Relationship between disorders of the intestinal microbiota and heart failure in infants with congenital heart disease.

Purpose: There is a close relationship between the intestinal microbiota and heart failure, but no study has assessed this relationship in infants with congenital heart disease. This study aimed to explore the relationship between heart failure and intestinal microbiota in infants with congenital heart disease. Methods: Twenty-eight infants with congenital heart disease with heart failure admitted to a provincial children's hospital from September 2021 to December 2021 were enrolled in this study. A total of 22 infants without heart disease and matched for age, sex, and weight were selected as controls. Faecal samples were collected from every participant and subjected to 16S rDNA gene sequencing. Results: The composition of the intestinal microbiota was significantly disordered in infants with heart failure caused by congenital heart disease compared with that in infants without heart disease. At the phylum level, the most abundant bacteria in the heart failure group were Firmicutes, Actinobacteria, Proteobacteria, and Bacteroidetes, and the most abundant bacteria in the control group were Firmicutes, Proteobacteria, Actinobacteria, and Bacteroidetes. At the genus level, the most abundant bacteria in the heart failure group were Enterococcus, Bifidobacterium, Subdoligranulum, Shigella, and Streptococcus, and the most abundant bacteria in the control group were Bifidobacterium, Blautia, Bacteroides, Streptococcus, and Ruminococcus. The alpha and beta diversities of the gut bacterial community in the heart failure group were significantly lower than those in the control group (p<0.05). Compared with the control group, retinol metabolism was significantly downregulated in the heart failure group. Conclusion: Heart failure in infants with congenital heart disease caused intestinal microbiota disorder, which was characterised by an increase in pathogenic bacteria, a decrease in beneficial bacteria, and decreases in diversity and richness. The significant downregulation of retinol metabolism in the intestinal microbiota of infants with heart failure may be related to the progression of heart failure, and further study of the underlying mechanism is needed.

Evaluation of health-related quality of life in children with postoperative delirium after surgical repair of ventricular septal defect: short- and mid-term follow-up.

BACKGROUND: To investigate health-related quality of life (HRQOL) in children with postoperative delirium (POD) after surgical repair of ventricular septal defects (VSDs). METHODS: A total of 109 patients were enrolled and assigned to the POD group (n = 47) and the non-POD group (n = 62). HRQOL was assessed by the PedsQLTM 3.0 Cardiac Module at discharge, and at the three- and six-month postoperative follow. RESULTS: Significant differences were detected in age, operation time, CPB time, mechanical ventilation duration, and length of ICU stay between the two groups, whereas sex and the VSD size did not significantly differ between groups. In terms of "cardiac heart problems and treatment" and "treatment-II", the HRQOL scores of the non-POD group were significantly better than those of the POD group. In terms of "perceived physical appearance" and "treatment anxiety", the POD group had significantly higher scores than the non-POD group at discharge and at the three-month postoperative follow-up. In terms of "cognitive problems" and "communication", the occurrence of POD still affected HRQOL at three months postoperatively, but the effect was significantly reduced at six months postoperatively. In terms of "total scores", both groups scored increasingly higher over time. The non-POD group had higher scores at discharge and three months postoperatively than the POD group, but no significant difference persisted at six months postoperatively. CONCLUSION: During the follow-up period, the HRQOL of the children with POD after surgical repair of VSD was inferior to that of the children without POD at discharge and three months postoperatively. However, the HRQOL did not differ between the two groups at six months postoperatively.

A comparison of the changes in serum lactate between surgical repair and transthoracic device closure of ventricular septal defects in pediatric patients.

