Publications by authors named "Jimei Chen"

68 Publications

Early and midterm outcomes of a modified single-patch technique for repairing complete atrioventricular septal defect in children and adults.

J Card Surg 2020 Jan 6;35(1):75-82. Epub 2019 Nov 6.

Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.

Objectives: The "modified single-patch" technique (Nunn's technique) has become more widely adopted, especially in small infants with common atrioventricular septal defect (CAVSD). In this study, we retrospectively reviewed our surgical experiences of the "modified single-patch" technique with CAVSD patients, including newborns and adults, to reveal the early and midterm clinical results.

Methods: There were 233 cases diagnosed with CAVSD undergoing biventricular repair in our hospital from June 2009 to 2016. A total of 197 cases (84.5%) with the "modified single-patch" technique were enrolled in the final analysis, including type A in 106 cases (53.8%), type B in 13 cases (6.6%), type C in 15 cases (7.6%), and intermediate type in 63 cases (32%). Major associated cardiovascular malformations included five cases of unroofed coronary sinus syndrome with LSVC (UCS), five cases of coarctation of the aorta and one case of translocation of the great artery. The median age at operation of the studied 197 cases was 44.3 ± 103.3 months (ranging from 18 days to 58 years old), including two newborns. Detailed information on the "modified single-patch" procedure was described previously, and the other cardiac malformations were repaired simultaneously with surgical repair.

Results: There were 14 (7.1%) early deaths and 3 (1.5%) late deaths at 3 months and 1 year after the initial operation, respectively. The total mortality rate was 8.1%, and there was no significant difference in mortality among the different age groups (P = .291). Five patients (2.5%) underwent reoperation because of severe mitral insufficiency (MI), and another patient was reoperated for left ventricular outflow tract obstruction 3 years after the initial surgery. Long-term survival in the <3 months group was significantly lower than that in the group of older children (1-18 years old). Of the 180 survivors who were followed up for at least 1 year, the proportion of severe MI began to drop from 26.2% before the operation to 13.8% just 1-week postoperation and continued to decline to the lowest level, 3.4%, at 3 months postoperation. However, MI began to rebound at 3 months and reached 20.8% at 1-year postoperation. The rebound of MI was evident in the (3 months, 6 months) age group and the >18 years age group. However, compared to the preoperation situation, the proportion of severe tricuspid insufficiencies decreased each month from 24.8% to 0.0% until 3 months after the operation and remained at a relatively low level within 1 year after surgery.

Conclusions: In our experience, age is not a limitation of the modified single-patch technique, and patients even in adults with surgical indications can apply this technique. In older children and adults, we should pay more attention to atrioventricular valve annuloplasty. Infants may suffer from severe residual left atrioventricular valve regurgitation, especially in the <3 months age group, so we should improve postoperative follow-up work during infancy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jocs.14330DOI Listing
January 2020

Older patients with anomalous origin of the pulmonary artery from the ascending aorta: Guidance via lung biopsy.

J Card Surg 2020 Feb 6;35(2):437-440. Epub 2019 Nov 6.

Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, P.R. China.

Anomalous origin of one pulmonary artery from the ascending aorta is a rare congenital cardiac anomaly characterized by progressive pulmonary arterial hypertension (PAH) and pulmonary vascular obstructive disease (PVOD) in early childhood. This condition is assumed to be inoperable in older children and adults. However, pulmonary vascular resistance of the isolated lung is difficult to measure by catheterization due to its unique anatomical features, and thus we have used lung biopsy as an alternative method to evaluate candidacy for repair. Here, we report our experience with two patients whose lung biopsy demonstrated reversible PVOD, leading us to perform a surgical repair.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jocs.14322DOI Listing
February 2020

Prevalence of Concomitant Coronary Artery Disease and Its Impact on Acute Kidney Injury for Chinese Adult Patients Undergoing Valvular Heart Surgery.

Cardiology 2019;144(1-2):60-68. Epub 2019 Sep 11.

Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,

Introduction: Significant coronary artery disease (CAD) in patients undergoing valvular heart surgery (VHS) is an indication for combined valvular heart surgery and coronary artery bypass grafting. However, the impact of nonsignificant CAD on postoperative outcomes is not well understood. This study illustrated the epidemiological characteristics of CAD in China and investigated the impact of CAD on postoperative acute kidney injury (AKI), intensive care unit (ICU) stay, and postoperative mortality.

Methods: This study comprised an epidemiological survey followed by a case-control investigation. The epidemiological characteristics of CAD were studied in 4,172 consecutive patients who underwent coronary angiography before planned VHS at a core cardiovascular center. Then, 3,618 patients were selected for the subsequent case-control study to further analyze the associations between CAD and postoperative advanced AKI (grade 2 or 3 by KDIGO criteria), longer ICU stay (highest quartile), and increased mortality by logistic regression.

Results: Of the participants, 5.1 and 9.3% had moderate and significant CAD, respectively. The incidence of CAD increased after 60 years of age. Although CAD was not related to longer postoperative ICU stay in a multivariate logistic model, moderate CAD (OR 1.539 [95% CI 1.078-2.199]) and significant CAD (OR 1.798 [95% CI 1.094-2.955]) remained independent risk factors for postoperative advanced AKI after adjusting for multiple traditional risk factors. Significant CAD, but not nonsignificant CAD, was associated with postoperative mortality.

Conclusions: Concomitant CAD is common in Chinese patients who undergo VHS. Moderate and significant CAD might have detrimental effects on postoperative advanced AKI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000502225DOI Listing
April 2020

The Functional Polymorphism R129W in the Gene Is Associated with Sporadic Tetralogy of Fallot in the Han Chinese Population.

Genet Test Mol Biomarkers 2019 Sep 6;23(9):601-609. Epub 2019 Aug 6.

State Key Lab of Development Biology of Freshwater Fish, Key Lab of MOE for Development Biology and Protein Chemistry, The Center for Heart Development, College of Life Sciences, Hunan Normal University, Changsha, China.

Tetralogy of Fallot (TOF) accounts for ∼10% of congenital heart disease cases. The blood vessel epicardial substance () gene has been reported to play a role in the function of adult hearts. However, whether allelic variants in contribute to the risk of TOF and its possible mechanism remains unknown. The open reading frame of the gene was sequenced using samples from 146 TOF patients and 100 unrelated healthy controls. qRT-PCR and western blot assays were used to confirm the expression of mutated variants in the TOF samples. The online software Polyphen2 and SIFT were used to predict the deleterious effects of the observed allelic variants. The effects of these allelic variants on the transcriptional activities of genes were examined using dual-fluorescence reporter assays. We genotyped four single nucleotide polymorphisms (SNPs) in the gene from each of the 146 TOF patients. Among them, the minor allelic frequencies of c.385C>T (p.R129W) were 0.035% in TOF, but ∼0.025% in 100 controls and the Chinese Millionome Database. This allelic variant was predicted to be a potentially harmful alteration by the Polyphen2 and SIFT softwares. qRT-PCR and western blot analyses indicated that the expression of in the six right ventricular outflow tract samples with the c.385C>T allelic variant was significantly downregulated. A dual-fluorescence reporter system showed that the c.385C>T allelic variant significantly decreased the transcriptional activity of the gene and also decreased transcription from the and promoters. c.385C>T (p.R129W) is a functional SNP of the gene that reduces the transcriptional activity of and in TOF tissues. This subsequently affects the transcriptional activities of and related to TOF. These findings suggest that c.385C>T may be associated with the risk of TOF in the Han Chinese population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/gtmb.2019.0085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8104024PMC
September 2019

Predictors of postoperative outcomes in infants with low birth weight undergoing congenital heart surgery: a retrospective observational study.

