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Background: We aimed to investigate risk factors of LCOS following pericardiectomy. Methods: This was a retrospective study of patients undergoing pericardiectomy at three hospitals between January 1994 and May 2021. Results: A total of 826 patients were divided into two groups: group with LCOS (N = 126) and group without LCOS (N = 700). The incidence of postoperative LCOS was 15.3%. There were 66 operative deaths (8.0%). Univariable and multivariable analyses showed that factors are associated with LCOS, including postoperative LVEDD (P < 0.001), preoperative LVEDD (P < 0.001), time between symptoms and surgery (P < 0.001), thickness of pericardium (P < 0.001), intubation time (P = 0.002), hospitalized time postoperative (P < 0.001), preoperative central venous pressure (P = 0.016), postoperative central venous pressure (P = 0.034), D0 fluid balance (P = 0.019), D2 fluid balance (P = 0.017), postoperative chest drainage (P < 0.001), surgical duration (P < 0.001), bleeding during operation (P = 0.001), serum creatinine 24h after surgery (P < 0.001), serum creatinine 48h after surgery (P = 0.017), fresh-frozen plasma (P = 0.005), packed red cells (P = 0.006), and tuberculosis pericarditis (P = 0.026). Conclusion: In our study, incomplete pericardial dissection, fluid overload, delayed diagnosis and treatment, and tuberculosis pericarditis are associated with LCOS following pericardiectomy.

Background: We aimed to investigate risk factors of early mortality following pericardiectomy. Methods: This was a retrospective study of patients undergoing pericardiectomy between January 1994 and May 2021 at The People’s Hospital of Guangxi Zhuang Autonomous Region, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, and The People’s Hospital of Liuzhou City. Results: This study included 826 patients, who were divided into two groups: group with operative deaths (N = 66) and group without operative deaths (N = 760). There were 66 operative deaths (66/826, 8.0%). The causes of operative deaths were multiorgan failure (86/826, 10.4%). Preoperative CVP (P < 0.001), chest drainage (P < 0.001), surgical duration (P < 0.001), fluid balance postoperative day D2 (P < 0.001), and tuberculosis pericarditis (P = 0.001) in group with operative deaths were significantly higher than those in group without operative deaths. Univariate and multivariate analyses showed that factors associated with operative deaths include male (P < 0.001), age (P < 0.001), ICU retention time (P < 0.001), postoperative hospitalization time (P < 0.001), preoperative central venous pressure (P = 0.018), postoperative central venous pressure (P < 0.001), D0 fluid balance (P < 0.001), D2 fluid balance (P < 0.001), postoperative chest drainage (P = 0.029), surgical duration (P = 0.003), serum creatinine baseline (P = 0.002), serum creatinine 24h after surgery (P < 0.001), serum creatinine 48h after surgery (P < 0.001), blood lactate (P < 0.001), and tuberculosis pericarditis (P = 0.033). Conclusion: In our study, incomplete pericardial dissection, fluid overload, and tuberculosis pericarditis are associated with operative deaths following pericardiectomy.

Background We aimed to investigate risk factors of multiorgan failure following pericardiectomy. Methods This was a retrospective study of patients undergoing pericardiectomy between January 1994 and May 2021 at three hospitals. Results 826 patients were included in the study and divided into two groups: group with multiorgan failure (n = 86) and group without multiorgan failure (n = 740). There were 86 patients with multiorgan failure (86/826, 10.4%). There were 66 operative deaths (66/826, 8.0%). The causes of operative deaths were multiorgan failure, including cardiogenic shock + AKI + ventricular fibrillation (13/66), cardiogenic shock + AKI (35/66), cardiogenic shock + AKI + hepatic failure + septicemia (8/66), cardiogenic shock + AKI + respiratory failure (10/66). Univariate and multivariate analyses showed the factors associated with multiorgan failure, including male (P = 0.006), time between symptoms and surgery (P P P P P P P P P P P P P P P = 0.042), serum creatinine 48 h after surgery (P P P P Conclusion In our study, incomplete pericardial dissection, fluid overload, delayed diagnosis and treatment are associated with multiorgan failure following pericardiectomy.

