Objective To evaluate the effects of milrinone on plasma levels of C reactive protein (CRP) , TNF-?, IL-8 and IL-10 during and after operation for tetralogy of Fallot performed under cardiopulmonary bypass (CPU) in children.Methods Sixteen ASA Ⅲ-Ⅳ pediatric patients aged l-12yr scheduled for operation for tetralogy of Fallot under CPB were randomly divided into two groups : (1) milrinone group ( M, n = 8) and (2) control group (C, n = 8) . In group M a loading dose of milrinone 50 ?g?kg-1 was given i.v. within 10 min, immediately after aortic unclamping, followed by continuous infusion at 0.2?g?kg ?min-1 . In group C equal volume of lactated Ringer's solution was infused instead of milrinone. Blood samples were taken from the CVP line before anesthesia (T0), 5 min after release of aortic cross-clamp (T1), 5 min after discontinuation of CPB (T2) , at the end of surgery (T3) and 24 h and 48h after operation (T4,5) for determination of plasma levels of CRP, TNF-?, IL-8 and IL-10 by radioimmunoassay.Results There was no significant change in plasma TNF-a concentration in both groups. Plasma CRP level increased significantly at 24 and 48 h after operation (T4 , T5 ) , in both groups and was significantly higher in group M than that in group C. Plasma IL-8 level increased significantly only at T2 and T3 compared to pre-anesthesia value (T0) in group M while in group C it increased significantly from T1-5 (P

Objective To evaluate the role of reperfusion injury salvage kinase signaling pathway in reduction of myocardial ischemia-reperfusion (I/R) injury by sevoflurane postconditioning in rats.Methods Seventy SPF healthy adult male Sprague-Dawley rats,weighing 300-350 g,were divided into 7 groups (n =10 each) using a random number table:sham operation group (group S),group I/R,sevoflurane postconditioning group (group SP),phosphatidylinositol 3-kinase inhibitor LY294002 group (group LY),sevoflurane postconditioning plus LY294002 group (group SPLY),mitogen-activated protein kinase kinase 1/2 inhibitor U0126 group (group U) and sevoflurane postconditioning plus U0126 group (group SPU).Myocardial I/R was induced by occlusion of the left anterior descending branch of the coronary artery for 30 min followed by 120 min of reperfusion.In group SP,1.8％ sevoflurane was inhaled for 5 min starting from the beginning of reperfusion.In LY and U groups,LY294002 0.3 mg/kg and U0126 0.5 mg/kg were intravenously injected,respectively,at 10 min before reperfusion.In SPLY and SPU groups,LY294002 0.3 mg/kg and U0126 0.5 mg/kg were intravenously injected,respectively,at 10 min before reperfusion,and 1.8％ sevoflurane was inhaled for 5 min starting from the beginning of reperfusion.At 15 min of reperfusion,myocardial specimens were obtained from the left ventricular area at risk for determination of the phosphorylation of protein kinase B (Akt) and extra-cellular signal-regulated kinase 1/2 (ERK1/2) (by Western blot) and NAD+ content in myocardial tissues (by fluorescence spectrophotometry).At the end of reperfusion,blood samples were collected from the jugular vein for measurement of serum cardiac troponin Ⅰ (cTnI) concentrations (by photoelectric colorimetry),and myocardial specimens were obtained from the left ventricular area at risk for determination of myocardial infarct size (IS).Resuits Compared with group S,the IS and serum cTnI concentrations were significantly increased,the NAD+ content was decreased (P＜0.05),and no significant change was found in the phosphorylation of Akt or ERK1/2 in group I/R (P＞0.05).Compared with group I/R,the IS and serum cTnI concentrations were significantly decreased,and the NAD+ content and phosphorylation of Akt and ERK1/2 were increased in group SP (P＜0.05),and no significant change was found in the parameters mentioned above in LY,SPLY,U and SPU groups (P＞0.05).Compared with group SP,the IS and serum cTnI concentrations were significantly increased,and the NAD+ content was decreased in SPLY and SPU groups,the phosphorylation of Akt was significantly decreased in group SPLY,and the phosphorylation of ERK1/2 was significantly decreased in group SPU (P＜0.05).Conclusion The mechanism by which sevoflurane postconditioning reduces myocardial I/R injury may be related to activation of reperfusion injury salvage kinase signaling pathway in rats.

