Gang Li

Pulmonary hypertension (PH) is a progressive cardiopulmonary disorder marked by increased pulmonary vascular resistance and poor prognosis. Right ventricular (RV) dysfunction is the principal determinant of mortality in patients with PH; however, the role of the PI3K/AKT pathway in PH‑induced RV remodeling remains poorly defined. The present study generated a hypobaric hypoxia‑induced PH model in C57BL/6J mice. Echocardiography, histology, reverse transcription‑quantitative PCR, western blotting and immunofluorescence staining were employed to assess RV structure, apoptosis‑associated protein expression and fibrosis, while RNA sequencing was used to identify enriched signaling pathways. In parallel, H9C2 cardiomyocytes were treated with angiotensin II (Ang II) with or without the PI3K inhibitor LY294002 to evaluate apoptosis‑associated protein expression changes. PH model mice developed RV dysfunction characterized by increased Bax and decreased Bcl‑2 expression, accompanied by fibrosis. Transcriptomic analysis revealed significant enrichment of the PI3K/AKT pathway in RV tissues from PH model mice compared with control mice. Pharmacological inhibition of PI3K/AKT signaling with LY294002 further upregulated Bax and downregulated Bcl‑2 in Ang II‑treated H9C2 cells. In conclusion, PI3K/AKT pathway enrichment may represent a compensatory but insufficient response during PH‑induced RV remodeling, and its precise modulation may offer a potential therapeutic strategy for PH‑associated RV failure.

Anomalous aortic origin of a coronary artery (AAOCA) is the second leading cause of sudden cardiac death in young athletes. While anomalous aortic origin o

Background Ebstein's anomaly (EA) is a kind of congenital heart disease, which is currently widely treated by cone reconstruction. However, the prediction of postoperative recovery is still challenging. Methods A retrospective analysis was performed on EA cases undergoing cone reconstruction from January 2010 to January 2016. Univariate and multivariate logistic regression analyses were performed, with postoperative adverse events defined as dependent variable and pre‐ and intraoperative parameters defined as independent variables. The predictive capacity of preoperative percutaneous oxygen saturation (SPO₂) and Great Ormond Street (GOS) score was evaluated using areas under the curve of the receiver operating characteristic (ROC). Results Preoperative SPO₂ was 95.7 ± 5.20%. Cardiopulmonary bypass, aortic cross‐clamp, postoperative mechanical ventilation, and hospitalization time were 101.7 ± 28.26 min, 60.9 ± 18.04 min, 16 h (8, 22), and 8 days (7, 11), respectively. The incidence of total postoperative adverse events, including low cardiac output syndrome, mechanical ventilation more than 3 days, postoperative hospitalization more than 2 weeks, postoperative reintubation, extracorporeal membrane oxygenation assistance, and death, was 13.1% (n = 13). Low preoperative SPO₂ (p = .001, odds ratio [OR] = 0.834), GOS score (p = .021, OR = 0.368), and cardiopulmonary bypass time (p = .034, OR = 1.021) were risk factors for adverse events. Multivariate logistic regression analysis showed that low preoperative SPO₂ (p = .002, OR = 0.846) and GOS score (p = .043, OR = 0.577) were independent risk factors for adverse events. The areas of SPO₂ and GOS score under the ROC curve were 0.764 and 0.740, respectively. Conclusions Low preoperative SPO₂ and GOS score were predictors of adverse events after cone reconstruction, and SPO₂ was more convenient and objective than the GOS score.