Background and Objective. Fatigue is a subjective symptom which is hard to quantify, it is prevalent in the subhealth and disease population, and there is still no accurate and stable method to distinguish disease fatigue from subhealth fatigue. Tongue diagnosis and pulse diagnosis are the reflection of the overall state of the body, and the modern research of tongue diagnosis and pulse diagnosis has made great progress. This study aims to explore the distribution rules of tongue and pulse data in a disease fatigue and subhealth fatigue population and evaluate the contribution rate of tongue and pulse data to fatigue diagnosis through modeling. Methods. The Tongue and Face Diagnosis Analysis-1 instrument and Pulse Diagnosis Analysis-1 instrument were used to collect the tongue image and sphygmogram of the subhealth fatigue population (n = 252) and disease fatigue population (n = 1160), and we mainly analyzed the tongue and pulse characteristics and constructed the classification model by using the logistic regression method. Results. The results showed that subhealth fatigue people and disease fatigue people had different characteristics of tongue and pulse, and the logistic regression model based on tongue and pulse data had a good classification effect. The accuracies of models of healthy controls and subhealth fatigue, subhealth fatigue and disease fatigue, and healthy controls and disease fatigue were 68.29%, 81.18%, and 84.73%, and the AUC was 0.698, 0.882, and 0.924, respectively. Conclusion. This study provided a new noninvasive method for the fatigue diagnosis from the perspective of objective tongue and pulse data, and the modern tongue diagnosis and pulse diagnosis have good application prospects.

This research aims to utilise heterogeneous sensor fusion using 3D Light Detection and Ranging (LiDAR) and cameras, combined with an object recognition system and a ranging system, to construct an edge computing platform such that a vehicle equipped with the platform can perform computations offline in real time. This work comprises two main sections: the first is heterogeneous fusion, and the second is obstacle recognition and ranging detection. To achieve heterogeneous sensor fusion, 3D–3D point matching was used to find rigid body transformation between two sensors and finally project the LiDAR 3D point cloud image onto the 2D image. For object recognition, YOLOv4-Tiny was used as the detection network. A lightweight network architecture and high computational speed could be effectively used on edge computing hardware with limited performance. Further, by drawing the bounding box, we could detect the point cloud within the bounding box to estimate the distance to the obstacle. For detecting distance, we conducted experiments in two ways: ‘minimum point in box’ and ‘median point in box’ and compared the results. With heterogeneous sensor fusion, object recognition and the ranging system, detecting the category and distance of obstacles ahead of the vehicle was possible in real time. Furthermore, integrating the edge computing platform architecture enabled moving the entire system offline, making it an independent system that returns results in real time. Finally, a dynamic test was conducted on a road. The experiment showed that the detection speed of YOLOv4-Tiny in the dynamic test was higher than 60 FPS, and the accuracy rate surpassed 70%. Furthermore, the distance detection error of the 3D LiDAR was less than 3 cm, which is sufficiently accurate to be applied to complex environments on roads.

Purpose: Fatigue is a subjective symptom which is hard to quantify, it is prevalent in sub-health and disease population, and there is still no accurate and stable method to distinguish disease fatigue from sub-health fatigue. Tongue and pulse diagnoses are the reflection of the overall state of the body, and the modern researches of tongue and pulse diagnoses have made great progress. This study aims to explore the distribution rules of tongue and pulse data in disease fatigue and sub-health fatigue population, and evaluate the contribution rate of tongue and pulse data to fatigue diagnosis through modeling. Methods: Tongue and Face Diagnosis Analysis-1 instrument and Pulse Diagnosis Analysis-1 instrument were used to collect tongue image and pulse sphygmogram of sub-health fatigue population (n=252) and disease fatigue group(n=1160), we mainly analyzed the tongue and pulse characteristics and constructed the classification model based on logistic regression method. Results: The results showed that sub-health fatigue people and disease fatigue people had different characteristics of tongue and pulse, and the logistic regression model based on tongue and pulse data showed a better classification effect. The accuracy of healthy controls & sub-health fatigue, sub-health fatigue & disease fatigue, health controls & disease fatigue model were 65.70%, 65.10%, 78.90%, and the AUC were 0.678, 0.834, and 0.879 respectively. Conclusion: This study provided a new non-invasive method for the fatigue diagnosis from the perspective of objective tongue and pulse data, the modern tongue and pulse diagnoses have a good application prospect.

