If one word is used to describe the development of congenital heart disease surgery in China, "hardship" would be the most appropriate. Generations of pioneers have used their ingenuity to overcome obstacles and promoted the development of the discipline. Seventy years of efforts have established the world's largest congenital heart disease treatment system. However, the huge number of potential patients, low early diagnosis rate and over-screening as well as the uneven developed diagnosis and treatment capabilities hinder the future development. The overall improvement of treatment of congenital heart disease in China lies on more efforts from our fellow experts. The publication of the "Chinese expert consensus on surgical treatment of congenital heart diseases" undoubtedly provides theoretical and practical guidance for the improvement of treatment.
Abstract： Tricuspid insufficiency founded in the setting of left-sided heart disease is usually secondary tricuspid insufficiency caused by tricuspid valve annular dilation. Some patients had rheumatic tricuspid valve diseases. Tricuspid valve repair rather than valve replacement is recommend for functional tricuspid regurgitation. Linear annuloplasty and ring annuloplasty are two main tricuspid valve repair methods. However, the indications for treatment of secondary tricuspid regurgitation remain controversial. The optimal surgical repair technique to eliminate secondary tricuspid regurgitation remains challenging. In this article, we review the assessment of tricuspid valve lesions, criteria for correction, and surgical management of secondary tricuspid insufficiency.methods. However, the indications for treatment of secondary tricus
Objective To review our experience of minimally invasive direct coronary artery bypass grafting （MIDCAB） via a lower median ministernotomy in 72 cases. Methods Via a lower median ministernotomy,the left internal mammary artery was harvested to bypass the left anterior descending coronary artery. Saphenous vein was resected and used for single - or multi-vessel coronary revascularization on the beating heart. Results There were 1 operative death （1.4 % ）. Complications occurred in 3 patients （4.2%）. The operative duration was 195.6 ± 50. 6 min. The number of distal anastomoses was 2.3±0. 8（1-4）. The median time to tracheal extubation, and lengths of postoperative ICU and hospital stays were 11 hours, 3 and 9 days, respectively. Total chest drainage was 8. 54±5.9 ml/kg and 47 patients needed blood transfusion with an amount of 1 091.3±636.2 ml. The incision on the chest wall was 9 to 11 cm long in all cases. Sixty-six patients （92.9%, 66/71） were followed-up for a duration of 36.2±17.6 months. There were no late death and 43 patients （65.2%） were free from angina. Eighteen patients （27.3%, 18/ 66） experienced marked relief of their symptoms. Conclusions MIDCAB is possible via a lower ministernotomy for single - or multi-vessel coronary revascularization. The small incision reduces the risk of infection and blood loss. It is safe, easy and requires no special operative instruments.
ObjectiveTo evaluate the feasibility of using acellular bovine pericardium as a viable tissue engineering vascular patch.MethodsFresh bovine pericardium was treated by enzyme detergent cell extraction, then they were used as vascular patches, ovine jugular vein segments were harvested, separated into endothelial and myofibroblast cells, expanded in cell culture, sequentially seeded onto acellular bovine pericardium patches (3cm×3cm). After 7 days of in vitro culture, the autologous cell/patches as experimental group ( n =5) were used to replace partial pulmonary artery wall. Animals were sacrificed at 4, 6, 8, 12 and 24 weeks. The acellular bovine pericardium patches without autologous cells were used as control group ( n =3). Animals were sacrificed at intervals of 4, 12 and 24 weeks. Explanted patches were evaluated by macroscopic and histologic examinations, assayed for calcium, elastin and collagen content.ResultsAll animals were survived without complications of thrombosis and aneurysm before sacrificed; there was no significant difference in calcium content in two groups; elastin ratio assay showed progressive increase over 4 to 24 weeks, similar to normal pulmonary artery wall, suggesting an ongoing tissue remodeling.ConclusionThe acellular bovine pericardium patch with or without autologous cell seeded to a certain extent can be changed into viable vascular wall tissue after being used to replace partial ovine pulmonary artery wall.
