Common factors for ischemic cerebral stroke in coronary artery bypass grafting in patients with concomitant carotid and coronary artery severe stenosis / 中南大学学报(医学版)

To analyze two common factors for perioperative ischemic stroke in patients with concomitant carotid and coronary artery severe stenosis and to improve the therapeutic effect.
 Methods: A total of 44 patients with multi-vessel coronary artery disease combined with carotid stenosis, who admitted to the Department of Cardiac Surgery, the First Affiliated Hospital of Xiamen University from 2008 to 2014, were enrolled in this study. Among them, 32 cases were male, 12 cases was female. All patients received coronary artery bypass grafting after treatment of neck diseases. The surgical outcomes and follow-up results were analyzed retrospectively.
 Results: One patient received carotid endarterectomy suffered hemiplegia, whose symptoms were improved after positive clinical treatment. One patient suffered transient ischemic attack, and 5 patients displayed the cerebrovascular syndromes a week later after surgery. Twelve patients suffered nerve function damage 48 hours later after surgery. Nine patients received intra-aortic ballon pump, 1 patient received thoracotomy hemostasis, 3 patients suffered sternal dehiscence; 27 patients showed atrial fibrillation. Two patients died after surgery. The follow-up duration ranged from 1-7 years and the follow-up rate was 90%. The ischemic symptoms were improved in 44 patients. Six patients complained the recurrence of angina, but no abnormalities were found in coronary angiography or computed tomography angiography. One patient died of malignant tumor during the follow-up duration.
 Conclusion: For patients with concomitant carotid and coronary artery severe stenosis, it is more likely to suffer ischemic cerebral stroke. However, carotid stenosis is not the only factor, other key factors relevant to ischemic cerebral stroke shouldn't be ignored either.

Induction of long-term heart survival after secondary transplantation by anti-RANTES monoclonal antibody combined with ciclosporin in mouse models / 器官移植

Objective To evaluate the effect of anti-RANTES monoclonal antibody in combination with ciclosporin (CsA)upon inhibiting the rejection response during secondary heart transplantation in mouse models. Methods BALB/c mouse models were used as the donors and C57BL/6 mice were utilized to establish secondary heart transplantation recipient models. The animals were randomly divided into the control (physiological saline,n =6 ),A (anti-RANTES monoclonal antibody treatment,n =6 ),B (CsA treatment,n =6 ) and C groups (anti-RANTES monoclonal antibody combined with CsA treatment,n=6). The survival time of heart after secondary transplantation was observed. The degree of acute heart rejection was assessed by histopathological analysis. The relative expression levels of RANTES,interleukin(IL)-2,IL-1 0,interferon(IFN)-γand transcription growth factor(TGF)-βmessenger ribonucleic acid (mRNA)in the heart grafts were quantitatively measured by real-time fluorescent quantitative polymerase chain reaction (qRT-PCR). The serum levels of RANTES,IFN-γ,IL-2,IL-1 0 and TGF-βwere detected by enzyme-linked immune absorbent assay (ELISA). Results The heart grafts of all mice survived after secondary cardiac transplantation. Compared with the control group,the survival time of hearts in group A,B and C was significantly prolonged (all P<0. 01 ). Pathological staining revealed that the quantity of infiltrated inflammatory cells in group C was significantly decreased than those in the other groups. The expression levels of heart RANTES,IFN-γand IL-2 mRNA in group C were significantly down-regulated, whereas the expression levels of IL-1 0 and TGF-βmRNA were considerably up-regulated compared with those in the other three groups (all P<0. 05). The serum levels of RANTES,IL-2 and IFN-γin group C were significantly down-regulated, whereas the serum contents of IL-1 0 and TGF-βwere considerably up-regulated compared with those in the other three groups (all P<0. 05 ). Conclusions Combined application of anti-RANTES monoclonal antibody and CsA can effectively induce the immune tolerance to secondary cardiac transplantation and prolong the survival time of the cardiac grafts in mouse models.

Performance effect of rabbit carotid artery treated with decellularization and photo-oxidation / 中南大学学报(医学版)

OBJECTIVE@#To analyze and discuss the feasibility of rabbit carotid artery treated with decellularization and photo-oxidation.@*METHODS@#Sixty vascular slices of rabbit carotid artery were divided into a fresh group, a cryopreservation group, a glutaraldehyde group, and a decellularization plus photo-oxidation group 15 in each group. To evaluate the physical properties of all the rabbit carotid arteries by testing heat-shrinking temperature, tensile stress and the max elongation of each group. Then by buliding subcutaneous embedding model in SD rats we evaluated the biological stability and the anti-calcification function property of the above rabbit carotid arteries, and the detection means included HE stain, atomic absorption spectrometry and Von-Kossa calcium salt stain.@*RESULTS@#The heat-shrinking temperature, tensile stress and the max elongation in the cryopreservation group were lower or shorter than those of the other groups and the difference had statistical significance (P<0.05). Although the heat-shrinking temperature and the tensile stress in the decellularization plus photo-oxidation group were lower or shorter than those in the glutaraldehyde group (P<0.05), the max elongation in the decellularization plus photo-oxidation group was much longer than that in the glutaraldehyde group (P<0.05). The rabbit carotid artery treated with decellularization plus photo-oxidation showed lower immunogenicity and better biological stability and better anti-calcification property compared with the other groups.@*CONCLUSION@#Decellularization associated with photo-oxidation is a suitable and novel protocol for small caliber artery allograft with a diameter of less than 6 mm which is unbreakable to mechanical properties and conducive to biological stability, which has a broad prospect.

