Sustained salutary effects of oral controlled-release nitroglycerin on ventricular function in congestive heart failure.

The hemodynamic effects of a controlled-release preparation of original nitroglycerin (ONTG), 6.5 mg to 19.5 mg, were determined during a four hour period in 10 patients with left ventricular failure. After ONTG ingestion left ventricular filling pressure (LVFP) diminished in 20 min (23 to 17 mm Hg, p < 0.01), declined maximally within one hour (15 mm Hg, p < 0.001) and remained decreased (p < 0.02) throughout the four hours. For the entire group no significant alterations (p > 0.05) occurred in systolic blood pressure, heart rate, cardiac index (CI) and peripheral vascular resistance (PVR). However, two subgroups were identified relative to ONTG hemodynamic response. In the four patients in whom LVFP declined but remained substantially elevated (29 to 23 mm Hg, p < 0.05), CI rose (1.7 to 2.1 l/min/m², p < 0.01) while PVR fell (2074 to 1571 dyne · s · cm^-5, p < 0.02). In contrast, in the six patients with LVFP reductions to 12 mm Hg or less (18 to 10 mm Hg, p < 0.005), CI was unchanged (2.2, p > 0.05) without alteration of PVR (1799, p > 0.05). This investigation provides objective evidence of the salutary hemodynamic effects of ONTG and confirms adequate gastrointestinal absorption with attainment of pharmacologically active blood levels. Moreover, oral sustained-release nitroglycerin is shown to possess long-acting peripheral vasodilator actions of considerable value in the treatment of congestive heart failure.     

两种血管升压药物治疗婴幼儿复杂心脏手术后血管舒张性休克的疗效比较

目的：比较血管加压素（AVP）和去甲肾上腺素（NE）对婴幼儿复杂先天性心脏病手术后血管舒张性休克患者的疗效。方法：回顾性总结2010年6月~2012年10月32例心脏术后早期使用小剂量AVP的复杂婴幼儿心脏手术患者（试药组）,与2008年8月~2010年5月实施的另外35例早期使用去甲肾上腺素（NE）的复杂婴幼儿心脏手术患者（对照组）的临床资料进行比较。结果：两组患者基本资料、心率、血压、中心静脉压、最高乳酸值、最低中心静脉血氧饱和度（ScvO2）、静动脉二氧化碳分压差（Pcv-aCO2） 、尿量、胸引量组间差异不显著 ;AVP组血管活性药物评分更低、心率失常发生率更低、呼吸机辅助时间及住监护室时间减少。结论：AVP改善体外循环下术后血管舒张性休克患者的疗效优于NE。     

Effect of Xiongshao Capsule（芎芍胶囊）on the Function of Vascular Endothelium of Patients with Cervical Atherosclerosis

Objective: To study the effect of Xiongshao Capsule (芎芍胶囊, XSC), a TCM herb that can promote blood circulation to remove blood stasis, on the endothelial dependent relaxation function, serum nitric oxide (NO), and plasma endothelin-1 (ET-1) of the patients with cervical atherosclerosis. Methods: Forty patients were randomly divided into two groups: XSC group and Probucol group (western medicine control).In addition, 20 healthy people were set as a normal control group. Plasma ET-1, serum NO, the internal diameter of basal brachial artery, endothelial dependent flow mediated dilation (FMD) and non-endothelial dependent nitroglycerin induced dilation (NID) to the trial group before and after therapy and to the healthy control group were determined respectively. Results: Compared to the healthy control group, FMD of patients with atherosclerosis was damaged obviously, the serum NO level decreased, plasma ET-1 increased (P＜0.01), NID also decreased (P＜0.05), the internal diameter of basal brachial artery has no obvious difference (P＞0.05). After the patients with atherosclerosis were treated with Xiongshao Capsule for 12 weeks,FMD increased evidently, plasma ET-1 decreased, serum NO and the ratio of NO/ET-1 increased, compared with the level before therapy and Probucol group, the difference was significant (P＜0.05, P＜0.01), NIDdidn′t change obviously (P＞0.05). Conclusion: XSC could regulate vascular activity factor and improve the function of endothelial dependent vascular dilation of patients with atherosclerosis.     

