Objective: To explore the peri-operative treatment and 3 years post-operative outcome in patients with rheumatic mitral valve stenosis and small left ventricle. Methods: A total of 152 patients with rheumatic mitral valve stenosis and severe pulmonary hypertension were studied. According to left ventricular end diastolic index (LVEDI) value, the patients were divided into 2 groups: Small left ventricle (Small) group, the patients with LVEDI value≤60 mm, n=67 and Non-small left ventricle (Non-small) group, the patients with LVEDI value>60 mm,n=85. Peri-operative condition and follow-up parameters were compared between 2 groups. Results: Compared with Non-small group, Small group had increased pre-operative CVP, SPAP and decreased LVEDV, LVEDVI and RVEF at admission, all P<0.05. All patients had liver damage at admission, the indexes (except alkaline phosphatase) were higher in Small group than Non-small group, and the function was recovered prior operation by proper treatment. The immediate post-operative SPAP in Small group and Non-small group were (67.3.1±23.4) mmHg and (61.3±26.9) mmHg, P>0.05. There were 52 severe pulmonary hypertension patients received iloprost inhalation, their SPAP was decreased than non-inhalation patients at incision closing; SPAP was lower in Small group inhalation patients than Non-small group inhalation patients, all P<0.05. Post-operative LVEDVI was lower and SPAP was higher in Small group than Non-small group. At 3 years post-operation, LVEDVI, RVEF increased, NYHA classification decreased and 6MWT prolonged in both groups; while LVEDVI was lower and 6MWT was shorter in Small group than Non-small group, P<0.05. The median survival time at (3.7±1.6) years post-operation was shorter in Small group than Non-small group,P<0.05, while the mortality was similar between 2 groups (2.6% vs 2.0%),P>0.05. Conclusion: The patients with mitral valve stenosis and small left ventricle had the worse pre-operative condition and higher risk in surgery; peri-operative treatment could improve their cardiac and liver function, but they still had the shorter post-operative median survival time.

Objective To analyze the treatment strategy of the atrial septal defect in the surgical treatment of Ebstein's anomaly combined with the atrial septal defect and the short-term follow-up results of the treatment of Ebstein's anomaly.Methods A retrospective analysis of the clinical data and follow-up results of 20 patients with Ebstein's anomaly and atrial septal defect was conducted from September 2017 to February 2021.And the statistical analysis on the preoperative and postoperative echocardiography results of this group of patients was performed.Results Sixteen patients underwent the biventricular correction surgery,among whom two cases underwent the horizontal atrial tricuspid valvuloplasty(Danielsons procedure),four cases underwent the vertical atrial tricuspid valvuloplasty(Carpentier procedure),and ten cases underwent the conical reconstruction.Two patients were given a half ventricular correction surgery(tricuspid valve reconstruction combined with bidirectional Glenn surgery)and two patients underwent the bidirectional Glenn surgery.The combined atrial septal defects were closed in one stage during extracorporeal circulation for correction of deformitie in 20 patients.At 1,3,6,and 12 months after the surgery,the patient's right ventricular size significantly decreased compared to preoperative(P<0.05),and cardiac function(left ventricular ejection fraction)significantly improved(P<0.05).Conclusion The surgical treatment of Ebstein's anomaly combined with the atrial septal defect should follow the principle of individualized treatment.Biventricular correction is still the first choice for the treatment of Ebstein's anomaly,and the atrial septal defect should be closed at one stage,so as to obtain a good therapeutic effect.

Objective To investigate the expression of lncRNA SENCR in aortic dissection(AD)tissues of AD patients and its effect on and mechanism in the proliferation apoptosis of human vascular smooth muscle cells(HVSMCs).Methods HE staining was done to detect the pathological changes of AD tissues.Fluorescence in situ hybridization(FISH)and RT-qPCR were used to determine the expression of SENCR in the AD tissue and HVSMCs and the expression of SENCR and miR-206 in the tissues,respectively.HVSMCs were cultured and trans-fected with pcDNA3.1-SENCR overexpression plasmids,or pcDNA3.1 blank plasmid.Then cell proliferation and apoptosis were detected by CCK-8 method and Annexin V/PI double staining flow cytometry assay,respectively.Double luciferase report verified the targeting relationship between SENCR and miR-206.Results SENCR was mainly located in the cytoplasm and nucleus of HVSMCs.Compared with the normal tissue,the expression of SENCR in the AD tissues was down-regulated(P＜0.01),but the expression of miR-206 was up-regulated(P＜0.01).Overexpressed SENCR decreased the cell proliferation of HVSMCs(P＜0.01),but significantly increased the cell apoptosis of HVSMCs(P＜0.01).SENCR could target and negatively regulate miR-206.Conclusion The expression of SENCR is down-regulated in AD tissues,and overexpressed SENCR may inhibit the proliferation and promote the apoptosis of HVSMCs by targeting down-regulated miR-206.

Objective To evaluate the safety and mid- to long-term efficacy of surgical correction of isolated partial anomalous pulmonary venous connection (IPAPVC). Methods We retrospectively collected consecutive patients who were diagnosed with IPAPVC and underwent surgical correction at Fuwai Hospital of Chinese Academy of Medical Sciences and Fuwai Yunnan Cardiovascular Hospital from June 2009 to May 2019, summarized the basic preoperative and intraoperative data of patients, analyzed the postoperative and mid- to long-term follow-up results. Results A total of 54 patients were enrolled, including 29 males and 25 females, with an average age of 16.20±2.40 years, ranging from 1 month to 62 years. There were 28 (51.9%) patients with varying degrees of arrhythmia, 22 (40.7%) patients with cardiac insufficiency, and 39 (72.2%) patients with pulmonary hypertension. According to Bordy's typing, 14 (25.9%) patients were classified as type A, 23 (42.6%) type B, 4 (7.4%) type C, 5 (9.3%) type D and 8 (14.8%) mixed type. Transthoracic echocardiography was performed in the whole group of patients and the accuracy of staging diagnosis was 66.7% (36/54), and cardiac CT angiography (CTA) was performed in 37 patients and the accuracy of staging diagnosis was 94.6% (35/37). All surgical procedures were assisted with cardiopulmonary bypass, aortic cross-clamping time was 0-219 (67.02±5.23) min, cardiopulmonary bypass time was 40-261 (105.09±5.23) min, and there was no serious intraoperative complication. Postoperative tracheal intubation time was 0-230 (13.33±4.20) h, intensive care unit stay was 0-13 (1.89±0.28) days, postoperative hospital stay was 5-18 (7.20±0.38) days, and follow-up time was 16-140 (62.58±5.12) months. There were 2 (3.7%) all-cause postoperative deaths, including 1 in-hospital death and 1 death during the follow-up, and there was no intraoperative death. Among the survivors, there were 3 patients with surgery-related complications: 1 patient had atrial septal defect with the second surgical treatment, 1 early obstruction of the superior vena cava and 1 arrhythmia. Two patients had complications of IPAPVC (atrial fibrillation, collateral circulation) prior to surgery and underwent the second surgery with a poor prognosis, and 1 patient had preoperative cardiac insufficiency and atrial fibrillation, whose symptoms persisted for a long time during the follow-up. Conclusion IPAPVC accounts for a lower percentage of partial anomalous pulmonary venous connection, transthoracic echocardiography combined with CTA improves diagnostic accuracy, and IPAPVC should be treated with elective surgery after diagnosis. The surgical approach should be individualized with imaging features such as disease staging, number of drains and drainage location. Surgical treatment of IPAPVC is safe and effective, and regular follow-up is warranted.