Background: The operative mortality of pericardiectomy still is high. This retrospective study was conducted to determine the risk factors of early mortality and multiorgan failure. Methods: We retrospectively analyzed patients undergoing pericardiectomy from January 2009 to June 2020 at our hospital. Pericardiectomy was performed via sternotomy. Histopathologic studies of pericardium tissue from every patient were done. All survivors were monitored to the end date of the study. Results: Ninety-two consecutive patients undergoing pericardiectomy for constrictive pericarditis were included in the study. Postoperatively, central venous pressure significantly decreased, and left ventricular end diastolic dimension and left ventricular ejection fractions significantly improved. The overall mortality rate was 5.4%. The common postoperative complications include acute renal injury (27.2%), and multiorgan failure (8.7%). Analyses of risk factors showed that fluid balance of the second day following operation is associated with early mortality and multiorgan failure. In this series from Guangxi, China, characteristic histopathologic features of tuberculosis (60/92, 65.2%) of pericardium were the most common histopathologic findings, and 32 patients (32/92, 34.8%) had the histopathologic findings of chronic nonspecific inflammatory changes. The functional status of the patients improved after pericardiectomy; 6 months later postoperatively 85 survivors were in class I (85/87, 97.7%) and two were in class II (2/87, 2.3%). Conclusions: Tuberculosis is the most common cause of constrictive pericarditis in Guangxi, China. Fluid balance of the second day following operation is associated with early mortality and multiorgan failure after pericardiectomy for constrictive pericarditis in our study.

Background: Low cardiac output syndrome is the main cause of death after pericardiectomy. Methods: Patients who underwent pericardiectomy for constrictive pericarditis from January 2009 to October 2020 at our hospital were included in the study. Histopathologic studies of pericardium tissue from every patient were performed. All survivors were followed up. Results: Ninety-two consecutive patients underdoing pericardiectomy were included in the study. The incidence of postoperative low cardiac output syndrome was 10.7% (10/92). There were five operative deaths. Mortality and incidence of LCOS in the group with pericardial effusion were significantly higher than those in the group without pericardial effusion. Tuberculosis of the pericardium (60/92, 65.2%) was the most common histopathologic finding in this study. Both univariate and multivariate analyses showed that preoperative pericardial effusion is associated with increased rate of low cardiac output syndrome. Eighty-five survivors were in NYHA class I (85/87, 97.7%), and two were in class II (2/87, 2.3%) at the latest follow up. Conclusions: Preoperative pericardial effusion is associated with low cardiac output syndrome after pericardiectomy. Tuberculosis of the pericardium was the most common histopathologic finding in this study. For constrictive pericarditis caused by tuberculous bacteria, systematic antituberculosis drugs should be given. Preoperative pericardial effusion is associated with increased rate of low cardiac output syndrome. Perfect preoperative preparation is very important to reduce the incidence of postoperative low cardiac output syndrome and mortality. It is very important to use a large dose of diuretics with cardiotonic or vasopressor in a short time after the operation.

Background:. The operative mortality of pericardiectomy is still high. This prospective study was to determine the risk factors for early mortality and multiorgan failure.Methods: We prospectively observe patients undergoing pericardiectomy from January 2009 to June 2020 at our hospital. Radical pericardiectomy was performed via sternotomy. Histopathologic studies of pericardum tissue from every patient was done. All survivors were monitored to the end date of the study.Results: 92 consecutive underdoing pericardiectomy for constrictive pericarditis were included in the study. Postoperatively ,CVP decreased significantly, and LVED and LVEF improved significantly. The overall mortality rate was 5.4%. The common postoperative complications inclued acute renal injury（27.2%）, low cardiac output syndrome (10.9% ), and multiorgan failure (8.7%). Analysis of risk factor showed that D2 (fluid balance of the second day following operation) was associated with decreased early mortality and decreased multiorgan failure. In this series from Guagxi, China, characteristic histopathologic features of tuberculosis（60/92,65.2%） of pericardium were the most common histopathologic findings, and 32 patients (32/92,34.8%) had the histopathologic findings of chronic nonspecific inflammatory changes. The functional status of the patients improved after pericardiectomy, 6 months postoperatively 85 survivors were in class I (85/87, 97.7%) and 2 in class II (2/87, 2.3%) .Conclusions: Our results show that pericardiectomy is an effective procedure in the treatment of constrictive pericarditis Early surgical intervention is advocated. Improvement of surgical technique and intraoperative and perioperative management can decrease mortality and morbidity.