Background: Right axillary thoracotomy has been performed for open‐heart procedures as a more aesthetic alternative to standard median sternotomy. This study aimed to evaluate the efficacy and safety of right axillary thoracotomy for the correction of simple congenital heart defects in adults. Methods: Between January 2014 and December 2017, the clinical data of 180 adults who underwent right axillary thoracotomy for simple congenital heart defects were compared with the data of a paired group of 192 adults who underwent median sternotomy. Results: Compared with the median sternotomy group, the right thoracotomy group showed shorter operative time, postoperative mechanical ventilation time, and postoperative hospitalization duration, as well as less drainage and transfusion volumes ( P < .05). Aortic cross‐clamping time, cardiopulmonary bypass time, and length of intensive care unit stay were similar between groups. No mortality or significant residual defects were reported in either group during follow‐up. In total, 172 patients (95.6%) in the right thoracotomy group and 134 patients (69.8%) in the median sternotomy group were satisfied with their cosmetic results ( P < .01). Conclusions: A right axillary thoracotomy is as safe and effective as a median sternotomy for the correction of simple congenital heart defects in adults. With lower trauma and better cosmetic results, this procedure provides a good alternative to the standard median sternotomy.

The reversibility of pulmonary arterial hypertension (PAH) determines the operability of congenital heart disease (CHD) complicating with PAH, but it lacks a method for evaluating the reversibility. The current study aims to investigate the serum survivin level in irreversible PAH rats and to explore its potential as a biomarker for evaluating the reversibility of PAH in CHD patients. Irreversible PAH rats were characterized by prominent obstructive lesions resulting from the intimal formation, which was associated with decreased apoptosis and increased survivin expression, while reversible PAH rats were featured by medial hypertrophy resulting in mild occlusion, with increased apoptosis and unchanged survivin expression. In addition, the serum survivin was significantly increased in irreversible PAH rats when compared to both reversible PAH and control rats, and a positive correlation of serum survivin with survivin expression in the lung was confirmed. Third, the preoperative serum survivin was significantly higher in patients with irreversible CHD‐PAH than in these with reversible CHD‐PAH, and significant correlations between the serum survivin and BNP, preoperative pulmonary vascular resistance index, and postoperative mean pulmonary arterial pressure were also identified. In conclusion, the increased survivin level is a feature of irreversible PAH and the serum survivin represents a candidate biomarker reflecting the operability of CHD‐PAH patients.

Background To investigate the effects of systemic‐to‐pulmonary shunts (SPSs) in older children with hypoplastic pulmonary arteries and the factors affecting the development of the pulmonary arteries. Methods Eighty‐six children (older than 3 years) who received SPSs were retrospectively analyzed. The perioperative parameters, the postoperative diameter of the pulmonary artery were collected, and the factors influencing the growth of the pulmonary arteries after an initial palliative shunt operation were analyzed. Results Two patients died postoperatively (2.33%), and the pulse oxygen saturation (SpO₂) increased from 71.70 ± 6.75% preoperatively to 85.20 ± 11.07% at discharge. During the follow‐up period of 56 (10–99) months, 37 patients (43.02%) underwent subsequent procedures, and in the remaining patients, the McGoon ratio was increased from 0.96 ± 0.48 at the surgery to 1.30 ± 0.31 at the final assessment (P < 0.05). Univariate analysis indicated that age younger than 5 years old (P < 0.05), pulmonary artery forward flow (P < 0.05) and a diagnosis of tetralogy of Fallot (P < 0.05) played positive roles in the growth of the pulmonary artery after surgery, while children with a McGoon ratio less than 0.6 showed poor development of the pulmonary arteries (P < 0.05). Multivariate analysis showed that age younger than 5 years old (P < 0.05) and pulmonary artery forward flow (P < 0.05) were positive effectors on the growth of the pulmonary artery. Conclusions Older children with cyanotic congenital heart disease benefited from a systemic‐pulmonary shunt and showed increased postoperative oxygen saturation and development of the pulmonary arteries. Age younger than 5 years and pulmonary artery antegrade flow were the positive factors influencing the growth of the pulmonary arteries postoperatively.

Two cases of asymptomatic double aortic arch with tetralogy of Fallot are reported. One presented with a non-dominant left arch and left-sided descending thoracic aorta and the other with a non-dominant left arch, a right-sided descending thoracic aorta and a patent ductus arteriosus. One-stage operation was performed and both patients were discharged free of symptoms and signs related to the double aortic arch and tetralogy of Fallot after the operation. A preoperative recognition of DAA is important, especially in echocardiographic investigation.