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Objective To investigate clinical effect and safety of ostium secundum atrial septal defect(ASD) treatment via one -stop hybrid and classical surgical procedures.Methods 45 patients were diagnosed ostium secun-dum simple ASD by ultrasound cardiogram and clinical manifestation,they were divided into one -stop hybrid proce-dure group (n =20)and classical surgical procedure (n =25).Age,gender,weight,post operation hospital day,on -pump time,blood transfusion amount,drainage flow,incision length and incidence of complication between the two groups were compared.Results Age and weight had no difference between the two groups(t =0.40 and 1.64,P >0.05),but the proportion of female cases in one -stop hybrid procedure group was higher than post operation(χ2 =9.45,P 0.05).And one -stop hybrid procedure group was off -pump without blood transfusion.Conclusion One -stop hybrid procedure was simple,could make a quick recovery post operation and was an ideal method for ostium secundum ASD treatment.
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Objective The presence of alloreactive memory T cells in recipient is a critical handicap to achieve transplantation tolerance.To make a mouse model which mimics the present transplant patient is important for research at this subject.Thus,we developed a novel re-transplant model and compared the alloresponse in this model with that in the conventional memory T cellstransfer model (transfer control).Methods The re-transplant model was established via microsurgery and vessel cannula techniques,and the experiment was composed of three groups:the re- transplant group,memory T cell-transfer group (transfer control) and the conventional blank group (blank control).The research indexes included survival time of donor heart,rejection score of allograft,and detection of proliferation and differentiation of the alloreactive memory/effector T cells by by flow cytometry (FCM) and in vitro mixed lymphocyte reaction (MLR).Results The median survival time of allograft in re-transplant recipients was significantly shortened compared to that of transfer control,but there was no significant difference in rejection score of graft between them (the score in retransplant group was the most intense of the three groups). Moreover, proliferation and differentiation of the alloreactive effector T cells were more intensive in re- transplant recipients than in the transfer control,which was confirmed by in vitro MLR and by FCM of the splenocytes for detecting CD44highCD62L-memory/effector phenotype cells.Conclusion The recall alloresponse in retransplantation is more intensive than that in memory-transfer setting and this re-transplant model is more close to the clinic situation than the memory-transfer model in rodents.
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Objective To retrospectively analyze the clinical management and follow-up of 13 recipients with survival of over ten years after cardiac transplantation. Methods Thirteen male recipients underwent orthotopic heart transplantation between August 1995 and June 2001 in our center and received standard immunosuppressive therapy protocols (8 cases) or induction therapy protocols (5 cases). Cyclosporine, azathioprine or mycophenolate mofetil, and prednisolone were applied as maintenance immunosuppressive regimens. Six recipients switched from azathioprine to mycophenolate mofetil when mycophenolate mofetil was available. Perioperative complications were prevented and treated. After operation, the recipients were followed up regularly to set up personnel long-term follow-up files. The incidence of acute rejection (AR) and (cardiac allograft vasculopathy (CAV) was monitored. Results The 13 survived recipients accounted for 48. 1 % of the total number in the corresponding period (13/27). All survivals recovered well and had a good quality of life. The recent (1 year) complications included acute allograft rejection (3 cases), infection (4 cases), renal insufficiency (3 cases), allograft right ventricular dysfunction (5 cases), post-transplant diabetes (2 cases) and liver dysfunction (5 cases). The long-term (1 year later) complications included acute allograft rejection (2 cases), CAV (2 cases), hypercholesterolemia (5 cases), hypertension (4 cases), hyperuricemia (10 cases) and chronic renal impairment (3 cases). One hepatitis B virus carrier died of liver cancer 13 years after transplantation. Conclusion The long-term survival of cardiac allograft recipients is closely associated with psychological state, financial condition, compliance and follow-up medical system, while the sociological and environmental factors may play important roles.
