The effects of a three-dimensional, saddle-shaped annulus on anterior and posterior leaflet stretch and regurgitation of the tricuspid valve

Tricuspid regurgitation (TR) is present in trace amounts or more in 82–86% of the population and is greater than mild in 14% of the population. In severe cases, it can contribute to right heart failure and adversely affect mitral valve repair durability. One major cause of TR is the dilation of the tricuspid annulus, which alters the geometry of the annulus from a saddle-shape to a more planar profile. Another cause of TR is the displacement of the papillary muscles (PMs), which results from right ventricular dilation. The objective of this study was to identify the effect of a saddle-shaped annulus on native tricuspid leaflet stretch mechanics and TR. In addition, the effects of geometric alterations, including annular dilatation and PM displacement, on leaflet stretch was investigated. Fresh porcine tricuspid valves (TVs) (n = 8) were excised and sutured to an adjustable three-dimensional annulus plate (allowing for dilatation and saddle-shape) and three PM attachment rods. The valve was then placed in the in vitro Georgia Tech right heart simulator. Dual-camera photogrammetry, was used to quantify the stretch ratio experienced by the valve leaflets at peak systole for the following conditions: physiologically normal, 100% annular dilatation, displaced PMs, and a combination of annular dilatation and PM displacement. In addition, a saddle and flat annulus were implemented for each of the four conditions. PM displacement was simulated by displacing all PMs by 10 mm in all directions (laterally, apically, posteriorly/anteriorly). The physiologically normal condition—normal annulus area, saddle-shaped annulus with PMs in a normal position, was used as a control. The results showed that the posterior leaflet exhibited significantly (p ≤ 0.05) higher major and areal stretch ratios as compared to the anterior leaflet at peak systole for all conditions tested. No significant difference was seen in stretch when a flat annulus was compared to saddle for the anterior or posterior leaflet for normal or disease conditions. Investigation of the impact of disease found a significant increase (p ≤ 0.10) in stretch in the posterior leaflet with a combination of annular dilatation and PM displacement (2.01 ± 0.68) as compared to the normal condition with a saddle annulus (1.43 ± 0.20). In addition displacement of the PMs resulted in a significant (p ≤ 0.01) reduction in TR, although the actual volume reduced was minimal (1.2 mL). Stretch values were measured for the anterior and posterior leaflet under both physiologic and pathologic conditions for the first time. Further, these results provide an understanding of the effects of geometric parameters on valve mechanics and function, which may lead to improved TV repairs.     

Transapical Coaptation Plate for Functional Mitral Regurgitation: An<Emphasis Type="Italic"> In Vitro</Emphasis> Study

A novel transapical coaptation plate (TCP) device was developed and anchored by sutures in the mitral valve to treat functional mitral regurgitation. The objective of this study was to test efficacy of the TCP in an in vitro model. Eight fresh porcine mitral valves were mounted in a left heart simulator to simulate functional mitral regurgitation by means of annular dilatation and asymmetrical or symmetrical papillary muscle (PM) displacement. Six polyurethane TCPs in thickness of 6.4(#1), 4.8(#2), 3.2(#3) mm and hardness of durometer 30 A (H) and 30 OO(S),were fabricated and labeled as H1, H2, H3 and S1, S2, S3, respectively. These TCPs were anchored by the sutures in the mitral annulus and left ventricle apex, and tested. Steady backward flow leakage in a hydrostatic condition and regurgitant volume in a pulsatile flow were measured before and after implantation of the TCPs. Mean regurgitant volume fractions in the asymmetric PM displacement were reduced significantly from 59.1 to 37.2% for H1, 43.2% for H2, 35.9% for S1 and 34.2% for S2 (p < 0.021), after implantation of the TCPs. No significant reduction in mitral regurgitation was seen for H3 and S3 (p > 0.067). Mitral regurgitation was mild in the symmetric PM displacement, and was not significantly reduced after implantation of the TCPs. In conclusion, the TCP anchored by the sutures in the mitral annulus and left ventricle apex functions successfully as a plug in the mitral valve leaflet gap. The TCP with thickness equal to or greater than 4.8 mm is effective to reduce functional mitral regurgitation. The TCP hardness has no effect on difference in reduction of functional mitral regurgitation.     

