Objective To investigate the rat model of cardiac allograft vasculopathy after heart transplantation in rat abdominal cavity. Methods Forty Wistar rats and 40SDrats were divided into control group and experiment group randomly pair-matching. Rat model ofheterotopic heart transplantation was developed. Low doseCyclosporine A were injected into the abdominal cavity in experiment group, while the control group had not received the Cyclosporine A. Transplant hearts were harvested at two weeks and four weeks post-operatively and changes of coronary artery were observed by light microscope. Results There were no alteration of tunica intima of coronary artery in control group at two weeks and four weeks post-transplantation. Tunica intima of coronary artery increased in thickness at two weeks post-transplantation in experiment group and concentric circular change occurred at four weeks post-transplantation. Lumen of coronary artery constricted transparent and cardiac allograft vasculopathy occurred. Conclusion This animal model is reliable of cardiac allograft vasculopathy.
Objective To investigate the clinical effects and the brain protection effect of different cardiopulmonary bypass in treating descending aortic aneurysms. Methods From January 2001 to December 2008, 65 patients were diagnosed to have descending aortic aneurysm with magnetic resonance imaging (MRI) in our hospital. Among them, there were 56 males and 9 females whose age was between 15 and 71 years old with an average of 48.1 years. The disease process ranged from 6 days to 4 months (19.0±6.5 d ). Preoperative diagnosis showed that there were 41 cases of DeBakey type Ⅲinterlayer, 9 cases of Marfan syndrome with postoperative complications of type Ⅲ interlayer, 7 cases of pseudoaneurysm and 8 cases of true aneurysm. We adopted artificial blood vessel repair patch to repair the damaged point of the descending aorta in 2 cases, performed vascular aneurysm resection and artificial vessel replacement on 63 patients, and carried out descending aorta replacement and intercostal artery grafting in 18 cases. Results Among the 65 cases of cardiopulmonary bypass patients, there were 13 cases of left heart bypass, 12 cases of heart bypass, 30 cases of deep hypothermic circulatory arrest (DHCA) with total body retrograde perfusion (TBRP) and 10 cases of modified separate perfusion of upper and low body. Cardiopulmonary bypass time, DHCA time, retrograde perfusion time, upper body circulatory arrest time and low body circulatory arrest time were respectively 51-212 min, 18-75min, 18-73 min, 21-31 min, and 39-67 min. No death occurred during the operation, and there were no brain complications or complications of paralysis among all the patients. Two patients died after operation because of renal failure. Conclusion Good results can be achieved by selecting different method of cardiopulmonary bypass based on the anatomical location and range of the thoracic descending aortic aneurysms. The selection criteria should be favorable to the surgical operation and organ protection.
Objective To evaluate the effect of smooth muscle cell transplantation on myocardial interstitial reconstruction shortly after myocardial infarction. Methods A total of 48 female Wister rats were randomly divided into two groups with the random number table, the control group (n=24) and the smooth muscle cell transplantation group (n=24). The left coronary artery was ligated to set up the myocardial infarction animal model. An amount of 05 ml phosphate buffered saline(PBS) containing 1×106 smooth muscle cells or 0.5 ml PBS without cells was injected into the injured myocardium immediately. By immunoblot and reverse transcriptionolymerase china reaction (RT-PCR), we observed the amount of protein and mRNA of matrix metalloproteinase2(MMP-2), matrix metalloproteinase-9(MMP-9) and tissue inhibitor of metalloprotease-3 (TIMP-3) in the myocardium of the rats. Results The transplanted smooth muscle cells survived well. Compared with the control group, myocardial TIMP3 mRNA (1.06±0.22 vs. 0.81±0.19, t=－2.358, P=0.033) and protein content (3.33±0.53 vs. 1.63±0.47, t=－6.802, Plt;0.001) were significantly increased in the transplantation group. Myocardial MMP-2, MMP-9 mRNA (0.49±0.12 vs. 1.16±0.18, t=8.453, Plt;0.001; 0.45±0.12 vs. 0.80±0.11, t=5.884, Plt;0.001) and protein content (3.98±1.08 vs. 6.05±0.91, t=4.139, P=0.001; 0.39±0.14 vs. 0.57±0.17, t=2.409, P=0.031) [CM(1585mm]were significantly reduced in the transplantation group compared with the control group. Conclusion transplanted smooth muscle cells can survive well in the infarction myocardium and can increase the amount of myocardial TIMP-3 mRNA and protein content and reduce myocardial MMP-2, MMP-9 mRNA and protein content, which is an effective way to prevent harmful cardiac remodeling.
