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再次冠状动脉旁路移植术一例

The significance of nuclear factor-kappa B activation in the rat heart during ischemia-reperfusion injury

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.

Coronary Artery Bypass Grafting in Senile Patients with Coronary Atherosclerotic Heart Disease

Objective\ To discuss the characteristics and experience of coronary artery bypass grafting in senile patients. Methods\ The operative techniques and postoperative management of coronary artery bypass grafting in 31 cases of patients with coronary atherosclerotic heart disease over 70 years old at our hospital were analyzed retrospectively. Results\ No operative death and no severe postoperative complications happened among this group. Conclusion\ Coronary artery bypass grafting for patients over 70 y...

5例心肌梗死后室间隔穿孔的外科治疗

目的 总结心肌梗死后室间隔穿孔的手术治疗经验。 方法 采用外科手术治疗心肌梗死后室间隔穿孔5例，其中急诊行冠状动脉旁路移植和室间隔穿孔修补术3例，择期行冠状动脉旁路移植和室间隔穿孔修补术2例。 结果 术后死亡1例，该患者发生心肌梗死室间隔穿孔10d后，因心力衰竭而接受冠状动脉旁路移植(移植2支血管)、室间隔穿孔修补和室壁瘤切除术，心脏复跳后心排血量低，安装主动脉内球囊反搏,最终因心律失常死亡。另有1例心脏复跳后开始行主动脉内球囊反搏支持，术后第3 d撤除主动脉内球囊反搏。其余3例患者术后恢复顺利。出院前超声心动图检查提示：未见残余分流。门诊随访4例,随访时间6~15个月，病情较平稳。心功能Ⅰ级1例、Ⅱ级1例、Ⅲ级2例，无残余分流。 结论 结合药物、器械辅助和外科手术治疗心肌梗死后室间隔穿孔可以获得基本满意的早期疗效。

一期手术治疗主动脉缩窄合并升主动脉瘤一例

Diagnosis and Treatment for Prosthetic Valve Endocarditis

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 broadspectrum 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 multipleorgan 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 multipleorgan 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 reoperated 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.

MicroRNA-129 Promotes Cardiomyogenesis in Bone Marrow Mesenchymal Stem Cells

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.

左心瓣膜手术后重度三尖瓣反流的外科治疗

目的 总结左心瓣膜手术后重度三尖瓣反流（TR）的外科治疗经验。 方法 回顾性分析自1999年2月至2009年12月上海交通大学医学院附属仁济医院31例左心瓣膜手术后重度TR患者的临床资料，男3例，女28例；年龄35～60岁（38.4 ± 8.3岁）。 31例左心瓣膜手术后重度TR患者均合并心房颤动，有不同程度的右心功能不全表现，其中心功能分级（NYHA）Ⅱ级3例，Ⅲ级24例，Ⅳ级4例。所有患者接受了三尖瓣手术，其中18例采用CarpentierEdwards半硬环行三尖瓣成形术（TVP），13例采用生物瓣行三尖瓣置换术（TVR）。对上述患者术前、术后的临床资料进行比较。 结果 围术期死亡2例，均死于心力衰竭，以右心功能衰竭为主。29例生存患者术后无严重并发症发生，均好转出院。随访29例，随访时间3个月~9年（5.3±2.5年），随访期间均给予强心、利尿等治疗。术后3个月患者心功能均有明显改善（NYHA分级Ⅰ级3例，Ⅱ级19例，Ⅲ级5例，Ⅳ级2例）；超声心动图提示：TR明显改善，右心房内径（50.2±8.8 mm vs. 63.1±12.4 mm，P=0.005）、右心室内径（28.3±7.1 mm vs. 35.7±8.2 mm，P=0.008）较术前明显缩小。 结论 对左心瓣膜手术后重度TR患者，早期应积极地行外科手术治疗；手术方式应根据患者三尖瓣的具体情况和手术者的经验，以选择置入半硬成形环的TVP为主，必要时采用生物瓣行TVR。但对有严重右心功能衰竭（NYHA分级Ⅳ级）患者需慎重选择手术治疗，应以内科保守治疗为主。

The Short and Medium Term Effect on Myocardial Contractile Force after Implantation of Autologous Endothelial Progenitor Cells

Objective To study the short and medium term effect of myocardial contractile force by implantation of endothelial progenitor cells （EPCs） in the myocardial infarction model. Methods Hundred and twenty SD rats were equally and randomly divided into experimental group and control group （60 rats in each group）. Acute myocardial infarction model was created by ligation of LAD. Autologous EPCs were purified from peripheral blood then implanted into the acute myocardial infarct site via topical injection. IMDM were used in control group. Specimens and muscle strip were harvested at 3, 6 weeks, 6, 8 and 12 months after EPCs implantation for contractile force study and to detect the expression of vascular endothelial growth factor（VEGF）, basic fibroblast growth factor （bFGF） and Ⅷ factor by immunohistology and video image digital analysis system. Results The expression of VEGF, bFGF and the microvessel counts in experimental group were much higher than those of control group（P〈 0.01） at 3, 6 weeks and 6 months after transplantation. The contractile force in experimental group was better than that in control group（P〈0.01） at the same time. But from 8 months after implantation, the contractile force and so on were not up in the experimental group. Conclusion EPCs, after being implanted into infarct myocardium, shows the ability of improvement of the contractile performance in infarcted myocardium by means of angiogenesis and vasculogenesis and the medium term results are persistent.

"J. D" technique: A method for in situ fenestration of left subclavian artery in thoracic endovascular aortic repair

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.