Application of modified ultrafiltration in infants undergoing cardiac surgery with cardiopulmonary bypass / 中国当代儿科杂志

<p><b>OBJECTIVE</b>Infants are usually subjected to serious complications after cardiac surgery with cardiopulmonary bypass (CPB). This study was conducted to evaluate the effects of a modified ultrafiltration technique (MUF) on infants undergoing cardiac surgery with CPB.</p><p><b>METHODS</b>A total of 261 infants less than 1 year old with congenital heart disease and who required CPB were randomized into receive MUF during CPB (n=205) or not (n=56, control group). Bypass duration, aortic cross-clamp duration, postoperative blood effluents and transfusions, mechanical ventilation duration following operation, and hematocrit and oxygenation index 24 hrs postoperatively were compared between the two groups.</p><p><b>RESULTS</b>No ultrafiltration-related complication was found in the MUF group. There were no significant differences in the duration of bypass and aortic cross-clamp between the two groups. Postoperative blood effluents and transfusions in the MFU group were significantly reduced (79.5+/-18.6 mL vs 57.3+/-15.4 mL and 78.1+/-32.5 mL vs 67.9+/-25.6 mL respectively) compared with the control group (P<0.05). The duration of mechanical ventilation following operation in the MFU group was shorter than that in the control group (28.6 +/- 9.1 hrs vs 32.3 +/- 8.7 hrs; P<0.05). MUF produced a significant improvement in hematocrit (34.6 +/- 3.7 min vs 29.8+/-2.8 min; P<0.01) and oxygenation index (275.2+/-39.1 vs 202.2+/-25.6; P<0.01) 24 hrs postoperatively when compared with the control group.</p><p><b>CONCLUSIONS</b>MFU can reduce postoperative bleeding and blood transfusions, improve pulmonary function and shorten the duration of mechanical ventilation in infants undergoing cardiac surgery with CPB.</p>

Anti-inflammatory effect of erythropoietin pretreatment on cardiomyocytes with hypoxia/reoxygenation injury and the possible mechanism / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the anti-inflammatory effect of erythropoietin (EPO) pretreatment on cardiomyocytes exposed to hypoxia/reoxygenation injury (H/R) and explore the possible mechanism.</p><p><b>METHODS</b>The cultured neonatal rats?ventricular cardiomyocytes were divided randomly into 4 groups, control group (C group), EPO pretreatment group (E group), EPO and pyrrolidine dithiocarbamate (PDTC) pretreatment group (EP group) and PDTC pretreatment group (P group). After 24 hours?pretreatment, the cardiomyocytes were exposed to H/R. After pretreatment and H/R, the expression of tumor necrosis factor-alpha(TNF-alpha) gene in all the groups was detected by RT-PCR and Western blot. The nuclear factor-kappa B (NF-kappa B) activity was detected by electrophoretic mobility shift assay (EMSA) and the inhibitor-kappa B alpha (I-kappa B alpha) protein level was detected by Western blot.</p><p><b>RESULTS</b>The decrement of I-kappa B alpha protein and the increasing NF-kappa B activity were found in cardiomyocytes pretreated with EPO before H/R compared to other groups (t equal to 3.321, 4.183, P less than 0.01). However, after H/R, NF-kappa B activity and expression of TNF-alphagene were significantly reduced, I-kappa B alpha protein expression was increased in cardiomyocytes of E group compared to other groups (t=3.425, 3.687, 3.454, P less than 0.01). All theses changes caused by EPO pretreatment were eliminated by the intervention of PDTC (an antagonist to NF-kappa B) during pretreatment.</p><p><b>CONCLUSIONS</b>EPO pretreatment can inhibit the activation of NF-kappa B and upregulation of TNF-alpha gene in cardiomyocytes exposed to H/R through a negative feedback of NF-kappa B signaling pathway, and thus produces the anti-inflammatory effect. This might be one of the ways EPO produces the anti-inflammatory effect.</p>

