Background: Degenerative mitral regurgitation (DMR) is a cardiovascular condition marked by progressive degeneration of the mitral valve, leading to complications such as heart failure and atrial fibrillation. Despite advancements, research trends and knowledge gaps remain inadequately addressed. Therefore, this study aimed to perform a comprehensive bibliometric analysis of DMR-related research to identify publication trends, influential contributors, and emerging research themes. Methods: A bibliometric analysis was conducted on articles related to DMR published from 2004 to 2024, retrieved from the Web of Science Core Collection (WoSCC) database. Data were analyzed using Microsoft Excel, R-bibliometrix, VOSviewer, and CiteSpace to evaluate publication trends, international collaborations, key contributors, and emerging research themes. Results: A total of 2,349 publications were identified, with an annual growth rate of 4.07%, involving 12,474 contributors from 79 countries. The USA led with 726 publications and 37,386 citations. Leading institutions included Mayo Clinic and Harvard University. The top journals were the Journal of the American College of Cardiology, Circulation, and The Journal of Thoracic and Cardiovascular Surgery. The most influential author was Enriquez-Sarano Maurice, followed by Delling Francesca N. and Pepi Mauro. Keyword analysis identified central themes such as "regurgitation", "surgery", and "echocardiography", with emerging topics like "mitral valve repair" and "transcatheter interventions". Conclusions: This bibliometric analysis highlights significant advancements in DMR research, particularly in surgical techniques and imaging modalities, and provides a foundation for future studies aimed at improving patient outcomes.

BACKGROUND:Mitochondrial dysfunction is implicated in mitral valve diseases (MVD), but specific genetically predicted genes and molecular mechanisms remain undefined. OBJECTIVE:We aimed to identify mitochondria-related genes driving rheumatic (RMVD) and non-rheumatic (NRMVD) MVD subtypes. METHODS:We performed a multi-omics Mendelian randomization (SMR) study integrating GWAS summary statistics for RMVD and NRMVD with blood DNA methylation (mQTL), gene expression (eQTL), and plasma protein (pQTL) data. Findings were evaluated using cardiac tissue transcriptomics (GTEx), explored in FinnGen, and further assessed by GEO tissue expression and protein-protein interaction (PPI) network analysis. RESULTS:Multi-omics and tissue-specific analyses consistently identified PCCB as a primary candidate risk gene for MVD, demonstrating risk-increasing effects across both blood and cardiac tissues. Independent GEO validation corroborated PCCB upregulation across diseased mitral valve and atrial myocardial tissues. Alongside PCCB, QRSL1 also exhibited consistent risk associations across blood and heart tissues. Exploratory FinnGen validation suggested nominal associations for PCCB and TRMU, though limited by phenotypic heterogeneity. Additionally, we identified a multi-layered epigenetic axis centered on RTN4IP1, where hypermethylation is genetically associated with reduced systemic expression and protein abundance. However, tissue-specific and GEO analyses revealed a paradoxical localized upregulation of RTN4IP1 in diseased atrial myocardium, suggesting a complex, tissue-specific regulatory mechanism. Finally, PPI network analysis demonstrated that these prioritized candidate genes are directly connected to mitochondrial master regulators and OXPHOS complexes. CONCLUSIONS:Our study prioritizes specific mitochondrial genes associated with MVD, identifying PCCB as the most consistent candidate risk gene supported by systemic and localized tissue evidence.