Objective To compare the clinical results of different thoracic incision approaches for congenital heart disease in children. Methods Retrospective analyses of the clinical results of different thoracic incision approaches for 1 669 children with congenital heart disease was performed. All patients were divided into median sternotomy group(Med group), right thoracotomy group (Rat group),and lower partial median sternotomy group (Pt group) according to different thoracic incision. Two hundred and forty five children underwent atrial septal defect(ASD) repair, 1 005 children underwent ventricular septal defect(VSD) repair and 419 children underwent tetralogy of Fallot(TOF) correct repair from Jan. 1999 to Dec. 2001. Results In ASD repair the incidence of pulmonary complications after operation in the Rat group was significantly higher than that in Med group and Pt group ( P lt;0 05). The percentage of pulmonary hypertension before operation in Med group was significantly greater than th...更多at in the Rat group and Pt group ( P lt;0 05), but the incidence of pulmonary complications in Rat group was significantly higher than that in the Med group and Pt group in children with VSD( P lt;0 05). The concentration of hemoglobin , the oxygen saturation and the percentage of transannular patch in Med group were significantly higher, lower and greater respectively than those in the Pt group and in Rat group in children with TOF( P lt;0 05). Conclusion The approaches to be selected should guarantee to correct the cardiac anomaly satisfactorily, reduce the postoperative complications maximally and ensure success of their operations.
Abstract： Objective To analyze possible associated risk factors of postoperative pulmonary complications (PPC) after lung resection in order to decrease the incidence and mortality of PPC. Methods We reviewed the data of 302 patients including 228 males and 74 females undergoing lung resection from January 2007 to December 2009 in our department. The age of the patients ranged from 23 to 91 years old with an average age of 63.38 years. Based on the present definition of PPC, we recorded the related information and data before, during and after the operation, and observed the rate of PPC. The independent risk factors of PPC were evaluated by multiple logistic regression analysis. Results A total of 22 patients (7.28%) died during the operation and 75 patients (24.83%) experienced 110 times of PPC, the majority of which were prolonged air leak/bronchopleural fistula (8.94%, 27/302), nosocomial pneumonia (6.95%, 21/302) and acute respiratory failure (6.29%, 19/302). The results of logistic regression analysis showed that an American Society of Anesthesiology (ASA) score ≥3 (OR=2.400，P=0.020) and prolonged duration of immediate postoperative mechanical ventilation (OR=1.620，P=0.030) were independent factors associated with the development of PPC.Conclusions The ASA score based on the patients’ general condition and the function status of the main organs, and the prolonged duration of immediate postoperative mechanical ventilation are independent risk factors of PPC. In order to decrease the PPC rate, more attention should be paid to perfecting preoperative preparation, improving the function and condition of the organs, preserving pulmonary function and decreasing the duration of immediate postoperative mechanical ventilation for patients with high risk factors.
Abstract： Objective To summarize the experiences and analyze the efficacy of mitral valvuloplasty in treating anterior leaflet prolapse. Methods A total of 152 consecutive nonrheumatic heart disease patients including 96 males and 56 females with anterior leaflet prolapse who underwent mitral valvuloplasty from February 1997 to March 2007 were analyzed retrospectively. The age of these patients ranged from 10 to 73 years old (38.54±17.22 years). There were 119 cases of mitral degenerative prolapse or chordae rupture, 24 of ongenital heart disease, 3 of ischemic mitral insufficiency, and 6 of native valve endocarditis. Echocardiography before operation showed the degree of mitral regurgitation was severe in 19, moderate to severe in 63, and moderate in 70 patients. Among the patients, 87 had anterior prolapse and 65 had bilateral prolapse. All patients underwent mitral valve repair under standard cardiopulmonary bypass. Results During the operation, transesophageal echocardiography and saline injection test showed satisfying results in all the patients. No early death occurred after operation. Followup was done to 135 patients for 3 months to 8.5 years with a followup rate of 88.82%. During the follow up, 93 patients were in New Yoke Heart Association（NYHA）class Ⅰ, 35 in Class Ⅱ, 3 in class Ⅲ and 4 in class Ⅳ. The Echocardiography showed that postoperative left atrium diameter (41.09±10.40 mm vs. 45.32±10.07 mm, t=4.186, P=0.000) and left ventricular enddiastolic dimension (52.04±7.74 mm vs. 60.70±7.72 mm,t=9.676, P=0.000) were significantly smaller than that before operation. No or trace mitral regurgitation (MR) was found in 36 patients, mild MR in 45 patients, mild to moderate MR in 38 patients, moderate MR in 9 patients, and moderate to severe MR in 7 patients. Mitral valve replacement was performed in 5 patients after valvuloplasty. Three died during the follow-up. Two of them died of heart failure and one of unknown cause. Conclusion In spite of the complexity, the longterm results of mitral valve repair for anterior leaflet prolapse are satisfactory if the best surgery method is chosen.
