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To explore the effect of growth hormone releasing peptide (GHRP) on myocardial cell apoptosis in heart failure (HF) rats. Methods: Rat's HF model was established by the ligation of left anterior descending coronary artery induced ischemia. 40 male SD rats were randomly assigned into 4 groups: Normal control group, Sham operation group, HF group and GHRP treated HF group. n=10 in each group and the rats were fed for 4 weeks after the operation. Cardiac function was examined and myocardial cell morphology was observed; protein expressions of Smac/DIABL0 and Bcl-2 were measured by Western blot analysis; cell apoptosis was evaluated by FCM technique. The differences for above parameters were compared among groups to explore the effect of GHRP on myocardial cell apoptosis in HF rats. Results: Compared with HF group, GHRP treated HF group showed the less heart dilation, higher LVEF, lighter pathological changes in myocardial cells and decreased protein expression of Smac/DIABL0, all P<0.05. Bcl-2 level was lower in HF group than the other 3 groups, P<0.05. Compare with Normal control group, GHRP treated HF group had elevated Bcl-2 level, all P<0.05. Myocardial cell apoptosis index was different between HF group and GHRP treated HF group, P<0.05. Conclusion: The effect of GHRP on anti-HF should be via inhibiting myocardial cell apoptosis; the mechanism may partly be through promoting Bcl-2 protein expression and depressing Smac/DIABLO mediated mitochondrial pathway of apoptosis.
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ObjectiveThis paper reported our experience with thoracoscopic management of isolated atrial fibrillation to define the efficacy and safety of this approach.MethodsThirtytwo patients ( 17 mem,15 women) with isolated atrial fibrillation underwent thoracoscopic surgery.All procedures were finished under 3 port incisions on left posterior chest.Among them 18 cases are paroxysmal and 8 persistent.ResultsThere was no operative death or major perioperative complications.One case was converted to limited thoracotomy because of bleeding.Operation time was 87 - 238 min.Paroxysmal atrial fibrillation occurred in 9 cases in hospital and all the cases were sinus rhythm after discharge.Followup 4 to 20 months,One persistent case was converted paroxysmal.ConclusionPatients with isolated atrial fibrillation can benefited by Videoassisted thoracoscopic left posterior approach with better exposure of left atrial and resection of the left atrial appendage,with decreased operative trauma and better results.
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ObjectiveTo summarize the clinical results of totally thoracoscopic cardiac surgery for mitral valve diseases.MethodsFrom May 2004 to October 2011,272 patients underwent totally thoracoscopic cardiac surgery for mitral valve diseases through three ports.Summarize the indication and contraindication are used and for the operation date.Results There was 1 case in-hospital deaths.The time of operations was 2.1 ～ 3.9 (3.0 ± 1.2 ) h.Time of cardiopulmonary bypass and aortic cross-clamp was 76 ～ 158 (98 ± 22) minites and 38 ～ 78 (52 ± 13 ) minites.Time of mechanical ventilation and intensive care unit stay was 5.8 ～ 34.5 ( 11.2 ± 3.6 ) hours and 14 ～ 67 ( 28.2 ± 7.6 ) hours.The volume of drainage was 20 ～ 1200(370 ± 80) ml.The hospital days were 7 ～ 18 ( 10.2 ± 2.1 ) days.The postoperative complications occurred in 14 cases.ConclusionTotally thoracoscopic cardiac surgery for mitral valve diseases is technically feasible and safe with less drainage and shortened hospital stay.