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Objective To evaluate the effect of Ebselen on the ischemia-reperfusion injury (IRI) in rat lungs from non-heart-beating donors (NHBD).Methods Forty Sprague-Dawley rats were paired randomly divided into two groups:group Ⅰ,NHBD with 30 min of warm ischemia time (WIT); group Ⅱ,NHBD with 30 min of WIT and administration of Ebselen.The donor lungs remained ventilated at the room temperature for 30 min after asystolia and then flushed with LPD solution.The recipient rats underwent left lung transplantation.The recipients of group Ⅱ were administered with Ebselen (500 mg/kg body weight) one h before transplantation.Results All the recipients survived during the observation period.In the group Ⅱ,the MDA of the pulmonary tissue was 0.631 ± 0.23 nrmol/mg protein,and the polymorphonuclear neutrophils and the total protein of the bronchoalveolar lavage fluid were (78.4 ± 35.2) × 107/L and (0.41 ± 0.12) mg/ml respectively.The MPO was (25.09 ± 1.19) ％ and W/D was 0.359 ± 0.017.There was significant difference between group Ⅱ and group Ⅰ (all P＜ 0.05).Conclusion The administration of ebselen is an effective treatment to attenuate the acute injury resulted from the ischermia-reperfusion in the rat lungs from non-heart-beating donors.
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Objective To evaluate the value of left ventricular (LV) torsion for assessing left ventricular function in adult heart transplant patients using two-dimensional speckle tracking imaging.Methods Basal and apical LV short-axis view and apical LV long-axis view of two-demensional images were acquired in 30 heart transplant patients and 17 healthy volunteers. Using two-dimensional strain software,LV basal and apical rotation versus time profiles were obtained at their short-axis level respectively. LV torsion was defined as apical rotation relative to the base, so the LV torsion versus time profiles could be drawn. LV basal rotation,apical rotation,global torsion and their time to peak were respectively measured,and the rate of LV untwisting was calculated. Statistical analysis was used to find the difference between the two groups and to investigate the relationship between LV torsion or the rate of LV untwisting and echocardiographic parameters. Results LV apical rotation and LV global torsion in heart transplant group were significantly lower than those in normal group. LV global torsion inversely correlated with LV end systolic volume,positively with LV ejection fraction. There was no significant difference between the two groups in the rate of LV untwisting. The rate of LV untwisting didn't correlate with echocardiographic parameters. Conclusions LV torsion can be measured exactly by two-dimensional speckle tracking imaging, it can be used to quantify LV global systolic function in heart transplant patients.
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Objective Isohemia-reperfusion injury oecurred during heart transplantation may result in failure of grafts and the death of receivers perioperatively. Over expression of TGF-β1 in the myocardium therapeutically was shown to be help-ful in limiting the reperfusion injury to the grafts. The study was designed to investigate the role of Ad. mTGF-β1 gene transfec-tion during ischemia-reperfusion injury in vitro after heart transplantation in rats and the possible mechanisms. Methods The model of heterotopic cardiac transplantation was established by Heron's technique with cuff vessel anastomosis. Animals were divided into 3 groups: in group A ( n =6, control group), the donor hearts were perfusod with 6 ml of Stanford University cardio-plegic solution via coronary arteries at 4℃ for about 40 minutes; in group B ( n =6, vector alone group), the donor hearts were perfused with 6 ml of Stanford University cardioplegic solution containing 5 × 10~9 plaque-forming units( pfu)/gram of the vec-tor, and in group C (study group), the donor hearts were perfused with the solution containing 5 × 10~9 pfu/gram vector with mTGF-β1. The donor hearts were observed with an electro-microscope. The expression of mTGF-β1 in the grafts was identified with immunohistochemical staining. Gene products expressed in tissues were quantified by one step RT-PCR. Activities of SOD ,MDA ,MPO in the grafts were measured. Results At 8 hours after transplantation, mTGF-β1 and its expression were de-tected by means of RT-PCR and immunohistochemical staining in the rats of group C. Expression scores of foreign gene were significantly higher in groups A and B. The apoptotic index of the myocardial cells in group C was lower than those in groups A and B. The activity of SOD was higher in group C than those in groups A and B, though the activities of MDA and MPO were decreased. Conclusion The study demonstrated that gent transfer in vitro via coronary artery was effective. Ad. mTGF-β1 gene transfection in vitro ameliorates the myocardial ischemia-reperfusion injury in rats, for which heart transplantation was per formed, increases the activity of SOD, and decreases the activities of MDA, MPO.
