Objective To study the effects of intracoronary transfer of adenovirus vector-mediated transforming growth factor ?_1 gene on acute rejection of cardiac allograft in rats. Methods In a cervical heterotopic cardiac transplantation model, donor hearts coronary arteries were perfused ex vivo after harvest with Stanford University solution containing 5?10~ 10 plaque-forming units/gram of donor heart of donor heart of Ad. TGF-?_1, then implanted in the necks of recipients. As controls, other hearts were perfused with Stanford University solution containing 5?10~ 10 plaque-forming units/gram of donor heart adenoviral bland-vector or with virus-free Stanford University solution by the same method. Results The exogenous TGF-?_1 gene transcripts and expression in the Ad.TGF-?_1 infected grafts were confirmed. The expression of CD_ 68 and the apoptosis index in the cardiac allografts of Ad. TGF-?_1 group were less than that of other two groups (P

Objective To study the effect of intracoronary adenovirus vector-mediated transforming growth factor ?_1 (Ad.TGF-?_1) gene transfer on discordant cardiac xenograft in the setting of acute vascular rejection. Methods In a cervical heterotopic cardiac transplantation model by cuff technique, after harvest, guinea pig donor hearts’coronary arteries were perfused ex vivo with Stanford University solution containing 5?1010 plaque-forming units/g of donor heart of Ad.TGF-?_1, then implanted in the necks of complement depleted and immunosuppressed rat recipients. As controls, other hearts were perfused with Stanford University solution containing 5?1010 plaque-forming units/g of donor heart adenoviral blank-vector or with virus-free Stanford University solution by the same method.Results The exogenous TGF-?_1 gene transcripts and expression in the Ad.TGF-?_1 infected grafts were confirmed. The number of inflammatory cells and macrophages and nature killer cell infiltration in the cardiac xenografts of Ad.TGF-?_1 infected grafts was less than that of other groups (P

Objective To summarize the early effect of orthotopic heart transplantation for 5 patients with end-staged coronary heart disease.Methods Orthotopic heart transplantations were performed on 1 patient with left ventricular mechanic circulatory support for 25 months after twice acute myocardial infarction, 3 patients with failing heart after acute myocardial infarction, 1 patient with failing heart after PTCA and CABG.Results Five patients recovered well. No any severe acute rejection and infection have been found. All survivors had good life quality and good heart function (NYHA I).Conclusion Orthotopic heart transplantation is an effective treatment for patients with end-staged coronary heart disease. Proper donor heart, excellent donor myocardial conservation, suitable immurosuppression treatment and appropriate control of hypertension, hyperglycemia, hypercholesterolemia and uricacidemia are key measures of successful orthotopic heart transplantation for patients with end-staged coronary heart disease.

Objective To analyse peritoneal dialysis(PD) in 30 infants and children with acute renal insufficiency after complex congenital heart disease surgery,sum up the clinical experience of PD therapy infants and children with acute renal insufficiency after complex congenital heart disease surgery.Methods The clinical records of 30 infants and children during January 2010 to June 2012 were analysed retrospectively,with 23 male and 7 female,aged from 7 days to 18 months[average (8.28 ± 5.17) months],weight 2.5-14 kg[average (5.15 ± 3.89) kg].The reasons for PD:7 cases because of oliguria (urine ＜ 1 ml · h-1 · kg-1,duration ＞ 4 h) and the other 23 cases because of anuria.Results One case with total anomalous pulmonary venous connection(TAPVC) died of left heart failure,1 case with transposition of the great arteries died of multiple organ failure,and the other 28 cases were all cured,cure rate 93.33％.Conclusion PD is easy,safe and low-cost,has definite curative effect in infants and children with acute renal insufficiency after complex congenital heart disease surgery,worth to popularize.