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Objective The risk for coronary artery bypass surgery is reported to be increased with age and associated with diabetes. We examined the outcomes of coronary artery bypass grafting (CABG) in patients with diabetes who were older than 70 years of age and evaluate the effect of diabetes on CABG in those patients. Methods From March 2000 to March 2008, the data of 649 patients older than 70 years of age were collected retrospectively and divided into diabetic group or non-diabetic group based on pre-operative diagnosis. The blood glucose level of patients was maintained between 7.0 mmol/L ( 126mg/dl) and 10.0 mmoL/L ( 180 mg/dl) porioporatively. Stats 7.0 was used for statistical analysis. The t test and χ~2 test were used to determine the differences in the numerical variables and categorical variables respectively. Results No statistical differences were observed between the two groups in the baseline variables, such as age [ ( 74.78±3.67 ) years for diabetic group vs. ( 75.00±3.65 ) years for non-diabetic group, P = 0. 4877 ], female patients ( 34.76% vs. 29.22%, P =0. 1663 ), ejection fraction [ ( 57.02±10. 10 ) % vs. ( 58.49±10. 39 ) %, P = 0. 1004 ) ], myocardial infarction history (26.20% vs. 28.35%, P =0. 5795), though there were more left main diseases in the diabetic group (52.41% vs.26.41%, diabetic vs. non-diabetic, P = 0. 0000 ). The overall in-hospital mortality was 6.32% (8.02% in the diabetic group vs. 5.63% in the non-diabetic group, P = 0. 2571 ). The main causes of death were sudden respiratory and cardiac arrest,low cardiac output syndrome ( LCOS), malignant arrhythmia, respiratory failure, renal failure, central nervous system compli-cations, and multiple organ failure. Major post-operative complications were bleeding, atrial fibrillation, plural effusion and pulmonary infection. Post-operative variables, such as EF (0.59±0. 13 in the diabetic group vs. 0. 61±0.15 in the non-dia-betie group, P =0. 1807), re-revascularization due to bleeding (2. 14% vs. 4.76%, P = 0. 1232), blood transfusion (89.84% vs. 84.63%, P = 0.0820) and the administration of vasoactive agent (21.93% vs. 27.71%, P= 0. 1286),were found no significant difference between the two groups. Conclusion Conclusions The early outcomes of CABG in aged patients are acceptable. The surgical consequences in diabetic patients may be similar to those in non-diabetic patients.
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Objective To summarize surgical experience of eight patients with pentalogy of Cantrell. Methods Six male and two female patients with pentalogy of Cantrell,aged from 4 months to 26 years old, average 7.35 years old, underwent surgical therapy for intracardiac anomalies and extracardiac anomalies from July 2007 to June 2009. Eight case with intracardiac anomalies include one case with only VSD, one case with only ASD, two cases with DORV, four cases with VSD and ASD or PTO. Experts majoring in cardiovascular surgery cooperated with doctors majoring in thoracic surgery and general surgery for satisfactory correction of intracardiac anomalies and extracardiac anomalies and repositioning heart to thoracic cavity. Results Ectopic heart of the first patient was simply repositioned into thoracic cavity following surgery of double outlet of right ventricle in another hospital two years before. Correction of introcardiac anomaly and reposition of ectopic heart finished at one time in 7 cases. Eight patients got full recovery except that residual shunt occurred in the second case which also got full recovery after transcatheter therapy. Ventricular diverticulum was removed in the fourth case because of difficult reposition of ectopic heart.With the help of general surgeon and thoracic surgeon, partial coronary ligament of liver and falciform ligament of liver in the left was cut in the first case and the left half lobe of liver was pushed downward. Bilateral pleural and marginal costal costochondral was cut and make thoracic wall upward so that ectopic heart can reset into thoracic cavity. And then, defect of diaphragm and abdominal wall were repaired with Proceed patch. In the other seven cases, bilateral pericardium and mediastinal pleura was cut and the 7th and 8th cartilage was transected and bilateral costal arch was closed so for complete thoracic angioplasty.Left ventricular dysfunction occurred in the fifth case with DORV and also got full recovery after symptomatic treatment. Full recovery was got in all cases after followingup from 1 to 23 months. No adverse complications occurred and every case live a wonderful life. Conclusion Pentalogy of Cantrell can be cured at one time by accurate correction of cardiac anomalies, cutting of bilateral pleural and marginal costal costochondral to make thoracic wall upward and enlarge thoracic space for repositinning of ectopic heart and using artificial patch to repair defect of diaphragm when necessary.
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Objective To explore the protective effects of erythropoietin (EPO) on cardiomyocytes against hypoxia/reoxygenation (HR) injury. Method Isolated and cultured rat eardiomyocytes were subjected to 2-hour hypoxia followed by 1 hour reoxygenation to establish model of HR injury. Cardiomyocytes were randomly divided into 4 groups: sham group, HR group, HR + EPO-treated group (EPO 10 U/ml), and HR + EPO + UO126-treated group (U0126 10?mol/L). The concentration of lactate dehydrogenase (LDH) in culture medium was detected by automatic biochemical analyzer; viability of eardiomyocytes was measured by MTT assay; apoptosis ratio was determined by TUNEL technology and Annexin-V-FITC with flow cytometer (FCM); level of extracellular signal- regulated kinase 1/2 (ERK_(1/2)) and phospho-ERK_(1/2) were measured by Western-blot analysis. Results EPO significantly decreased the leakage of LDH, enhanced activity, reduced apoptosis ratio, and increased level of phospho-ERK_(1/2).However, the effects were blocked by U0126, an inhibitor of MAPK. Conclusions EPO has the protective effects on cardiomyocytes against HR injury possibly via the mechanism of activation of ERK_(1/2) and inhibition of apoptosis.
