiparallel phosphorothioate triplex-forming oligonucleotide （apsTFO）, which was designed according to shear stress response element （SSRE） in tissue factor （TF） gene prom...Objective： To determine the effect of antiparallel phosphorothioate triplex-forming oligonucleotide （apsTFO）, which was designed according to shear stress response element （SSRE） in tissue factor （TF） gene promoter region, on the expression of endothelial TF in carotid artery stenosis rats. Methods： Rat model of severe carotid artery stenosis were inflicted by silica gel tube ligation. Half an hour before the model infliction, GT20-apsTFO, GT20-psTFO and GT21-apsTFO labeled with green fluorescence （FITC） were injected into the vena caudalis of rat at a dose of 0.5 mg/kg. Half an hour, 4 or 9 h after the ligation, the distribution of TFO in the common carotid artery, the liver and the kidney was detected with aid of fluorescence microscopy. And the mRNA and protein expressions of TF, Egr-1 and Spl in the above-mentioned organs were determined with in situ hybridization and immunohistochemical assay respectively in 6 h after the model establishment, and the results were analyzed with an image analysis system. Results： Only in 1 h after TFO injection, fluorescent granules appeared in the liver, the kidney and the vascular wall and lumen of carotid artery, and then in 4.5 h, they still deposited in above sites except the vascular lumen. GT20-apsTFO and GT21-apsTFO significant down-regulated the mRNA and protein expressions of TF compared to the rats without treatment （P〈0.05）, and the former apsTFO had a more stronger effect than the later （P〈0.05）. GT20-psTFO had no such effect （P〉0.05）. The 3 TFOs had no inhibition on the mRNA and protein expressions of Egr-1 and Spl. Conclusion： Pretreated apsTFO can partly come into the vascular endothelial cells, and inhibit TF expression induced by shear stress, but had no effect on Egr-1 and Spl gene expressions.展开更多
Background In the current era of transcatheter aortic valve replacement, there is renewed interest in balloon aortic valvuloplasty （BAV） and invasive hemodynarnic evaluation of aortic stenosis （AS）. The current re...Background In the current era of transcatheter aortic valve replacement, there is renewed interest in balloon aortic valvuloplasty （BAV） and invasive hemodynarnic evaluation of aortic stenosis （AS）. The current report aimed to study the invasive hemodynamics of se- vere AS patients treated with BAV as destination therapy and to identify factors associated with better hemodynamic outcome and prognosis. Methods From 2009 to 2012, 63 high risk elderly patients were treated with BAV as destination therapy for symptomatic severe AS and were all prospectively included in the study. Their hemodynamies were invasively evaluated during catheterization, pre- and post-BAV at the same session. All Post-BAV patients were regularly followed-up. Results The patients （82 ~ 6 years, 52% male） had post-BAV aortic valve area index （AVAi） significantly increased and mean pressure gradient （MPG） significantly reduced. During the follow-up of 0.9 （maximum 3.3） years, those with post-BAV AVAi 〈 0.6 cm2/m2 compared with the AVAi _〉 0.6 cm2/m2 group had significantly higher mortality （60% vs. 28%, log-rank P = 0.02）, even after adjusting for age, gender, atrial fibrillation, chronic kidney disease, diabetes mellitus, coronary artery disease and EuroSCORE [HR： 5.58, 95% confidence interval （CI）： 1.62-19.20, P = 0.006]. The only independent predictor of moderate AS post-BAV was the pre-BAV AVAi increase by 0.1cm^2/m^2 （OR： 3.81, 95% CI： 1.33-10.89, P = 0.01）. Pre-BAV AVAi 〉 0.39 cm^2/m^2 could predict with sensitivity 84% and specificity 70% the post-BAV hemodynamic outcome. Conclusions BAV as destination therapy for severe AS offered immediate and significant hemodynamic improvement. The survival was significantly better when a moderate degree of AS was present.展开更多
1 Introduction Pulmonary hypertension （PH） is a haemodynamic and pathophysiological condition defined as increase in mean pulmonary arterial pressure≥ 25 mmHg at rest as assessed by right heart catheterization （...1 Introduction Pulmonary hypertension （PH） is a haemodynamic and pathophysiological condition defined as increase in mean pulmonary arterial pressure≥ 25 mmHg at rest as assessed by right heart catheterization （RHC）.展开更多