Ebstein's anomaly--an autopsy study of 28 cases

Twenty eight autopsy specimens of Ebstein's anomaly were studied in order to evaluate the morphologic features of the abnormal tricuspid valve. All cases showed marked dilatation of the original tricuspid annulus, a normally positioned anterior leaflet and variable downward displacement of the posterior and septal leaflets. Sixteen cases showed a very large anterior leaflet. All three leaflets showed dysplastic features and a wide range of anatomic abnormalities in the valve and valve apparatus. A thin walled atrialised right ventricle was present in nine cases. Associated cardiac anomalies were seen in 21 cases, the commonest being an atrial septal defect (17 cases).     

A fluid–structure interaction model of the aortic valve with coaptation and compliant aortic root

While aortic valve root compliance and leaflet coaptation have significant influence on valve closure, their implications have not yet been fully evaluated. The present study developed a full fluid–structure interaction (FSI) model that is able to cope with arbitrary coaptation between the leaflets of the aortic valve during the closing phase. Two simplifications were also evaluated for the simulation of the closing phase only. One employs an FSI model with a rigid root and the other uses a “dry” (without flow) model. Numerical tests were performed to verify the model. New metrics were defined to process the results in terms of leaflet coaptation area and contact pressure. The axial displacement of the leaflets, closure time and coaptation parameters were similar in the two FSI models, whereas the dry model, with imposed uniform load on the leaflets, produced larger coaptation area and contact pressure, larger axial displacement and faster closure time compared with the FSI model. The differences were up to 30% in the coaptation area, 55% in the contact pressure and 170% in the closure time. Consequently, an FSI model should be used to accurately resolve the kinematics of the aortic valve and leaflet coaptation details during the end-closing stage.     

A Novel Coaptation Plate Device for Functional Mitral Regurgitation: An In Vitro Study

A novel mitral valve repair device, coaptation plate (CP), was proposed to treat functional mitral regurgitation. The objective of this study was to test efficacy of the CP in an in vitro model of functional mitral regurgitation. Ten fresh porcine mitral valves were mounted in a left heart simulator, Mitral regurgitation was emulated by means of annular dilatation, and the asymmetrical or symmetrical papillary muscles (PM) displacement. A rigid and an elastic CPs were fabricated and mounted in the orifice of regurgitant mitral valves. Steady flow leakage in a hydrostatic condition and regurgitant volume in a pulsatile flow were measured before and after implantation of the CPs. The rigid and elastic CPs reduced mitral valve regurgitant volume fraction from 60.5 ± 11.4 to 35 ± 11.6 and 36.5 ± 9.9%, respectively, in the asymmetric PM displacement. Mitral regurgitation was much lower in the symmetric PM displacement than in the asymmetric PM displacement, and was not significantly reduced after implantation of either CP. In conclusion, both the rigid and elastic CPs are effective and have no difference in reduction of functional mitral regurgitation. The CP does not aggravate mitral valve coaptation and may be used as a preventive way.     

