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不切开右心室根治小儿法洛四联症

主动脉瓣狭窄合并右冠状动脉缺如一例

Effects of Inflammatory Reaction Related to Different Cerebral Protective Methods on Brain

Objective To observe the changes of inflammatory cytokines in brain protective methods, study the inflammatory mechanism during cerebral protection tissues in different cerebral Methods Eighteen healthy adult dogs were randomly divided into three groups （6 dogs in each group）： normothermic cardiopulmonary bypass （NCPB group）, deep hypothermic circulatory arrest （DHCA group）, and intermittent selective antegrade cerebral perfusion （ISACP） during DHCA（DHCA＋ISACP group）. After operation the water contents in brain tissue were measured ,the hippocampus were removed, and radio-immunity analysis （RIA） was used to measure the content of interleukin-1β（IL-1β） and tumor necrosis factor-alpha （TNF-α） of the hippocampus tissue. The morphology of the hippocampus were examined by transmission electron （TE） microscopy. Results The contents of IL-1β and TNF-α of DHCA group was higher significantly than those of NCPB group and DHCA＋ISACP group （P〈0.01）, there was no significant difference between NCPB group and DHCA＋ISACP group （P〉0.05）. And the contents of TNF-α and IL-1β were positive linear correlated with degree of edema of brain tissues （r = 0. 987, 0.942; P〈 0.01）. TE examination revealed that the damage of the uhrastructure in the DHCA group was more severe than that in NCPB group and DHCA＋ISACP group. Conclusions This experiment revealed that long duration DHCA can bring some damages to the brain and that ISACP during long-term DHCA has brain protective effects to some extent. IL-1β and TNF-α play an effective role in the brain damage of long-term DHCA.

生物瓣心瓣膜置换术后远期疗效

目的评价生物瓣心瓣膜置换术后远期疗效。方法1979年1月至2001年12月施行生物瓣心瓣膜置换术303例，按年龄分为两组，≥55岁者123例（≥55岁组）；（55岁者180例（〈55岁组）。其中160例早期使用经戊二醛处理的猪主动脉瓣，143例使用经环氧氯丙烷改性的新型猪主动脉瓣。所有心瓣膜置换术均在全身麻醉体外循环下进行。结果术后早期死亡9例，随访267例（90．8％），随访时间3～20年，5年生存率94．1％±2．3％，10年生存率85．0％±2．7％，15年生存率78．3％±1．2％。51例出现瓣膜衰坏，40例再次手术；5年、10年、15年累计瓣膜未衰坏率分别为90．1％±2．2％、79．4％±3．6％和36．8％±1．6％。且≥55岁组患者瓣膜未衰坏率高于（55岁组（P〈0．05）。经环氧氯丙烷改性的新型生物瓣10年瓣膜未衰坏率明显高于早期戊二醛处理的生物瓣。全组血栓发生率低，15年为0．014％。发生感染性心内膜炎7例，3例治愈，4例死亡。结论人工生物瓣心瓣膜置换术后疗效良好，尤其适合老年患者。经环氧氯丙烷改性的新型生物瓣有较强的抗衰坏能力；术后发生感染性心内膜炎应予以足够的重视。

Primary Studies on Autologous Marrow Stromal Cells Transplantation Improves Rabbit Cardiac Performance after Myocardiac Infarction

Objective To test the hypothesis that marrow stromal cells （MSCs）, when implanted into selfmyocardium in rabbits, can undergo milieu-dependent differentiation and express cardiomyogenic phenotypes and enhance cardiac function of ischemic hearts, through establish a clinically relevant model for autologous MSCs transplantation, Methods Thirteen New Zealand White rabbits were randomly divided into experimental group （n= 7） and control group （n= 6）. In experimental group, autotogous MSCs（3× 106 cells/30μl） labeled with Bromodeoxyuridine （BrdU） were respectively injected into superior, central and inferior sites in the periphery of the myocardial infarct region. Phosphate buffer saline （PBS） was injected into the scar of the control group hearts according to the same procedure used in the experimental group. Four weeks later, the transplanted labeled MSCs were detected by laser scanning confocal microscopy and the cardiac function were examined by echocardiogram and muhichannel physiologic recorder. Results After 4 weeks, transplanted MSCs were demonstrated myogenic differentiation with the expression of α-sarcomeric actin and connexin 43 located in intercalated disk. MSCs increased the number of vessels compared with controls in myocardial ischemia area. MSCs implantation resulted in markedly improved left ventricular contractility[left ventricular ejection fraction （LVEF）： 0. 51 ± 0.07 vs. 0. 43 ± 0.06 ,left ventricular lateral wall motion distance （LVLWMD） ：1. 75±0. 42mm vs. 1.09±0. 28mm, left ventricular systolic wall thickening ratio（LVAT） ：0. 19%±0.05% vs. 0. 11%±0.04%, left ventricular systolic pressure （LVSP）： 113. 1± 6.3mmHg vs. 99, 5 ± 5, lmmHg, left ventricular end diastolic pressure （LVEDP）： 11. 5±2. lmmHg vs, 14, 3 ±3. lmmHg, maximum rate of left ventricular pressure rise （＋dp/dtmax）：4 618. 3±365. 2 mmHg/s vs. 3 268. 1± 436.9 mmHg/s, maximum rate of left ventricular pressure fall （-dp/dtmax） ：3 008.8±346.7 mmHg/s vs. 2 536.9± 380.4 mmHg/s, P〈0.05]. Conclusion Transplanted autologous MSCs are able to undergo differentiation to form myocardial cells and improve the cardiac function of ischemia myocardium effectively. Autologous MSCs transplantation may have significant clinical potential in treatment myocardial ischemia.

