This study aims to compare the early and mid-term follow-up results of total thoracoscopic mitral valve repair versus median sternotomy mitral valve repair. Data from patients with mitral regurgitation treated in our hospital from January 2020 to December 2024 were collected, including 165 cases of total thoracoscopic mitral valve repair and 160 cases of median sternotomy mitral valve repair. Demographic characteristics, technical indicators, complications, and follow-up results were compared between the two groups. The results showed that the total thoracoscopic mitral valve repair group had a shorter ICU stay (30.2 ± 6.1 h vs. 75.3 ± 15.6 h, P < 0.001), shorter postoperative mechanical ventilation time (12.5 ± 4.2 h vs. 28.1 ± 4.6 h, P < 0.001), shorter hospital stay (8.6 ± 4.5d vs. 13.8 ± 7.6d, P < 0.001), and less postoperative drainage (157.2 ± 47.1 ml vs. 382.5 ± 181.5 ml, P < 0.001). There was no perioperative mortality in either group. Cardiac ultrasound follow-up results at 3 months, 6 months, 1 year, 2 years, 3 years, and 4 years post-surgery showed no statistically significant difference in the recurrence rate of mitral regurgitation (Grade IV) between the two groups (1.21

Objective: To preliminarily investigate the clinical feasibility, early efficacy, and safety of transcatheter edge-to-edge repair (TEER) in patients with acute mitral regurgitation caused by papillary muscle rupture complicating acute myocardial infarction (AMI). Methods: The study is a retrospective case series. A retrospective analysis was conducted on clinical data of 12 patients with AMI complicated by papillary muscle rupture and severe mitral regurgitation who underwent TEER at Xiamen Cardiovascular Hospital affiliated to Xiamen University from December 2021 to October 2024. Collected data included demographic characteristics, diagnostics and treatment processes, in-hospital outcomes data. Procedural success of TEER was defined as successful grasping of the anterior and posterior mitral leaflets and reduction of mitral regurgitation to grade 2+or less. Patients were followed up for 30 days post-procedure to evaluate survival status and the severity of mitral regurgitation. Results: The mean age of the patients was 67.4 years, with 10 males. Eleven patients were diagnosed with ST-segment elevation myocardial infarction, and 11 out of 12 cases involved complete rupture of the posteromedial papillary muscle. Cardiogenic shock was present in 10 patients and the median Society of Thoracic Surgeons score was 51.9%. Procedural success was achieved in all 12 patients, with mitral regurgitation reduced to ≤2+immediately post-procedure. Eleven patients survived to discharge, and no device-or procedure-related complications occurred during the perioperative period. During the follow-up period, 2 patients died and 1 was readmitted for acute heart failure. At the 30-day follow-up, 9 patients maintained a mitral regurgitation grade of ≤2+. Conclusions: TEER is technically feasible for treating acute severe mitral regurgitation caused by papillary muscle rupture following AMI. It can effectively reduce mitral regurgitation and improve hemodynamic status in selected high-risk patients in the short term. However, these findings necessitate further validation through larger-scale multicenter studies and long-term follow-up.

Aortic dissection (AD), characterized by rupture of the aortic wall, presents significant diagnostic challenges due to its rapid onset and nonspecific clinical symptoms. Although conventional imaging techniques are clinically useful, they typically lack sensitivity for early AD detection, are often unavailable in resource-limited settings, and cannot elucidate the mechanistic basis of AD pathogenesis. In this study, we used metabolomics and lipidomics to analyze serum samples from healthy controls, hypertensive AD patients, and normotensive AD patients, revealing distinct metabolic and lipidomic perturbations associated with AD, independent of blood pressure status. Notably, mitochondrial dysfunction was a pivotal factor in AD pathogenesis, and key metabolites such as acetylcarnitine served as both an AD biomarker and an indicator of disrupted lipid metabolism. Lipidomic profiling further revealed a consistent accumulation of specific fatty acids in AD patients, including elevated levels of FA(16:1), FA(20:1), FA(22:5), and FA(20:2) in both hypertensive and normotensive subgroups. Additionally, the sphingolipid signaling pathway was the most markedly altered lipidomic pathway between the two AD groups. These findings offer new insights into the complex lipidomic and metabolic mechanisms underlying AD pathogenesis, paving the way for improved diagnostics and targeted therapeutic strategies.

