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风湿性心瓣膜病三尖瓣关闭不全的外科治疗

目的 总结风湿性心瓣膜病三尖瓣关闭不全（ TI）手术治疗的临床经验，以提高对该类患者的治疗效果。 方法 1999年1月至2009年1月安徽医科大学第一附属医院对167例风湿性心瓣膜病累及三尖瓣患者行手术治疗，其中男76例，女91例；年龄16.0～75.0岁（40.7±10.4岁）；病程2.0～35.0年（13.2±3.8年）。112例轻度至中度三尖瓣反流采用改良或节段性De Vega成形术，40例中度或中度至重度三尖瓣反流采用Kay或改良Kay成形术；12例因瓣环扩张明显、反流量大，行人工瓣环成形术，三尖瓣置换术3例。术后观察三尖瓣反流情况，随访超声心动图结果。 结果 术后早期死亡6例，其中死于心搏骤停1例，肾功能衰竭2例，脑血管意外1例，心室破裂1例，纵隔感染致败血症1例。1例术中因低心排血量使用主动脉内球囊反搏（IABP）治疗，治愈出院。随访159例，随访时间3～123个月，失访2例。随访期间心功能分级(NYHA)Ⅰ级115例，Ⅱ级32例，Ⅲ级12例。三尖瓣轻度反流15例，中度反流5例，重度反流2例。随访期间三尖瓣隔瓣与前瓣瓣环间直径（2.1±0.3 cm vs. 3.5±0.4 cm, P=0.000）、三尖瓣瞬时反流量(1.8±0.6 ml vs. 7.8±3.5 ml, P=0.001)和右心房容积（54.2±18.4 ml vs. 67.8±22.5 ml, P=0.012）较术前明显减少或缩小； 射血分数（56.1%±7.2% vs. 54.3%±6.5%,P=0.313）较术前有所提高。 结论 心脏瓣膜病中TI需引起重视，应选择适宜的方法积极治疗。

房、室间隔缺损合并左心室憩室伴胸骨下段裂一例

hVEGF165 Gene Clone and Its Expression in COS-7 Cells

Objective To study clone human vascular endothelial growth factor gene165(hVEGF165) to construct the recombined plasmid pcDNA 3.1/hVEGF165 and observe its expression in COS-7. Methods hVEGF gene was amplified by reverse transcription polymerase chain reaction(RT-PCR) method from fetal human myocardium tissue, was then loned into T-vector; identified by polymerase chain reaction(PCR); and was inserted into the expression plasmid pcDNA3.1 to construct the recombined plasmids that encoding VEGF165 comlementary DNA(cDNA). COS-7 cells were transfected mediated by liposome, then expressed protein was detected by Western blotting. Results Exact gene order of hVEGF165 was obtained from the fetal human myocardium tissue by RT-PCR; pcDNA3.1/VEGF165 was constructed, and transient expression was going after transfecting COS-7 cell. Conclusion The recombined plasmids we constructed could successfully express the hVEGF protein after eukaryotic cells COS-7 were transfected.

Application of Castor branched stent combined with parallel stent in Z1 zone TEVAR

Objective To investigate the short and medium term results of Castor single branched stent combined with parallel stent technique in the reconstruction of supra-aortic branches in total endovascular repair of aortic arch lesions. Methods The clinical data of patients with aortic arch disease who were treated with single-branch stents combined with parallel stents for Z1 anchoring and total endovascular repair from April 2022 to August 2022 in the Department of Cardiovascular Surgery of the First Affiliated Hospital of University of Science and Technology of China were retrospectively analyzed, and the perioperative and follow-up conditions of the patients were analyzed. ResultsThere were 4 males and 1 female with an average age of 46.2±18.6 years. This study included 1 patient of thoracic aortic aneurysm and 4 patients of acute non-A non-B aortic dissection. The success rate of surgical technique was 100.0%. The operative time was 132.3±45.1 min, the immediate postoperative isolation of lesions was satisfactory, and there were no adverse events and death in perioperative period. The median follow-up time was 13 (11-15) months. During the follow-up period, all patients survived without stent displacement, type Ⅰa endoleak, parallel stent stenosis and occlusion, and no re-operation. Conclusion The short and medium term results of single branched stents combined with parallel stents in total endovascular repair of aortic arch diseases requiring Z1 anchoring is satisfactory.

Perioperative results of cardiac valve surgery in patients with asymptomatic SARS-CoV-2 infection

ObjectiveTo analyze the perioperative outcomes of cardiac valve surgery in patients with asymptomatic SARS-CoV-2 infection. MethodsThe perioperative clinical data of patients receiving heart valve replacement in the Department of Cardiovascular Surgery, the First Affiliated Hospital of University of Science and Technology of China from November 2022 to February 2023 were retrospectively analyzed. According to whether the patients were infected with SARS-CoV-2, they were divided into a non-infected group and an asymptomatic group. The perioperative data of the patients were compared between the two groups, and the effect of asymptomatic infection on the result of heart valve replacement surgery was analyzed. ResultsA total of 66 patients were enrolled including 36 males and 30 females with a mean age of 58.0±11.1 years. There were 51 patients in the non-infected group and 15 patients in the asymtomatic group. There were 2 patients of mitral valve replacement, 20 patients of aortic valve replacement, 1 patient of double valve replacement, 3 patients of aortic valve replacement with tricuspid valvoplasty, 22 patients of mitral valve replacement and tricuspid valvoplasty, 18 patients of double valve replacement and tricuspid valvoplasty. Asymptomatic infected patients received more emergency surgery than uninfected patients (26.7% vs. 0.0%, P<0.01). There was no statistical difference in the duration of extracorporeal circulation, aortic occlusion, mechanical ventilation time after the surgery, ICU stay, postoperative drainage volume, or postoperative complications between the two groups. ConclusionPerioperative results of cardiac valve surgery in patients with asymptomatic SARS-CoV-2 infection and non-infection are almost the same.