Objective To review the clinical changes and the management experience of hemodynamics after orthotopic heart transplantation.Methods Orthotopic homologous heart transplantation was performed on 25 cases from January 2000 to October 2003. The hemodynamic changes were monitored after operation with Swan-Ganz catheter and color Dopplor ultrasound. The therapy strategy was regulated when the monitor index and the clinical situation were referenced.Results PAWP, PASP, CVP, CO and CI were increased on the operation day. From the first day to the 7th day, PAWP, PASP and CVP were increased with right ventricle enlarged and sometimes arrhythmia and hydrothorax occurred. After strengthening heart, diuresis and stretching vessel, the hemodynamic changes of 23 cases were inversed and two cases’ conditions got worse. The two patients died of multiple organ failure on the 16th and 23rd day respectively.Conclusion The hemodynamic changes often occur at the early term after orthotopic heart transplantation. The main change is the right ventricular failure. It is important for the patient’s condition recovery and prognosis to monitor the hemodynamic changes and analyze the cause in order to direct the therapy.

Objective To evaluate the matching degree of donor's and receptor's tissue typing and analyze the relationship between the degree and the early survival of cardiac transplantation with donor's and receptor's tissue typing of 9 cases of cardiac transplantation. Methods In accordance with the international standard, donor's and receptor's blood type, HLA antibody, lymphocytotoxicity and panel reactive antibody were determined in 9 cases of cardiac transplantation, and the donor's and receptor's matching degree evaluated by methods of amino acid triplets and cross-reactive group. Results Of 9 cases, 6 survived while 3 died. Of the 3 dead cases, 2 came respectively from the two best comprehensively evaluated matching cases and two worst, and postoperative biopsy showed that there was no rejection in either survival cases or the dead cases. Conclusion With the effective immunosuppressant, the HLA typing doesn't affect the early survival.

AIM: We tested the hypothesis that marrow s tr omal cells (MSCs), when implanted into self-myocardium, can undergo milieu-depen dent differentiation, express cardiomyogenic phenotypes and enhance angiogenesis and cardiac function of ischemic hearts in vivo. METHODS: In order to achieve a safe and persistent effect, we ex plored the potential of autologous MSCs transplantation. One week after myo cardial infarction induced by occlusion of left anterior descending artery, auto logous MSCs labeled with BrdU (bromodeoxyuridine) in vitro was administered intramyocardially into the infarct area of the same donor rabbits. RESULTS: By 1 months, transplanted MSCs demonstrated to be myoge nic differentiation with the expression of ?-sarcomeric actin (5C5). MSCs impla ntation significantly increased vascular density in the infarct zone and resulte d in markedly improved the left ventricular contractility. CONCLUSION: The finding indicates that autologous MSCs transplan tation may represent a promising therapeutic strategy with free of ethical conce rns and immune rejection.

0. 05) in rate of success, recurrence and complication between RFCA and OHO for the patients with AVRT. Medical workers were fewer, operation, du-ration, hospital days (including days of pre-operation preparation and post-operation recovery) and days of looking after the patients in RFCA were shorter than those in OHO,p

Objective To explore the method of atrial septal defect (ASD)occlusion with occluder by minimally invasive chest ways. Methods 34 patients with ASD were anaesthetized and a 2cm～3cm-long incision was made in the 4th intercostal space of right side of sternum and a Dasdo round or elliptic occluder was placed in the heart.The ASD size and edge in various sections were measured by transesophageal echocardiography,and the type and size of occluder were accordingly selected.Two umbrellas were opened on two sides of ASD under monitoring of echocardiography.After confirming the firm of occluder and no evident atrial shunt,occluder was released,and right atrium and chest were sewed. Results 33 patients with ASD were successfully occluded and one case was failed who received extracorporeal circulation operation.The maximum diameter of ASD was 8～32(19 3?6 3)mm.The shortest edge in variant side was 0 mm to posterior wall of aortea,3.5mm to superior vena cava,6.0mm to inferior vena cava and 6.0mm to the base of mitral valve.The time for closing ASD guided by echocardiography was about 2～3 minutes. Conclusions The placement of ASD occluder through minimal incision of the chest is a new method for the treatment of ASD.It might have wider indications for ASD occlusion.