Background:Aortic rupture is a leading cause of early mortality in patients with Stanford type A aortic dissection (TAAD). Current risk assessment models lack critical imaging features, which could enhance their accuracy and sensitivity. This study aimed to identify potential imaging-based risk factors for in-hospital aortic rupture in patients with TAAD. Methods:We conducted a retrospective cross-sectional study of TAAD cases treated medically between January 2020 and May 2021 at Xiamen Cardiovascular Hospital. A total of 45 patients were initially enrolled; however, 14 patients who did not undergo computed tomography angiography (CTA) at Xiamen Cardiovascular Hospital and 1 patient whose quality of image was poor were excluded. We analyzed clinical data, including basic characteristics, clinical presentations, and morphological features derived from CTA and reconstructed images for the remaining 30 patients. Results:Aortic rupture accounted for 82% (14/17) of in-hospital deaths among conservatively treated patients with TAAD. Patients who experienced rupture demonstrated a significantly higher proportion of dissected false lumen (P=0.04), a longer false lumen arc length (P=0.02), and an increased distance from the sinotubular junction to the origin of the celiac trunk (P=0.02). Single factor logistic regression analysis identified two risk factors: arc length ≥130 mm (odds ratio =5.78; 95% confidence interval: 1.12-29.85; P=0.04) and centerline distance from the sinotubular junction to the origin of the celiac trunk ≥391 mm (odds ratio =11; 95% confidence interval: 2-60.57; P=0.006). Conclusions:Morphological features observed on computed tomography imaging can serve as valuable predictors for the risk of aortic rupture in patients with TAAD. Incorporating these features into predictive models could improve risk stratification, allowing for earlier surgical intervention in patients at the highest risk of rupture.

Background Acute type A aortic dissection (ATAAD) complicated by mesenteric malperfusion is a critical and complicated condition. The optimal treatment strategy remains controversial, debate exists as to whether aortic dissection or mesenteric malperfusion should be addressed first, and the exact time window for mesenteric ischemia intervention is still unclear. To solve this problem, we developed a new concept based on the pathophysiological mechanism of mesenteric ischemia, using a 6-hour time window to divide newly admitted patients by the time from onset to admission, applying different treatment protocols to improve the clinical outcomes of patients with ATAAD complicated by mesenteric malperfusion.Methods This was a retrospective study that covered a five-year period. From July 2018 to December 2020(phase I), all patients underwent emergency open surgery. From January 2021 to June 2023(phase II), patients with an onset within 6 h all underwent open surgical repair, followed by immediately postoperative examination if the malperfusion is suspected, while the restoration of mesenteric perfusion and visceral organ function was performed first, followed by open repair, in patients with an onset beyond 6 h.Results There were no significant differences in baseline and surgical data. In phase I, eleven patients with mesenteric malperfusion underwent open surgery, while in phase II, our novel strategy was applied, with sixteen patients with an onset greater than 6 h and eleven patients with an onset less than 6 h. During the waiting period, none died of aortic rupture, but four patients died of organ failure, twelve patients had organ function improvement and underwent surgery successfully survived. The overall mortality rate decreased with the use of this novel strategy (54.55% vs. 18.52%, p = 0.047). Furthermore, the surgical mortality rate between the two periods showed even stronger statistical significance (54.55% vs. 4.35%, p = 0.022). Moreover, the proportions of patients with sepsis and multiorgan failure also showed differences.Conclusions Our novel strategy for patients with ATAAD complicated by mesenteric malperfusion not only improves the surgical success rate but also reduces the overall mortality rate.

