Abstract： Objective To construct an Anticoagulation Therapy Database of Chinese Patients after Heart Valve Replacement in accordance with blood coagulation characteristics of Chinese patients， fill the gap of Chinese clinical research in valvular heart diseases， and provide a scientific and objective basic data and information exchange platform. Methods A national multicentre，prospective and cohort clinical research method was applied to establish an anticoagulation therapy database of Chinese patients after heart valve replacement， using the Internet as a platform. A case report form （CRF）， which was in line with the actual situation of Chinese anticoagulation patients after heart valve surgery， was formulated through the discussion of experts from 36 cardiovascular surgery centers in China in the starting meeting of National Science amp; Technology Support Program during the Twelfth Five-year Plan Period.We planned to prospectively include patients receiving warfarin anticoagulation therapy and formal anticoagulation monitoring after heart valve replacement from January 1, 2011 to December 31, 2014. Database was constructed using warehousing technology， which allowed not only data monitoring， query and statistics， but also regular data backup and system updates. Results A network database entitled Anticoagulant Therapy Database of Chinese Patients after Heart Valve Replacement was constructed and linked with the homepage of Chinese Journal of Clinical Thoracic and Cardiovascular Surgery （http：//www. zgxxwkzz. com）， which constituted a national Internet information platform. From 1 January 2011 to 1 December 2012， 8 452 anticoagulation patients after heart valve replacement from 34 level-3A hospitals in China had been registered in the database. Further follow-up of these patients was being carried out in respective hospitals. Conclusion A large multi-center and open database and network information platform has been constructed. The database variables are in line with clinical characteristics of Chinese anticoagulation patients after heart valve replacement， which provide scientific and objective basic data and support for future clinical research and systemic analysis.
Abstract： Objective To use tissue Doppler strain rate imaging to evaluate the impact of low dose dopamine and milrinone on systolic and diastolic function of the left ventricle of patients undergoing heart valve replacement. Methods Forty patients undergoing selective heart valve replacement in West China Hospital of Sichuan University between March and May 2011 were included in this study. All the patients were randomized into 2 groups with 20 patients in each group： milrione group and dopamine group. After anesthesia induction and before cardiopulmonary bypass setup， left ventricular ejection fraction （LVEF） was measured by echocardiography. Tissue Doppler strain rate imaging was used to measure the left ventricular lateral wall and midventricular segment from the four-chamber view， which was compared with Doppler parameters. Results LVEF， ratio of early-diastolic to end-diastolic velocity （E/A） of transmitral flow， ratio of mitral inflow velocity to early diastolic velocity in the annulus （E/Et） of both 2 groups were significantly different between before and after dopamine and milrinone administration （P＜0. 05）. In the milrinone group， 4 segments systolic peak velocity （Vs）， 1 segment early diastolic peak velocity （Ve）， 4 segments late diastolic peak velocity （Va）， 3 segments Ve/Va ratio， 2 segments systolic peak strain rate （SRs）， 2 segments late diastolic peak strain rate （SRa）， and 3 segments early diastolic peak strain rate SRe/SRa ratio after dopamine and milrinone administration were significantly higher than those before dopamine and milrinone administration （P＜0. 05）. In the dopamine group， 4 segments systolic peak velocity （Vs）， 1 segment Ve， 4 segments Va， 1 segment Ve/Va ratio， 2 segments SRs， 1 segment SRe， 1 segment SRa， and 1 segment SRe/SRa ratio after dopamine and milrinone administration were significantly higher than those before dopamine and milrinone administration （P＜0.05）. To compare the milrione group and dopamine group after medication administration， 2 segments Vs， 4 segments Va， 1 segment SRe， 1 segment SRa， 2 segments Ve/Va ratio， and 2 segments SRe/SRa ratio of the milrione group were significantly higher than those of the dopamine group （P＜0.05）， and 1 segment Vs， two segments SRs of the milrione group were significantly lower than those of the dopamine group （P＜0.05）. Conclusion Both milrinone and dopamine can improve left ventricular systolic function of perioperative patients undergoing heart valve replacement assessed by tissue Doppler strain rate imaging， while milrinone can improve the diastolic function of the left ventricle on the long axis more significantly.
