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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.
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BACKGROUND: It has been found that xenogenic extracellular matrix (ECM) may cause a strong inflammatory response in humans during clinical application of decellularized porcine heart valve (synergraft valves). An early inflammatory reaction severely weakens matrix structure of valve wall, leading to structural rupture and decay of grafts. From Synergraft's event, the decellularized porcine heart valves still had immunogenicity, especially for pediatric patients. The mechanisms by which the ECM triggers this immune process need to be further evaluated. OBJECTIVE: To find the difference of gene sequence between human and porcine ECM and to identify the ECM immunogenicity based on bioinformatics. DESIGN, TIME AND SETTING: A contrast study between human and porcine ECM based on type IV collagen was performed at the Laboratory of Cardiothoracic Surgery, Changhai Hospital, the Second Military Medical University of Chinese PLA from June 2008 to February May.MATERIALS: The fresh porcine heart valves were obtained from Shanghai Wufengshangshi Slaughter House. Decellularized porcine aortic valves, hybridoma cells, and monoclonal antibodies were provided by our laboratory. METHODS: Similar region and conservative site of gene sequence among human, porcine, and rat were compared so as to look for common similar region, site, and sequence difference and investigate the segment which caused common and different gene sequence. Type IV collagen monoclonal antibody was used to evaluate the persistence of ECM of decellularized porcine heart valve following immunohistochemical staining. MAIN OUTCOME MEASURES: Type IV collagen gene sequence; efficacy of self-made antibody using immunohistochemistry; effect of self-made antibody on type IV collage of decellularized porcine heart valve. RESULTS: The differential gene serial in type IV collagen protein was found out by bioinformatics method. Monoclonal antibodies were successfully produced by human-mouse hybridoma technique. Residual porcine ECM was observed on decellularized porcine heart valve. CONCLUSION: Residual porcine ECM was observed on decellularized porcine heart valve and had immunogenicity.
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To investigate the electrophysiologic characteristics of f-wave amplitude and to evaluate its role in development and persistence of chronic atrial fibrillation (AF) associated with rheumatic heart disease (RHD). Methods: Epicardial mapping was performed in 44 patients with chronic AF of RHD who underwent heart valve surgery. Ten patients with supraventricular tachycardia served as the control group. Results:The f-wave amplitude of left atrium (LA) and middle and low LA posterior regions were significantly lower than those of the control group. The f-wave amplitudes of the upper, middle and low sections in LA posterior region were significantly lower than those in right atrium (RA) (P<0.05). The f-wave amplitudes were compared before and after electrocardioversion in 14 patients with chronic AF. The mean atrial electrogram amplitude during sinus rhythm was significantly higher than that during AF (P<0.01).The f-wave amplitude in left appendage was higher than that in LA posterior region (the upper,middle and the lower part),P<0.05.The f-wave amplitude in the upper section of LA was significantly higher than that in the middle section. The f-wave amplitude in AF group was not correlated to the diameter or volume of both atria. Conclusion: There are amplitudes differences between the upper, middle and lower LA,suggesting that the middle and lower sections of LA posterior wall may be the region producing anisotropy and reentrant circle.
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BACKGROUND: Cell transplantation is a new technique to treat myocardial ischemic diseases in recent years. There are not many reports regarding smooth muscle cell(SMC) transplantation at moment.OBJECTIVE: To investigate the impact of autologous SMC transplantation on the survival and the restoration of cardiac function after myocardial infarct.DESIGN: An observatory comparative study based on experimental animals.SETTING: Institute of cardiothoracic surgery in a military medical university of Chinese PLA.MATERIALS: The study was conducted in the Institute of Cardiothoracic Surgery of the Second Military Medical University of Chinese PLA from January 2003 to June 2003. Totally 24 male adult SD rats in cleanness grade with a body mass of(300 ± 20) g were randomly divided into two groups,i. e. ,transplant group and control group with 12 rats each. All rats were fed in clean environment.METHODS: Autologous SMC was separated and extracted from the ductus deferens of SD rats by enzymic digestion for culture and amplification in vitro. BrdU-labeled autologous SMC was directly injected into the scarring tissues of cardiac infarct area induced by the ligation of anterior descending branch of left coronary artery 2 weeks ago in rats of transplant group. DMEM culture medium of same volume was injected into the rats of control group. Cardiac function was evaluated by ultrasound examination before and 4 weeks after transplantation. The survival of the transplanted SMC and its effect of vasoformation in myocardial scarring tissues were detected by immunohistochemical staining.soformation in myocardial scarring area after autologous SMC transplantation;after transplantation.RESULTS: Transplanted autologous SMC survived and formed muscle-like tissues in myocardial infarct area. Compared with control group, left ventricnlar end diastolic volume(LVEDV) of transplant group was significantly reduced( P < 0.01), left ventricular ejection fraction(LVEF) was significantly elevated( P < 0.01 ), and the vasoformation in myocardial scarring tissue was significant( P < 0.01 ).CONCLUSION: Autologous SMC transplantation can prevent ventricle enlargement after myocardial infarct, promote vasoformation in infarct area, and ameliorate cardiac function.
