0.05),while the leptin level in serious injury group was higher than in all the other groups(P

Objective To establish a differently expressed genetic profile in placental tissues of pregnancy induced hypertension(PIH). Method The total RNAs were isolated from the tissues by Trizol and mRNA was purified by Midi Kit. The expression of 17 000 genes in placental tissues of 6 PIH and 5 normoten sive women were evaluated by cDNA array technique. Results Ninety-six differently expressed genes were identified in placental tissue of PIH compared with normal pregnancy cases. Seventy-eight genes were up-regulated and 18 were down-regulated. There were 6 unclassified genes, 8 unknown expressed sequence tag (EST) fragments and 3 cDNA fragments among these differently expressed genes. The differently expressed genes were involved in transcription and translation,cell differentiation,receptor,apoptosis,immune,metabolism and growth. Conclusion The cellular mechanism of PIH involves changes in genes expression in placental tissue. Microarray is a useful method to identify differently expressed genes in tissue.

Objective To summary the methods and results of first and second operations on patients with aortic valve disease and non-specific aortitis.Methods The total 34 patients including 23 cases with aortitis and 11 cases with Behcet disease were studied from Jan 2000 to Dec 2010.The first operation was Bentall procedure in 18 cases and AVR in 16 cases.Fourteen of 16 cases who had AVR developed severe paravalvular leakage,and undewent the second operation including 10 aortic root replacement (8 valve-conduit and 2 homograft) and 4 non-anatomic AVR.Results Eighteen patients who had first operation of Bentall procedure all survive without aortic pseudoaneurysm after the follow-up of 6 months to 11 years.Fourteen redo cases all survive except for one case died of repture of aortic pseudoaneurysm 1.2 years postoperatively.Conclusion Preoperative diagnosis in these patients is very difficulty.The first operation of root replacement is of choice.The second operation is very difficulty to handle,root replacement can achieve satisfactory results.Non-anatomic AVR is easy to perform,and good hemo stasis intraoperatively,and is a satisfied alternative method with good results.

Objective The results of Aortic valve replacement (AVR). Combined with ascending aortic replacement(group A) or aortoplasty (group B) in patients with aortic valve disease and ascending aortic dilatation were analysed to assess the clinical outcomes and respective indications. Methods Among the two groups, the age, gender, NYHA class, types of aortic valve lesions and left ventricular ejection fraction were not different statically. The ascending aortic diameters in group A[(50.41 ±3.71) mm] and group B [(48.29±2.18) mm] were not statically different. Ascending aortic replacement was performed in Group A. A Dacron tube(diameter 28 ～ 30mm) was routinely wrapped around the ascending aorta after aortoplasty in group B. Results There was 1 postoperative death in group B, blood transfusion volume and postoperative complications were not stasticaly different in the two groups. Cardiopulmonary bypass time [(110.52 ± 27.51) min] and aortic across clumping time [(71.70 ± 17.13)min] in group A were significantly longer than that of group B [(97.31 ± 19.46) min,P=0. 004; (57.13 ±19.46) min, respectively. P=0.025]. Conclusion Aortic valve disease, especially bicuspid valve disease often combines with ascending aortic dilatation or aneurysm. In younger patients, ascending aorta should be actively treated surgically when the diameter is equal or more than 40mm. Aortoplasty with external reinforcement of a Dacron tube is simpler and safer than aortic replacement in patient without aortic atherosclerosis or ulceration, and large aneurysm.

Objective To summarize the results and methods of left subclavian artery revascularization by stented trunk fenestration for acute Stanford type A aortic dissection.Methods Clinical data of 67 patients (54 male and 13 female,mean age of (50 ± 10) years) underwent surgical treatment of left subclavian artery fenestration for acute Stanford A aortic dissection in Department of Cardiothoracic Surgery,Changhai Hospital,Second Military Medical College between September 2008 and December 2014 were analyzed retrospectively.The origin of the left subclavian artery was in the true lumen and no dissection existed near the artery's starting.There were 18 cases of Marfan's syndrome.Preoperative echocardiography showed moderate to severe aortic regurgitation in 10 cases,and mitral regurgitation in 3 cases.Electrocardiogram showed myocardial ischemia in 5 cases.Three patients had acute impaired renal function.All the patients received total arch replacement combined with stented elephant trunk implantation.Left subclavian artery revascularization was performed by stented trunk fenestration as follows:firstly,stented elephant trunk was implanted to completely cover the left subclavian artery,then part of stented trunk's polyester lining was removed which is located at the origin of left subclavian artery.Aortic root procedures included aortic valve replacement in 2 cases,Bentall procedure in 21 cases and aortic valve sparing in 44 cases.Three patients received mitral valve repair and 6 patients received coronary artery bypass grafting.Results The cardiopulmonary bypass time,cross-clamp time,and circulatory arrest time were (179 ± 32) minutes,(112 ± 25) minutes,and (26 ± 10) minutes,respectively.The in-hospital mortality was 7.5％ (5/67):2 patients died of multiple organ failure,1 patient died of acute renal failure and another 2 patients died of severe infection shock.Two patients required reexploration for root bleeding.Transient neurology dysfunction developed in 6 patients.Six patients received tracheotomy and prolonged ventilation due to pulmonary infection.All patients discharged from the hospital were followed up for 1 to 5 years.During long-term follow-up,the survival rate was 100％ and 89.8％ at 1 and 5 years,respectively.CT angiography was performed once per year after discharged.The left subclavian artery perfusion was good.No dissection or anastomosis leakage was identified in any case.Stroke and left limb ischemia did not develope.Conclusion For acute Stanford type A aortic dissection whose origin of the left subclavian artery is in the true lumen and no dissection existed near the artery's starting,the left subclavian artery revascularization by stented trunk fenestration technique during total arch replacement combined with stented elephant trunk implantation is reliable and effective.