Background The mortality of acute type A aortic dissection (ATAAD) with malperfusion syndrome (MPS) is high. However, the management strategy remains controversial. We aimed to evaluate the strategy for MPS at our institution. Methods Among 724 patients with ATAAD, 167 patients with MPS were treated with immediate central repair (first stage) or an optimized strategy (second stage). In the second stage, the optimized strategy used was based on 6-hour threshold from symptom onset. For MPS with symptom onset within 6 hours, immediate central repair was performed, followed by endovascular reperfusion if malperfusion persisted. With symptom onset beyond 6 hours, individualized delayed central repair was performed. We compared outcomes between the first and second stages. Results The in-hospital mortality of ATAAD was significantly decreased when the optimized strategy was used (4.3% in the second stage vs 12.5% in the first stage; P < .01). In the second stage, the in-hospital mortality for MPS was decreased (10.2% vs 33.9%; P < .01). Moreover, the in-hospital mortality for MPS with symptom onset within 6 hours and beyond 6 hours decreased from 24% to 7.5% and from 41.2% to 11.8%, respectively. The operative mortality of MPS in the second stage was comparable to that in patients without MPS (4.0% vs 2.4%; P > .05). Conclusions The optimized strategy significantly improved the outcomes of MPS. The 6-hour threshold from symptom onset could be very useful in determining the timing of central repair. For patients with MPS symptom onset within 6 hours, immediate central repair is reasonable; for those with symptom onset beyond 6 hours, individualized delayed central repair should be considered.

Ascending aortic pseudoaneurysm (AAP) is rare but may cause life-threatening complications. Although the placement of a stent graft and the use of occluder devices and vascular plugs to exclude pseudoaneurysm are adopted for some patients, the management of progressive pseudoaneurysms that may rupture at any time remains a challenge that needs to be addressed. In this study, we present the case of a patient with an AAP that was caused by aortic and mitral valve replacement for the giant left ventricle. Aortic pseudoaneurysm was suspected on the basis of a spherical cystic echo (70 × 80 mm) of the ascending aorta; this pseudoaneurysm was detected by an ultrasonic cardiogram, and the diagnosis was confirmed by an aortic computed tomography angiography (CTA) examination. To prevent the unexpected rupture of a progressive pseudoaneurysm, our patient was treated with a 28- mm ASD occluder without any procedural complications. Our patient has a good prognosis, which will inspire clinicians to choose minimally invasive procedures when dealing with such high-risk cases in emergency situations.

1例53岁急性Stanford A型主动脉夹层合并脑梗塞昏迷女患者，在严格控制血压和心率、脱水降颅压、密切监测有无心包积液、有无重度主动脉瓣关闭不全的基础上，等待接近2个月后行孙氏手术治疗，术中采用双侧脑灌注，术后顺利转出重症监护室并出院，随访1年，左侧肌力恢复3~4级，可独立行走。急性Stanford A型主动脉夹层合并脑灌注不良表现为颈总动脉假腔血栓压迫或真腔严重受阻的患者，在严格控制血压、心率的基础上可密切观察患者神志、四肢活动、心包积液、主动脉瓣启闭的综合判断下积极行手术治疗，术后加强呼吸道管理、营养支持、康复训练基础上，患者可获得满意的临床预后结局。

[This corrects the article DOI: 10.3389/fcvm.2023.1134196.].

在现代化医院发展和人才梯队建设中，青年医师起着举足轻重的作用。我院在青年医师培养过程中，积极探索、创新，开展以“标准化晨间会议（standardized morning meeting，SMM）”为巩固理论的渠道，辅以问题式培训及模拟化医学教育等方法，两位一体培养青年医师。该方法能够让青年医师掌握基本医疗知识，调动青年医师学习的主动性和积极性，锻炼青年医师的独立思考能力，增强解决临床问题的能力。

Objective Cardiac surgery associated-acute kidney injury (CS-AKI) occurs in 40–55% of patients undergoing surgery for repair of acute type A aortic dissection (ATAAD). Few studies have investigated the association of postoperative AKI with kidney dysfunction seen long-term in patients after surgical repair for ATAAD. The aim of our study was to identify the risk factors of developing post-ATAAD repair chronic kidney disease (CKD) at 6 months.

