Risk factors and prognosis of new on-set postoperative atrial fibrillation undergoing isolated coronary artery bypass grafting surgery / 中华胸心血管外科杂志

Objective To analyse the risk factors and prognosis of new on-set postoperative atrial fibrillation in different age and gender groups.Methods The study is a retrospective analysis in 516 patients from a single center.All cases were divided into 5 groups by ages as:＜ 40 years (n =61),40-49 years (n =97),50-59 years (n =115),60-75 years (n =140),and ＞ 75 years(n =103).We retrospectively analysed the difference in the occurrence-and recurrence-rate of POAF,risk factors,feature of coronary artery in different age and gender groups.Results There were no statistics differences in the same age group.The major risk factors were smoking,family history of coronary artery disease and hyperlipaemia in age ＜40 years group and 40 ～ 49 years group.while the major risk factors were hypertension and diabetes in the 60-75 years group and age ＞ 75 years group.The percentage of smoking patients decreased along with adding age.There was obviously statistical difference in the recurrence-rate of POAF across all groups during 24 follow-up months (P ＜ 0.05).The number of coronary lesion was increased with age.There were more ostial lesions in the 60-75 years group and age ＞ 75 years group.Conclusion There are different risk factors and characteristics among POAF patients in different age and gender groups.It is of great significance for us that comprehensive clinical intervention measures are taken to prevent recurrence of AF.

Reconstruction of right ventricular outflow tract with BalMedic pulmonary valved conduit / 中华胸心血管外科杂志

Objective To evaluate the reconstruction of right ventricle outflow tract (RVOT) with BalMedic pulmonary valved conduit in multiple medical center.Methods Since January 2007,50 patients age (4.90 ± 7.63) years (range 6 month to 39 years),weight (16.20 ± 13.69) kg (range 4.50 to 65.0 kg),had been corrected by reconstruction of RVOT.There were 22 patients with pulmonary atresia and ventricular septal defect (PA/VSD) ; 10 patients with corrected transposition of the great arteries and pulmonary stenosis (C-TGA/PS) ; 7 patients with truncus; 4 patients with double outlet of right ventricle and pulmonary stenosis (DORV/PS) ; 3 patients with tetralogy of Fallot (TOF) ; 2 patients with complete transposition of the great arteries and pulmonary stenosis (TGA/PS) ; and each 1 with aortic stenosis (AS) and pulmonary stenosis (PS).Fifty BalMedic pulmonary valved conduits were implanted between pulmonary and RVOT underwent cardiopulmonary bypass.There were different diameter of pulmonary valved conduit included 10 mm to 24 mm depend on the patients weight and pulmonary size.All patients were followed up after operation on 1 month,3-6 months and more than 12 months.Results There was no death.Three patients were lost followed up after 12 months and one late death.There were no pulmonary valve stenosis about 91.1％,moderate pulmonary regurgitation 16.0％,no RVOT obstruction 95.6％,no main pulmonary artery stenosis 80.0％,and no right and left pulmonary artery stenosis 73.0％.Conclusion These results demonstrated that the BalMedic pulmonary valved conduit is reliable and effective in surgical procedure,but the long-term results should be followed up continually.

Clinical study of the appropriate range of warfarin anticoagulant therapy intensity in patients after heart valve replacement / 中国综合临床

Objective To explore the best range of international normalized ratio for anticoagulation treatment after mitral valve replacement (MVR) and double valve replacement (DVR).Methods We conducted a follow-up study involving 1592 patients who received the warfarin anticoagulant therapy after MVR or DVR in our hospital.Clinical data was collected including the admission information,the dose of warfarin and the INR level,and the occurrence of bleeding and thrombosis were recorded.The patients were divided into 2 (MVR and DVR) groups in terms of the different valve prostheses,and then each group was assigned to four subgroups according to their INR level ( A:INR=1.4-1.7;B:INR=1.7-2.0;C:INR=2.0-2.3;and D:INR=2.3-2.6) to compare the incidence of bleeding and thrombosis among these subgroups.Results The analysis of the incidence of bleeding:In MVR group,the subgroups with different INR levels had significant difference with participants with INR level at D having higher incidence of bleeding than the other 3 groups (Group A:x2=17.991,Group B:x2=13.436,Group C:x2=7.186;P＜0.01 ).We observed significant difference in DVR groups (x2=19.067,P＜0.01 ) with the increased incidence of bleeding of INR level at D compared with the other three groups ( Group A:x2=16.736,Group B:x2=10.486,Group C:x2=7.773;P＜0.01 ).The analysis of the occurrence of thrombosis;The groups of MVR and DVR had no significant differenceson in the incidences of thrombosis in all the levels of INR ( P ＞ 0.05 ).No significant statistical differences were found on the incidence of bleeding and thrombosis at INR level 1.4-2.3 ( P ＞ 0.05 ) Conclusion The present study suggestes that the level of INR at 1.4-2.3 is appropriate after the anticoagulation therapy in the MVR and DVR groups.

