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Clinical application and management of temporary mechanical circulatory support:A clinical consensus

Chinese Medical Journal 2024年第10期137卷 1135-1139页

作者： Nianguo Dong Liangwan Chen Xin Chen Huishan Wang Yingbin Xiao Xianqiang Wang Jinsong Huang Yang Yan Pramod Bonde Neel Sodha Pavan Atluri Juan Pablo Maureira AndréVincentelli Masanobu Yanase Yixuan Wang Haitao Zhang Xiaotong Hou Yoshijuki Takami Pascal Leprince Thierry Folliguet Frank W Sellke Chinese Society for thoracic and cardiovascular surgery Chinese Association of cardiovascular Surgeons Cardiac Critical Care Professional Committee of Chinese Medical Association Chinese Society of Extracorporeal Life Support European Society of cardiovascular and Endovascular surgery French Society of thoracic and cardiovascular surgery Japanese Society for cardiovascular surgery Japanese Society of Artificial Organs Department of cardiovascular surgery Union Hospital of Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei 430022China Department of cardiovascular surgery Fujian Medical University Union HospitalFuzhouFujian 350000China Department of thoracic and cardiovascular surgery Nanjing First HospitalNanjing Medical UniversityNanjingJiangsu 210000China Department of cardiovascular surgery General Hospital of Northern Theater CommandShenyangLiaoning 110000China Department of cardiovascular surgery Xinqiao HospitalThird Military Medical UniversityChongqing 400037 China Department of cardiovascular surgery Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100000 China Department of cardiovascular surgery Guangdong Provincial Cardiovascular InstituteGuangdong General HospitalGuangdong Academy of Medical SciencesGuangzhouGuangdong 510000 China Department of cardiovascular surgery First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anShaanxi 710061China Department of Cardiac surgery Yale School of Medicine330 Cedar St204 BoardmanNew HavenCT 06510USA Department of Cardiothoracic surgery Alpert Medical SchoolBrown University Rhode Island HospitalProvidenceRI 02912USA Department of cardiovascular surgery Department of SurgeryUniversity of PennsylvaniaPhiladelphiaPA 19113USA Department of cardiovascular surgery and Transplantation University Hospital of NancyUniversity of LorraineVandoeuvre-lès-Nancy 54500France Department of cardiovascular surgery University Hospital of LilleUniversity of LilleLille 59037France Department of Cardiology Fujita Health University School of MedicineToyoakeAichi 470-1192Japan Department of Adult Surgical Intensive Care Unit Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100000China Department of Cardiac Intensive Care Beijing Institute of HeartLung and B

Temporary mechanical circulatory support(tMCS)plays a pivotal role in managing severe or refractory cardiogenic shock(CS),furnishing essential hemodynamic support,and sustaining organ perfusion from hours to weeks,or to even *** the past decade,the utilization of tMCS has witnessed a signicant increase in American and European *** in Asia,the newly developed concepts and devices constituting tMCS have also made rapid ***,the absence of a consensus or standardized guidelines,especially for the Asian population considering inherited polymorphism,is *** address this knowledge gap,eight associations/societies and experts in thiseld came up with the present consensus after repeated discussions,more specically for the Asian *** comprehensively elucidates the commonly employed tMCS devices,criteria for patient selection,indications and contraindications,clinical management,and the optimal timing for implantation and *** goal of this statement is to promote the standardized application of tMCS and make reasonable decisions in clinical ***-length version of the consensus can be seen in Supplementary File,http://***/CM9/B883.

关键词： application statement discussions

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The activity and immune dynamics of PD-1 inhibition on high-risk pulmonary ground glass opacity lesions:insights from a single-arm,phase II trial

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Signal Transduction and Targeted Therapy 2024年第5期9卷 2202-2214页

