Preliminary Study Of Circulating Circular RNA Hsa C Irc 0 029642 And Pulmonary Hypertension In Adults With Congenital Heart Disease

Objectives:With the development of medical technology,the patients with congenital heart diseases（CHD）survived to adulthood increased obviously.Although we can diagnose these diseases early and the technology for the treatment of heart structure disorders is in progress,the patients with congenital heart diseases related pulmonary hypertension still constantly increased.Patients without surgery suffer from pulmonary hypertension which is mainly due to the increased lung blood flow and shear force led to lung vascular reconstruction.10%-11% of adult patients with congenital heart diseases suffer from pulmonary hypertension.The pathophysiology of congenital heart diseases is different due to defect size,reflux size and the state of right ventricle,so that the causes of pulmonary hypertension are also distinguished.The patients with pulmonary hypertension for surgery often depend on the degree of pulmonary hypertension and the reversible conditions.Thus,early diagnosis,assessment and treatment of pulmonary hypertension are very significant.The right heart catheter test is the gold standard among the existing diagnosis of pulmonary hypertension.Other detections include chest ultrasound,lung perfusion scan and Serological markers such as BNP.However,all methods are lack of unified and effective defined standard.Therefore,it is very meaningful to search for novel serum markers of pulmonary hypertension.Circular RNA（circular RNA,Circ RNA）is a non-coding RNA.It widely exists in cells and it has the structure of closed ring which is more stable and less vulnerable to effects of RNA exonuclease.The circular RNA participates in a variety of disease processes and it is possible for the Circ RNA to become the potential disease markers.We queried the database and found a circular RNA as the trial’s object which is associated with cell proliferation（hsa_circ₀029642）.We further investigate whether it has significant correlation with congenital heart diseases with pulmonary hypertension.Discuss its potential to become serum markers of pulmonary hypertension.Methods:First,we collected patients admitted in Xinqiao hospital for congenital heart surgery from March 2016 to July 2016.The patients with pulmonary hypertension,without pulmonary hypertension and patients with rheumatic heart disease with pulmonary hypertension were included and divided into 3 groups which included 20 cases respectively.The serums were collected from patients.Second,total RNA was extracted after the removal of DNA in the serum for quality inspection.Third,the reverse transcription reaction was done to get the corresponding c DNA.Fourth,real-time fluorescence quantitative PCR reaction was used to obtain corresponding CT values,calculate RQ value for comparison.Results: The quality of total RNA in each group was good.Compared with the congenital heart diseases without pulmonary hypertension patients,the relative expression quantity of hsa_circ₀029642 in the serum of congenital heart diseases with pulmonary hypertension and rheumatic heart diseases with pulmonary hypertension was decreased（P=0.011,P<0.05）.Compared with the congenital heart diseases with pulmonary hypertension patients,the Relative Quantification of hsa_circ₀029642 in the serum of rheumatic heart diseases with pulmonary hypertension had no significant difference（P=0.690,P>0.05）.ROC curve showed the area under the curve and AUC=0.752 P=0.002 95%CI（0.624,0.884）.Conclusions:1.The correlation of Circular RNA hsa_circ₀029642 with pulmonary hypertensioan has not yet been reported.Through bioinformatics analysis,we found Circular RNA hsa_circ₀029642 had a correlation with CRYLI,which participated in the regulation of pulmonary vasculature endothelial cells’ proliferation.In our study we successfully detected hsa_circ₀029642 in the serum of both congenital heart diseases patients and rheumatic heart diseases patients with pulmonary hypertension.2.Compared with the congenital heart diseases without pulmonary hypertension patients,the relative expression quantity of hsa_circ₀029642 in the serum of congenital heart diseases with pulmonary hypertension and rheumatic heart diseases with pulmonary hypertension was decreased（P=0.011,P<0.05）.That demonstrates hsa_circ₀029642 has some correlation with the formation of pulmonary hypertension.Objectives:To summarize and analyze the clinical experience of reoperation of tricuspid valve replacement for secondary tricuspid regurgitation in thirteen cases.Methods:Analyzing the clinical data of reoperation of tricuspid valve replacement for csecondary ticuspid regurgitation in 13 cases from February 2013 to February 2017 in Xinqiao Hospital of Third Military Medical University.Among them,8 patients with rheumatic heart disease underwent valve replacement,3 patients with congenital heart disease underwent operation.,and 1 patient with traumatic valve insufficiency underwent tricuspid annuloplasty（TAP）.When they were readmitted to the hospital,12 patients have valve insufficiency and 1 patient has valve stenosis and insufficiency.Clinical data including the causes and operation methods of the primary operation,preoperative complications,New York Heart Association function（NYHA）,methods of reoperation,Preoperative cardiac ultrasound parameters,Intraoperative blood transfusion,the results of postoperative liver and kidney function,postoperative albumin infusion quantity,postoperative blood transfusion volume,postoperative drainage volume,postoperative complications,postoperative ultrasonographic findings,postoperative mortality rate,and telephone follow-up results.Results:Of the 13 patients,12 were female and 1 was male,aging from 12 to 66 years old（43.9 ± 13.9）.The interval between the two operations is 1-28 years,with an average of 14.5 ± 8.2 years.The preoperative complications include 9 cases of atrial fibrillation,5 cases of hepatic congestion,4 cases of pulmonary hypertension,2 cases of ascites,1 cases of coronary heart disease,1 cases of pulmonary congestion,and 1 cases of pleural effusion.There were 9 cases underwent Isolated valve replacement,2 cases underwent mitral valve and aortic valve replacement,1 case underwent aortic valve replacement.The operative approaches were through a median re-sternotomy and all the prosthetic volves were biological valves.One patient had Renal function deterioration and low cardiac output syndrome（LCOS）and died four days after operation.The postoperative complications include 3 cases of pleural effusion needing thoracic puncture drainage,1 case of pneumothorax needing closed thoracic drainage,4 cases of atrioventricular block（AVB）needing temporary pacemaker with appearing time of 1、2、5 and 10 days respectively.Duodenal ulcer bleeding occurred in 1 patients 10 days after the operation,and needed hemostasis by electrocoagulation and titanium clip under endoscope.Mild hyponatremia occurred in 7 patients,ranging from 3-15 days after the operation.The residual tricuspid regurgitation occurred in 3 patients with the reverse flow area of 0.7、2.4、7.4cm2 respectively.There were 2 cases reoccurred tricuspid regurgitation 13 and 26 days after operation respectively with the regurgitation area of 1.1、8.2cm2.Echocardiography was performed 7 days after the operation,and the right atrium of the patients was significantly decreased than that before operation（P < 0.05）.The discharged patients were followed up for 5-34 months,there is no readmitted one due to valve dysfunction,no structural valvular deterioration,and no hemorrhagic or thromboembolic events.Conclusions:Secondary tricuspid insufficiency is often associative with rheumatic heart disease and congenital heart disease.The patients are often accompanied by a variety of complications.Tricuspid valve replacement for secondary tricuspid insufficiency through a median re-sternotomy is effective for correcting the dysfunction of the tricuspid valve.However,this operation has longer operative times,and greater intraoperative blood loss,with more blood transfusion,more drainage,more postoperative complications.It will cause higher mortality rate.So reoperation of TVR for secondary tricuspid insufficiency should be teated with caution.We should strictly control the indication,evaluate the overall condition of the patients comprehensively,and prevent complications after the operation.