Significance of the changes of growth hormone receptor mRNA in liver after cardiopulmonary bypass in a rat model / 中华外科杂志

<p><b>OBJECTIVE</b>To study the significance of the changes of growth hormone receptor mRNA (GHR mRNA) in liver after cardiopulmonary bypass (CPB) in a rat model.</p><p><b>METHODS</b>The rat model of CPB was established and plasma samples were collected at different intervals. Growth hormone (GH), GH binding protein (GHBP), endotoxin, interleukin (IL)-6, prealbumin and liver function were determined respectively. The liver tissues were collected for the detection of the GHR mRNA by RT-PCR analysis.</p><p><b>RESULTS</b>Both the lesion of liver function and the rising of the concentrations of endotoxin and IL-6 were obviously at 1 h after CPB, and increased markedly 2 h after CPB. However, the changes of concentrations of GH and GHBP, the expressions of GHR mRNA were opposite. In addition, the expression of GHR mRNA, concentrations of GH and GHBP had a significant negative correlation to the concentration of bilirubin, endotoxin respectively (P < 0.01), and a positive correlation to prealbumin (P < 0.01).</p><p><b>CONCLUSIONS</b>The liver injury and downregulation of GH-GHR axis obviously exist during early stage of CPB because of the GHR mRNA expression inhibition resulting from endotoxemia. It may be one of the most important factors intervening the pathophysiology changes of liver during CPB.</p>

Effects of preoperatively selected gut decontamination on cardiopulmonary bypass-induced endotoxemia / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the influence of preoperatively selected gut decontamination (SGD) on intestinally derived endotoxemia(ETM) in patients with rheumatic heart disease undergoing valve replacement operation with cardiopulmonary bypass(CPB).</p><p><b>METHODS</b>Thirty patients were randomly divided into control group and SGD group. The patients in control group underwent preoperative bowel preparation, i.e, diet preparation and enema. The patients in SGD group were administrated 100 mg Tobramycin, 40 mg garlicin and 20% Lactulose for 10 ml three times per day for 3 days besides routinely preoperative bowel preparation. Bacteria cultivation and identification and Gram staining of feces in both groups were used to evaluate species of intestinal flora and their ratios. The levels of endotoxin, D-lactate, TNF-alpha and complement 3 were determined at four time points of anesthetic induction, CPB end, 2 h after CPB, 24 h after CPB. And the related clinical biochemical and clinical markers were recorded.</p><p><b>RESULTS</b>Aerobic gram-negative bacilli (AGNB) ratio in post-SGD group decreased significantly as compared with that in control group and pre-SGD group (P less than 0.05). The level of D-lactate reduced significantly at time points of anesthetic induction and 2 h after CPB (P less than 0.05). Endotoxin levels of patients in both groups elevated significantly after CPB (P less than 0.05), and endotoxin levels of the patients in SGD group decreased significantly at points of CPB end (P less than 0.01) and 24 h after CPB (P less than 0.05) compared with those in control group. The levels of TNF-alpha and complement 3 were similar in both groups as well as clinical and biochemical markers.</p><p><b>CONCLUSIONS</b>CPB induces endotoxemia, while the regime of SGD is an effective way to prevent endotoxemia but may not affect activation of inflammatory media and clinical outcomes.</p>