作者： Bo Cheng Caichen Li Jianfu Li Longlong Gong Peng Liang Ying Chen Shuting Zhan Shan Xiong Ran Zhong Hengrui Liang Yi Feng Runchen Wang Haixuan Wang Hongbo Zheng Jun Liu Chengzhi Zhou Wenlong Shao Yuan Qiu Jiancong Sun Zhanhong Xie Zhu Liang Chenglin Yang Xiuyu Cai Chunxia Su Wei Wang Jianxing He Wenhua Liang Department of thoracic surgery and Oncology the First Affiliated Hospital of Guangzhou Medical UniversityGuangzhou Institute of Respiratory HealthState Key Laboratory of Respiratory DiseaseNational Clinical Research Center for Respiratory DiseaseGuangzhouChina Medical Department Genecast Biotechnology Co.LtdWuxiChina Department of Radiation Oncology the First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina Department of Respiratory Medicine the First Affiliated Hospital of Guangzhou Medical UniversityGuangzhou Institute of Respiratory HealthState Key Laboratory of Respiratory DiseaseNational Clinical Research Center for Respiratory DiseaseGuangzhouChina Department of Cardiothoracic surgery Affiliated Hospital of Guangdong Medical UniversityZhanjiangChina Department of thoracic surgery National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital&Shenzhen HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeShenzhenChina Department of VIP Inpatient Sun Yat-sen University Cancer CenterState Key Laboratory of Oncology in South ChinaSun Yat-sen UniversityGuangzhouChina Department of Medical Oncology Shanghai Pulmonary HospitalSchool of MedicineTongji UniversityShanghaiChina

Immune checkpoint inhibitors targeting the programmed cell death-1(PD-1)protein significantly improve survival in patients with advanced non-small-cell lung cancer(NSCLC),but its impact on early-stage ground-glass opacity(GGO)lesions remains *** is a single-arm,phase II trial(NCT04026841)using Simon’s optimal two-stage design,of which 4 doses of sintilimab(200 mg per 3 weeks)were administrated in 36 enrolled multiple primary lung cancer(MPLC)patients with persistent high-risk(Lung-RADS category 4 or had progressed within 6 months)*** primary endpoint was objective response rate(ORR).T/B/NK-cell subpopulations,TCR-seq,cytokines,exosomal RNA,and multiplexed immunohistochemistry(mIHC)were monitored and compared between responders and ***,two intent-to-treat(ITT)lesions(pure-GGO or GGO-predominant)showed responses(ORR:5.6%,2/36),and no patients had progressive disease(PD).No grade 3-5 TRAEs *** total response rate considering two ITT lesions and three non-intent-to-treat(NITT)lesions(pure-solid or solid-predominant)was 13.9%(5/36).The proportion of CD8^(+)T cells,the ratio of CD8^(+)/CD4^(+),and the TCR clonality value were significantly higher in the peripheral blood of responders before treatment and decreased over ***,the mIHC analysis showed more CD8^(+)T cells infiltrated in ***,responders’cytokine concentrations of EGF and CTLA-4 increased during *** exosomal expression of fatty acid metabolism and oxidative phosphorylation gene signatures were down-regulated among ***,PD-1 inhibitor showed certain activity on high-risk pulmonary GGO lesions without safety *** effects were associated with specific T-cell re-distribution,EGF/CTLA-4 cytokine compensation,and regulation of metabolism pathways.

关键词： lesions metabolism doses

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Current status and impact of the Young Scientist Foundation of the National Natural Science Foundation on Chinese young scholars in cardiovascular research

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Science China(Life Sciences) 2024年第10期67卷 2294-2296页

作者： Fei Gao Zhenzhen Chen Wendong Li Hujun Jiang Rui Wang Department of Cardiology Beijing Anzhen HospitalCapital Medical UniversityBeijing 100029China Hypertension center Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeState Key Laboratory of Cardiovascular DiseaseNational Center for Cardiovascular DiseasesBeijing 100037China Department of Vascular surgery Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjing 210008China Department of Health Sciences National Natural Science Foundation of ChinaBeijing 100085China

cardiovascular disease(CVD)remains the leading cause of disease burden globally,and continued efforts are required in identifying new targets for CVD prevention and treatment(Vaduganathan et al.,2022).Breakthroughs in... 详细信息

关键词： prevention modality

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International consensus guidelines on robotic pancreatic surgery in 2023

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Hepatobiliary surgery and Nutrition 2024年第1期13卷 89-104页

