ObjectiveTo assess the suitability of P (3HB-co-4HB) combined with embryonic stem cells (ESCs) for myocardial patch formation and whether adding vitamin C would improve inductivity or not. Method We extracted mouse embryonic fibrous cell from three clean female white Kunming mouses at a mean body weight of 37.5 grams. We recovered and cultured mouse ESCs. Those mouse embryonic stem cells were obtained from Shanghai Institutes of Biological Sciences. We took pendant-drop method to form embryonic bodies (EBs) and co-cultured them with myocardial patch. The experimental group were cultured in the substate with vitamin C while the control group were cultured in the substate without vitamin C. We immunostained the myocardial patch and observed them by scanning electron microscope. We calculated the differentiation efficiency and mapped the distribution curve of induction time. ResultsThe scattergram showed that the differentiation efficiency increased gradually. The differentiation efficiency of the group with vitamin C was 71.1% and the group without vitamin C was 17.8%. There was a statistical difference between the two groups (P < 0.05). ConclusionOn the biological patch of P (3HB-co-4HB), ESCs could grow, proliferate, and differentiate into myocardial cell and adding vitamin C into it could improve the differentiation efficiency.
ObjectiveTo investigate the feasibility of small molecule compound XAV939 to induce mouse embryonic stem cells (mESC) to differentiate into cardiac myocytes. MethodsWe revived and cultured undifferentiated mESC growing confluently on trophoderm made of mouse embryonic inoblast cell. The mESCs were digested by trypsin to form embryoid bodies (EBs) by handing drop method. After plated, EBs were induced by XAV939 to differentiate into cardiac myocytes. We observed the cardiac myocytes with lightmicroscopy and identified it with immunofluorescence method. Result The XAV939 can effectively induce mESC into cardiac myocytes with the mean efficiency rate of 71.85%±1.05%. The differentiated cardiac myocytes shrinked spanteously and rhythmicly. The cardiac troponin T as the special marker of cardiac myocyte was positive. ConclusionThe small molecule compound XAV939 could effectively induce mES cells into cardiac myocytes.
ObjectiveTo study the external biocompatibility bewteen the mouse induced pluripotent stem cells (miPSCs) and poly-3-hydroxybutyrate-co-3-hydroxyhexanoate (PHBHHx). MethodsAfter we recovered and subcultured miPSCs, we divided them into two groups. There was one group cultured with material of PHBHHx films outside the body. We observed the adhesive pattern of miPSCs on film by fluorescence of 4, 6-diamidino-2-phenylindole (DAPI) staining. The cell vitality was detected by cell counting kit-8 (CCK-8). The morphology of miPSCs attached on the film was visualized under scanning electron microscope (SEM). We used the traditional petri dish to culture miPSCs and detect the cell activity by CCK-8. ResultsMiPSCs can adhere and proliferate on PHBHHx films. The result of cell vitality which detected by CCK-8 showed that there was a statistical difference in OD value between culturing on PHBHHx films and traditional cultivation (0.617±0.019 vs. 0.312±0.004, P < 0.05). ConclusionThere are adhesion and proliferation on the surface of cells patch made by miPSCs co-culturing with PHBHHx film. Compared with traditional culturing in the cell culture dish, culturing in PHBHHx films have great advantages in the process of adhesion and proliferation. PHBHHx can be used as one of the scaffold for stem cells treating various disease.
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 clinical outcomes of mitral valve replacement (MVR) with modified anterior leaflet preservation technique,improve therapeutic effects and reduce postoperative mortality and morbidity. MethodsFrom May 2005 to December 2012,128 patients underwent MVR with modified anterior leaflet preservation technique (modified group) in Beijing Anzhen Hospital,among whom 14 patients received concomitant aortic valve replacement. There were 49 male and 79 female patients in the modified group with their age of 45.0±12.3 years. Another 128 patients who underwent routine MVR during the same period were also included in this study as the control group,including 55 male and 73 female patients with their age of 48.0±8.4 years. There was no statistical difference in preoperative clinical characteristics between the 2 groups (P>0.05). ResultsIn the modified group,there was no perioperative death. Postoperatively,6 patients received reexploration for bleeding,4 patients had low cardiac output syndrome,5 patients had pulmonary infection,1 patient received tracheostomy,and 3 patients had acute kidney failure (AKI). In the control group,5 patients died postoperatively including 3 patients with left ventricular rupture and 2 patients with severe low cardiac output syndrome. Postoperatively,5 patients received reexploration for bleeding,12 patients had low cardiac output syndrome,4 patients had pulmonary infection,and 6 patients had AKI. Echocardiography at 6th month during follow-up showed that left ventricular ejection fraction (LVEF) left ventricular end-diastolic dimension (LVEDD) and left ventricular end-systolic dimension (LVESD) of modified group patients were improved compared with control group patients. There was statistical difference in LVEF and LVESD between the 2 groups (P<0.05). There was no statistical difference in LVEDD between the 2 groups (P>0.05). LVEF,LVEDD and LVESD of modified group patients during follow-up were statistically different from preoperative values (P<0.05). LVEDD of control group patients during follow-up was statistically different from preoperative LVEDD (P<0.05). LVEF and LVESD of control group patients during follow-up was not statistically different from preoperative values (P>0.05). ConclusionMVR with modified anterior leaflet preservation technique is simple to perform with satisfactory short-term results. This technique is suitable for various types of mitral valve diseases especially degenerative mitral valve disease and infective endocarditis.