Objective: To study the effect of CO2 pneumoperitoneum and the special 30 degree head-down tilt position on the venous hemodynamics in the lower extremity. Methods: Color doplex ultrasound was adopted to evaluate the ...Objective: To study the effect of CO2 pneumoperitoneum and the special 30 degree head-down tilt position on the venous hemodynamics in the lower extremity. Methods: Color doplex ultrasound was adopted to evaluate the diameter and blood flow velocity of the right femoral vein of 18 patients undergoing gynecologic laparoscopy under the same pressure of pneumoperitoneum of 12 mmHg. The diameter of femoral vein and the flow velocity were measured; the blood flow volume was calculated based on the equation of Q = vπr2 . Result: After establishment of pneumoperitoneum, the dilation of the femoral vein and the decrease in the velocity and volume can be observed (P < 0.05). And the 30 degree head-down position could increase the flow velocity and volume of the femoral vein and decrease the diameter of the vessel ( P < 0.05). At 30 minutes of the 30 degree head-down tilt position, the blood flow ameliorated compared with that in prone position after the establishment of pneumoperitoneum. After deflation of pneumoperitoneum, the femoral vein remained dilated( P < 0. 05). Conclusion: During laparoscopy, CO2 pneumoperitoneum may result in the dilation of the vein in lower extremity and retar dance of blood flow. The 30 degree Trendlenburg position can ameliorate the blood flow in the lower extremity. The deflation of the pneumoperitoneum cannot eliminate the effect of CO2 pneumoperitoneum on the lower extremity veins, which may predispose deep venous thrombosis after laparoscopy.展开更多
Objective To evaluate the effect of carotid artery stenting combined with nimodipine on cerebral hemodynamics by comparing and analyzing the change of anterior cerebral blood flow before and after treatment through tr...Objective To evaluate the effect of carotid artery stenting combined with nimodipine on cerebral hemodynamics by comparing and analyzing the change of anterior cerebral blood flow before and after treatment through transcrania Doppler （TCD）. Methods Twenty patients with ischemic cerebrovascnlar disease were detected in blood flow velocity of bilateral middle cerebral arteries （MCA） and anterior cerebral arteries （ACA） and artery pulsatility index with TCD before and two weeks after treatment. Results After treatment, TCD examination showed dynamic changes in blood flow significantly, lpsilateral MCA flow velocity significantly increased; ipsilateral ACA flow velocity did not change significantly; there was no significant increase in the contralateral MCA flow velocity; flow rate decreased significantly in contralateral ACA. Conclusion Carotid artery stenting combined with nimodipine treatment can cause anterior cerebral hemodynamic changes in ipsilateral hemisphere and significantly improve blood flow展开更多
Background: Recent data suggest that beta-blockers can be beneficial in patients with chronic heart failure (CHF). Atrial fibrillation (AF) is present in a significant number of patients with CHF and is associateing w...Background: Recent data suggest that beta-blockers can be beneficial in patients with chronic heart failure (CHF). Atrial fibrillation (AF) is present in a significant number of patients with CHF and is associateing with significant morbidity and increasing mortality rates. Thus it is necessary to establish therapy to improve the poor prognosis in this high-risk population, but a specific benefit of beta-blockers to the subset with concomitant AF and CHF has been little demonstrated. Objective: To examine the effects of Bisoprolol (6 months treatment) on the ventricular function and hemodynamics in patients with AF and CHF. Methods: 84 patients with stable CHF (NYHA≤Ⅲ class) and AF were assigned to Treated Group( n = 37) or Control group Ⅰ ( n = 22, 24-hour heart mean rate < 70/min) or Control Group Ⅱ ( n = 25, 24-hour heart mean rate ≥ 70/min) . All patients were given the basic therapy for CHF, and Treated Group received Bisopolol. Clinical and echocardiographic variables were measured in 3 groups at baseline and after 6 months, and the results were compared . Results: After 6 months of treatment with Bisoprolol, left ventricular ejection fraction (LVEF) and NYHA class had significandy improved (P < 0.05), and