Objective To summarize the experience of microinvasive surgical occlusion for ostium secundum atrial septal defects (ASD). Methods A total of 43 patients with ostium secundum ASD was given microinvasive surgical occlusion. The diameter of ASD was 9.8~36.3 mm. An incision 2~3 cm in length was made on the right anterior chest. A special occluder was inserted to close the ostium under the guidance of transesophageal echocardiography. Results All of the patients were successfully occluded. Transient third degree AV block happened in 2 patients during the procedure. Moderate amount of pleural effusion occurred in 3 patients (cured). Echocardiography at 3 months after operation showed significant relief of pulmonary artery hypertension (from 52?21 mm Hg to 38?16 mm Hg; t=2.917, P=0.005). The patients were followed for 3~21 months (13.6?8.3 months), no dislocation of the device or atrial shunt was found. Conclusions Microinvasive surgical occlusion is safe and efficient for the closure of ostium secundum ASD. It is suitable for all patients in various age ranges.

Objective To study the possible cause and the feasibility of diagnosis and treatment of coronary disease after heart transplantation.Methods An 8-year survivor of heart transplantation received close follow-up. The clinical symptoms were recorded. Blood laboratory tests, electrocardiogram, endomyocardial biopsy, left ventricular Tc scintigraphy, endothelium-dependent vasodilatation of the brachial artery and coronary angiography were performed.Results The patient had good life quality without any symptoms such as chest discomfort, palpitation, dyspnea. Serum lipid and lipoprotein levels remained normal range. No any myocardial ischemic signs were detected in electrocardiogram. Endothelium-dependent vasodilatation was normal. No any acute rejective manifestation was observed in endomyocardial biopsy samples. Left ventricular Tc scintigraphy showed that left ventricular wall perfusion was progressively decreased. Coronary angiography showed that a typical vasculopathy with diffuse stenosis involved all coronary braches to some extent and right coronary had a proximal local severe stenosis with distal mild diffuse stenosis. Coronary angioplasty and stent placement of proximal right coronary was performed. The perfusion of the left ventricular wall was improved by this angioplasty.Conclusion Chronic rejection is probably the main cause of coronary disease after heart transplantation. Serial left ventricular scintigraphy can detect the change of myocardial perfusion. Local severe stenosis of coronary after heart transplantation can be treated by coronary stenting.

Objective To investigate living quality of patients after orthotopic cardiac transplantation and to provide scientific evidence for specific strategy of therapy and improvement of living quality of patients with cardiac transplantation. Methods SF-36 and the social support questionnaire were used to analyze living quality of 79 patients who received orthotopic cardiac transplantation in the Department of Cardiovascular surgery of Affiliated Union Hospital of Fujian Medical University. The mode of SF-36 was from the investigative numerical value of residents in Sichuan province. Description, t-test and Spearman correlation analysis were used to study the related factors. Results Compared with a reference general population, the heart transplant recipients showed a significantly worse living quality score on all domains of the SF-36 scales (P＜0. 05), except the domain of somatic pain. Among the patients after cardiac transplantation, living quality was more significantly improved in ＞2-year survival group than that in ＜one-year survival group (P＜0. 05),except the domain of somatic pain. The relationships between the social support and living quality were analyzed,and it was found that as compared with a reference general population, the heart transplant recipients showed significantly lower scores on all domains of the social support questionnaire (P＜0. 01 ). The total social support scores were positively related to mental health related living quality (P＜0.05, r = 0.223 - 0.710), except the domain of somatic pain. Conclusion Compared with a general population, heart transplant recipients demonstrated a significantly worsened living quality. But evidence showed the living quality can be improved gradually with the prolongation of the survival time after heart transplantation. Social support was related to the living quality of heart transplantation patients. Improvement of availability on social support will probably improve living quality.