ObjectiveTo summarize our clinical experience and improve clinical outcomes of chordal transfer and artificial chordae in mitral valvuloplasty (MVP). MethodsClinical data of 74 patients who received chordal transfer or artificial chordae in MVP for the treatment of anterior mitral leaflet prolapse[degenerative mitral regurgitation (MR)] from January 2008 to February 2013 were retrospectively analyzed. There were 34 male and 40 female patients with their age of 22-64 (48.00±6.40)years. According to different surgical techniques, all the 74 patients were divided into 2 groups. In the chordal transfer group, there were 42 patients who received chordal transfer with posterior leaflet chordae transferred to anterior leaflet. In the artificial chordae group, there were 32 patients who received artificial chordae with loop technique. Postoperative mortality, morbidity and MR were analyzed. Left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD)and end-systolic diameter (LVESD)were examined by echocardiography during follow-up. ResultsThere was no perioperative death in either group. Two patients underwent reexploration for postoperative bleeding. Nine patients had paroxysmal atrial fibrillation postoperatively, and were cured by intravenous administration of amiodarone. Echocardiography before discharge showed mild MR in 5 patients, trivial MR in 12 patients, and none MR in 25 patients in the chordal transfer group, and mild MR in 6 patients, trivial MR in 15 patients and none MR in 11 patients in the artificial chordae group. Seventy patients[94.59%(70/74)] were followed up after discharge. In both groups, LVEF at 6 months after MVP was significantly higher than that before discharge (chordal transfer group:64.00%±4.20% vs. 55.00%±5.10%; artificial chordae group:63.00%±3.50% vs. 56.00%±4.20%). LVEDD (chordal transfer group:47.00±2.20 mm vs. 58.00±6.90 mm; artificial chordae group:45.00±3.80 mm vs. 57.00±5.10 mm, P < 0.05)and LVESD at 6 months after MVP were significantly smaller than preoperative values. There was no statistical difference in LVEF, LVEDD or LVESD preop-eratively, before discharge and 6 months after MVP respectively between the chordal transfer group and artificial chordae group (P > 0.05). One patient in the chordal transfer group underwent mitral valve replacement for severe MR 14 months after MVP. One patient in the artificial choadae group underwent mitral valve replacement for persistent hemoglobinuria 6 months after MVP. ConclusionChordal transfer and artificial chordae technique are both suitable for the treatment of complex anterior leaflet prolapse. Artificial chordae has wider range of application, and chordae transfer needs advanced and flexible surgical skills. Both techniques have good short-term clinical outcomes and deserve clinical application.
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.
ObjectiveTo analyze the clinical outcomes of cardiac surgery in patients after kidney transplantation underwent immunosuppression therapy. Methods Clinical data of 6 patients (including 4 males and 2 females aged from 27 to 66 years) undergoing cardiac surgery after kidney transplantation with immunosuppression between January 2011 and October 2013 in Beijing Anzhen Hospital were retrospectively analyzed. Two patients underwent off pump coronary artery bypass grafting, 3 patients underwent aortic valve replacement and 1 patient underwent mitral valve replacement. The interval between kidney transplantation and cardiac operation was 8.5±1.7 years (range, 6-10 years). ResultsAll the operations were performed successfully without in-hospital death and complications. Operation time was 237.0±93.0 min. Cardiopulmonary bypass (CPB) time was 101.3±16.7 min. Aortic cross-clamping time was 75.6±9.7 min. in-hospital stay was 17±6 d. There was a statistical difference in preoperative and postoperative left ventricle ejection fraction (63.5%±4.5% vs. 56.5%±5.8%, P < 0.05), as well as preoperative and postoperative left ventricular enddiastolic diameter (54.5±8.5 mm vs. 43.7±6.8 mm, P < 0.05), but there was no statistical difference in preoperative and postoperative serum creatinine levels (103.7±15.1μmol/L vs. 106.6±34.7μmol/L, P > 0.05). The mean follow-up time of the 6 patients was 4-15 months. The follow-up rate was 100%. All the patients were in cardiac function NYHA classⅠ-Ⅱ. And the quality of life was improved. ConclusionCardiac operations for kidney transplant recipients undergoing immunosuppressive treatment are effective and safe as long as appropriate perioperative treatment are taken.
