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不切開右心室根治小兒法洛四聯癥

Cerebral Protection During Deep Hypothermic Circulatory Arrest by Retrograde Cerebral Perfusion

To valuate cerebral protection by retrograde cerebral perfusion (RCP) via superior vena cava,the study results for the last ten years have been reviewed.RCP is regarded as an assistant method in deep hypothermic circulatory arrest(DHCA) in that it provides partial brain blood flow,maintains a low brain temperature,optimizes cerebral metabolic function during DHCA by supplying oxygen and some nutrient and removal of catabolic products;it also reduces the incidence of cerebral embolization by flushing out air...

主動脈瓣狹窄合并右冠狀動脈缺如一例

電視胸腔鏡輔助的心臟外科

電視胸腔鏡于90年代初開始在心臟外科應用,與傳統的心臟外科手術相比具有創傷小、疼痛輕、恢復快、費用低以及美容效果好等優點.現將電視胸腔鏡在非體外循環下的冠狀動脈旁路移植術,體外循環下的房間隔缺損修補術、室間隔缺損修補術、二尖瓣瓣膜修復與置換術、三尖瓣瓣膜修復與置換術以及冠狀動脈旁路移植術中的臨床應用進行綜述.

小兒先天性心瓣膜病的外科治療

目的 探討小兒先天性心瓣膜病手術治療的方法,并總結其經驗.方法 45例先天性心瓣膜病患兒實施主動脈瓣修復成形術4例,二尖瓣綜合成形術31例,二尖瓣置換術、三尖瓣置換術和主動脈瓣環擴大瓣膜置換術各1例,三尖瓣綜合成形術9例次.外科技術包括瓣葉或交界折疊(懸吊)成形,瓣環環縮,置Carpentier環,升主動脈加寬換瓣,瓣葉楔形切除及瓣下結構畸形修復等,同期矯治其它心內畸形.結果 1例術后死于重度低心排血量綜合征,其余44例順利恢復.二維超聲心動圖示5例有輕度二尖瓣反流,1例有輕度三尖瓣反流,隨訪5個月～8年,效果穩定.結論 采用綜合成形技術,保留自身瓣膜是小兒先天性心瓣膜病外科治療的首選方法,具有效果確切,術后心功能好,并發癥少,無需長期抗凝及不影響生長發育等優點.

同種原位心臟移植四例

目的 總結4例終末期心臟病患者施行原位心臟移植術的經驗. 方法 2000年1月26日～2000年9月26日,先后對4例終末期心臟病患者施行原位心臟移植術.供者均為腦死亡者,供者心肌保護采用冷晶體心臟停搏液順行性灌注;手術方法為中度低溫體外循環下標準原位心臟移植術;術后采用新三聯(FK506、驍悉和強的松)免疫治療. 結果 1例因肝、腎功能衰竭,術后18天死亡.3例患者存活至今,且生活質量良好. 結論 掌握適應證、術后防治感染和合理的免疫治療,是提高心臟移植存活率的重要因素.

生物瓣心瓣膜置換術后遠期療效

目的評價生物瓣心瓣膜置換術后遠期療效。方法1979年1月至2001年12月施行生物瓣心瓣膜置換術303例，按年齡分為兩組，≥55歲者123例（≥55歲組）；（55歲者180例（〈55歲組）。其中160例早期使用經戊二醛處理的豬主動脈瓣，143例使用經環氧氯丙烷改性的新型豬主動脈瓣。所有心瓣膜置換術均在全身麻醉體外循環下進行。結果術后早期死亡9例，隨訪267例（90．8％），隨訪時間3～20年，5年生存率94．1％±2．3％，10年生存率85．0％±2．7％，15年生存率78．3％±1．2％。51例出現瓣膜衰壞，40例再次手術；5年、10年、15年累計瓣膜未衰壞率分別為90．1％±2．2％、79．4％±3．6％和36．8％±1．6％。且≥55歲組患者瓣膜未衰壞率高于（55歲組（P〈0．05）。經環氧氯丙烷改性的新型生物瓣10年瓣膜未衰壞率明顯高于早期戊二醛處理的生物瓣。全組血栓發生率低，15年為0．014％。發生感染性心內膜炎7例，3例治愈，4例死亡。結論人工生物瓣心瓣膜置換術后療效良好，尤其適合老年患者。經環氧氯丙烷改性的新型生物瓣有較強的抗衰壞能力；術后發生感染性心內膜炎應予以足夠的重視。

Primary Studies on Autologous Marrow Stromal Cells Transplantation Improves Rabbit Cardiac Performance after Myocardiac Infarction