红景天苷通过抑制氧化应激防治大鼠低氧性肺动脉高压

目的:观察低氧性肺动脉高压大鼠肺组织及血清中氧化/抗氧化相关指标的变化,研究红景天苷(Sal)能否通过恢复氧化/抗氧化系统平衡防治低氧性肺动脉高压。方法:将32只SD大鼠随机分为4组:常氧(normoxia,N)组、低氧4周(hypoxia for 4 weeks,H_4)组、Sal低剂量(hypoxia for 4 weeks and treatment with Sal at 16mg/kg,H_4S16)组和Sal高剂量(hypoxia for 4 weeks and treatment with Sal at 32 mg/kg,H_4S32)组。造模完成后测定平均肺动脉压(m PAP)、右心室/(左心室+室间隔)[RV/(LV+S)]和血管壁面积/血管总面积(WA/TA);测量肺组织和血清中丙二醛(MDA)和8-异构前列腺素F_(2α)(8-iso-PGF_(2α))含量,并测量血清中超氧化物歧化酶(SOD)活性及肺组织中NADPH氧化酶(NOX4)和SOD1的相对表达量。结果:与N组相比,H_4组的NOX4相对表达量及MDA和8-iso-PGF_(2α)含量均显著升高(P0.05);而与H4组相比,Sal低、高剂量组除m PAP、RV/(LV+S)和WA/TA明显减低外,NOX4的相对表达量及MDA和8-iso-PGF_(2α)含量亦明显减低(P0.05)。与N组相比,H_4组的SOD1相对表达量和SOD活性显著下降,而Sal低、高剂量组的SOD1相对表达量和SOD活性均显著升高并呈剂量依赖性。结论:红景天苷可能通过减轻低氧引起的肺组织氧化应激损伤、恢复氧化/抗氧化系统平衡而起到改善肺动脉高压的作用。     

腺苷A2a受体在红景天苷调节大鼠低氧性肺动脉高压中的作用

 目的：探讨腺苷A_2a受体（A_2aAR）对低氧性肺动脉高压大鼠的保护作用及红景天苷对大鼠低氧性肺动脉高压的调控作用及其机制。方法：将SD大鼠60只随机分为6组：正常组、低氧组、低氧+红景天苷低剂量组、低氧+红景天苷中剂量组、低氧+红景天苷高剂量组、低氧+A_2aAR激动剂（CGS-21680）组。测定各组大鼠平均肺动脉压（mPAP）、平均颈动脉压（mCAP）和右心室(RV)/（左心室+室间隔）(LV+S),观察各组肺细小动脉显微结构变化;用免疫组化法和原位杂交法测定肺细小动脉管壁A_2aAR含量的变化;用实时荧光定量PCR法和Western blotting法测定肺组织匀浆A_2aAR mRNA和蛋白含量的变化。结果：（1）低氧组大鼠mPAP明显高于正常对照组,A_2aAR激动剂组和红景天苷高剂量组可以明显降低mPAP,红景天苷中、低剂量组mPAP虽有下降趋势,但差异无统计学意义。（2）低氧组大鼠RV/(LV+S)显著高于正常组,A_2aAR激动剂组和红景天苷中、高剂量组RV/(LV+S)显著低于低氧组,红景天苷低剂量组较低氧组有减低趋势,但差异无统计学意义。（3）低氧组大鼠肺细小动脉重构显著, A_2aAR激动剂组及红景天苷低、中、高剂量组肺血管重构较低氧组明显减轻。（4）低氧组肺血管和肺组织A_2aAR mRNA和蛋白表达均明显高于正常组,A_2aAR激动剂组和红景天苷高剂量组肺血管和肺组织A_2aAR mRNA和蛋白水平均较低氧组进一步升高。结论：A_2aAR对低氧性肺动脉高压大鼠具有保护作用;红景天苷能够上调低氧性肺动脉高压大鼠肺血管和肺组织A_2aAR的表达,该通路可能是其减轻低氧性肺动脉高压和肺血管重建的重要机制。     