a trend towards a reduction in combined end point of death or CHF hospitalization was also observed (P < 0.20) in Treated Group; The increase of LVEF in Treated Group were associated with a reduction in mitral regurgitation degree and left atrial volume; The heart rate in mean 24-hour and at peak exercise decreased in Treated Group, but were similar to that in Control Group Ⅰ. Conclusion: 6 months of Bisoprolol therapy resulted in an improvement in the NYHA class and LVEF, and also showed a trend towards a reduction in hospitalization or death. The beneficial effects of Bisoprolol on patients with AF and CHF may be partly mediated by improvement of ventricular diastolic function.展开更多
Objective： To investigate the effect of preoperative limited fluid resuscitation on the patients with traumatic shock. Methods： Eighty-nine patients with multiple injuries complicating with shock were treated in Cha...Objective： To investigate the effect of preoperative limited fluid resuscitation on the patients with traumatic shock. Methods： Eighty-nine patients with multiple injuries complicating with shock were treated in Changhai Hospital Between January 2002 to October 2005 and were divided into 3 groups according to the preoperative levels of systolic blood pressure （SBP）. SBP of group A and group B were about 70 and 80 mmHg, respectively; and the SBP of group C was over 90 mmHg. Results, （1） There was no significant difference in age, gender, and injury severity score （ISS）, initiated resuscitation time and initiated operation time among the 3 groups. Preoperatively, there was significant difference in the amount of fluid resuscitation and infused erythrocyte suspension among group A, B and C （1687 ± 96 ml, 2096 ± 87 ml, 2976±93 ml, P〈0. 05; and 294±110 ml, 404±113 ml, 798±230 ml, P〈0. 05）. （2） The hemoglobin level in group C （94±45 g/L） was lower than that in group A （110±22 g/L） and group B （103±24 g/L） （P〈0.05）. However, there was no significant difference in the level of hemoglobin between group A and B. （3） There was no significant difference in the incidence of acute renal failure （ARF） among the 3 groups. The incidence of acute respiratory distress syndrome （ARDS） of group C （31.2%） was higher than that of group A （16.7%） and group B （18.2%） （P〈0.05）. The mortality of group C （34.4%） was higher than that of group A （12. 5% ） and group B （12. 1% ） （P〈0.05）. Conclusion： Preoperative limited resuscitation applied on patients with traumatic shock can reduce blood loss, incidence of ARDS and mortality.展开更多
Introduction In the United States, there are about 17.6 million patients suffer from symptomatic coronary artery disease （CAD）, affecting 7.9% of adults ≥ 20 years of age.1 An estimated 10.2 million patients have ...Introduction In the United States, there are about 17.6 million patients suffer from symptomatic coronary artery disease （CAD）, affecting 7.9% of adults ≥ 20 years of age.1 An estimated 10.2 million patients have angina, and 500,000 patients will develop new angina pectoris each year. 1 A subset of angina patients are categorized as refractory when symptoms continue despite optimal medical therapy and revascularization.Routine daily activities become impossible without experiencing chest pain in this patient population.2展开更多
文摘Approximately 40% of pheochromocytoma and paraganglioma(PPGL) cases are familial, typically presenting earlier with more complex symptoms. This paper synthesizes literature and guidelines to inform on clinical characteristics and perioperative care for PPGL. Pheochromocytoma in von Hippel-Lindau(VHL) disease exhibits heightened secretion activity without significant perioperative hemodynamic changes. Tumors in multiple endocrine neoplasia type 2(MEN2) have a stronger endocrine function, which may induce hemodynamic fluctuations during surgery. Therefore, pheochromocytoma screening is essential at all stages of MEN2. Neurofibromatosis type 1(NF1) often presents multisystem lesions and can result in difficult airway. Pheochromocytoma should be evaluated when NF1 patients present hypertension. Pheochromocytoma and paraganglioma type 5 may present multiple lesions of pheochromocytoma or paraganglioma. In summary, hereditary PPGLs may present with severe lesions in other systems, beyond tumor function. A multi-disciplinary team(MDT) approach is often invaluable in perioperative management.