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Objective To investigate the role of tissue factor in the occurrence and development of co agulation in acute vascular rejection of heart xenotransplantation. Methods An animal model for acute vascular rejection of heart xenotransplantation was es tablished by using rat as recipient and guinea pig as donor. The xenografts were removed at 4, 8, 12, 16, and 24 h after the operation for fibrin sedimentation by immunohistochemical technique to evaluate coagulation. Meanwhile, the express ion of tissue factor mRNA was detected at different time points by RT-PCR. Hear ts of normal guinea pigs were used as controls. Results Immunohistochemical examination showed that coagu lation developed at the 8 h when interstitial fibrin deposition and fibrinous th rombus appeared and aggravated with time. High expression of guinea pig tissue factor mRNA appeared at 4 h after the transplantation and then steadily d eclined and totally terminated at the 16 h. The expression of rat tissue factor mRNA appeared 16 h post operation and then kept steadily enhanced. Conclusions The tissue factor acts as an important role in the acute vascular rejection of h eart xenotransplantation. The high expression of donor tissue factor mRNA might be related to the trigger of coagulation and the high expression of the receptor ’s tissue factor may be related to the further development of coagulation.
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Objective To investigate the feasibility of aortic and mitral valves replacement under video-assisted thoracoscope.Methods The subjects included 16 dogs(Experimental Group) and a clinical volunteer(Clinical Group).The procedure was performed under extracorporeal circulation with femoral artery and vein intubation.An incision 4~5 cm in length and two 1.5 cm ports were made in the right chest wall.The superior and inferior vena cava were cross-clamped by a self-made clamp and the myocardium was protected by cold cardioplegic coronary perfusion.Artificial mechanical aortic and mitral valves were intermittently sutured.Results In the Experimental Group: the time of extracorporeal circulation was 104~196 min(143.2?46.5 min) and the ascending aorta cross-clamped time was 58~128 min(82.4?26.1 min).Autopsy findings showed satisfactory valve suture fixation,without thread loosing or paravalvular rupture.In the Clinical Group: the time of extracorporeal circulation was 157 min,the ascending aorta cross-clamped time was 112 min,the time of mechanical ventilation was 10 h,and the drainage volume,150 ml.The patient was discharged from hospital on the 10 postoperative day.Follow-up observations for 9 months found no paravalvular leakage or other complications.Echocardiography showed normal prosthetic valve movement.Conclusions Video-assisted thoracoscopic aortic and mitral valves replacement is technically feasible.
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Objective: To explore the feasibility of observing hemodynamics on ischemia/reperfusion(I/R) rat heart model in vivo by studying the changes of hemodynamics,myocardial zymogram and electrocardiogram. Methods: Twenty SD rats were randomly divided into 2 groups(n=10)(IR group and control group).The left anterior descending coronary artery was ligated or left untouched,a catheter was put into the left ventricle to trace the pressure change index and peak pressure of left ventricle,and to record ST segment changes of ECG.At the end of experiment,the levels of myocardial zymogram were determined.The results of two groups were compared. Results: Compared with control group,IR group showed reduced dp/dt max,declined LVSP,raised ST segment in ECG,and elevated myocardium zymogram. Conclusion: Our I/R rat heart model in vivo is feasible and stable to explore the cardiac hemodynamics.
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Objectives:To investigate the effect of TP 5 on the immune function and infection rate in patients undergoing cardiopulmonary bypass(CPB) operation. Methods:Ninety four patients were divided into two groups to observe the effect of TP 5 on the immune function and infection rate. Results:The immunological parameters in the TP 5 group was better than the control group, and postoperative infection was prevented. Conclusions:TP 5 can improve patients' cell mediated immunity and reduce infection rate.
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Objective To assess the effectiveness of carotid endarterectomy(CEA) in the surgical treatment of stenosis of carotid artery.Methods From December 2003 to June 2006,28 patients of carotid arteriosclerotic stenosis received CEA and vascular repair or plasty(VP).Before and after operation,the hemodynamic parameters including inner diameter of internal carotid canal,blood flow rate,blood flow and blood flow rate of middle cerebral artery of 28 patients were measured by color Doppler flow imaging(CDFI) and transcranial Doppler(TCD).Results The inner diameter of internal carotid canal in all patients recovered to normal range.Blood flow rate and blood flow after operation were improved.No postoperative complications occurred,and no aneurysms formed.Conclusion CEA is one of the effective ways to manage carotid stenosis and angioplasty can improve the long-term efficiency.