作者： Rong Liu Mohammed Abu Hilal Marc G.Besselink Thilo Hackert Chinnusamy Palanivelu Yupei Zhao Jin He Ugo Boggi Jin-Young Jang Fabrizio Panaro Brian K.P.Goh Mikhail Efanov Yuichi Nagakawa Hong-Jin Kim Xiaoyu Yin Zhiming Zhao Yi-Ming Shyr Shridhar Iyer Eli Kakiashvili Ho-Seong Han Jae Hoon Lee Roland Croner Marco Vito Marino Arun Prasad Wei Wang Songqing He Kehu Yang Qu Liu Zizheng Wang Mengyang Li Shuai Xu Kongyuan Wei Zhaoda Deng Yuze Jia Tess M.E.van Ramshorst Faculty of Hepatopancreatobiliary surgery The First Medical Center of Chinese People’s Liberation Army(PLA)General HospitalBeijingChina Department of surgery Poliambulanza Foundation HospitalBresciaItaly Department of surgery University Hospital Southampton NHS Foundation TrustSouthamptonUK Amsterdam UMC location University of AmsterdamDepartment of SurgeryAmsterdamThe Netherlands Cancer center Amsterdam AmsterdamThe Netherlands Department of General Visceral and Thoracic SurgeryUniversity Hospital Hamburg-EppendorfHamburgGermany Department of Minimal Invasive Hernia surgery GEM Hospital and Research CentreChennaiTamil NaduIndia Department of General surgery Peking Union Medical College Hospital BeijingBeijingChina Department of surgery Johns Hopkins University School of MedicineBaltimoreMDUSA Division of General and Transplant surgery University of PisaPisaItaly Department of surgery Seoul National University HospitalSeoul National University College of MedicineSeoulKorea Department of surgery/Division of HBP surgery&Transplantation University of MontpellierMontpellierFrance Department of Hepatopancreatobiliary and Transplant surgery Singapore General Hospital and National Cancer Centre SingaporeSingaporeSingapore Department of Hepato-Pancreato-Biliary surgery Moscow Clinical Scientific CenterMoscowRussia Department of Gastrointestinal and Pediatric surgery Tokyo Medical UniversityShinjukuTokyoJapan Department of surgery Yeungnam University College of MedicineDaeguKorea Department of Pancreato-Biliary surgery The First Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina 18 Division of Hepatobiliary Pancreatic Surgery and Liver TransplantationNational University HospitalSingaporeSingapore Department of surgery Galilee Medical CenterNahariyaIsrael Department of surgery Seoul National University Bundang HospitalSeoul National University College of MedicineSeongnam-siKorea Division of Hepato-Biliary and Pancreatic surgery Department of SurgeryAsan Medical Cente

Background:With the rapid development of robotic surgery,especially for the abdominal surgery,robotic pancreatic surgery(RPS)has been applied increasingly around the ***,evidence-based guidelines regarding its application,safety,and efficacy are still *** harvest robust evidence and comprehensive clinical practice,this study aims to develop international guidelines on the use of ***:World Health Organization(WHO)Handbook for Guideline Development,GRADE Grid method,Delphi vote,and the AGREE-II instrument were used to establish the Guideline Steering Group,Guideline Development Group,and Guideline Secretary Group,formulate 19 clinical questions,develop the recommendations,and draft the *** online meetings were held on 04/12/2020,30/11/2021,and 25/01/2022 to vote on the recommendations and get advice and suggestions from all involved *** the experts focusing on minimally invasive surgery from America,Europe and Oceania made great contributions to this consensus ***:After a systematic literature review 176 studies were included,19 questions were addressed and 14 recommendations were developed through the expert assessment and comprehensive judgment of the quality and credibility of the ***:The international RPS guidelines can guide current practice for surgeons,patients,medical societies,hospital administrators,and related social *** randomized trials are required to determine the added value of RPS as compared to open and laparoscopic surgery.

关键词： Robotic surgery guidelines pancreatectomy pancreaticoduodenectomy distal pancreatectomy(DP)

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Bioengineered skin organoids:from development to applications

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Military Medical Research 2024年第3期11卷 449-466页

作者： Zi-Xuan Hong Shun-Tian Zhu Hao Li Jing-Zhi Luo Yu Yang Yang An Xi Wang Kai Wang Department of Physiology and Pathophysiology School of Basic Medical SciencesState Key Laboratory of Vascular Homeostasis and RemodelingPeking UniversityBeijing 100191China Department of Hepatopancreatobiliary surgery the Third Affiliated Hospital of Soochow UniversityChangzhou 213000JiangsuChina Department of Plastic surgery Peking University Third HospitalBeijing 100191China Clinical Stem Cell Research center Peking University Third HospitalBeijing 100191China State Key Laboratory of cardiovascular Disease Fuwai HospitalBeijing 100037China Beijing Key Laboratory of Metabolic Disorder Related cardiovascular Disease Capital Medical UniversityBeijing 100050China

Signifcant advancements have been made in recent years in the development of highly sophisticated skin *** as three-dimensional(3D)models that mimic human skin,these organoids have evolved into complex structures and are increasingly recognized as efective alternatives to traditional culture models and human skin due to their ability to overcome the limitations of two-dimensional(2D)systems and ethical *** inherent plasticity of skin organoids allows for their construction into physiological and pathological models,enabling the study of skin development and dynamic *** review provides an overview of the pivotal work in the progression from 3D layered epidermis to cyst-like skin organoids with ***,it highlights the latest advancements in organoid construction facilitated by state-of-the-art engineering techniques,such as 3D printing and microfuidic *** review also summarizes and discusses the diverse applications of skin organoids in developmental biology,disease modelling,regenerative medicine,and personalized medicine,while considering their prospects and limitations.