Ther Clin Risk Manag 2019 9;15:851-860. Epub 2019 Jul 9.

Department of Anesthesiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China.

Background: Despite improvements in neonatal cardiac surgery and postoperative care, hospitalized death for infants with low birth weight remains high.

Objective: This study sought to identify predictors of postoperative outcomes in low-birth-weight infants undergoing congenital heart surgery and establish nomograms to predict postoperative intensive-care unit (ICU) stay.

Methods: From June 2009 to June 2018, a retrospective review of 114 infants with low birth weight (≤2.5 kg) undergoing congenital heart surgery was conducted at Guangdong Provincial People's Hospital. Purely surgical ligation of patent ductus arteriosus was excluded from this study. A total of 26 clinical variables were chosen for univariate, multivariate, and Cox regression analysis, and 14 variables were analyzed as predictors of postoperative outcomes. Nomograms were established to predict risk of postoperative cardiac ICU (CICU) stay, postoperative neonatal ICU (NICU) stay, and total ICU length of stay in infants with cardiac diseases.

Results: Two variables were independent predictors in multiple logistic regression analysis of hospitalized death: operation weight and Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) risk categories. Six variables were independent predictors in the Cox model of postoperative ICU length of stay, including sex, prematurity, birth weight, preoperative stay time in NICU, diagnostic classification, and STAT risk categories. We calculated concordance-index values to estimate the discriminative ability of models of risk of postoperative CICU stay, postoperative NICU stay, and total ICU length of stay, with values of 0.758 (95% CI 0.696-0.820), 0.604 (95% CI 0.525-0.682), and 0.716 (95% CI 0.657-0.776), which indicated the possibility of true-positive results.

Conclusion: Our findings might help clinicians predict postoperative outcomes and optimize therapeutic strategies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/TCRM.S206147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6628950PMC
July 2019

The cardioprotective effects of carvedilol on ischemia and reperfusion injury by AMPK signaling pathway.

Biomed Pharmacother 2019 Sep 11;117:109106. Epub 2019 Jun 11.

Department of Cardiac surgery, Affiliated of South China Hospital, Southern Medical University (Guangdong Provincial People's Hospital), Southern Medical University/The Second School of Clinical Medicine, Guangzhou 510515, China; Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China. Electronic address:

Carvedilol, a third generation beta blocker, is in clinical use for heart failure patients. However, besides adrenergic receptor blockade, the pharmacological effects of carvedilol on cardiomyocytes remain unknown. AMP-activated protein kinase (AMPK) is an emerging target recognized for heart failure treatment. The mechanical properties and intracellular Ca properties were measured in isolated cardiomyocyte contractile functions in response to ischemic stress. Treatment of cardiomyocytes with carvedilol augmented phosphorylation of AMPK and downstream acetyl CoA carboxylase (ACC), and ameliorated hypoxia-induced impairment in maximal velocity of shortening (+dL/dt) and relengthening (-dL/dt), and the impaired peak height and peak shortening (PS) amplitude caused by hypoxia. Carvedilol treatment improved calcium homeostasis with rescuing the peak Ca signal, the maximum rate of Ca change during contraction (+dF/dt) and the maximum rate of Ca change during relaxation (-dF/dt) under hypoxia conditions. In mouse hearts perfused ex vivo with carvedilol, the function of post-ischemia left ventricle was improved and an augmentation in myocardial glucose uptake and glucose oxidation, and inhibition of fatty acid oxidation during ischemia and reperfusion. The protective effect of carvedilol was further supported in an in vivo regional ischemia model by ligation of left anterior descending coronary artery (LAD), mice treated with carvedilol followed by LAD occlusion and reperfusion showed significant size reduction in infarcted myocardium and improved cardiac functions. Therefore, Carvedilol as a clinical drug can modulate cardiac AMPK signaling pathway to reduce ischemic insults by ischemia and reperfusion.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.biopha.2019.109106DOI Listing
September 2019

Co-initiation of continuous renal replacement therapy, peritoneal dialysis, and extracorporeal membrane oxygenation in neonatal life-threatening hyaline membrane disease: A case report.

Medicine (Baltimore) 2019 Jan;98(4):e14194

Department of Cardiovascular Surgery.

Rationale: Extracorporeal membrane oxygenation (ECMO) is a well-known technique to provide cardio-pulmonary support. Although continuous renal replacement therapy (CRRT) is frequently indicated, the need for faster fluid removal as the primary indication for ECMO is uncommon. Experiences on concomitant applications of ECMO, peritoneal dialysis (PD) and CRRT in neonates are relatively limited.

Patient Concerns: We report a 2-day-old male neonate with life-threatening hyaline membrane disease (HMD), accompained by severe systemic fluid retention, sepsis and abdominal compartment syndrome.

Diagnosis: Hyaline membrane disease (HMD), neonatal respiratory distress syndrome, sepsis, capillary leakage syndrome, and abdominal compartment syndrome.

Intervention: Veno-arterial ECMO, CRRT, and PD were synchronously initiated for the sake of faster fluid removal possible.

Outcomes: The infant was successfully weaned from ECMO circuit and fluid overload was greatly improved four days after extracorporeal life support (ECLS), without major complications.

Lessons: Initiation of CRRT and PD during ECMO therapy is effective and safe to release fluid overload in neonates, and severe complications are absent. When a neonate requires dialysis of urgency, ECMO offers assured vascular access to hemodialysis, allowing faster fluid removal.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MD.0000000000014194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6358340PMC
January 2019

Ankyrin repeat domain 1: A novel gene for cardiac septal defects.

J Gene Med 2019 04 19;21(4):e3070. Epub 2019 Feb 19.

Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.

Introduction: Cardiac septal defects account for more than 50% of congenital heart defects. Ankyrin repeat domain 1 (ANKRD1) is an important transcription factor that is mutated in multiple cardiac diseases; however, a relationship between the ANKRD1 mutation and cardiac septal defects has not been described.

Methods: We examined genetic mutations in a large family with three cardiac septal defect patients. Whole exome sequencing, bioinformatics and conservation analysis were utilized to predict the pathogenicity of candidate mutations. Dual luciferase reporter assay and nuclear localization experiments were performed to evaluate the influence of target mutation.