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Objective To report the outcome of surgical treatment of prosthetic valve endocarditis (PVE). Methods From 1990 to Aug 2003, 21 patients with PVE were operated on, including 5 acute PVE and 16 subacute PVE. Blood culture was positive in 13 cases. Echocardiographic findings showed aortic and mitral valve leakage in 6 and 3 cases respectively. Aortic and mitral vegetation was found in 3 and 5 cases, respectively. Mechanical valve was used to replace mitral valve in 11 cases, aortic valve in 10 cases. Ascending aortic false aneurysm was resected, and ascending aorta repaired in one case. Vegetations were found in all cases, mitral annulus abscess in 7 cases and myocardial abscess in 3, aortic annulus abscess in 8 and myocardial abscess in 4. Results There were 5 early-death, 3 due to recurrence of infection, 2 due to multiorgans failure. One late death was due to fungus infection. The survivors were followed up from 4 months to 13 years, one case had recurrence of PVE and died after ineffective medical treatment. Conclusion Early diagnosis of PVE, optimal timing of surgery, radical debridement of infected tissue, and utilizing sensitive and high dose of antibiotics perioperatively, are the key factors to improve the surgical outcome.
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Objective: To evaluate the protective effect of bone marrow stromal cells (BMSCs) transferred by Ad?ANG ex vivo on ischemic myocardium. Methods: ELISA method was used to assay the expression and secretion of angiogenin (ANG) after Ad?ANG transfection of BMSCs ex vivo. Then BMSCs with Ad?ANG were transplanted into ischemic myocardium of isogenic Lewis rats. 4 weeks later, the parameters of heart function, such as EF and EDLV, were examined by echocardiography. Survival and differentiation of transplanted BMSCs and angiogenesis were appraised by histology and transmission electron micrography. Results: ANG was found in both lysate and culture medium after transfection of BMSCs. A maximum expression of ANG was observed at 4-7 days after transfection and could still be assayed 15 days later. 4 weeks later after transplantation in the BMSCs with Ad?ANG group, heart function improved better than the single BMSCs group(P
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Objective The long-term effects of cell transplant on cardiac function are unknown. Therefore, we tested the survival and functional impact of rat autologous smooth muscle cells up to 12 weeks after transplant into infracted hearts. Methods Autologous smooth muscle cells were acquired from the ductus deferens of adult Sprague-Dawley rats(weight,300g), and cultured for 4 weeks before transplant. 4 weeks after left coronary artery ligation, the cultured cells(4?10 6 , n=10), marked with 5-bromo-2'-deoxyuridine(BrdU), or culture medium alone(n=10) were injected directly into infarcts of the heart. Cardiac function was assessed by echocardiography before and 12 weeks after transplantation. BrdU in the cells and smooth muscle cells were identified by immunohistochemical staining technique using monoclonal antibodies against BrdU and ?-smooth muscle actin. Results Grafted autologous smooth muscle cells were presented in infarcts and formed musclelike tissue. They thickened the wall of the left ventricle〔(2.36?0.31) vs (1.03?0.11)mm,P
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<p><b>OBJECTIVE</b>To study the morphologic classification and its clinical significance of giant left atrium (GLA) combined with mitral valvular disease.</p><p><b>METHODS</b>Between January 1993 and December 1999, a total of 62 consecutive patients with mitral valvular disease, whose preoperative left atrial endodiastolic volume index >/= 300 ml/m(2) or endosystolic diameter >/= 6.0 cm, were enrolled as research candidates. Morphologically, GLA was classified by Q Hierarchical cluster analysis according to the right or left side cardiothoracic ratio of the left atrium (r- or l-LATR) on an anteroposterior chest roentgenogram and the ratio of the distant diameter of the left main bronchus to the approximate diameter of the left main bronchus (LBDd/Dp) or to the trachea (LB/TR) on an left anterior oblique chest roentgenogram.