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Biomedical subjects

Shu-Hsun Chu

Publications and source records attributed to Shu-Hsun Chu.

49 records · Page 3Linked to original sources
PubMed2003

Non-transplant cardiac surgery for end-stage dilated cardiomyopathy in small children.

Between October 1997 and December 2000, a total of 7 pediatric patients with end-stage dilated cardiomyopathy (DCM) were referred to our service for heart transplantation; non-transplant cardiac surgery was offered as a biologic bridge. Two patients died before surgery and the in-hospital surgical mortality rate was 50%: 75% in 4 patients who received emergency surgery and 0% in 2 patients who received urgent surgery. Non-transplant cardiac surgery improved clinical outcome and acted as a biologic bridge, instead of a mechanical bridge, to heart transplantation in small children with DCM and severe heart failure.

Cardiac Surgical Procedures↗
PubMed2003

Orthotopic heart transplantation in a child with severe heart failure and chylous ascites.

We report a case of a heart transplantation in a 12-year-old girl 9 years after extensive lung resection and adjuvant chemo- and radiotherapy for intra-thoracic embryonic rhabdomyosarcoma. She had restrictive cardiomyopathy with severe heart failure and chylous ascites. She was treated successfully with orthotopic heart transplantation and her symptoms of chylous ascites subsided gradually after transplantation. Her abdominal girth decreased from 79 cm before the transplant to 53 cm 9 months after the transplant.

Chemotherapy, Adjuvant↗
PubMed2003

Soluble inflammatory markers in coronary sinus and peripheral blood of heart transplant recipients.

Cardiac allograft rejection is a focal inflammation and soluble markers are released into coronary sinus (CS). We investigated whether plasma-soluble markers in CS is better to predict the clinical status of transplant recipients than in peripheral blood (PB). Between February 1998 and January 2001, 51 patients admitted for endomyocardial biopsy were included. The clinical events of the transplant recipient were recorded as: early post-transplant, long-term uneventful status, infection, acute rejection and transplant coronary artery disease. The plasma levels of interleukin-2 (IL-2), tumor necrosis factor-alpha (TNF-alpha), ICAM-1, P-selectin, high-sensitive C-reactive protein (CRP) and troponin-I of CS and PB were determined. There were 71 blood samples. In patients within 1 month after heart transplant, there was a higher level of P-selectin, ICAM-1, CRP and troponin-I in CS and PB. In patients with infection, there was a higher level of all soluble markers except IL-2 in CS and PB. Patients with a long-term uneventful status had a lower level of CRP in PB but not in CS. Patients with acute rejection had a higher level of IL-2 in PB but not in CS. Patients with transplant coronary artery disease had a higher level of TNF-alpha in PB but not in CS. Soluble markers in CS failed to predict the occurrence of acute or chronic rejections.

Biomarkers↗
PubMed2003

Growth of human endothelial cells on different concentrations of Gly-Arg-Gly-Asp grafted chitosan surface.

To improve the adhesion and growth of endothelial cells on chitosan, different concentrations of cell adhesive peptide, Gly-Arg-Gly-Asp (GRGD), were photochemically grafted to its surface. After different concentrations of GRGD-SANPAH (N-Succinimidyl-6-4'-azido-2'-nitrophenylamino]-hexanoate) solutions were formed, they were grafted to chitosan surfaces by performing surface adsorption of the peptide solutions and subsequent ultraviolet (UV) irradiation to induce photoreaction. The grafted efficiency for GRGD peptide to chitosan surface was higher than 80%, as semiquantitatively analyzed by a high performance liquid chromatography (HPLC). FTIR spectra and electron spectroscopy for chemical analysis (ESCA) also confirmed that GRGD was successfully grafted to form chitosan-GRGD surfaces. For example, the composition fraction of nitrogen (N1s) for chitosan-GRGD surface grafted at 0.05 M GRGD was 6.8% instead of 3.2% for chitosan only. Human umbilical vein endothelial cells (HUVECs) adhered well and grew on different GRGD grafted concentrations of chitosan-GRGD surfaces after 36 hrs of incubation, but not on the chitosan surface. Furthermore, viability for the growth of HUVECs was increased with an increase in initial concentration of GRGD grafted chitosan-GRGD surfaces analyzed by MTT assay. In conclusion, an increased concentration of GRGD grafted on the chitosan-GRGD surface leads to more HUVECs adhered and grown on the surface.

