The clinical experience of double-orifice tricuspid valve.

BACKGROUND AND AIM OF THE STUDY: Double-orifice tricuspid valve (DOTV) is an extremely rare congenital anomaly. By analysing the feature of its diagnosis and surgical treatment, we want to summarise the clinical experience of treating DOTV. MATERIALS AND METHODS: Review two cases of DOTV treated by us between August 2009 and December 2011. One case was diagnosed as partial atrioventricular septum defect, and the other was tetralogy of Fallot. The defects were both identified during the operation for other congenital cardiac malformations and both accessory orifices were normal. But one of them was sutured because of its possible effect in future. RESULTS: Cardiac colour Doppler echocardiogram was made at three to five days after operation and all results were normal. No operative complication or late deaths occurred. The time of follow-up were one month, three months, six months, one year and two years after operation, and all examinations were normal. CONCLUSIONS: The accessory orifice of DOTV patients has its own independent chordae tendinea and mastoid muscle. So the gap of tricuspid valve should be excluded and the classification should be amended according to it. It should be surgically treated, when there is of dysfunction with it or potential harmful effect in sequent treatment.

Overexpression of DNA damage-induced 45 α gene contributes to esophageal squamous cell cancer by promoter hypomethylation.

BACKGROUND: Environmental factors-induced dysfunction of esophageal squamous epithelium, including genomic DNA impairment and apoptosis, play an important role in the pathogenesis of esophageal squamous cell cancer. DNA damage-induced 45α (GADD45α) has been found promoting DNA repair and removing methylation marker, Therefore, in this study we will investigate whether GADD45α expression is induced and its mechanism in esophageal squamous cell cancer. METHODS: Two human esophageal squamous cell lines (ESCC), ECA109 and KYSE510 were cultured in RPMI-1640 medium supplemented with 10% fetal bovine serum (FBS). Lipofectamine 2000 was used to transfect cells. mRNA level of GADD45α was measured by reverse transcription-quantitive PCR (RT-qPCR), protein level of GADD45α was detected by western blot and Immunohistochemistry. Global DNA methylation of tissue sample was measured using the Methylamp Global DNA Methylation Quantification Ultra kit (Epigentek Group) and promoter methylation was measured by bisulfite sequencing. RESULTS: GADD45a mRNA and protein levels were increased significantly in tumor tissue than that in adjacent normal tissue. Hypomethylation of global genomic DNA and GADD45α promoter were found in ESCC. The cell sensitivity to Cisplatin DDP was decreased significantly in Eca109 and Kyse510 cells, in which GADD45α expression was down-regulated by RNA interference (RNAi). In addition, silence of GADD45a expression in ESCC cells inhibited proliferation and promoted apoptosis. CONCLUSION: Overexpression of GADD45α gene is due to DNA hypomethylation in ESCC. GADD45α may be a protective factor in DDP chemotherapy for esophageal squamous cell carcinoma.

Altered serum creatine kinase level and cardiac function in ischemia-reperfusion injury during percutaneous coronary intervention.

BACKGROUND: Myocardial ischemia-reperfusion injury (MIRI) resulting from primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) is considered harmful to the patient, but its clinical significance remains unclear. This study explored the relationship of cardiac function examined by echocardiography and serum creatine kinase (CK) and CK-MB levels with MIRI in a cohort of Chinese AMI patients. MATERIAL/METHODS: We retrospectively analysed the clinical and angiographic data in 228 AMI patients in whom the infarct-related artery (IRA) was successfully recanalized by primary PCI. Cardiac function was evaluated by use of echocardiography before discharge from hospital. RESULTS: The in-hospital mortality rate in the MIRI group was 13.4% (16/119), which was significantly higher than the 4.6% (5/109) mortality rate in the non-MIRI group (P=0.021). The median of peak serum CK level was remarkably lower in the suppression-type MIRI group than in the non-MIRI group. There were no significant differences in the peak serum CK or CK-MB levels between the irritation-type MIRI group and the non-MIRI group. The peak CK and CK-MB levels were significantly higher in the no-reflow-type MIRI group than in the non-MIRI group. Left ventricular ejection fraction in the no-reflow-type MIRI group was significantly lower than in the non-MIRI group; left ventricular end-diastolic volume was significantly higher than in the irritation-type MIRI subgroup; and left ventricular end-systolic volume was greater than that in non-MIRI group and suppression-type MIRI group. CONCLUSIONS: MIRI (especially the no-reflow type) may lead to acute hemodynamic disorders and increase the mortality rate. However, suppression- and irritation-type MIRI may imply the existence of surviving myocardium.

Determinants and prognostic implications of reperfusion injury during primary percutaneous coronary intervention in Chinese patients with acute myocardial infarction.

BACKGROUND: The poor clinical outcome in acute myocardial infarction (AMI) patients undergoing primary percutaneous coronary intervention (PCI) has been attributed to myocardial ischemia-reperfusion injury (MIRI). OBJECTIVE: This study aimed to identify the predictive factors of MIRI during PCI in Chinese AMI patients with or without ST-segment elevation. METHODS: Clinical and angiographic data of 228 patients in whom the infarct-related artery (IRA) was successfully recanalized by primary PCI were retrospectively analyzed. Multiple logistic regressions were used. RESULTS: Compared with non-MIRI group (n=109), patients with MIRI (n=119) were characterized by more inferior infarct location, shorter ischemic duration, more frequently right coronary artery as IRA, more lesion vessels, more often thrombolysis in myocardial infarction (TIMI) 0 flow in IRA prior to PCI, less preinfarction angina, and more renal insufficiency. Ischemic time

[Reperfusion arrhythmias in acute myocardial infarction do not enhance myocardial injury].