</p><p><b>RESULTS</b>According to r-LATR and l-LATR, the morphology of GLA was classified clinically into three types: type L (l-LATR >/= 0.6 and r-LATR < 0.58), type R (r-LATR >/= 0.58 and l-LATR < 0.6) and type B (r-LATR >/= 0.58 and l-LATR >/= 0.6). According to LBDd/Dp and LB/TR, GLA in type L and B was further classified into two subtypes, respectively: left posterior downward type (L(I) and B(I)), in which LBDd/Dp is equal or exceeds 0.38 or LB/TR is equal or exceeds 0.33, and left posterior upward type (L(II) and B(II)), in which LBDd/Dp is less than 0.38 or LB/TR less than 0.33.</p><p><b>CONCLUSION</b>The morphologic classification of GLA may represent the main pathophysiological changes of GLA and might be a guideline for the selection of the optimal plication procedures of GLA in patients with valve diseases.</p>
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Adolescent , Adult , Female , Humans , Male , Middle Aged , Cardiomegaly , Pathology , Heart Atria , Pathology , Mitral Valve Insufficiency , Pathology , Mitral Valve Stenosis , PathologyABSTRACT
Objective: To elucidate the possible mechanism responsible for the improved protection of terminal warm blood cardioplegia (TWBC) after hypothermic cardiopulmonary bypass (CPB) through analysis of tubulin (TB) components changes in myocardial cells exposed to TWBC. Methods: Stable animal models of CPB were established in cats, which were then randomly divided into 2 groups. Group Ⅰ was subjected to intermittent cold blood cardioplegia (ICBC) whereas group Ⅱ to ICBC followed by TWBC before uncross-clamping. Left ventricular performance was then monitored and evaluated by LVSP, LVEDP, ±dp/dtmax and t-dp/dtmax in both groups and semi-quantitive analysis was conducted with Western blot method as to the content and constitution of TB in myocardial cells at 15 min, 120 min after aortic crossclamping (ACC) and 5 min,15 min, 60 min,120 min after reperfusion. Results: Within 120 min after reperfusion, systolic and diastolic functions decreased significantly in group Ⅰ as compared with group Ⅱ(P<0.05). At 115 min after ACC and 15 min after reperfusion, the content of free and polymerized TB in both groups had no difference (P>0.05). At 120 min after ACC and 5 minutes after reperfusion, there was a significant difference between groupⅠ andⅡ (P<0.01). Conclusion: TWBC accelerates the repolymerization of myocardial TB during hypothermic CPB, which may mediate the improved cardiac performance in the early stage of myocardial reperfusion.
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The experiences of coronary artery bypass grafting (CABG ) surgery and perioperative management for critical patients are reported. Forty-five critical CAD patients aged from 41 to 78 years old with 32 male and 13 female underwent CABG.The critical conditions included coronary artery disease complicated with left ventricular dysfunction (LVEF less than 30%) in 7 patients, heart valve disease in 13, postinfarction giant LV aneurysm in 6, aged 75 years or older patients with hypertension, diabetes, and renal or severe lung dysfunction in 8, and emergent CABG because of insufficient blood supply from left coronary artery during cardiac valve replacement or ascending aortic aneurysm operation in 5. Among all the patients, pure CABG was performed in 20, and CABG with other simultaneous procedures in 25. Each of 45 patients received l to 4 bypass grafts with a mean of 2 9. During the early stage of postoperation,there were low cardiac output syndrome in 6 patients, renal failure in 3, pulmonary failure in 2, and MOSF in 1.With the application of IABP, 5 from 6 LCDS patients recovered.Three patients were complicated with renal failure, and they also recovered with the use of peritoneal or blood dialysis postoperatively. During the early stage of postoperation,two patients (4 4%) died of LCOS and MOSF, respectively. One died of arrhythmia 15 months later after operation .The experiences suggest that control of hypertension,heart rate and diabetes before operation, perfect revascularization of ischemic myocardium and effective myocardial protection during operation,prevention of LCOS and renal failure after operation could improve the results of CAD patients undergoing CABG.