Background:Regular aerobic exercise has been shown to improve mitochondrial function and delay mitochondrial aging. Mitochondria play a crucial role in maintaining cardiac function and metabolism in myocardial cells. However, the effect of aerobic exercise on the incidence of atrial fibrillation (AF) is unclear. The aim of this study was to investigate the effects of aerobic exercise of different intensities on the susceptibility of aged mice to AF, and the relationship between altered mitochondrial structure and function and susceptibility to AF. Methods:Thirty-two 18-month-old C57BL/6N aged mice were selected and divided into low-, medium-, and high-speed aerobic exercise groups, and a no-exercise control group. Electrophysiological characteristics, susceptibility to AF, mitochondrial morphology and structure, mitochondrial membrane potential, adenosine triphosphate (ATP)ase activity, cytosolic calcium ion concentration, and mitochondrial function were assessed in each group of aged mice using the intracardiac catheterization technique, transmission electron microscopy, cellular flow technique, and Seahorse mitochondrial stress test. Results:A negative correlation was found between the success rate of AF induction/AF duration and the speed of exercise, such that the success rate of AF induction/AF duration was significantly lower in the high-speed group than the no-exercise group (P=0.01/P=0.02). Transmission electron microscopy revealed that the number and density of mitochondria in mouse atrial myocytes were positively correlated with exercise velocity. The basal oxygen consumption, mitochondrial energy supply, and maximum mitochondrial energy supply potential of atrial myocytes increased as exercise speed increased (P<0.001). Conclusions:Both moderate- and vigorous-intensity aerobic exercise significantly reduced the susceptibility of the aged mice to develop AF while concurrently enhancing mitochondrial morphology and structural integrity, ultimately leading to improved mitochondrial bioenergetic function.

BACKGROUND:Whether tricuspid valve (TV) repair should be performed during degenerative mitral valve repair in patients with less than moderate regurgitation remains controversial. OBJECTIVES:This study aimed to explore the clinical outcomes of degenerative mitral valve repair for less than moderate tricuspid regurgitation (TR). METHODS:Between 2010 and 2019, 541 patients with less than moderate TR underwent mitral valve repair for degenerative mitral disease at the Beijing Anzhen Hospital. Among these patients, 255 underwent concomitant TV repair. The median follow-up was 8 years (Q1-Q3: 6-11 years). The primary endpoint was the development of moderate TR. The secondary endpoint was death, recurrent mitral regurgitation (MR), reoperation for MR or TR, new-onset atrial fibrillation, and permanent pacemaker implantation. Propensity score matching was performed to reduce selection bias. RESULTS:After baseline adjustment, propensity score matching analysis identified 207 pairs. There were no significant differences in the primary endpoints between the patients who underwent simultaneous TV repair and those who did not. Mortality, recurrent MR, permanent pacemaker implantation, and reoperation for MR or TR did not differ significantly between groups. Concomitant TV repair only contributed to new-onset atrial fibrillation, with 24 (11.6%) in the TV-repair group and 7 (3.4%) in the no-repair group (P = 0.001). CONCLUSIONS:Considering its minimal effects on the development of TR and potential contributions to postoperative new-onset atrial fibrillation during follow-up among these patients, more aggressive TV repair is not encouraged among patients with less than moderate TR during MV surgery.

This study investigated the impact of changes in weight-bearing line following open-wedge high tibial osteotomy (HTO) on muscle activation within the lower limb kinetic chain in patients with medial knee osteoarthritis (KOA). A cohort study was conducted with 21 patients diagnosed with KOA who underwent HTO. Three-dimensional gait analysis and surface electromyography were performed preoperatively and at 6 and 12 months postoperatively. Seven lower limb muscles were assessed for co-contraction index, integrated electromyography, root mean square, duration, and SMA during the stance phase. Intragroup and intergroup comparisons were made using one-way and repeated-measures analysis of variance. Preoperatively, the co-contraction indices of the vastus medialis-biceps femoris and vastus medialis-gastrocnemius were significantly higher compared with other muscle pairs (p < 0.05), but these indices decreased significantly at 6 and 12 months postoperatively (p < 0.05). The integrated electromyography and root mean square values for six muscles, excluding the vastus lateralis, significantly increased at 6 months postsurgery (p < 0.05). At 12 months, the root mean square value of the vastus lateralis decreased significantly compared with preoperative levels (p < 0.05). The gluteus medius and vastus medialis showed significant increases in integrated electromyography, root mean square, and duration of muscle activation at 12 months postoperatively, along with earlier muscle activation timing (p < 0.05). The vastus medialis demonstrated improved activation compared with preoperative levels. HTO reduces co-contraction indices, enhances muscle activation, and improves lower limb muscle coordination within 1 year postoperatively.