关键词： Skin organoid Organoid generation Skin appendage Tissue engineering Disease modelling Regenerative medicine

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Enhancing the Circularly Polarized Luminescence of Self-assembled Cyanostilbenes through Extended π-Conjugation

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Chinese Journal of Chemistry 2024年第2期42卷 135-141页

作者： Tongjin Lv Song Wu Yu Jin Jianfei Ma Sixun Jiang Yuncong Xue Feng Wang Key Laboratory of Precision and Intelligent Chemistry Department of Polymer Science and EngineeringUniversity of Science and Technology of ChinaHefeiAnhui 230026China Department of thoracic surgery Shanghai Jiao Tong University Affiliated Sixth People's HospitalShanghai 200233China

Chiral supramolecular assembly of π-conjugated luminophores provides a promising avenue for enhancing circularly polarized *** this study,we shed light on the impact of π-conjugation length on circularly polarized luminescent performance of the resulting supramolecular assemblies,by designing a tetra-cyanostilbene monomeric compound alongside two dicyanostilbene control *** cyanostilbene-based compounds possess the ability to form chiral supramolecular polymers in toluene,driven by a synergistic combination of intermolecular hydrogen bonding and π-stacking *** extended π π-aromatic skeleton brings bathochromic-shifted fluorescence and enhanced intermolecular stacking capability for the tetra-cyanostilbene ***,chiral supramolecular assemblies formed by the tetra-cyanostilbene compound demonstrate a remarkable two-fold increase in g_(lum) values relative to the assemblies formed by the dicyanostilbene ***,this study provides valuable insights into the relationship between-conjugation length and the circularly polarized luminescent performance of π-conjugatedsupramolecularassemblies.

关键词： Self-assembly Supramolecular polymer Supramolecular chirality Circularly polarized luminescence Cyanostilbene πInteractions Aggregation Nanostructures

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A Comparative Analysis on Surgical Outcomes and Complications of Endoscopic and Open Vein Harvesting Techniques

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Open Journal of thoracic surgery 2024年第2期14卷 29-39页

作者： Mohammed Fawzy Eltaweel Ismail N. El-Sokkary Ahmed Alherazi Mohamed Wael Badawi Mohammed G. Abdellatif Bahaa A. Elkhonezy Ibrahim K. Gamil Haytham Mohamed Abd El Moaty Sarra Sadmi Mahmoud Khalil Department of Cardiothoracic surgery Faculty of Medicine Menoufia University Shibin El Kom Egypt Department of cardiovascular & thoracic surgery Faculty of Medicine Al-Azhar University Cairo Egypt Department of Cardiothoracic surgery Faculty of Medicine Alexandria University Alexandria Egypt Faculty of Medicine University of Algiers Algiers Algeria Department of Cardiac surgery Sabah Al-Ahmed Cardiac Center Al-Amiri Hospital Kuwait City Kuwait

Objective: The great saphenous vein (GSV) is commonly used as a conduit for grafting during CABG surgery, and open GSV harvesting (OVH), commonly used with long incision to expose the vein. However, endoscopic vein harvesting (EVH) is an alternative approach, utilizing specialized instruments and small incisions to harvest the vein. Methods: A retrospective analysis was conducted on a cohort of patients who underwent Coronary artery bypass graft (CABG) requiring great saphenous vein (GSV) harvesting which was done by EVH or OVH procedures. Demographic variables, including age and gender, were assessed for both groups. Intraoperative variables such as the number of grafts, cardiopulmonary bypass time, X clamp time, and type of procedure were analyzed. Postoperative variables, including infection and bleeding rates, were also evaluated. Results: The study included 30 patients each undergoing Coronary artery bypass graft (CABG) with need of great saphenous vein harvesting which was done by EVH and OVH. Demographic variables were well-matched between the two groups in terms of age, while a significant difference in gender distribution was observed. Obesity and smoking were more prevalent in the OVH group, and EVH was associated with a higher mean number of grafts compared to OVH. Conversion to an open technique occurred in a portion of the EVH cases, and infection rates did not significantly differ between the EVH and OVH groups. However, the incidence of postoperative bleeding was significantly higher in the EVH group. Conclusion: This study provides valuable insights into the demographic, intraoperative, and postoperative variables associated with EVH and OVH techniques. EVH demonstrated advantages in terms of reduced infection rates compared to OVH. However, the higher incidence of postoperative bleeding associated with EVH raises concerns about potential risks.