Background: Mitral repair has been widely used in the treatment of secondary mitral lesions in recent years. Hemolytic anemia is known to be a rare complication after mitral repair. This study aimed to investigate the diagnosis and treatment of mechanical hemolysis after mitral repair in adults. Methods: In this retrospective study, we reviewed the medical records of patients undergoing mitral repair complicated with mechanical hemolysis at our institution between August 2006 and May 2020. Results: Twenty-four patients undergoing mitral repair complicated with mechanical hemolysis were included in the study. They were divided into two groups: the reoperation group (patients who underwent reoperation; N = 18) and the conservative treatment group (patients who received symptomatic treatments, including blood transfusion, diuresis, alkalization of urine, liver protection, hemodialysis, and oral metoprolol; N = 6. All patients in the reoperation group underwent mitral valve replacement. There were six hospital deaths, all in the conservative treatment group. Seventeen of eighteen patients (94.4%) completed follow up. Fifteen of seventeen survivors (88.2%) were in NYHA class I and 11.8% (2/17) in NYHA class II at the last time follow up. Conclusions: Hemolysis is a sign of failure of mitral repair. Reoperation is the best choice once the hemolysis has been diagnosed. Reoperation should be carried out as soon as possible.

Background: With the wide application of digital tongue diagnosis instrument, massive tongue images will be produced. Adequate image quality is the prerequisite to ensure accurate tongue image analysis. In the process of tongue image collection, improper operation may lead to many poor-quality images (fogging, underexposure, overexposure, blurred focus, wrong tongue posture, etc.), which seriously affect the image processing and the accuracy of image analysis. However traditional pattern recognition is difficult to evaluate the quality of tongue images by extracting features and manual removal of tongue images with bad quality consumes a lot of labor and has a high error rate. In this research, we utilized a deep convolutional neural network to automatically select bad quality tongue images.Methods: The present study was conducted to identify the most appropriate CNN model for Tongue Image Quality Assessment based on deep CNN. The CNN model was evaluated by using Residual neural network and compared with VGGNet and DenseNet. Evaluation metrics such as accuracy, precision, recall, and F1-score were used for CNN model performance.Results: A detection model is established for tongue image quality control based on deep residual network, with an average accuracy of 99.04%, accuracy of 99.05%, recall of 99.04%, and F1-score of 99.05%, which can be used for quality screening of massive tongue images.Conclusions: Our research findings demonstrate various CNN models in the decision-making process for the selection of tongue image quality assessment and prove that applying deep learning methods, specifically deep CNN, to evaluate bad quality tongue images is feasible.

Meningioma is one of the common brain tumors in adults. It had been shown that the allopregnanolone biosynthesis was associated with tumorigenesis and PK11195, the translocator protein 18 KDa (TSPO) antagonist, had the effects of the allopregnanolone biosynthesis. However, little is known about the association between the effects of PK11195 on meningioma and the allopregnanolone biosynthesis. To evaluate this, the meningioma cell line IOMM-LEE was applied. Cell viability and proliferation were determined by CCK-8 assay. The IC50 of PK11195 on the IOMM-LEE was 1.505 ± 0.08 nM. The cell viability and proliferation of AC-5216 (TSPO selective ligand, 2 and 4 nM) was blocked by PK11195 (1.5 nM). Further, we evaluated the role of allopregnanolone biosynthesis in the effects of TSPO on meningioma. Enzyme-Linked ImmunoSorbent Assay (ELISA) was used in the measurement of the allopregnanolone level. It showed that the allopregnanolone level was increased by AC-5216 (2 and 4 nM) and the increase was reversed by PK11195 (1.5 nM). Collectedly, it firstly indicated that the effects of PK11195 on meningioma were relevant to the decrease of allopregnanolone biosynthesis, which was mediated by TSPO.

Recently, advanced therapies for pulmonary arterial hypertension have become available, and have been effective in reducing pulmonary vascular resistance and symptoms in patients with Eisenmenger syndrome, previously thought to be inoperable. This review summarizes the current knowledge on the pathophysiology and treatment of Eisenmenger syndrome. The recent introduction of targeted therapies in pulmonary arterial hypertension has led to a renewed insight in the pathophysiology and treatment of Eisenmenger syndrome. Patients with Eisenmenger syndrome using a diagnostic-treatment-and-repair strategy are amenable to surgery after successful treatment with advanced therapy. With continued improvements in the diagnosis, preoperative management, refinement of surgical techniques and intra- and postoperative management strategies, the patients with Eisenmenger syndrome selected using a diagnostic-treatment-and-repair strategy are operable with safety and efficacy in the current era with advanced pulmonary arterial hypertension therapy. Future directions of Eisenmenger syndrome may be the combination of reversal of pulmonary vascular remodeling and correction.