Background: Mitral valve repair (MVr) is an effective treatment for degenerative mitral regurgitation (DMR).And the outcomes and repair rates for posterior leaflet prolapse (PLP), anterior leaflet prolapse (ALP), and bileaflet prolapse (BLP) vary. This study aimed to compare the outcomes of mitral valve repair for patients with PLP, ALP, and BLP. Methods: From 2010 to 2019, 1192 patients with degenerative mitral valve regurgitation underwent surgery at our hospital. And 1069 patients were identified. The average age of all patients was (54.74 ± 12.17) years old for all patients. 273 patients (25.5%) had ALP, 148 patients (13.8%) had BLP, and 648 patients (60.6%) had PLP. All patients were followed up for an average duration of 5.1 years. We compared the outcomes of patients with ALP, PLP, and BLP. Results: Patients with ALP were the youngest of the 3 groups and had the highest prevalence of atrial fibrillation. Patients with PLP had the highest prevalence of hypertension, whereas patients with BLP and ALP had larger left ventricular end-diastolic and left ventricular end-systolic diameters. ALP and BLP repairs had a longer cardiopulmonary bypass and aortic cross-clamp time.10 patients dead in-hospital, 5 patients had PLP, 3 had ALP, and 2 had BLP. The 10-year survival cumulative incidences of reoperation among ALP, BLP, and PLP repairs were not significantly different. ALP repair still had higher cumulative incidences of recurrent mitral regurgitation (MR) compared to PLP. Conclusions: The rates of long-term survival and freedom from reoperation were not significantly different among patients with ALP, BLP, and PLP. ALP repair has higher cumulative incidences of recurrent MR compared to PLP.

OBJECTIVE:To evaluate the long-term outcomes of degenerative mitral valve (MV) repair.METHODS:This study analysed 1,069 patients who underwent MV repair due to degenerative MV disease at Beijing Anzhen Hospital from January 2010 to December 2019. All patients were clinically followed until December 2019, with an average follow-up period of 4.7 years. Perioperative complications, 30-day mortality, long-term outcomes, and risk factors of all-cause death and recurrent mitral regurgitation (MR) were summarised.RESULTS:Ten patients died in the hospital and 33 died during the follow-up period. Recurrent MR occurred in 113 patients. Fourteen patients underwent re-operation. Rates of long-term survival, absence of recurrent MR, and no re-operation were 94.0% (91.6%-96.6%), 81.2% (77.3%-85.3%), and 98.2% (97.2%-99.3%), respectively. The risk factors for long-term all-cause death included age and an ejection fraction (EF) <60%. The risk factors for recurrent MR included age, female sex, E-wave velocity, anterior prolapse, residual 1+MR postoperatively, and lower body mass index.CONCLUSIONS:Mitral valve repair is an effective treatment for degenerative MV disease that, in an experienced heart centre, can be performed with low mortality, recurrence, and re-operation rates. Advanced age and an EF <60% were risk factors for long-term all-cause death. Age, female sex, residual 1+MR postoperatively, lower body mass index, higher peak E-wave velocity, and anterior prolapse were risk factors for recurrent MR.

Purpose: This study aimed to illustrate how percutaneous balloon mitral valvuloplasty (PBMV) and mitral valve (MV) surgeries influence women of childbearing age with rheumatic mitral valve diseases (RMVDs) from two aspects, including clinical outcomes and their postoperative childbearing performances. Methods: Female patients with RMVD who were of childbearing age and underwent MV interventions between 2007 and 2019 at Beijing Anzhen Hospital were identified. Outcomes included all-cause deaths, repeated MV interventions, and atrial fibrillation. A survey about childbearing attempts and complications during pregnancy was also performed during follow-up. Results: A total of 379 patients were involved in this study, consisting of 226 cases of mitral valve replacements, 107 cases of mitral valve repairs (MVrs), and 46 cases of PBMVs. PBMV was associated with higher possibilities of repeated MV interventions (P <0.05). Postoperative childbearing attempts were more frequently observed among bioprosthesis, MVr, and PBMV (P <0.05). However, PBMV and MVr showed a higher incidence of cardiac complications during pregnancy as compared to prosthesis replacement (P <0.05). Conclusions: MVr and PBMV are not recommended to young female patients for higher incidences of postoperative complications. Safe pregnancy is more likely to be present among patients with biological prosthesis.