Results: A heterozygous, missense variant of ANKRD1 (MIM* 609599): NM_014391: exon6: c.C560T:p.S187F was identified at a highly conserved region. Sanger sequencing in extended family members demonstrated an incomplete inheritance model. When co-activated with NKX2.5, ANKRD1 repressed ANF expression as assessed by a dual-luciferase reporter assay, and p.S187F mutation enhanced the repressive effect (0.318 ± 0.018 versus 0.564 ± 0.048, p < 0.01). A real-time polymerase chain reaction confirmed that p.S187F mutation of ANKRD1 decreased the expression of endogenous ANF (0.85 ± 0.05 versus 0.61 ± 0.04, p < 0.01). Furthermore, nuclear localization experiments demonstrated that the mutation significantly decreased the nuclear distribution of ANKRD1.

Conclusions: The present study is the first to identify the p.S187F mutant of ANKRD1, which is associated with cardiac septal defects.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jgm.3070DOI Listing
April 2019

Loss of the Nodal modulator Nomo results in chondrodysplasia in zebrafish.

Curr Mol Med 2018 ;18(7):448-458

The Center for Heart Development, State Key Lab of Development Biology of Freshwater Fish, The National & Local Joint Engineering Laboratory of Animal Peptide Drug Development, Key Lab of MOE for Development Biology and Protein Chemistry, College of Life Sciences, Hunan Normal University, Changsha, Hunan, China.

Background: Transforming growth factor-β (TGF-β)/nodal signaling is involved in early embryonic patterning in vertebrates. Nodal modulator (Nomo, also called pM5) is a negative regulator of nodal signaling. Currently, the role of nomo gene in cartilage development in vertebrates remains unknown.

Methods: Nomo mutants were generated in a knockout model of zebrafish by clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein 9 (CRISPR/Cas9) targeting of the fibronectin type III domain. The expression of related genes, which are critical for chondrogenesis, was analyzed by whole-mount in situ hybridization and qRT-PCR. Whole-mount alcian staining was performed to analyze the cartilage structure.

Results: nomo is highly expressed in various tissues including the cartilage. We successfully constructed a zebrafish nomo knockout model. nomo homozygous mutants exhibited varying degrees of hypoplasia and dysmorphism on 4 and 5 dpf, which is similar to chondrodysplasia in humans. The key genes of cartilage and skeletal development, including sox9a, sox9b, dlx1a, dlx2a, osx, col10a1, and col11a2 were all downregulated in nomo mutants compared with the wildtype.

Conclusion: The nomo gene positively regulates the expression of the master regulator and other key development genes involved in bone formation and cartilage development and it is essential for cartilage development in zebrafish.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2174/1566524019666181212095307DOI Listing
October 2019

The outcome of pediatric patients undergoing congenital cardiac surgery under pulsatile cardiopulmonary bypass in different frequencies.

Ther Clin Risk Manag 2018 3;14:1553-1561. Epub 2018 Sep 3.

Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China,

Purpose: To investigate the influence and possible pathophysiological mechanism of pulsatile cardiopulmonary bypass (CPB) in various frequencies in pediatric patients undergoing congenital cardiac surgery.

Patients And Methods: Clinical data and hemodynamic parameters were collected in 80 patients who underwent congenital cardiac surgeries and were perfused in different settings: pulsatile perfusion (PP) in frequencies of 30 beats/min, PP 60 beats/min, PP 100 beats/min and non-pulsatile perfusion (NP). Serum proteins, plasma-free hemoglobin (PFH), endothelin-1 (ET-1) and nitric oxide (NO) were collected to study possible pathophysiological changes, possible hematological injury and oxidative status under different perfusing conditions.

Results: Patients in all groups had similar baseline characteristics, aortic cross-clamping time and CPB duration. More effective pulse gradient (PG), energy-equivalent pressure (EEP) and surplus hemodynamic energy (SHE) were observed in pulsatility with lower frequency setting, under which more patients achieved physiologically normal mean arterial pressure (MAP), without the support of inotropic agents during bypass. Significant between-group differences of serum proteins and PFH were absent the whole time during and after bypass, while a relatively lower percentage of perioperative requirement of diuretics was observed in the low frequency pulsatile group. A better performance to oxidative stress was seen in the low frequency group with higher levels of NO and lower concentration of ET-1, and both intergroup differences were found (<0.01). Satisfactory clinical outcome was obtained on post procedure course in all groups.

Conclusion: Pulsatile perfusion with low frequency setting in pediatric patients undergoing congenital cardiac surgery showed better hemodynamic profiles, potential protective effects on vital organs, better oxidative status and satisfactory clinical outcome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/TCRM.S170642DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6130281PMC
September 2018

Evaluation of Unroofed Coronary Sinus Syndrome Using Cardiovascular CT Angiography: An Observational Study.

AJR Am J Roentgenol 2018 08 27;211(2):314-320. Epub 2018 Jun 27.

1 Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People's Republic of China.

Objective: The purpose of this study was to determine the prevalence of unroofed coronary sinus (CS) syndrome at a tertiary hospital and analyze the clinical information, cardiovascular CT angiography (CCTA) imaging findings, associated anomalies, and surgical treatment of the identified cases.

Materials And Methods: We retrospectively searched the database of a tertiary hospital for cases of unroofed CS syndrome among patients who underwent CCTA for known or suspected congenital heart disease. After the prevalence of unroofed CS syndrome was determined, CCTA findings, associated cardiovascular abnormalities, presence or absence of airway compression, clinical information, and surgical outcome were recorded.

Results: A total of 23 patients with unroofed CS syndrome were identified, with the syndrome therefore having a prevalence of 0.36% among patients with congenital heart disease who underwent CCTA. The diagnostic accuracy of CCTA for unroofed CS syndrome was 100%, whereas that of echocardiography was 69%. Type I unroofed CS syndrome was the most commonly noted type (52% of patients). All 23 patients had associated cardiovascular anomalies, including persistent left superior vena cava (65% of patients) and atrial septal defect (65%). Surgery was performed for 70% of patients because of cardiovascular anomalies. Seven patients (30%) had associated secondary airway compression but did not require surgical correction.

Conclusion: At our institution, the prevalence of unroofed CS syndrome was 0.36% among patients with congenital heart disease who underwent CCTA. CCTA has excellent diagnostic performance, delineating different subtypes of unroofed CS syndrome and associated cardiovascular planning for treatment of unroofed CS syndrome abnormalities, improving clinical decision making, and permitting preoperative planning for treatment of unroofed CS syndrome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2214/AJR.17.19128DOI Listing
August 2018

Fabrication of engineered nanoparticles on biological macromolecular (PEGylated chitosan) composite for bio-active hydrogel system in cardiac repair applications.

Int J Biol Macromol 2018 Oct 25;117:553-558. Epub 2018 May 25.

