Chronic thromboembolic pulmonary hypertension(CTEPH)is a potentially life-threatening pulmonary vascular disease,which belongs to the fourth largest category of pulmonary hypertension as defined in the 2022 European Society of Cardiology guidelines.Percutaneous balloon pulmonary angioplasty(BPA)is an interventional technique,which uses continuous and phased balloon expansion to treat the narrowed site under pulmonary angiography guidance,providing a completely new therapeutic method for CTEPH patients who are unable to receive surgical treatment and for CTEPH patients who have post-surgical residual pulmonary hypertension.This paper comprehensively introduces the interventional therapeutic technology of BPA,focusing on the development history,the clinical indications and the development of operative technique of BPA,meanwhile,the latest development of BPA in the treatment of CTEPH is also introduced.

Objective:To investigate whether changes in CT pulmonary angiography (CTPA) parameters before and after balloon pulmonary angioplasty (BPA) are correlated with treatment effects in patients with chronic thromboembolic pulmonary hypertension (CTEPH).Methods:A retrospective study was conducted, including patients with CTEPH who underwent BPA treatment at Beijing Anzhen Hospital from November 2021 to Febbruary 2024. Clinical data and CTPA parameters were analyzed before the initial BPA session and at least 6 months after the final BPA session. Clinical data included WHO functional class, 6-minute walk distance (6MWD), and plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. The CTPA parameters included the widest diameter of the pulmonary artery diameter (dPA), ascending aorta diameter (dAA), the widest transverse diameter of the right atrium (dRA), the widest short-axis diameter of the right ventricle (dRV), the widest short-axis diameter of the left ventricle (dLV), and the diameter of right ventricular free wall thickness(dRVW). Multiple linear regression was applied to identify variables associated with the decrease in mean pulmonary artery pressure (mPAP) among the CTPA parameters.Results:All CTEPH patients underwent a total of 115 BPA treatments. Postoperatively, the WHO functional class of the patients improved compared to preoperative levels ( χ2=5.01, P<0.001), 6MWD improved ( t=4.50, P<0.001), and NT-proBNP levels decreased ( Z=4.47, P<0.001). Hemodynamic parameters, including mPAP, pulmonary vascular resistance, cardiac output, and cardiac index, were significantly improved postoperatively (all P<0.001). CTPA-related parameters, including dPA, dRA, dRV, dRVW, dPA/dAA, dRV/dLV, and dRA/dPA, significantly decreased compared to preoperative values (all P<0.001). Multiple linear regression analysis showed that the decrease in dPA ( β=0.314, P=0.037) and dRA ( β=0.334, P=0.046) were significantly correlated with the improvement in mPAP. Conclusions:Exercise tolerance, hemodynamics, and CTPA parameters in patients with CTEPH significantly improved after BPA treatment. The decrease in dPA and dRA were significantly correlated with the improvement in mPAP, suggesting that CTPA is a potentially novel, objective, effective, and noninvasive method for evaluating the therapeutic efficacy of BPA.

Objective:To investigate whether changes in CT pulmonary angiography (CTPA) parameters before and after balloon pulmonary angioplasty (BPA) are correlated with treatment effects in patients with chronic thromboembolic pulmonary hypertension (CTEPH).Methods:A retrospective study was conducted, including patients with CTEPH who underwent BPA treatment at Beijing Anzhen Hospital from November 2021 to Febbruary 2024. Clinical data and CTPA parameters were analyzed before the initial BPA session and at least 6 months after the final BPA session. Clinical data included WHO functional class, 6-minute walk distance (6MWD), and plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. The CTPA parameters included the widest diameter of the pulmonary artery diameter (dPA), ascending aorta diameter (dAA), the widest transverse diameter of the right atrium (dRA), the widest short-axis diameter of the right ventricle (dRV), the widest short-axis diameter of the left ventricle (dLV), and the diameter of right ventricular free wall thickness(dRVW). Multiple linear regression was applied to identify variables associated with the decrease in mean pulmonary artery pressure (mPAP) among the CTPA parameters.Results:All CTEPH patients underwent a total of 115 BPA treatments. Postoperatively, the WHO functional class of the patients improved compared to preoperative levels ( χ2=5.01, P<0.001), 6MWD improved ( t=4.50, P<0.001), and NT-proBNP levels decreased ( Z=4.47, P<0.001). Hemodynamic parameters, including mPAP, pulmonary vascular resistance, cardiac output, and cardiac index, were significantly improved postoperatively (all P<0.001). CTPA-related parameters, including dPA, dRA, dRV, dRVW, dPA/dAA, dRV/dLV, and dRA/dPA, significantly decreased compared to preoperative values (all P<0.001). Multiple linear regression analysis showed that the decrease in dPA ( β=0.314, P=0.037) and dRA ( β=0.334, P=0.046) were significantly correlated with the improvement in mPAP. Conclusions:Exercise tolerance, hemodynamics, and CTPA parameters in patients with CTEPH significantly improved after BPA treatment. The decrease in dPA and dRA were significantly correlated with the improvement in mPAP, suggesting that CTPA is a potentially novel, objective, effective, and noninvasive method for evaluating the therapeutic efficacy of BPA.