BACKGROUND:Acute type A aortic dissection complicated by limb malperfusion presents a risk of mortality to the patients. Debates exist regarding management, whether focused on reperfusion first or immediate repair. Here, we aimed to describe our experience with the management of acute type A aortic dissection (ATAAD) complicated by limb malperfusion.METHODS:From January 1, 2020 to December 31, 2021, 22 consecutive patients were admitted to Xiamen Cardiovascular Hospital, due to acute type A aortic dissection complicated by limb malperfusion. All perioperative variables were recorded and analyzed. Limb malperfusion was diagnosed, according to the clinical symptoms, computed tomography angiography, and laboratory test. We adopted the clinical categories of acute limb ischemia to stratify severity of limb ischemia. Surgery strategies are as follows: Reperfusion first followed by central repair, immediate central repair, and immediate central repair followed by stenting.RESULTS:There were 21 males and one female with an average of 53.3±11.7 years. Management strategies were as follows: immediate central repair using total arch replacement with frozen elephant trunk in 15 patients, endovascular stenting followed by central repair in four patients, and endovascular stenting after central repair in two patients. The average extracorporeal circulation time was 258.8 ± 70.5 min; the average aortic cross-clamp time was 177.9 ± 54.2 min; and the average circulatory arrest time was 45.5 ± 13.1 min. The early mortality rate was 13.6% (3/22). Two patients left the hospital voluntarily, due to cerebral infarction and bleeding. One patient underwent fasciotomy for osteofascial compartment syndrome and uneventfully was discharged. Six patients underwent continuous renal replacement therapy and hemoperfusion.CONCLUSION:Central repair is safe and feasible for ATAAD complicated with limb malperfusion. For serious limb malperfusion, endovascular stenting followed by central repair is a good choice with continuous renal replacement therapy (CRRT) and hemoperfusion. Hospital mortality rate is high in cases with multiple organ malperfusion.