Department of Cardiac Surgery, Affiliated South China Hospital, Southern Medical University (Guangdong Provincial People's Hospital), Guangzhou, Guangdong 510515, China; Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China. Electronic address:

The development of advanced nano-mediated biological macromolecular (PEGylated Chitosan) hydrogel materials is a vital approach to enhance the efficiency of cardiac tissue applications for treatment of cardiac tissue repair. Definite properties of PEG and chitosan hydrogel matrixes including swelling, mechanical stability and porosity need to be further improved with effective and non-toxic nanoparticles to promote the cell adhesion and organization of cardiac cells. In the current study, we fabricated engineered spherical TiO nanoparticles into the biologically active macromolecular (PEG/CTS) hydrogel matrixes with enhanced physico-chemical and biological properties. The morphological improved spherical TiO NPs have been highly dispersed in the porous hydrogel structure and effectively promoted young modulus and swelling properties and also exhibited favorable cell adhesion and organization with the cardiomyocytes cells. The stained fluorescence images of TiO-PEG/CTS hydrogels on the cardiomyocytes cells show the excellent cell-hydrogel matrix interactions comparable to the PEG/CTS hydrogel in the absence of TiO NPs. Thus, the investigation results of the present study clearly suggested that efficient cardiac patches with superior bioactive and mechanical properties for cardiac tissue repair.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijbiomac.2018.04.196DOI Listing
October 2018

Does maternal environmental tobacco smoke interact with social-demographics and environmental factors on congenital heart defects?

Environ Pollut 2018 Mar 24;234:214-222. Epub 2017 Nov 24.

Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Guangzhou 510100, Guangdong, China. Electronic address:

Congenital heart defects (CHDs) are a major cause of death in infancy and childhood. Major risk factors for most CHDs, particularly those resulting from the combination of environmental exposures with social determinants and behaviors, are still unknown. This study evaluated the main effect of maternal environmental tobacco smoke (ETS), and its interaction with social-demographics and environmental factors on CHDs in China. A population-based, matched case-control study of 9452 live-born infants and stillborn fetuses was conducted using the Guangdong Registry of Congenital Heart Disease data (2004-2014). The CHDs were evaluated by obstetrician, pediatrician, or cardiologist, and confirmed by cardia tomography/catheterization. Controls were randomly chosen from singleton newborns without any malformation, born in the same hospital as the cases and 1:1 matched by infant sex, time of conception, and parental residence (same city and town to ensure sufficient geographical distribution for analyses). Face-to-face interviews were conducted to collect information on demographics, behavior patterns, maternal disease/medication, and environmental exposures. Conditional logistic regression was used to estimate odds ratios and 95% confidence intervals of ETS exposure on CHDs while controlling for all risk factors. Interactive effects were evaluated using a multivariate delta method for maternal demographics, behavior, and environmental exposures on the ETS-CHD relationship. Mothers exposed to ETS during the first trimester of pregnancy were more likely to have infants with CHD than mothers who did not (aOR = 1.44, 95% CI 1.25-1.66). We also observed a significant dose-response relationship when mothers were exposed to ETS and an increasing number of risk factors and CHDs. There were greater than additive interactions for maternal ETS and migrant status, low household income and paternal alcohol consumption on CHDs. Maternal low education also modified the ETS-CHD association on the multiplicative scale. These findings may help to identify high-risk populations for CHD, providing an opportunity for targeted preventive interventions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.envpol.2017.11.023DOI Listing
March 2018

SMAD Axis Functions as a Key Mediator for Cardiac Fibrosis.

Heart Lung Circ 2018 Mar 6;27(3):e28. Epub 2017 Oct 6.

Department of Cardiac Surgery, Guangdong Provincial Cardiovascular Institute, Guangdong General Hospital, China. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.hlc.2017.09.010DOI Listing
March 2018

Perinatal and early postnatal outcomes for fetuses with prenatally diagnosed d-transposition of the great arteries: a prospective cohort study assessing the effect of standardised prenatal consultation.

Cardiol Young 2018 Jan 8;28(1):66-75. Epub 2017 Aug 8.

2Department of Cardiac Surgery,Guangdong Cardiovascular Institute,Guangdong Provincial Key Laboratory of South China Structural Heart Disease,Guangdong General Hospital,Guangdong Academy of Medical Sciences,Guangzhou,Guangdong,China.

Background: The aim of this study was to explore perinatal and early postnatal outcomes in fetuses with prenatally diagnosed d-transposition of the great arteries and impacts of standardised prenatal consultation.

Methods: All fetuses with prenatally diagnosed d-transposition of the great arteries prospectively enrolled at South China cardiac centre from 2011 to 2015. Standardised prenatal consultation was introduced in 2013 and comprehensive measures were implemented, such as establishing fetal CHD Outpatient Consultation Service, performing standard prenatal consultation according to specifications, and establishing a multidisciplinary team with senior specialists performing in-person consultations. Continuous follow-up investigation was conducted. Perinatal and postnatal outcomes were compared before and after consultation including live birth, elective termination of pregnancy, spontaneous fetal death, stillbirths, referral for surgery, and survival.

Results: In all, 146 fetuses were enrolled with 41 (28%) lost to follow-up. Among 105 remaining fetuses, 29 (28%) were live births and 76 (72%) were terminated. After consultation, live birth rate was higher (50 versus 33%) and termination rate was lower (50 versus 76%), although there was no statistical significance. Excluding three live births without postnatal d-transposition of the great arteries, 65% (17/26) underwent arterial switch operation within 30 days. A total of three in-hospital deaths occurred and during the 10-month follow-up period, one death was observed. In one case, the switch procedure was performed at 13 months and the infant survived. Out of eight infants without arterial switch operation, two died.

Conclusions: Live birth rate increased after consultation; however, termination remained high. Combining termination, patients without arterial switch operation, and operative mortality, outcomes of d-transposition of the great arteries infants can be improved. Standard consultation, multidisciplinary collaboration, and improved perinatal care are important to improve outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S1047951117001615DOI Listing
January 2018

Associations between toxic and essential trace elements in maternal blood and fetal congenital heart defects.

Environ Int 2017 09 20;106:127-134. Epub 2017 Jun 20.

Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China. Electronic address:

Prenatal exposure to toxic trace elements, including heavy metals, is an important public health concern. Few studies have assessed if individual and multiple trace elements simultaneously affect cardiac development. The current study evaluated the association between maternal blood lead (Pb), cadmium (Cd), chromium (Cr), copper (Cu), mercury (Hg), and selenium (Se) levels and congenital heart defects (CHDs) in offspring. This hospital-based case-control study included 112 case and 107 control infants. Maternal peripheral blood draw was made during gestational weeks 17-40 and used to determine trace element levels by inductively coupled plasma mass spectrometry. Multivariable logistic regression was used to assess associations and interactions between individual and multiple trace elements and fetal CHDs, adjusted for maternal age, parity, education, newborn gender, migrant, folic acid or multivitamin intake, cigarette smoking, maternal prepregnancy body mass index, and time of sample collection. Control participants had medians of 2.61μg/dL Pb, 1.76μg/L Cd, 3.57μg/L Cr, 896.56μg/L Cu, 4.17μg/L Hg, and 186.47μg/L Se in blood. In a model including all measured trace elements and adjusted for confounders, high levels of maternal Pb (OR=12.09, 95% CI: 2.81, 51.97) and Se (OR=0.25, 95% CI: 0.08, 0.77) were harmful and protective predictors of CHDs, respectively, with positive and negative interactions suggested for Cd with Pb and Se with Pb, respectively. Similar associations were detected for subgroups of CHDs, including conotruncal defects, septal defects, and right ventricle outflow tract obstruction. Our results suggest that even under the current standard for protecting human health (10μg/dL), Pb exposure poses an important health threat. These data can be used for developing interventions and identifying high-risk pregnancies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.envint.2017.05.017DOI Listing
September 2017

Long-Term Clinical Outcomes of the Carpentier-Edwards Perimount Pericardial Bioprosthesis in Chinese Patients with Single or Multiple Valve Replacement in Aortic, Mitral, or Tricuspid Positions.