Objective:To summarize and analyze the early clinical outcomes of aortic endovascular remodeling device (AERD) for single-stage complete repair of acute aortic dissection.Methods:A total of 19 patients with acute aortic dissection who underwent proximal aortic dissection repair combined with distal AERD implantation at the Center for Aortic Surgery of Beijing Anzhen Hospital, Capital Medical University between May 2023 and October 2023, of whom 6 had type A aortic dissection and 13 had type B aortic dissection, were retrospectively analyzed. One-month postoperative follow-up and aortic CTA were completed to compare pre- and postoperative abdominal branch outcomes and aortic wall remodeling.Results:The success rate of AERD implantation in this patient cohort was 100%, and no complications such as paraplegia or visceral ischemia were observed during the perioperative and postoperative follow-up periods. All abdominal branches were patent postoperatively, and 15 branches had preoperative " high-risk" subtype malperfusion, 14 of which improved postoperatively. All patients showed significant increase of the true lumen volume compared with the preoperative one, and 89.5% (17/19) had a postoperative true lumen/overall volume ratio of more than 70%.Conclusion:The single-stage complete repair of proximal aortic dissection repair combined with distal AERD implantation is simple, safe and effective, associated with satisfactory early outcomes.

Objective:This study aims to summarize the pathological anatomy characteristics of residual aortic dissection (RAD) in patients with acute aortic dissection (AAD) during the perioperative period by measuring and analyzing the preoperative and postoperative 60-day computed tomography angiography (CTA) images of the aorta, with the intention of guiding further clinical treatment.Methods:A retrospective cohort study design was adopted. A total of 224 patients hospitalized with acute aortic dissection from December 2021 to October 2022 at a single center were included according to inclusion and exclusion criteria and divided into two groups based on Stanford classification. Computed tomography angiography (CTA) images of the aorta during the perioperative period (preoperative or postoperative 60 days) were collected, and relevant indicators were measured to describe the pathological anatomy characteristics of residual aortic dissection.Results:Among the measured range, there were 4 patients (1.8%) without distal tears, with a total of 648 identified distal tears. The numbers of tears in the A, B, and C segments were 211 (32.6%), 203 (31.3%), and 234 (36.1%), respectively. The average numbers of tears in the A, B, and C segments were 0.9±1.1, 0.9±0.9, and 1.0±1.2 per person, respectively. The corresponding average tear areas were(34.9±46.7)mm 2, (29.0±30.5)mm 2, and(18.6±23.9)mm 2, respectively. The average distances from tears to the upper and lower edges of the celiac trunk were(36.8±33.2)mm and(2.3±3.8)mm, respectively; to the upper and lower edges of the superior mesenteric artery (SMA) were(2.3±4.1 )mm and(1.2±2.6) mm, respectively; to the upper and lower edges of the left renal artery were(0.1±0.6) mm and(38.5±24.4) mm, respectively; and to the upper and lower edges of the right renal artery were(0.7±2.6) mm and(8.1±17.3) mm, respectively. True lumen blood supply for the celiac trunk was observed in 151 cases (67.4%); dual luminal supply in 49 cases (21.9%); and false lumen supply in 24 cases (10.7%). True lumen blood supply for the SMA was observed in 187 cases (83.5%); dual luminal supply in 32 cases (14.3%); and false lumen supply in 5 cases (2.2%). True lumen blood supply for the left renal artery was observed in 150 cases (67.0%); dual luminal supply in 27 cases (12.1%); and false lumen supply in 47 cases (21.0%). True lumen blood supply for the right renal artery was observed in 148 cases (66.1%); dual luminal supply in 30 cases (13.4%); and false lumen supply in 46 cases (20.5%). True lumen blood supply for both renal arteries was observed in 83 cases (37.1%); dual luminal supply in 4 cases (1.8%); and false lumen supply in 1 case (0.5%). Conclusion:The results of this study suggest that the average number of distal tears per person in patients with AAD is 2.9±1.9, with only 1.8% of patients having no distal tears. The average tear areas in the A, B, and C segments are(34.9±46.7) mm 2, (29.0±30.5) mm 2, and (18.6±23.9) mm 2, respectively. 61.2% of patients have tears in the abdominal aortic branch segment, and the tears are located at the same level as the abdominal aortic branches. Among the branches of the abdominal aorta, the renal arteries are most commonly affected by dissection, while the SMA is least affected. This study elucidates the anatomical basis for the limitations of existing repair methods and provides a theoretical basis for the design of subsequent repair techniques.