BACKGROUND:This study aimed to investigate if surgery before pregnancy would result in better maternal and fetal outcomes in patients with congenital heart disease.METHODS:A retrospective study was conducted using data collected from the medical records of pregnant patients with congenital heart disease, who were seen at Beijing Anzhen Hospital between 2010 and 2019. The patients were divided into surgical and non-surgical groups, and the differences in outcomes were compared.RESULTS:A total of 999 patients with congenital heart disease (mean age, 28.7±4.3 years) were enrolled, with 403 (40.0%) and 596 (60.0%) in the surgical and non-surgical groups, respectively. The percentages of almost all adverse events were higher in the non-surgical group than in the surgical group. The adverse events included preterm delivery (9.9 vs. 17.1%), low birth weight (6.5 vs. 11.6%), heart failure (2.7 vs. 6.7%), cesarean section (75.7 vs. 85.9%), pulmonary hypertension (13.6 vs. 36.2%), and death (0.5 vs. 2.3%) (all P < 0.05). A total of 16 (1.6%) patients died, including 14 and two in the non-surgical and surgical groups, respectively. Regardless of the type of congenital heart disease, preterm delivery and low birth weight were more common in the non-surgical group compared with the surgical group, and there were no statistical between group differences in the other remaining events.CONCLUSIONS:In the non-surgical group, the results were similar regardless of the type of congenital heart disease, except for preterm delivery and low birth weight. The overall outcome of the surgical group was better than that of the non-surgical group, and surgery before pregnancy reduced maternal and infant risk.

Abstract Objective Previous studies have shown that knee arthritis is a disease influenced by environmental and genetic factors. In this paper, we mainly investigate the association between SNPs in the DVWA gene region and the susceptibility to KOA in north Chinese Han people. Methods We performed two-center cross-sectional observational study that included 103 Chinese Han patients with KOA and 128 healthy Chinese Han volunteers. We investigated four SNPs (rs11718863, rs7639618, rs7651842 and rs7639807) in the DVWA gene region and extracted the genes using QIAamp DNA Mini Kit. We amplified the target gene fragment and sequenced the genotype.The corresponding frequency were counted and the counting results were statistically analyzed. Results The patient group was significantly older than the control group, and the difference was statistically significant(P < 0.001). There were no statistically significance between-group differences in gender, height, weight, or BMI (P > 0.05, respectively). The chi-square test was used to analyze the four SNPs of DVWA gene, and rs11718863 and rs7639618 polymorphism was statistically different between the two groups(P = 0.04, P = 0.04, respectively). The rs11718863 and rs7639618 was consistent with Hardy-Weinberg equilibrium. Logistic regression analysis showed that KOA risk was significantly increased in the rs11718863 TT genotype (3.31, 95%CI 1.32, 8.34, P = 0.011) and the rs7639618 TT genotype (OR 2.86 ,95% CI 1.16, 7.04, P = 0.023). After age adjustment, the same result was observed in the rs11718863 SNP(OR 2.79, 95% CI 1.04, 7.43, P = 0.041), and the risk of KOA disappeared in the rs7639618 SNP (OR 1.50, 95% CI 0.79, 2.86, P = 0.217). The rs7651842 and rs7639807SNP were monomorphic for the T and C allele respectively. Conclusions We found that the rs11718863 SNP was associated with KOA. The TT genotype and T allele were the highest risk factors for the development of KOA in the north Chinese Han population.