Role of RANTES in evolution of alloreactive CD4+ memory T cells adoptive transfer-induced cardiac allograft acute rejection / 中华器官移植杂志

Objective To observe the intluence ot chemokine RANTES influence on cardiac allograft acute rejection caused by alloreactive memory CD4+ T cells (Tm) adoptive transfer.Methods Heterotopic heart transplantation (HTx) from Balb/c donors to C57BL/6 recipients was performed by anastomosis of the vessels of the neck.Mice undergoing heterotopic heart transplantation received either adoptive transfer of 1 × 106 CD4+ Tm from the spleen of alloantigen-primed C57BL/6 mice or no cells (control group).After the cardiac transplantation,the mean survival time (MST),mean histologic rank of rejection,relative gene expression and serum concentration of RANTES in the cardiac grafts.Results (1) The percentage of CD4+ Tm was 26.83％ at the spleen of alloantigenprimed mice; (2) The MST was 5.17 ± 0.17 days in the CD4+ Tm+ HTx group versus 7.76 ± 0.21 days at the HTx group (control group) (P＜0.01); (3) The histological tests revealed that mean histologic rank of rejection activity in the sections of cardiac allografts on the day 5 post grafting was grade 3.92 ± 0.08 in the HTx+ CD4+Tm group versus grade 2.67 ± 0.14 in HTx group (P＜0.01) ;(4) The relative gene expression level of RANTES was 2.6 ± 0.21 in the CD4+ Tm + HTx group,significantly higher than in the control group (P＜0.01) ; (5) The serum concentration of RANTES in the CD4+ Tm+ HTx group was 223.6 ± 16.79 pg/mL,higher than in the control group (120.7 ±9.47 pg/mL,P＜0.01).Conclusion Alloreactive CD4+ Tm contribute to the increased expression and secretion of RANTES,and cardiac allograft acute rejection was more extensive in the CD4 + Tm + HTx group.

A case-control study on risk factors analysis of surgical site infection in adult patients after major heart surgery / 中国综合临床

Objective To investigate the risk factors of surgical site infection ( SSI) in adult patients undergoing major heart surgery, and to provide the reference of controlling the development of SSI. Methods A case-control study was conducted with 54 SSI patients underwent major heart surgery from January 2001 to December 2009 in the case group and 162 controls in the control group. Univariate and multivariate conditional logistic regression analysis were used to analyse the risk factors of SSI development Results Univariate conditional logistic regression showed the risk factors for the development of SSI were left ventricular ejection fraction ( LVEF) < 50% (odds ratio ( OR) = 2.134,95% C/: 1.095 - 4. 159, P = 0. 026) , heart function New York Heart Association classification (NYHA) ≥Ⅲ grade, (OR =2. 390,95% CI: 1. 218 -4. 690; P = 0. 011) .diabetes (OR=3.275, 95% CI: 1.391 - 7. 708; P = 0.007), chronic obstructive pulmonary disease (COPD) ( OR = 5. 408,95% CI: 1.248- 23.445,P = 0.024),extracorporeal circulation time>90 mins ( OR =3. 045,95% CI: 1.540 - 6.024, P = 0. 001 ) , operation time > 4 h ( OR = 3. 281, 95% CI: 1. 610 - 6. 685, P = 0.001 ) , blood product consumption >2 u ( OR = 1. 929,95% CI; 1. 018 -3. 675;P =0. 044) .incision continuous suture close ( OR = 2.344,95%CI: 1.221 -4.498;P =0.010) exploration for bleeding (OR =6. 625,95%CI: 1.597-27.491 ;P =0. 009) , postoperative hyperglycemia (OR = 3. 510,95%CI:l. 5% -7. 718;P =0. 002) ,the stay in intensive care units (ICU) > 72 h ( OR = 3. 281,95% CI: 1. 505 - 7. 150;P = 0. 003). Multivariate analysis showed 3 variables increased with the risk of SSI: operation time >4h (OR = 3. 100,95% CI: 1.470 - 6. 537,P = 0.003 ) , incision continuous suture close (OR =2. 340,95% CI: 1. 183 - 4. 692, P = 0. 015 ) , and postoperative hyperglycemia (OR = 3. 272,95% CI:1.427 -7. 505,P=0. 005 ). Conclusions This study shows that the operation time >4 h, incision continuous suture close and postoperative hyperglycemia are risk factors most likely associated with SSI development in major heart surgery.

Surgical treatment of cardiac myxoma / 中国综合临床

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.

Emergency treatment of endobronchial stent placement for serious main bronchial stenosis following high-risk orthotopic heart allotransplantation: One case report / 中国组织工程研究

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.

Experimental study of pulmonary surfactant administration to the rabbits' lung grafts / 中华器官移植杂志

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