文摘Heart failure （HF） with preserved ejection fraction （HFpEF） is the most common form of HF in older adults, and is increasing in preva- lence as the population ages. Furthermore, HFpEF is increasing out of proportion to HF with reduced EF （HFrEF）, and its prognosis is worsening while that of HFrEF is improving. Despite the importance of HFpEF, our understanding of its pathophysiology is incomplete, and optimal treatment remains largely undefined. A cardinal feature of HFpEF is reduced exercise tolerance, which correlates with symptoms as well as reduced quality of life. The traditional concepts of exercise limitations have focused on central dysfimction related to poor cardiac pump function. However, the mechanisms are not exclusive to the heart and lungs, and the understanding of the pathophysiology of this dis- ease has evolved. Substantial attention has focused on defining the central versus peripheral mechanisms underlying the reduced functional capacity and exercise tolerance among patients with HF. In fact, physical training can improve exercise tolerance via peripheral adaptive mechanisms even in the absence of favorable central hemodynamic function. In addition, the drug trials performed to date in HFpEF that have focused on influencing cardiovascular function have not improved exercise capacity. This suggests that peripheral limitations may play a significant role in HF limiting exercise tolerance, a hallmark feature of HFpEF.
文摘Objective There are still a high proportion of patients with ST-segment elevation myocardial infarction （STEMI） missing out early reperfusion even in the primary percutaneous coronary intervention （PCI） era. Most of them are stable latecomers, but the optimal time to undergo delayed PCI for stable ones remains controversial. Methods We investigated all STEMI patients who underwent delayed PCI （2-28 days after STEMI） during 2007-2010 in Beijing and excluded patients with hemodynamic instability. The primary outcome was maj or adverse cardiovascular events （MACEs）. Results This study finally enrolled 5,417 STEMI patients and assigned them into three groups according to individual delayed time （Early group, 55.9%; Medium group, 35.4%; Late group, 8.7%）. During 1-year follow-up, MACEs occurred in 319 patients. The incidence of MACEs were respectively 7.1%, 5.6% and 6.7% among three groups. The Medium group had less recurrent myocardial infarction plus cardiac death （hazard ratio, 0.525; 95% confidence interval, 0.294-0.938, P = 0.030） than Late group and less repeat revascularization （hazard ratio, 0.640; 95% confidence interval, 0.463-0.883, P = 0.007） than Early group in pairwise comparisons. We depicted the incidence of major adverse cardiovascular event （MACE） by delayed time as a quadratic curve and found the bottom appeared at day 14. Conclusions The delayed PCI time varied in the real-world practice, but undergoing operations on the second week after STEMI had greater survival benefit and less adverse events for whom without early reperfusion and hemodynamic instability.
文摘Backgrounds Pulmonary arterial hypertension （PAH） was previously considered an illness that affects mostly the young, but now it is also increasingly recognized in the elderly. The aim of this study was to compare the features of elderly versus younger patients diagnosed with PAH, and to define the prognostic factors which affect their long-term survival. Methods In this prospective, single center study, the clinical, echocardiographic, hemodynamic characteristics, and the outcomes of younger （18-65 years） and elderly （〉 65 years） patients with definitive diagnosis of precapillary PAIl were compared. Results A total of 119 patients were analyzed in this study; 43 were elderly （mean age： 71.5 ± 5.5 years）, while 76 were non-elderly （mean age 44.5 ±15.2 years）. During the mean follow-up duration of 26.8 ±25.0 months, 43 deaths occurred, 17 of which were among the elderly group, with 28 among non-elderly group. Comparison of baseline parameters showed that 6 min walking distance, hemoglobin levels, pulmonary artery pressures and pulmonary vascular resistance were significantly lower; and estimated glomerular filtration rate, body mass index, E/e＇ and pulmonary capillary wedge pressure were significantly higher in the elderly group than in the younger group. Survival analysis demonstrated that the independent predictors of death were tricuspid plane annular systolic excursion （TAPSE; HR： 1.272, 95% CI： 1.079-1.499, P = 0.004） and uric acid （HR： 1.291, 95% CI： 1.042-1.600, P = 0.019） in the elderly group. In contrast, in the non-elderly group, higher brain natriuretic peptide （HR： 1.002, 95% CI： 1.001-1.004, P 〈 0.001） and higher right atrial pressure （HR： 1.128, 95% CI： 1.026-1.241, P = 0.013） values were the only parameters associated with mortality. Conclusions Our data suggest that elderly PAH patients have a unique clinical and hemodynamic profile, with totally different prognostic markers compared to younger PAH patients.