羟胺对慢性低氧高二氧化碳大鼠肺动脉高压的影响

目的: 探讨羟胺(HA)对慢性低氧(O₂)高二氧化碳(CO₂)大鼠肺动脉压的影响。方法: 24只清洁级雄性SD大鼠随机分为3组(每组8只):正常对照组(NC)、低O₂高CO₂+生理盐水组(NS)和低O₂高CO₂+HA组(HA),NS组和HA组置于常压低O₂高CO₂舱内(舱内O₂浓度维持在9%-11%,CO₂浓度为5%-6%),每天8 h,每周6 d,共4周。入舱前,HA组腹腔注射HA溶液(12.5 mg/kg)1 mL,NS组腹腔注射1 mL生理盐水。4周后,戊巴比妥钠(35 mg/kg)腹腔注射麻醉,以右心导管测定大鼠肺动脉平均压(mPAP),分离右心室(RV) 和左心室加室间隔(LV+ S),计算右心室重量与左心室加室间隔重量的比值 ,以光学显微镜观测肺血管结构变化,用分光光度计测定血浆中硫化氢(H₂S)的水平,用免疫组织化学方法及RT-PCR技术观察肺小动脉及支气管胱硫醚-γ-裂解酶(CSE)的表达。结果: (1)与NC组相比:NS组和HA组的mPAP、RV/(LV+S)、肺细小动脉管壁面积/管总面积比值(WA/TA) 和肺细小动脉中膜厚度(PAMT)明显升高(P<0.05);NS组的血浆中H₂S水平、肺小动脉及支气管CSE的含量和CSE mRNA的表达显著降低(P<0.05)。(2)与NS组相比:HA组的mPAP、RV/(LV+S)、肺小动脉管壁面积/管总面积比值(WA/TA) 和肺小动脉中膜厚度(PAMT)明显降低(P<0.05);血浆中H₂S水平、肺小动脉及支气管CSE的含量和CSE mRNA的表达显著升高(P<0.05)。结论: 羟胺通过提高血浆中H₂S的水平、肺小动脉及支气管CSE的含量和CSE mRNA的表达和改善肺部血管重构,降低慢性低O₂和高CO₂所致的大鼠肺动脉高压。     

Transfer of human hepatocyte growth factor reduces inflammation and prevents pulmonary arterial remodeling in monocrotaline-induced

Inflammation and endothelial dysfunction contribute to the pathogenesis and development of pulmonary arterial hypertension (PAH). This study was to investigate the therapeutic effect of human hepatocyte growth factor (HGF) gene transfer on monocrotaline (MCT) induced PAH rat models. PAH was induced by injecting MCT for 4 weeks. The rats were randomly assigned to phosphate buffered saline control group, MCT group, and HGF treatment group. After 2 weeks of induction, measures of mean pulmonary artery pressure (mPAP), weight ratio of the RV to the LV plus septum, percent wall thickness index (TI) and area index (AI) were significantly increased in MCT-group and HGF treatment-group compared with those in control group (P < 0.05). Those measurements in MCT-group were significantly higher than those in HGF treatment-group (P < 0.05). IL-6 significantly decreased in HGF treatment-group compared with MCT-group, but higher than that of control group (all P < 0.05). IL-10 in HGF treatment-group significantly increased compared with MCT-group, but lower than that of control group (all P < 0.05). Endothelial microparticles (EMP) started to decrease in the HGF treatment-group 3 days after treatment and was most significant after 1 and 2 weeks of treatment (all P < 0.05). Our results showed that transfer of human HGF may attenuate the inflammatory cell infiltrate, reduce the expression of inflammatory factors, and those effects are possibly due to the inhibition of EMP production which may decrease pulmonary vascular wall damage in PAH.     

Prognostic value of late gadolinium enhancement mass index in patients with pulmonary arterial hypertension

PurposeDysfunction of the right ventricle (RV) is an important determinant of survival in patients with pulmonary arterial hypertension (PAH). The presence of late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR) at RV insertion points (RVIPs) has been found in majority of PAH patients and was associated with parameters of RV dysfunction. We hypothesize, that more detailed quantification of LGE may provide additional prognostic information.Material and methodsTwenty-eight stable PAH patients (mean age 49.9 ​± ​15.9 years) and 12 healthy subjects (control group, 44.8 ​± ​13.5 years) were enrolled into the study. Septal LGE mass was quantified at the RVIPs and subsequently indexed by subject’s body surface area. Mean follow-up time of this study was 16.6 ​± ​7.5 months and the clinical end-point (CEP) was defined as death or clinical deterioration.ResultsMedian LGE mass index (LGEMI) at the RVIPs was 2.75 ​g/m2 [1.41–4.85]. We observed statistically significant correlations between LGEMI and hemodynamic parameters obtained from right heart catheterization – mPAP (r ​= ​0.61, p ​= ​0.001); PVR (r ​= ​0.52, p ​= ​0.007) and from CMR – RVEF (r ​= ​−0.54, p ​= ​0.005); RV global longitudinal strain (r ​= ​0.42, p ​= ​0.03). Patients who had CEP (n ​= ​16) had a significantly higher LGEMI (4.49 [2.75–6.17] vs 1.67 [0.74–2.7], p ​= ​0.01); univariate Cox analysis confirmed prognostic value of LGEMI. Furthermore, PAH patients with LGEMI higher than median had worse prognosis in Kaplan-Meier analysis (log-rank test, p ​= ​0.0006).ConclusionsThe body surface indexed mass of LGE at RV septal insertion points are suggestive of RV hemodynamic dysfunction and could be a useful non-invasive marker of PAH prognosis.     