A 61-year-old man with a history of partial liver resection 2 years previously for hepatocellular carcinoma (HCC) was referred to our university hospital from an outside clinic. He was experiencing dyspnea on exertion and had New York Heart Association functional class III heart failure. Emergency laboratory examination revealed a substantial rise in the levels of coagulation markers (D-dimer level, 6.48 mg/L; fibrin degradation product level, 19.8 μg/mL) and an obvious increase in N-terminal pro-B-type natriuretic peptide levels to 2,035 pg/mL. Analysis of tumor marker levels indicated an elevated cancer antigen-125 level of 275.10 U/mL, and a normal α-fetoprotein level (1.86 ng/mL). ECG at admission showed a right bundle branch block and right axis deviation. A CT scan of the thorax and abdomen revealed no suspicious nodules in the liver. Subsequently, transthoracic echocardiography (TTE) was performed (Fig 1, Video 1). Question 1: What is the differential diagnosis for this patient, based on clinical history and the TTE findings in Video 1, and what is the next step in diagnosis? Question 2: How should pacemaker implantation be carried out, considering the presence of residual tumor tissue in the right ventricle? Answer to Question 1: The differential diagnosis included thrombus or isolated right ventricular metastasis of HCC. The next step in diagnosis is contrast echocardiography (CE). CE was performed after 2 days of anticoagulation therapy. The mass had not decreased in size. It showed contrast hyperenhancement compared with the surrounding myocardium after the administration of a contrast agent, suggesting a highly vascular or malignant tumor (Fig 2, Video 2). Because of his progressive dyspnea, the patient required surgical resection of the mass to relieve the obstruction of the right ventricular outflow tract (Fig 3). The tricuspid valve was replaced with a bioprosthetic valve (Mosaic valve, 27 mm; Medtronic). Histopathology of the surgically extracted masses revealed HCC metastasis (Fig 3). Recovery went well until postoperative day 27, when the patient experienced sudden ventricular tachycardia (VT) followed by dyspnea, undetectable BP, and transient dilation of the pupils. After successful electrical cardioversion, the patient recovered consciousness. Considering that 24-hour Holter ECG detected atrioventricular block (AVB) before this emergency, VT occurred secondary to AVB. A risk of Adams-Stokes syndrome and sudden death remained. Therefore, permanent pacemaker implantation was necessary. Answer to Question 2: Because of the residual tumor tissue in the right ventricle (RV), it was impossible to carry out traditional RV pacing, and the patient could not undergo full sternotomy again for epicardial pacing. Here, after comprehensive and careful evaluation, the electrophysiologist decided to use the transseptal approach with a new pacing technique (pacing leads [model 3830; Medtronic] delivered through a fixed-curve sheath [C315HIS; Medtronic]) (Fig 4, Video 3). Left ventricular septal myocardial pacing (LVSP) was then confirmed by intracavity electrogram (GE Healthcare). The patient did not experience cardiac arrhythmia over 8 months of follow-up. In this extraordinary case, a patient with a metastatic relapse of HCC and a prominent RV mass received implantation of a special permanent pacemaker after surgical debulking and tricuspid valve replacement. The incidence of intraventricular masses is generally low (the estimated prevalence is 0.195%).1Bugra Z. Emet S. Umman B. et al.Intracardiac masses: single center experience within 12 years: I-MASS Study.Am Heart J Plus. 2022; 13100081Google Scholar Intracardiac thrombus represents the most commonly encountered intraventricular mass in clinical practice; however, the differential diagnosis includes neoplastic masses, including primary cardiac tumors as well as intracardiac metastases.1Bugra Z. Emet S. Umman B. et al.Intracardiac masses: single center experience within 12 years: I-MASS Study.Am Heart J Plus. 2022; 13100081Google Scholar HCC most commonly metastasizes to the lungs, followed by the intraabdominal lymph nodes, bones, adrenal glands and, rarely, the brain.2Uka K. Aikata H. Takaki S. et al.Clinical features and prognosis of patients with extrahepatic metastases from hepatocellular carcinoma.World J Gastroenterol. 2007; 13: 414-420Crossref PubMed Scopus (301) Google Scholar, 3Choi H.J. Cho B.C. Sohn J.H. et al.Brain metastases from hepatocellular carcinoma: prognostic factors and outcome: brain metastasis from HCC.J Neurooncol. 2009; 91: 307-313Crossref PubMed Scopus (89) Google Scholar, 4Katyal S. Oliver III, J.H. Peterson M.S. Ferris J.V. Carr B.S. Baron R.L. Extrahepatic metastases of hepatocellular carcinoma.Radiology. 