Objective To observe cardiac structural and functional alterations one year following orthotopic heart transplantation. Methods In 23 patients with orthotopic heart transplantation, the end-diastolic diameter of the atria and the ventricles(LAD, RAD, LVEDD and RVED), the thickness of interventricular septum,left ventricular posterior wall and right ventricular anterior wall(IVS,LVPW and RVAW),and pericardial effusion(PE) were measured by M- and B-mode echocardiography, ventricular early and late diastolic filling peak velocities(E, A and E/A) and systolic peak pulmonary artery pressure(PAP) were assessed by Doppler techniques. Results PAP, RAD and RVED increased at 2 week following heart transplantation and gradually returned normal at one month. At 1-2 month after operation, IVS, LVPW and RVAW increased, and E decreased with a reversed E/A. PE was detected in moderate amount at 1-2 week, in small amount at 1-3 month, and disappeared at 6 month following the transplantation. Conclusions The structures and functions of the transplanted heart undergo serially adaptive changes postoperatively, and evaluation of these alterations echocardiographically may be helpful to identifying allograft rejection.

Objective To evaluate the changes of cardiac function, cardiac cavity size and hemodynamic after percutaneous balloon mitral valvuloplasty (PBMV) in patients with rheumatic mitral stenosis and small left ventricle Methods PBMV was performed with Inoue technique in 27 patients with rheumatic mitral stenosis and small left ventricle The diameter of balloon was the height (cm) of patient/10+10 mm To measure the changes of hemodynamic during PBMV; to evaluate the cardiac function, size of the left atrium and ventricle, mitral valve area and its mean gradient, maximal pulmonary systolic pressure by echocardiogram 1 week before PBMV and 1 week, 1, 3, 6 month after PBMV Results The left atrial pressure, mean gradient and diastolic murmur decreased; and diastolic pressure of left ventricle increased immediately after PBMV; the cardiac function improved at 1 month after PBMV Conclusion The diameter of balloon can be height (cm) of patient/10+10 mm in the patients with rheumatic mitral stenosis and small left ventricle The cardiac cavity size has significant changes at 1 week and the largest effect was seen at 1 month At 1 month the cardiac function has been improved apparently

Objective To investigate the changes of cardiac aldosterone and mineralocorticoid receptor (MR) in Sprague-dawley (SD) rats with chronic heart failure (CHF) induced by isoproterenol (ISO). Methods The SD rats were randomly divided into CHF group (n=9) and normal control(NC) group (n=10). The experimental CHF group was induced by subcutaneous injection of ISO, and the NC group received same dose injection of sodium chloride. The heart function was evaluated with both echocardiography and hemodynamics. The contents of aldosterone in both plasma and heart were assessed by radioimmunoassay. The expression of MR was measured by Western blot and immunohistochemistry staining. Results Compared with NC group, the heart function was decreased in CHF group, the left ventricular ejection fraction was (38.8%±4.0%) in CHF and(79. 4%±4.6%), in NC group. The maximal rate of increase of ventricular pressure (+dp/dtmax) was (7164.4±502.6) mm Hg(1 mm Hg=0.133 kPa)/s in CHF and (10199.5±462.9) mm Hg/s in NC group (both P＜0. 01 ). The contents of aldosterone both in plasma and heart were higher in CHF group than in NC group [(0.63±0.06)μg/L vs. (0.3±0.07) μg/L, (0.41±0.05) μg/kgvs. (0.08±0.01)μg/kg, both P＜0. 01]. The MR expression was increased in CHF group versus in NC group (P＜0.01). Conclusions The heart function is decreased in rats with CHF induced by ISO, which is similar to dilated cardiomyopathy. The higher levels of aldosterone both in circulation and in heart as and well as MR expression upregulation in heart may play important roles in the pathogenesis of CHF induced by ISO.

Objective:To explore the influence of nephroblastoma over expressed gene (CCN3)on differentiation of bone marrow mesenchymal stem cells (BM-MSCs)into endothelial cells.Methods:BM-MSCs differentiation into endothelial cells induced by condition medium containing vascular endothelial growth factor (VEGF,50ng/ml)was regarded as positive control group.BM-MSCs differentiation into endothelial cells induced by condition medium con-taining recombined CCN3 protein (100 ng/ml)and VEGF (50 ng/ml)was regarded as CCN3 group,and BM-MSCs incubated in pure complete medium was regarded as negative control group.Immunofluorescence staining and semi-quantitative reverse transcription-polymerase chain reaction method (RT-PCR)were used to measure expression of von Willebrand factor (vWF)after 16d to evaluate endothelial cell differentiation,and semi-quantitative RT-PCR method was used to measured expression of Notch1 gene mRNA before and after induced BM-MSCs differentiation. Results:On 16d after induced BM-MSCs differentiation,some cells of positive vWF fluorescence staining were ob-served in positive control group,those of CCN3 group was significantly more than those of positive control group, and expression of vWF mRNA [ratio of optical density (OD): (0.550±0.090)]of CCN3group was significantly higher than that of positive control group (0.358±0.080),(P<0.01),and no vWF-positive cells were observed in negative control group;Besides,before induced differentiation,expression of Notch1 gene mRNA were low in three groups without significant difference between any two groups (P>0.05 all),on 16d after induced differentiation, expressions of Notch1 gene mRNA in positive control group (0.232±0.047)and CCN3 group (0.352±0.029)were significantly higher than that of negative control group (0.132±0.033),P<0.01 all,it of CCN3 group was signifi-cantly higher that of positive control group (P<0.01).Conclusion:CCN3 can enhance BM-BMCs differentiation into endothelial cells by activating Notch1 signal pathway.

ystolic LS and RS are equal in the indentification of the infarcted segments.

