ObjectiveTo report a simple and safe method for in situ fenestration of left subclavian artery in thoracic endovascular aortic repair (TEVAR).MethodsTwenty-eight patients received in situ fenestration of left subclavian artery in TEVAR from June 2018 to May 2019 in our center, including 23 males and 5 females at an average age of 57.7±9.6 years. Among them, 12 patients used adjustable sheath or guiding catheter (a group A) and 16 patients used "J. D"technique (a group B). The clinical efficacy of the two groups was compared.ResultsIn the group A, 1 patient failed to receive fenestration and was transferred to the chimney technique. In the group B, 1 patient due to the traction system shift during operation, was completed by traditional adjustable sheath puncture. The group B had shorter alignment-perforation time and trigger time and less complications. There was no significant difference in endoleak during short-term follow-up between the two groups.ConclusionThe "J. D" technique is simple, safe and easy to obtain materials. It effectively reduces the risk caused by difficult sheath alignment during the in situ fenestration of the left subclavian artery. Although the results of recent follow-up are not significantly different from traditional methods, it still needs to accumulate the cases to observe the possible risks and difficulties.
Objective To explore the induction of cardiomyogenesis of microRNA-129 （mir-129） in rat bone marrowmesenchymal stem cells （BM-MSCs） and its mechanism. Methods BM-MSCs were isolated from Sprague-Dawley rats and cultured in vitro. Overexpression of mir-129 or both mir-129 and glycogen synthase kinase-3β （GSK-3β） in BM-MSCs was produced with a lentiviral vector system. All the BM-MSCs were divided into four groups: control group （MSCs），Lentiviral vectors＋MSCs group （Lv-MSCs），mir-129 transfection group （mir-129-MSCs），and mir-129＋GSK-3βdouble transfection group （mir-129＋GSK-3β-MSCs）. Five-Azacytidine （5-Aza） （10 μmol/L） was used to induce BM-MSCsdifferentiation into cardiomyocytes. On the 1st，5 th，10 th，15 th and 20 th day after induction，realtime-PCR was performedto detect mRNA levels of GATA-4，Nkx2.5 and MEF-2C. On the 10 th，15 th and 20 th day after induction，Western blottingwas performed to examine expression levels of cTnI，Desmin，GSK-3β，phosphorylated β-catenin and dephosphorylated β-catenin. Results Compared with the control group，at respective time points，mRNA levels of cardiomyogenic genes and expression levels of cardiomyocyte-related proteins of mir-129 transfection group were significantly elevated，theexpression level of GSK-3β was significantly decreased，and the ratio of dephosphorylated/phosphorylated β-catenin was significantly elevated. When both mir-129 and GSK-3β were overexpressed in BM-MSCs，mRNA levels of cardiomyogenicgenes and expression levels of cardiomyocyte-related proteins were significantly lower than those of mir-129 transfection group，and the ratio of dephosphorylated/phosphorylated β-catenin was significantly decreased. Conclusion Overexpression of mir-129 can promote cardiomyogenesis of rat BM-MSCs possibly via inhibiting GSK-3β production and thus decreasing the inhibition of phosphorylation of β-catenin which then enters the nucleus and activates downstream signaling pathways that regulate cardiomyogenic differentiation of BM-MSCs.
Abstract: Objective To summarize the experiences of treatment for prosthetic valve endocarditis (PVE), paying special emphasis on some interrelated conceptions of PVE, its microbiology, diagnosis, prevention and treatment. Methods From September 1979 to September 2009, 33 patients diagnosed to have PVE were treated in our department. There were 17 males and 16 females. Their age ranged from 19 to 57 years old with an average age of 34 years. The incidence of PVE was 1.48% （33/2 236）including 1.03%（16/1 551）, 3.00%（7/233）, 2.28%（10/438）, and 0% of PVE in mitral valve replacement (MVR), aortic valve replacement (AVR), double valve replacement (DVR), tricuspid valve replacement (TVR), respectively. Pure medical treatment (Penicillin or Vancomycin with other broadspectrum antibiotics, Fluconazole and Amphotericin) was performed on 22 patients. Combined medical and surgical treatment was performed in 11 patients. The patients underwent operation after adequate antibiotics treatment and general condition improvement. The infective tissue and vegetation were completely debrided after the infective prosthetic valve was removed. Before the new valve was transplanted, paravalvular tissue was cleaned with antibiotics, iodine solution and normal saline. Results Hospital death occurred in 19 patients (86.36%) and only 3 patients (13.64%) recovered in the group with pure medical treatment. The main reasons for death were infective shock and cardiac failure in 9 patients, and cerebral complications including embolism, bleeding and multipleorgan failure in 10 patients. For the group with combined medical and surgical treatment, 10 patients (90.91%) survived and only one patient (9.09%) died of multipleorgan failure. Follow-up was done in 13 patients for 6 months to 15 years averaging 41 months. During the follow-up, only one patient was reoperated because of the paravalvular leak eight year later. There was no PVE recurrence in all the rest patients. Conclusion Compared with pure medical treatment, combined medical and surgical treatment is a better solution for PVE.
