Effect of self made artificial blood vessel pre-sewed and wrapped the pericardium on the treatment of Stanford type A aortic dissection / 中国医师进修杂志

Objective:To explore the efficacy of right atrium drainage method in Stanford A aortic dissection by using self made artificial blood vessel pre-sewed and wrapped the pericardium.Methods:The clinical data of 60 Stanford type A aortic dissection patients undergoing Sun′s surgery in the First Affiliated Hospital of University of Science and Technology of China from December 2016 to October 2019 were retrospectively analyzed. Among them, 26 patients were treated with directly wrapped artificial blood vessels for right atrial drainage (group A), and 34 patients were treated with self made artificial blood vessel pre-sewed and wrapped the pericardium (group B). The intraoperative and postoperative conditions were compared between 2 groups.Results:All operations were completed successfully. The extracorporeal circulation time, intraoperative red blood cell dosage, intraoperative plasma dosage and 24 h postoperative drainage volume in group B were significantly lower than those in group A: (174.09 ± 12.11) min vs. (225.23 ± 20.40) min, (5.56 ± 1.16) U vs. (10.50 ± 2.25) U, (650.00 ± 137.62) ml vs. (953.85 ± 221.33) ml and (515.59 ± 89.16) ml vs. (667.88 ± 76.55) ml, and there were statistical differences ( P<0.01); there were no statistical differences in aortic cross-clamping time, deep hypothermic circulatory arrest time, ventilation time, hospital stay, morbidity and mortality between 2 groups ( P>0.05). Conclusions:Self made artificial blood vessel pre-sewed and wrapped the pericardium is used to perform Sun′s operation in Stanford type A aortic dissection patients, which simplifies the operation and further optimizes the internal drainage technology and is beneficial to reduce the intraoperative blood loss and blood consumption and reduce the extracorporeal circulation time, and the effect is accurate.

Research on diagnosis and surgical treatment of congenital coronary artery fistula / 中国医师进修杂志

Objective To summarize and analyze clinical diagnosis and surgical treatment methods of 11 cases with congenital coronary arterial fistula (CCAF). Methods The clinical data of 11 patients who were definited by ultrasonic cardiogram, CT angiography (CTA) and coronary angiography were analyzed retrospectively. Four cases were simple CCAF, 7 cases coexisted with other heart abnormalities. Six cases were given surgical closure of fistula without cardiopulmonary bypass. One of the cases adopted coronary artery under the tangent cotton-padded mattress suture, and 4 cases fistula arterial were ligatured directly. Six cases were given surgical closure of fistula under cardiopulmonary bypass. The right coronary arterial was opened in three of the cases with right coronary artery aneurysm to close fistula. The chambers of heart in the others were opened to close fistula. Results All patients received surgical treatment successfully, and no death happened during the operation. The ultrasonic cardiography showed that all patients recovered well. Follow-up was conducted on 10 patients with the time period ranging from 3 months to 5 years. There was no death and no complication. Conclusions Combined application of ultrasonic cardiogram, coronary angiography and CTA increases the accuracy rate of diagnosis greatly and offers visual bases to formulate operation plan. Surgical operation is quite effective for congenital coronary arterial fistula after definite diagnosis. Operator should try to reserve the expanded coronary arterial, strengthen the anticoagulant after opeation to prevent thrombosis.

"Application of selective cerebral perfusion by the""individual""single-branch stent graft in treating Stanford type A aortic dissection" / 实用医学杂志

Objective To summarize the individualized cavity Single branch stent grafting through rebuilding the aortic arch surgery in 26 cases of the application of the Stanford type A aortic dissection. Methods From 2010 January to 2014 October, 26 patients received Stanford type A aortic dissection surgery, 26 patients received individualized cavity single branch stent grafting to rebuild the aortic arch surgery , together with improved myocardial protection fluid. Results In the present study, 26 cases with aortic dissection that were treated with single branch stent grafting for the reconstruction of aortic arch under DHCA and selective cerebral perfusion. Twenty-six patients received individualized cavity single branch stent grafting reconstruction of aortic arch surgery alone, and were stopped by using deep cryogenic loop (DHCA) plus selective cerebral perfusion surgical treatment. One patient suffered from permanent nerve dysfunction iand give up treatment. Conclusion The sexua branch stent grafting in reconstruction of aortic arch operation could simplify the operation procedures , shorten the operation time, and reduce the amount of blood transfusion and postoperative drainage.