Biopolymers↗
PubMed2002

Shear stress-induced aggregation of oxidized platelets.

Although shear stress-induced platelet aggregation (SIPA) has been noted, the shear stress-induced aggregation of oxidized platelets (SIOPA) has not been investigated. To investigate SIOPA, small quantity of hemoglobin (Hb) solution was first added to plasma to induce oxidation stress of platelets and then the plasma was sheared by a cone/plate viscometer at shear stress of 66 dyn/cm2. In addition, to investigate the change in expression of the membrane receptors of glycoprotein Ib (GpIb) for oxidized platelets, mean fluorescence intensity (MFI) for those platelets was detected by flow cytometric technique. The results showed that the level of the oxidation stress of platelets, as presented in malondialdehyde (MDA) values, was well correlated with the quantities of added Hb. Moreover, the aggregation of SIOPA corresponded with the levels of oxidation stress of platelets. Platelets pretreated with aspirin could only partially reduce the aggregation of SIOPA. Similarly, aspirin pretreatment could partially reduce the lowering of MFI value that indicated downexpression of GpIb receptors. Furthermore, the aggregations of SIOPA corresponded with the lowered percentage of those MFI values for studied cases. We thereby suggested that the aggregation of SIOPA is related to both the level of oxidation stress and the downexpression of GpIb receptors for oxidized platelets.

Aspirin↗
PubMed2002

Growth of human endothelial cells on photochemically grafted Gly-Arg-Gly-Asp (GRGD) chitosans.

To improve ECs adhesion and growth on chitosan, cell adhesive peptide Gly-Arg-Gly-Asp (GRGD) was photochemically grafted to its surface. Grafting 0.025 M of GRGD-SANPAH (N-Succinimidyl-6-[4'-azido-2'-nitrophenylamino]-hexanoate) solutions to chitosan and tripolyphosphate anhydrous crosslinked chitosan (chitosan-TPP) surfaces was performed by surface adsorption of the peptide and subsequent ultraviolet (UV) irradiation for photoreaction. FTIR spectra and electron spectroscopy for chemical analysis (ESCA) confirmed that GRGD was successfully grafted to form chitosan-GRGD surfaces (e.g., the composition fraction of nitrogen (N(1s)) for chitosan-GRGD surface was 5.2% instead of 3.2% for chitosan only). Moreover, the grafting efficiencies for 0.025 M of GRGD to chitosan and chitosan-TPP surfaces were about 83% and 53%, semi-quantitatively analyzed by an HPLC. Human umbilical vein ECs were well adhered and grew on chitosan-GRGD and chitosan-TPP-GRGD surfaces after 36 h of incubation but not chitosan and chitosan-TPP ones. Moreover, the viability for the growth of ECs on the chitosan-GRGD and chitosan-TPP-GRGD surfaces analyzed by MTT assay also confirmed the efficacy of the GRGD immobilization. In conclusion, the chitosan-GRGD and chitosan-TPP-GRGD surfaces were prepared by a photochemical technique that could enhance the adhesion and growth of ECs on those surfaces for further applications for tissue engineering.

Biocompatible Materials↗
PubMed2002

Increased dispersion of ventricular repolarization during head-up tilt test late after orthotopic heart transplantation in humans.