Background: Pulmonary hypertension (PH) seriously affects the health of patients. We have found in clinical studies that PH has adverse effects on both maternal and offspring. Objective: To establish a animal model of PH induced by hypoxia/SU5416 and observe the effects of PH on pregnant mice and their fetuses. Methods: Twenty-four C57 mice aged 7-9 weeks were selected and divided into 4 groups with 6 mice in each group. ① Female mice with normal oxygen; ② Female mice with hypoxia/SU5416; ③ Pregnant mice with normal oxygen; ④ Pregnant mice with hypoxia/SU5416. After 19 days, weight, right ventricular systolic pressure (RVSP) and right ventricular hypertrophy index (RVHI) were compared in each group. Lung tissue and right ventricular blood were collected. The number and weight of fetal mice were also compared between the two pregnant groups. Results: There was no significant difference in RVSP and RVHI between female and pregnant mice under the same condition. Compared with normal oxygen condition, two groups of mice in hypoxia/SU5416 had poor development, RVSP and RVHI were significantly increased, the number of fetal mice was small, hypoplasia, degeneration and even abortion. Conclusion: The model of mice PH was successfully established. PH affects the development and health of female and pregnant mice, and seriously affects the fetuses. & COPY; 2023 Elsevier Inc. All rights reserved.

OBJECTIVES: Atrial functional mitral regurgitation (AFMR) in patients with heart failure with recovered ejection fraction has received insufficient attention. This study analysed the prognosis and outcomes of mitral valve (MV) repair combined with the Cox-maze procedure. METHODS: A prospective cohort study of patients with AFMR with left ventricular ejection fraction (LVEF) <40% was conducted. All patients received guideline-directed medical therapy. Those with recovered ejection fraction underwent MV repair combined with the Cox-maze procedure. Mortality, atrial fibrillation (AF) recurrence, mitral regurgitation (MR) and postoperative tricuspid regurgitation were assessed using the inverse probability weighting (IPW) method.RESULTS: In total, 312 patients were enrolled in this study between 2010 and 2019, 247 of whom underwent MV repair combined with the Cox-maze procedure [full recovery (LVEF > 50%): n =132, partial recovery (LVEF of 40-50%): n =115]. IPW-adjusted survival of patients with LVEF =50% and LVEF 40-50% showed no significant difference [hazard ratio (HR): 2.18, 95% confidence interval: 0.46-10.38, P = 0.33]. However, patients with LVEF =50% had better IPW-adjusted long-term freedom from recurrent MR [HR: 2.44 (1.28-4.63), P = 0.0065] and AF recurrence [HR: 1.85 (1.06-3.21), P = 0.030] than those with LVEF of 40-50%.CONCLUSIONS: MV repair combined with the Cox-maze procedure was effective and feasible in patients with severe AFMR with heart failure with recovered ejection fraction. Additionally, patients with LVEF =50% after guideline-directed medical therapy undergoing these combined procedures had better long-term freedom from recurrent AF and MR than those with LVEF of 40-50%.

Purpose: This study explored the sex differences in the outcomes of degenerative mitral valve repair (MVr).Methods: From 2010 to 2019, 1069 patients who underwent MVr due to degenerative mitral disease at Beijing Anzhen Hospital were analyzed. The average patient follow-up was 5.1 years (interquartile range: 5-7 years). The primary endpoint was overall survival. Secondary endpoints were freedom from reoperation and recurrent mitral regurgitation. A propensity-matched analysis was used to compare the outcomes of males and females.Results: Females were older, had a higher prevalence of atrial fibrillation and moderate-to-severe tricuspid regurgitation, and had smaller left atrial, left ventricular end-diastolic, and left ventricular end-systolic diameters. Males were more likely to undergo concomitant coronary artery bypass grafting and had longer cardiopulmonary bypass and aortic cross-clamp times. The in-hospital mortality was <1% (10/1,069). After propensity score match-ing of 331 pairs of patients, most variables were well balanced. Before and after propensity score matching, the long-term survival and freedom from reoperation rates were similar. Males had higher durability after surgery compared with females.Conclusions: Females were referred to surgery later and had more complications than males. Long-term survival and freedom from reoperation rates were not significantly dif-ferent between the sexes.