Enhancement of proliferation and differentiation of bone mesenchymal stem cells by basic fibrous growth factor controlled release nanoparticles / 生物医学工程学杂志

This research was carried out to investigate the effect of basic fibrous growth factor (bFGF) controlled release hydrogel nanoparticles on the proliferation and differentiation of mesenchymal stem cells. The dex-GMA-bFGF-NPs were prepared by an improved emulsion polymerization method; their morphology, size and encapsulated ratio were assessed by routine procedure. Dynamic dialysis method was used to determine the release characteristics of dex-GMA-bFGF-NPs in vitro. The secondary culture MSCs were divided into four groups according the different ingredients being added into the DMEM culture medium: free bFGF group (A), blank dex-GMA nanoparticles group (B), dex-GMA-bFGF nanoparticles group (C), nothing group (D). The proliferation of cultured MSCs was measured by using cell counting method, MTT method and flow cytometry. ALP kit was used to evaluate the ALP activity of the MSCs to show the differentiation of the cells by adding the dex-GMA-bFGF-NPs to the DMEM culture medium (C group) or bFGF only (A group). B group and D group were taken as the controls. The results were analyzed by statistical analysis software (SPSS11.0). All results showed that the shape of dex-GMA-bFGF-NPs was spherical. The encapsulated ratio was 88% and more than 85% of the encapsulated bFGF could be released during 14 days. The in vitro cellular study showed the control release of bFGF from nanoparticles could promote the proliferation of MSCs. After 12 days, the cell number in groups A, B and C was (21.97 +/- 0.25) x 10(4) cells/ml, (12.43 +/- 0.13) x 10(4) cells/ml, (27.45 +/- 0.78) x 10(4) cells/ml and (12.03 +/- 0.43) x 10(4) cells/ml, with the difference being statistically significant among them (P < 0.05). The flow cytometry revealed that the G2/M+S percentage in group C was the highest at 4-8 days after plate culture(P < 0.05). During the first 3 days, the proliferation and differentiation of BMSCs between group A and group B were of no significance (P > 0.05), but were much faster than those of group C and D. After 7 days, dex-GMA-bFGF-NPs could enhance BMSCs proliferation and differentiation continually, but bFGF had no enhancement any more, the difference between group A and group B became more significant (P < 0.05). So we made the conclusions the bFGF loading dex-GMA hydrogel nanoparticles can release bFGF more than 21 days and can promote the proliferation and differentiation of the BMSCs through a long period of controlled release of bFGF. Dex-GMA-bFGF-NPs may be an ideal controlled release carrier for bioactive growth factors.

Mechanism and Interference therapy of HMGB1 after Ischemia/Reperfusion Injury / 国际外科学杂志

After operations such as organ transplantation or cardiopulmonary bypass complicated with is-chemia/reperfusion injury,activated inflammatory cells can express and secret HMGB1,and cooperate with other inflammation factor to induce tissue damage.The mechanism is HMGB1 actives such receptors as TLRs,RAGE,TM,and NF-κB transcription factor,P38MAPK pathway,induce releasing of HMGB1 itself and other inflammation factors.Different with sepsis,HMGB1 emerges much earlier,lasting longer.Inter-ference therapy of HMGB1 could effectively decrease secretion of HMGB1 after ischemia/reperfusion injury.