Objective: The purpose of this study was to compare the changes in serum lactate between surgical repair and transthoracic device closure of ventricular septal defects (VSDs) in pediatric patients. Methods: This study was a retrospective analysis, and 314 pediatric patients with simple VSD from October 2019 to October 2021 were selected. The patients were divided into the S group (surgical repair) and the D group (transthoracic device closure). The serum lactate value at ICU admission and 6 h after operation, as well as the highest serum lactate value were collected, and the 6-h serum lactate clearance rate was calculated. Result: Through propensity score matching, 43 pairs of cases were successfully matched. Compared with the S group, the D group had a shorter operation duration, ventilation duration, and ICU duration, as well as a lower drainage volume and total hospitalization cost. There was no significant difference between the two groups in the initial and highest serum lactate values after VSD closure, while the 6-h serum lactate value in the D group was significantly lower than that in the S group, and the 6-h serum lactate clearance rate in the D group was five times faster than that in the S group. In addition, the 6-h serum lactate clearance rate in the S group was mainly related to the operation time, CPB time, and ventilation time, while the 6-h serum lactate clearance rate in the D group was only related to the operation time. Conclusion: The initial and highest serum lactate levels were not significantly different between surgical repair and transthoracic device closure of VSD, but the 6-h serum lactate clearance rate of device closure was five times faster than that of surgical repair.

Transthoracic Device Closure, Transcatheter Device Closure, and Surgical Repair via Right Submammary Thoracotomy for Restrictive Ventricular Septal Defect, a Respective Comparative Study.

BACKGROUND: Few comparative studies have focused on the advantages and disadvantages of transthoracic device closure, transcatheter device closure, and surgical repair via right submammary thoracotomy for restrictive ventricular septal defect (VSD). In this article, we compared the safety, efficacy, and clinical effects of these three treatments. Methods: The clinical data of 192 pediatric patients with a restrictive VSD in our hospital from January 2017 to May 2018 were retrospectively collected and analyzed. According to the different treatments, the patients were divided into three groups (the surgical and device groups). Results: There was no significant difference in the demographic characteristics, VSD size, mean pulmonary artery pressure, or cardiothoracic ratio. In addition, there were significant differences in the duration of mechanical ventilation, operation, hospitalization, and ICU stay between the two device groups and the surgical group, but there were no significant differences between the two device groups. Conclusions: Transthoracic device closure, transcatheter device closure, and surgical repair via right submammary thoracotomy for restrictive VSD repair are all safe and feasible. These three treatments have their own disadvantages and advantages and should be selected according to individual patients.

Comparison of Postoperative Changes in Inflammatory Marker Levels Between Transthoracic and Transcatheter Device Closures of Atrial Septal Defects in Children.

OBJECTIVE: To explore the postoperative changes in inflammatory markers in children who underwent device closure of an atrial septal defect (ASD) via a transthoracic or transcatheter approach. METHODS: The experimental and clinical data were retrospectively collected and analyzed for a total of 53 pediatric patients between September 2018 and December 2018. According to the different treatments, 19 patients who underwent transthoracic device closure were assigned to group A, and the remaining 34 patients who underwent a transcatheter approach were assigned to group B. RESULTS: All patients were successfully occluded without any device-related severe complication. Compared with the preoperative levels, the postoperative levels of most inflammatory cytokines in both groups were significantly increased and reached a peak on the first day after the procedure. The level of postoperative inflammatory cytokines was significantly lower in group B than in group A. In addition, there was no significant difference in procalcitonin before and after the transcatheter approach. CONCLUSION: Systemic inflammatory reactions occurred after transthoracic or transcatheter device closure of ASDs in pediatric patients. However, these inflammatory reactions were more significant in patients who underwent a transthoracic approach than in patients who underwent a transcatheter approach.

Comparison of postoperative changes in inflammatory marker levels between transthoracic and transcatheter device closures of atrial septal defects in children

Abstract Objective: To explore the postoperative changes in inflammatory markers in children who underwent device closure of an atrial septal defect (ASD) via a transthoracic or transcatheter approach. Methods: The experimental and clinical data were retrospectively collected and analyzed for a total of 53 pediatric patients between September 2018 and December 2018. According to the different treatments, 19 patients who underwent transthoracic device closure were assigned to group A, and the remaining 34 patients who underwent a transcatheter approach were assigned to group B. Results: All patients were successfully occluded without any device-related severe complication. Compared with the preoperative levels, the postoperative levels of most inflammatory cytokines in both groups were significantly increased and reached a peak on the first day after the procedure. The level of postoperative inflammatory cytokines was significantly lower in group B than in group A. In addition, there was no significant difference in procalcitonin before and after the transcatheter approach. Conclusion: Systemic inflammatory reactions occurred after transthoracic or transcatheter device closure of ASDs in pediatric patients. However, these inflammatory reactions were more significant in patients who underwent a transthoracic approach than in patients who underwent a transcatheter approach.