Objective To study the effect and mechanism of paeonol(PAE)on renal interstitial fibrosis in rats.Methods The rats were randomly divided into sham operation(Sham)group,unilateral ureteral obstruction(UUO)group,PAE low dose(PAE-L)group,PAE medium dose(PAE-M)group,PAE high dose(PAE-H)group and irbesartan(IRB)group.Except for the Sham group,the UUO model was established in other groups.Each group was given a corresponding intervention for two weeks.Serum creatinine(Scr),blood urea nitrogen(BUN),serum 8-hydroxydeoxyguanosine(8-OHdG)levels,renal tissue superoxide dismutase(SOD),glutathione peroxidase(GPX)activities,α-smooth muscle actin(α-SMA),type Ⅰ collagen(Col-Ⅰ),fibronectin(FN),silent information regulator 1(SIRT1),nuclear factor E2-related factor 2(Nrf2)protein expression were detected;observe pathological changes of kidney tissue and calculate collagen volume fraction(CVF).Results Compared with the UUO group,the serum levels of Scr,BUN,and 8-OHdG in each dose group of PAE were decreased,the activities of SOD and GPX in kidney tissue were increased,the positive expressions of α-SMA,Col-Ⅰ and FN in kidney tissue were decreased,and the protein expressions of SIRT1 and Nrf2 were increased.Masson staining showed a decrease of CVF in renal tissue(all P<0.05),and HE staining showed a different degree of improvement in pathological changes such as inflammatory cell infiltration and tubular dilatation in renal tissue;PAE improves renal interstitial fibrosis in rats in a dose-dependent manner(P<0.05),and the effect of large dose PAE on renal interstitial fibrosis in rats was similar to that of IRB.Conclusion PAE can alleviate UUO-induced rat renal interstitial fibrosis and oxidative stress,and improve rat renal function.And this mechanism may be related to the activation of the SIRT1/Nrf2 signaling pathway.

During the pain treatment process,to reduce the use of opioids,alternative pain relievers have been used.Increasing data indicated that N-methyl-D-aspartic acid(NMDA)receptor antagonists may enhance the analgesic effect of opioids.Furthermore,numerous studies have shown that the auxiliary analgesic effect of magnesium sulfate has a good application prospect in pain treatment and perioperative anesthesia.The primary pharmacological mechanism of magnesium sulfate in pain treatment is that it acts as a physiological voltage-dependent blocker of NMDA coupling channels,and its anti-nociceptive effect is related to magnesium blocking calcium inflow,thereby inhibiting central sensitization and reducing preexisting hyperalgesia.This paper reviewed the current application of magnesium sulfate in perioperative period,focusing on its auxiliary analgesic effect through intravenous,intrathecal,and local administration,and the reduction of opioid consumption.As well as its potential role and application prospects in opioid-free anesthesia program.

Bupivacaine is a long-acting local anesthetic widely used clinically,but its 6-8 hours duration is insufficient for postoperative analgesia.Designing drug dosage forms to prolong the action time of local anesthetics is the research content of local anesthetics.In 2011,the FDA approved a bupivacaine liposome preparation based on DepoFoam TM technology:Exparel,which can be used for more than 72 hours.This article reviewed the clinical safety research of Exparel and the research progress of its application in clinical postoperative analgesia.