Cardiology 2017;138(2):97-106. Epub 2017 Jun 16.

Department of Cardiac Surgery, Guangdong Provincial Cardiovascular Institute, Guangdong General Hospital, Guangzhou, China.

Objectives: To report the safety and efficacy results of a 9- to 15-year follow-up investigation among patients who had received Carpentier-Edwards Perimount (CE-P) bovine pericardial bioprostheses (Edwards Lifesciences, Irvine, CA, USA) for valve replacement.

Methods: This retrospective study investigated freedom from structural valve deterioration (SVD) as well as survival and reoperation among different age and etiology groups in patients who were implanted with a CE-P bioprosthesis at Guangdong General Hospital between 2001 and 2007. Kaplan-Meier survival analysis and multivariate Cox proportional hazards regression were performed.

Results: The mean age of the patients (N = 225) was only 61.2 ± 11.5 years at valve replacement. More than half of the patients (55.1%) had rheumatic heart disease. The survival rates were 86.46, 81.58, and 74.42% at 5 years, 64.39, 66.19, and 55.85% at 10 years, and 48.37, 57.33, and 46.54% at 15 years for the groups with mitral valve replacement (MVR), aortic valve replacement (AVR), and double valve replacement (DVR), respectively. The median time to freedom from SVD was 12.5, 13.2, and 11.2 years, respectively, for patients with MVR, AVR, and DVR. A higher age at valve replacement was a significant risk factor for SVD in all patients (p < 0.01).

Conclusions: Good long-term clinical results of CE-P valves have been demonstrated in Chinese patients >60 years.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000471478DOI Listing
August 2018

Surgical ablation for persistent atrial fibrillation in concomitant cardiac surgery: mid-long-term result.

Eur J Cardiothorac Surg 2017 Nov;52(5):888-894

Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.

Objectives: Surgical ablation is an option for patients with atrial fibrillation (AF) undergoing concomitant cardiac surgery. This study aims to evaluate the outcome of surgical ablation during concomitant cardiac surgery and to identify the independent predictors for a primary end-point consisting of AF or atrial flutter (AFL) recurrence, death, permanent pacemaker implantation and necessity for anti-arrhythmic drugs and the effects of reintervention for AF/AFL recurrence.

Methods: A retrospective analysis was performed for 1028 patients who underwent surgical ablation during concomitant cardiac surgery from October 2004 to April 2015. Nine hundred and twenty-seven of 1017 (91.2%) discharged patients were followed up. Sixty-three recurrent patients received reintervention. Predictors of ablation failure were identified using univariate analysis and the Cox regression model.

Results: The mean follow-up length was 29.0 ± 22.7 months. The New York Heart Association class, ejection fraction, left atrial and right atrial diameters and left ventricular end-diastolic diameter were improved at follow-up compared with the preoperative status. The rate of freedom from the primary end-point at 1, 2 and 3 years was 86.8, 79.4 and 68.3%. Independent predictors of reaching the primary end-point were AF/AFL at discharge, preoperative right atrial diameter, hypertension, diabetes and smoking. The rate of sinus rhythm without anti-arrhythmic drugs at 12, 24 and 36 months after reintervention was 78.3, 62.8 and 49.9%, respectively.

Conclusions: Surgical ablation has a high success rate and may improve cardiac function postoperatively. AF/AFL at discharge, preoperative right atrial diameter, hypertension, diabetes and smoking are the major independent predictors for ablation failure. Reintervention in AF/AFL recurrent patients can achieve a favourable clinical outcome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ejcts/ezx179DOI Listing
November 2017

DNA methyltransferase 1 rs16999593 genetic polymorphism decreases risk in patients with transposition of great arteries.

Gene 2017 Jun 16;615:50-56. Epub 2017 Mar 16.

Department of Cardiovascular Surgery of Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Laboratory of South China Structural Heart Disease, Guangzhou 510080, China. Electronic address:

Complete transposition of the great arteries (TGA) is the most frequent cyanotic heart defect diagnosed in neonates. However, the exact etiology of TGA is unknown. The aim of the present study was to assess the association of TGA pathogenesis with single nucleotide polymorphisms (SNPs) in DNA methyltransferases (DNMTs)-1 and 3a- in Chinese children. We genotyped 5 SNPs (rs16999593, rs16999358, and rs2228611 in DNMT1; and rs2276599 and rs2276598 in DNMT3A) in 206 patients with complete TGA and 252 healthy children. Statistical analysis was performed to explore the association of the 5 SNPs with complete TGA susceptibility. Compared with the T/T and C/C genotypes, the heterozygous genotype C/T of rs16999593 correlated with a decreased risk for complete TGA under codominant (OR=0.46; 95% CI=0.29-0.72), dominant (OR=0.58; 95% CI=0.38-0.88), and overdominant (OR=0.44; 95% CI=0.28-0.68) models. In contrast, the genotype C/C of rs16999593 correlated with a higher risk for TGA under a recessive model (OR=3.15; 95% CI=1.14-8.68) compared with the T/T and C/T genotypes. Furthermore, the TGC, TGT, CGC, and CGT haplotypes of DNMT1 did not differ significantly between the two groups, whereas the frequency of the TAC haplotype was lower in the case group (OR<1; P=0.002). No significant differences in the frequencies of the TC, CC, TT, and CT haplotypes of DNMT3A were found between the two groups. Furthermore, logistic regression showed that sex and the rs16999358 SNP were two independent risk factors for complete TGA. Overall, the C/T genotype of the rs16999593 SNP in DNMT1 might decrease the risk of complete TGA pathogenesis in the Southern Chinese population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.gene.2017.03.012DOI Listing
June 2017

The application of autologous pulmonary artery in surgical correction of complicated aortic arch anomaly.

J Thorac Dis 2016 Nov;8(11):3301-3306

Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China.

Background: In the patients with longer-segment aortic arch hypoplasia or interruption with ventricular septal defect, surgery with homograft vessel or autologous pericardial patch to augment descending aortic arch will not result in adverse reactions caused by end-to-end anastomosis. In this study, we retrospectively analyzed primary experience of surgical correction of complicated aortic arch anomaly with autologous main pulmonary artery.