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Objective To review and sum up the experience of diagnosis and surgical treatment of cardiac myxoma. Methods 133 patients with cardiac myxoma of different locations from January 1990 to May 2007 admitted in Qilu Hospital of Shandong University and Department of Cardivovascular Affdiafed Zhong shan Hospital of Xiamen Unversity were clearly diagnosed by two dimensional echecardiography. The tumors of 109 patients were located in left atrium ,22 in right atrium and 2 in both cardiac atria. All the patients underwent tumor extirpation under extracor-poreal circulation. Atrioventricular valve plasty was performed when necessary. 11 underwent bicuspid valvuloplasty and 6 underwent tricuspid valvuloplasty at the same time. All the minors were sent to histopathology examination. Re-suits Two patients died of low cardiac output syndrome in early postoperative period. Cerebral embolism happened in 6 cases,left lower extremity embolism and pulmonary embolism in 1 ease respectively. Other patients' symptoms were improved and the physical sign disappeared. All the tumors were demonstrated to be benign cardiac myxoma. Conclusions Most cardiac myxoma is benign but its clinical consequence is severe. So tumor extirpation should be performed as soon as possible and the following-up is important after operation. Prevention of tumor defluvium is im-portant. Two dimensional echocardiography is preferred in the diagnosis of cardiac myxoma.
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BACKGROUND: Ventilation dysfunction caused by bronchomalacia induced bronchostenosis following high-risk heart transplantation is an acute clinical disease, which seriously impairs the function of transplant heart. The case of emergency bronchial stent placement following heart transplantation with high-risk multi-complication has not been reported yet.OBJECTIVE: To investigate the curative effect of emergency stent placement for worse left main bronchial malacia, stenosis and collapse following orthotopic heart allotransplantation.DESIGN: A case analysis.SETTINGS: National Ministry of Health Transplantation Engineering and Technical Research Center, the Third Xiangya Hospital, Central South University; Department of Cardiosurgery, Zhongshan Hospital affiliated to Xiamen University.PARTICIPANTS: An 18-year-old female patient with dilated cardiomyopathy accompanied by moderate to severe pulmonary artery hypertension, who sequentially carried out orthotopic heart allotransplantation, was selected from the Department of Cardiosurgery, Zhongshan Hospital affiliated to Xiamen University in April, 2004. She had suffered from dilated cardiomyopathy for 15 years, and the mean pulmonary artery pressure (MPAP) was 50-51 mm Hg, she was also accompanied by left main bronchial malacia, stenosis and collapse, mixed (mainly central-) sleep apnea syndrome, left inferior pulmonary sequestration, right emphysema, and rheumatoid arthritis for half a year.METHODS: After heart transplantation, bronchus inflammation, congested edema aggravated the severity of bronchial malacia, stenosis and collapse, tenosis reduced to 4/5, and led to obstructive type of ventilation, and the patient was also accompanied by supraventricular tachycardia, ventricular extrasystole, and hypofunction of transplant cardiac systolic function (peak E＜peak A, ejection fraction reduced to 40%, inharmonious motion of ventricular wall). Attempted with inotropic agents and ventilator/support were not relieved, which resulted in the aggravation of illness. In order to improve the post-transplant cardiac function, to relieve bronchial collapse and stenosis, and correct the obstructive type of ventilation, an emergency bronchial stent placement surgery was carried out on the