Application of valve-sparing aortic root reimplantation for aortic root disorders in patients with Marfan syndrome / 第二军医大学学报

ObjectiveTo evaluate the appropriate indications, key points of surgical techniques, and early to midterm outcomes of valve-sparing aortic root reimplantation in patients with Marfan syndrome. MethodsThe clinical data of 52 patients with Marfan syndrome who underwent valve-sparing aortic root reimplantation in our department from June 2006 to July 2017 were retrospectively analyzed. Preoperative patient characteristics, surgical techniques, and follow-up outcomes were summarized. ResultsThe patients had a mean age of (36.6±14.5) years, with 35 males and 17 females. Severe aortic valve insufficiency (AI) was found in 37 cases (71.2%) preoperatively. Echocardiography indicated that the average diameter of aortic annulus, aortic sinus, and sinotubular junction of this cohort were 22-30 mm, 40-56 mm, and 34-51 mm, respectively. Pure valve-sparing aortic root reimplantation was performed in 40 patients presenting aortic root aneurysm, with a cross-clamp time of 61-108 min and a mean of (81.3±11.6) min, and with a cardiopulmonary bypass time of 88-129 min and a mean of (97.3±10.8) min. The other 12 patients with Stanford type A aortic dissection underwent concomitant total arch replacement and elephant trunk implantation in the descending aorta, with a cross-clamp time of 93- 126 min and a mean of (107.4±11.2) min, and with a cardiopulmonary bypass time of 127-180 min and a mean of (143.5±17.1) min. Vascular prostheses with a diameter of ≤30 mm were adopted in all patients. Aortic root bleeding was drained to the right atriums in 9 patients. Transesophageal echocardiography was performed in 42 cases before extracorporeal circulation removal, with 16 cases presenting no AI, 18 presenting trace AI, and 8 presenting mild AI. There was one in-hospital death (1.9%) and no secondary thoracotomy for bleeding or other major complications. The mean follow-up was (3.2±2.1) years, with 43 cases completed the follow-up and no death during follow-up. Echocardiography in the latest follow-up indicated that 6 cases presented no AI, 24 presented trace AI, 12 presented mild AI, and only one case presented moderate AI, with 97.7% (42/43) patients free from moderate AI. No case underwent aortic valve replacement for severe AI. There were 39 (90.7%) patients in New York Heart Association classIand 4 (9.3%) patients in classII . ConclusionApplication of valve-sparing aortic root reimplantation using vascular prostheses with appropriate diameter is safe and effective for suitable patients with Marfan syndrome, and can obtain satisfactory outcomes.

Expression and biological functions of Myc associated factor X in human aortic dissection tissue / 第二军医大学学报

Objective To observe the expression of Myc associated factor X (MAX) in aortic dissection tissue, and to discuss its biological functions. Methods MAX expression level was evaluated by qRT-PCR and Western blotting analysis in 15 dissected aorta samples. The adenovirus vector was used to transfect human aortic smooth muscle cells (HASMCs) for overexpression of MAX. The effects of MAX overexpression on proliferation and apoptosis of HASMCs were analyzed by Cell Counting Kit-8 and flow cytometry, respectively. Results MAX mRNA and protein expression levels were significantly higher in the aortic dissection tissue compared with that in the healthy controls. Overexpression of MAX significantly inhibited the proliferation of HASMCs and promoted its apoptosis (P<0.05). Conclusion MAX might induce the loss of HASMCs via regulating their proliferation and apoptosis process, thus play an important role in the development and progression of aortic dissection.

Prosthesis-patient mismatch: Recent progress / 第二军医大学学报

Prosthesis-patient mismatch occurs when the effective orifice area of the prothesis is too small according to the patient's body size after insertion, which may consequently result in consistent presence of eignificant residual transvalvular pressure gradients postoperativtly, hampeeing the prognoses of patients. Currency the indexed effective oeitice area measured by postoperative transthoracic echocardiography is considered the only appropriate parameter which can accurately desceibe the mismatch. Valves of various types can have very different indexed effective orifice areas, so the incidence of mismatch also vaeies. Recently, the mismatch following transcatheter aortic valve implantation is drawing increasing attention. The clinical implication of prosthesis-patient mismatch is still debated. Many factors, including the indices, standard and other mixing factors, together with the age, preoperative cardiac function and types of valve disease of patients can be related to the mismatch, the previous conclusions have been various. Prosthesis-patient mismatch may cause a greater influence to patients with left heart dysfunction and young patients. It can be largtly prevented by choosing prostheses of appropriate size or by enlarging the aortic root by operation if necessary; a final decision should be made according to the patients' condition. Severe mismatch and mismatch in patients with severe cardiac dysfunction should be avoided. In this paper we reviews the recent progress on prosthesis-patient mismatch.