OBJECTIVE: To investigate the clinical implications of reperfusion arrhythmias during primary percutaneous coronary intervention (PCI) for patients with acute myocardial infarction (AMI). METHODS: Data from 228 AMI patients in whom the infarct-related artery (IRA) were successfully recanalized by primary PCI were retrospectively analyzed. The 228 patients were divided into 2 groups: myocardial ischemia-reperfusion injury (MIRI) group (n=119) in whom MIRI events occurred within minutes after successful recanalization of IRA, and non-MIRI group (n=109). The 119 patients in MIRI group were further divided into 3 subgroups: severe bradycardia with hypotension (brady-arrhythmia subgroup), lethal ventricular arrhythmias requiring electrical cardioversion (tachy-arrhythmia subgroup), and IRA antegrade flow less than or equal to TIMI 2 grade without angiographic evidence of abrupt closure (no-reflow subgroup). RESULTS: (1) Clinical and angiographic data: Compared with non-MIRI group, MIRI group was characterized by more inferior infarct location, shorter ischemic duration, more frequently right coronary artery as IRA, more diseased vessels, more often TIMI 0 grade of initial antegrade flow in IRA, less pre-infarction angina, more renal insufficiency, and higher in-hospital mortality (13.4% vs. 4.6%, P=0.021). (2) The peak CK level was remarkably lower in brady-arrhythmia subgroup than that in non-MIRI group (2010 IU/L vs. 2521 IU/L, P=0.039). The peak CK or CK-MB level was notably higher in no-reflow subgroup than in non-MIRI group (4573 IU/L, 338 IU/L, respectively, P=0.000). (3) Left ventricular ejection fraction in no-reflow subgroup was significantly lower than in non-MIRI group (38.7% +/- 8.3% vs. 51.2% +/- 8.1%, P=0.000), left ventricular end-diastolic volume in no-reflow subgroup was greater than that in tachy-arrhythmia subgroup [(135 +/- 32) ml vs. (105 +/- 19) ml, P=0.029]. CONCLUSION: Reperfusion arrhythmias may imply the existence of much survived myocardium and do not enhance myocardial damage, while no-reflow increases myocardial injury and induces permanent impairment of cardiac function.

[Analysis on correlative factors for occurrence of myocardial ischemia-reperfusion injury during primary percutaneous coronary intervention for acute myocardial infarction].

OBJECTIVE: To explore the risk and protective factors for the occurrence of myocardial ischemia-reperfusion injury (MIRI) during primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). METHODS: Clinical and angiographic data of 228 AMI patients in whom the infarct-related arteries (IRA) were successfully revascularized by primary PCI were analyzed retrospectively. MIRI was defined if the following conditions existed after PCI: severe bradycardia with hypotension, or lethal ventricular arrhythmias requiring electrical cardioversion, or IRA antegrade flow < or = TIMI 2 grade flow without angiographic evidence of thrombus, emboli, dissection or spasm. Multivariate logistic regression was used to identify independent relative factors among 18 clinical and angiographic factors for occurrence of MIRI. RESULTS: Multivariate logistic regression analysis showed that independent risk factors for MIRI were the time intervals from AMI onset to IRA reflow < or = 6 h (P = 0.014), inferior infarction localization (P = 0.006), IRA antegrade flow prior to PCI < or = TIMI 1 grade (P = 0.028), multivessel lesions (P = 0.063) and renal insufficiency (P = 0.067). Pre-infarction angina was found to be an independent protective factor (P = 0.005). CONCLUSIONS: Short time intervals from AMI onset to IRA revascularization, inferior wall infarction location, low IRA antegrade flow prior to PCI, multivessel lesions and renal insufficiency may promote the occurrence of MIRI during primary PCI, whereas pre-infarction angina may be a cardioprotective factor attenuating MIRI.

[Effect of percutaneous coronary intervention on QT dispersion and its clinical implication in patients with acute myocardial infarction].

OBJECTIVE: To observe the effects of percutaneous coronary intervention (PCI) on QT dispersion (QTd) and explore its clinical significance in patients with acute myocardial infarction (AMI). METHODS: The electrocardiograms recorded before and one day after PCI were analyzed in 138 patients with AMI. The duration from the onset of AMI to PCI operation was less than 6 h in 72 patients and 6 to 12 h in the other patients. All the patients underwent emergency percutaneous transluminal coronary angioplasty and subsequent coronary stenting. QT intervals, QTd, and heart rate-corrected QT intervals (QTc) and QTd (QTcd) were measured and calculated. RESULTS: In both patient groups receiving PCI with delay shorter and longer than 6 h after AMI, QT and QTc after PCI were not significantly different from that before PCI, but the QTd and QTcd were remarkably decreased after PCI (all the P <0.01). Moreover, the QTd and QTcd in the patients with delay of PCI less than 6 h were significantly shorter than those in patients the with greater-than-6-hour delay (P<0.05), and the inhospital mortality was 4.2% and 7.6% in the two groups, respectively (P=0.394). CONCLUSION: Successful PCI may notably reduce QTd in the patients with AMI, whose earlier performance usually produces better effects.