A meta-analysis of perventricular device closure of doubly committed subarterial ventricular septal defects.

BACKGROUND: To investigate the safety and efficacy of perventricular device closure of doubly committed subarterial ventricular septal defects (dcsVSDs). METHODS: PubMed and Scopus were searched for studies in English that focused on perventricular device closure of dcsVSDs and were published up to the end of September 2019. We used a random-effects model to obtain pooled estimates of the success and complication rates. RESULTS: A total of 9 publications including 459 patients with dcsVSDs were included. The median follow-up duration ranged from 2 months to 5 years, with the mean age of patients ranging from 6.1 months to 4.5 years. The pooled estimate of the overall success rate of device closure in the 9 studies was 0.89 (95% CI: 0.86-0.93, I2 = 26.5%, P = 0.208). Further meta-regression analysis indicated no significant correlation between the success rate and the following factors: publication year, sample size, study type, mean age, mean weight, mean VSD size, and ratio of device size/weight. The pooled rate of postoperative aortic regurgitation was 0.045 (95% CI: 0.018-0.071, I2 = 50.96%, P = 0.000). The pooled rate of follow-up aortic regurgitation (AR) was 0.001 (95% CI, - 0.003-0.004, I2 = 63.00%, P = 0.009.) The pooled estimated rate of severe intraoperative complications was 0.106 (0.073-0.140, I2 = 70.7%, P = 0.208). Postoperative and follow-up complications were rare. No occurrence of a complete atrioventricular block was reported up to the last follow-up visit. CONCLUSIONS: Perventricular device closure may be an alternative to conventional surgical repair in selected patients with dcsVSDs. The success rate was stable regarding the publication year and sample size, suggesting a relatively short learning curve and the technique's potential for application.

Effects of the Sounds of Different Mechanical Mitral Valves on Quality of Life at Different Follow-Up Times: A Single-Center Study.

OBJECTIVE: To compare the effects of the sounds of different types of mechanical mitral valves on the quality of life (QoL) of patients at different follow-up times. METHODS: We collected data from 150 patients who underwent mechanical mitral valve replacement. Three time points were assessed, including at discharge, the third postoperative month (POM3), and the twelfth postoperative month (POM12). The SF-36 and a self-questionnaire were used to assess the QoL. RESULTS: Regarding the SF-36 scores, the ATS valve was superior to the Sorin and SJM valves in terms of some items. Moreover, the scores at discharge of all three mechanical valve groups were lower than those at POM3 and POM12. For the self-questionnaire scores, with the increase in postoperative time, the number of patients affected by the mechanical valve sounds decreased gradually. Considering the relevant influencing factors, older women were more likely to be affected by the valve sounds than were younger individuals and men. CONCLUSION: The overall postoperative QoL improved for patients who underwent mechanical mitral valve replacement. In the comparative study, the impact of the ATS valve was better than those of the Sorin and SJM valves, but this difference gradually disappeared over time.

Comparison of quality of life in patients who underwent mechanical mitral valve replacement: star GK vs SJM.

BACKGROUND: We want to compare the impact on health-related quality of life (HRQoL) between the Star GK and the SJM valve in the Chinese population. METHODS: We retrospectively enrolled a total of 172 patients who had undergone mechanical mitral valve replacement (MVR) (SJM valve in 87 patients and Star GK valve in 85 patients) at our institution from January 2013 to December 2015. We measured the sound pressure level, and used 2 self-administered questionnaires and the Chinese version of SF-36 to measure the HRQoL and valve-specific questions to evaluate patient anxiety. RESULTS: The Star GK group and the SJM group were similar in age, gender, body surface area, diameter of the implanted valve, underlying disease and current median NYHA class. Regarding the valve sound pressure perceived 1 year after operation, the SJM valve was slightly quieter than the Star GK valve, but the sound pressures of the two valves showed no significant differences. No significant differences in any of the eight subscales of the SF-36 were found between the two groups. CONCLUSIONS: The present study suggests that the Star GK valve is similar to the SJM valve in its impact on HRQoL and audibility of mechanical sound in the Chinese population.

Effect of the Different Mechanical Mitral Valve Sounds on the Patients' Quality of Life.