Prolongation of allograft survival by donor mesenchymal stem cells infusion in rat heart transplantation / 中华器官移植杂志

Objective To investigate the immunomodulatory effect of mesenchymal stem cells (MSCs) and their role in prolonging allograft survival in rat heart transplantation. Methods Inbred Wistar rats were used as donors, and Fisher 344 as recipients. MSC were isolated from femur and tibia bone marrow of donors and cultured in vitro. Mixed lymphocyte reaction assays were performed to assess the immunosuppressive effects of different concentrations of MSC on allogeneic T cell proliferation. Cardiac allograft model was established and according to different intervention measures recipients were divided into two groups (MSC treatment group and control group) (n=8 in each group). In MSC treatment group, recipients were infused with 2×106 MSC via the tail vein at designated intervals (one week before operation, during operation and consecutive three days postoperation), while in control group, the recipients were treated with Ringer's solution at the same interval& At day 5 posttransplantation real-time PCR was used to detect the changes in the expression of Thl and Th2 cytokine genes in transplanted hearts. Results In vitro allogeneic T cell response was greatly suppressed by MSC in a dose-dependent manner. Real-time PCR revealed that IL-1β,IFN-γ, IL-4 and IL-10 were expressed in MSC treatment group, while IL-4 and IL-10 were not expressed in control group but with significantly higher expression of IL-1β and IFN-γ. As compared with control group, survival of MSC-treated allografts was markedly prolonged as compared with control group (mean survivaldays: 12.4±5.3 vs 6.4±2.0, P＜0.05). Conclusion Intravenous adrninistmtion of MSC can prolong the survival of transplanted heart possibly by induction of allograft tolerance through changing Th1/Th2 balance.

Evidence-Based Medicine in Coronary Artery Bypass Grafting Using Arterial Conduits / 医学研究杂志

To promote the understanding and practice of evidence-based medicine (EBM) in coronary artery bypass grafting (CABG). The transition of CABG graft materials from saphenous vein to arterial conduits were perceived using the principles of EBM. The arterial conduits were increasingly performed based on the principles and practice of EBM, therefore the postoperatively long-term graft patency rate, survival rate, and free cardiac event rate were significantly improved. CABG outcomes can be significantly improved by using arterial conduits based on principles of EBM.

Cytotoxicity study of heparin coated polyvinyl chloride material / 生物医学工程学杂志

In this study, heparin ionically coated polyvinyl chloride (PVC) material was prepared by heparin-benzalkonium chloride complex (Group A), heparin-benzalkonium bromide complex (Group B) and heparin-polyethyleneimine compound (Group C). Cytotoxicity evaluation was conducted by direct cell contact evaluation and MTT colorimetry method. The results showed Group A and Group B caused L-929 cells to die out while Group C showed good compatibility with cells. The OD levels of Group A and B were lower than that of the Group C in MTT test. Method A and method B of heparin coating had remarkable cytotoxicity, while method C had little cytotoxicity and could be further studied for clinical use.

Summary of orthotopic cardiac transplantation in 28 cases / 中华器官移植杂志

Objective To summarize the clinical data of cardiac transplantation in 28 patients of our hospital,and study the effectiveness of operation and the methods of immunosuppressive regime.Methods From January 2000 to May 2005,in our center,28 patients were subjected to orthotopic cardiac transplantation.In early stage(before 2003) ciclosporin A and mycophenolate mofetil were used for immunosuppression.In late stage(after 2003) Daclizumab and mycophenolate mofetil were used for immunosuppression.Results Orthotopic cardiac transplantations were done successfully in 28 patients.There was no haemorrhage,twist and right heart insufficiency postoperatively.In the patients before 2003,the complications of hepatic-renal inadequacy to varying degrees occurred in 6 cases and infection in 3 cases respectively.In the patients after 2003,there were no complications of hepatic-renal inadequacy and infection.Conclusions Cardiac transplantion is an effective way for end stage cardiomyopathy.Immunosuppressive effect of Daclizumab and mycophenolate mofetil is satisfactory.