Nano-hydroxyapatite film as a support to improve the proliferation of human umbilical vein endothelial cells / 中国组织工程研究

BACKGROUND:A new type of nano-hydroxyapatite artificial mechanical heart valve has been developed using pulsed laser deposition technology at the Department of Materials, Hefei University and Anhui Institute of Optics and Fine Mechanics, Chinese Academy of Sciences, China. OBJECTIVE:To investigate the compatibility of nano-hydroxyapatite artificial mechanical heart valve with human umbilical vein endothelial cels. METHODS:Human umbilical vein endothelial cels were in vitroisolated, cultured and passaged to the 2-4 generations, and then the cel suspension was inoculated onto the nano-hydroxyapatite artificial mechanical heart valve. After 3, 7, 12 days of culture, the cel growth on the artificial mechanical heart valve was observed under scanning electron microscope. In addition, the human umbilical vein endothelial cels were respectively cultured in room-temperature and high-temperature extract liquids of nano-hydroxyapatite artificial mechanical heart valve, high-density polyethylene and phenol solution extracts for 72 hours, and then, the proliferation of cels was detected by MTT method. RESULTS AND CONCLUSION:Under the scanning electron microscope, the human umbilical vein endothelial cels were fusiform- or polygon-shaped with protuberances adhered to the artificial mechanical heart value at 3 days of culture; the cels were stretched thoroughly and fused at 7 days of culture; and the cels were confluent to pieces that tightly overlaid the heart valve surface and the extracelular matrix was formed localy at 21 days of culture. Results from MTT test displayed that the nano-hydroxyapatite artificial mechanical heart valve had no cytotoxicity to the human umbilical vein endothelial cels, indicating a good cytocompatibility.

Nano-hydroxyapatite is non-toxic to human umbilical cord vein endothelial cells / 中国组织工程研究

BACKGROUND:Pulsed laser deposition synthesis technology has been used to prepare new nano-hydroxyapatite thin film coating by colagen deposition on artificial mechanical heart valve. OBJECTIVE: To investigate the toxicity of new nano-hydroxyapatite thin film on human umbilical vein endothelial cels. METHODS: Human umbilical vein endothelial cels were cultured with nano-hydroxyapatite film room-temperature leaching solution, nano-hydroxyapatite film high-temperature leaching solution, high-density polyethylene and phenol solution. Within 72 hours, cel growth was observed under the inverted phase contrast microscope. At 7 days after culture, cel proliferation and toxicity grading were detected using Cel Counting Kit-8. RESULTS AND CONCLUSION:At 24 hours after culture, cels grew wel, showed fusiform shape, and had strongrefraction in the nano-hydroxyapatite film room-temperature leaching solution, nano-hydroxyapatite film high-temperature leaching solution, high-density polyethylene groups, and no significant differences in cel morphology and number were detected among above groups. Cels in the phenol solution group were suspended, round, pyknotic and dead. At 48 hours, except phenol solution group, cel number increased significantly, and cel grew densely in other three groups. At 72 hours, cels grew strongly, and the gap became smal obviously. Within 7 days after culture, cel proliferation activity was not significant in the nano-hydroxyapatite film room-temperature leaching solution, nano-hydroxyapatite film high-temperature leaching solution, and high-density polyethylene groups, which was significantly higher than in the phenol solution group (P < 0.05). The toxicity of nano-hydroxyapatite film graded 0 to 1. These results suggested that nano-hydroxyapatite artificial mechanical heart valve has good histocompatibility, but no toxicity.

