Effects of intraoperative expansion on expression of stenosis-related genes in saphenous vein graft / 局解手术学杂志

Objective To investigate the effect of high pressure distention on the expression of stenosis-related genes of saphenous vein graft(SVG) during the coronary artery bypass grafting(CABG).Methods The biopsy specimens of saphenous vein collected from 10 patients who have undergone CABG,were divided into expansion group and no-expansion group.Real-time PCR and immunohistochemical staining were performed for examination of mRNA and protein expression of VE-cad,Egr-1,VCAN respectively.Student's t and Chi-square test were used to do statistic analysis.Results The results of RT-PCR showed that the mRNA transcription of Egr-1,VCAN in the expansion group were statistically significantly higher than those in no-expansion group(P<0.05).The mRNA transcription VE-cad in expansion group was statistically significantly lower than that in the no-expansion group(P<0.05).The immunohistochemical staining results showed that the expression of Egr-1 and VCAN in expansion group were significantly stronger than those in no-expansion group,while the expression of VE-cad was significantly lower than no-expansion group.Conclusion The intraoperative expansion of SVG can increase the expression of stenosis-related genes Egr-1 and Versican,and decrease the expression of stenosis-related gene VE-cad,which may be related with the SVG stenosis after CABG.

Perioperative management and impact of preoperative renal dysfunction on short-term survival for patients undergoing valve replacement / 中华胸心血管外科杂志

Objective To review the experience of perioperative management and effect of valve replacement combined with renal dysfunction.Methods 536 cases of valve replacement.According to preoperative glomerular filtration rate(GFR),renal dysfunction was classified as normal in 322 cases,mild in 162,moderate in 40 and severe in 12.Logistic regression analysis was used to assess the effect of preoperative renal dysfunction on operative mortality and morbidity.Results Patients with a lower GFR were older and more likely to have hypertention.They also tended to have larger left ventricular end-diastolic diameter and worse left ventricular ejection factor.Operative mortality rose inversely with declining renal function,from 2％ for those with normal renal function to 17％ for patients with severe renal dysfunction.Renal dysfunction was significantly associated with a large blood transfusions,re-intubation,longer mechanical ventilation,intensive care unit stay and hospital stay.Conclusion Preoperative renal dysfunction is an important factor of postoperative mortality and morbidity for valve replacement.We must pay more attention to perioperative management.

Clinical analysis of treatment of myocardial bridge by coronary artery bypass grafting / 上海交通大学学报（医学版）

Objective To analyse the clinical features and outcomes of myocardial bridge treated by coronary artery bypass grafting (CABG). Methods The hospitalization and follow-up data of patients with myocardial bridge treated between March 1999 and March 2009 were collected. The symptoms, examinations, diagnosis, treatment and follow-up findings were retrospectively analysed, the clinical features and outcomes were analysed, and discussion was performed after literature review. Results Twenty-six patients with myocardial bridge were hospitalized, all of whom were confirmed by coronary angiography. All patients experienced symptoms of myocardial ischemia such as angina, which could not be relieved by medication. Electrocardiography was characterized by depressed ST, flat or inversed T wave. All patients received CABG (off-pump operation in 15 patients and on-pump operation in 11 patients). No surgery-related death or complications occurred. Patients were followed up for (3.5 ±2.0) years, and symptom of myocardial ischemia was relieved in all. Angina took place in 5 patients, and was eased by medication. Electrocardiographic reexaminations revealed that ST was normal in 22 patients, and flat ST was improved in the other 4 patients after operation. Conclusion Myocardial bridge is one of the congenital coronary artery malformations, and was mainly diagnosed through coronary arteriography examination. CABG is one of the best choices for the treatment of myocardial bridge with severe myocardial ischemia. Angina after operation in some patients may be related to the vascular spasm, as well as the blood flow competition between own vessels and grafts.