ObjectiveTo investigate the effects of granuloeyte colony stimulating factor (G-CSF) on myocardial apoptosis and left ventricular function following coronary mieroembolization (CME).MethodsA total of 68 male Sprague Dawley rats were randomized into control group(n=24), G-CSF-treated group(n= 24) and sham-operated group(n= 20). The control group and G-CSF -treated group underwent injection of homologous microthrombotic particle suspension into left ventricle when clamping the ascending aorta. The sham-operated group were treated with saline.rhG-CSF(100 yg · kg<'-1> · d<'-1>) were injected subcutaneously for 5 days since 2 h after operation in C-CSF group, meanwhile, the control group and sham-operated group were treated with saline respectively. The rats were sacrificed at day 3,7,14 and 28 after operation. The mRNA expressions of Bcl-2, Bax, Fas, FasL and glyceraldehyde phosphate dehydrogenase (GAPDH) were evaluated by real time PCR. The ratio of Bcl-2/Bax was calculated. The protein expressions of easpase-3 and cleaved poly ADP-ribose polymerase (PARP) were detected by Western blot. Myocardial apoptosis and leftventricular function were checked byterminal-deoxynucleotidyl transferase mediated nick end labeling (TUNEL)staining and hemodynamics respectively. ResultsCompared with sham-operated group,the mRNA expression of Bcl-2, Bax, Fas and FasL were increased whereas the ratio of Bcl-2/Bax markedly decreased in control group(0.28±0.04 vs. 2.98±0.49), P<0.05.Simultaneously, the protein expressions of caspase-3 and cleaved PARP enhanced (0.762±0.129 vs. 0.133±0.027;0.992±0.146 vs. 0.386+0.074) ,all P<0.05. The myocardial apoptosis index was elevated(17.2±1.9 vs. 1.2±0.6)and the left ventricular function decreased significantly (P<0.05). Compared with control group, the mRNA expression of Bct-2 increased and that of Bax, Fas and FasL decreased in G-CSF-treated group. Meanwhile, the ratio of Bcl-2/Bax markedly increased(2.07±0.29 vs. 0.28±0.04)and the protein expression of caspase-3 and cleaved PARP decreased(0.371±0.041 vs. 0.762±0.129;0.548±0.093 vs. 0.992±0.146, all P<0.05). The myocardial apoptosis index was reduced (6.1±1.0 vs. 17.2±1.9)and the left ventricular function increased significantly (P<0.05).ConclusionsG-CSF could lighten the myocardial apoptosis and improve the left ventrieular functionafter CME.

Objective To compare the procedural difficulty index (PDI) and immediate outcome (IM) of percutaneous coronary intervention (PCI) in patients with various stages of myocardial infarction.Methods Ninety-four patients with myocardial infarction were divided into three groups, direct PCI(n=38), delayed PCI(n=22) and late PCI(n=34). The characteristics of infarct-related coronary artery, PDI and IM of PCI were evaluated angiographically, and severe procedural complications (SPC) and major adverse cardiac events (MACE) during hospitalstay were documented. Results In the three groups, PDI was 1.47 ?1.79, 1.82 ?1.72 and 2.85 ?2.83, respectively (P

Objective To investigate the feasibility and safety of modified percutaneous left atrial appendage occlusion (PLAAO) under transthoracic echocardiographic (TTE) guidance without general anesthesia instead of transesophageal echocardiographic guidance.Methods A total of 14 patients who met the inclusion criteria underwent modified PLAAO guided by TTE instead of TEE without general anesthesia.Regular clinical follow-up observations of PLAAO-related major adverse events were done in the perioperative period.Results All patients were successfully implanted with left atrial appendage occluder device (Watchman) without device-related serious complications.Immediately occlusion success rate was 100％.No major adverse events occurred during hospitalization and follow-up.The mean operation time was 108 ± 22 min(range 75-150 min)and the mean radiation exposure time was 15.8 ± 7.6 min(range 8-32 min).Conclusion Modified PLAAO guided by TTE instead of TEE without general anesthesia may be safe and effective.This method simplifies the operation process and is favorable for PLAAO application.But this modified PLAAO is still needed to be validated in more patients.