Objective To investigate the molecular mechanism of multiple cellular factors expressed shortly after ischemia reperfusion (IR) injury from the pathway of nuclear factor kappa B (NF κB). Methods The isolated heart models were established and sixty six rats were randomly divided into experimental group and control group. The deoxyribonucleic acid (DNA) binding activities of NF κB, the inhibitory kappa B (IκBα) levels in cytoplasm and tumor necrosis factor α (TNF α) messenger ribonucleic acid (mRNA) expressions were determined after 5, 15 min ischemia in experimental group, both after 0, 5, 15, 30 min ischemia and concomitantly 5, 15, 30, 45, 60 min reperfusion in control group. Results Augment of DNA binding activities of NF κB and reduction of IκBα in cytoplasm shortly after ischemia results were observed in control group. The level of IκBα was restored after reperfusion, the DNA binding activities of NF κB was further augmented. DNA binding activities of NF κB and TNF α mRNA expressions were lower in experimental group than those in control group. Conclusions NF κB in IR myocardium is activated by two different pathways: p65 p50 heterodimers and p50 p50 homodimers. In addition, the results suggest that early activation of NF κB induced by ischemia in the myocardium could be a signal mechanism for controlling and regulating immediate gene expressions during ischemia reperfusion.
ObjectiveTo evaluate the effect and experience of monopolar or bipolar radiofrequency ablation for organic heart disease with atrial fibrillation under the open heart surgery. MethodsWe retrospectively analyzed the clinical data of 305 patients with organic heart disease such as atrial fibrillation underwent the open heart surgery in Changle People's Hospital and Shanghai Renji Hospital between December 2004 year and December 2013 year. There were 188 male and 117 female patients at age of 38 to 81 years. The patients were divided into three groups according to monopolar or bipolar radiofrequency ablation used. There were 128 patients in a monopolar group, 165 patients in a bipolar group, and 12 patients in a combined group with monopolar radiofrequency ablation plus bipolar radiofrequency ablation. ResultTwo patients died after operation. There were 249 patients (81.6%) with sinus rhythm after operation. Sinus rhythm was restored 78.9% in the monopolar group compared with 83.6% in the bipolar group with a statistical difference (P>0.05). We followed up the patients for 3 to 85 (38.2±15.4) months after operation. There were no statistical differences in sinus rhythm rates after following-up 0.5 year (80.5% vs. 83.9%, P>0.05), 1 year (78.4% vs. 83.3%, P>0.05), 2 years (76.5% vs. 81.1%, P>0.05), and 5 years(73.8% vs. 77.1%, P>0.05). ConclusionMonopolar or bipolar radiofrequency ablation for atrial fibrillation with open heart surgery is an effective method, especially in long-term effect. There was no significant difference between the monopolar group and the bipolar group in effect. Bipolar radiofrequency ablation can reduce the ablation time.
Objective To summarize the experiences of surgical treatment for partial atrioventricular canal defect. Methods The data of 66 patients of surgical treatment for partial atrioventricular canal defect from January 1984 to December 2007 were analyzed retrospectively. The cleft of mitral valve presented in all of those patients. There were 52 cases with direct suture on cleft, 8 cases with direct suture with commissurroplasty, 1 case with posterior leaflet plasty, 3 cases with direct suture St.Jude ring and 2 cases mitral valve replacement. The ostium primum atrial septal defects were repaired with patches of Dacron in 12 cases and autologous pericardium in 54 cases. Coronary sinus was situated on the left atrium in 5 and ostium primum atrial septal defects were repaired in Kirklin’s way; the others in MeGoon’way. Meanwhile other heart abnormalities were done. Results There were two early deaths (3.03%), one patient died of heart arrhythmia and one patient died of respiratory failure. Complications of total A-V block was in 2 cases. Both of them were replanted with pace makers.52 cases were followed up, followup time was 5 months to 22 years(mean follow-up 15 years). All patients had better life. Four patients have been re -operated for different reasons post primary operation. One had good result after re-mitral valve replacement. One case died of acute renal failure and the other two died of low cardiac output syndrome. Conclusions Early operation is definitely recommended when the diagnosis is confirmed. Because the structure or function of mitral valve is saved, pulmonary hypertension is avoided and the mortality is lower in the future. The key points of operation are to rectify the mitral insufficiency, repair ostium primum atrial septal defects and avoid atrioventricular block. The patients of mild regurgitation of mitral valve have good results. Provided in those have more than middle regurgitation of mitral valve then their longterm results are poor.