关键词： Endoscopic Vein Harvesting (EVH) Open Vein Harvesting (OVH) Coronary Artery Bypass Grafting (CABG) Great Saphenous Vein (GSV) Surgical Outcomes

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Mex-3 RNA binding family member A(MEX3A)/circMPP6 complex promotes colorectal cancer progression by inhibiting autophagy

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Signal Transduction and Targeted Therapy 2024年第5期9卷 2091-2103页

作者： Ri-Xin Chen Shui-Dan Xu Min-Hua Deng Shi-Hui Hao Jie-Wei Chen Xiao-Dan Ma Wei-Tao Zhuang Jing-Hua Cao Yong-Rui Lv Jin-Long Lin Si-Yu Li Gui-Bin Qiao Dan Xie Feng-Wei Wang Department of thoracic surgery Guangdong Provincial People’s Hospital(Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhou 510080China State Key Laboratory of Oncology in South China Guangdong Provincial Clinical Research Center for CancerSun Yat-sen University Cancer CenterGuangzhou 510060China Medical Research Institute Guangdong Provincial People’s Hospital(Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhou 510080China Department of Pathology Sun Yat-sen University Cancer CenterGuangzhou 510060China

RNA-binding proteins(RBPs)-RNA networks have contributed to cancer *** RNAs(circRNAs)are considered as protein recruiters;nevertheless,the patterns of circRNA-protein interactions in colorectal cancer(CRC)are still *** bodies(PBs)formed through liquid-liquid phase separation(LLPS)are membrane-less organelles(MLOs)consisting of RBPs and *** evidence suggests a connection between PBs dynamics and cancer *** the increasingly acknowledged crucial role of RBPs and RNA in the accumulation and maintenance of MLOs,there remains a lack of specific research on the interactions between PBs-related RBPs and circRNAs in ***,we identify that MEX-3 RNA binding family member A(MEX3A),frequently upregulated in CRC tissues,predicts poorer patient *** MEX3A accelerates malignance and inhibits autophagy of CRC ***,MEX3A undergoes intrinsically disordered regions(IDRs)-dependent LLPS in the ***,circMPP6 acts as a scaffold to facilitate the interaction between MEX3A and PBs *** MEX3A/circMPP6 complex modulates PBs dynamic and promotes UPF-mediated phosphodiesterase 5A(PDE5A)mRNA degradation,consequently leading to the aggressive properties of CRC ***,CRC patients exhibiting high MEX3A expression and low PDE5A expression have the poorest overall *** findings reveal a collaboration between MEX3A and circMPP6 in the regulation of mRNA decay through triggering the PBs aggregation,which provides prognostic markers and/or therapeutic targets for CRC.

关键词： colorectal inhibiting MPP

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Enhancing cartilage regeneration and repair through bioactive and biomechanical modification of 3D acellular dermal matrix

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Regenerative Biomaterials 2024年第3期3卷 105-121页

作者： Wei Gao Tan Cheng Zhengya Tang Wenqiang Zhang Yong Xui Min Han Guangdong Zhou Chunsheng Tao Ning Xu Huitang Xia Weijie Sun Qingdao Medical College of Qingdao University Qingdao266071China Department of Infectious Diseases The First Affliated Hospital of Anhui Medical UniversityShushanHefei230022China Department of Orthopaedic surgery Shanghai Sixth People's Hospital Affliated to Shanghai jiao Tong University School of MedicineShanghai200025China Department of Orthopedic surgery Shanghai Eighth People's HospitalShanghai200235China Department of Plasticsurgery&Jinan ClinicalResearch center for Tissue Engineering Skin Regeneration and Wound Repair The First Affliated Hospital of Shandong First Medical UniversityJinan266299China Department of Orthopaedics Ninety-seventh Hospital of the Chinese People's Liberation Army NavyQingdao266071China Department of Orthopaedics The First Affliated Hospital of Shandong First Medical UniversityJinan266299China Department of Plastic surgery Shanghai Key Laboratory of Tissue EngineeringShanghai Ninth People's HospitalShanghai jiao Tong University School of MedicineShanghai200023China Department of thoracic surgery Shanghai Children's HospitalShanghai Jiao Tong University School of MedicineShaghai200040China Department of thoracic surgery Shanghai Pulmonary HospitalSchool of MedicineTongji UniversityShanghai200433China