Methods: From July 2010 to March 2016, the twenty-one cases of aortic arch complex anomalies were reconstructed with autologous main pulmonary artery. There were 5 patients with interrupted aortic arch and 16 patients with coarctation of aorta. In patients with interrupted aortic arch, anterior wall of main pulmonary artery was excised to form a conduit whose diameter varied according to the area of patient's body surface. Both ends of the conduit were anastomosed to aortic arch and descending aorta, respectively. In other patients with coarctation of aorta, aortic arch was augmented with tailored pulmonary artery patch in oval shape. The defect of main pulmonary artery was repaired with autologous pericardial patch.

Results: There was only one patient died of multiple organ failure postoperatively. The other twenty patients survived without any neurologic complications. Differences of blood pressure between upper and lower limbs were not significant in all cases. During follow-up period, the echocardiography for all patients in the third, sixth, twelfth, and twenty-fourth months showed that blood flow in the descending aortic arch was fluent and there was no obvious blood pressure gradient.

Conclusions: Autologous main pulmonary artery can be used to repair complicated aortic arch anomalies completely without any anastomotic tension or bronchial obstruction postoperatively. This procedure is feasible and possesses predominant early and mid-term effects, and autologous main pulmonary artery can retain growth capacity during follow-up period. Of course, it is necessary to draw a definite conclusion of this technique during long-term follow-up period.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/jtd.2016.11.43DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5179460PMC
November 2016

Evaluation of left pulmonary artery sling, associated cardiovascular anomalies, and surgical outcomes using cardiovascular computed tomography angiography.

Sci Rep 2017 01 5;7:40042. Epub 2017 Jan 5.

Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China; Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.

We evaluated the prevalence, image appearance, associated cardiovascular anomalies, and surgical outcomes of left pulmonary artery sling (LPAS) using cardiovascular computed tomography angiography (CCTA). A retrospective search of patients from our database between October 2007 and December 2014 identified 52,200 patients with congenital heart diseases (CHD) referred for CCTA, echocardiography, or magnetic resonance imaging. Clinical information, CCTA findings, associated cardiovascular anomalies, and surgical outcomes were analyzed. We showed a hospital-based prevalence of 71 patients with LPAS (0.14%, 71/52,200) among CHD patients. Of these, 47 patients with CCTA examinations were assessed further. Most patients (40/47, 85%) had associated cardiovascular anomalies, of which ventricular septal defects (22/47, 47%), atrial septal defects (20/47, 43%), patent ductus arteriosus (16/47, 34%), persistent left superior vena cava (14/47, 30%), and abnormal branching of the right pulmonary artery (ABRPA) (14/47, 30%) were most commonly identified. In total, 28 patients underwent LPA reanastomosis and/or tracheoplasty in our center, and 5 died. LPAS had a hospital-based prevalence of 0.14% among CHD patients. ABRPA is not uncommon and must be recognized. CCTA is a feasible method for demonstrating LPAS and its associated cardiovascular anomalies for an optimal pre-operative assessment of LPAS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/srep40042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5215389PMC
January 2017

Comparison of Sutureless and Conventional Techniques to Repair Total Anomalous Pulmonary Venous Connection.

Semin Thorac Cardiovasc Surg 2016 Summer;28(2):473-484. Epub 2016 Jun 11.

Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China. Electronic address:

Surgical repair of total anomalous pulmonary venous connection (TAPVC) is challenging. This study aimed to compare the outcomes of the sutureless and conventional techniques for primary repair. From October 2007 to December 2013, 179 consecutive patients underwent repair of TAPVC (sutureless, n = 81; conventional, n = 98). Propensity score matching was used to submit 140 patients to stratified analysis by the presence or absence of preoperative pulmonary venous obstruction (pre-PVO). Surgeons׳ performance differences were assessed with multilevel mixture survival analysis. Freedom from death and postoperative PVO (post-PVO) were evaluated with Kaplan-Meier curves. Risk factors for death and post-PVO were explored using Cox proportional hazard model. Surgeons׳ multilevel effects did not exist in this study. Following matching, Kaplan-Meier curves showed that for patients with pre-PVO (totally 38 cases), rates of freedom from death and post-PVO at 1 year were 80.0% (59.8%-100.0%) in the sutureless group, which was significantly better than that in the conventional group (38.3% [15.2%-61.4%], P = 0.02). For patients without pre-PVO (totally 102 cases), rates of freedom from death and post-PVO at 1 year were 96.1% [95% CI: 90.8%-100.0%] and 86.7% [76.5%-96.9%] in the sutureless and conventional groups, respectively (P = 0.15). Conventional technique was a risk factor for death (hazard ratio = 4.14, 95% CI: 1.29-13.28) and post-PVO (hazard ratio = 5.56, 95% CI: 1.18-26.27) adjusting for type of TAPVC, pre-PVO, and other confounders. In conclusions, the sutureless strategy for primary repair of TAPVC is safe and effective. For patients with pre-PVO, this strategy may associate with decreased mortality and post-PVO with statistical significance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1053/j.semtcvs.2016.05.009DOI Listing
June 2017

Total Anomalous Pulmonary Venous Connection: The Current Management Strategies in a Pediatric Cohort of 768 Patients.

Circulation 2017 Jan 15;135(1):48-58. Epub 2016 Nov 15.

From Department of Cardiothoracic Surgery, Heart Center, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China (G.S., Z.Z., H.H., H.Z., J. Zheng, Q.S., J.L., H.C.); and Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences (J.C., Y.O., Z.N., X.L., J. Zhuang), Guangdong, China.

Background: Total anomalous pulmonary venous connection (TAPVC) is a rare form of congenital heart disease. This study describes current surgical treatment strategies and experiences in a cohort of patients from 2 congenital cardiac centers in Shanghai and Guangdong in China.

Methods: This retrospective study included 768 patients operated on between 2005 and 2014. Although most patients (n=690) underwent conventional repair, a sutureless technique was used in 10% (n=78) of cases. A multilevel mixed-effects parametric survival model and a competing-risk analysis were used to analyze associated risk factors for death and recurrent pulmonary venous obstruction (PVO), respectively. Kaplan-Meier analysis was used to analyze the overall survival. The Nelson-Aalen cumulative risk curve was used to compare distributions of time with recurrent PVO.

Results: The mean surgical age and weight were 214.9±39.2 days and 5.4±3.6 kg, respectively. Obstructed TAPVC (PVO) was documented in 192 (25%) of the 768 patients. There were 38 intraoperative deaths and 13 late deaths. A younger age at the time of repair (P=0.001), mixed (P=0.004) and infracardiac (P=0.035) TAPVC, preoperative PVO (P=0.027), prolonged cardiopulmonary bypass time (P<0.001), and longer duration of ventilation (P=0.028) were associated with mortality. The median follow-up was 23.2 months (range; 1-112 months). Among the 717 survivors, recurrent PVO was observed in 111 patients (15%). Associated risk factors for recurrent PVO included preoperative PVO (P<0.001), infracardiac TAPVC (P<0.001), mixed TAPVC (P=0.013), and prolonged cardiopulmonary bypass time (P<0.001). Sutureless technique was associated with a lower restenosis rate compared with conventional repair in patients with preoperative PVO (P=0.038), except in newborn patients (P=0.443). Reintervention for restenosis was performed in 24 patients. The function of most survivors (91%) was classified according to the New York Heart Association as functional class I or II.