Sympathetic reinnervation after heart transplantation may be regionally heterogeneous. It remains undetermined if such heterogeneous reinnervation will result in increased ventricular repolarization dispersion. To determine the changes of ventricular repolarization after transplantation, a 15-minute, 80-degree head-up tilt test was prospectively performed with isoproterenol provocation in 30 patients who were studied within 5 months after transplantation (early group) and 30 patients who were studied > or =12 months (late group). Holter monitor was initiated to evaluate heart rate variability, which was a surrogate of cardiac reinnervation. JT dispersion was defined as the difference between maximal and minimal JT interval measurements occurring among any of the 12 leads on a standard electrocardiogram. No subject had fewer than nine measurable leads. Compared with patients in the early group, the patients in the late group had higher low frequency activity, indicating partial sympathetic reinnervation. Analysis of the electrocardiogram showed that there were significant differences in the corrected JT dispersion in the late group compared with the early group and controls (74+/-18 vs 56+/-15 and 55+/-14 ms, both P <0.05) during isoproterenol infusion. Head-up tilt test is a useful tool to unmask the increased dispersion of ventricular repolarization, particularly during states of isoproterenol infusion. Early after cardiac transplantation, neither postural changes nor isoproterenol infusion caused a significant increase of corrected JT dispersion. Late after transplantation, heterogeneous sympathetic reinnervation may result in increased corrected JT dispersion. However, whether increased dispersion of ventricular repolarization is related to cardiac death late after operation warrants further investigation in a large and long-term trial.

Adult↗
PubMed2002

Surgical treatment for primary infected aneurysm of the descending thoracic aorta, abdominal aorta, and iliac arteries.

OBJECTIVE AND METHOD: In this retrospective review, we report the surgical results of infected aortic aneurysms treated at a single center over 5 years. RESULTS: From October 1996 to October 2001, 19 patients with infected aortic aneurysm were treated with surgery, nine with suprarenal infections (four proximal descending thoracic aortic aneurysms, two distal descending thoracic aortic aneurysms, and three suprarenal abdominal aortic aneurysms) and 10 with infrarenal infections (eight infrarenal abdominal aortic aneurysms and two iliac artery aneurysms). All had a positive blood or tissue culture; 89% were febrile, 89% had leukocytosis, and 32% were hemodynamically unstable. The most common responsible pathogens were Salmonella organisms (74%) followed by Streptococcus species (11%). Nine of 10 infrarenal infections were caused by Salmonella organisms. Both infrarenal and suprarenal infections were treated with wide débridement of infected aorta, in situ prosthetic graft or patch repair, and prolonged intravenous antibiotics. Hospital survival rate was 95%: 100% for infrarenal and 89% for suprarenal infections. There was no perioperative intestinal ischemia or perioperative limb loss. Acute renal failure occurred in two patients with suprarenal infection. Late deaths have occurred in three patients with one early graft infection (5%) resulting in the only one in-hospital death at 4 months. Sixteen patients remain alive at mean follow-up of 17.8 months (range, 4-47 months). There have been no late aortic or graft infections. During the same period, there were five unoperated patients, four of whom died of shock during hospitalization. CONCLUSIONS: Infected aortic aneurysm is common in Taiwan, and Salmonella species were the most common responsible microorganisms. With surgical intervention and prolonged intravenous antibiotics, in situ graft replacement provided a good outcome. The incidence of prosthetic graft infection was low, even in patients with infections due to Salmonella species and with in situ graft replacement.

Aged↗
PubMed2002

Nontransplant cardiac surgery as a bridge to heart transplantation in pediatric dilated cardiomyopathy.

Partial left ventriculectomy and mitral valve repair, alone or in combination, have been used successfully to treat adult patients with end-stage dilated cardiomyopathy, yet the clinical results of this procedure in small children have been described only rarely. We report 2 cases of nontransplant cardiac surgery in small children with end-stage dilated cardiomyopathy The 1st patient received both a partial left ventriculectomy and mitral valve repair; the 2nd received only mitral valve repair. Subsequently, both underwent successful heart transplantation. We believe that nontransplant cardiac surgery can improve clinical status and act as a biological bridge, instead of a mechanical bridge, to heart transplantation in small children with end-stage dilated cardiomyopathy.

Cardiac Surgical Procedures↗
PubMed2002

Determinants of successful surgical revascularization for failed angioplasty in patients with acute myocardial infarction and cardiogenic shock.

