Application and development of stabilizers in coronary artery bypass grafting / 中国医师杂志

The first robotic heart surgery was performed more than two decades ago. Less invasive cardiac surgical techniques have become increasingly popular in recent years. The integration of emerging materials, computers and engineering technologies has provided the conditions for the application of robotic surgery in various cardiac procedures. Coronary artery bypass grafting (CABG), mitral valvuloplasty/valvuloplasty and radiofrequency/cryoablation for atrial fibrillation are some of the most common surgical procedures. Currently, only a few international cardiac centers have teams specializing in total endoscopic coronary artery bypass grafting. Although some studies have shown good results in robot-assisted heart surgery, questions remain about its safety, cost-benefit ratio, and long-term clinical outcomes. Robotic heart surgery poses higher challenges to myocardial protection and precise anastomosis. The role of stabilizers is to provide a relatively stable field of vision for heart surgery, which is the basis of all non-stop heart surgery. Because of their importance, researchers around the world are constantly exploring how to develop new, more sophisticated stabilizers. This review focuses on the research and development status and development trend of the stabilizer, summarizes the advantages and disadvantages of the current commonly used stabilizer, closely follows the clinic, makes in-depth analysis, and puts forward the key points of the future development of the stabilizer in coronary artery bypass surgery.

Diagnostic experience in 3 cases of cardiac occupying lesion / 中南大学学报(医学版)

The clinic symptoms of cardiac occupying lesions are complex and difficult to diagnose currently. In this study, three cases of atrial angiosarcoma, left ventricular aneurysm and left ventricular diverticulum were selected, respectively. The clinical characteristics, imaging features (echocardiogram, cardiac CT and MRI) and the postoperative and pathological results for patients were studied. We compared the differences in clinical symptoms, morphology, histology and haemodynamics among the three patients. The diagnosis were confirmed by intraoperative and postoperative pathological examination. We conclude that proper imaging approaches would be beneficial to diagnose the cardiac occupying lesions. Accurate preoperative diagnosis is beneficial to preoperative preparation as well as the decrease in operative risks.

8.5 year-follow-up of combined heart-lung transplantation in a patient / 中南大学学报(医学版)

To summarize the case of combined heart-lung transplantation for a patient who survived for 8.5 years. On September 20, 2003, at Second Xiangya Hospital of Central South University, homologous heartlung transplantation was performed on a male patient who was diagnosed with cardiopulmonary failure secondary to congenital ventricular septal defect with severe pulmonary hypertension. Heart-lung allograft was preserved with 1500 mL modified St.Thomas solution and 3000 mL modified LPD solution. Postoperative immunosuppressive therapies included: methylprednisolone and human anti-lymphocyte globulin protein in the induction period; and combination of ciclosporin A, CellCept and prednisolone in the stable period. In 2007, the treatment was changed to CellCept mg, twice a day+FK506 4 mg, twice a day. The patient lived 8.5 years of normal life with cardiac function of NYHA I-II. Echocardiogram showed left ventricular ejection fraction of 61% to 74%. Heart-lung transplantation proved reliable therapy modality for terminal cardiopulmonary failure. Excellent donor organ preservation and proper perioperative treatment are key factors for long-term survival after heart-lung transplantation.

Expression and significance of matrix metalloproteinase-1,9, tissue inhibitor of metalloproteinase-4 and extracellular matrix metalloproteinase inducer in the myocardium of congestive heart failure in patients with rheumatic heart diseases / 中南大学学报(医学版)

OBJECTIVE@#To investigate the expression of the matrix metalloproteinase-1, -9 (MMP-1,9), and tissue inhibitor of metalloproteinase-4 (TIMP-4), extracellular matrix metalloproteinase inducer (EMMPRIN) in the myocardium of congestive heart failure in patients with rheumatic heart diseases.@*METHODS@#The papillary muscle specimens of the left ventricle were obtained from 18 patients with heart failure during rheumatic heart valve replacement, and the normal specimens were obtained from the autopsy of 10 adults without heart disease. The specimens were stained to examine the expression of MMP-1, MMP-9, TIMP-4, and EMMPRIN by the EnVision immunohistochemical assays.@*RESULTS@#The expressions of MMP-1, MMP-9, and EMMPRIN in the myocardium of the patients with the cardiac function classes III and IV (NYHA III and IV) were significantly higher than those the normal cardiac function (NYHA I) (P<0.05) except MMP-1 expression between NYHA III and I. The TIMP-4 level was significantly lower in patients with NYHA III and IV than that of the NYHA I ( P<0.05). The expression of MMP-1, MMP-9, and EMMPRIN was significantly higher in patients with atrial fibrillation than those in the control group with regular sinus rhythm (P<0.05), whereas the TIMP-4 level was obviously lower in patients with atrial fibrillation than that in the control group with regular sinus rhythm (P<0.05). The expressions of MMP-1, MMP-9, and EMMPRIN were positively correlated with each other, but were negatively correlated with TIMP-4.@*CONCLUSION@#MMPs, TIMP, and EMMPRIN were significantly unbalanced in the myocardium of congestive heart failure patients with rheumatic heart diseases. They may play an important role in congestive heart failure through myocardial remodeling.

Preliminary Study of Microarray Gene Expression Profiles in Chronic Congestive Heart Failure due to Rheumatic Heart Disease / 中国循环杂志

Objective:To analyze gene expression profiling of left ventricular myocardium in patients with chronic congestive heart failure(CHF)caused by rheumatic heart disease(RHD)with the normal controls in order to identify CHF associated target genes. Methods:The gene expression profiles of left ventricular myocardium from patients with CHF by RHD and normal controls were obtained from six human whole-genomic oligonucleotide microarrays(Affymetrix HG U133 Plus 2.0 GeneChip). GeneSpring software was used to identify the differentially expressed genes in both groups,and bioinformatic analysis was applied to analyze the target genes associated with CHF. Real-time PCR was carried out to validate the expression of three target genes. Results:We identified 102 target genes associated with CHF which were classified into 7 gene clusters. Microarray results were further confirmed by real time PCR for three genes. ATF3 was markedly down-regulated,IGFBP2 and NPPB were notably up-regulated in the left ventricular myocardium samples from CHF patients. Conclusion:A lot of differentially expressed genes,obtained by using the whole-genomic expression profiling technology,might be a contributory factor for the initiation and progression of CHF and it helpful for the understanding of underlying pathophysiological implications. Further investigation on these genes would provide a strategy to identify genetic markers and molecular events associated with CHF caused by RHD.