Conclusions: Surgical correction in patients with TAPVC with a biventricular anatomy can achieve an acceptable outcome. Risk factors such as a younger age at the time of repair, infracardiac and mixed TAPVC, and preoperative PVO were associated with a poorer prognosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/CIRCULATIONAHA.116.023889DOI Listing
January 2017

5-Aminolevulinic acid with sodium ferrous citrate induces autophagy and protects cardiomyocytes from hypoxia-induced cellular injury through MAPK-Nrf-2-HO-1 signaling cascade.

Biochem Biophys Res Commun 2016 Oct 29;479(4):663-669. Epub 2016 Sep 29.

Division of Transplantation Immunology, National Research Institute for Child Health and Development, Tokyo, Japan. Electronic address:

Background: Hypoxia causes cardiac disease via oxidative stress and mitochondrial dysfunction. 5-Aminolevulinic acid in combination with sodium ferrous citrate (ALA/SFC) has been shown to up-regulate heme oxygenase-1 (HO-1) and decrease macrophage infiltration and renal cell apoptosis in renal ischemia injury mice. However, its underlying mechanism remains largely unknown. The aim of this study was to investigate whether ALA/SFC could protect cardiomyocytes from hypoxia-induced apoptosis by autophagy via HO-1 signaling.

Materials & Methods: Murine atrial cardiomyocyte HL-1 cells were pretreated with ALA/SFC and then exposed to hypoxia.

Results: ALA/SFC pretreatment significantly attenuated hypoxia-induced cardiomyocyte apoptosis, reactive oxygen species production, and mitochondrial injury, while it increased cell viability and autophagy levels. HO-1 expression by ALA/SFC was associated with up-regulation and nuclear translocation of Nrf-2, whereas Nrf-2 siRNA dramatically reduced HO-1 expression. ERK1/2, p38, and SAPK/JNK pathways were activated by ALA/SFC and their specific inhibitors significantly reduced ALA/SFC-mediated HO-1 upregulation. Silencing of either Nrf-2 or HO-1and LY294002, inhibitor of autophagy, abolished the protective ability of ALA/AFC against hypoxia-induced injury and reduced ALA/SFC-induced autophagy.

Conclusion: Taken together, our data suggest that ALA/SFC induces autophagy via activation of MAPK/Nrf-2/HO-1 signaling pathway to protect cardiomyocytes from hypoxia-induced apoptosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.bbrc.2016.09.156DOI Listing
October 2016

Incidence of Congenital Heart Disease: The 9-Year Experience of the Guangdong Registry of Congenital Heart Disease, China.

PLoS One 2016 13;11(7):e0159257. Epub 2016 Jul 13.

Department of Cardiovascular Disease Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.

There are 16.5 million newborns in China annually. However, the incidence of congenital heart disease (CHD) has not been evaluated. In 2004, we launched an active province-wide hospital-based CHD registry in the Guangdong Province of southern China. In this study, we examined the incidence of CHD and its subtypes from 2004 to 2012 and compared our findings to the literature. Our results indicate there is an increasing trend of CHD incidence. The increase in incidence occurred mainly for single lesion and the most common subtypes (e.g., ventricular or atrial septal defect, patent ductus arteriosus). There were no increases found for multiple lesions or more complex subtypes. The proportion of CHD cases that were detected early (e.g., 1 week) increased over time. The incidence of CHD stabilized in 2010-2012 with the average cumulative incidences of 9.7, 9.9, and 11.1 per 1,000 live births at 1 week, 1 month, and 1 year, respectively. The incidences of CHD subtypes were comparable with recent international results. The data did not support previous reports that Asian children have a higher incidence of pulmonary outflow obstructions and lower incidence of transposition of the great arteries. However, there was a lower incidence of left ventricular outflow tract obstructions observed in our series. The increase in CHD incidence observed over time was due to improved detection and diagnosis. The true incidence of CHD in China was approximately 11.1 per 1,000 live births, which is higher than previously reported.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0159257PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4943720PMC
August 2017

Diagnostic, Prognostic, and Therapeutic Value of Circulating miRNAs in Heart Failure Patients Associated with Oxidative Stress.

Oxid Med Cell Longev 2016 9;2016:5893064. Epub 2016 Jun 9.

Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510100, China.

Heart failure is a major public health problem especially in the aging population (≥65 years old), affecting nearly 5 million Americans and 15 million European people. Effective management of heart failure (HF) depends on a correct and rapid diagnosis. Presently, BNP (brain natriuretic peptide) or N-terminal pro-brain natriuretic peptide (NT-proBNP) assay is generally accepted by the international community for diagnostic evaluation and risk stratification of patients with HF. However, regardless of its widespread clinical use, BNP is still encumbered by reduced specificity. As a result, diagnosis of heart failure remains challenging. Although significant improvement happened in the clinical management of HF over the last 2 decades, traditional treatments are ultimately ineffective in many patients who progress to advanced HF. Therefore, a novel diagnostic, prognostic biomarker and new therapeutic approach are required for clinical management of HF patients. Circulating miRNAs seem to be the right choice for novel noninvasive biomarkers as well as new treatment strategies for HF. In this review, we briefly discuss the diagnostic, prognostic, and therapeutic role of circulating miRNAs in heart failure patients. We also mentioned our own technique of extraction of RNA and detection of circulating miRNAs from human plasma and oxidative stress associated miRNAs with HF.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2016/5893064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4917723PMC
March 2017

CXXC5 is required for cardiac looping relating to TGFβ signaling pathway in zebrafish.

Int J Cardiol 2016 Jul 31;214:246-53. Epub 2016 Mar 31.

The Center for Heart Development, Key Lab of MOE for Development Biology and Protein Chemistry, College of Life Sciences, Hunan Normal University, Changsha, Hunan 410081, China. Electronic address:

Background: CXXC-type zinc-finger protein CXXC5 has been reported to be associated with the development of cardiovascular disease. Recently, through signaling pathway screening we found that CXXC5 activated Tgfβ and myocardial differentiation signaling pathways simultaneously. Although the physiological and pathological function of CXXC5 in many organs has been well elucidated, its function in heart remains unclear.

Methods And Results: Here, we found that zebrafish CXXC5 and SMAD were interacting through ZF-CXXC and MH1 domain. Over-expression of CXXC5 in cardiomyocyte increased the luciferase report activity of Tgfβ signaling pathway. Spatiotemporal expression profile of cxxc5 showed that it consistently expressed during cardiogenesis. Knockdown of cxxc5 in zebrafish displayed looping defects, cardiac dysplasia, pericardial edema, and decreased contraction ability, accompanied with down-regulation of members referring to cardiac looping downstream genes of Tgfβ signaling pathway, such as nkx2.5, hand2, and has2. Co-injection of hand2 mRNA with cxxc5 morpholino rescued the cardiac looping detects.