A good resuscitation model of nonjtransthoracic cardiopulmonary bypass in rats / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To establish a good recoverable rat model of cardiopulmonary bypass (CPB) to lay the foundation for studying the pathophysiology of CPB.</p><p><b>METHODS</b>Twenty adult male Sprague-Dawley rats weighing 480 g+/-20 g were randomly divided into CPB group (n equal to 10) and Sham group (n equal to 10). All rats were anaesthetized, intubated and ventilated. The carotid artery and jugular vein were cannulated. The blood was drained from the right atrium via the right jugular vein and further transferred by a miniaturized roller pump to a hollow fiber oxgenator and back to the rat via the left carotid artery. Priming consisted of 8 ml of homologous blood and 6 ml of colloid. The surface of the hollow fiber oxgenator was 0.075 m(2). Rats were catheterized and brought in bypass for 120 min at a flow rate of 100-120 ml/kg/min. Oxygen flow/perfusion flow was 0.8 to 1.0, the mean arterial pressure (MAP) kept in 60-80 mmHg. Blood gas analysis, lactate dehydrogenase (LDH), and survival rate were examined subsequently.</p><p><b>RESULTS</b>All CPB rats recovered from the operative process without incident and remained uneventful within one week. Normal cardiac function after successful weaning was confirmed by electrocardiography and blood pressure measurements. MAP remained stable. The results of blood gas analysis at different time points were within a normal range. No significant haemolysis could be detected in the given time frame under bypass condition by using LDH.</p><p><b>CONCLUSIONS</b>The rat model of CPB can principally simulate the clinical setting of human CPB. The non-transthoracic model is easy to establish and is associated with excellent recovery. This well reproducible model may open the field for various studies on pathophysiological process of CPB and also of systemic ischemia-reperfusion injury in vivo.</p>

Expressions of L-type calcium channel and potassium channel Kv4.3 in rapid paced primary cultured atrial myocytes / 中华心血管病杂志

<p><b>OBJECTIVE</b>To study the expressions of L-type calcium channel alpha1c and potassium channel Kv4.3 at early stages of atrial fibrillation in a rapid paced primary cultured atrial myocyte model.</p><p><b>METHODS</b>Primary rat atrial myocytes were cultured and a rapid paced cell model was established. The atrial cells were divided into five groups with pacing durations within 0 and 24 h. Reverse transcription-polymerase chain reaction and Western blot were applied to detect the messenger ribonucleic acid (mRNA) and proteins of L-type calcium channel alpha1c and potassium channel Kv4.3, respectively.</p><p><b>RESULTS</b>mRNA expression of L-type calcium channel alpha1c reduced after 6 h of rapid pacing and continued to decline as the pacing process. The decrease of L-type calcium channel alpha1c protein was paralleled with mRNA expression and reached the lowest levels at 24 h. Similarly, changes of potassium channel Kv4.3 protein and mRNA were paralleled. Kv4.3 mRNA was not altered within the first 6 h. It was reduced after 12 h. However, longer pacing periods did not further decrease mRNA and protein expression levels of potassium channel Kv4.3.</p><p><b>CONCLUSIONS</b>Expressions of L-type calcium channel alpha1c and potassium channel Kv4.3 were both reduced at different levels in early phase of rapid pacing atrial myocytes. It implicates the occurrence of ion channel remodeling of atrial myocytes, which may serve as molecular mechanism of electrical remodeling in the development of atrial fibrillation.</p>

Role of bcl-2 transcriptional regulation induced by calmodulin I pressure overload rat hypertrophic hearts / 生理学报

This study was designed to evaluate the role of bcl-2 transcriptional regulation induced by calmodulin I (CaM I) in pressure overload rat hypertrophic hearts. The model of hypertensive Sprague-Dawley rat was established by abdominal aortic constriction. The hearts were collected four weeks after abdominal aortic constriction. Velocity and isopyknic gradient centrifugation was employed to fractionate rat myocardial nuclei. Western blot analysis revealed a marked increase in phosphorylated cAMP response-element binding protein (pCREB) of cardiac hypertrophy group compared with that in control group (P<0.05), while the protein level of cAMP response-element binding protein (CREB) was constant (P>0.05). Immunohistochemistry results showed a significant increase of CaM I protein in cardiac hypertrophy group relative to the control group (P<0.05). Nuclear run off transcription assay displayed a significant increase in bcl-2 mRNA treated with trifluoperazne compared with non-drug treatment (P<0.05). The results obtained suggest that the transcription of bcl-2 is possibly regulated by CaM I hypertrophic rat hearts, and CREB phosphorylation seems to be a minor factor in bcl-2 transcriptional regulation.