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The experiences of surgical treatment of valvular heart diseases in children were reported. Cardiac valve operations were performed in 87 children including 58 males and 29 females between the age of 4 to 14 years ( mean 10 2 years) . Of the 87 patients, 36 underwent mitral valve replacement, 13 aortic valves replacement, 6 mitral and aortic valves replacement, 13 aortic valvuloplasty, and 29 mitral valvuloplasty. Associated cardiac lesions were simultaneously managed. Postoperative complications included low cardiac output syndromes in 7 patients, respiratory failure in 3, and arrhythmia in 5 patients. The operative mortality was 4 60% (4 patients). Follow up was 0 5 to 14 5 years (mean 6 51 years). Late mortality was 3 61% (3 patients). The valvuloplasty operations were first choice for cardiac valve operations in children. It was advisable to use cardiac valve prosthesis of larger size(adult) for valve replacement in children.Anticoagulation with Warfarin was routinely used and the treatment of rheumatic fever should be emphasized postoperatively.
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Objective To evaluate the therapeutic efficacy of peritoneal dialysis(PD) for acute renal failure(ARF) subsequent to cardiac surgical procedures in adults.Method Clinical data of 125 consecutive adult patients,admitted from Feb.1997 to Nov.2007,with ARF subsequent to cardiac surgery and undergone PD,were analyzed retrospectively.The levels of creatinine(Cr),blood urea nitrogen(BUN),albumin and kalium ion([K+]) were compared before and after PD.Results Of 8451 consecutive adult patients undergone operations on heart,358 cases(4.2%) experienced ARF,and 125 cases(1.5%) required PD.In 117 patients performed PD,[K+] declined to normal level within one day,BUN and Cr were 10.5?3.6mmol/L and 129.3?41.6?mol/L at the third day after PD respectively,significantly lower than those before PD(P
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Objective:To investigate the effects of transplanting autologous smooth muscle cells on cardiac function after cardiac infarction. Methods:Autologous smooth muscle cells were isolated from the ductus deferens of SD rats, and cultured for 4 weeks before transplantation. Two weeks after the left coronary artery ligation, the cultured cells(4?10 6), labeled with 5 bromo 2' deoxyuridine(BrdU), were transplanted into the scar tissue in the left ventricular free wall by direct injection(transplant group, n =12). Control group were treated with culture medium alone(control group, n =12). Heart function was assessed by echocardiography 2 weeks after the left coronary artery ligation and 4 weeks after cell transplantation. Then the hearts were immunohistochemically processed using monoclonal antibodies against ? smooth muscle actin and BrdU for the identification of transplanted smooth muscle cells. Vascular endothelial cells were stained for factor Ⅷ using monoclonal antibodies. The blood vessels were counted on the tissue sections under light microscope. Results:The injected autologous smooth muscle cells survived in the infarcted scar tissue and formed muscle like tissue at the site of transplantation 4 weeks later. Left ventricular end diastonic volume(LVEDV) decreased [(0.78?0.16) vs (0.92?0.15) ml, P
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AIM: To generate the angiopoietin-1 recombinant adenovirus for the further studies about adenoviral mediated angiopoietin-1 gene transfer in ischemic myocardium and its effect on the development of neoangiogenesis.METHODS: Angiopoietin-1-PAxCAwt cosmid DNA and adenoviral DNA-TPC were cotransfected to 293 cells by the use of calcium phosphate precipitation method. All recombinant adenoviruses were propagated and titrated in 293 cells, purified by cesium chloride density purification, dialyzed, and stored at-70 ℃. RESULTS: The result shows that the direction of the insert in the cosmid is correct and the replication-deficient angiopoietin-1 recombinant adenovirus was generated efficiently by COS/TPC homologous recombination, with the titers of 5.6?10 11 pfu/L. The viral stocks were demonstrated to be free of replication-competent wild type adenoviruses. The virus stocks in high titer were harvested in our experiment. CONCLUSION: The COS/TPC is an efficient method to prepare recombinant adenovirus and the angiopoietin-1 recombinant adenovirus could be further used in gene therapy.