Clinical analysis of the children with multiple ventricular septal defects / 中华外科杂志

<p><b>OBJECTIVE</b>To review the experiences in surgical management and diagnosis for the children with multiple ventricular septal defects (VSDs).</p><p><b>METHODS</b>The clinical data of 21 children with multiple VSDs (8 males, 13 females) were analysed retrospectively. Multiple muscle defects in all patients were repaired by left ventricle incision and their near future clinical outcome was investigated.</p><p><b>RESULTS</b>The accuracy of diagnosis was 95.2% and the mortality was 9.5%. No residual shunts were found. Complete atrioventricular block was found early in 2 patients postoperation.</p><p><b>CONCLUSIONS</b>The operative outcome of children with multiple VSDs is satisfied. For these patients detailed preoperative color flow mapping and careful observation during operation are essential to increase the accuracy of diagnosis and prevention of residual shunts.</p>

Therapeutic effect of free triiodothyronine on heart dysfunction caused by thoracic gunshot injuries / 中华创伤杂志

Objective　To investigate the changes of free triiodothyronine (FT3) and its therapeutic effects on heart dysfunction after thoracic trauma.　 Methods　Eighteen rabbits were assigned randomly into 3 groups. The rabbits in Group A were served as a control, that in Group B were shot at the left thoracic wall passing through the cardiac region with small diameter rifle, that in Group C were treated by FT3 into veins (10 ng/kg) after thoracic trauma. 　Results　In Group B, MAP was much lower than that in Group A after trauma (P<0.05). In Group B, LVEDP and CVP respectively was much higher than that in Group A. Plasm concentration of cTnT in Group B was much higher than that in Group A. But level of FT3 was in Group B decreased more markedly than that in Group A after trauma. In myocardial interstitium, many red cells were leaked out of vessel. In Group C, MAP was much higher than that in Group B, no significant difference was found. CVP and LVEDP in Group C were much lower than that in Group B. Level of FT3 was near to normal and much higher than that in Group B. Edema of myocardial cells and hemorrhage of myocardial interstitium were alleviated markedly. 　Conclusions　Rabbits shot dead at the left thoracic wall passing through cardiac region with small diameter rifle can contribute to an animal model establishment of heart dysfunction. Reduction of FT3 is in correspondence with heart dysfunction. Correcting thyroid sick syndrome after trauma can improve significantly the heart function.

A study of cytotoxicity of membrane material of cardiac assist pump / 解放军医学杂志

Objective To study the cytotoxicity of the membrane material of heart assist pump. Methods The membrane materials tested incladed polyurethane (group A) and medical polychloroethylene (group B),and a blank control group with none of the material. L-929 cells (the mouse fibroblasts) were cultured on either material in groups A and B,and 6 cell cultures were without any material. After 24,48 and 72 hours,the growth of cell in groups A,B and the control was observed,and the number was counted. Educts of two materials used in groups A and B was respectively added to culture medium,then the OD was measured every 24h and proliferation rate was determined by MTT test. Results L-929 cells grew very well in groups A and B with less death. The cell counts showed no difference between 2 groups at each time. The OD of group A was always higher than that of group B after 24,48 and 72h ( P

Comparison of endoscopic and conventional great saphenous vein harvesting in coronary artery bypass grafting / 中国微创外科杂志

Objective To observe the clinical effects of endoscopic great saphenous vein harvesting(ESVH) in coronary artery bypass grafting. Methods Endoscopic great saphenous vein harvesting was performed in 89 patients undergoing coronary artery bypass grafting(CABG) from April 2004 to May 2005.An incision 2 cm in length was made on the knee joint and the great saphenous vein was harvested using the VasoView-5 system.Clinical data of the 89 patients(Endoscopic Group) were compared with another 38 patients undergoing conventional great saphenous vein harvesting for CABG from April 2003 to March 2005(Conventional Group) in respect of complications of the leg, the recovery time to walking,and the patency rate at 6 postoperative months.Results The number of harvested vein grafts in the Endoscopic Group was 2~3(mean,2.6).Complications of the leg were significantly less in the Endoscopic Group(6/89) than in the Conventional Group(8/38)(?~2=4.197,P=0.040).The occurrence of pain and numbness of the leg was 7/89 in the Endoscopic Group and 36/38 in the Conventional Group(?~2=89.740,P=0.000).The occurrence of swelling of the leg was 9/89 in the Endoscopic Group and 30/38 in the Conventional Group(?~2=59.299,P=0.000).The recovery time to walking was significantly shorter in the Endoscopic Group(2.3?0.9 d) than in the Conventional Group(3.4?1.6 d)(t=-4.952,P=0.000).There was no significant difference in the patency rate at 6 postoperative months between the Endoscopic Group(96.0%,48/50) and the Conventional Group(95.3%,19/20)(?~2=0.000,P=1.000).Conclusions Use of endoscopic vein harvesting in coronary artery bypass grafting decreases the incidence of postoperative leg-wound infections,post-operative pain,and length of hospital stay.

