Background. Myocardial bridging (MB) is a congenital anomaly involving the myocardial tissue encasement of a segment of the coronary artery. The purpose of the present study was to assess safety and efficacy of two surgical methods used for treating MB patients at our institute. Methods. Off-pump MB unroofing was performed in 45 adult patients between January 2016 and December 2021 by traditional surgical unroofing techniques (conventional group, n = 26) and blunt dissection techniques (blunt dissection group, n = 19). We retrospectively reviewed our patients by examining the baseline clinical characteristics, risk factors, medications, and diagnostic data for coronary artery disease. The Seattle Angina Questionnaire (SAQ) was used to assess angina symptoms both preoperatively and 6 months postsurgery. Results. No significant difference in preoperative clinical characteristics was observed between the two groups. The blunt dissection group had shorter unroofed period (14.69 vs. 18.91 mins, ), less ventilator time (16.26 vs. 24.62 hours, ), and a shorter hospital stay (8.74 vs. 12.89 days, ). Although both traditional and blunt dissection techniques significantly improved postoperative SAQ scores including physical limitation due to angina, anginal stability, anginal frequency, treatment satisfaction, and quality of life ( ), no significant difference was observed between the traditional and blunt dissection techniques for SAQ. No cases of left anterior descending (LAD) injury in the blunt dissection group were observed although seven patients in the conventional group had LAD injuries. Conclusions. In our single-center experience of MB unroofing, the blunt dissection technique is a safe, effective technique that significantly reduces surgical and ventilator time and hospital stay. MB patients with severe angina who underwent the blunt dissection for surgical unroofing experienced significant improvements in anginal symptoms and quality of life six months after the surgery.
Introduction Ventricular septal rupture (VSR) following acute myocardial infarction (AMI) is a rare but serious complication often causing cardiogenic shock (CS). The timing of surgery is a difficult problem for surgeons because of high mortality and surgical complexity. We present a case of successful use of extracorporeal membrane oxygenation (ECMO) for maintaining haemodynamic stability preoperative and delaying surgical repair of VSR patient in severe CS. Case report A 57-year-old man with AMI complicated by severe CS due to an massive VSR. Emergency surgery was considered a too high mortality risk. The patient was implanted with a percutaneous veno-arterial ECMO (VA-ECMO) system as a bridge to surgery for stabilizing general condition. On the 31th day after ECMO implantation, the ventricular septal defect was successfully repaired and weaning from the ECMO. Discussion This case study illustrates that it may be considered to use long term ECMO preoperative to delayed surgery which leads to higher survival in cases of massive VSR patient after AMI in hemodynamically compromised patients. Still the optimal duration of mechanical circulatory support and the optimal timing for surgery need more research to define. Conclusion This case indicates the feasibility of preoperative using of a long term VA-ECMO as a bridge to surgical repair of VSR patient after AMI in severe CS. The optimal duration of mechanical circulatory support and the optimal timing for surgery still require further investigation.
Objective This study was performed to evaluate the clinical efficacy and safety of a novel surgical procedure in treating tracheal or bronchial compression related to severe congenital heart disease. Methods The clinical data of 28 patients with tracheal or bronchial compression related to severe congenital heart disease were retrospectively analyzed. In the control group, 12 patients underwent surgery for congenital cardiac malformations. In the treatment group, 16 patients underwent surgery for congenital cardiac malformations combined with partial resection of the pulmonary artery wall. The cardiothoracic ratio, pulmonary arterial pressure, left ventricular end-diastolic dimension, diameter of the pulmonary artery, and diameter of the trachea in the stenotic segment were quantitatively measured before and 9 days after the operation. Results The diameter of the pulmonary artery and diameter of the trachea in the stenotic segment were almost restored to the normal range in the treatment group. Patients in the treatment group recovered more rapidly and effectively than those in the control group. Conclusion Partial resection of the pulmonary artery wall is an efficacious and safe technique in the treatment of tracheal or bronchial compression related to severe congenital heart disease.
Objective
To analyze clinical outcomes of myocardial incision and tearing for the treatment of myocardial bridge.
Methods
A retrospective cohort study was conduct to review the clinical date of 29 patients who underwent surgical myotomy from January 2014 to January 2018 in the Second Hospital of Lanzhou University. A total of 11 patients(incision group) were experienced traditional myotomy on myocardial bridge that the myocardium was longitudinally incised along the direction of the coronary artery, while 18 patients(tearing group) were treated by myocardial incision combined with tearing that longitudinally incised myocardium and deeply tissue tearing. The operation time of surgical myotomy, the amount of bleeding, the number of branches of vascular injury and the number of ventricular ruptures during operation were compared between the two groups. After followed up half a year to one year, the clinical symptoms of angina pectoris, myocardial ischemia by electrocardiogram suggested, and coronary stenosis by coronary CT suggested were collected.