Objective To test the hypothesis that marrow stromal cells （MSCs）, when implanted into selfmyocardium in rabbits, can undergo milieu-dependent differentiation and express cardiomyogenic phenotypes and enhance cardiac function of ischemic hearts, through establish a clinically relevant model for autologous MSCs transplantation, Methods Thirteen New Zealand White rabbits were randomly divided into experimental group （n= 7） and control group （n= 6）. In experimental group, autotogous MSCs（3× 106 cells/30μl） labeled with Bromodeoxyuridine （BrdU） were respectively injected into superior, central and inferior sites in the periphery of the myocardial infarct region. Phosphate buffer saline （PBS） was injected into the scar of the control group hearts according to the same procedure used in the experimental group. Four weeks later, the transplanted labeled MSCs were detected by laser scanning confocal microscopy and the cardiac function were examined by echocardiogram and muhichannel physiologic recorder. Results After 4 weeks, transplanted MSCs were demonstrated myogenic differentiation with the expression of α-sarcomeric actin and connexin 43 located in intercalated disk. MSCs increased the number of vessels compared with controls in myocardial ischemia area. MSCs implantation resulted in markedly improved left ventricular contractility[left ventricular ejection fraction （LVEF）： 0. 51 ± 0.07 vs. 0. 43 ± 0.06 ,left ventricular lateral wall motion distance （LVLWMD） ：1. 75±0. 42mm vs. 1.09±0. 28mm, left ventricular systolic wall thickening ratio（LVAT） ：0. 19%±0.05% vs. 0. 11%±0.04%, left ventricular systolic pressure （LVSP）： 113. 1± 6.3mmHg vs. 99, 5 ± 5, lmmHg, left ventricular end diastolic pressure （LVEDP）： 11. 5±2. lmmHg vs, 14, 3 ±3. lmmHg, maximum rate of left ventricular pressure rise （＋dp/dtmax）：4 618. 3±365. 2 mmHg/s vs. 3 268. 1± 436.9 mmHg/s, maximum rate of left ventricular pressure fall （-dp/dtmax） ：3 008.8±346.7 mmHg/s vs. 2 536.9± 380.4 mmHg/s, P〈0.05]. Conclusion Transplanted autologous MSCs are able to undergo differentiation to form myocardial cells and improve the cardiac function of ischemia myocardium effectively. Autologous MSCs transplantation may have significant clinical potential in treatment myocardial ischemia.

同種帶瓣大動脈的取材、滅菌及保存

目的 報告50個同種帶瓣大動脈的取材、滅菌及液氮保存方法。方法 供者為年齡20～39歲的腦死亡患者，均在死亡后2小時取材。修剪后48個同種帶瓣大動脈用抗生素滅菌24小時放入含8%二甲基亞砜的RPMI 1640液中液氮保存。結果 抗生素滅菌后48個同種帶瓣大動脈細菌和霉菌培養均為陰性。解凍11個有10個用于臨床，解凍后的同種帶瓣大動脈可基本保持正常功能，其細菌和霉菌培養均為陰性。結論 無菌取材加抗生素滅菌效果可靠，經液氮保存的同種帶瓣大動脈解凍后可滿足臨床應用的要求。

Effects of Inflammatory Reaction Related to Different Cerebral Protective Methods on Brain

Objective To observe the changes of inflammatory cytokines in brain protective methods, study the inflammatory mechanism during cerebral protection tissues in different cerebral Methods Eighteen healthy adult dogs were randomly divided into three groups （6 dogs in each group）： normothermic cardiopulmonary bypass （NCPB group）, deep hypothermic circulatory arrest （DHCA group）, and intermittent selective antegrade cerebral perfusion （ISACP） during DHCA（DHCA＋ISACP group）. After operation the water contents in brain tissue were measured ,the hippocampus were removed, and radio-immunity analysis （RIA） was used to measure the content of interleukin-1β（IL-1β） and tumor necrosis factor-alpha （TNF-α） of the hippocampus tissue. The morphology of the hippocampus were examined by transmission electron （TE） microscopy. Results The contents of IL-1β and TNF-α of DHCA group was higher significantly than those of NCPB group and DHCA＋ISACP group （P〈0.01）, there was no significant difference between NCPB group and DHCA＋ISACP group （P〉0.05）. And the contents of TNF-α and IL-1β were positive linear correlated with degree of edema of brain tissues （r = 0. 987, 0.942; P〈 0.01）. TE examination revealed that the damage of the uhrastructure in the DHCA group was more severe than that in NCPB group and DHCA＋ISACP group. Conclusions This experiment revealed that long duration DHCA can bring some damages to the brain and that ISACP during long-term DHCA has brain protective effects to some extent. IL-1β and TNF-α play an effective role in the brain damage of long-term DHCA.