体内转染血管内皮生长因子基因对慢性低氧诱导小鼠肺动脉高压的影响

目的 探讨血管内皮生长因子（Vegf）体内转基因对慢性低氧诱导小鼠肺动脉高压(PAH)的治疗作用。 方法 将昆明雄性小鼠36只随机分为3组：低氧Vegf治疗组(P-V组),模型组（PAH组）,对照组(C组),每组12只。采用间断性常压缺氧法复制小鼠PAH模型。观察4周后,P-V组经尾静脉注射聚乙烯亚胺（PEI）包被的pBudCE4.1-Vegf-EGFP载体,其他组注射等量生理盐水,继续低氧处理。转基因治疗后30 d,观察小鼠的一般情况、平均肺动脉压（mPAP）、动脉血气、右心肥大指数［右心室/(左心室+室间隔)］及肺小动脉形态学改变,RT-PCR方法检测增强绿色荧光蛋白（EGFP）表达情况;Real-time PCR方法检测各实验组肺组织Vegf mRNA量; ELISA方法及硝酸还原酶法分别检测各实验组肺组织VEGF和NO含量。 结果 PAH组小鼠出现代谢性酸中毒,平均肺动脉压升高,右心室肥厚,肺小动脉管壁厚度（WT）增加,与C组相比,差异有统计学意义（P<0.05）。与PAH组相比,P-V组小鼠平均肺动脉压升高、右心室肥厚及肺小动脉管壁增厚减轻,差异有统计学意义（P<0.05）。与PAH组小鼠相比,P-V组小鼠外源基因Vegf的mRNA及蛋白水表达增加,差异有统计学意义（P<0.05）。 结论 Vegf转基因治疗能上调慢性低氧诱导小鼠的肺组织中Vegf mRNA和VEGF的表达,从而拮抗肺动脉压升高,减轻右心肥厚及肺动脉血管增厚。     

Modelling of Lesions Associated with Functional Mitral Regurgitation in an <Emphasis Type="Italic">Ex Vivo</Emphasis> Platform

Functional mitral regurgitation (FMR) is a complex pathology involving valvular and subvalvular structures reconfiguration, and its treatment is considered challenging. There is a lack of experimental models allowing for reliable preclinical FMR treatments’ evaluation in a realistic setting. A novel approach to simulate FMR was developed and incorporated into an ex vivo passive beating heart platform. FMR was obtained by dilating the mitral annulus (MA) mainly in the antero-posterior direction and displacing the papillary muscles (PMs) apically and laterally by ad hoc designed and 3D printed dilation and displacing devices. It caused hemodynamic and valve morphology alterations. Isolated MA dilation (MAD) led to significantly increased antero-posterior distance (A-P) and decreased coaptation height (CH), tenting area (TA) and systolic leaflets angulation, resembling clinically recognized type I of mitral regurgitation with normal leaflet motion. Whereas concomitant MAD with PM displacement caused an increase in A-P, TA, CH. This geometrical configuration replicated typical determinants of type IIIb lesion with restricted leaflet motion. The proposed methods provided a realistic and repeatable ex vivo FMR model featuring two lesions clinically associated with the pathology. It bears a promise to be successfully utilized in preclinical studies, clinical training and medical education.     