sixth day after heart transplantation. Under monitoring of electrocardiogram (EGG) and percutaneaous oxygen saturation (SpO2), patient was awake and in supine to relieve left main bronchial stenosis with a nickel-titanium shape memory alloy stent (Diameter: 12 mm; length: 20 mm) by D20 fiberoptic bronchoscope. Fibrobronchoscopy was used to observe the proximal end of bronchostenosis and set the proximate location mark by using video fluoroscopy; the patency of distal end was explored by stricture, and set the distal location mark; guidewire was inserted into working path of bronchofibroscope and led through the stricture; then loaded the Ni-Ti stent on a special placement apparatus, and led in bronchial stent implantation apparatus along guidewire. When targeting well, the stent was slowly released and adjusted properly. When it was completely released, the stent implantation apparatus was drawn out. Bronchofibroscope was performed postoperatively to observe the adherence of stent; immediately photographed to observe its unfolding. Synchronized intermittent mandatory ventilation (SIMV) was given postoperatively as supportive treatment.MAIN OUTCOME MEASURES: Ameliorations of the cardiac and pulmonary functions of the patient.RESULTS: ①Carbon dioxide retention and hypercapnia were remarkably improved as compared with those preoperatively; hypertensive pulmonary vascular disease was alleviated gradually, and MPAP reduced to 30 mm Hg. One week later, re-examination of bronchofibroscopy was carried out, and the results showed that bronchi of left upper lobe, lingual lobe as well as left lower lobe could be seen distinctly, mucous membrane had slightly congested edema, and lumens were unobstructed.②Supraventricular tachycardia and premature ventricualr contraction disappeared, and the transplant cardiac function recovered well (peak E ＞ peak A, ejection fraction 70%, FS41%), and the heart rate fluctuated at 100-110 beats per minute. ③The chest-radiography and CT postoperatively indicated the relief of left main bronchial stenosis. When the ventilation function of the patient was improved, the parameters of breathing machine were reduced gradually, and replaced by low-flow oxygen. There was no recurrence of obstructive ventilatory disorder. The sleep apnea syndrome of the patient was moderated.CONCLUSION: Emergency treatment with stent placement for bronchial malacia, stenosis and collapse occurring after orthotopic heart allotransplantation cAN improve ventilation dysfunction caused by bronchial malacia and stenosis,and increase the survival rate of heart transplantation.
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Objective To explore the related causes and management of the death cases (following) orthotopic heart transplantation (OHT). Methods The data of the death cases (14 cases) were studied retrospectively.Results Fourteen cases died among the total 54 cases of OHT from Aug. 1995 to Dec. 2004 in our hospital. Eight cases died within 1 month and 1 case subject to combined heart-kidney transplantation died on the 38th day, and the other 5 cases died during the period from 17 weeks to 4 years. The death cases died of acute right ventricular failure (4 cases), lung infection (5 cases, including 3 cases associated with fungus infection), acute rejection (4 cases), acute renal failure (4 cases), arrhythmia (4 cases), adult respiratory distress syndrome (2 cases) and diabetes (2 (cases)). The death of 8 cases was related with several causes.Conclusion Various causes should be (responsible) for the results. In order to decrease the mortality rate, the recipients should be selected with low pulmonary vascular resistance and less preoperative complications. It is very important to discover and manage complications in time perioperatively.