Conclusion: Our study is the first to provide an in vivo evidence for cxxc5 regulating heart development and cardiac looping via Tgfβ related signaling pathway. This finding suggested that CXXC5 may serve as a possible marker that has potential diagnostic and prognostic value in fetus with congenital heart disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijcard.2016.03.201DOI Listing
July 2016

Risk factors of different congenital heart defects in Guangdong, China.

Pediatr Res 2016 Apr 17;79(4):549-58. Epub 2015 Dec 17.

Bureau of Environmental and Occupational Epidemiology, Center for Environmental Health, New York State Department of Health, Albany, New York.

Background: Limited studies have evaluated the risk factors for congenital heart defects (CHDs) in China and compared them for different types of CHDs. This study examined risk factors between isolated and multiple CHDs as well as among CHDs subtypes in Guangdong, Southern China.

Methods: This population-based case-control study included 4,034 pairs of case and control infants enrolled in the Guangdong Registry of CHD study, 2004-2013. Multivariate logistic regression was used to compute adjusted odds ratios (ORs) while simultaneously controlling for confounders.

Results: Multiple maternal environmental exposures, including living in newly renovated rooms, residential proximity to main traffic, paternal smoking, and maternal occupation as manual worker, were significantly associated with CHDs with ORs ranging 1.30-9.43. Maternal perinatal diseases (including maternal fever, diabetes, influenza, and threatened abortion), maternal medication use (antibiotic use), advanced maternal age, low socioeconomic status, and paternal alcohol intake were also significantly associated with CHDs, with ORs ranging 1.60-3.96. Isolated CHDs and multiple defects have different profiles of risk factors, while subtype of CHD shares common risk factors.

Conclusion: These results suggest that maternal environmental exposures/occupation and perinatal diseases/medication use were dominant risk factors associated with CHDs in Southern China. Isolated and multiple CHDs may have different etiologic factors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/pr.2015.264DOI Listing
April 2016

Anomalous Origin of One Pulmonary Artery Branch From the Aorta: Role of MDCT Angiography.

AJR Am J Roentgenol 2015 May;204(5):979-87

1 Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, No.106, Zhongshan 2 Rd, Guangzhou, China.

Objective: The purpose of this study was to evaluate the prevalence, MDCT angiography (MDCTA) appearance, associated congenital cardiovascular abnormalities, and prognosis of anomalous origin of one pulmonary artery from the aorta (AOPA) on the basis of MDCTA.

Materials And Methods: We conducted a retrospective search of patients with AOPA from our database in a single center, consisting of 5729 patients referred for MDCTA with known or suspected congenital heart diseases from transthoracic echocardiography. The clinical information, subtypes of AOPA, associated cardiovascular anomalies, and surgical and clinical outcomes were retrospectively collected and analyzed. The MDCTA images were retrospectively processed for analysis, and the MDCTA and echocardiography images were interpreted by radiologist and cardiologist without knowledge of the actual diagnosis or surgical outcome.

Results: AOPA was seen in 19 patients (14 males and five females; median age, 3 months; range, 4 days-21 years) showing a prevalence of 0.33%. Anomalous origin of the right pulmonary artery (AORPA, 89%), proximal origin subtype of the AOPA (89%), and ipsilateral aortic wall origin of AOPA (58%) were more commonly seen. In addition to the benefit of preoperative planning, MDCTA also supplemented echocardiography by providing accurate diagnosis of AOPA and other associated cardiovascular anomalies compared with transthoracic echocardiography (TTE). We found a total of four patients (21%) with misdiagnosis by TTE, including three patients with underdiagnosis of AOPA and one patient with misdiagnosis as transposition of the great arteries. In addition, two other patients had AOPA diagnosed, but the associated patent ductus arteriosus (PDA) was not detected. MDCTA revealed 95% association with other congenital cardiovascular anomalies, including PDA (71% of AORPA), and aortic arch anomalies (100% of anomalous origin of the left pulmonary artery, AOLPA). The types of surgery depended on the MDCTA findings, including the sub-type, origin sites of AOPA, and associated cardiovascular anomalies. Analysis of the pulmonary arterial sizes showed the McGoon ratios in these patients with a median value of 2.4 (range, 1.5-2.9). Surgical treatment performed before the age of 1 year enabled normalization of pulmonary artery pressure in 92% of patients.

Conclusion: AOPA had a prevalence of 0.33% among patients with congenital heart disease in our series. MDCTA was an important supplement for the diagnosis, delineating the different subtypes and origin sites of AOPA and permitting preoperative planning of AOPA in patients suspected on the basis of echocardiography of having AOPA because accurate diagnosis and early surgical treatment remain the mainstays in improving patient outcome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2214/AJR.14.12730DOI Listing
May 2015

5-aminolevulinic acid combined with sodium ferrous citrate ameliorates H2O2-induced cardiomyocyte hypertrophy via activation of the MAPK/Nrf2/HO-1 pathway.

Am J Physiol Cell Physiol 2015 Apr 4;308(8):C665-72. Epub 2015 Feb 4.

Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China;

Hydrogen peroxide (H2O2) causes cell damage via oxidative stress. Heme oxygenase-1 (HO-1) is an antioxidant enzyme that can protect cardiomyocytes against oxidative stress. In this study, we investigated whether the heme precursor 5-aminolevulinic acid (5-ALA) with sodium ferrous citrate (SFC) could protect cardiomyocytes from H2O2-induced hypertrophy via modulation of HO-1 expression. HL-1 cells pretreated with/without 5-ALA and SFC were exposed to H2O2 to induce a cardiomyocyte hypertrophy model. Hypertrophy was evaluated by planar morphometry, (3)H-leucine incorporation, and RT-PCR analysis of hypertrophy-related gene expressions. Reactive oxygen species (ROS) production was assessed by 5/6-chloromethyl-2',7'-ichlorodihydrofluorescein diacetate acetylester. HO-1 and nuclear factor erythroid 2-related factor 2 (Nrf2) protein expressions were analyzed by Western blot. In our experiments, HL-1 cells were transfected with Nrf2 siRNA or treated with a signal pathway inhibitor. We found several results. 1) ROS production, cell surface area, protein synthesis, and expressions of hypertrophic marker genes, including atrial natriuretic peptide, brain natriuretic peptide, atrial natriuretic factor, and β-myosin heavy chain, were decreased in HL-1 cells pretreated with 5-ALA and SFC. 2) 5-ALA and SFC increased HO-1 expression in a dose- and time-dependent manner, associated with upregulation of Nrf2. Notably, Nrf2 siRNA dramatically reduced HO-1 expression in HL-1 cells. 3) ERK1/2, p38, and SAPK/JNK signaling pathways were activated and modulate 5-ALA- and SFC-enhanced HO-1 expression. SB203580 (p38 kinase), PD98059 (ERK), or SP600125 (JNK) inhibitors significantly reduced this effect. In conclusion, our data suggest that 5-ALA and SFC protect HL-1 cells from H2O2-induced cardiac hypertrophy via activation of the MAPK/Nrf2/HO-1 signaling pathway.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1152/ajpcell.00369.2014DOI Listing
April 2015
-->