Abstract: Objective To evaluate if cardiac function and myocardial perfusion in acute ischemia myocardial transplanted by autologous bone mesenchymal stem cells (MSC) can be improved. Methods Sixteen New Zealand rabbits were studied.The left anterior descending coronary artery under the first diagonally branch was ligated to result in acute myocardial ischemia models,the sixteen models were divided into two groups with randomed number table. Control group(n=8): 0.6ml αminimum essential medium was injected into myocardium; transplanted group (n=8): 0.6ml medium of autologous MSC marked with 5-bromium,2-deoxy-uridine (BrdU) was injected into myocardium. Echocardiography were erformed to measure left ventricular ejection fraction(LVEF),as well as the displacement and strain of apex segment of left ventricle pre-ichemia,beforeand 4 weeks after treatment; the target myocardial tissues were harvested 4 weeks after treatment,double immunohistochemistry staining of anti-BrdU and anti-troponin T(TnT) were used to evaluate the survival and differentiation of implanted MSC; immunohistochemistry staining of anti-CD146 endothelium factor were used to evaluate the density of capillary vessels in treated myocardium. Results Double immunohistochemistry staining showed that positive cells were found in transplanted group and not found in control group. Anti-CD146 immunohistochemistry staining showed density of capillary vessels of transplanted group was significantly more than that of control group(Plt;0.05) ; LVEF,displacement and strain of cardiac apex of transplanted group improved significantly more than those of control group(Plt;0.05). Conclusion Transplanted to acute myocardium ischemia models of rabbits, MSC can differentiate into myocardium-like cells in myocardial microenvironment,and improve global and part cardiac systolic function and then improving perfusion of ischemia myocardium.
Objective To investigate surgical strategies using bilateral pectoralis major muscle flaps for the treatment of sternal dehiscence after cardiac surgery. Methods From May 2005 to October 2010，21 patients with sternal dehiscence, sternal osteomyelitis and mediastinitis after cardiac surgery were admitted to Beijing An Zhen Hospital of Capital Medical University. There were 13 male patients and 8 female patients with their age of 53-72 （64.5±7.8） years. There were 19 patients after coronary artery bypass grafting （CABG） and 2 patients after heart valve replacement. The non-viable and necrotic bones were debrided and sternal wires partially or completely removed. The sternal origins of pectoralis major were released on both sides. The pectoralis major muscle flaps were tensionlessly sutured across medially over the sternal defect. Multiple suction drains were placed and removed in due time. The skin was intermittently closed. Results All the pectoralis major muscle flaps lived well after surgery，and all the patients were discharged in 2 weeks after surgery. Twenty patients were discharged with complete wound closure，and 1 patient had wound fistula and infection after removal of suction drains that was healed after another surgery to resect the wound fistula. During 6 month follow-up，sternal wound healed well in all the patients with normal thoracic appearance，and none of the patients had abnormal respiratory movement, infection recurrence or persistent infection. Conclusion Bilateral pectoralis major muscle flap technique is a positive and efficient surgical strategy for the treatment of refractory sternal dehiscence after cardiac surgery.
Objective To summarize surgical techniques，advantages and clinical outcomes of mitral valvuloplasty for anterior mitral leaflet prolapse with looped artificial chordae. Methods Clinical data of 13 patients with anteriormitral leaflet prolapse and severe mitral regurgitation （MR） who underwent mitral valvuloplasty with looped artificial chordaefrom January 2009 to December 2011 in Beijing Anzhen Hospital were retrospectively analyzed. There were 8 male and 5 female patients with their age of 21-61 （39.5±12.9） years. There were 10 patients with anterior mitral leaflet chordal rupture and 3 patients with anterior mitral leaflet elongation. Preoperative left ventricular end-diastolic diameter （LVEDD） was 52-65 （58.3±1.7） mm，and left ventricular ejection fraction （LVEF） was 53%-65% （58.8%±2.8%）. All the patients underwent mitral valvuloplasty. We measured the neighboring normal chordae with a caliper for reference and constructed the artificial chordal loops on the caliper with expended polytetrafluoroethylene（ePTFE） CV4 Gore-Tex suture lines. Three to five loops were made and fixed to the papillary muscle with a Gore-Tex suture line and the free edge of the prolapsedanterior mitral leaflet with another Gore-Tex suture line，with the intervals between the loops of 5 mm. Left ventricular watertesting was performed to evaluate MR status，annuloplasty ring implantation or “edge to edge” technique was used if nece-ssary，and left ventricular water testing was performed again to confirm satisfactory closure of the mitral valve. Patientsreceived re-warming on cardiopulmonary bypass and the heart incision was closed. The effect of mitral annuloplasty was alsoassessed by transesophageal echocardiography （TEE） after heart rebeating. Warfarin anticoagulation was routinely used for 3 months after discharge. Results There was no perioperative death in this group. Twelve patients received satisfactory outcomes after 1-stage mitral valvuloplasty with looped artificial chordae and annuloplasty ring implantation. One patient didn’t receive satisfactory outcomes in the left ventricular water testing after mitral valvuloplasty with looped artificial chordae，but satisfactory outcome was achieve after “edge to edge” technique was used，and annuloplasty ring was not used for this patient. Postoperative echocardiography showed trivial to mild MR in all the patients，their LVEDD was significantly reducedthan preoperative LVEDD （47.5±2.1 mm vs. 58.3±1.7 mm，P＜0.05），and there was no statistical difference between postoperative and preoperative LVEF（58.5%±2.6% vs. 58.8%±2.8%，P＞0.05）. All the patients were followed up for 3-36 （19.5±3.7） months. Echocardiography showed mild MR in 4 patients and none or trivial MR in 9 patients during follow-up.Conclusion Mitral valvuloplasty with looped artificial chordae is an effective surgical technique for the treatment of anterior mitral leaflet prolapse with satisfactory clinical outcomes，and this technique is also easy to perform.