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<p><b>OBJECTIVE</b>To investigate the rehabilitation of the sexual function of male patients after heart transplantation.</p><p><b>METHODS</b>Eleven discharged adult male cardiac transplant recipients (ranging 32-54 years) with a normally functioning allograft for at least 9 months were questioned on their pre- and post-operative sexual function.</p><p><b>RESULTS</b>All the recipients complained of a significant pretransplantive decrease and 10 stated a significant posttransplantive increase in sexual function.</p><p><b>CONCLUSION</b>The sexual function of the male recipients was significantly improved after cardiac transplantation. Psychosocial factors affecting the rehabilitation of sexual function should not be neglected.</p>
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Adulto , Humanos , Masculino , Persona de Mediana Edad , Trasplante de Corazón , Psicología , Conducta Sexual , Trasplante HomólogoRESUMEN
Objective: To study the effect of bone marrow cells on myocardial regeneration. Methods: Bone marrow cells were implanted into the acute myocardial infarct via topical injection. Specimens were harvested at 1st, 2nd, 4th, 8th weeks after bone marrow cells implantation for morphologic examination. Results: Bone marrow cells with fluorescence had been observed in the implanted site. A portion of the implanted cells had differentiated into myogenic cells. The regenerating myocardial cells observed by electron micrography had been connected with the host myocardium through intercalated discs. The infarct size was significantly smaller in implant group. Conclusion: This study suggested that bone marrow cells are capable to differentiate and regenerate into myocardial cells in the acute myocardial infarct sites and reduce size of infarct.
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AIM: The aim of this study was to investigate the hemodynamic characteristics of the denervated orthotopic transplanted hearts. METHODS: Eighteen patients with end - stage cardiopathy underwent orthotopic cardiac transplantation received immunosuppressive induction therapy. The changes of hemodynamics were closely monitored during the perioperative period and the periodic check-up of echocardiogram and electrocardiograph were followed up in the postoperative long-term period. RESULTS: All recipients were received vasoactive drug and active diuretic therapy during the perioperative period. An increase in central venous pressure in concomitance with decrease in cardiac output, cardiac index and mixed venous oxygen saturation within 24 to 48 hours and tend to stable 48 hours postoperation were detected. In the follow - up period, the cardiac functions of allografts were all recovered well. No recipient complained angina pectoris. CONCLUSIONS: The hemodynamic characteristics and clinical pharmacological therapeutic implications of cardiac denervation are very unique. Rational application of inotropic support and diuretic therapy and vasodilatation combined with prudent administration of some agents, which affect the physiology of denervated heart, are the most effective measures for the prevention of postoperative complications of cardiac allograft.
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Orthotopic heart transplantation was performed on two critical patients with end-stage dilated cardiomyopathy on Oct.14, 1996 and March 20, 1997 respectively.One case of pre-operative hepatic-renal failure died of systemic organs failure and severe circulation failure in oper-ation, and the other case of severe pulmonary hypertension preoperatively died of right heart fail-ure and pulmonary hypertension crisis on the seventh day after operation.Operating time and indi-cations of heart transplantation, preoperative evaluation for the patients with pulmonary hyperten-sion, and management of right heart failure after heart transplantation were detailedly discussed.
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Kaneko's rahbit heart-lung transplant model was used xo investigate the effect of low flow perfusion(LFP)on rabbit heart-lung preservation.Thirty-two healthy rabbits were randomly divided into control group and experimental group.The donors in the experimental group were continuously perfused via aorta and pulmonary artery at low flow rate with the same perfusates during preservation.After heart-lung transplanted, the donors' LVsp, LVedp, RAP and Paw, and PaO2 were measured every 30 min for 90 min to evaluate the function of heart and lung.After finishing the trial, the contents of MDA in heart and lung were determined and the water weight gain calculated.The results showed that the rabbits in the experimental group had a significantly lower water weight gain and better cardiac and pulmonary function than in the control group.The experimental group produced less levels of MDA in heart and lung than did the control group.It is concluded that LFP is more effective than cold storage on rabbit heart-lung preservation.
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Orthotopic heart transplantation was successfully performed on one patients with endstage dilated cardiomyopathy.The patient has been survived for more than 1 year until today and is now living well.The immunosuppressive therapy and the acute rejective surveillance for 1 year after operation were detailedly introduced and discussed in this paper.In the second week and sixteenth week after operation,two episodes of acute cardiac rejection occurred and were promptly treated well with methylprednisolone.
