Video assisted application in minimally invasive cardiac surgery / 中国医师进修杂志

Objective To investigate the short-term efficacy and safety through analyzing the results of 11 cases of video assisted minimally invasive cardiac surgery. Methods Eleven patients who had underwent video assisted minimally invasive cardiac surgery in the second hospital of Anhui medical university from November 2017 to August 2018 were retrospectively analyzed. One patient underwent simple atrial septal defect repair, 6 patients underwent atrial septal defect repair+tricuspid valve repair, 3 patients underwent mitral valve replacement, and 1 patient underwent mitral valve repair + tricuspid valve repair. Results All patients underwent video cardiac surgery without death, with no major bleeding (need secondary thoracotomy to stop bleeding) and no neurological complications. One patient of incision fat liquefaction healed after dressing change. One patient developed lower limb artery stenosis, which was treated conservatively and discharged after hospitalization. Conclusions Video assisted minimally invasive cardiac surgery can be safely applied to simple congenital heart disease and valve surgery as long as patients are strictly screened. Due to the advantages of small trauma, less bleeding, and quick recovery, it is worth promoting.

The application of individual open fenestrated stent graft in type A aortic dissection / 实用医学杂志

Objective To observe the recent clinical effect of application of individual open fenestrated stent graft in type A aortic dissection without developing the greater curve of the arch. Method From December 2014 to November 2016,15 patients of type A aortic dissection without developing the greater curve of the arch un-derwent endovascular total arch replacement using individual open fenestrated stent graft in the Anhui Province Hospital.Among them,8 cases were only operated with open fenestrated stent graft in aortic arch, 7 cases with open fenestrated stent graft in aortic arch added 1 or 2 small stent graft.Result There was 1 postoperative death caused by severe low cardiac output. The rest of the patients were successfully discharged from the hospital, without ner-vous system and related complications. Follow-up computerized tomographic angiography showed all implanted stents were wide expansion and in a good position. No endoleaks and thrombus obliterated of the corresponding false lumen was found. Conclusion Individual open fenestrated stent graft is suitable for type A aortic dissection without developed the greater curve of the arch.Its significantly simplify the total arch replacement operation steps, reduce anastomotic and shorten the lower body arrest time. Consequently, reduce the risk of operation difficulty, postoperative blood loss and other viscera damage probability significantly. The early and middle term clinical re-sults is satisfactory.

Influence of exercise rehabilitation combined diet guidance on patients after heart valve replacement / 心血管康复医学杂志

Objective:To observe influence of exercise rehabilitation combined diet guidance on cardiac function and quality of life (QOL) in patients after heart valve replacement .Methods:A total of 120 patients after heart valve replacement were selected and randomly divided into control group (n=60 ,received routine health education ) and experiment group (n=60 ,received diet guidance and exercise rehabilitation based on routine health education ) .After discharge ,patients re‐ceived outpatient follow‐up for six months ,body weight ,cardiac function and QOL on six months after surgery were fol‐lowed up and observed in two groups ,and the results were statistically compared .Results:Compared with control group six months after discharge ,there were significant rise in left ventricular ejection fraction [ (51.75 ± 9.30)% vs .(57.73 ± 6.13)% ] andoxygenmetabolicequivalent [(7.05±1.85)METsvs.(11.34±2.18)METs],andeachitemscoreofQOL and total score of QOL [ (4.98 ± 0.40) scores vs .(6.49 ± 0.53) scores] ,P<0.05 or <0.01;and significant reduction in body weight [(67.75 ± 10.67) kg vs .(61.25 ± 10.34) kg] in experiment group ,P<0.01. Conclusion:Exercise rehabili‐tation combined diet guidance can avoid rapid increase in body weight after surgery ,promote recovery of cardiac function and improve quality of life after surgery in patients with heart valvular diseases .

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 rapid proto-typing technology in the treatment of Standford type a aortic dissection / 安徽医科大学学报

To explore the feasibility of rapid proto-typing ( RP) technology in the treatment of Standford type A aortic dissection. 5 patients with Standford type A aortic dissection received computed tomography angiography (CTA) of their aortas. The CTA images were then processed by 3D reconstruction with MIMICS16. 0 in order to create aortic dissection models through RP technology based on real patient aorta size with a ratio of 1 ∶ 1 . Accord-ing to these models, the surgeons were able to fully understand the aortic diseases of patients, thus establish indi-vidualized treatment strategies for each patient. Besides, the surgeons simulated operations on the models, which helped them achieve better results in real surgery. These patients experienced no post-operative complications and were discharged from hospital with recovery. In conclusion, RP technology can provide adequate preoperotive prep-arations for patients with Standford type A aortic dissection, improve operation efficiency and accuracy in aortic dis-section and guide precise proximal anchoring of stents during intracavitary therapy.

"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 research on autologous valved pericardial patch in the correction surgery of tetralogy of fallot / 安徽医科大学学报

Objective To investigate the activity of autologous pericardial patch treated by distilled water in right ventricular outflow tract reconstruction of tetralogy of fallot,and to evaluate its clinical effect. Methods The study used 125 patients who had applied correction surgery of tetralogy of fallot and autologous pericardial patch treated by distilled water in the right ventricular outflow reconstruction. 39 cases used fresh autologous pericardial patches,and 86 cases used autologous valved pericardial patch. The degree of insufficiency and activity of the pulmonary valve were compared. Results The mean follow-up time was ( 63 ± 8 ) months in fresh autologous pericardial patches group, while (55 ± 7) months in valved patch group. No significant difference was found in age, body surface area, heart rate, pulmonary artery diameter, cardiopulmonary bypass time and priming volume postoperative between the two groups. The exacerbations of pulmonary valve insufficiency and activity in fresh autologous pericardial patches group were significantly higher than in valved patch group. Conclusion Autologous pericardial patch treated by distilled water was beneficial in right ventricular outflow tract reconstruction of tetralogy of fallot. It reduced pulmo-nary valve insufficiency and sclerosis after the correction surgery and showed good mid-term clinical results .