Experience on transthoracic occlusion of atrial septal defect / 中国微创外科杂志

30 mm in 100 patients.The ASD was associated with atrial septal aneurysm in 2 patients.An incision 2~3 cm in length was made in the 4th intercostal space of the right parasternum to expose the right atrium,at which a purse-string suture was placed.A double-lumen delivery catheter was then punctured into the right atrium,and passed through the defect to the left atrium under the guidance of transesophageal echocardiography.An occluder made of a nickel-titanium metal alloy and 4 mm bigger than the defect was released to engage on the defect.The delivery catheter was then withdrawn.Results The operation was successfully accomplished in all the 206 patients.The operation time was 18~32 min(mean,26?7 min). No surgery-related death happened and no occluder dislodgment occurred.Mechanical ventilation was stopped at 5 hours after operation,and all the patients got out of bed on the operation day.Colour Doppler imaging 3 days after operation showed complete occlusion of the ASD without residual shunt.The length of hospitalization was 4?2 days.Follow-up examinations for 6 months in 186 patients and for 3~4.5 years in 57 patients by using Colour Doppler imaging revealed no residual shunt and normal cardiac functions.Conclusions Mini-incision transthoracic occlusion of atrial septal defect is safe and reliable in patients contraindicated to transcatheter closure.

Comprehensive surgical management of giant coronary artery aneurysm secondary to Kawasaki disease:5 cases report / 解放军医学杂志

Objective To investigate the clinical features and surgical management of giant coronary artery aneurysm due to mucocutaneous lymph node syndrome(Kawasaki disease).Methods From May 2006 to Oct.2007,5 patients with giant coronary artery aneurysm were undergone surgical correction.The aneurysm mainly appeared in the left bole of coronary artery and the right coronary artery.The ST segment of electrocardiogram changed in 5 cases,cardiac ejection fraction reduced observably in 4 cases,and 1 case suffered from cardiac dysfunction.Coronary angiography showed that the right coronary artery was entirely occluded and ventricular wall motion was depressed in one case.During operation,4 cases were undergone thrombus clearing,endoarterectomy and replasty of coronary artery(with additional procedure of stent placement in one case),one case was undergone coronary artery bypass grafting(CABG) with the aneurysm sequestration.Results The surgical results were satisfactory.No operative death occurred,and all the patients recovered uneventfully and were free of symptoms.In 4 cases,the ST segment of electrocardiogram showed that the blood supply of ischemic myocardium was improved,and the cardiac ejection fraction increased obviously.With 2 to 18 months following-up,all patients were free of symptoms with no death or coronary artery aneurysm recurrence.Conclusions For stage 3 Kawasaki disease complicated with giant coronary artery aneurysm,surgical procedure is necessary.The cardiac function can be improved greatly after comprehensive treatment of thrombus clearing,endoarterectomy,replasty of coronary artery and CABG.

Effects of theoracoscopic cardial surgery under video monitoring on inflammatory cytokine / 解放军医学杂志

0.05),while the levels of IL-8 and IL-6 declined,but were still significantly higher than that at immediately after induction of anesthesia(P

The influence of body weight on total thoracoscopic cardiac surgery in children / 解放军医学杂志

0.05).Compared with group A,the aortic occlusion time,ventilation time and the length of stay in ICU were shorter in groups B and C(P0.05)were found between group B and C in the aortic occlusion time,ventilation time and length of stay in ICU.Conclusion TTS is a safe and reliable surgical madality for the treatment of pediatric cardiac diseases.Patients weighed over 20kg are strong enough to withstand TTS and may recover sooner.

