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The clinical data of 31 patients with congenital heart disease(CHD)receiving minimally invasive surgical closure through chest or femoral venous catheter from June 2016 to September 2017 were analyzed retrospectively.All patients were diagnosed with esophageal echocardiography before operation.During the operation,the insert of guide wire and the sheath tube,and the placement of the sealing parasol were monitored and guided by transesophageal echocardiography (TEE).Satisfactory results were obtained in 30 patients.In 1 patients,the sealing parasol was detached,and open chest surgery was performed to remove the detached parasol and to repair the defect.TEE-guided minimally invasive surgical closure through chest or femoral vein catheter is safe and effective in the treatment of congenital heart disease and has certain clinical applicative value.
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Objective To observe the expression of Caspase-12 and GRP78 of endoplasmic reticulum stress (ERS) in cardiac arrest and beating heart mitral valve replacement Methods Thirty patients with rheumatic heart disease mitral stenosis were randomly divided into beating heart group (BH,n=15) and cardiac arrest group(CA, n = 15). Both groups accepted MVR by beating heart surgery and cardiac arrest surgery under cardiopulmonary bypass (CPB) respectively. Right atrial myocardial tissues were collected at prior the start of CPB (T0), after aortic cross-clamping 30 minutes (BH group 30 minutes after CPB, T1) and stitched right atrium (T2) respectively. The method of reverse transcriptase polymerase chain reaction (RT-PCR) was applied to detect the expression level of Caspase-12 and GRP78 in two groups and positive staining of Caspase-12 and GRP78 of myocardial tissue slices in both groups was observed by immunohistochemical method. Results The expression of Caspase-12 in CA group heightened at T1and significantly increased at T2 (P < 0.05) but the expression of Caspase-12 in BH group had increased in T2 only (P < 0.05). Caspase-12 in CA group expressed higher than that in BH group at T1 and T2. The expression of GRP78 had increased at T1 in two groups but it in CA group expressed higher than that inBH group at T2. The number of positive staining of Caspase-12 and GRP78 in CA group was higher than that in BH group at T2. Conclusion MVR of beating heart can reduce the reaction of ERS to enhance the myocardial protection under CPB.
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Objective To explore the characteristics of operation,curative effects and operative management in elderly patients of age older than 70 years with coronary heart disease receiving coronary artery bypass grafting.Methods 108 elderly patients of age older than 70 years with coronary heart disease were divided into two groups:OPCAB group(n = 76) and CCABG group (n = 32) The clinical curative effects, early postoperative mortality and complications of the two groups were compared and analyzed respectively. Results OPCAB group was better than CCABG group in these series(P ＜ 0.05): The early postoperative mortality (5.8%, 11.2%)、 myocardial infarction (2.9%, 10.6%), respiration failure(8.7%, 17.5%), pulmonary complications: (11.8%, 31.5%) 、complication of CNS:(1.8% ,9.8%) 、acute renal failure(1.8% ,6.2%) ,the time of intubation: (9.3 ±4.5), (25.4 ±7.5) h,ICU stay(3.1 ± 1.8) ,(7.1 ±2.9) d,hospital stay(15.5 ±8.6) ,(26.4 ±8.6)d. Conclusion OPCAB could reduce operative mortality and complication, it should be the first option for the surgery of elder patients with coronary heart disease;surgical skills and correct perioperative management were the key factors to assure surgical outcome.
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BACKGROUND: Cell apoptosis and ventricle reconstitution following myocardial infarction are of mutual cause-effect, and they cause vicious cycle. How to reduce the apoptosis events following myocardial infarction is one of keys to saving heart function.OBJECTIVE: To observe the effect of umbilical cord blood mesenchymal stem cell (UCBSMC) transplantation on remaining myocardial tissue of dogs with acute myocardial infarction.DESIGN: A randomized controlled observation.SETTING: Department of Cardiothoracic Surgery, Xinhua Hospital.MATERIALS: This study was carried out in the Central Laboratory of Xinhua Hospital from October 2005 to May 2007.Thirty-six adult hybrid dogs, male and female in half, were provided by the Animal Experimental Center of Xinhua Hospital.METHODS: Thirty-six dogs were divided into cell transplantation group and control group, with 18 dogs in each according to table of random digit. Mesenchymal stem cells were isolated from the umbilical cord blood of full-term pregnant hybrid dogs, cultured and amplified. Then, they were labeled with Laz gene, in vitro induced with 5-azacytidine, and transplanted into the dogs with acute myocardial infarction in the cell transplantation group. Rats in the control group were injected with the same amount of normal saline. Each dog was euthanized by anesthesia for harvesting myocardial specimen 1,4 and 8 weeks after transplantation.MAIN OUTCOME MEASURES: ① Remaining and apoptosis index detected by TUNEL method. ② Myocardial cell volume and histomorphology detected by confocal microscopy. ③ Histological change of myocardial collagen network detected by haematoxylin-basic fuchsin-picric acid staining.RESULTS: Thirty-six involved experimental dogs all entered the stage of final analysis. ①The apoptosis index in the cell transplantation group was significantly lower than that in the control group 1, 4 and 8 weeks after cell transplantation (P ＜0.05). ② Myocardial cell volume in the cell transplantation group 1, 4 and 8 weeks after cell transplantation was significantly larger than that in the control group (P ＜ 0.05). ③ Collagen fiber in the myocardial tissue of dogs in the cell transplantation group was arranged in order and regularly, and in contrast that in the control group was not, and fibers in the control group fused partially.CONCLUSION: UCBSMC transplantation reduces the apoptosis of myocardial cells, promotes the hypertrophy of remaining myocardial cells, regulates myocardial collagen network and improves heart function.