文摘Objective To examine the effects of exogenously administered intermedin （IMD,adrenomedullin-2） on arterial blood pressure,cardiac function and the cardiovascular IMD receptor system in spontaneously hypertensive rats （SHRs） as well as to investigate the associated mechanisms.Methods Thirteen week-old male rats were divided in Wistar Kyoto （WKY） group （n =12）,SHR group （n =12）,IMD group （SHRs infused with IMD 1-47 500 ng/kg per hour,n =12）,and ADM group （SHRs infused with adrenomedullin 500 ng/kg per hour,n =12）.Results A two-week continuous administration of low dose IMD 1-47 via mini-osmotic pumps markedly reduced blood pressure,the maximal rates of increase and decrease of left-ventricle pressure development （LV ± dp/dtmax）,left ventricular systolic pressure and heart rate in SHRs.Furthermore,IMD also inhibited protein over-expression of cardiovascular IMD receptors,myocardial Receptor Activity-Modifying Proteins （RAMP1 and RAMP2）,aortic RAMP1,RAMP2,RAMP3,and calcitonin receptor-like receptor （CRLR）;suppressed up-regulation of aortic RAMP1,RAMP2,RAMP3 and CRLR gene expression; and markedly elevated the mRNA abundance of myocardial atrial natriuretic peptide （ANP） and myocardial brain natriuretic peptide （BNP）.Additionally,IMD 1-47 administration in SHRs increased aortic cAMP concentration and reduced myocardial cAMP concentration.Conclusion These findings support the speculation that IMD,as a cardiovascular active peptide,is involved in blood pressure reduction and cardiac function amelioration during hypertension.The mechanism underlying this effect may involve IMD binding of a receptor complex formed by RAMPs and CRLR,and consequential regulation of cAMP levels and other cardiovascular active factors,such as ANP and BNP.
文摘To investigate the dynamic changes of serum vascular endothelial growth factor(VEGF) levels in a rat model of acute myocardial infarction. Materials and methods.Eighty eight adult male Sprague Dawley rats weighing approximately 270 g were used in this study. Eighty rats were subjected to left coronary artery ligation, with 8 rats for each different duration of infarct. Eight sham operated animals in which the left coronary artery was surgically exposed without ligation were used as controls. Blood samples were drawn from the right atrium before (sham animals) and 1,3,6,12,24 h and 2,3,5,7,14 d after myocardial infarction. The concentrations of serum VEGF were measured by a sensitive enzyme linked immunosorbent assay with a rabbit polyclonal antibody specific for VEGF. Results. In the 8 control animals, the mean concentration of serum VEGF was 66.99±17.83 pg/ml. Six hours after myocardial infarction, the level of serum VEGF significantly increased to 125.68±28.07 pg/ml (P<0.01 vs. sham controls), and reached a peak (240.61±70.63 pg/ml. P<0.01 vs. sham animals) at 24 h after ligation and then decreased gradually over the remaining 2 weeks. However, the level remained significantly elevated for 14 d (107.64±30.13pg/ml, P<0.01 vs. sham controls). Conclusion. The present study shows that the levels of serum VEGF are markedly increased until 14 d in the rat model of acute myocardial infarction. The increased serum VEGF level may play an important role in the angiogenesis associated with myocardial infarction.
文摘Background Endomyocardial biopsy （EMB） is an important tool when patients with inflammatoric cardiomyopathy （DCMi） are evaluated. We aimed to assess the clinical profile of elderly patients with DCMi on EMB. Methods Retrospective study of all consecutive patients hospitalized from January 2007 to December 2011 with clinical suspicion of DCMi undergoing EMB. Patients with evidence of DCMi on EMB （Group 1 〉 70 years, n = 85; Group 3 〈 70 years; n = 418） were compared to patients of the same age group without evi- dence of DCMi on EMB （Group 2 〉 70 years, n = 45; Group 4 〈 70 years; n = 147）. Results Among 24,275 patients treated at our institu- tion during the study period, 695 had clinical suspicion of DCMi and underwent EMB; 503 （2.1%） patients had DCMi on EMB. There were more male patients in Group 1, mean age was 74 ~ 2.8 years, mean ejection fraction was 38% q- 14%. On presentation, signs of hemody- namic compromise （NYHA functional class IIUIV, low cardiac output/index, and low cardiac power index） were more frequent in Group 1. EMB revealed viral genome in 78% of the patients, parvovirus B 19 （PVB） was frequently encountered in both age groups （Group 1： 69.4% vs. Group 2： 59.6%）; detection of more than one viral genome was more frequent in Group 1 （21.2% vs. 11.2%; P = 0.02） whereas the extent of immune response was significantly lower in individuals with advanced age. Conclusions In patients 〉 70 years with DCMi on EMB signs of hemodynamic compromise, detection of multiple viral genomes together with an overall lower extent of immune response were more frequently observed.