Objective To retrospectively analyze the clinical management and follow-up of 13 recipients with survival of over ten years after cardiac transplantation. Methods Thirteen male recipients underwent orthotopic heart transplantation between August 1995 and June 2001 in our center and received standard immunosuppressive therapy protocols (8 cases) or induction therapy protocols (5 cases). Cyclosporine, azathioprine or mycophenolate mofetil, and prednisolone were applied as maintenance immunosuppressive regimens. Six recipients switched from azathioprine to mycophenolate mofetil when mycophenolate mofetil was available. Perioperative complications were prevented and treated. After operation, the recipients were followed up regularly to set up personnel long-term follow-up files. The incidence of acute rejection (AR) and (cardiac allograft vasculopathy (CAV) was monitored. Results The 13 survived recipients accounted for 48. 1 % of the total number in the corresponding period (13/27). All survivals recovered well and had a good quality of life. The recent (1 year) complications included acute allograft rejection (3 cases), infection (4 cases), renal insufficiency (3 cases), allograft right ventricular dysfunction (5 cases), post-transplant diabetes (2 cases) and liver dysfunction (5 cases). The long-term (1 year later) complications included acute allograft rejection (2 cases), CAV (2 cases), hypercholesterolemia (5 cases), hypertension (4 cases), hyperuricemia (10 cases) and chronic renal impairment (3 cases). One hepatitis B virus carrier died of liver cancer 13 years after transplantation. Conclusion The long-term survival of cardiac allograft recipients is closely associated with psychological state, financial condition, compliance and follow-up medical system, while the sociological and environmental factors may play important roles.

Objective To summarize and analyze the primary data from China Heart Transplant Registry in 2013 in order to explore the current status of heart transplantation in Chink Method Seventeen transplant centers have conducted 231 cases of heart transplantation in the year 2013.We analyzed the preoperative risk factors which impacted the survival of heart transplant recipients by using univariate and multivariate logistic regression analysis.And long-term survival of the 398 heart recipients from Beijing Fu Wai Hospital,who were followed up from June 2004 to December 2013 (follow-up rate was 100 ％) was calculated by the Kaplan-Meier method.The risk factors for long-term survival of heart transplant recipients were calculated by the COX survival analysis methods.Result The mean hospital stay of the 231 recipients was 24 days.There were 25 cases who died in hospital,and the total mortality was 10.8 ％ (25/231),while the average in-hospital mortality was 2.2 ％ in the three largest centers.By using the univariate and multivariate logistic regression analysis,we found that recipients positive PRA was the only preoperative risk factor which impacted the in-hospital mortality.(OR=12.435,95％ CI 1.369～ 112.938,P =0.025).The median follow-up time of the 398 heart transplant recipients from Beijing Fu Wai Hospital was 1383 days,and the 1-,3-,5-and 7-year survival rate was 94.7％,91.6％,88.0％ and 82.6％ respectively.The univariate and multivariate COX regression analysis revealed that preoperative primary diseases (coronary heart disease vs.cardiomyopathy,P ＜ 0.01),the history of chronic obstructive pulmonary disease (P ＜ 0.01),the preoperative total bilirubin level (P＜0.05) and serum creatinine level (P＜ 0.01) were risk factors affecting long-term postoperative survival.Conclusion In China the number of heart transplants has increased in 2013.The survival rate of recipients is high in large heart transplant centers.The integrity of registration data needs to be further improved in some centers.

ObjectiveTo know the recent status of heart transplantation in Chinese multicenters.MethodsThe retrospectively data from 24 centers before 2010 (438 cases) and the data from China heart transplant Registry database between 2010 (149 cases from 15 centers)-2011(148 cases from 19 centers) were analyzed.Results In 2010,15 centers performed heart transplantation,including one large-scale center (60 transplants per year),3 moderate-scale centers (10 to 30 transplants per year),and 6 small-scale center (2-8 transplants per year).The rest 5 centers had one transplant per year each.In 2011,19 centers performed heart transplantation,including one large-scale center (52 transplants per year),3 moderate-scale centers (10 to 30 transplants per year),and 5 small-scale centers (2-8 transplants).The rest 8 centers had one transplant per year each.In 2010 and 2011,the median ages of heart transplant recipients were 44.6 and 42.9 years,respectively.Nonischemic cardiomyopathy was the leading indication for heart transplantation.The median donor age in 2010 and 2011was 30.2 and 30.8 years respectively.In 2010 and 2011,up to 99.3％ and 97.3％ of patients were treated with immune induction therapy,respectively.In 2010,the mortality at discharge was 10％,and that was 6％ in 2011.ConclusionAlthough total volume of heart transplants is still small in recent years,the discharge survival in China is similar to ISHLT report.