Objective To summarize the experience of 11 orthotopic allogeneic heart transplantations for patients suffering from terminal heart disease, and to discuss how to improve the selection of donor and recipient, protection for the donated heart, postoperative treatment and immune surveillance suitable for our country. Methods 1.All the donated hearts were protected by perfusing cold modified St.Thomas cardioplegia and cold oxygenated blood. 2. Orthotopic heart transplantation was performed with the standard technique of medium low temperature extracorporeal circulation. 3. FK506, mycophenolate mofetil(MMF) and steroid were given to prevent rejection. 4. Troponin I, ? 1 and ? 2 microglobulin, C reactive protein (CRP), interleukins, lymphocyte subgroups and mixed lymphocyte reaction (MLR) were employed to monitor the immune rejection reactions. Furthermore, myocardial biopsy and coronary arteriography were conducted periodically. Results Three patients died of systemic failure and infection due to hepatic failure and mental disorder after operation. All the others survived with no complications. Conclusion Strictness in selection of the recipient, high quality of donor heart, correct early postoperative treatment and sound use of immunosurppressant are key to achieving successful cardiac transplantation.

Objective To evaluate the protective effects of stroma-free bovine hemoglobin(SFBHB)on preservation of the donor heart.Methods 24 isolated perfused rabbit hearts were equally divided into two groups.In control group,the cardiac arrest were induced with St Thomas Ⅱ solution and repeated every 30 min.the myocardial temperature remained at 40℃.In experimental group,the isolated rabbit hearts were perfused continuously with St Thomas Ⅱ solution containing stroma-free bovine hemoglobin and the myocardial temperature remained at 37℃.The preservation lasted 6 h.Results There were significant differences between the two groups in the follows:(1)The mean values of the left ventricular developed pressure(LVDP)and coronary flow rate(CFR)were higher in experimental group(P＜0.001);(2)The ATP level and myocardial oxygen uptake were significantly decreased in control group(P＜0.001);(3)The mean values of released creatine phosphate kinase(CPK),lactec dehydrogenase(LDH)and myocardial contents of malondialdehyde(MDA)were higher in control group(P＜0.01);(4)More water was present in the myocardial in control group(P＜0.01);(5)The myocardial ultrastructural injuries were greater in control group.Conclusion The stroma-free bovine hemoglobin could offer great protective effects on preservation of the isolated rabbit hearts.

Objective To analyze the clinical features of intestinal infection in patients with acute leukemia (AL) after chemotherapy. Methods The data of 103 cases of AL patients after chemotherapy from January 2014 to April 2016 were retrospectively analyzed, and categorical variables were compared by using chi-square test. Results A total of 364 cycles of chemotherapy was conducted among 103 patients, of which 66 times (18.13 %) in 59 cycles occurred intestinal infections, including twice intestinal infections in one cycle of chemotherapy in 7 cases. The incidence of intestinal infection was 27.48%(36/131) in group without complete remission (CR), and 9.87%(23/233) in CR group. There was a statistical difference between the two groups (P<0.01). Repeated intestinal infections were found in 46.67%of the patients who accepted multiple cycles of chemotherapy. In the same cycle of chemotherapy, the probability of recurrence of intestinal infection after chemotherapy was 3.7 times than patients without intestinal infection occurred during chemotherapy. The incidence of intestinal infection of patients with acute lymphoblastic leukemia (ALL) after primary inducing chemotherapy was higher than that of patients with acute myelogenous leukemia (AML) (P= 0.019). The incidence of intestinal infection combined with neutropenic was 9.89 % (36/364), and the incidence of intestinal infection was 8.24 % (30/364) in neutrophils > 0.5 × 109/L. There was no significant difference (P> 0.05). After chemotherapy, some patients with intestinal infection occurred acute abdomen, with high mortality rate. Conclusions Intestinal infection may occur in the procession of chemotherapy and myelosuppression. Special attention should be paid on intestinal infection, including reduction of blood stream infection and risk factors, as well as timely intervention.

ObjectiveTo assess the effects of constraint-induced movement therapy(CIMT) on sub-acute stroke patients with upper extremity motor dysfunction.Methods63 patients with hemiplegia after stroke were divided into two groups: control group(31 cases) and CIMT group(32 casese). The two groups received the regular rehabilitation training for 14 d. Then the control group went on the the regular rehabilitation training, while the CIMT group received CIMT for 14 d. All patients were assessed by the Action Research Arm Test(ARAT) and Fugl-Meyer(FMA) on the first day, the 15th day and the 30th day after the treatment.ResultsARAT score and FMA scores were higher in CIMT group than in the control group 30 d after the treatment and in CIMT group 15 days after the treatment(P<0.001).ConclusionCIMT is more effective to improve the upper limb motor function of the sub-acute stroke patients than the regular rehabilitation training.