Objective To study the effects of exercise after myocardial infarction on the survival rate and the dynamic functioning of the left ventricle ( LV) . Methods Ninety-six male Sprague-Dawley rats were randomly assigned to a sedentary sham operation group ( Sed-Sh) , a previous exercise and sham operation group ( PreE-Sh) , a sedentary myocardial infarction ( MI) group ( Sed-MI) , a previous exercise MI group ( PreE-MI) , a post exercise MI group (PostE-MI) and a combined exercise MI group (ComE-MI), each of 16.All of the rats underwent either MI in-duction or a sham MI operation, the PreE groups after exercising for 5 weeks on a treadmill. The Sed groups did not exercise. The Post E-MI group did not exercise before the operation, but performed treadmill exercises for 4 weeks be-ginning 8 weeks after the operation. The ComE-MI group exercised for 5 weeks before and 4 weeks after the operation. All the exercising rats ran on the treadmill for 60 minutes daily, 5 d/wk. Life situation and spontaneous mortality were recorded, and echocardiographic measurements were performed on the4thday and 2, 4, 8 and 12weeks after the oper-ation. All of the rats were sacrificed at the end of the experiment. Results Compared with the Sed-Sh group, the Sed-MI group had significantly larger average LV dimensions at the end of both the diastol ( LVEDd) and the systol (LVEDs, but it had lower average fractional shortening (FS) and a smaller average ejection fraction(EF) at all of the different measuring times. The PreE-MI group had significantly lower average LVEDd and LVEDs, but a signifi-cantly higher FS and EF than the Sed-MI group on the 4th day. However, 2 weeks after the intervention the difference in LVEDd between the two groups was no longer significant. Significantly higher FS and EF were observed in the PostE-MI group at 12 weeks compared to the Sed-MI group. The ComE-MI group had significantly lower average LVEDd and LVEDs, but significantly higher FS and EF at all the time points than the Sed-MI group. The ComE-MI group had a significantly lower average LVEDs but a higher average FS and EF than the PreE-MI group at 12 weeks after the intervention. Conclusion Pre-MI exercise improves LV function significantly at the early stage, though the difference is temporary. Post-MI exercise improves LV function in the longer term. Combined exercise improves LV function the most effectively.

Objective: To explore the impact of PI3K-Akt-eNOS signaling on atrial fibrillation inducibility in diabetic rats. Method: Eight-week-old male diabetic rats were randomized assigned into GK group, IGF group and L-NAME group (n=8 each) which respectively received normal saline (NS), insulin like growth factor (IGF-1) or L-NAME+IGF-1 through tail vein daily for 4 weeks. Eight 8-week-old male homologous Wister-Kyoto(WKY) rats treated with intravenous NS served as control group (WKY group). Blood glucose was measured once per week. The left atrial diameter (LAD) was measured by echocardiography, the atrial electrical parameters, including the P-wave duration, the atrial effective refractory period (AERP) and its dispersion (AERP-d), the incidence and the duration of atrial fibrillation induced by atrial burst pacing, were evaluated by electro-physiological instrument at 4 weeks post various treatments. Rats were then sacrificed, left atrial (LA) cell morphology was determined on HE stained sections, LA interstitial collagen was determined on Masson stained sections. The protein expression of phosphatidylinositol 3-kinase (PI3K) and phosphate endothelial nitric oxide synthase (p-eNOS) were detected by Western blot. Results: (1) At the beginning of the study, the random blood glucose (GLU) level was significantly higher and LAD was large in GK, IGF and L-NAME groups than in WKY group;after 4 weeks, GLU level and LAD dimension of IGF group were lower than GK and L-NAME groups (P<0.01 or 0.05). (2) One rat in L-NAME group died during operation. Four weeks later, the incidence of atrial fibrillation in GK group, IGF group, L-NAME group and WKY group was 7/8, 2/8, 6/7 and 3/8. The median duration of atrial fibrillation in GK group, IGF group, L-NAME group and WKY group was 11.9(9.3, 13.1), 0(0, 1.8), 11.5(4.4, 12.0), and 0(0, 3.0) s. Compare with WKY group, the P-wave duration and PR interval were significantly longer, AERP-d, incidence, and duration of atrial fibrillation were significantly higher in GK group (P<0.01), these changed were significantly reversed in IGF group compared to GK and L-NAME groups (all P<0.01). Heart rate and AERP were similar among the 4 groups on (P>0.05). (3) Four weeks later, the CSA and CVF of LA were significantly larger in GK group than in WKY group (P<0.01), which were significantly reversed in IGF group (P<0.01 vs. GK group), and the beneficial effects of IGF disappeared by co-treatment with L-NAME (P<0.01 vs. IGF group). (4) Four weeks later, compare with WKY group, the protein expression of PI3K (P<0.01) and p-eNOS (P<0.05) of LA were significantly downregulated in GK group, which could be significantly upregulated by IGF (P<0.01 and 0.05 vs. GK group), these effects diminished by co-treatment with L-NAME (P<0.01 or 0.05 vs. IGF group). Conclusion Increased atrial fibrillation susceptibility in diabetic rat is linked with structural and electrical remodeling in LA, possibly mediated through downregulated PI3K-Akt-eNOS signaling.