Objective:To evaluate the correlation and consistency between quantitative coronary flow fraction (QFR) and cardiac magnetic resonance imaging (CMR) in assessing myocardial ischemia in patients with coronary heart disease (CAD).Methods:A retrospective analysis was conducted on the data of coronary heart disease patients who underwent load CMR examination and coronary angiography at the Beijing Anzhen Hospital, Capital Medical University from August 2017 to March 2022. CMR examination includes cardiac cine, load/rest myocardial perfusion imaging, and delayed enhancement sequence. According to the results of CMR examination, the patient′s left ventricular myocardial segments were divided into normal segment group and abnormal segment group (further divided into ischemic segment group and infarcted segment group). On the basis of coronary angiography, an artificial intelligence based platform (AngioPlus system) was applied to calculate the preoperative coronary artery QFR value of patients undergoing percutaneous coronary intervention treatment. Kappa test was used to evaluate the consistency of QFR and CMR in diagnosing abnormal myocardium; Mann Whitney U test was used to compare the differences in QFR between groups; The receiver operating characteristic (ROC) curve was used to evaluate the efficacy of QFR in diagnosing abnormal myocardium; Spearman correlation analysis was used to clarify the relationship between myocardial infarction area and QFR value of the supplying coronary artery in patients.Results:Among the 70 CAD patients enrolled, there were 60 males and 10 females, aged (54.1±11.1)years. At the vascular level, the consistency between QFR and CMR in diagnosing myocardial injury (including ischemia and infarction) is moderate (Kappa value=0.514). The sensitivity and specificity of detecting abnormal myocardial segments in CAD patients were 57% and 91%, respectively. The area under the curve (AUC) value of QFR predicting abnormal myocardium in CAD patients was 0.769, and the optimal cutoff value was QFR=0.865. At this time, the sensitivity and specificity of QFR predicting myocardial injury in CAD patients were 67.2% and 84.3%, respectively. The difference in vascular QFR between the normal segment group, ischemic segment group, and infarcted segment group was statistically significant ( P<0.001), with the infarcted segment group having significantly lower QFR values than the other two groups (all P<0.01). The range of myocardial infarction was negatively correlated with the QFR value of the supplying coronary artery ( r=-0.45, P<0.001). At the patient level, the consistency between QFR and CMR in diagnosing myocardial injury (including ischemia and infarction) was moderate (Kappa value=0.445), with a sensitivity of 74% and a specificity of 81% for diagnosing myocardial injury in CAD patients. Conclusions:Compared with CMR, QFR has better specificity in detecting myocardial injury in CAD patients. The QFR value of the infarcted segment group is significantly lower than that of the ischemic group and the normal group. The area of myocardial infarction is negatively correlated with the QFR value of the supplying coronary artery.

Objective:To explore the value of predicting new-onset heart failure events in patients with hypertrophic cardiomyopathy (HCM) using clinical and cardiac magnetic resonance (CMR) features based on machine learning algorithms.Methods:The study was a retrospective cohort study. Patients with a confirmed diagnosis of HCM who underwent CMR examinations at Beijing Anzhen Hospital from May 2017 to March 2021 were selected and randomly divided into the training set and the validation set in a ratio of 7∶3. Clinical data and CMR parameters (including conventional parameters and radiomics features) were collected. The endpoint events were heart failure hospitalization and heart failure death, with follow-up ending in January 2023. Features with high stability and P value<0.05 in univariate Cox regression analysis were selected. Subsequently, three machine learning algorithms—random forest, decision tree, and XGBoost—were used to build heart failure event prediction models in the training set. The model performance was then evaluated using the independent validation set, with the performance assessed based on the concordance index. Results:A total of 462 patients were included, with a median age of 51 (39, 62) years, of whom 332 (71.9%) were male. There were 323 patients in the training set and 139 in the validation set. The median follow-up time was 42 (28, 52) months. A total of 44 patients (9.5% (44/462)) experienced endpoint events (8 cases of heart failure death and 36 cases of heart failure hospitalization), with 31 events in the training set and 13 in the validation set. Univariate Cox regression analysis identified 39 radiomic features, 4 conventional CMR parameters (left ventricular end-diastolic volume index, left ventricular end-systolic volume index, left ventricular ejection fraction, and late gadolinium enhancement ratio), and 1 clinical feature (history of non-sustained ventricular tachycardia) that could be included in the machine learning model. In the prediction models built with the training set, the concordance indices for the random forest, decision tree, and XGBoost models were 0.966 (95% CI 0.813-0.995), 0.956 (95% CI 0.796-0.992), and 0.973 (95% CI 0.823-0.996), respectively. In the validation set, the concordance indices for the random forest, decision tree, and XGBoost models were 0.854 (95% CI 0.557-0.964), 0.706 (95% CI 0.399-0.896), and 0.703 (95%CI 0.408-0.890), respectively. Conclusion:Integrating clinical and CMR features of HCM patients through machine learning aids in predicting heart failure events, with the random forest model showing superior performance.