To evaluate the efficacy of nanohydroxyapatite/polyamide 66 (nHA/Pa66)-coated femoral stem prosthesis in total hip arthroplasty (THA) and the advantages of combined post-operative staged rehabilitation functional exercises (SRFE) in restoring hip function, 112 patients with femoral neck fractures were enrolled in the clinical study. Patients were randomized to routine and nHA/Pa66 groups. Patients in the nHA/Pa66 group were treated with nHA/Pa66-coated femoral stem prosthesis and the post-operative SRFE program. We evaluated the physical properties, cytotoxicity, and osteogenic capacity of nHA/Pa66 in an in vitro trial, and the clinical treatment, postoperative improvement in joint function (Barthel score, VAS score, Harris score), imaging performance, and incidence of adverse events were compared between groups. The porosity of nHA/Pa66 was ∼75% and its pore size was in the range of 300–500 μ m. Moreover, nHA/Pa66 had good biocompatibility and could improve bone marrow stem cells (BMSCs) activity and enhance the osteogenic function of BMSCs, effectively increasing the levels of COL I, ALP, and OCN. A combination of nHA/Pa66 and SRFE could effectively shorten hospital stay, better restore hip function, and reduce the incidence of complications. Therefore, nHA/Pa66-coated femoral stem prosthesis combined with SRFE showed great potential in THA for femoral neck fractures.

BACKGROUND:To explore the outcomes of mothers with Eisenmenger syndrome (ES) and their offspring. METHODS:Pregnant women with ES admitted to the Beijing Anzhen Hospital between 2010 and 2019 were retrospectively analyzed and followed up. RESULTS:Forty-two parturient women with ES were recruited, with an average age of 26.7 years (standard deviation [SD], ±4.0 years). The average gestational age was 33.7 weeks (SD, ±2.5 weeks). The average percutaneous oxygen saturation was 84.1 (±9.2), and 40 (95.2%) had caesarean delivery. The average pulmonary artery systolic pressure was 107.5 mmHg (SD, ±20.3 mmHg). Twelve (28.6%) women experienced pulmonary hypertensive crisis; 11 (26.2%) of these women died. Regarding the offspring, the average fetal weight was 1778.1 g (SD, ±555.3 g), six (14.3%) died, and congenital heart disease was diagnosed in three (7.1%). There were significant differences in age, gestational age, percutaneous oxygen saturation, Apgar score, and heart failure between the maternal death and non-death groups (P < 0.05). Death was mainly related to pulmonary hypertensive crisis and heart failure. CONCLUSIONS:We recommend pregnancy termination if ES occurs during early pregnancy; however, patients should be informed of the risks if it occurs during late pregnancy. Multidisciplinary cooperation should be strengthened to improve the prognosis of the mothers and their offspring.

PURPOSE:We aimed to compare the efficacy of radiofrequency ablation (RFA) in patients undergoing mitral valve (MV) surgery with or without giant left atria.METHODS:This retrospective, single-center, cohort study investigated patients who underwent MV surgery and concomitant RFA from 2009 to 2019. Patients were divided into non-giant left atria (diameter ≤65 mm, n = 1543) and giant left atria (diameter >65 mm, n = 241) groups. Five-year freedom from atrial tachyarrhythmia recurrence and thromboembolic event (TE) rates were assessed with death as the competing risk factor with and without propensity-score matching.RESULTS:Patients with giant left atria had higher mortality (10.8% versus 6.2%, P = 0.008) and readmission rates for heart failure than those without (12.0% versus 6.8%, P = 0.004). Atrial tachyarrhythmia recurrence rates were higher in patients with giant left atria than in those without (49% versus 24% at 5 years, P <0.001), but the cumulative incidence of TEs before (P = 0.944) and after (P = 0.695) propensity-score matching was comparable.CONCLUSIONS:RFA effectively prevented TEs in patients with giant left atria, despite significant atrial tachyarrhythmia recurrence. Atrial tachyarrhythmia recurrence did not increase the risk of TEs. A lower success rate should be considered when deciding whether to perform surgical ablation in patients with giant left atria.

