Chunyang Li^1,2, Mingyao Chen², Dedong Zhang⁴, Tianying Xu², Zhenmeng Wang³

¹School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China. ²School of Anesthesiology, Naval Medical University/Second Military Medical University, Shanghai 200433, China. ³Department of Anesthesiology, Eastern Hepatobiliary Surgery Hospital, Naval Medical University/Second Military Medical University, Shanghai 200438, China. ⁴Pharmacy Department, Xiamen Special Service Convalescent Center, Xiamen 361001, Fujian Province, China.

Address correspondence to: Zhenmeng Wang, Department of Anesthesiology, Eastern Hepatobiliary Surgery Hospital, Naval Medical University/Second Military Medical University, 225 Changhai Road, Yangpu District, Shanghai 200438, China. Tel: +86-13022130811. E-mail: wzm11998@163.com. Tianying Xu, School of Anesthesiology, Naval Medical University, 800 Xiangyin Road, Yangpu District, Shanghai 200433, China. Tel: +86-021 81872029. E-mail: xutianying@smmu.edu.cn.

DOI: https://doi.org/10.61189/554453zztqhf

Received January 7, 2024; Accepted March 13, 2025; Published March 31, 2025

Highlights

● Elevated bile acid concentrations impair myocardial structure and function by disrupting mitochondrial integrity and acting on TGR5 and FXR receptors.

● Endotoxins contribute to cardiovascular dysfunction by exacerbating systemic inflammation, primarily via NF-κB activation and increased levels of pro-inflammatory cytokines such as TNF-α.

● Reactive oxygen species alter cardiac electrophysiology by modulating L-type calcium channels and reversing Na+/Ca2+ exchanger activity, leading to contractile dysfunction. Excessive nitric oxide disrupts vascular tone regulation.

● Autophagy is activated through the AMPK-mTOR-ULK1 signaling pathway, while apoptosis-driven myocardial injury is mediated by caspase activation and the Bax/Bcl-2 protein family.

● Appropriate preoperative management, anesthetic selection, and the application of traditional Chinese medicine can alleviate cardiac injury associated with obstructive jaundice.