Early acute lung injury following Stanford A aortic dissection / 中国综合临床

Objective To investigate the clinical biomarkers of acute lung injury(ALI) after the Stanford A aortic dissection.Methods Thirty patients underwent Stanford A aoatic dissection were selected as subjects,who hospitalized from January 2006 to March 2013.Of which,21 patients underwent total arch replacement with stented elephant trunk procedure and 9 patients underwent triple-branched stent graft placement.The general information of patients,preoperation echocardiogram data,and arterial partial pressure of oxygen (PaO2),partial pressure of carbon dioxide (PaCO2) and fraction of inspired oxygen(FiO2) were recorded before,after the operation and entering ICU.Alveolar-arterial oxygen difference (A-aDO2),oxygenation index (OI) were calculated.Results A-aDO2 and OI at preoperation,postoperative and entering ICU point were (112.47 ±41.06) mmHg,(136.13 ± 29.51) mmHg and (141.37 ± 25.94) mmHg; (535.23 ± 70.15) mmHg; (491.50 ± 73.12) mmHg and (387.33 ± 91.32) mmHg respectively,and the differences were significant (F=35.926,323.742;P =0.000).The levels of A-aDO2 and OI at entering ICU were significant different from that of pre-operation and post-operation (P ＜ 0.01,P ＜ 0.05).Conclusion Early postoperative oxygenation and switching functions of patients with Stanford A aortic dissection are subject to damage to some degree.The A-aDO2 and OI might be sensitive biomarkers of the diagnosis for early acute lung injury of aortic dissection patients.

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.

Dysfunction of branded-chain amino acids catabolism in rat cardiac allograft / 中华器官移植杂志

Objective Allograft vasculopathy (AV), feature of chronic rejection, is a major serious long-term post-operation complication in organ transplantation. The accurate mechanisms for AV have not been definitively established, but extensive basic and clinical studies demonstrate AV is triggered by immune reaction and nonimmunologic factors, and also possibly attributed to the metabolism of branched-chain amino acids (BCAA). Methods The transplanted hearts from Lewis to Sprague-Dawely rats served as allografts and those from Lewis to Lewis rats as isografts based on Ono 's model. The differential proteins in transplanted hearts were separated by comparative proteomic technique, and some enzymes which regulated the metabolism of BCAA were identified and validated.Results All transplanted hearts at second week postoperation were characterized by lumen loss (total area-luminal area/total area) in coronary artery, but more predominant at 8th week. All samples from the left ventricles were analyzed by proteomic techniques and the subunits E1 a, E1β and E3 of branched-chain α-ketoacid dehydrogenase (BCKDH) complex were decreased in the heart allografts.Immunohistological detection also showed the expression of BCKDH was reduced not only in the cardiac muscle but also more significantly in blool vessels with cardiac allograft vasculopathy (CAV).BCAA concentrations were increased in the cardiac allografts, but there was no difference in the serum. Conclusion These findings suggest that the catabolic pathways of the BCAA may be inhibited owing to the reduced expression of BCKDH complex, and elevated intracellular concentrations of leucine. The vascular smooth muscle cell and cardiac muscle cell proliferation is stimulated via mTOR-dependent and mTOR-independent pathways, which is associated with the formation of myocardial hypertrophy and AV in the heart allografts.

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.

Minimally invasive small incision surgical repair versus interventional device closure for secundum atrial septal defects / 中国微创外科杂志

Objective To compare merits and shortages between minimally invasive small incision surgical repair and interventional device closure for isolated secundum atrial septal defect (ASD). Methods A retrospective analysis was made on clinical results of 69 patients with isolated secundum ASD from January 2004 to June 2006. Among them 37 patients underwent minimally invasive small incision surgical repair on the beating heart (Small Incision Group) and 32 patients underwent interventional device closure of ASD (Interventional Group). Results There were no deaths in either group. The small incision surgical repair was successfully completed in all the 37 patients, with the procedure time, cardiopulmonary bypass time, and hospital stay being 145.86?27.84 min, 35.11?8.45 min, and 15.46?3.09 d, respectively. Major and minor complications occurred in 2 and 6 patients, respectively. The hospitalization costs was 21 900?3600 yuan. In the Interventional Group, the closure was successfully performed in 30 out of 32 patients. The procedure time and hospital stay were 88.59?7.75 min and 10.81?5.02 d, respectively. Major and minor complications occurred in 1 and 2 patients, respectively. The hospitalization costs was 27 800?3900 yuan. Follow-up observations were performed in the Small Incision Group for 3~12 months in 20 patients and for 12~30 months in 17 patients, and in the Interventional Group for 3~12 months in 16 patients and for 12~30 months in 14 patients. No residual shunt was found. Conclusions Both of minimally invasive methods are safe and effective for isolated secundum ASD. Small incision surgical repair involves lower costs, higher successful rate, and broader indications, whereas interventional device closure offers shorter hospital stay, milder trauma, and better cosmetic results.