Clinical analysis of total aortic arch reconstruction with a novel individualized combined branched stent grafting technique for patients with Stanford A aortic dissection / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the clinical efficacy between total aortic arch reconstruction with a individualized combined branched stent grafting technique and total aortic arch replacement combined with stented elephant trunk implantation for patients with Stanford A aortic dissection.</p><p><b>METHODS</b>Totally 44 patients with Stanford A aortic dissection treated with surgical treatment from January 2007 to July 2013 were included in this study. The patients were divided into two groups. Group A (n = 22) patients were treated by total arch replacement with stented elephant trunk procedure. Group B (n = 22) patients received individualized combined branched stent grafting technique. Age, gender and disease severity were similar between the two groups (all P > 0.05). Echocardiography and aortic CT angiography were performed pre-operation and at 1 month after operation.</p><p><b>RESULTS</b>Operation was successful in all 44 patients. Cardiopulmonary bypass time, aortic cross clamp time, circulation arrest time and duration of ventilator assisted breathing were significantly longer, postoperative drainage volume and blood transfusion volume were significantly larger and hospitalization cost was significantly higher in group A patients compared those in group B patients (t = 2.791 to 43.465, all P < 0.05). One month after operation, the maximum internal diameter of aorta was smaller than pre-operation in both group A ((33 ± 1) mm vs. (45 ± 6) mm, t = 10.076, P = 0.000) and group B ((33 ± 2) mm vs. (45 ± 8) mm, t = 5.979, P = 0.000) . Left ventricular ejection fraction had no significant difference before and 1 month after operation in both groups (P > 0.05).</p><p><b>CONCLUSION</b>The total aortic arch reconstruction with individualized combined branched stent grafting technique is technically easier, shortens the operation time, reduces the blood transfusion volume compared to the classical aortic arch operation.</p>

Toxicity assessment of hydroxyapatite-coated mechanical heart valve embedded with collagen to vascular endothelial cells / 中国组织工程研究

BACKGROUND:In early experiments, we prepared hydroxyapatite-coated mechanical heart valve embedded with col agen using impulse laser sediment method. OBJECTIVE:To further analyze the histocompatibility and toxicity of hydroxyapatite-coated mechanical heart valve embedded with col agen. METHODS:After passage, canine vascular endothelial cellsuspension was inoculated onto the hydroxyapatite-coated mechanical heart valve embedded with col agen. One group was inoculated in 5%CO2, 37 ℃ incubator for 3 weeks static culture, and the other group was inoculated in 5%CO 2 , 37 ℃ incubator for 3 weeks spinner culture. Scanning electron microscope was used to observe cellattachment on the material. 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay was used to the proliferative capacity of vascular endothelial cells cultured with the hydroxyapatite-coated mechanical heart valve embedded with col agen. RESULTS AND CONCLUSION:During the spinner culture, adherent cells were found on the surface of mechanical heart valve, and the cells distributed evenly and confluent at 21 days to cover the surface of the material. The number of adherent cells in the spinner culture was higher than that in the static culture. The cells during the static culture were aggregated and distributed irregularly. The mechanical heart valve exhibited no effects on the proliferation of canine vascular endothelial cells which grew wel . These findings indicate that the hydroxyapatite-coated mechanical heart valve embedded with col agen exert no effect on proliferation of vascular endothelial cells, has no toxicity and has good biocompatibility.

Application of myocardial protection fluid in infant open heart operation / 中国组织工程研究