Objective To evaluate the effect of Schwann cell (SC) on the proliferation of marrow mesenchymal stem cells (MSCs) and provide evidence for application of SC in construction of the tissue engineered vessels.Methods SC and MSCs were harvested from SD rats(weight 40 g). SC were verified immunohstochemically by the S-100 staining, and MSCs were verified by CD 44, CD 105, CD 34 and CD 45. The 3rd passages of both the cells were cocultured in the Transwell system and were amounted by the 3H-TDR integration technique at 1, 3, 5 and 7 days,respectively. The results were expressed by the CPM(counts per minute, CPM) values. However, MSCs on both the layers were served as the controls. The Westernblot was performed to assess the expression of the vascular endothelial growth factor (VEGF), its receptor Flk-1, and the associated receptor neuropilin 1(NRP-1) in SC, the trial cells, and the controls. Results SC had a spindle shape in the flasks, and more than 90% of SC had a positive reaction for the S-100 staining.MSCs expressed CD44 and CD105, and had a negativesignal in CD 34 and CD 45. The CPM values of MSCs in the trial groups were 2 411.00±270.84，3 016.17±241.57，6 570.83±2 848.27 and 6 375.8±1 431.28at 1, 3, 5 and 7 days, respectively. They were significantly higher in their values than the control group (2 142.17±531.63，2 603.33±389.64，2 707.50±328.55，2 389.00±908.01), especially at 5 days （P＜0.05）. The Western blot indicated that VEGF was expressedobviously in both the SC group and the cocultured MSCs grou,p and was less visible in the control cells. The expressions of Flk-1 and NRP-1 inthe cocultured MSCs were much ber than in the controls. Conclusion SC can significantly promote the proliferation of MSCs when they are cocultured. The peak time of the proliferation effect appeared at 5 days. This effect may be triggered by the up-regulation of VEGF in MSCs, which also leads to the upregulation of Flk-1 and NRP-1 .
Objective To summarize and analyze the clinical outcomes and experiences of continuous renal replacement therapy(CRRT) in patients with acute renal insufficiency after heart transplantation. Methods There were 39 patients received orthotopic heart transplantation from September 2007 to September 2008 in Fu Wai hospital. Seven cases required the use of PRISMA CRRT machine (Gambro Healthcare,Inc.) because of acute renal insufficiency after heart transplantation, and received continuous venovenous hemodiafiltration(CVVHDF) treatment via M100 blood filter (hemofilters). Activated coagulation time (ACT) was maintained in 160200 s. Results Six survivals with New York Heart Association (NYHA)Ⅰdischarged ，1 case died of multiple system organ failure (MSOF) and severe infection. The time of CRRT was 48658 h, with an average of 252 h. Seven patients were oliguric or anuric during CRRT, but hemodynamics and internal environment were stable. After stopping CRRT, the creatinine level rose to 267.1±68.5 μmol/L， then the creatinine level decreased to normal range with urine increasing gradually. Postoperative glomerular filtration rate (GFR) was 56.5±19.0 ml/min， and there was no statistical significance compared with preoperative GFR（Pgt;0.05）. Six survivals were followed up for 513(9.7±3.8)months，and their creatinine level was in normal range(90.6±26.7 μmol/L). There was no statistical significance compared with the creatinine level at discharge (83.2±26.5 μmol/L, Pgt;0.05）. Conclusion The prognostic outcomes of patients with acute renal insufficiency after heart ransplantation are excellent after using CRRT. No significant renal dysfunction is found.
Objective\ To test whether off pump coronary artery bypass grafting(OPCAB) has advantages over conventional coronary artery bypass grafting(CCABG).\ Methods\ Between January 1999 and February 2000, 170 patients with multivessel coronary disease underwent only coronary artery bypass grafting by one surgeon. They were divided into two groups, OPCAB group:88 cases underwent CABG with off pump and beating heart via sternotomy; CCABG group: 82 cases underwent conventional CABG with extracorporeal circulation....