同种原位心脏移植四例

目的 总结4例终末期心脏病患者施行原位心脏移植术的经验. 方法 2000年1月26日～2000年9月26日,先后对4例终末期心脏病患者施行原位心脏移植术.供者均为脑死亡者,供者心肌保护采用冷晶体心脏停搏液顺行性灌注;手术方法为中度低温体外循环下标准原位心脏移植术;术后采用新三联(FK506、骁悉和强的松)免疫治疗. 结果 1例因肝、肾功能衰竭,术后18天死亡.3例患者存活至今,且生活质量良好. 结论 掌握适应证、术后防治感染和合理的免疫治疗,是提高心脏移植存活率的重要因素.

同种带瓣大动脉的取材、灭菌及保存

目的 报告50个同种带瓣大动脉的取材、灭菌及液氮保存方法。方法 供者为年龄20～39岁的脑死亡患者，均在死亡后2小时取材。修剪后48个同种带瓣大动脉用抗生素灭菌24小时放入含8%二甲基亚砜的RPMI 1640液中液氮保存。结果 抗生素灭菌后48个同种带瓣大动脉细菌和霉菌培养均为阴性。解冻11个有10个用于临床，解冻后的同种带瓣大动脉可基本保持正常功能，其细菌和霉菌培养均为阴性。结论 无菌取材加抗生素灭菌效果可靠，经液氮保存的同种带瓣大动脉解冻后可满足临床应用的要求。

电视胸腔镜辅助的心脏外科

电视胸腔镜于90年代初开始在心脏外科应用,与传统的心脏外科手术相比具有创伤小、疼痛轻、恢复快、费用低以及美容效果好等优点.现将电视胸腔镜在非体外循环下的冠状动脉旁路移植术,体外循环下的房间隔缺损修补术、室间隔缺损修补术、二尖瓣瓣膜修复与置换术、三尖瓣瓣膜修复与置换术以及冠状动脉旁路移植术中的临床应用进行综述.

小儿先天性心瓣膜病的外科治疗

目的 探讨小儿先天性心瓣膜病手术治疗的方法,并总结其经验.方法 45例先天性心瓣膜病患儿实施主动脉瓣修复成形术4例,二尖瓣综合成形术31例,二尖瓣置换术、三尖瓣置换术和主动脉瓣环扩大瓣膜置换术各1例,三尖瓣综合成形术9例次.外科技术包括瓣叶或交界折叠(悬吊)成形,瓣环环缩,置Carpentier环,升主动脉加宽换瓣,瓣叶楔形切除及瓣下结构畸形修复等,同期矫治其它心内畸形.结果 1例术后死于重度低心排血量综合征,其余44例顺利恢复.二维超声心动图示5例有轻度二尖瓣反流,1例有轻度三尖瓣反流,随访5个月～8年,效果稳定.结论 采用综合成形技术,保留自身瓣膜是小儿先天性心瓣膜病外科治疗的首选方法,具有效果确切,术后心功能好,并发症少,无需长期抗凝及不影响生长发育等优点.

Cerebral Protection During Deep Hypothermic Circulatory Arrest by Retrograde Cerebral Perfusion

To valuate cerebral protection by retrograde cerebral perfusion (RCP) via superior vena cava,the study results for the last ten years have been reviewed.RCP is regarded as an assistant method in deep hypothermic circulatory arrest(DHCA) in that it provides partial brain blood flow,maintains a low brain temperature,optimizes cerebral metabolic function during DHCA by supplying oxygen and some nutrient and removal of catabolic products;it also reduces the incidence of cerebral embolization by flushing out air...