Surgical treatment for traumatic transection of left common carotid artery / 中华创伤杂志(英文版)

Injury to the supraaortic artery is a rare event, with poor prognosis and high mortality. Improvement of the outcome may lie on the combination of several aspects, including better pre-hospital care, use of emergency cardiopulmonary bypass (CPB), improved surgical techniques and facilities, and advanced postoperative intensive care. Some researchers emphasized the importance of emergency CPB in the treatment and thought that it was responsible mainly for the improved outcome. However, there exists controversies about it. In this article, we reported that a patient with life-threatening hemorrhage due to traumatic transection of the left common carotid artery, who was admitted to our hospital in July 2003, was treated successfully with operations with help of emergency CPB and systemic hypothermia.

Comparative study on cerebral injury after open heart surgery in patients with congenital and rheumatic heart disease / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To comparatively study the different effects of open heart surgery on brain tissues of patients with congenital and rheumatic heart disease.</p><p><b>METHODS</b>Forty patients with congenital heart disease (CHD, CHD group, n = 20) or rheumatic heart disease (RHD, RHD group, n = 20) underwent on-pump (cardiopulmonary bypass, CPB) heart-beating open heart surgery. Blood samples before CPB, and 20 minutes, 1 hour, 24 hours and 7 days after CPB were collected, and the levels of neuron-specific enolase (NSE) and protein S-100b in the plasma were determined with enzyme-linked immunoadsorbent assay (ELISA), respectively. All the patients were examined with electroencephalogram (EEG) before and 1 week after operation. The changes of NSE, S-100b and EEG compared to verify the difference of postoperative cerebral injury between CHD cases and RHD cases.</p><p><b>RESULTS</b>The plasma level of S-100b increased significantly 20 minutes after CPB and was still higher than the preoperative level at 24 hours after operation in both groups (P < 0.01). The plasma level of NSE increased more significantly in the CHD group than in the RHD group 20 minutes after CPB and it returned to the normal level 24 hours after CPB in the CHD group but remained at a high level in the RHD group (P < 0.01). The levels of NSE and S-100b returned to the normal levels on the 7th day after CPB. Abnormal EEG was found in 75% of the patients in the CHD group and 60% in the RHD group.</p><p><b>CONCLUSIONS</b>On-pump heart-beating open heart surgery can cause certain cerebral injury in the patients with CHD or RHD. The injury was more severe and recovered more quickly in the CHD group than in the RHD group.</p>

Establishment of an animal model of non-transthoracic cardiopulmonary bypass in rats / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To establish an animal model of non-transthoracic cardiopulmonary bypass (CPB) in rats.</p><p><b>METHODS</b>Ten adult male Sprague-Dawley rats, weighing 350-500 g, were used in this study. CPB was established in these animals through cannulating the left carotid and right jugular vein for arterial perfusion and venous return. The components of perfusion circuit, especially the miniature oxygenator and cannula, were specially designed and improved. The mean arterial pressure was measured with a blood pressure meter through cannulating the left femoral artery. The hemodynamic and blood gas parameters were also monitored.</p><p><b>RESULTS</b>The rat model of non-transthoracic CPB was established successfully. The hemodynamical parameters were changed within an acceptable region during CPB. The miniature oxygenator was sufficient to meet the standard of satisfactory CPB.</p><p><b>CONCLUSIONS</b>The rat model of non-transthoracic CPB established through the carotid and jugular cannulation is feasible, easily operated, safe, reliable, and economic. It is an ideal model for the pathophysiological research of CPB.</p>