文摘Objective:To determine whether long-term survival(>10 years) after heart transplantation is possible and identify complications influencing long-term survival.Methods:We analyzed clinical outcomes in the group of 21 patients who had undergone heart transplantation at the Second Affiliated Hospital of Harbin Medical University since 1992 and 4 of them survived more than 10 years.Results:Nine patients are still alive with normal left ventricular function,and 4 of them have survived more than 10 years.The longest survival patient has lived more than 18 years after transplantation,whose survival is the longest in China and in Asia.We have also found that there has been a high incidence of complications,such as rejection episodes during the first 6 months,and transplant vasculopathy in the long-term survival patients.Conclusion:Long-term survivors maintain normal hemodynamic function of their allografts,and long-term survival following cardiac transplantation is possible.Aggressive preventive and therapeutic measures are essential to limit the risk factors for development of complications such as rejection episodes and transplant vasculopathy,and enable long-term survival after cardiac transplantation.
文摘This ten-year retrospective study was designed to examine the morbidity and mortality of three cases of Cantrell＇s syndrome between 1998 and 2008. The three patients showed different degrees of Cantrell＇s pentalogy including abdominal ectopia cordis, thoracic-abdominal ectopia cordis and left ventricular diverticulum. Of the three, the 5-month-old boy suffering from complicated congenital heart disease with abdominal ectopia cordis received a successful single stage repair and reconstruction of the abdominal wall. The 33-week-old premature girl with thoracic-abdominal ectopia cordis underwent two stage correction of tetraology of Fallot. The 4-year-old girl underwent ectomy of left ventricular diverticulum and thoracoabdominal wall repair. Twenty-four to thirty-five months follow-up were satisfactory. We hold that two-stage repair are technically feasible for Cantrell＇s syndrome, especially for those with complex congenital heart diseases. Post-operative ventilatory support and multiple post-operative care should be prolonged. Malnutrition, infection and arrhytbmia are central problems in medical care and surgery should be considered if there was progressive heart failure or hemodynamic instability.
基金the National Natural Science Foundation of China (39970269)
文摘Objective： To determine the effect of antiparallel phosphorothioate triplex-forming oligonucleotide （apsTFO）, which was designed according to shear stress response element （SSRE） in tissue factor （TF） gene promoter region, on the expression of endothelial TF in carotid artery stenosis rats. Methods： Rat model of severe carotid artery stenosis were inflicted by silica gel tube ligation. Half an hour before the model infliction, GT20-apsTFO, GT20-psTFO and GT21-apsTFO labeled with green fluorescence （FITC） were injected into the vena caudalis of rat at a dose of 0.5 mg/kg. Half an hour, 4 or 9 h after the ligation, the distribution of TFO in the common carotid artery, the liver and the kidney was detected with aid of fluorescence microscopy. And the mRNA and protein expressions of TF, Egr-1 and Spl in the above-mentioned organs were determined with in situ hybridization and immunohistochemical assay respectively in 6 h after the model establishment, and the results were analyzed with an image analysis system. Results： Only in 1 h after TFO injection, fluorescent granules appeared in the liver, the kidney and the vascular wall and lumen of carotid artery, and then in 4.5 h, they still deposited in above sites except the vascular lumen. GT20-apsTFO and GT21-apsTFO significant down-regulated the mRNA and protein expressions of TF compared to the rats without treatment （P〈0.05）, and the former apsTFO had a more stronger effect than the later （P〈0.05）. GT20-psTFO had no such effect （P〉0.05）. The 3 TFOs had no inhibition on the mRNA and protein expressions of Egr-1 and Spl. Conclusion： Pretreated apsTFO can partly come into the vascular endothelial cells, and inhibit TF expression induced by shear stress, but had no effect on Egr-1 and Spl gene expressions.