BACKGROUND: The purpose of this study was to compare the opening and closing sounds of three different mechanical mitral valves and to analyze their effects on the quality of life of patients. METHODS: Ninety patients who underwent mechanical mitral valve replacement (MVR) were divided into three groups: those who received Advancing the Standard (ATS), St. Jude Medical (SJM), or Carbomedics (CM) mechanical valves. The sound pressure of the different valves was measured with a microphone. A detailed, self-designed questionnaire with a 1 to 10 analog scale and the 36-item Short Form Health Survey (SF-36) score was used to assess the quality of life of the patients. RESULT: The sound pressure measured by ATS was 64.4 ± 3.1 dB, while that measured by SJM, and CM was 64.5 ± 4.7 and 67.2 ± 5.3 dB, respectively. The overall subjective interference score in the ATS group was the lowest compared with that in the SJM and CM groups (ATS: 1.3 ± 0.9 dB, SJM: 3.9 ± 1.6 dB, CM: 4.1 ± 1.5 dB). Relatives and nonfamily members of the ATS group also had the lowest analog scale scores. Specific questions showed that the ATS valve had the least impact on sleep and daily life (impact on sleep: ATS: 4/30, SJM: 9/30, CM: 11/30, impact on daily life: ATS: 2/30, SJM: 8/30, CM: 8/30). The SF-36 score showed that there were significant differences in social functioning, role-emotional, mental health, and vitality. CONCLUSION: Patients receiving ATS mechanical MVR may be less disturbed by valve noise than those receiving SJM or CM mechanical MVR in a single Chinese cardiac center.

Resveratrol attenuates neuroinflammation after deep hypothermia with circulatory arrest in rats.

Deep hypothermia with circulatory arrest (DHCA) in cardiac surgery may exert a significant burden on the neuroinflammation which can cause brain injury. Resveratrol is a natural product and acts as a neuroprotective agent to suppress inflammatory response in brain. Even so, the specific mechanism regarding brain protective effect of resveratrol in DHCA is still unclear. In the current research, we tested brain protective function of resveratrol on neuroinflammation and cognition in rat DHCA model or hypothermic oxygen-glucose deprivation (OGD) model. The activation of microglial, cell apoptosis, inflammation in brain and circulation, NF-κB pathway were evaluated. We found that resveratrol treatment improved neurocognitive function and attenuated the neuroinflammation, cell apoptosis, microglial activation and NF-κB pathway after DHCA. The in vitro studies showed that resveratrol had similar neuroprotective effect in hypothermic OGD model. Importantly, we also found that the modulation of TRAF6 and RIP1 ubiquitination by A20 was playing a pivotal role in relation to the mechanism of resveratrol inhibiting NF-κB pathway. Thus, resveratrol expands the horizons for exploring treatment tactics to avert or restrict brain injury and related neurocognitive obstacles after DHCA.

Health-related quality of life in children and adolescents undergoing intraoperative device closure of isolated perimembranous ventricular septal defects in southeastern China.

OBJECTIVES: To investigate the health-related quality of life (HRQOL) in children and adolescents who underwent intraoperative device closure of perimembranous ventricular septal defects (pmVSDs). METHODS: From October 2017 to January 2018, a total of 126 children and adolescents with isolated pmVSDs who underwent intraoperative device closure were enrolled in this study. We used the Pediatric Quality of Life Inventory Measurement Models 4.0 generic core scales to measure HRQOL 24 h before the operation and three months and one year after surgery. RESULTS: A total of 126 patients were successfully occluded. No severe complications occurred during the operative time, and 1 case of Mobitz type I atrioventricular block (AVB) and 1 case of complete cAVB occurred during the postoperative period. Compared with the data before the operation, the total score and five domain scores, including physical, psychosocial, emotional, social and psychological functioning, were significantly higher at three months after the operation. In addition, the total score, physical functioning score, and the psychosocial functioning score at the 1-year follow-up were even higher than those at 3 months after the operation. CONCLUSIONS: The present study suggests that intraoperative device closure of pmVSD could improve health-related quality of life in children/adolescents and that the improvement may progress as the time after the operation increases. Further studies should concentrate on comparisons with other medical methods, larger samples, and longer follow-up periods.