Clinical experience with systemic vasodilator therapy in the newborn infant

Newborn infants with impaired myocardial performance may not respond to inotropic drugs and volume loading. Vasodilator therapy was tried in 10 such patients and in most there was improvement in peripheral perfusion, blood pH, arterial oxygenation, blood pressure and urine output. No complications of these drugs were detected. Vasodilator therapy has a role in the management of the acutely sick newborn infant with clinical signs of low cardiac output.     

Tetrandrine and related bis—benzylisoquinoline alkaloids from medicinal herbs：cardiovascular effects and mechanisms of action

Tetrandrine(TET),a bis-benzylisoquinoline alkaloid purified and identified an active ingredient in a Chinese medicinal herb,Radix Stephanae tetrandrae,has been used traditionally for the treatment of congestive circulatory disorder and inflammatory diseases.TET,together with a few of its structural analogues,has long been demonstrated to have antihypertensive action in clinical as well as animal studies.Presumably,the primary anti-hypertensive action of TET is due to its vasodilatory properties.TET prevents or inhibits vascular contraction induced by membrane depolarization with KCl or α-adrenoceptor activation with phenylephrine (PE).TET(30μmol/L) also inhibits the release of endothelium-derived nitric oxide(NO) as well as NO production by inducible NO synthase.TET apparently inhibits multiple Ca^2 entry pathways as demonstrated in cell types lacking the L-type Ca^2 channels.In cardiac muscle cells,TET inhibits both L-and T-type Ca^2 channels.In addition to its actions on cardiovascular tissues,TET may also exert its anti-hypertensive action via a Ca^2 -dependent manner on other tissues intimately involved in the modulation of blood pressure control,such as adrenal grands.In adrenal glomerulosa cells,KCl-or angiotensin II-induced aldosterone synthesis is highly dependent on extracellular Ca^2 .Steroidogenesis and Ca^2 -influx in bovine adrenal glomerulosa cells have been shown to be potently inhibited by TET.In bovine adrenal chromaffin cells,TET inhibits Ca^2 currents via L-and N-type channels as well as other unidentified channels with IC50 of 10μmol/L.Other than the Ca^2 antagonistic effects.TET also interacts with the α-adrenergic receptors and muscarinic receptors based on functional as well as radioligand binding studies.Apart from its functional effects,TET and related compounds also exert effects on tissue structures,such as remodelling of hypertrophied heart and inhibition of angiogenesis,probably by causing apoptotic responses.TET is also known for its anti-inflammatory and anti-fibrogenic actions,which make TET and related compound potentially useful in the treatment of lung silicosis,liver cirrhosis,and rheumatoid arthritis.     

Role of inhaled nitric oxide as a selective pulmonary vasodilator in pediatric cardiac surgical practice

Our aim was to assess the role of inhaled nitric oxide (NO) therapy in post operative cases of congenital heart defects who developed pulmonary arterial hypertensive (PAH) crisis and had no response with conventional management. From February '95 to January '97, inhaled NO therapy was used in 21 children. Age ranged from 2 months to 9 years (mean 5.6 years) and duration of therapy ranged from 1 to 13 days. Of 21 patients, 17 responded well with 5–20 ppm while 4 did not. The preoperative mean pulmonary systolic pressure was 88 mm Hg against mean systemic pressure of 96 mm Hg. Post operatively, their PA pressure reduced to 62 mm Hg, with systemic pressure of 98 mm Hg. After using inhaled NO, PA pressure dropped to 24 mm Hg (mean systolic) (p<0.007), after excluding the non responders. Of 4 non responders, two died due to irreversible pulmonary vascular disease and remaining two died due to residual defects. The study shows that inhaled NO is a selective pulmonary vasodilator, which is useful in postoperative PAH crisis and also reduces the transpulmonary gradient in single ventricle repair cases. It is safe and effective for prolonged use. It is very useful in Indian perspective, when more number of cases with congenital heart defects (CHD) alongwith severe PAH are encountered routinely.