Objective: To study subclinical hypothyroidism (SCH) with its treatment in patients after coronary artery bypass grafting (CABG). Methods: A total of 1500 patients received CABG by the same surgical team in our hospital from 2010-06 to 2014-03 were retrospectively studied. According to thyroid function, the patients were divided into 2 groups: SCH group,n=107 and Normal group, n=1393. With 1:4 propensity score matching, there were 104 patients in SCH group and 416 patients in Normal group enrolled in our research. The rates of intra-aortic balloom pumping (IABP) implantation and peri-operational blood transfusion, mechanical ventilation time, new onsets of stroke, myocardial infarction and atrial ifbrillation, malignant arrhythmia, acute kidney injury and in-hospital mortality were observed. The outcome of treatment was assessed by single- and multi-factor analysis. Results: Compared with Normal group, SCH group showed increased mechanical ventilation time (23.3±47.9) h vs (15.0±5.5) h, P<0.05; more patients had mechanical ventilation time>12 h (89.4% vs 78.8%),P<0.05 and more patients had IABP implantation (3.8% vs 0.72%),P<0.05. SCH was related to mechanical ventilation time>12 h (OR=2.363, 95% CI 1.183-4.516) and IABP implantation (OR=6.126, 95% CI 1.190-31.537). The in-hospital death and other events were similar between 2 groups,P>0.05. Conclusion: Our research indicated that SCH was related to mechanical ventilation time and IABP implantation in patients after CABG.

Objective To evaluate the effects of sevoflurane postconditioning on ischemia-reperfusion injury in chronically-infarcted rat hearts.Methods Left anterior descending coronary artery was ligated to induce myocardial infarction in male Sperague-Dawley rats.Six weeks later,chronically-infarcted hearts were isolated and passively perfused in a Langendorff apparatus.Eighty chronically-infarcted hearts were randomized into 8 groups (n =10 each)∶ Ⅰ-Ⅷ groups.In group Ⅰ,hearts were continously perfused with Krebs-Henseleit (K-H) solution for 90 min.In group Ⅱ,hearts were subjected to 30 min of global ischemia,followed by 60 min of reperfusion.In groups Ⅲ to Ⅵ,hearts were exposed to 30 min of global ischemia,specific phosphatidylinositol-3-kinase (PI3K) inhibitor LY294002 15 μmol/L and mitogen-activated extracellular regulated kinase 1/2 (MEK1/2) inhibitor PD98059 20 μmol/L,0.02％ dimethyl sulfoxide,and K-H solution saturated with 3％ sevoflurane were administered,respectively,during the first 15 min of reperfusion,followed by perfusion with plain K-H solution for 45 min.In groups Ⅶ and Ⅷ,hearts were exposed to 30 min of global isehemia,K-H solution saturated with 3％sevoflurane was given during the first 15 min of reperfusion,LY294002 15 μmol/L and PD98059 20 μmol/L were simultaneously administered,respectively,followed by perfusion with plain K-H solution for 45 min.Coronary flow (CF),left ventricular developed pressure (LVDP),± dp/dt,left ventricular end-diastolic pressure (LVEDP) and heart rate (HR) were recorded after 20 min of equilibration (baseline,T0),immediately before ischemia (T1),and at 15,30 and 60 min of reperfusion (T2-4).The concentrations of lactate dehydrogenase (LDH) and creatine kinase-MB (CK-MB) in the collected coronary effluent were determined at T0 and T4.Acute myocardial infarct size was determined at T4.Left ventricular tissue samples were collected at T2 to measure the phosphorylation of protein kinase B/Akt (PKB/Akt),and extracellular regulated kinase 1/2 (ERK1/2) and degree of mitochondrial permeability transition pore (rnPTP) opening.Results Compared with group Ⅰ,LVDP,± dp/dt,HR and CF were significantly decreased,LVEDP was increased,the acute myocardial infarct size was enlarged,and the concentrations of LDH and CK-MB in the coronary effluent and degree of mPTP opening were increased during reperfusion in groups Ⅱ-Ⅷ (P ＜ 0.05).LVDP,± dp/dt,HR and CF were significantly higher,LVEDP was lower,the acute myocardial infarct size was smaller,the concentrations of LDH and CK-MB in the coronary effluent were lower,the phosphorylation of PKB/Akt and ERK1/2 was higher,and the degree of mPTP opening was lower during reperfusion in group Ⅵ than in group Ⅱ (P ＜ 0.05).Conclusion Sevoflurane postconditioning protects chronically-infarcted rat hearts against ischemia-reperfusion injury by activating PI3K-PKB/Akt and MEK1/2-ERK1/2 and inhibiting mPTP opening.