2000; 216: 698-703Crossref PubMed Scopus (534) Google Scholar Tumors can spread to the heart through four alternative paths: by direct extension, through the bloodstream, through the lymphatic system, and by intracavitary diffusion through either the inferior vena cava or the pulmonary veins. However, isolated RV metastasis without right atrial and inferior vena cava involvement is extremely rare.5Bussani R. De-Giorgio F. Abbate A. Silvestri F. Cardiac metastases.J Clin Pathol. 2007; 60: 27-34Crossref PubMed Scopus (415) Google Scholar CE helps us easily distinguish thrombi from tumors. Tumors show contrast hyper- or hypoenhancement whereas thrombi show no enhancement. Although cardiac MRI is more useful in the identification of the nature of a cardiac mass, CE is more rapid and convenient, especially in patients who are not able to tolerate cardiac MRI or who have contradictions for MRI. The usefulness of CE has now been extended beyond the analysis of cardiac structure and functional assessment to evaluate perfusion of both the myocardium and the intracardiac structures. It has been demonstrated that this modality can be used to characterize the vascularity of cardiac masses and assist with the differentiation of malignant, highly vascular tumors from benign tumors or thrombi. Most malignancies have abnormal neovascularization that supplies rapidly growing tumor cells, often in the form of highly concentrated, dilated vessels.6Porter T.R. Mulvagh S.L. Abdelmoneim S.S. et al.Clinical applications of ultrasonic enhancing agents in echocardiography: 2018 American Society of Echocardiography guidelines update.J Am Soc Echocardiogr. 2018; 31: 241-274Abstract Full Text Full Text PDF PubMed Scopus (200) Google Scholar This patient was treated with surgical resection. Fan and colleagues7Fan C.T. Lin W.W. Chen M.J. Shiu S.I. Isolated right ventricular metastasis in a woman with advanced hepatocellular carcinoma after palliative therapy.Case Rep Gastroenterol. 2019; 13: 487-497Crossref PubMed Scopus (1) Google Scholar have reported that surgical resection for isolated metastatic HCC in the RV might be beneficial not only in alleviating symptoms but also in improving survival after an individualized and comprehensive evaluation. Treatments for cardiac mass are mainly surgical, and the prognosis is rather poor, with survival times ranging from 0 months (death immediately after surgery) to 9 months. Therefore, the prognosis remains poor.8Zhang X.T. Li Y. Ren S.H. et al.Isolated metastasis of hepatocellular carcinoma in the right ventricle.BMC Cardiovasc Disord. 2019; 19: 287Crossref PubMed Scopus (5) Google Scholar In this case, the tricuspid valve was infiltrated by metastatic HCC, and a bioprosthetic valve replacement was also performed. The atrioventricular node is known to reside in the triangle of Koch, which borders the septal leaflet of the tricuspid valve. Because of these anatomic features, atrioventricular nodes are highly susceptible to damage and result in a risk of AVB. In this case, AVB was detected, and VT and a cardiac emergency occurred. Permanent pacemaker implantation was necessary to reduce the risk of sudden death. Traditional RV pacing methods were not applicable. Electrophysiologists have developed 3830 pacing leads, which can be screwed deep into the basal segment of the septum, bypassing residual tumor tissue in the right ventricle. More recently, newer pacing techniques such as His-Purkinje conduction system pacing have emerged. LVSP and direct capture of the left Tawara bundle (left bundle branch pacing), using the transseptal approach, have been described.9Huang W.J. Su L. Wu S.J. et al.A novel pacing strategy with low and stable output: pacing the left bundle branch immediately beyond the conduction block.Can J Cardiol. 2017; 33: 1736.e1-1736.e3Abstract Full Text Full Text PDF PubMed Scopus (371) Google Scholar According to the appearance of the ECG,10Jastrzębski M. Kiełbasa G. Curila K. et al.Physiology-based electrocardiographic criteria for left bundle branch capture.Heart Rhythm. 2021; 18: 935-943Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar we finally confirmed LVSP. The patient did not experience cardiac arrhythmia over 8 months of continued follow-up. See Narration Video for a detailed explanation of Videos 1-3. 1.Physicians should be aware of the potential risk of isolated right ventricular metastasis in patients with hepatocellular carcinoma, even after standard partial hepatectomy.2.Understanding contrast echocardiography helps easily distinguish thrombi from tumors.3.Early surgical debulking should be considered to improve symptoms; pacemaker implantation prevents sudden death and improves survival. This study was supported as a Xiamen Key Project of Medical and Health Sciences (3502Z20191103) and as a Science and Technology Planning Project of Xiamen (3502Z20214ZD2183).