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With the development of tissue engineering technology .tissue engineering of heart valve by seeding cells and scaffolds has become a hot issue in valve surgery. In this article we reviewed the selection of scaffold. acquirement and culture of seeding cells, in vitro pre-condition and in vivo experiment. The questions need to be resolved in the future study is also put forward.
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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.
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Objective: To assess the hydrodynamic performance of C L pugestrut valve prosthesis in vitro . Methods: The leakage, steady flow and pulsatile flow of the valve prosthesis was tested in vitro with the C L standard valve and Medtronic Hall valve prosthesis as control. Results: The rate of leakage of the C L pugestrut valve was (298?66) ml/min, accorded with the demand of clinical use. The steady flow pressure drop across the C L pugestrut valve was significantly lower than the C L standard valve( P
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Objective To investigate the long-term morphologic and functional changes of the tricuspid valve after mitral valve replacement. Methods The tricuspid valve function was evaluated by Doppler echocardiography in 903 patients who underwent mitral valve replacement during recent 10 years. Tricuspid regurgitation and annular dilatation in various degrees were found in all patients preoperatively. 686 patients underwent Kay annuloplasty or DeVega annuloplasty, 106 patients underwent tricuspid ring annuloplasty, and 201 untreated. Results Among 201 patients who did not undergo tricuspid annuloplasty, severe tricuspid regurgitation developed in 46 during 2 to 3 years follow-up. One out of 16 patients who underwent tricuspid ring annuloplasty developed moderate tricuspid regurgitation 2 years after operation. Of 686 patients who underwent Kay annuloplasty or DeVega annuloplasty, 150 developed moderate or severe tricuspid regurgitation during 3~5 years after operation. Conclusion Tricuspid annular dilatation, right heart impairment and severe pulmonary hypertension are responsible for the development of late tricuspid regurgitation after mitral valve replacement. For the patient who underwent mitral valve replacement ,tricuspid annuloplasty should be performed when annular dilatation was found, even without tricuspid regurgitation and tricuspid ring annuloplasty should be performed in patient with severe tricuspid regurgitation and obvious tricuspid annular dilatation.
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Objective To investigate the feasibility in improving the heart function by smooth muscle cells transplantation into the ischemic myocardium model established by coronary artery ligation. Methods Myocardial infarct was produced by ligation of the left coronary artery. At 2 weeks after establishment of myocardial infarct, cultured fetal rat gatric smooth muscle cells marked with BrdU were transplanted into the ischemic myocardium by direct injection (transplantation group, n=10), or culture medium alone (control group, n=10). Heart function was assessed by echocardiography before and at 4 weeks after transplantation. At 4 weeks after transplantation, the hearts were harvested. The transplanted smooth muscle cells were assessed by immunostaining against BrdU and ?-SMA. Results The injected fetal smooth muscle cells survived in the infarcted regions and formed muscle-like tissues at the site of transplantation at 4 weeks after transplantation. The grafts thickened the wall of the left ventricle [(2.51?0.22) mm vs (1.32?0.16) mm, P
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Objective: To study the clinical significance of liver pathological changes in patients with rheumatic heart valve disease (rheumatic heart disease, RHD). Methods: Forty one patients with RHD and tricuspid valve incompetence in 30 patients underwent heart valve replacement. Light microscopy and H 800 transmission electron microscopy were used to observe liver tissue harvested by biopsy performed before institution of cardiopulmonary bypass. Results: Typical pathological changes of liver as the following: (1) Changes of liver intercellular substance including sinusoid widening, blood stasis, liver fibroplasia. (2)Hepatocyte changes: hepatocyte swollen, mitochondria swollen, crest disappearence, hepatocyte degeneration and necrosis. There was correlation between liver pathological changes and magnitude of tricuspid valve regurgitation. Conclusion: To improve liver pathological changes, it is important to operate on patients with rheumatic heart diseases and tricuspid valve incompetence as early as possible and to eliminate tricuspid valve regurgitation.