Objective To conduct a comparative analysis of the complications and outcomes in pregnant women with and without congenital heart disease (CHD) in Beijing, China. Methods We compared pregnancy-related complications and outcomes experienced by women with and without CHD throughout 19,424 deliveries in Beijing Anzhen Hospital between 2010 and 2019, including cardiovascular and obstetric factors, fetal events, delivery methods, and other complications over a mean 5-years post-delivery follow-up period. Results There were 1,040 women with CHD (5.35% of all deliveries). Compared to women without CHD, these women had longer hospital stays (7.83 ± 4.65 vs. 4.93 ± 3.26 days) and a higher death rate (1.92 vs. 0.02%). They also had a greater risk of comorbidities, including pre-term delivery (odds ratio: 13.65 vs. 6.71), heart failure (odds ratio: 4.90 vs. 0.40), and arrhythmia (odds ratio 12.69 vs. 4.69). Pulmonary hypertension, New York Heart Association functional class III~IV, and no congenital heart disease surgery prior to pregnancy were associated with adverse events such as cesarean section, pre-term delivery, and heart failure. The fetuses of mothers with CHD were more likely to be born pre-term (odds ratio: 13.65 vs. 6.71) and have low birth weight (odds ratio: 8.56 vs. 4.36). Eleven infants (1.82%) born to mothers with CHD and four infants (0.64%) born to mothers without CHD were diagnosed with CHD. Conclusions Women with CHD generally increase maternal and infant risk during pregnancy and the perinatal period. Pulmonary hypertension, decrease in cardiac function, and no previous CHD surgery increase the risk in women with CHD. Greater attention should be paid to pregnant women with CHD and their fetuses, newborns.

AbstractAs pulmonary arterial hypertension associated with congenital heart disease (PAH‐CHD) may increase maternal and fetal risk, this study explored the pregnancy outcomes of Chinese women with PAH‐CHD. The clinical data of pregnant women with PAH‐CHD admitted to the Beijing Anzhen Hospital from 2010 to 2019 were retrospectively analyzed; these patients and their offspring were followed up, with a mean period of 5.9 ± 2.7 years. Overall, 260 patients with PAH‐CHD were included. The mean maternal age was 27.7 ± 4.1 years, and 205 (78.8%) patients were nulliparous. The estimated systolic pulmonary artery pressure was 40–50 mmHg in 34.6% of the patients, 50–70 mmHg in 23.1%, and >70 mmHg in 42.3%. More than 96% of patients were diagnosed with PAH‐CHD before pregnancy. During pregnancy, heart failure occurred in 19.2% of the patients. Cesarean delivery was performed in 88.1% (15.0% emergency) of the patients. Complications included fetal distress (5.8%), preterm delivery (34.2%), and low birth weight (33.8%). A total of 15 mothers (5.8%) died, with the highest mortality rate in those with Eisenmenger syndrome (10/43, 23.3%), and 10 offspring died (3.8%), two (0.8%) following hospital discharge and eight (3.1%) while in hospital. Although most pregnant women with PAH‐CHD were able to have children, PAH increased the maternal and fetal risk. Thus, an individualized risk‐based approach with shared decision‐making may be more appropriate in pregnant women with PAH‐CHD.