ObjectiveTo evaluate early and midterm outcomes of aortic root enlargement (ARE) combined with supra-annular valve implantation for adult patients with aortic stenosis (AS) and small aortic roots (SARs). MethodsFrom January 2007 to July 2011, ARE combined with supra-annular valve implantation was performed for 38 adult patients with AS and SARs in Department of Cardiac Surgery of Beijing Anzhen Hospital. There were 12 males and 26 females with their age of 16-58 (38.6±21.0) years, body weight of 48-78 (58.5±12.0) kg, body height of 153-176 (162.8±12.0) cm and a mean body surface area (BSA) of 1.67±0.32 m2. There were 19 patients with rheumatic AS, 11 patients with congenital bicuspid aortic valve and AS, 5 patients with degenerative AS and 3 patients with AS and infective endocarditis. Preopera-tively, 8 patients were in NYHA class Ⅱ, 29 patients were in NYHA class Ⅲ, and 1 patient was in NYHA class Ⅳ. Aortic annular diameter (AAD) was 15-20 (17.6±2.8) mm and trans-aortic pressure gradient was 53-75 (62.8±10.5) mm Hg. ResultsCardiopulmonary bypass time was 83-145 (112±29) minutes, and aortic cross-clamping time was 58-116 (87±28) minutes. Intraoperative measurement of AAD was 15-20 (17.3±2.6) mm, AAD after ARE was 20-25 (22.6±2.3) mm. AAD after ARE was 12-17 (14.0±2.6) mm larger than AAD before ARE. Actual size of prosthetic valves was 2-3 sizes larger than predicted size without ARE in all the patients. There was no perioperative death or severe complication including bleeding. Length of ICU stay was 12-41 (26±14) hours, and length of hospital stay was 9-15 (12.5±3.2) days. A total of 37 patients (97.4%) were followed up for over 2 years after discharge. All the patients were in NYHA class Ⅰ. Grade 2/6 systolic murmur was heard in 3 patients. Electrocardiogram (ECG) showed significant improvement or complete disappearance of left ventricular hypertrophy in 35 patients, and mild left ventricular hypertrophy in 2 patients. ECG during follow-up didn't show any sign of myocardial ischemia, ventricular arrhythmia or severe atrioventricular block in any patient. ConclusionEarly and midterm outcomes of ARE combined with supra-annular valve implantation for adult patients with AS and SARs are satisfactory, but long-term outcomes of this procedure need further follow-up.
ObjectiveTo evaluate surgical outcomes of combined off-pump coronary artery bypass grafting (OPCAB)and bipolar radiofrequency ablation (RFA)for atrial fibrillation (AF). MethodsFrom January 2008 to October 2013, 49 patients with coronary artery disease and AF underwent OPCAB and concomitant Atricure bipolar RFA for AF in Beijing Anzhen Hospital. According to their AF duration, all the 49 patients were divided into 2 groups. In group A, there were 14 patients with permanent AF including 9 males and 5 females with their age of 56.7±7.5 years. In group B, there were 35 patients with paroxysmal AF including 27 males and 8 females with their age of 60.2±10.5 years. AF duration was 9.4±6.0 months. Coronary artery stenosis was 85%-100%. Ambulatory electrocardiogram and echocardiography were performed to observe AF recurrence during follow-up. ResultsNone of the patients received intraoperative conversion operation under cardiopulmonary bypass, and there was no in-hospital death. Postoperatively, 81.6% (40/49)patients had conversion to sinus rhythm (SR)or junctional rhythm, 18.4% (9/49)patients remained AF, but none of the patients had second or third-degree atrioventricular block. A total of 139 distal anastomoses were performed with a mean of 2.8 distal anastomoses per patient. Length of hospital stay was 10-15 (12±3)days. SR was observed in 34 patients (69%)before discharge including 9 patients (64%)in group A and 25 patients (71%)in group B. All the patients (100%)were followed up for 5-12 months. 39 patients (80%)maintained SR over 6 months, including 10 patients (71%)in group A and 29 patients (83%)in group B. 44 patients (90%)maintained SR over 12 months, including 11 patients (79%)in group A and 33 patients (94%)in group B. There was no statistical difference in SR maintenance rate between the 2 groups (P > 0.05). ConclusionOPCAB and concomitant bipolar RFA for AF is safe, efficacious and feasible.