Objective To investigate the effect and prognosis of patients with ventricular septal rupture after myocardial infarction treated by surgical repair combining an occluder and a patch. Methods Clinical data of 42 patients with myocardial infarction complicated with ventricular septal rupture admitted to the First Affiliated Hospital of Zhengzhou University from January 2010 to September 2021 were retrospectively analyzed. According to the surgical methods, 27 patients were divided into a traditional group, including 17 males and 10 females, with an average age of 62.81±6.81 years, who were repaired by patch only, and 15 patients were divided into a modified group, including 11 males and 4 females, with an average age of 64.27±9.24 years, who were repaired by surgery combining an occluder and a patch. Perioperative and follow-up data of the two groups were compared and analyzed.Results There were statistical differences between the two groups in preoperative Killip grading, rate of intra-aortic balloon pump use, interval from myocardial infarction to operation, and the number of culprit artery (P<0.05). There was no statistical difference in other preoperative data, the cardiopulmonary bypass time, aortic cross-clamping time, postoperative hospital stay or in-hospital death rate between the two groups (P＞0.05). No residual shunt occurred in the modified group, and the difference was statistically significant compared with the traditional group (P=0.038). There was no statistical difference in other complications between the two groups (P＞0.05). The median follow-up time was 4 years. Two patients in the traditional group and one in the modified group died during follow-up. The follow-up cardiac function grading of patients in the modified group was statistically different from that in the traditional group (P=0.023). Conclusion The perioperative mortality of ventricular septal rupture after myocardial infarction is high, but the long-term effect is satisfactory. Surgical repair combining an occluder and a patch is a safe and effective treatment for ventricular septal rupture, which can effectively reduce postoperative residual shunt.
The capacity for self-regeneration of the adult heart is very limited, conventional therapies cannot solve the loss of cardiomyocytes in the infarcted heart leads to continuous ventricular remodeling. Cell transplantation therapy is emerging as a novel approach for myocardial repair over conventional therapies. Various types of cell transplantation have improved cardiac function and angiogenesis in animal models and clinical settings. The safety and feasibility of some clinical trials have been initiated. In this review, we summarize the advantages and limitations of different cell types proposed for cell transplantation in myocardial infarction and give an overview of the clinical trials using this novel therapeutic approach in patients with myocardial infarction.
For the purposes of promoting the effect of secondary prevention of myocardial infarction, and improving the compliance with myocardial infarction (MI) secondary prevention, a guideline for strengthening patients self-management on non-pharmacological secondary prevention was produced by an multidiscipline team leaded by Chinese Association of Integrative Medicine clinical cardiovascular branch, Lanzhou University Evidence-Based Medicine Center, Peking University School of Nursing, Tianjin University of Traditional Chinese Medicine and Beijing University of Chinese Medicine. This is the first version of patient guideline in China. This paper introduces the main methods, processes and characteristics of the patient guideline development. It will provide reference to future researchers to the development of the patient guideline.
ObjectivesTo evaluate the efficacy and safety of newer-generation antidepressants for patients with myocardial infarction (MI) and depression.MethodsPubMed, The Cochrane Library, EMbase, Web of Science, CBM, CNKI, WanFang Data, and VIP databases were searched from inception to December 2017 to collect randomized controlled trials (RCT) on newer-generation antidepressants for patients with MI and depression. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software.ResultsTen RCTs involving 552 participants were included. The results showed that the antidepressant group was superior to the placebo or treatment group in terms of the improvement of depressive symptoms (SMD=–1.38, 95%CI –1.93 to –0.82, P<0.000 01), and incidence of angina (RR=0.42, 95%CI 0.25 to 0.71,P=0.001), recurrent MI (RR=0.43, 95%CI 0.22 to 0.83, P=0.01), and re-hospitalization for cardiac reasons (RR=0.51, 95%CI 0.28 to 0.92, P=0.03). However, there were no significant differences between two groups on all-cause mortality (RR=0.45, 95%CI 0.18 to 1.11, P=0.08), cardiovascular mortality (RR=0.53, 95%CI 0.16 to 1.73, P=0.29) and incidence of heart failure (RR=0.75, 95%CI 0.39 to 1.43, P=0.38). Subgroup analysis revealed that the type of antidepressants could affect the improvement of depression outcome. Citalopram and fluoxetine might be the most effective drugs for patients with MI and depression.ConclusionsNewer-generation antidepressants are effective for treatment of depressive symptoms in patients with MI and depression, with no significant impact on all-cause mortality and cardiovascular mortality. Moreover, antidepressants can reduce the incidence of angina, recurrent MI, and re-hospitalization for cardiac reasons in patients suffering from MI and depression. Due to limited quantity and quality of included studies, more high quality studies are required to verify above conclusions.