Acellular dermal matrix(ADM)shows promise for cartilage regeneration and ***,an effective decellularization technique that removes cellular components while preserving the extracellular matrix,the transformation of 2D-ADM into a suitable 3D scaffold with porosity and the enhancement of bioactive and biomechanical properties in the 3D-ADM scaffold are yet to be fully *** this study,we present an innovative decellularization method involving 0.125%trypsin and 0.5%SDS and a 1%Triton X-100 solution for preparing ADM and converting 2D-ADM into 3D-ADM *** scaffolds exhibit favorable physicochemical properties,exceptional biocompatibility and significant potential for driving cartilage regeneration in vitro and in *** further enhance the cartilage regeneration potential of 3D-ADM *** incorporated porcine-derived small intestinal submucosa(SIS)for bioactivity and calcium sulfate hemihydrate(CSH)for biomechanical *** resulting 3D-ADM+SIS scaffolds displayed heightened biological activity,while the 3D-ADM+CSH scaffolds notably bolstered biomechanical *** scaffold types showed promise for cartilage regeneration and repair in vitro and in vivo,with considerable improvements observed in repairing cartilage defects within a rabbit articular cartilage *** summary,this research introduces a versatile 3D-ADM scaffold with customizable bioactive and biomechanical properties,poised to revolutionize the field of cartilageregeneration.

关键词： acellular dermal matrix three-dimensional scaffolds cartilage regeneration small intestinal submucosa calcium sulfate hemihydrate

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Subxyphoid Pericardial Drainage for Tuberculous Pericardial Effusion in Antananarivo

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World Journal of cardiovascular surgery 2024年第2期14卷 21-31页

作者： Tsirimalala Rajaobelison Zakarimanana Lucas Randimbinirina Maharo Ramifehiarivo Manoahasina Ranaliarinosy Rabarison Toky Mamin’ny Aina Rajaonanahary Andriamihaja Jean-Claude Rakotoarisoa Department of cardiovascular surgery Faculty of Medicine of Antananarivo University of Antananarivo Antananarivo Madagascar Department of Pathology Faculty of Medicine of Antananarivo University of Antananarivo Antananarivo Madagascar Department of Vascular surgery Faculty of Medicine of Antananarivo University of Antananarivo Antananarivo Madagascar Department of thoracic surgery Faculty of Medicine of Antananarivo University of Antananarivo Antananarivo Madagascar

Introduction: Tuberculosis is the leading cause of pericardial effusion in sub-Saharan African countries. The aim of this study was to describe the diagnosis and the surgical management of tuberculous pericardial effusion in low-income country. Methods: This was a retrospective and descriptive study performed at Vascular surgery Unit for 10 years-period (from January 2012 to December 2021), including all cases of drainage of pericardial effusion due to tuberculosis. Results: Sixty-seven cases were recorded, including 38 males (56.71%) and 29 women (43.28%). The average age was 35.47 years old. Patients lived in urban areas in 67.16% of cases. Thirteen patients (13.43%) had a previous history of pulmonary tuberculosis. The most common risk factors for tuberculosis infection were malnourishment (80.59%), indoor air pollution (77.61%) and close contact with tuberculosis patient (40.29%). The commonest symptom were dyspnea, (95.52%), chest pain (89.55%), fever (67.16%), tachycardia (95.52%) and cough (80.59%). Twenty-seven patients (39.02%) presented clinical signs of cardiac tamponade. Electrocardiogram showed sinus tachycardia (97.53%) with microvoltage (39.02%). Chest-X-ray showed cardiomegaly (100%) and pleural effusion (56.71%). Echocardiography showed moderate (43.28%) and large (56.71%) pericardial effusion. All patients underwent subxiphoid pericardial drainage. Mycobacterium tuberculosis detection via GeneXpert test of pericardial effusion were positive in 38.80% of patients. Pericardial biopsies confirmed the diagnosis of tuberculosis in 41.79%. The mortality rate was 8.95%. Conclusion: Subxiphoid pericardial drainage reduced thr risk of cardiac tamponade in patients with massive pericardial effusion. Histopathology of pericardial biopsies made a definitive diagnosis for tuberculosis.

关键词： Tuberculosis Echocardiography Pericardial Effusion surgery Cardiac Tamponade

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