BACKGROUND AND PURPOSE: Previous studies have reported encouraging results with percutaneous transluminal coronary angioplasty (PTCA) in patients with acute myocardial infarction (AMI) and cardiogenic shock (CS). However, PTCA fails in many patients and the mortality rate associated with the procedure is very high. This study sought to assess the determinants of successful coronary artery bypass grafting (CABG) in patients with AMI, CS and failed PTCA. MATERIALS AND METHODS: From April 1997 to May 2001, 33 patients with a mean age of 62.9 +/- 10.5 years underwent CABG for AMI, CS and failed PTCA. PTCA failed or was not attempted because of primary failure in 13 patients, reocclusion in three, no-reflow in one, and multivessel disease in 18. Patients were initially stabilized with inotropic infusion and mechanical circulatory support. Before June 2000, patients underwent conventional CABG, while after June 2000, patients underwent beating heart CABG. Risk factor analysis was performed using retrospective chart review. RESULTS: The overall in-hospital mortality rate was 30.3%-33.3% in 24 patients who underwent conventional CABG and 22.2% in nine patients who underwent beating heart CABG. Risk factors for death were unstable hemodynamics (p < 0.001), non-right coronary artery as the infarct-related artery (IRA) (p = 0.012), high inotropic dose (p = 0.013), intubation (p = 0.021), cardiopulmonary resuscitation (p = 0.021), and early bypass (p = 0.050). CONCLUSIONS: CABG was associated with a high in-hospital mortality rate in patients with AMI, CS and failed PTCA. Patients with unstable hemodynamics and high inotropic dose before surgery had the worst survival rate.

Acute Disease↗
PubMedDate not supplied

Extracorporeal membrane oxygenation for perioperative cardiac allograft failure.

The utility of mechanical support in pretransplant stabilization and postcardiotomy shock is well established, but its use in perioperative cardiac allograft failure (PCAGF) rescue has not been well documented. Ventricular assist devices (VADs) have been applied to PCAGF rescue with acceptable results. However, studies have not described the results of using extracorporeal membrane oxygenation (ECMO) in PCAGF. We evaluated the outcome of PCAGF rescue with ECMO. A retrospective review of 204 consecutive heart transplants revealed 19 cases of PCAGF requiring ECMO rescue. Donor-, surgery- and ECMO-related variables were evaluated for association with operative mortality, success of weaning, and survival rate. Transplant recipients included 14 males and 5 females with median age of 44.2 years. Weaning rate was 84.2% and survival rate was 52.6%, with duration of ECMO support 157 +/- 129 hours. Long ischemic time is a PCAGF risk factor (206.8 +/- 96.1 minutes vs. 158.3 +/- 60.8 minutes in non-PCAGF, p < 0.05). PCAGF etiology included primary graft failure (n = 7); right heart failure secondary to pulmonary hypertension, coagulopathy/intraoperative hemorrhage (n = 7); and sepsis (n = 2). Compared with data from VAD-supported PCAGF, ECMO had a better weaning and graft survival rates (p < 0.05). ECMO is another choice for PCAGF rescue. It has an acceptable survival rate and may be considered instead of VADs as a first-line rescue for PCAGF.

Adult↗
PubMedDate not supplied

Hybrid angioplasty for left pulmonary artery stenosis after total correction of tetralogy of Fallot: report of one case.

Pulmonary artery stenosis is common in tetralogy of Fallot. Surgical correction usually achieves good results. For those patients undergoing total correction with residual pulmonary artery stenosis, percutaneous transluminal angioplasty (PTA) plays an important role. However, this might not be possible for complex anatomies. We report a 19-month-old boy who underwent total correction of tetralogy of Fallot at 1 year of age. He developed main pulmonary artery (MPA) aneurysm and left pulmonary artery (LPA) stenosis 4 months after the operation. PTA was attempted, but the guidewire failed to thread into the LPA due to the dilated MPA and tiny LPA ostium. A hybrid approach consisting of left anterior small thoracotomy and balloon angioplasty via the introducer sheath in the MPA was proposed. Rapid access to the LPA and successful balloon angioplasty followed by stenting concluded the hybrid intervention. Such intervention is a good alternative to treat this complex anatomy.

Angioplasty, Balloon↗