L-精氨酸对缺氧性肺动脉高压大鼠内皮素释放的影响

目的：探讨Ｌ－精氨酸（Ｌ－Ａｒｇ）对缺氧性肺动脉高压（ＨＰＨ）大鼠血浆内皮素－１（ＥＴ－１）释放的影响。方法：将Ｗｉｓｔａｒ大鼠４０只分为：对照组,缺氧组,缺氧＋Ｎ＾ω－硝基－Ｌ－精氨酸甲脂（Ｌ－ＮＡＭＥ）组和缺氧Ｌ－Ａｒｇ组。结果：缺氧组的肺动脉平均压（ｍＰＡＰ）显著高于对照组（Ｐ〈０．０５）,缺氧组＋Ｌ－Ａｒｇ组的ｍＰＡＰ显著低于缺氧组（Ｐ〈０．０５）及缺氧＋Ｌ－ＮＡＭＥ组（Ｐ〈０．０１）,缺     

L-精氨酸脂质体对慢性低O2高CO2肺血管L-精氨酸转运的影响

目的:探讨慢性低O₂高CO₂对大鼠肺动脉L-精氨酸(L-Arg)转运的影响与L-Arg脂质体的作用。方法:雄性SD大鼠40只,随机分成4组,正常对照组(NC)、单纯低O₂高CO₂组(HH)、低O₂高CO2加L-Arg组(HL)和低O₂高CO₂加L-Arg脂质体组(HP)。将肺动脉孵育,测定其对[³H]-L-Arg的摄取率,同时光镜下观察肺细小动脉显微结构的变化。结果:(1)肺动脉平均压(mPAP)、右心室(RV)和左心室加室间隔(LV+S)重量比值(RV/LV+S)比较:HH组明显高于NC组(P<0.05),HP组明显低于HH组及HL组(P<0.01);HL组与HH组相比无显著差别(P>0.05)。(2)肺动脉薄片对0.005mmol/L、0.01mmol/L、0.02mmol/L、0.05mmol/L、0.1mmol/L和0.2mmol/L[³H]-L-Arg摄取率比较:HH组明显低于NC组,HL组明显高于HH组;HP组显著高于HH组及HL组(P<0.01)。(3)光镜下HH组肺细小动脉内弹力板扭曲,中膜平滑肌细胞增生,管腔明显狭窄;HP组肺细小动脉内弹力板扭曲明显减轻,中膜平滑肌层变薄,管壁较均匀一致。结论:慢性低O₂高CO₂大鼠肺血管存在L-Arg的转运障碍,用脂质体作为载体可显著提高肺血管对L-Arg的跨膜转运,L-Arg脂质体治疗慢性肺动脉高压具有潜在临床应用价值。     

三七总皂苷对低氧大鼠肺动脉压和肺组织p38 MAPK表达的影响

目的:探讨三七总皂苷(PNS)对低氧大鼠p38丝裂原活化蛋白激酶(p38 MAPK)表达的影响,及预防低氧性肺动脉高压(HPH)的作用和机制。方法:将30只SD大鼠随机分为3组:正常对照组、低氧组和低氧+PNS组。观察各组大鼠平均肺动脉压(mPAP)、平均颈动脉压(mCAP)和右心室/(左心室+室间隔重量)比[RV/(LV+S)],免疫组化法和RT-PCR法分别检测肺小血管壁磷酸化p38 MAPK(p-p38 MAPK)蛋白和肺组织中mRNA的含量。结果:与对照组相比,低氧组大鼠mPAP、RV/(LV+S)明显升高,肺小动脉p-p38 MAPK及肺组织p38 MAPK mRNA含量显著升高(P0.05)。低氧+PNS组mPAP、RV/(LV+S)、肺小动脉p-p38 MAPK及肺组织p38 MAPK mRNA含量明显低于低氧组(P0.05)。结论:PNS具有显著预防HPH的作用,其机制可能与其降低p38 MAPK mRNA的表达有关。     

