Surgical treatment on aortic valve disease combined with non-specific aortitis / 中华胸心血管外科杂志

Objective To summary the methods and results of first and second operations on patients with aortic valve disease and non-specific aortitis.Methods The total 34 patients including 23 cases with aortitis and 11 cases with Behcet disease were studied from Jan 2000 to Dec 2010.The first operation was Bentall procedure in 18 cases and AVR in 16 cases.Fourteen of 16 cases who had AVR developed severe paravalvular leakage,and undewent the second operation including 10 aortic root replacement (8 valve-conduit and 2 homograft) and 4 non-anatomic AVR.Results Eighteen patients who had first operation of Bentall procedure all survive without aortic pseudoaneurysm after the follow-up of 6 months to 11 years.Fourteen redo cases all survive except for one case died of repture of aortic pseudoaneurysm 1.2 years postoperatively.Conclusion Preoperative diagnosis in these patients is very difficulty.The first operation of root replacement is of choice.The second operation is very difficulty to handle,root replacement can achieve satisfactory results.Non-anatomic AVR is easy to perform,and good hemo stasis intraoperatively,and is a satisfied alternative method with good results.

The early diagnostic value of serum Cys-C、β~2-MG、RBP in patients with diabetic nephropathy / 国际检验医学杂志

Objective To evaluate the Cys-C、β~2-MG、RBP as marker三of early diagnosis in patients with diabetic nephropathy Ⅱ(DN).Methods ninety patients with DN were divided into three groups according to urinary albumin excretion rate (UAER),that is normal,micro and mass group.Serum Cys-C、β~2-MG、RBP、BUN,Crea were detected and parallelly contrasted in the three groups and control group with thirty healthy people.Results compared with the control group,the serum Cys-C、β~2-MG、RBP of micro and mass group both significantly increased and the normal group had no significant difference.The positive rate of Cys-C、β~2-MG,RBP in mass group was respectively 100%、100%、96.1%;the positive rate in micro group as follows:Cys C (92.3%)＞B2-MG(84.6%)＞RBP(66.6%)＞Crea(46.1%)＞BUN(28.2%).Conclusion serum Cys-C、β~2-MG、RBP have high positive rates in patients with diabetic nephropathy Ⅱ(DN).They can be used as early diagnostic marker of diabetic nephropathy Ⅱespecially Cys-C.

Ascending aortic dilatation combined with aortic valve disease: ascending aortic replacement or aortoplasty / 中华胸心血管外科杂志

Objective The results of Aortic valve replacement (AVR). Combined with ascending aortic replacement(group A) or aortoplasty (group B) in patients with aortic valve disease and ascending aortic dilatation were analysed to assess the clinical outcomes and respective indications. Methods Among the two groups, the age, gender, NYHA class, types of aortic valve lesions and left ventricular ejection fraction were not different statically. The ascending aortic diameters in group A[(50.41 ±3.71) mm] and group B [(48.29±2.18) mm] were not statically different. Ascending aortic replacement was performed in Group A. A Dacron tube(diameter 28 ～ 30mm) was routinely wrapped around the ascending aorta after aortoplasty in group B. Results There was 1 postoperative death in group B, blood transfusion volume and postoperative complications were not stasticaly different in the two groups. Cardiopulmonary bypass time [(110.52 ± 27.51) min] and aortic across clumping time [(71.70 ± 17.13)min] in group A were significantly longer than that of group B [(97.31 ± 19.46) min,P=0. 004; (57.13 ±19.46) min, respectively. P=0.025]. Conclusion Aortic valve disease, especially bicuspid valve disease often combines with ascending aortic dilatation or aneurysm. In younger patients, ascending aorta should be actively treated surgically when the diameter is equal or more than 40mm. Aortoplasty with external reinforcement of a Dacron tube is simpler and safer than aortic replacement in patient without aortic atherosclerosis or ulceration, and large aneurysm.