Abstract: Objective To transplant the microencapsulated recombinanted Chinese hamster ovary (CHO ) cells into the infracted myocardium of rodent animals and investigate whether vascular endothelial growth factor (VEGF) secreted by the implanted CHO cells could augment angiogenesis and improve cardiac function. Methods The cDNA of VEGF was transferred into CHO cells with plasmid stable transfection. After microencapsulation, the cell growth in microcapsules and the VEGF level in the culture supernatant were evaluated. Two weeks after myocardial infarction, the microencapsulated CHO cells (MC-CHO group ) were implanted into the border of infracted myocardium, as well as similar amount of CHO cells (CHO group ) , blank microcapsule (MC group ) and non-serum culture medium (control group ) as controls, 12 rats per group. The cardiac function improvement was evaluated 3 weeks after transplantation, while the survival status of implanted CHO cells, in situ secretion of VEGF and capillary density were assayed by histology. Results CHO cells could grow and proliferate after microencapsulation. The secretion of VEGF was detectable in culture media supernatant, with the highest concentration of 3 852 pg/m l at day 8. As compared to the other three groups, the left ventricular dimension and cardiac function were significantly improved in MC-CHO group 3 weeks after transplantation. The capillary density of MC-CHO group were increased significantly than those of CHO group, MC group and control group (22. 3±3. 1 vs. 15. 6±2. 8, 11. 4±2. 5, 13. 2±2. 7 vessels per 0.13 mm2, P lt; 0.05). The implanted microcapsule maintained its original shape and protected theCHO cells in it. Conclusion M icroencapsulaed recombinanted CHO cells transplantation might be a promising app roach to augment angiogenesis and improve the cardiac function in infarction myocardium.
Abstract: Objective To investigate the relationship between graft flow and incidence of perioperative myocardial infarction (MI) in coronary artery bypass grafting (CABG). Methods Between January 2010 and June 2010, 58 consecutive patients with coronary artery disease who underwent offpump CABG in the First Hospital of Peking University were enrolled in this study. An anastomosis between left internal mammary arteries (LIMA) and left ant erior descending coronary artery (LAD) were performed. And saphenous vein (SV) graft s were used as bypass grafts. Graft flow was measured intraoperatively using a transi t time flowmeter, and the total graft flow of each patient was calculated as a parameter of myocardial revascularization. The 58 patients were divided into a MI group and a nonMI group retrospectively. There were 11 patients in the MI group, including 7 males and 4 females, with an average age of 67.4±10.3 years.There were 47 patients in the nonMI group, 38 males and 9 females, with a mean age of 633±99 years. The graft flow of the two groups was tested and compared, and the preoperative variables were compared. Results There was no statistically significant difference in operation time (205.4±59.6min versus 1834±32.4 min, t=1.691, P=0.096) between the two groups. Therewere also no statistical differences in the average number of grafts (3.00±1.00 branches versus 2.96±0.78 branches, t=0.154, P=0878) or LIMALAD flow (1540±11.37 ml/min versus 16.50±10.83 ml/min, t=0.301, P=0.764) between the two groups. However, a significant difference was found in the total graft flow between the two groups (41.03±19.50 ml/min versus 64.09±32.44 ml/min, t=2.254, P=0.028), with lower total graft flow in the MI group. Further analysis showed [CM(159mm]that a total graft flow lt;48.5ml/min was a risk factor for MI (odds ratio 4.706, 95% confidence interval 1.099 to 20.147). Conclusion Total graft flow could be used to predict the occurrence of perioperative myocardial ischemia, as there is a high probability of MI for patients with a total graft flow of less than 48.5 ml/min.
Objective To report an acute ischemic left ventricular heart failure model of safe, simple, relatively steady, and reproducible in sheep. Methods Fourteen female sheep with a body weight of 36.80±3.43kg were used in this study. Heart failure model was induced by partial occluding the middle left circumflex coronary artery （LCX） combined with pacemaker-induced tachycardia. Hemodynamic measurement was done before and after heart failure, myocardial examination was observed. Results Heart failure model was induced successfully in 10 sheep. Cardiac output dropped from 3.74±0.48L/min to 2.02±0. 51L/min （P〈0. 01）, mean arterial pressure decreased from 116. 10± 14.15 mmHg（1kPa = 7.5mmHg） to 68. 10± 14. 72mmHg （P〈0.01）, central venous pressure rose from 7. 10±2.18mmHg to 10. 70± 3.50 mmHg （P〈0.05）, right ventricular end-diastolic pressure increased from 6.10±3.57mmHg to 9.90±4.41mmHg（P〈0.05）, left atrial pressure increased from 8.10±2.13 mmHg to 12.00± 4.57mmHg （P〈0. 01 ）, and left ventricular end-diastolic pressure increased from 8. 50± 4. 17mmHg to 13.10± 10. 64mmHg（P〉 0. 05）. The myocardial ultrastructure injuries was marked. Conclusions Acute ischemic left ventricular heart failure could be induced by partial occlusion of the middle LCX combined with pacemaker-induced taehyeardia in sheep. This model is simple, easy to manipulate, relatively steady, and reproducible . It may be used for assessing cardiac assist devices.