慢性低氧对大鼠肺血管L-精氨酸

目的:探讨慢性低氧对大鼠肺血管L-精氨酸/一氧化氮(L-Arg/NO)途径的影响。方法:采用慢性低氧性肺动脉高压(HPH)大鼠肺血管孵育,测定慢性HPH对大鼠肺动脉L-Arg转运,一氧化氮合酶(NOS)活性和NO生成释放的影响。结果:(1)低氧4周大鼠肺动脉平均压(mPAP)比对照组高33.7%(P＜0.01),右心室(RV)和左室加室间隔(LV+S)重量比值(RV/LV+S)高44.2%(P＜0.01)。(2)低氧对血浆L-Arg含量无明显影响。(3)低氧大鼠离体孵育的肺动脉摄取低浓度(0.2mmol/L)和高浓度(5.0mmol/L)[³H]-L-Arg分别低于对照组15.8%(P＜0.05)和27.2%(P＜0.01)。(4)低氧大鼠肺动脉tNOS、iNOS和cNOS活性较对照组高38.0%、32.8%和53.0%(P＜0.01)。(5)低氧大鼠血浆NO含量低于对照组,与mPAP和RV/LV+S呈负相关(P＜0.01)。结论:慢性HPH时NOS活性代偿性增强,但L-Arg转运受损使血浆NO生成仍减少,说明L-Arg转运是NO生成的重要限速步骤。     

高碳酸血症通过赖氨酰氧化酶依赖的胶原蛋白交联影响大鼠缺氧性肺动脉高压

目的:通过研究缺氧和/或高碳酸血症时赖氨酰氧化酶(LOX)以及细胞外基质胶原蛋白的交联变化,探讨高碳酸血症对缺氧性肺动脉高压的影响机制。方法:SD大鼠随机均分为4组,分别为常氧对照组、缺氧组、高碳酸血症组以及缺氧+高碳酸血症组。比色法测定胶原蛋白含量,荧光光谱法分析LOX酶活性,免疫组织化学和Western blot法检测肺动脉LOX蛋白含量,实时荧光定量PCR检测肺动脉LOX的mRNA水平。结果:缺氧组大鼠平均肺动脉压(m PAP)、右心室/(左心室+室间隔)重量比值[RV/(LV+S)]及血管壁面积(WA)/血管总面积(TA)均明显高于常氧对照组;高碳酸血症组与常氧对照组的m PAP、RV/(LV+S)差异无统计学显著性;缺氧+高碳酸血症组大鼠的m PAP及RV/(LV+S)显著低于单纯缺氧组。缺氧组大鼠肺组织的胶原交联程度则明显高于常氧组及高碳酸血症组;高碳酸血症组大鼠肺组织的胶原交联程度与常氧组比较无显著差异;缺氧+高碳酸血症组大鼠肺组织的胶原交联程度显著低于缺氧组。缺氧组大鼠肺动脉LOX的mRNA、蛋白表达量及其酶活性均高于常氧组(P0.01);缺氧+高碳酸血症组大鼠肺动脉LOX mRNA、蛋白表达以及酶活性均明显低于缺氧组(P0.01)。结论:缺氧能诱导肺动脉LOX高表达,通过促进胶原合成及交联,参与肺动脉高压的形成。高碳酸血症通过抑制缺氧诱导的LOX表达和胶原交联,延缓缺氧性肺动脉高压的进展。     

经导管植入钳夹装置治疗三尖瓣膜关闭不全的应用解剖

目的　为经导管植入钳夹装置治疗三尖瓣膜关闭不全提供三尖瓣区相关的应用解剖。 方法　解剖28例(男18,女10)外形大小正常的成年人心脏标本,观察三尖瓣膜的形态及与周围组织的解剖关系,测量与三尖瓣膜相关的数据。 结果　三尖瓣环周长为(109.4±14.2) mm,长径为（43.5±6.5）mm,短径为（29.3±5.4）mm。前瓣游离缘到附着缘最大距离为（22.3±4.1）mm,后瓣游离缘到附着缘最大距离为（20.5±3.8）mm。 结论　钳夹装置的大小和形状的设计应根据三尖瓣区解剖特点及与周边结构的关系来决定,钳夹三尖瓣的前后瓣叶可行。     