ObjectiveTo summarize our clinical experience of artificial chordal replacement with loop technique for the treatment of mitral insufficiency (MI) due to mitral valve prolapse. MethodsFrom January 2008 to August 2011, pre-measured expanded polytetrafluoroethylene (ePTFE) loops were used for the treatment of MI in 22 patients in the Department of Cardiac Surgery,Beijing Anzhen Hospital. There were 15 males and 7 females with their age of 26-69(53.1±8.5) years. Six patients were in NYHA class Ⅱ and 16 patients were in NYHA class Ⅲ. There were 14 patients with anterior mitral leaflet chordal rupture,2 patients with anterior mitral leaflet chordal elongation,4 patients with both anterior and posterior mitral leaflet chordal rupture,and 2 patients with posterior mitral leaflet chordal rupture. All the patients had severe MI. One patient had concomitant cor triatriatum,and another patient had coronary heart disease. Left ventricular end-diastolic diameter (LVEDD) was 49-67 (58.1±3.9) mm,ejection fraction (EF) was 58%-69% (61.8±2.1%) and cardiothoracic ratio was 0.53±0.16. We measured the length of normal chordae adjacent to the ruptured or elongated chordae with a caliper for reference,and constructed the artificial chordal loops on the caliper with ePTFE suture according to the scope of mitral valve prolapse,then fixed the loops to the corresponding papillary muscles and free edge of the prolapsed mitral leaflets. Ring annuloplasty was routinely performed for all the patients. One patient received concomitant repair for cor triatriatum, and another patients underwent concomitant coronary artery bypass grafting. All the patients received oral anticoagulation with warfarin for 3 months after discharge. ResultsThere was no in-hospital death. Postoperatively,1 patient had hemoglobinuria and another patient had wound infection,both of whom were cured after treatment. Pre-discharge echocardiography showed mild or no MI in 1 patients and trivial MI in 21 patients. Postoperative LVEDD was 43-53 (48.1±2.1) mm and significantly smaller than preoperative LVEDD. All the patients were follow up for 4-39 (18.3±5.2) months after discharge. During follow-up,there were 5 patients with mild MI and 17 patients with none or trivial MI. Seventeen patients were in NYHA class Ⅰ,5 patients were in NYHA class Ⅱ,and their heart function was significantly improved than preoperative heart function. ConclusionArtificial chordal replacement with loop technique is easy to perform with satisfactory short-to mid-term results for the treatment of MI due to mitral valve prolapse.
ObjectiveTo summarize surgical experience and explore the best treatment strategy for the management of complicated mediastinitis after cardiac surgery. MethodsClinical data of 18 patients who received vascularized muscle flap transposition combined with negative pressure wound therapy (NPWT)for the treatment of complicated mediastinitis after cardiac surgery in one stage in the Department of Cardiac Surgery of Beijing Anzhen Hospital, Capital Medical University between June 2006 and December 2012 were retrospective analyzed. There were 12 male and 6 female patients with their average age of 65.5±8.2 years. The average interval between cardiac surgery and vascularized muscle flap reconstruction was 12.5±5.8 days. ResultsPostoperatively, 1 patient died of recurrent mediastinitis, sepsis and multiple organ dysfunction syndrome. Seventeen patients had an uneventful postoperative recovery and one-stage wound healing. Postoperative hospital stay was 18.6±7.2 days and wound healing time was 4.5±2.4 weeks. All the 17 patients were followed up for over 6 months, no recurrent mediastinitis was observed, and they had a good quality of life. ConclusionVascularized muscle flap transposition combined with NPWT is a simple and effective surgical strategy for the treatment of complicated mediastinitis after cardiac surgery in one-stage.