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 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 the experience of emergency coronary artery bypass grafting （CABG） after failed percutaneous coronary intervention. Methods From January 1998 to December 2002, 9 patients underwent emergency CABG after failed percutaneous coronary intervention. The indications of emergency CABG were coronary artery dissection （5 cases）or perforation （2 cases） and acute arterial occlusion （2 cases）. The time averaged 2 hours from onset of ischernia to revascularization. The CABG was performed under off-pump bypass in 3 cases and under CPB in 6 cases. The mean graft number was 3. Results There were no hospital death. The mean follow-up was 17 months. No death and angina occurred. The function of New York Heart Association class Ⅰ-Ⅱ were in 8 patients, class Ⅲ in 1 patient. Conclusion Emergency CABG is an effective management for failed percutaneous coronary intervention if the indication is right.
Coronary artery bypass grafting (CABG) is an effective method for the treatment of coronary heart disease at present. However, there is still a high rate of vein graft occlusion after CABG, which has a serious impact on the short and long-term clinical results. Venous access technique has been considered as an important factor on affecting the long-term patency rate. Compared with harvesting technology of the open saphenous vein harvesting, no-touch technology retained the surrounding tissue and vascular adventitia of great saphenous vein, and it avoided the high pressure of expansion vein. After CABG was performed by using the no-touch technique, the vein grafts obtained a better short and long-term patency rate, but the effect still needs further clinical verification.
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 improve the operative effects of patients who had tetralogy of Fallot with aortopulmonary collateral arteries (TOF-APCAs) and evaluate the clinical effects of staging and onestop hybrid approach for TOFAPCAs. Methods From January 2003 to December 2007, thirty patients with TOF-APCAs had undergone combined therapy of APCAs embolization and complete surgical repair. Fifteen patients had APCAs embolization therapy before or after TOF radical operation(staging hybrid group ); Fifteen had onestop hybrid treatment(onestop hybrid group). Results Angiography revealed that there were 19 APCAs in staging hybrid group, and of which 15(78％) were embolized successfully. Five cases had complications and one died from respiratory circulating failure. The rest all recovered and discharged. And 22 APCAs were found in one-stop hybrid group, eighteen (82％) of them were embolized successfully. Only one case had pulmonary effusion. The time of hospitalization(median 37 d vs. 22 d, P=0.011),ICU staying（median 7.0 d vs. 4.7 d,P=0.029）and endotracheal intubation（median 131 h vs. 19 h,P=0.009） was obviously longer, and the hospitalization expenses（median 64 101 [CM(159mm]yuan vs. 48 021 yuan, P=0.033）were obviously higher in staging hybrid group than that in one-stop hybrid group.And there was no statistical significance in cardiopulmonary bypass time（P=0.126） and aortic clamping time（P=0.174） between two groups. Conclusion In comparison with traditional staging hybrid approach, one-stop hybrid approach can simplify the operative process for patients who have TOFAPCAs, improve the operative successful rate and cut down expenses.