Objective To report a reliable left heart failure model in sheep using selected ligation of the diagonal branch. Methods Four male sheep were used. After a left anterior thoracotomy in sheep, the diagonal branch of coronary artery was ligated at a point approximately 40% of the distance from the apex to the base of the heart. Hemodynamic and echocardiography measurements were done preligation, 30 minutes and 7 days after the coronary artery of diagonal branch ligation. The electrocardiograms were obtained as needed, and cardiac function was also evaluated. The sheep were killed for postmortem examination of their hearts. Results Four sheep survived the experimental procedures. Comparing with before surgery, systemic arterial blood pressure and cardiac output were decreased, pulmonaryartery systolic pressure, pulmonary capillary wedge pressure and central venous pressure were increased at 30 min and 7 days after selected ligation of the coronary artery of diagonal branch; left ventricular end-diastolic dimension and left ventricular end-systolic dimension were increased; left ventricular ejection fraction and left ventricular fractional shortening were also decreased (Plt;0.05). Conclusion A reliable ovine model of left ventricular failure using selected ligation of the diagonal branch of the coronary artery can be achieved. This animal model is comparable to the clinical correlation.
Objective Engineer heart tissue (EHT) was constructed with mesenchymal stem cells (MSCs) and poly lacticacidCOglycolic acid (PLGA), and grafted onto the surface of myocardial infarction rats. We hypothesized that great omentum wrapping would increase EHT blood supply and ameliorate EHT microenvironment which is in favor of cardiac collagen remodling and heart function. We hope that omentun wrapped EHT could provide a valuable strategy for surgically myocardial infarction therapy. Methods MSCs were isolated from SD rats.Eight weeks after SD rats were subjected to left anterior descending (LAD) ligation, 18 rats were enrolled and divided into three groups, group A(n=6): great omentum wrapped MSCsPLGA EHT implantation; group B (n=6):MSCsPLGA EHT implantation; control group (n=6): the myocardial infarction; the sham group (n=6): only opened and closed chest, underwent LAD ligation, but no EHT implantation. Four weeks after transplantation, the following variables were evaluated: specimen stained with picrosirius red, left ventricle function evaluated by echocardiography, infarction ventricular wall motion by color kinesis (CK). Results Hearts of group A showed significantly less fibrosis than group B and control group (Plt;0.05). Infarction ventricular wall motion assessed by CK indicated significantly improvement in group A compared with group B and control group (Plt;0.05). Four weeks after transplantation, cardiac echocardiography showed left ventricle ejection fraction was lower in control group and group B compared with group A (Plt;0.05). Conclusion Transplantation of MSCsPLGA EHT with great omentum wrapping ameliorated infarction ventricular collagen remodeling, ameliorated infarction ventricular wall motion and preserved left ventricular function.
ObjectiveTo systematically review the effectiveness and safety of thrombolytics for treating ST-segment elevation myocardial infarction (STEMI) in China by network meta-analysis.MethodsThe PubMed, EMbase, The Cochrane Library, Web of Science, CBM, WanFang Data, and CNKI databases were searched for randomized controlled trials (RCTs) of thrombolytics for Chinese patients with STEMI from inception to October 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Statistical analysis was performed by WinBUGS 1.4.3 software and R 3.3.1 software.ResultsA total of 32 RCTs involving 3 164 patients with 7 types of thrombolytics were included. The results of network meta-analysis showed: the urokinase had lower reperfusion rate than tenecteplase (rhTNK-tPA), reteplase, alteplase, and pro-urokinase (all P values <0.05), however, had higher mortality or major adverse cardiovascular events rates than rhTNK-tPA, reteplase, alteplase, and pro-urokinase (all P values <0.05), and higher incidence of non-intracranial hemorrhage than those of alteplase and pro-urokinase (both P values <0.05). The incidence of intracranial hemorrhage had no statistical differences among different thrombolytics (all P values >0.05). The results of area under the cumulative ranking curve which ranked effectiveness of all thrombolytics showed that rhTNK-tPA had the best effectiveness and urokinase had the relative worst effectiveness among different thrombolytics.ConclusionsThe current evidence shows that domestic rhTNK-tPA may be effective in thrombolytic treatment. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.