Objective To investigate the efficacy and safety of percutaneous induced thrombosis closure on small patent ductus arteriosus (PDA) solely under echocardiography guidance.Methods From June 2013 to September 2016,276 PDA patients were treated by femoral artery retrograde approach under echocardiography guidance.Twenty-five patients (14 boys,11 girls) among them with small PDA received percutaneous induced thrombosis closure because the delivery sheath could not pass PDA,with mean age (3.7 ± 1.6) years,mean body weight (16.6 ±5.4) kg and the mean diameter of the most narrow PDA was (1.3 ± 0.4) mm.All patients were assessed by transthoracic echocardiography,chest radiography and electrocardiography preoperatively.The intraoperative and postoperative effects were evaluated by echocardiography.Outpatient assessment was performed at 1,3,6 and 12 months after operation with electrocardiography and echocardiography,and yearly thereafter.Results Twenty-five patients were successfully treated with percutaneous induced thrombosis closure solely under echocardiography guidance.The mean operation time was (35.2 ± 6.1) minutes.The immediate residual shunt rates and 24 hours after operation were 28.0％ (7/25 cases) and 16.0％ (4/25 cases),respectively.All patients recovered and were discharged from hospital.The average hospitalization stay was (3.0 ± 0.6) days.The mean follow-up was (16.8 ± 12.3) months,residual shunt was observed in 2 patients (8.0％),and it decreased from 1.5 mm and 2.0 mm preoperatively to 0.8 mm and 1.0 mm postoperatively,respectively.All patients survived without peripheral vascular injury,cardiac perforation,PDA rupture or thrombembolia.Conclusions Percutaneous induced thrombosis closure of small PDA solely under echocardiography guidance is safe and effective.It can avoid occluder implantation and radiation injury.However,the residual shunt after operation needs following up closely.

OBJECTIVETo avoid the radiation injuries and use of contrast agent, we assessed the safety and efficacy of percutaneous patent ductus arteriosus closure solely under thoracic echocardiography guidance.

METHODSFrom June 2013 to June 2014, thirty patients (mean age: (6.3 ± 2.5) years, mean body weight:(22.5 ± 7.3) kg) with pure patent ductus arteriosus were continuously included in this study. The mean diameter of patent ductus arteriosus was (3.8 ± 0.9) mm. Patients were all treated by percutaneous patent ductus arteriosus closure via right femoral artery solely under thoracic echocardiography guidance. The efficacy of the procedure was evaluated by thoracic echocardiography. Follow-up was performed at one month after procedure.

RESULTSAll 30 cases were successfully treated with percutaneous patent ductus arteriosus closure solely under thracic echocardiography guidance. The procedural time was (32.8 ± 5.7) minutes. The mean diameter of Amplatzer ADO II was (4.9 ± 1.0) mm. Postoperative trivial residual shunt occurred in six patients immediately after the procedure. All patients survived without peripheral vascular injury or complications such as cardiac perforation. Hospitalization time was (3.4 ± 0.7) days. At one-month follow-up, no complications such as residual shunt or pericardial effusion were observed.

CONCLUSIONEchocardiography guided percutaneous patent ductus arteriosus closure by femoral artery approach is safe and effective, and can avoid X-ray and the use of contrast agents.

Body Weight ; Child ; Child, Preschool ; Ductus Arteriosus, Patent ; surgery ; Echocardiography ; Hospitalization ; Humans ; Postoperative Period ; Prostheses and Implants ; Treatment Outcome ; Ultrasonography, Interventional

Objective    To assess the efficacy and safety of percutaneous closure of patent ductus arteriosus (PDA) solely under echocardiography guidance. Methods    We retrospectively analyzed the clinical data of 200 patients who received the percutaneous closure of PDA under echocardiography guidance in Fuwai Hospital from August 2013 to April 2016. According the different approach, they were divided into 2 groups: a femoral artery approach group (n=143) and a femoral vein approach group (n=57). In the femoral artery approach group, there were 42 males and 101 females aged 3.20±5.63 years. In the femoral vein group, there were 10 males and 47 females aged 7.30±11.36 years. All Patients were treated by percutaneous PDA closure solely under echocardiography guidance. The follow-up was performed at one month after the operation by echocardiography, chest radiograph and electrocardiogram. Results    All 200 patients were successfully treated with percutaneous closure of PDA. The patients’ gender, in-hospital stay, rates of occluder  detachment were similar between the two groups (P>0.05). Compared with the femoral vein approach group, the femoral artery approach group had a younger age (3.20±5.63 years vs. 7.30±11.36 years, P<0.001), less body weight (14.25±11.54 kg vs. 24.25±19.14 kg, P<0.001) and shorter diameter of PDA (3.06±0.79 mm vs. 5.93±0.68 mm, P<0.001) and PDA occluders (5.43±1.00 mm vs. 12.14±0.54 mm, P<0.001), but had higher hospitalization expenses (32 108.2±3 100.2 yuan vs. 25 120.7±3 534.1 yuan, P<0.001). In the femoral vein approach group, one patient was closed under radiation guidance because guide wires could not pass through PDA. One patient in the femoral artery approach group suffered from occluder detachment at one day after operation and was cured by transthoracic minimally invasive PDA occlusion. There were no complications of occluder detachment, residual shunt, pericardial effusion or left pulmonary stenosis during the follow-up. Conclusion    Echocardiography-guided percutaneous PDA closure is safe and effective, while the proper interventional approach should be chosen by the anatomical features of PDA.