mtDNA mutations in mouse tumors / 中华病理学杂志

<p><b>OBJECTIVE</b>To investigate variations of mtDNA in mouse tumors and to explore the relationship between mtDNA mutations and murine carcinogenesis.</p><p><b>METHODS</b>Variations of D-loop, ND3 and tRNAIle + Glu + Met gene fragments of mtDNA from six mouse tumor cell lines were analyzed by PCR-RFLP and PCR-SSCP techniques.</p><p><b>RESULTS</b>ND3 and tRNAIle + Glu + Met gene fragments of mtDNA from the tumors showed no variations at 27 endonuclease sites. The D-loop of mtDNA from Hca-F demonstrated an additional endonuclease site of Hinf I in contrast to the inbred mouse. Upon PCR-SSCP analysis, the D-loop of mtDNA was found to possess mutations in 4 of 6 tumors.</p><p><b>CONCLUSION</b>D-loop appears to be the hot spot for tumor mtDNA mutations, which may contribute to the carcinogenesis of murine tumors.</p>

The roles of nuclear Ca2+/CaM dependent kinases and calcineurin on the development of myocardial hypertrophy in rat / 中国应用生理学杂志

<p><b>AIM</b>To evaluate whether protein phosphorylation and dephosphorylation in nuclei play roles in the development of myocardial hypertrophy, distribution of protein kinases and phosphatases in cell fractions were determined.</p><p><b>METHODS</b>The model of hypertensive rat was established by abdominal aortic constriction. Velocity and isopyknic gradient centrifugation was employed to fractionate rat myocardium to membrane, cytosol and nuclei. Enzymatic methods were employed to determine kinases and phosphatases.</p><p><b>RESULTS</b>Compare with control group, the activity of CaMK increased by 101.1% (P < 0.01) and 40.16% (P < 0.01) respectively in nuclear and membranous fractions, changed without significance in cytosolic fraction; the activity of calcineurin in nuclei increased by 43.57%, (P < 0.05), lightly changed without significance in membranous and cytosolic fractions.</p><p><b>CONCLUSION</b>Nuclear translocation of CaMK and calcineurin, might play important roles on overload-induced cardiac hypertrophy.</p>

Gene polymorphism of tumor necrosis factor-?affecting severity of myocardial damage during cardiopulmonary bypass / 中华创伤杂志

Objective To investigate the effect of polymorphism of TNF-?gene G308A on sever- ity of myocardial damage during cardiopulmonary bypass(CPB).Methods Sixty-three congenital ca- ses with ventrieualr septal defect(VSD)were divided into groups TNF1 and TNF2 after TNF-?gene pol- ymorphism was identified by polymerase chain reaction-restriction fragment length polymorphism(PCR- RFLP)before surgery.When the right atrium was opened and closed,specimens of myocardium were ob- tained to study the ultrastructural changes by electron microscope and determine expression of TNF-?mR- NA.Concentration of TNF-?in plasma was measured by radio-immunity after anesthetic induction(T1), 20 minutes of CPB(T2),at the end of CPB(T3) and six hours after CPB(T4)in all cases,respective- ly.Results (1)TNF-?level and the expression of TNF-?mRNA in myocardium were significantly increased during CPB(P＜0.05)in both groups.(2)TNF-?mRNA level of group TNF2 was significant- ly higher than that of group TNF1(P＜0.05).The myocardial CK-MB in group TNF2 was significantly higher than that in group TNF1 at 24 hours postoperatively(P＜0.01).The electron microscope showed more severe ultrastructural changes of myocardium in TNF2 group compared with that in group TNF1(P＜0.05).(3)The concentration of TNF-?in blood plasma in group TNF2 was significantly higher than that in group TNF1 at time points of T2-T4(P＜0.05).Conclusion Polymorphism of TNF-?gene G308A may influence the transcription and production of TNF-?in vivo and hence affect severity of myo- cardial damage.