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Objective To investigate the protective effects of pulmonary surfactant (PS) in lung transplantation.Methods Forty-eight rabbits were divided into control group (group C),PS1 group,and PS2 group. Rabbit lungs were harvested and preserved at 4 ℃ for 6 h before transplantation. The PS1 group received 100 mg /kg of intratracheal PS before reperfusion,while the PS2 group received the same dosage PS before preservation. Using the hetero-heart-lung transplantation model,pulmonary graft function and airway compliance was assessed every 30 min for 3 h when the model was transformed into self-working state. After finishing the observation,the tissue specimens were taken for analysis of wet/dry ratio (W/D),the contents of malondialdehyde (MDA) and myeloperioxidase (MPO). All values were compared to the control group.Results The two groups treated with PS showed better airway compliance and higher PaO 2 and lower PaCO 2 than group C ( P
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ObjectiveTo study the effect of implantation of the bone marrow cells into infarction myo cardium on the secretion of basic fibroblast growth factor (bFGF), insulin-like growth factor 1 (IGF-1), transforming growth factor-?1 (TGF-?1 ), interleu kin-1 (IL-1), and interleukin-8 (IL-8).MethodsBone marrow cells were implanted into the region of acute myocardial infarct via topical injection. Specimens were harvested at first, 2nd, 4th, 8th week after implantation for the expression of cytokines and vascular density examination by immunohistochemical analysis and the levels of cytokines by radioimmunoassay. ResultsAt first, 2nd, 4th, 8th week after transplantation, the vascular density in the bone marrow cell implant group was significantly higher than that in the control group (P
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25?cm H 2O). Three of 6 d ead cases died of right heart failure after transplantation, whose PVR were more than 5 woods preoperatively. Twenty-two patients survived for 18 months with g ood quality of life.ConclusionAccurate selection for donor and recipient, suitable surgical procedure, excelle nt myocardial preservation, effective protection of recipient's renal function, early prevention and management of right graft-heart dysfunction can significa ntly decline incidence of right heart failure at postoperative early stage.
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Objective To explore the experience of long-term outcomes of orthotopic heart transplantation. Methods From Aug. 1995 to Dec. 2004, 40 patients with end-stage dilatation cardiomyopathy, 36 males and 4 females, aged 13～60 years underwent orthotopic heart transplantation (OHT) , 39 standard styles and 1 total style. Results 40 cases were all successful treated. The survival time is from 8 to 112 months with heart function of 0-I degree. All cases are in good quality of live and enjoy normal entertainments and work. Pulmonary infection and cardiac arrhythmia are the most common complications but they did not degrade the result after proper treatments. Conclusion Heart transplantation is an effective treatment for patients with end-stage heart diseases. Appropriate selections of recipients with low pulmonary vascular resistance, satisfactory myocardial preservation are the key points to success. The precautions and prompt treatments to the postoperative complications are guarantee for the ultimate results of heart transplantations.
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AIM and METHODS: To investigate the cardioprotective effect of adenosine infusion before ischemic preconditioning on immature myocardial reperfusion injury in rabbit heart. Isolated perfused working heart model were performed, all hearts were subjected to 2-hour global hypothermic ischemia and received intermittent cold cardioplegia perfusion. RESULTS:During reperfusion, the recovery of left ventricular systolic pressure, left ventricular end-diastolic pressure, +d p /d t max, and -d p /d t max of hearts received adenosine infusion before ischemic preconditioning were significantly improved, myocardial adenosine triphosphate and adenosine diphosphate content and superoxide dismutase activity were higher, the leakage of myocardial creatine kinase and the malondialdehyde content were lower, and myocardial water content was obviously less. CONCLUSION: These results suggest adenosine infusion before ischemic preconditioning enhances cardioprotection of ischemic preconditioning against immature myocardial reperfusion injury in the rabbit heart.