Glucagon receptor plays an important role in the regulation of glucose metabolism. Studies have revealed that glucagon receptor antagonism is a potential effective treatment for diabetes. However, the functions of GCGR have not been fully illustrated. Although two Gcgr truncation knockout mice models have been widely used for GCGR function studies, truncated gene may remain neomorphic and/or dominant-negative function. In this study, we took the advantages of Crispr-Cas9 technique and generated a novel allele of GCGR in the mouse that yields complete loss of GCGR protein. Our studies reveal that complete deletion of Gcgr results in hyperglucagonemia, α-cell hyperplasia, improvement of glucose tolerance. These results are similar to the Gcgr-truncated mutation in mice. Hence, we provide a novel strain of GCGR knockout mice for the GCGR function studies.

Objective:To explore different strategies of central repair first or malperfusion first to treat type A aortic dissection complicated with limb malperfusion.Methods:From January 2020 to December 2021, 302 patients were diagnosed with acute type A aortic dissection, and 17 consecutive patients were diagnosed as type A acute aortic dissection complicated with limb malperfusion and underwent Sun’s procedure. There were 16 males and 1 female with an average of(52.6±4.2)years. Surgical strategies were as follows: immediate central repair-Sun’s procedure in 14 patients, endovascular stenting followed by central repair in 3 patients, endovascular stenting after central repair in 1 patient.Results:The incidence rate of limb malperfusion of acute Stanford A aortic dissection was 5.6%(17/302). Average extracorporeal circulation time was(271.8±38.9)min, average aortic cross-clamp time was (186.3±31.8)min, and the average circulatory arrest time was (48.75±11.3)min. Early mortality rate was 17.6%(3/17). Two patients were left hospital voluntarily because of cerebral infarction. One patient underwent leg incision osteofascial compartment syndrome and discharged unevently. Five patients underwent continuous renal replacement therapy and hemoperfusion. Follow-up results showed that patients with serious limb malperfusion have symptoms of nerve dysfunction including amyosthenia and sensory disturbance, but recovered gradually with rehabilitation.Conclusion:Sun’s procedure is safe and feasible for type A acute aortic dissection complicated with mild limb malperfusion. For serious limb malperfusion, endovascular stent followed by Sun’s procedure is a good choice with CRRT and hemoperfusion.

BACKGROUND:Although many clinicians have made efforts to improve the prognosis for giant left ventricular with valve disease patients, potential markers to judge the prognosis of giant left ventricular patients undergoing valve surgery are still unknown. The purpose of this study was to explore the possible impact factors for giant left ventricle prognosis. METHODS:From September 2019 to September 2022, 75 patients with preoperative valvular disease with a giant left ventricle (left ventricular end diastolic diameter (LVEDD) >65 mm) underwent cardiac valve surgery. The changes in cardiac function one year after surgery were used to describe prognosis and analyze the potential independent factors affecting surgical prognosis. The left ventricular ejection fraction (LVEF) was considered to be recovered if it was ≥50% on follow-up echocardiography at least 6 months after the diagnosis. RESULTS:The cardiac function of patients with a giant left ventricular and valve disease improved. Compared with preoperation, the left ventricular end diastolic diameter (LVEDD), left ventricular end-systolic dimension (LVESD), pulmonary artery systolic pressure (PASP), NT-proBNP, and cardio thoracic ratio (CTR) were significantly decreased (p < 0.05), and the ratio of severe heart failure was decreased from 60% to 37.33%. In the univariate analyses, the preoperative NT-proBNP levels and PASP were significantly associated with the cardiac function recovery (odds ratio [OR] = 1.001, 95% CI 1.000-1.002, p = 0.027; OR = 1.092, 95% CI 1.015-1.175, p = 0.018). However, during the diagnostic test, PASP did not account for cardiac function recovery (AUROC = 0.505, 95% CI = 0.387-0.713, p = 0.531). Based on the cutoff value in the experiment, we found that a NT-proBNP >753 pg/mL (AUROC = 0.851, 95% CI = 0.757-0.946, p < 0.0001) was a potential prognostic marker for patients with a giant left ventricular valve disease. CONCLUSIONS:We have demonstrated that an elevated preoperative NT-proBNP level is an independent predictor of cardiac function recovery in a cohort of giant left ventricular patients undergoing valve surgery, and this is the first study about this specific cohort of patients.