文摘Background In the current era of transcatheter aortic valve replacement, there is renewed interest in balloon aortic valvuloplasty （BAV） and invasive hemodynarnic evaluation of aortic stenosis （AS）. The current report aimed to study the invasive hemodynamics of se- vere AS patients treated with BAV as destination therapy and to identify factors associated with better hemodynamic outcome and prognosis. Methods From 2009 to 2012, 63 high risk elderly patients were treated with BAV as destination therapy for symptomatic severe AS and were all prospectively included in the study. Their hemodynamies were invasively evaluated during catheterization, pre- and post-BAV at the same session. All Post-BAV patients were regularly followed-up. Results The patients （82 ~ 6 years, 52% male） had post-BAV aortic valve area index （AVAi） significantly increased and mean pressure gradient （MPG） significantly reduced. During the follow-up of 0.9 （maximum 3.3） years, those with post-BAV AVAi 〈 0.6 cm2/m2 compared with the AVAi _〉 0.6 cm2/m2 group had significantly higher mortality （60% vs. 28%, log-rank P = 0.02）, even after adjusting for age, gender, atrial fibrillation, chronic kidney disease, diabetes mellitus, coronary artery disease and EuroSCORE [HR： 5.58, 95% confidence interval （CI）： 1.62-19.20, P = 0.006]. The only independent predictor of moderate AS post-BAV was the pre-BAV AVAi increase by 0.1cm^2/m^2 （OR： 3.81, 95% CI： 1.33-10.89, P = 0.01）. Pre-BAV AVAi 〉 0.39 cm^2/m^2 could predict with sensitivity 84% and specificity 70% the post-BAV hemodynamic outcome. Conclusions BAV as destination therapy for severe AS offered immediate and significant hemodynamic improvement. The survival was significantly better when a moderate degree of AS was present.
文摘1 Introduction Pulmonary hypertension （PH） is a haemodynamic and pathophysiological condition defined as increase in mean pulmonary arterial pressure≥ 25 mmHg at rest as assessed by right heart catheterization （RHC）.
文摘Objective: To study the effect of CO2 pneumoperitoneum and the special 30 degree head-down tilt position on the venous hemodynamics in the lower extremity. Methods: Color doplex ultrasound was adopted to evaluate the diameter and blood flow velocity of the right femoral vein of 18 patients undergoing gynecologic laparoscopy under the same pressure of pneumoperitoneum of 12 mmHg. The diameter of femoral vein and the flow velocity were measured; the blood flow volume was calculated based on the equation of Q = vπr2 . Result: After establishment of pneumoperitoneum, the dilation of the femoral vein and the decrease in the velocity and volume can be observed (P < 0.05). And the 30 degree head-down position could increase the flow velocity and volume of the femoral vein and decrease the diameter of the vessel ( P < 0.05). At 30 minutes of the 30 degree head-down tilt position, the blood flow ameliorated compared with that in prone position after the establishment of pneumoperitoneum. After deflation of pneumoperitoneum, the femoral vein remained dilated( P < 0. 05). Conclusion: During laparoscopy, CO2 pneumoperitoneum may result in the dilation of the vein in lower extremity and retar dance of blood flow. The 30 degree Trendlenburg position can ameliorate the blood flow in the lower extremity. The deflation of the pneumoperitoneum cannot eliminate the effect of CO2 pneumoperitoneum on the lower extremity veins, which may predispose deep venous thrombosis after laparoscopy.