目的 总结单心室瓣膜反流的外科治疗经验，观察治疗效果。 方法 回顾性分析2006年7月至2012年1月上海交通大学医学院附属新华医院61例单心室患者的临床资料，其中男36例，女25例；手术年龄2个月至 20岁；体重2～58 kg。右心室型41例，左心室型13例，未定型型7例。根据瓣膜反流程度不同分为3组，无/微量反流组：28例，瓣膜未行处理；轻/中度反流组：21例，瓣膜未行处理；重度反流组：12例，手术同期行瓣膜成形。收集所有患者住院及随访资料，分析轻/中度反流组、重度反流组瓣膜反流变化趋势，以及影响瓣膜反流的因素。结果 住院死亡5例，住院死亡率8.2% （5/61）。重度反流组患者行瓣膜成形术后反流程度较术前明显减轻（由术前4.00级下降至术后2.08级）。随访56例，随访时间6～38个月，重度反流组随访10例，随访期间死亡2例，其余8例中重度反流2例，中度反流3例，轻度反流2例，微量反流1例；瓣膜反流程度增加趋势明显（由术后平均2.08级增加至平均2.75级）。轻/中度反流组随访19例，随访中无死亡，其中反流程度增加至重度3例（原1例轻度反流，2例中度反流），反流程度由轻度增加至中度3例，瓣膜反流程度由术后平均2.33级增加为平均2.58级。轻/中度反流组瓣膜反流增加率与无/轻微反流组比较差异无统计学意义（瓣膜反流增加率为31.5% vs. 19.2%，χ2=0.36，P=0.55）。单因素分析结果显示，瓣膜反流增加者在随访过程中心功能较瓣膜反流无变化或减轻者明显降低（术后左心室射血分数53.11%±5.61% vs. 59.65%±3.32%，t =-5.49，P=0.00），而左心室舒张期末容积较瓣膜反流无变化或减轻者明显增加（t =2.58，P=0.01）。 结论 单心室合并重度瓣膜反流行瓣膜成形术近期效果较好，但随着心功能下降、心室扩张，瓣膜反流程度加重趋势明显；轻/中度瓣膜反流可暂不进行处理，但部分患者瓣膜反流有增加趋势，提示应注重术后随访。
The application of stem cell therapy for ischemic heart disease has aroused widespread interest. There have been many experimental studies concerning a variety of tissue stem cells such as bone marrow，blood，skin and skeletalmuscle stem cells，and their origins, differentiation and protein expressions are compared. In recent years，it is found that adipose-derived stromal cells （ADSCs） have potential advantages over other types of stem cells in that they are widely available and easily harvested through a simple liposuction procedure，and have a high regenerative capacity and therapeuticpotential for myocardial infarction. This review describes molecular and biological properties of ADSCs，their differentiationpotential，and regenerative and therapeutic potential for myocardial repair.
Abstract: The cyanotic congenital heart defect remains a focal point to study in congenital heart diseases. A successfully developed model of cyanotic congenital heart defect can contribute to a profound advancement of clinical diagnosis and treatment. Various kinds of animal models simulating cyanotic heart diseases have been created and improved step by step , such as experimental pulmonary arteriovenous fistulas, inferior vena cava-left atrium shunt, pulmonary artery-left atrium shunt and breeding animals in mionect ic environment. As an important means, they are used to investigate the animal’s pathophysilolgocal characteristics in cyanotic and hypoxic state. However, it need a further exploration since these models are not fully perfect yet.
Abstract: Objective To observe the combined protective effects of U50 488H and hypothermia preservation on isolated rabbit hearts preconditioned. Methods Forty rabbits were randomly divided into five groups, 8 rabbits in each group. The perfusion model of isolated rabbit hearts was established by the Langendorff device. In the control group: the isolated rabbit hearts were preserved with the University of Wissconsin solution (UW ) for six hours; groupI : the isolated rabbit hearts were preconditioned with St. ThomasII cardioplegic solution containing U50 488H (1. 6mmo l/L ) and then preserved with hypothermic preservation for four hours; groupII ; the precondition was the same as group II , hypothermic preservat ion fo r six hours; group III : the precondit ion was the same as group I , hypothermic preservation for eight hours; group IV : the precondit on was the same as group I , hypothermic preservation for ten hours. The cardiac function, myocardial sarcoplasmic reticulum calcium ion adenosine triphosphatase (SRCa2+ -ATPase) act ivity and calcium ion concentrations in mitochondria were determined at thirty minutes after reperfusion. Results As the hypothermic preservation time increased from four to ten hours, the recovery rate of each index of cardiac function, coronary artery flow (Cf) and SRCa2+ -ATPase activity also decreased, but the calcium ion concentrations in the mitochondria increased. Cardiac function index recovery rates in group I and group II w ere higher than those in group III and groupIV respectively (P lt; 0. 05, 0. 01) ,meanwhile recovery rates of cardiac function index in group III were higher than that in group IV (P lt; 0. 05). Recovery rate of Cf in groupII ( 84. 56%±10. 38%)were higher than those in group III (79. 45%±9. 67% ) and group IV (68. 31%±6. 84% , P lt;0.01) , meanwhile the recovery rate of Cf in group III was higher than that in group IV (P lt; 0. 05). SRCa2+ -A Tpase activity in group II (4. 43±0. 41μmo l/m g?h)were higher than those in control group (3. 04±0. 22Lmo l/mg?h ) , group III (3. 26±0. 29Lmo l/m g?h) and group IV (2. 57±0. 63Lmo l/m g?h, P lt; 0. 05) , SRCa2+ -ATPase activity in group III was higher than that in group IV (P lt; 0. 01). The calcium ion concentrations in mitochondria in group II (38176±4. 30μmo l/g ?dw ) and in the control group (40. 23±3. 75μmol/g ?dw )were less than those in group III (43125±5116μmol/g?dw ) and groupIV (45. 78±3. 26μmol/g?dw , P lt; 0. 05, 0. 01) respect ively. Conclusion The hypothermic preservation time for isolated dono r’s hearts p re-treated with St. Thomas II cardioplegic solution containing U 50 488H should the kep tunder 8h. The myocardial protection effects of both UW solution and U50 488H- containing St. Thomas II cardioplegic solution on isolated dono r’s hearts appear to be the same at 6 hours.