BACKGROUND:The research at home and abroad for appropriate immature myocardial cardioplegia has no breakthrough, and it may be a better mean to improve the protection effect of existing cardioplegia on immature myocardial by adding ingredients. Adenosine can reduce ischemia and neutrophil-mediated reperfusion injury, and salvia miltiorrhiza can reduce the content of ischemic myocardial lipid peroxide and increase the scavenging of myocardial cells to oxygen radical. OBJECTIVE:To investigate the protection effect of improved myocardial protection fluid containing adenosine and salvia miltiorrhiza on the heart, liver and kidney. METHODS:Sixty cases of infant open heart operation of the first time were randomly divided into three groups, 20 cases in each group. The adenosine group received the improved myocardial protection fluid added with adenosine, the combination group received the improved myocardial protection fluid added with adenosine and miltiorrhiza salvia, and the control group received the improved myocardial protection fluid in the same volume. The blood samples were taken at the time before anesthesia induction, 30 minutes after cardio pulmonary bypass beginning, 1 hour after cardio pulmonary bypass end and 24 hours after cardio pulmonary bypass end. The serum levels of the creatine kinase, alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine, tumor necrosis factor-α, interleukin-6, interleukin-8 and interleukin 10 were detected. RESULTS AND CONCLUSION:The serum levels of the alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine and creatine kinase in three groups were increased, but the control group was increased significantly (P<0.01), and there were significant differences between adenosine group and combination group (P<0.05);the levels of tumor necrosis factor-α, interleukin-6 and interleukin-8 were significantly increased after operation (P<0.05). The levels of tumor necrosis factor-α, interleukin-6 and interleukin-8 in the control group were significantly higher than those in the adenosine group and combination group before induction and at the same time point (P<0.01);at 3 minutes and 24 hours after cardio pulmonary bypass, the level of interleukin-10 was increased in three groups, but the level of interleukin-10 in the adenosine group was significantly higher than that in the control group (P<0.01). The results indicate that improved myocardial protection fluid has great protection effect on immature myocardial, and can significantly reduce the serum levels of tumor necrosis factor-α, interleukin-6 and interleukin-8, promote the secretion of interleukin-10 that can inhibit inflammatory cytokine and can significantly reduce the inflammatory response caused by cardiopulmonary bypass. So the improved myocardial protection fluid has protection effect on important organs, such as heart, lung, liver and kidney.

Biocompatibility between tissue-engineering diamond-like carbon film and human vascular endothelial cells / 中国组织工程研究

OBJECTIVE: To verify the biocompatibility between diamond-like carbon (DLC) film and human vascular endothelial cells and to provide evidences for construction of artificial mechanical valve prosthesis. METHODS: Nanophase DLC film was deposited using pulse laser deposition, while vascular endothelial cells derived from human umbilical vein was cultured with nanophase DLC film in vitro. Cell growth and adhesion were observed under inverted microscope, and cell proliferation was measured with MIT method. In addition, levels of nitric oxide (NO) and prostacyclin (PGI2) were measured in the DLC group and blank control group in order to evaluate their activities. RESULTS: Adhesion, proliferation, and growth of vascular endothelial cells derived from human umbilical vein were great on the surface of nanophase DLC film. There were no significant differences in the levels of NO and PGI2 between DLC group and blank control group (P > 0.05), showing that nanophase DLC film had no effect on activity of vascular endothelial cells derived from human umbilical vein. CONCLUSION: Nanophase DLC film has a good biocompatibility, and it can become an ideal material of tissue-engineering artificial mechanical valve prosthesis.

Surgical treatment of ruptured aneurysm of the sinus of Valsalva combined with infective endocarditis / 中国医师进修杂志

Objective To summarize the susceptible factors and the experience of the surgical treatment of ruptured aneurysm of the sinus of Valsalva combined with infective endecarditis.Methods From January 2000 to March 2008,30 cases with raptured aneurysm of the sinus of Valsalva were admitted, clinical data of 10 cases combined with infective endocarditis were retrospectively reviewed.Nine cases underwent the surgical treatment,including 6 cases accepted aortic valve replacement (AVR).Results Nine eases underwent the surgical treatment followed up for 2 months to 8 years,cardiac function of the survivors recovered to Class Ⅰ-Ⅱ in NYHA,7 cases were Ⅰ grade,2 cases were Ⅱ grade.One case was dead for MSOF not underwent the surgical treatment.Conclusions Associated with ventricular septal defect is one of the susceptible factors.Following diagnosis of ruptured aneurysm of sinus of Valsalva combined with infective endocarditis,sufficiently and validly antibiotic and surgical treatment should be pedormed as quickly as possible,and AVR to the moderate and severe aortic insufficiency.