Abstract: Objective To study the antiacute rejection effect of Pachymic acid (PA) in heart transplantation rats, in order to select a new antirejection medicine with low side effect from traditional Chinese medicine. Methods We established the model by transplanting Wistar rats (32,donor) heart allografts into the abdomen of SD rats (32,receptor). The homologous hearttransplanted rats were then randomly divided into 4 groups with 16 rats in each group. Olive oil solution with PA 1 mg/(kg·d), PA 10 mg/(kg·d), Cyclosporine (CsA) 5 mg/(kg·d) and olive oil solution 0.5 ml/(kg·d) were respectively given intragastrically to lowdosage PA group, highdosage PA group, CsA group and the control group till the end of observation. Survival time of heart allografts, heart beating and the histological changes of allografts were examined and serum level of interleukin2 (IL-2) and interferon-γ (IFN-γ) were determined by enzymelinked immunosorbent assay (ELISA). Results Survival time in the highdosage PA group, the lowdosage PA group and the CsA group were 24.90±0.99 d, 15.50±1.60 d and 26.80±0.88 d respectively, which is much better than the control group (6.10±1.10 d, q=22.363, P=0.000; q=44.793, P=0.000; q=49.272,P=0.000). IL-2 serum level in the highdosage PA group, the lowdosage PA group and the CsA group were all lower than that in the control group (q=14.483, P=0.000; q=3.705, P=0.000; =21.418,P=0.000), whileIL-2 serum level in the highdosage group was lower than that in the lowdosage group (q=10.778,P=0.000). Similarly, IFN-γ serum level in the first three groups were all lower than that in the control group (q=16.508,P=0000; q=4.281, P=0.000;q=19.621, P=0.000) and IFNγ serum level in the highdosage group was also lower than that in the lowdosage group (q=14.975, P=0.000). Pathological examination 7 days after the surgery showed that pathologic lesion was much more relieved in the two PA groups and the CsA group than the control group. Conclusion Acute rejection of heart transplantation can be effectively suppressed by PA.
Objective To investigate the application of sequential noninvasive ventilation (NIV) in weaning patients off mechanical ventilation after coronary artery bypass grafting (CABG). Methods From July 2007 to July 2009, 52 patients who underwent CABG with mechanical ventilation for no less than 24 hours and P/F Ratio lower than 150 mm Hg were divided into two groups with random number table. In the sequential NIV group (SNIV group), there were 19 patients including 16 males and 3 females whose ages were 69.26±8.10 years. In the prolonged mechanical ventilation group (PMV group), there were 33 patients including 28 males and 5 females whose ages were 70.06±7.09 years. Clinical data of these two groups were compared and the influence of NIV on the circulation and respiration of the patients were observed. Results The SNIV group weaned off mechanical ventilation earlier than the PMV group (26.46±3.66 h vs. 38.65±9.12 h, P=0.013). The SNIV group held shorter total ventilation time (29.26±21.56 h vs.54.45±86.57 h,P=0.016), ICU stay time (2.44±2.99 d vs. 4.89±7.42 d, P=0.028) and postoperative hospital time (10.82±4.31 d vs. 14.01±19.30 d, P=0.039) than the PMV group. Furthermore, the SNIV group had lower pneumonia rate (5.26% vs. 30.30%, P=0.033) and total postoperative complication rate (10.53% vs.45.45%, P=0.030) than the PMV group. However, there was no significant difference (Pgt;0.05) between the two groups in the successful weaning rate, repeated tracheal intubation rate, tracheotomy rate and mortality 30 days after operation. After NIV, SNIV group had no significant change in heart rate, central vein 〖CM(1585mm〗pressure, pulmonary arterial pressure and pulmonary arterial wedge pressure than the baseline value, while systolic pressure (129.66±19.11 mm Hg vs. 119.01±20.31 mm Hg, P=0.031), cardiacindex ［3.01±0.30 L/(min.m2) vs. 2.78±0.36 L/(min.m2), P=0.043］ and P/F Ratio (205.95±27.40 mm Hg vs. 141.33±9.98 mm Hg, P=0.001) were obviously elevated. Conclusion Sequential NIV is a effective and safe method to wean CABG patients off mechanical ventilation.
Objective To investigate the operative characteristic and results of the modified Fontan procedure, and improve the application of Fontan procedure in the clinic. Methods From Sep. 1992 to June 2006, 77 cases (aged 2.5 years to 20.0 years) with a wide range of complicated congenital heart diseases underwent the modified Fontan procedure.Right atriumpulmonary artery connection were performed in 21 cases, intraatrium fenestrated baffle or conduit total cavopulmonary connection were performed in 28 cases, extracardiac conduit total cavopulmonary connection were performed in 24 cases, atrium wall lateral tunnel total cavopulmonary anastomosis were performed in 2 cases, extracardiac pericardialtube total cavopulmonary anastomosis was performed in 1 case, and extracardiac direct total cavopulmonary connection was performed in 1 case. Results In early postoperative period, there were 1 case of successful reoperation and 5 death, the cause of death were heart failure (3 cases), arrhythmia (1 case) and cerebral hemorrhage (1 case). The early survival rate was 93.5%(72/77), with 92.0% free from failure. The eject fractions of left ventricle (LVEF) after operation were increased than those before operation （68.5%±4.0% vs.62.0%±4.5%,P=0.032） and left ventricular enddiastolic diameter (LVEDD) were decreased than those before operation （52.5±7.8mm vs.62.5±11.0mm, P=0.013）. A total of 63 cases (87.5%) were followed up from 1 to 15 years after operation. In late postoperative period, there were 4 cases of death, and 1 of successful re-operation. Late survival rate was 88.3%, with 86.0% free from failure. Conclusion In the treatment for complicated congenital heart diseases, the modified Fontan procedure could result in good early and longterm outcome, and the choices for surgical procedure are various.