Objective: To investigate whether it is better to have surgery before pregnancy for pregnant women with congenital heart disease (CHD). Methods: Patients with CHD in Beijing Anzhen Hospital from 2010 to 2019 were collected and divided into surgical and non-surgical group, and the differences of events between the two groups were compared. Results: A total of 999 patients with CHD (mean age, 28.7±4.3years) were collected, including 403 cases (40.0%) in the surgical group and 596 cases (60.0%) in the non-surgical group. The most common CHD was atrial septal defect(33.1%), followed by ventricular septal defect (26.9 %), patent ductus arteriosus (9.9 %), and Tetralogy of Fallot (6.9 %). There were significant statistical differences in region, education degree and gravidity (P＜0.05), and the percentage of almost all events in the surgical group was higher. Pre-term delivery (17.1 vs. 9.9), low birth weight (11.6 vs. 6.5), heart failure (6.7 vs. 2.7), cesarean section (85.9 vs. 75.7), pulmonary arterial hypertension (36.2 vs. 13.6), Eisenmenger syndrome (9.7 vs. 0.2), and death (2.3 vs. 0.5) had statistically significant (P＜0.05). A total of 16 (1.6%) patients died, 14 (87.5%) in the surgical group, more than 2 (12.5%) in the non-surgical group. Conclusions: The outcome of surgical group was better than that of non-surgical group, surgery before pregnancy can reduce maternal and infant risk.

Objective:This study aims to explore the application value of quantitatively evaluating and comparing the elastic modulus of shoulder girdle muscles between healthy adults and patients with scapular dyskinesis by using shear wave elastography (SWE).Methods:A case-control study was conducted. From Mar 2019 to Sep 2019, 33 patients (33 shoulders) with scapular dyskinesis(SD) including 10 males and 23 females aged 35 to 71 years from China Rehabilitation Research Center were selected into SD group. In the same period, 32 healthy volunteers (61 shoulders) including 10 males and 22 females aged from 22 to 74 years were also recruited as control group. Thickness, shear wave velocity of upper trapezius (UT), levator scapulae (LS), middle trapezius (MT), rhomboid (RM), lower trapezius (LT), and serratus anterior (SA) were measured with 2-D ultrasound and SWE. Elastic modulus was calculated. Thickness and elastic modulus of shoulder girdle muscles were compared between SD and control groups, and the effects of age and sex on thickness and elastic modulus of shoulder girdle muscles were analyzed.Results:Patients with SD had higher elastic modulus of UT, UT/MT, UT/LT(44.42±29.17) kPa (1 mmHg=0.133 kPa), 1.59±0.56, and 1.56±0.63 than healthy adults (31.00±12.68) kPa, 1.30±0.30, and 1.30±0.30, but had lower thickness of LS (0.40±0.11) cm than healthy adults (0.47±0.17) cm, and the differences were statistically significant (all P values < 0.05). The elastic modulus of RM in young patients with SD (31.14±3.93 )kPa was higher than that of young healthy adults (23.30±8.24) kPa. The UT/SA in middle-aged patients with SD (1.57±0.38) was greater than that of middle-aged healthy adults (1.30±0.33). Moreover, the UT/MT, the elastic modulus of UT, LS, and SA in elderly patients with SD [1.81±0.68, (53.59±36.99) kPa, (36.54±11.41) kPa, (18.51±8.05) kPa] were greater than those of elderly healthy adults [1.40±0.39, (32.01±11.93) kPa, (28.82±9.42) kPa, (13.04±7.23) kPa]. The differences were statistically significant (all P values<0.05). Among the 32 healthy adults and 33 patients with SD, SA was significantly thicker in males [(0.82±0.24) cm and (0.80±0.17) cm] than in females[ (0.63±0.15) cm and (0.69±0.17 )cm]. Furthermore, the elastic modulus of UT was greater in females[(32.91±13.87) kPa than in males (26.77±8.37) kPa], and the difference was statistically significant (all P values<0.05). Among the 32 healthy adults, SA thickness, elastic modulus of LT, and SA were negatively associated with age ( r=-0.334, -0.416, -0.431). UT/LT and UT/SA were positively associated with age ( r=0.317, 0.300). Among the 33 patients with SD, UT/MT and elastic modulus of LS were positively associated with age ( r=0.410, 0.399). However, the elastic modulus of RM was negatively associated with age ( r=-0.317, -0.300), and the difference was statistically significant (all P values<0.05). Conclusions:SWE can be used to quantify the elastic modulus of shoulder girdle muscles and can reflect the characteristics of imbalance of scapular muscle couple in patients with SD. This work provides certain guiding significance for prevention, early diagnosis, and precision rehabilitation of SD.