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Objective To summarize the experience of mitral valve replacement (MVR) using video-assisted thoracoscope. Methods 28 cases of MVR were performed through three right anterior ports under thoracoscopy using femorofemoral extracorporeal circulation. The aorta was cross-clamped and the myocardium was protected by coronary perfusion with cold cardioplegic. 33 patients underwent routine open approach MVR as control group. Results There was no death and no morbidity directly related to this approach. Comparing with control group, time of extracorporeal circulation was 82～146 (96?38)min vs. 80～132(92?31)min, cross-clamped 37～76(47?18)min vs. 34～72(45?13)min and ventilation time were 8.6～14.8(10.2?3.1)h vs. 8.3～15.9(11.3?3.4)h . The volume of drainage was 50～230 (72?28)ml in VATS group while 70～460(108?4.2)ml in control group((P
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Objective To summarize the treatment of 7 cases of severe coronary artery disease with CO2 laser transmyocardial revascularization(TMLR). Methods The mean preoperative angina class (Canadian Cardiovascular Society, CCS), number of diseased coronary arteries were 3.6±0.7 and 2.8±0.6 respectively. All the patients underwent left anterolateral thoracotomy through the fifth intercostal space under general anesthesia, the left ventricule was exposed and then TMLR was performed. The mean channels in TMLR was 32.5. Results The symptoms of angina disappeared during the first postoperative month, with no relapse reported in the first follow-up year. There was significant difference in the angina class (P＜0.05), ejection fraction also increased. The ischemia region of the heart decreased through the single photon emission computed tomographic(SPECT) test. Conclusion TMLR can relieve angina and improve life quality of patients with severe coronary artery disease. It can accelerate the recovery of dormant myocardium and enhance the contractility.
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Objective To investigate the high risk factors for severe complications after cardiopulmonary bypass cardiac surgery of patients aged 70 years and over. Methods 204 consecutive patients aged 70 years and over undergoing cardiopulmonary bypass cardiac surgery in our department were investigated.The patients′ characteristics,perioperative outcomes and the high risk factors for severe complications after surgery were analyzed.Results The overall mortality was 6.4%(13 of 204).A total of 40 cases with severe complications,including early death after surgery,were recorded.It was significantly higher than that in patients aged
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Objective To explore the feasibility of off-pump coronary artery bypass grafting (OPCAB) in the treatment of severe coronary atherosclerotic heart disease. Methods Clinical data of 37 cases of severe coronary heart disease from January to December, 2002, were retrospectively reviewed. All operations were conducted under general anesthesia by midline sternotomy. The left internal mammary artery (LIMA) and the great saphenous vein (SV) were divided for grafting. Then we stabilified the local myocardium and exposed the diseased coronary arteries. Following the insertion of an intracoronary shunt, the LIMA was anastomosed to the left anterior descending artery (LAD). Afterwards, the SV was proximally anastomosed to the aorta, and then, to the coronary artery. Results All the operations were completed by beating heart revascularization. The number of bypass grafting was 3 2?0 5 (range, 1～6). Except 1 patient died on the 10th postoperative day, no severe complications, such as peri-operative myocardial infarction, respiratory failure, renal insufficiency or cerebrovascular accident, took place in the remaining 36 patients. Conclusions In the context of skillful procedure techniques and strict peri-operative management, OPCAB in the treatment of severe coronary atherosclerotic heart disease is feasible.
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Objective: This study was designed to determine the expression of IFN-γ mRNA in heart allograft and its correlation to postoperative, cell infiltrating and allograft survival time. Methods: The heterotopic rat heart transplantation model was established with a simplified method, and the allografts and isografts were harvested at 1, 3,5,7,9 and 11 postoperative days. After the total RNA was prepared, the standard primer and target primer were amplified in the same tube, the average ratio of the target products pixel volume to primer's was calculated and a coordinates chart was made. Results: The expression level of IFN-γ mRNA in heart allograft was elevated and its peak was on the fifth postoperative day, and prior to the heart death has a positive correlation with cell infiltrating. Conclusion: IFN-γ may play on important role in postoperative rejection.