Objective To summarize the results and methods of left subclavian artery revascularization by stented trunk fenestration for acute Stanford type A aortic dissection.Methods Clinical data of 67 patients (54 male and 13 female,mean age of (50 ± 10) years) underwent surgical treatment of left subclavian artery fenestration for acute Stanford A aortic dissection in Department of Cardiothoracic Surgery,Changhai Hospital,Second Military Medical College between September 2008 and December 2014 were analyzed retrospectively.The origin of the left subclavian artery was in the true lumen and no dissection existed near the artery's starting.There were 18 cases of Marfan's syndrome.Preoperative echocardiography showed moderate to severe aortic regurgitation in 10 cases,and mitral regurgitation in 3 cases.Electrocardiogram showed myocardial ischemia in 5 cases.Three patients had acute impaired renal function.All the patients received total arch replacement combined with stented elephant trunk implantation.Left subclavian artery revascularization was performed by stented trunk fenestration as follows:firstly,stented elephant trunk was implanted to completely cover the left subclavian artery,then part of stented trunk's polyester lining was removed which is located at the origin of left subclavian artery.Aortic root procedures included aortic valve replacement in 2 cases,Bentall procedure in 21 cases and aortic valve sparing in 44 cases.Three patients received mitral valve repair and 6 patients received coronary artery bypass grafting.Results The cardiopulmonary bypass time,cross-clamp time,and circulatory arrest time were (179 ± 32) minutes,(112 ± 25) minutes,and (26 ± 10) minutes,respectively.The in-hospital mortality was 7.5％ (5/67):2 patients died of multiple organ failure,1 patient died of acute renal failure and another 2 patients died of severe infection shock.Two patients required reexploration for root bleeding.Transient neurology dysfunction developed in 6 patients.Six patients received tracheotomy and prolonged ventilation due to pulmonary infection.All patients discharged from the hospital were followed up for 1 to 5 years.During long-term follow-up,the survival rate was 100％ and 89.8％ at 1 and 5 years,respectively.CT angiography was performed once per year after discharged.The left subclavian artery perfusion was good.No dissection or anastomosis leakage was identified in any case.Stroke and left limb ischemia did not develope.Conclusion For acute Stanford type A aortic dissection whose origin of the left subclavian artery is in the true lumen and no dissection existed near the artery's starting,the left subclavian artery revascularization by stented trunk fenestration technique during total arch replacement combined with stented elephant trunk implantation is reliable and effective.

Objective    To study the clinical characteristics, therapy strategies and the outcomes of female patients with acute aortic dissection during late pregnancy and puerperal period. Methods    We retrospectively analyzed the clinical data of 7 patients with acute aortic dissection during late pregnancy and puerperal period in Shanghai Changhai Hospital between August 2012 and June 2017. Five of the 7 patients were late stage pregnancy, 2 were puerperal period (1 at the postpartum night, 1 in 18 days after delivery). There were 6 patients of Stanford type A aortic dissection (85.7%), and 1 patient of type B aortic dissection (14.3%). The age of the patients ranged from 26 to 34 (30.8±3.1) years. Cardiac ultrasonography of patients with type A showed that the maximum diameter of the ascending aortas was 4.2–5.7 (4.7±0.6) cm, of which 2 patients were aneurysm of aortic sinus, 3 patients were with Marfan syndrome. Bentall procedure was conducted in 1 patient, Bentall+Sun’s surgery in 2 patients, ascending aorta replacement+Sun’s+coronary artery bypass grafting surgery in 1 patient, aortic root remodeling+ascending aorta replacement+Sun’s surgery in 2 patients. One patient with Stanford type B acute aortic dissection was performed with thoracic endovascular aortic repair (TEVAR) after cesarean section. Results     Aortic blocking time ranged from 51 to 129 (85.5±22.9) min.  Cardiopulmonary bypass time was 75–196 (159.0±44.0) min. Moderate hypothermic circulation arrest with selective cerebral perfusion time was 20–30 (23.8±3.5) min. All maternal and fetuses survived. The infant whose mother received aortic repair in early stage and then received cesarean section was diagnosed with cerebral palsy. Maternal and fetuses were followed up for 9 months to 4 years. During the follow up period, all the fetuses grew well except the cerebral palsy one, and all maternal recovered well. The patient who received aortic repair in the early stage, had a sigmoid rupture during cesarean section and was treated with sigmoid colostomy. Another patient with Stanford type A dissection was diagnosed as left renal vein entrapment syndrome after 2 years. Conclusion    Type A aortic dissection is more common in late pregnancy and puerperal patients. And Marfan syndrome is a high-risk factor for acute aortic dissection in pregnancy women. Early and appropriate surgical treatment strategy based on the type of aortic dissection and gestational age are the key points to achieve good outcomes both for maternal and fetus.