Fetal bone marrow stromal cells support the in vitro expansion of human hematopoietic bone marrow progenitor cells: requirement for cell-to-cell interactions and colony-stimulating factors / 第二军医大学学报

Objective： To elucidate the role of bone marrow stromal cells in cooperation with exogenous cytokines in hematopoiesis. Methods： Fetal bone marrow stromal cells (FBMSC) was combined with cytokines including SCF,IL-3,IL-6,GM-CSF in a 5-day liquid culture system of adult bone marrow mononuclear cells, then we cultured bone marrow derived CD34+-enriched cells with FBMSC+SCF+IL-3+IL-6+G-CSF+EPO for 2 weeks. Results：FBMSC were in good cooperation with above mentioned exogenous cytokines. When CD34+-enriched cells from adult bone marrow were cultured with combinations of FBMSC, SCF, IL-3, IL-6, G-CSF and EPO, total nucleated cells, CFU-GM, BFU-E and CD34+ cells were increased by 119.6±30.9, 54.6±17.4, 25.2±4.4, 11.1±4.2 folds, respectively. Conclusion：FBMSC in cooperation with exogenous cytokines support the in vitro expansion of human hematopoietic progenitor cells efficiently.

Pathology of the lungs in rheumatic mitral stenosis with pulmonary hypertension / 第二军医大学学报

Objective: To review the pathological characteristics of the lungs in mitral stenosis with pulmonary hypertension, and provide evidence for clinical treatment. Methods: Pulmonary pathological changes in 37 patients with rheumatic mitral stenosis and secondary pulmonary hypertension received mitral valve replacement. Six patients of aortic valve disease without pulmonary hypertension received aortic valve replacement and were taken as control. The lung biopsies were obtained from the middle lobe of the right lung in operation. Pulmonary muscular arteries were studied quantitatively and qualitatively. Results: All patients with mitral stenosis showed various degrees of vascular and other associated parenchymal changes. The structural changes in the muscular arteries was graded according to the degree of MT/R. There was 81% of patients with mitral stenosis in mild to moderate degree. Conclusion: The pulmonary vascular pathological changes of patients who have rheumatic mitral stenosis with pulmonary hypertension are related to the level of preoperative pulmonary artery pressure. And in most of them the pulmonary vascular pathological changes are in mild to moderate degree.

The surgical procedure and clinical results of Stanford A aortic dissection / 中华胸心血管外科杂志

Objective To evaluate the methods and consequences of surgical technique in the treatment of Stanford A aortic dissection.Methods 108 patients with type Standford A aortic dissection underwent surgery in our study,including urgent surgery in 53 and selective surgery in 55.The operation was performed under deep hypothennic circulatory arrest (DHCA) in 85 cases.Surgical procedures included ascending and semi arch replacement or total arch replacement (some cases combined with stented graft implanted into the descending aorta),"elephant trunk" procedure.Concomitant procedures included repair of intimal tear in arch or descending aorta,Bentall procedure,aortic valve replacement,Cabrol or modified Cabrol procedure,aortic valvuloplasty,mitral valvuloplasty or mitral valve replacement,tricuspid valvuloplasty and CABG.Results In-hospital mortality was 6.5% (7 of 108 patients).The mor- tality was 7.5% (4 of 53 patients) in urgent surgery group and in elective surgery group was 5.4% (3 of 55 patients).Ninety six percent survived patients were followed up for 1 month to 13.3 years [mean (3.2?1.3) years] and 2 deaths occurred during the fel- low-up period.3 patients underwent re-operatian.Conclusion The choice of surgical procedures depend on the location of intimal tear for Stanford A aortic dissection.The better operative effects can be expected with proper surgical indication,perfecting surgical technique,and enhancing postoperative treatment.

Chronic stenosis of mechanical prosthetic valve complicated with acute dysfunction:diagnosis and surgical treatment / 第二军医大学学报

Objective To investigate the surgical diagnosis and treatment of chronic stenosis of mechanical prosthetic valve complicated with acute dysfunction,so as to deepen our knowledge on chronic stenosis of mechanical prosthetic valve.Methods The clinical data of 5 patients with chronic stenosis of mechanical prosthetic valve complicated with acute dysfunction were retrospectively analyzed,and the relevant literatures were reviewed.Results Re-operation(mechanical prosthetic valve replacement) was performed once the diagnoses were confirmed.The patients recovered well;the cardiac function was obviously improved;and there were no early complications.Conclusion Chronic stenosis of mechanical prosthetic valve should be strongly suspected when they have symptoms indicating valvular stenosis.Complication of acute mechanical prosthetic valve dysfunction is not difficult to diagnose,and prompt operation is important to save the life of patients.