Expression of CD44v3 and CD44v6 in patients with non small cell lung cancer and its relationship with lymph node metastasis / 第三军医大学学报

objective　To study the expression of CD44v3 and CD44v6 and its relationship with lymph node metastasis in non small cell lung cancer (NSCLC). Methods　Specimens (lung tissues) from 52 c ases of NSCLS and 12 normal lung tissue were used to detect the expression of CD 44v3 and CD44v6 by immunohistochemical method (SP method) and flow cytometry, co rrelation was analysed between the expression of CD44v3 or CD44v6 a nd lymph node metastasis of the lung cancer. Results　CD44v3 and CD44v6 were not, or weakly expressed in all normal lung tissues from 12 cases. In contrast, the expression levels of CD44v3 and CD44v6 were obviously higher in lung cancer than that in normal tissue(P<0.05). The expression of CD44v 3 and CD44v6 were much higher in patients with lymph node metastasis than those without lymph node metastasis(P<0.05). Conclusion　① CD44v3 and CD44v6 are expressed with different degree in NSCLC. ②There is a close rel ationship between high expression of CD44v6 and lymph node metastasis, and CD44v 6 may be a co-marker for predicting the potentiality of lymph node metastasis i n lung cancer.

Evaluation and clinical significance on echocardiography of tricuspid i nsufficiency in patients with rheumatic mitral disease / 第三军医大学学报

Objective　To investigate the relationship betwee n tricuspid insufficiency (TI) and the function of the right ventricle, degree o f pulmonary vascular pathological change in patients with rheumatic heart diseas e so as to provide the indication of operation for treating TI. Methods 　41 cases of rheumatic heart disease with TI accompanying with bicuspid pathological changes were reviewed. Correlation analysis was done between the s everity of TI and the right ventricular size(RVS), pulmonary artery pressure(PAP ), pulmonary artery resistance(PAR) etc. Results　It was found t hat the size of the right ventricle, PAP, PAR were positively correlated to th e degree of TI. Tricuspid annuloplasty should be carried out in patients with RV D>40 mm, PAR >48 kPa*s/L, PAP>8 kPa. Conclusion　TI resulted ma inly from insufficient function of the right ventricle and marked patholog ical changes of the pulmonary blood vessels. Doppler echocardiography evaluation for the function of right ventricle and pathological condition of pulmonary blo od vessels might be of significant in deciding whether tricuspid annuloplasty sh ould be performed simutaneously in patients of bicuspid valve replacement.

Clinical analysis of 234 cases of mitral valve replacement in beating heart / 第三军医大学学报

Objective　To introduce the technique of mitral v alve replacements in beating heart, and review the clinical experience in 234 ca ses of operation. Methods　A total of 234 patients of mitral val ve replacement in beating heart with mild hypothermic extracorporeal circulation (30～32 ℃) were reviewed. Results　 The procedures underwe nt fluently and only 2(0.85%) died early postoperatively. No low cardiac output , arrhythmia and cer ebral embolism complications was found. Conclusion　Results sugg ested that mitral valve replacement in beating heart is a safe and available method and is good in extenuating myocardial and pulmonary i njury from ischemia-reperfusion and deep hypothermia.

Comparison of mild hypothermic and moderate hypothermic cardiopulmonary bypass in pediatric cardiac surgery / 第三军医大学学报

Objective　To compare the effects of mild hypothe rmic cardiopulmonary bypass (CPB) and moderate hypothermic cardiopulmonary bypas s in pediatric cardiac surgery. Methods　A total of 118 cas es of less than 3 years of age that had undergone open heart surgery were review ed, in which 46 patients received moderate hypothermic CPB(group 1) and 72 patie nts received mild hypothermic CPB(group 2). The CPB duration, incidence of low c ardiac output and postoperative concentration of CK-MK, etc, were compared with each other betwee n the two groups. Results　Duration of bypass and postoperative mechanical respiratory assistance of group 2 was shorter than that of group 1 ( P<0.05). Transfusion requirements, incidence of low cardiac output syndrome, concentration of CK-ME and percentage of metabolic acidosis were lower in grou p 2 than in group 1 (P<0.05), while the index of oxygenation was higher in g roup 2(P<0.05). Conclusion　The mild hypothermic CPB is saf er and more effective and therefore is superior to moderate hypothermic CPB in p ediatric cardiac surgery.