Rapid and reliable biomarkers of renal allograft rejection have not been available. This study aimed to investigate biomarkers in renal allograft tissue using proteomic analysis. Orthotopic kidney transplantations were performed using Fisher (F344) or Lewis rats as donors and Lewis rats as recipients. Syngenic control group (Group I) constituted F344-to-F344 orthotopic kidney allo-transplantations (n = 8); and allogenic group (Group II) consisted of F344-to-Lewis orthotopic kidney allo-transplantations (n = 8). Renal tissues were harvested 7 days after transplantation. Samples were analyzed using 2-D electrophoresis and matrix assisted laser desorption ionization-time of flight mass spectrometry. 6 differentially expressed proteins were identified between allogenic group and syngenic control group. A rat model of acute renal allograft rejection was successfully set up. Differentially expressed proteins in renal allograft tissue of rat were detected using proteomic analysis and might serve as novel diagnostic and therapeutic targets in human. Quantitative proteomics, using MALDL-TOF-MS methodology has the potential to provide a profiling and a deeper understanding of acute renal rejection.

Background It is widely accepted that patients older than 6 months with dextrotransposition of the great arteries and nonrestrictive ventricular septal defect or Taussig-Bing anomaly and severe pulmonary hypertension usually are not candidates for an arterial switch operation or even repair. This study aimed to evaluate the midterm results of the arterial switch operation in these selected patients. Methods The records of 86 patients older than 6 months with dextrotransposition of the great arteries and nonrestrictive ventricular septal defect or Taussig-Bing anomaly and severe pulmonary hypertension undergoing the arterial switch operation at our institution from 2000 to 2008 were reviewed retrospectively. Eighty survivors were followed. Results There were 6 hospital deaths (7.0%, 95% confidence interval, 1.6% to 12.4%). From 2006 to 2008, 46 were operated without deaths occurring. The median duration of follow-up was 42 months. Two late deaths occurred. Latest follow-up data showed that 2.8% of survivors were in New York Heart Association class II and 97.2% in class I. Conclusions Midterm results of the arterial switch operation for patients older than 6 months with dextrotransposition of the great arteries and nonrestrictive ventricular septal defect or Taussig-Bing anomaly and severe pulmonary hypertension are excellent in the current era.

Cardioplegic reperfusion during a long-term ischemic period interrupts cardiac surgery and increases cellular edema due to repeated administration. The present clinical study compared the protective effects of histidine-ketoglutarate-tryptophan (HTK) solution and St. Thomas crystalloid cardioplegia. Clinical experiences of the myocardial protection induced by one single perfusion with HTK were reviewed in high-risk patients with severe pulmonary arterial hypertension associated with complex congenital heart disease. This retrospective study included 88 high-risk patients (aortic cross-clamp time, >120 min) between March 2001 and July 2012. The cohort was divided into two groups according to the technique used. Either myocardial protection was performed with one single perfusion with HTK solution (HTK group) or with conventional St. Thomas crystalloid cardioplegia (St group). The duration of cardiopulmonary bypass did not differ between the two groups. The mortality, morbidity, intensive care unit (ICU) stay, postoperative hospitalization, and transfusions of HTK group are significantly lower than those of the St group (P

Epigenetics refers to changes in phenotype and gene expression that occur without alterations in DNA sequence. MicroRNAs are relatively recently discovered negative regulators of gene expression and act at the posttranscriptional level.This review summarizes epigenetic mechanisms of pulmonary hypertension, focusing on microRNAs related to pulmonary hypertension.There are three major mechanisms of epigenetic regulation, including methylation of CpG islands, modification of histone proteins, and microRNAs. There may be an epigenetic component to pulmonary hypertension. These epigenetic abnormalities can be reversed therapeutically.By better integrating network biology with evolving technologies in cell culture and in vivo experimentation, we will better understand epigenetic mechanisms of pulmonary hypertension and identify more diagnostic and therapeutic targets in pulmonary hypertension.