Results
The operation time of surgical myotomy, the amount of bleeding patients and the number of branches of vascular injury during operation in the incision group were higher than those in the tearing group(P 0.05). After followed up half a year to one year, there was no significant difference in the clinical symptoms of angina pectoris, myocardial ischemia by electrocardiogram suggested, and coronary stenosis by coronary CT suggested(P>0.05).
Conclusion
Myocardial incision combined with tearing is a surgical procedure with short operation time and low bleeding risk, which is more beneficial than the traditional longitudinally incised for the myocardial bridge.
Key words:
Myocardial bridge; Myotomy; Clinical outcome
Daunorubicin (Dau) has been widely used in the treatment of many solid tumors. However, the side effects of Dau seriously hinder its further application in clinical use. How to increase the drug accumulation in tumors and reduce the damage to normal tissues is an urgent problem to be solved. In this study, we developed c(RGDfK) decorated PEG-PLA micelles for target delivery of Dau to C6 glioblastoma cells. The enhanced uptake of cRGD decorated micelles by C6 cells were observed via CLSM and flow cytometry experiments. Moreover, the cRGD decorated micelles showed more cytotoxicity to C6 cells than undecorated micelles ex vivo. Therefore, cRGD decorated micelles represent a promising approach in improving drug accumulation for treatment of glioblastoma.
MicroRNA-663 (miRNA-663) regulates the expression of transforming growth factor β1 (TGF-β1), which participates in the pathogenesis of myocardial fibrosis. Therefore, microRNA-663 may also serve a role in myocardial fibrosis. The present study aimed to determine whether miRNA-663 participates in myocardial fibrosis via interaction with TGF-β1. In the present study, the expression of miRNA-663 was significantly downregulated, whereas that of TGF-β1 was significantly upregulated in the endomyocardial biopsies of patients with myocardial fibrosis compared with those in control necropsies. Pearson's correlation analysis revealed that the expression levels of miRNA-663 were negatively correlated with those of TGF-β1 in patients with myocardial fibrosis, but not in the controls. Receiver operating characteristic curve analysis demonstrated that the downregulation of miRNA-663 distinguished patients with myocardial fibrosis from controls. In the AC16 human cardiomyocyte cell line, miRNA-663 overexpression resulted in downregulated TGF-β1 expression, whereas exogenous TGF-β1 treatment exhibited no significant effects on miRNA-663 expression. These results indicate that miRNA-663 may participate in myocardial fibrosis, possibly through interaction with TGF-β1.
Ruptured sinus of Valsalva aneurysm (RSVA) often has an abrupt onset, and can chest pain, acute heart failure, and even sudden death. The effectiveness of different treatment modalities remains controversial. Thus, we completed a meta-analysis to evaluate the efficiency and safety of traditional surgery vs. percutaneous closure (PC) for RSVA.We carried out a meta-analysis using PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), WanFang Data, and the China Science and Technology Journal Database. The primary outcome was comparing in-hospital mortality between the two procedures, and the secondary outcome was documenting postoperative residual shunts, postoperative aortic regurgitation, and length of hospital stay in the two groups. Differences were expressed as odds ratios (ORs) with 95% confidence intervals (CIs) to assess the relationships between predefined surgical variables and clinical outcomes. This meta-analysis was conducted using Review Manager software (version 5.3).The final qualifying studies included 330 patients from 10 trials (123 in the percutaneous closure group, and 207 in the surgical repair group). When PC was compared to surgical repair, there were no statistically significant differences in in-hospital mortality (overall OR: 0.47, 95%CI 0.05-4.31, P = 0.50). However, percutaneous closure did significantly decrease the average length of hospital stay (OR: -2.13, 95% CI -3.05 to -1.20, P < 0.00001) when compared to surgical repair, but there were no significant between-group differences in the rates of postoperative residual shunts (overall OR: 1.54, 95%CI 0.55-4.34, P = 0.41) or postoperative aortic regurgitation (overall OR: 1.54, 95%CI 0.51-4.68, P = 0.45).PC may become a valuable alternative to surgical repair for RSVA.
Review question / Objective: The past decade has witnessed considerable improvement in implantation techniques for percutaneous closure of ruptured sinus of valsalva aneurysm.This meta-analysis was undertaken to compare the efficiency and safety of traditional surgery and percutaneous closure of ruptured sinus of Valsalva aneurysm.Rationale: Sinus of Valsalva aneurysm is a rare anomaly and most often caused by a congenital deficiency of muscular and elastic tissue in the aortic wall of the sinus of Valsalva or acquired after periaortic inflammation, atherosclerosis, trauma, and aortic dissection.It may also occur in patients after corrective surgery for congenital heart diseases INPLASY registration number: This protocol was registered with the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) on 25 November 2022 and was last updated on 25 November 2022 (registration number INPLASY2022110131).
RNAi become a popular technique in exploring gene function. Synthesized siRNA duplexes and vector-based siRNA are mostly used in gene silencing. However, vector-based siRNA constructed from plasmids are rarely used in inhibition gene expression.In our study, vector-based siRNA are used in reducing PSMD4 expression. Our study suggests that vector-based siRNA can be used in cancer research.
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