Application of self-made bipolar venous cannula in total thoracoscopic operation for atrial septal defect in children / 解放军医学杂志

Objective To summarize the feasibility of the application of the self-made bipolar venous cannulae to repair atrial septal defect(ASD)totally through thoracoscope in children.Methods Twenty-eight children,aged 4.2?1.3 years in average and weighed 14.6?3.9kg,were diagnosed as congenital ASD.Among these patients 3 were complicated by moderate to severe pulmonary hypertension,4 by partial pulmonary venous teratosis and 3 by tricuspid valve insufficiency.During the operation,patients were placed in a supine position,and the right shoulder was padded 30? higher than the left.A tracheal cannula was inserted and air was given with high frequency jet ventilation.Three small thoracotomies with a diameter of 2 to 3 cm were made in the 4th intercostal space on the right side of the sternum and the 4th and 7th intercostal spaces on the right middle axillary line.The cardiopulmonary bypass(CPB)was set up through the right femoral artery and femoral vein with bipolar femoral venous cannulae.The ASD was repaired through the thoracoscope.Results In all the 28 patients,the mean extracorporeal circulation time was 53.5?17.8min,and cross-clamp time was 25.2?7.9min.Automatic heart beat recovered after the declamping of the aorta in all the patients.No serious complication occurred.Heart murmur vanished,and ultrasonic examination was negative.Half a year after operation,ECG showed that the size of right ventricle and right atrium became maller in size,the diameter of pulmonary artery diminished,and the cardiac function was improved(P

Experimental study on hemorheological and pathological changes following severe myocardial contusion / 中华创伤杂志(英文版)

OBJECTIVE: To investigate the mechanism of severe myocardial contusion in rabbits. METHODS: A total of 32 New Zealand rabbits were randomly divided into 2 groups, the severe myocardial contusion group (the experimental group, n=16) and the sham-impact control group (the control group, n=16). Hemorheological parameters, interleukin-8 (IL-8) in serum, the water contents of myocardium and polymorphonuclear neutrophil (PMN) infiltration in contused myocardium were observed at 24 hours after the experiment. RESULTS: As compared with the control group, the hemorheological parameters in the experimental group including the whole blood viscosity (etab), erythrocyte aggregation index (EAI), hematocrit (HCT), serum fibrinogen (Fib), Casson viscosity (Gammay) and erythrocyte sedimentation rate (ESR), significantly increased. The IL-8, PMN infiltration and the water contents of the contused myocardium also significantly increased. CONCLUSIONS: It suggests that the hemorheological disorder, increase of IL-8 in serum, and PMN infiltration in contused myocardium may contribute to the development of cardiac edema and secondary myocardial damage following severe myocardial contusion in rabbits.

Transcatheter closure of perimembranous ventricular septal defects using domestic symmetric double-disk occluders / 中国介入心脏病学杂志

Objective To evaluate the safety and efficacy of transcatheter closure of perimembranous ventricular septal defects(VSD) using domestic symmetric double-disk occluders.Methods From March 2003 to July 2007,689 VSD patients were treated with transcatheter intervention using domestic symmetric double-disk occluders and received clinical follow up at 1 month,3 months,6months after the procedure and annually thereafter.Complications including residual shunt,heart rhythm changing,shape of the occluder and the presence of tricuspid/aortic regurgitation were observed thoroughly.Results The overall technical success rate was 98.8%.One patient died of cerebral bleeding 7 days after intervention.One patient suffered complete A-V block and required permanent pacemaker implantation and another patient conversed to open surgery because of moderate tricuspid regurgitation.Asymmetric Amplatzer occluders were used in 6 patients but the intervention failed in 2 patients whom required an open conversion.Comorbidities such as atrial septum defect,patent foramen ovale were treated concomitantly.No other complications were observed during the follow-up period.Conclusion Complication associated with transcatheter closure of perimembranous VSD using domestic symmetric double-disk occluders was relatively low.The procedure was safe and applicable.Meanwhile,it is necessary to stick to the procedural indications and avoid complications such as tricuspid regurgitation etc.