基金Supported by the Shaanxi Scientific and Technical Plan(2009K18-02)
文摘Objective To evaluate the effect of carotid artery stenting combined with nimodipine on cerebral hemodynamics by comparing and analyzing the change of anterior cerebral blood flow before and after treatment through transcrania Doppler （TCD）. Methods Twenty patients with ischemic cerebrovascnlar disease were detected in blood flow velocity of bilateral middle cerebral arteries （MCA） and anterior cerebral arteries （ACA） and artery pulsatility index with TCD before and two weeks after treatment. Results After treatment, TCD examination showed dynamic changes in blood flow significantly, lpsilateral MCA flow velocity significantly increased; ipsilateral ACA flow velocity did not change significantly; there was no significant increase in the contralateral MCA flow velocity; flow rate decreased significantly in contralateral ACA. Conclusion Carotid artery stenting combined with nimodipine treatment can cause anterior cerebral hemodynamic changes in ipsilateral hemisphere and significantly improve blood flow
文摘Background: Recent data suggest that beta-blockers can be beneficial in patients with chronic heart failure (CHF). Atrial fibrillation (AF) is present in a significant number of patients with CHF and is associateing with significant morbidity and increasing mortality rates. Thus it is necessary to establish therapy to improve the poor prognosis in this high-risk population, but a specific benefit of beta-blockers to the subset with concomitant AF and CHF has been little demonstrated. Objective: To examine the effects of Bisoprolol (6 months treatment) on the ventricular function and hemodynamics in patients with AF and CHF. Methods: 84 patients with stable CHF (NYHA≤Ⅲ class) and AF were assigned to Treated Group( n = 37) or Control group Ⅰ ( n = 22, 24-hour heart mean rate < 70/min) or Control Group Ⅱ ( n = 25, 24-hour heart mean rate ≥ 70/min) . All patients were given the basic therapy for CHF, and Treated Group received Bisopolol. Clinical and echocardiographic variables were measured in 3 groups at baseline and after 6 months, and the results were compared . Results: After 6 months of treatment with Bisoprolol, left ventricular ejection fraction (LVEF) and NYHA class had significandy improved (P < 0.05), and a trend towards a reduction in combined end point of death or CHF hospitalization was also observed (P < 0.20) in Treated Group; The increase of LVEF in Treated Group were associated with a reduction in mitral regurgitation degree and left atrial volume; The heart rate in mean 24-hour and at peak exercise decreased in Treated Group, but were similar to that in Control Group Ⅰ. Conclusion: 6 months of Bisoprolol therapy resulted in an improvement in the NYHA class and LVEF, and also showed a trend towards a reduction in hospitalization or death. The beneficial effects of Bisoprolol on patients with AF and CHF may be partly mediated by improvement of ventricular diastolic function.
文摘Objective： To investigate the effect of preoperative limited fluid resuscitation on the patients with traumatic shock. Methods： Eighty-nine patients with multiple injuries complicating with shock were treated in Changhai Hospital Between January 2002 to October 2005 and were divided into 3 groups according to the preoperative levels of systolic blood pressure （SBP）. SBP of group A and group B were about 70 and 80 mmHg, respectively; and the SBP of group C was over 90 mmHg. Results, （1） There was no significant difference in age, gender, and injury severity score （ISS）, initiated resuscitation time and initiated operation time among the 3 groups. Preoperatively, there was significant difference in the amount of fluid resuscitation and infused erythrocyte suspension among group A, B and C （1687 ± 96 ml, 2096 ± 87 ml, 2976±93 ml, P〈0. 05; and 294±110 ml, 404±113 ml, 798±230 ml, P〈0. 05）. （2） The hemoglobin level in group C （94±45 g/L） was lower than that in group A （110±22 g/L） and group B （103±24 g/L） （P〈0.05）. However, there was no significant difference in the level of hemoglobin between group A and B. （3） There was no significant difference in the incidence of acute renal failure （ARF） among the 3 groups. The incidence of acute respiratory distress syndrome （ARDS） of group C （31.2%） was higher than that of group A （16.7%） and group B （18.2%） （P〈0.05）. The mortality of group C （34.4%） was higher than that of group A （12. 5% ） and group B （12. 1% ） （P〈0.05）. Conclusion： Preoperative limited resuscitation applied on patients with traumatic shock can reduce blood loss, incidence of ARDS and mortality.
文摘Introduction In the United States, there are about 17.6 million patients suffer from symptomatic coronary artery disease （CAD）, affecting 7.9% of adults ≥ 20 years of age.1 An estimated 10.2 million patients have angina, and 500,000 patients will develop new angina pectoris each year. 1 A subset of angina patients are categorized as refractory when symptoms continue despite optimal medical therapy and revascularization.Routine daily activities become impossible without experiencing chest pain in this patient population.2