The effects of asymmetric ventricular filling on left–right ventricular interaction in the normal rat heart

Heart failure is characterised by ventricular dysfunction and with the potential for changes to ventricular volumes constraining the mechanical performance of the heart. The contribution of this interaction from geometric changes rather than fibrosis or metabolic changes is unclear. Using the constant pressure Langendorff-perfused rat heart, the volume interaction between left ventricle (LV) and right ventricle (RV) was investigated. RV diastolic stiffness (P?<?0.001) and developed pressure (P?<?0.001) were significantly lower than LV. When the RV was fixed at the end-diastolic volume (EDV) or EDV?+?50?%, both LV systolic and diastolic performance were unaffected with increasing LV balloon volume. However, at fixed LV volume, RV systolic performance was significantly decreased when LV volume increased to EDV?+?50?% when RV volume was increased incrementally between 50 and 300?μl (P?<?0.001). Systolic interaction in RV was noted as declining RV peak systolic load with increasing LV systolic pressure (P?<?0.05) and diastolic interaction was noted for RV when LV volume was increased from EDV to EDV?+?50?% (P?<?0.05). RV diastolic wall stress was increased with increasing LV balloon volume (P?<?0.05), but LV wall stress was unaltered at fixed RV balloon volume. Taken together, increasing LV volume above EDV decreased systolic performance and triggered ventricular constraint in the RV but the RV itself had no effect on the performance of the LV. These results are consistent with overload of the LV impairing pulmonary perfusion by direct ventricular interaction with potential alteration to ventilation–perfusion characteristics within the lung.     

血红素氧合酶1基因表达与慢性低氧高二氧化碳性肺动脉高压的关系

 目的：研究一氧化碳体系对低氧高二氧化碳性肺动脉高压的调控作用。方法：将SD大鼠分为正常对照组(A组),4周低O₂高CO₂组(B组),4周低O₂高CO₂+血晶素组(C组)。采用透射电镜、图像分析、免疫组化、组织原位杂交技术等方法,观察各组大鼠肺动脉平均压(mPAP)、颈动脉平均压(mCAP)、右心室/(左心室+室间隔)重量比、肺细小动脉显微和超微结构、血CO浓度及肺细小动脉HO-1及其基因表达的变化。结果：①B组mPAP、RV/(LV+S)显著高于A组(P<0.01),C组mPAP、RV/(LV+S)明显低于B组(P<0.01),3组间mCAP比较差异无显著性(P>0.05)。②全血CO浓度B组明显高于A组(P<0.01),C组明显高于B组(P<0.01)。③光镜下肺细小动脉管壁面积/管总面积(WT/TA)、肺细小动脉中膜平滑肌细胞核密度(SMC)、肺细小动脉中膜厚度(PAMT)B组显著高于A组(P<0.01),C组明显低于B组(P<0.01)。④电镜下B组肺细小动脉中膜平滑肌细胞增生,面积增大,染色质增多,外膜胶原纤维密集,C组大鼠肺细小动脉中膜平滑肌细胞和外膜胶原纤维增生明显轻于B组。⑤免疫组化、原位杂交发现B组I级(直径＞200μm)、Ⅱ级(直径50-200μm)、Ⅲ级(直径<50 μm)肺细小动脉HO-1及HO-1mRNA平均吸光度值显著高于A组(P均<0.01),C组各级肺细小动脉HO-1及HO-1 mRNA平均吸光度值明显高于B组(P均<0.01)。结论：一氧化碳体系表达增强可抑制慢性低氧高二氧化碳性肺动脉高压的形成和肺血管结构重建,提高一氧化碳体系表达可能是防治COPD、肺动脉高压的新途径。