Health-related quality of life in adults undergoing transthoracic device closure of ventricular septal defect.

OBJECTIVE: To evaluate the health-related quality of life (HRQoL) of adult patients who underwent transthoracic device closure of ventricular septal defect (VSD). METHODS: During the perioperative and postoperative period, a standard scale involving eight dimensions was used to analyze the HRQoL of 85 adult patients who underwent thoracic device closure of VSD and 80 healthy adults located locally were randomly selected as the control group in our center. RESULTS: A total of 80 patients' and 80 healthy adults' questionnaires were received with complete feedback. Out of all of the items that were investigated, postoperative patients experienced better feelings in some dimensions than the control group. Postoperative feedback was also better than preoperative feedback in some dimensions. In the comparison of the subgroups of these patients, the scores of the elderly were lower than those of the young in most dimensions. Males had more positive feedback in two aspects ("role-physical" (p = 0.01) and "vitality" (p = 0.003)), whereas unmarried people seemed to have poor emotional responses ("role-emotional" (p < 0.01) and "vitality" (p = 0.023)). There was no significant difference in any dimensions except "social functioning" (p < 0.01) between people with different levels of education. CONCLUSIONS: Most of the adult patients who underwent thoracic closure of VSD felt that they could lead a normal life. They seemed to have reasonably normal psychosocial responses compared to healthy controls. Many patients even though their HRQoL was better than healthy individuals.

The effect of valve noise on the quality of life of patients after mechanical mitral valve replacement in a Chinese population.

OBJECTIVE: To investigate the effect of valve noise on the quality of life (QOL) in Chinese patients who underwent mechanical mitral valve replacement. METHODS: We enrolled a total of 103 patients who underwent mechanical mitral valve replacement (MVR, CM valve in 52 patients, SJM valve in 51 patients) from January 2016 to December 2016 in our institution and used the SF-36 as an instrument to assess patients' QOL. RESULTS: Patients' QOL improved over time. Patients who experienced disturbances due to valve noise had lower SF-36 scores in each scale, especially in general health, vitality, and mental health. Only 8.74% (n = 9) of patients complained of valve noise 1 year after the operation compared to 19.42% (n = 20) in the first month after the operation. The number of patients who experienced disturbances due to valve noise decreased over time, with a P value of 0.58. Logistic regression analysis showed that female patients those aged < 60 years old had a higher risk of experiencing disturbances due to valve noise. The valve type (CM vs SJM), body mass index (BMI) and valve size showed no significant differences in patients who experienced disturbances due to continuous valve noise. The SF-36 results were similar in the CM group and SJM group 1 year after the operation. CONCLUSIONS: QOL evaluated by the SF-36 improved over time in Chinese patients who underwent mechanical MVR. Age less than 60 years and female sex were high risk factors for experiencing disturbances due to valve noise. CM and SJM mechanical valves demonstrated similar valve noise levels and impact on QOL in patients who experienced mechanical MVR.

Changes in the levels of inflammatory markers after transthoracic device closure of ventricular septal defects in pediatric patients.

BACKGROUND: Transthoracic device closure of ventricular septal defect (VSD) is widely used in the clinic, especially in China. Changes in inflammatory marker levels after transthoracic device closure of VSD in pediatric patients have not been reported. METHODS: We retrospectively collected clinical data for 85 pediatric patients in our hospital from September 2017 to January 2018. The patients were divided into two groups according to treatment (device group vs. surgical group). The clinical and experimental data from the two groups were statistically analyzed. RESULTS: Clinical outcomes were good in all patients without any fatal complications. Similar increasing trends in inflammatory markers (white blood cell (WBC) count, procalcitonin (PCT), C-reactive protein (CRP), and interleukin-6 (IL-6)) were found in the two groups, both of which showed noticeable systemic inflammatory responses. In addition, no significant difference in the postoperative levels of inflammatory markers was observed between these two groups. CONCLUSIONS: Although transthoracic device closure of VSD seems to be less traumatic and involves a quicker recovery, it also induces a systemic inflammatory response as measured by WBC count and PCT, CRP and IL-6 levels, and the altered trends in inflammatory markers were similar to those of conventional surgery under CPB.