Background: This study aimed to compare clinical and pathologic data for selected patients with congenital heart disease (CHD) and severe pulmonary hypertension (PH) treated with a diagnostic-treatment-and-repair strategy and to compare results for patients with pulmonary vascular disease (PVD) with simple left-to-right shunt CHD with patients with transposition of the great arteries (TGA) and ventricular septal defect (VSD).Methods: Group I comprised 38 patients with simple left-to-right shunt CHD and severe PH; group II included 11 older patients with TGA with VSD and severe PH; and group III comprised 6 autopsy cases of individuals with a normal circulation. The nature of the pulmonary arteries was determined by the Heath-Edwards classification system. All specimens were quantitatively analyzed.Results: Group I showed 31 patients with a change to grade I, 3 patients were grade II, 3 patients were grade III, and only 1 patient was grade IV. Group II showed 7 patients with a change to grade I, 2 patients were grade II, 1 patient was grade III, and only 1 patient was grade IV. The media wall thickness percentage (%MT), the media wall area percentage (%MS), and arteriole density were significantly higher in groups I and II than in group III. %MS was significantly higher in group II than in group I; no significant differences in %MT and arteriole density could be found between groups I and II.Conclusions: The PVD in these selected patients with CHD and severe PH who were cared for with a diagnostic-treatment-and-repair strategy is generally reversible, and the changes in PVD in the patients with TGA and VSD were similar to those in the patients with simple left-to-right shunt CHD.

Objective: The goal of the study was to evaluate the quality of life of children after the older corrective arterial switch operation (ASO) by means of the Pediatric Quality of Life Inventory (PedsQL), version 4.0.Methods: The records of 86 patients who had complete transposition of the great arteries plus a nonrestrictive ventricular septal defect, or a Taussig-Bing anomaly, and severe pulmonary arterial hypertension, and who underwent a corrective ASO at an older age (>6 months) between May 2000 and October 2008 were reviewed retrospectively. Eighty survivors were followed up, and the health-related quality of life of the survivors was evaluated with the PedsQL, version 4.0.Results: There were 6 hospital deaths. The mean (SD) follow-up interval was 3.5 � 2.3 years, and the mean age at last visit was 7.0 � 1.2 years. Two late deaths occurred, and 8 patients were lost to follow-up. Patients who underwent a corrective ASO at an older age showed acceptable scores for all scales, and they were all comparable with those of a healthy population.Conclusions: Our data suggest that the quality of life of children who undergo a corrective ASO at an older age (>6 months) is acceptable, compared with that of healthy children in China.

Congenital heart disease (CHD) is the most common type of birth defect. Despite the many advances in the understanding of cardiac development and the identification of many genes related to cardiac development, the fundamental etiology for the majority of cases of congenital heart disease remains unknown. This review summarizes normal cardiac development, and outlines the recent discoveries of the genetic causes of congenital heart disease and provides possible strategies for exploring genetic causes.

Congenital heart disease with near-systemic pulmonary arterial pressures, previously thought to have irreversible pulmonary vascular disease (PVD), has been successfully corrected at our institution recently. Whether the PVD is reversible remains unknown. This study aimed to examine the nature of the pulmonary arterial vessels in these selective patients.All patients with congenital heart disease and severe pulmonary hypertension (PH) were selected using Diagnostic-treatment to undergo radical repair (n=49). Lung biopsy specimens were obtained during operation. The nature of PVD was determined by Heath-Edwards classification system. All specimens were quantitatively analyzed by calculating percentage media wall area, percentage media wall thickness and arteriole density.Transcutaneous oxygen saturation of all selected patients increased significantly after Diagnostic-treatment (P0.001). There were no operative deaths. Mean pulmonary artery pressure and pulmonary vascular resistance regressed significantly postoperatively (P0.001). The incidence of postoperative PH was 59.2% (29/49). Of 49 selected patients with severe PH, 38 (77.6%) showed grade I change, 5 (10.2%) showed grade II change, 4 (8.2%) showed grade III change and only 2 (4%) showed grade IV change with plexiform lesion. The percentage media wall area, percentage media wall thickness and arteriole density were significantly increased in patients associated with PH than in normal subjects (P0.001). Follow-up data showed the reversal of PVD in these 2 patients with plexiform lesions.The PVD in these selective patients with congenital heart disease and severe PH using a Diagnostic-treatment-and-Repair strategy is generally reversible and these patients are operable in current era.

Advanced pulmonary arterial hypertension is characterized by extensive vascular remodeling that is usually resistant to vasodilator therapy. As the major component of the vascular media, decreased apoptosis of pulmonary arterial smooth muscle cell (PASMC) plays key roles during pulmonary vascular remodeling. Recent studies showed that enhancement of apoptosis of PASMC can reverse pulmonary vascular remodeling and severe pulmonary arterial hypertension. Enhancement of apoptosis of PASMC is becoming a novel strategy to reverse severe pulmonary arterial hypertension. This review analyzes some potential strategies to reverse pulmonary vascular remodeling.