On-pump, beating-heart intracardiac procedures for congenital heart disease with severe pulmonary hypertension / 第三军医大学学报

Objective　To compare the clinical efficiency of intracardiac procedures on traditional cardioplegic arrested-heart and on-pu mp beating-heart for congenital heart disease (CHD) with severe pulmonary hyper tension. Methods　Among all 153 cases, 95 cases underwent operat ions on cardioplegic arrested-heart, while 58 on-pump beating-heart. In arres ted-heart group, 79 cases with ventricular septal defect (VSD), 13 with atria l septal defect (ASD) and 3 with patent ductus arteriosus (PDA) were examined whi le in beating-heart group, 43 cases with VSD, 10 with ASD, and 5 with PDA were examined. Results　There were 12 cases of operative death (12.6%) and 8 of tracheotomy (8.4%) in heart arrested group. No operative death and tracheotomy in beating-heart group. 141 patients were followed up for 3 months to 10 year s with good recovery. There were 2 cases of right heart function failure six yea rs later in arrested-heart group. Conclusion　Results sugges t that on-pump beating-heart technique is superior to traditional cardiopl egic arrested-heart for CHD with severe pulmonary hypertesion. The cause might be t hat on-pump beating-heart intracardiac operation is more effective in cardio pulmon ary protection.

Clinical analysis of on-pump, beating-heart intracardiac proc edures in 1 032 cases / 第三军医大学学报

Objective　To improve intracardiac operation skil ls on bea-ting-heart with mild hypothermic cardiopulmonary bypass (On pump beating-heart technique), and to review the clinical experience in 1 032 c ases. Methods　A total of 1 032 cases of intracardiac operatio ns on pump beating-heart from November 1997 to September 2000 were reviewed. Of them, 714 cases were congenital heart diseases (CHD), and 318 cases were valvul ar heart diseases (VHD). The technique was improved by establishing simultaneous left atrium and ventricle suction and integrating sequential de-airing procedu re. Results　The operative mortality was 2.33% (24/1 032), the m ortality was 2.7% (19/714) in cases with CHD, and 1.6% (5/318) in those with VHD. There was no pati ent complicated with systemic air embolism or permanent atrioventricular conduct ion block. Conclusion　Results suggested that intracardiac procedures on pump beating-heart with mild hypothermic cardiopnlmonary bypass is safe and available in patients with CHD or VHD. It might extenuate the heart and lung injury by hypothermia and ischemia-reperfusion during cardiopulmonary bypass. Cardiac conducting block might be prevented during operation.

Effect of cardiopulmonary bypass serum on pulmonary surfacant-associated protein A and the preventive effect of pentoxifylline / 第三军医大学学报

Objective　To explore the injurious effect of the serum drawn from patient under cardiopulmonary bypass (CPB) on pulmonary surfacant-associated protein A(SP-A) and the preventive effect of pentoxifylline (PTX) on the protein. Methods　The cultured rat alveolar epithelial cell type Ⅱ(AT-Ⅱ) were incubated with CPB serum to observe the change of the cell morphology, and the expressions of SP-A and SP-A mRNA. Results　Traumatic changes and the decrease of SP-A and SP-A mRNA expressions were found in AT-Ⅱ cells cultured with CBP serum. PTX exerted protective effect on the cells. Conclusion　The serum after CPB can directly injure rat AT-Ⅱ cells in vitro, and inhibit the SP-A expression at transcription and translation levels, which probably is an important reason for the quantitative and qualitative abnormality of pulmonary surfactant after operation. PTX may alleviate the inhibitory effect of CPB serum on SP-A.