Postoperative myocardial infarction (POMI) in acute type A aortic dissection rarely has been reported, we report a case of postoperative myocardial infarction in acute type A aortic dissection, and the clinical presentation and possible mechanisms are described. This case illustrates that postoperative myocardial infarction in acute type A aortic dissection is a rare fatal complication in patients without coronary lesions or coronary malperfusion before aortic repair. Type 2 myocardial infarction may account for POMI. Effective treatment may include anticoagulation therapy, volume adjustment, blood pressure support, administration of blood products, heart rate control, and individualized respiratory support.

Hypothyroidism is closely associated with increased serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG). The thyroid gland plays an important role in this process because thyroid hormones (THs) modulate cholesterol production, transformation and clearance. Although recent evidence suggests that thyroid-stimulating hormone (TSH) itself also participates in hyperlipidemia, the underlying mechanism remains unclear. Others demonstrated that the pathologic development of hypothyroidism-related hyperlipidemia was associated with down-regulated THs and up-regulated TSH in serum. This finding suggests a role for hypothyroidism in hyperlipidemia and potentially in related cardio-metabolic disease. Multiple newly identified modulatory biomarkers, such as proprotein convertase subtilisin/kexin type 9 (PCSK9), angiopoietin-like protein (ANGPTLs), and fibroblast growth factors (FGFs), might play a role in modulating the risk of hyperlipidemia induced by hypothyroidism. Moreover, hypothyroidism also contributes to the production of dysfunctional high-density lipoprotein (HDL) particles. In the present review, we examine the relationship between hypothyroidism with the risk and pathologic development of hyperlipidemia. We explore mechanisms by which hypothyroidism promotes hyperlipidemia in general and its contribution to cardio-metabolic disease specifically.

Objectives:Most patients with acute aortic dissection (AAD) have a history of hypertension. Diagnosis of AAD in patients with hypertension at an early stage is complicated and challenging. This study aimed to explore the distinctive metabolic changes in plasma samples of AAD patients with hypertension and patients with hypertension only and provide early identification and diagnosis of AAD in patients with hypertension.Materials and methods:We collected blood samples from 20 patients with type A AAD and hypertension admitted to the emergency department and physically examined other 20 patients with hypertension as controls. The plasma metabolomic profiles of these patients were determined using untargeted metabolomics with ultra-high-performance liquid chromatography-quadrupole time-of-flight mass spectrometry.Results:A total of 38 metabolites that differed between the AAD and hypertension groups were screened. In the positive ion mode, 12 metabolites were different between the two groups, and in the negative ion mode, 26 metabolites were different. Among the 26 different metabolites detected by the negative ion mode, 21 were significantly upregulated and five were downregulated in patients with AAD compared to patients with hypertension. Moreover, five metabolites were upregulated and seven were significantly downregulated in patients with AAD compared to those with hypertension, as detected by the positive ion mode. The metabolites differentially expressed in AAD were mainly involved in lipid metabolism (fatty acid biosynthesis, biosynthesis of unsaturated fatty acids, and linoleic acid metabolism), carbohydrate metabolism (galactose, fructose, and mannose metabolisms), and membrane transport (ATP-binding cassette transporters). Interestingly, plasma hydrocortisone and dimethylglycine concentrations were significantly increased in patients with type A AAD, with the highest area under the curve value (AUC = 0.9325 or 0.9200, respectively) tested by the receiver operating characteristic curve analysis.Conclusion:This study provides possible metabolic markers for the early clinical diagnosis of AAD in patients with hypertension.