This paper presents the results of aortic and double valve replacement with tilting disc valves in 75 patients.Preoperafive diagnosis was rheumatic lesion in 48 cases, bacterial endocarditis in 22, congenital aortic stenosis in 3, and VSD with prolapse of aortic valve in 3.There were 9 early deaths with an overall operative mortality rate of 12%. During the follow-up of 7 months to 7 years and 11 months, there were 66 long-term survivals and 1 late death.The authors conclude that the early operation should be performed on patients with valve lesion or with combination of mitral valve lesions resulting in left ventricular impairment. The protection of the myocardium during operation is the most important procedure in reducing the operative mortality.

Valvular disease is a commonly seen heart disorder,valve replacement is an effective approach to treat valve disorders.Both the mechanic valves and bioprosthesis used now have their own defects,making it important for the cardio surgery field to develop some kind of ideal valves.With the development of tissue engineering techniques,the tissue engineering valves are thought to have great potential and bright clinical future,and now it has become a hot point in cardiac surgery.This article is to evaluate the frame materials,resource of tissue cells and implantation, in vitro pre adaptation testing and in vivo animal experiment results,and the existing problems are pointed out in the present study.

Ischemic preconditioning (IPC), as a powerful endogenous cardioprotective adaptation, has brought a new research field for prevention and inhibition of myocardial ischemic reperfusion injury. This article is to evaluate the current information regarding the process of IPC and the possible mechanisms involved, with special attention paid to the protein kinase C and mitochondrial ATP sensitive potassium channels. The article also pointed out that the future role of IPC in clinical practice would strongly depend on the exact cellular and molecular mechanism underlying the IPC phenomenon. Pharmacological preconditioning seems to represent a perspective role of IPC in clinical practice.

Objective: To investigate the angiogenic potentiality of angiogenin in ischemic myocardium and estimate the possibility of its application in biologic treatment. Methods: Recombinant human angiogenin derivative Asp116His was applied in an acute myocardial infarction model in rabbits which were established by direct intramyocardial injection into the border zone of the ischemic myocardium. The animals were sacrificed on the eighth postoperative day and their hearts were harvested and subjected to histologic studies. Results: Myocardium around the injection sites was apparently less ischemia in the experiment group as compared with control groups. A large number of small vessels were observed in the interstitial tissues and even more were revealed in the myocardium on immunohistochemistry studies. Conclusion: The results indicate for the first time that angiogenin or its derivatives may act on ischemic myocardium and stimulate neo angiogenesis, which holds great promise for their future application in biologic revascularization of ischemic myocardium.

Surgical outcome of 188 patients with coronary artery disease was analized. 132 of them were male and 56 female (mean age 60 3 yrs).Fifty six patients had acute or post MI, 46 diabetes, 14 renal dysfunction, 26 stroke, 21 valve disease, 7 left ventricular aneurysm, and 1 type I dissecting aneurysm. Cardioplegia was used in 104 patients, intermittent aortic cross clamping in 59, OPCAB in 25, average number of graftings was 2 7 per patient. Concomitant procedures included 8 MVR or MVP, 4 AVR, 9 DVR and 1 Bentall′s procedure. Total early mortality was 5 9%, but the mortality decreased to 3 2% in 124 patients undergone CABG since Jan, 2000. Late death occurred in 2, recurrence of chest pain in 4 patients in 2 to 5 yrs postoperatively. Improved surgical techniques and perioperative management were the main factors reducing early mortality. Timing of operation, respiratory management, prevention of digestive track bleeding, and postoperative rehabilitation, should be emphasized.

Myocardial protection has been the subject of intensive investigation. Several studies have suggested that Ginsenosides may protect against ischemia/reperfusion injury. The isolated, working rat heart model was used in this study to evaluate the effects of St. Thomas' Hospital Cardioplegic Solution containing various concentrations of Ginsenosides on the enhancement of myocardial protection following hypothermic ischemic arrest (20 ℃, 120 min). The added concentration of Ginsenosides in cardioplegic solution was 0(control), 50, 100 150?g/ml, respectively. Recoveries of aortic flow, cardiac output, and minute work were markedly improved by adding Ginsenosides to cardioplegia. Dose-response study indicated that 100?g/ml in cardioplegia had the best protective effects, in which group the generation of thiobarbituric acid reactive materials (MDA) was markedly reduced. Our results indicated that Ginsenosides provides additional myocardial protection in St. Thomas' Hospital Cardioplegia. Addition of Ginsenosides to cardioplegia may protect the ischsmic myocardium from free-radical injury also.

Objective: To review the pathological characteristics of the lungs in mitral stenosis with pulmonary hypertension, and provide evidence for clinical treatment. Methods: Pulmonary pathological changes in 37 patients with rheumatic mitral stenosis and secondary pulmonary hypertension received mitral valve replacement. Six patients of aortic valve disease without pulmonary hypertension received aortic valve replacement and were taken as control. The lung biopsies were obtained from the middle lobe of the right lung in operation. Pulmonary muscular arteries were studied quantitatively and qualitatively. Results: All patients with mitral stenosis showed various degrees of vascular and other associated parenchymal changes. The structural changes in the muscular arteries was graded according to the degree of MT/R. There was 81% of patients with mitral stenosis in mild to moderate degree. Conclusion: The pulmonary vascular pathological changes of patients who have rheumatic mitral stenosis with pulmonary hypertension are related to the level of preoperative pulmonary artery pressure. And in most of them the pulmonary vascular pathological changes are in mild to moderate degree.

The experiences of surgical treatment of valvular heart diseases in children were reported. Cardiac valve operations were performed in 87 children including 58 males and 29 females between the age of 4 to 14 years ( mean 10 2 years) . Of the 87 patients, 36 underwent mitral valve replacement, 13 aortic valves replacement, 6 mitral and aortic valves replacement, 13 aortic valvuloplasty, and 29 mitral valvuloplasty. Associated cardiac lesions were simultaneously managed. Postoperative complications included low cardiac output syndromes in 7 patients, respiratory failure in 3, and arrhythmia in 5 patients. The operative mortality was 4 60% (4 patients). Follow up was 0 5 to 14 5 years (mean 6 51 years). Late mortality was 3 61% (3 patients). The valvuloplasty operations were first choice for cardiac valve operations in children. It was advisable to use cardiac valve prosthesis of larger size(adult) for valve replacement in children.Anticoagulation with Warfarin was routinely used and the treatment of rheumatic fever should be emphasized postoperatively.

The experiences of coronary artery bypass grafting (CABG ) surgery and perioperative management for critical patients are reported. Forty-five critical CAD patients aged from 41 to 78 years old with 32 male and 13 female underwent CABG.The critical conditions included coronary artery disease complicated with left ventricular dysfunction (LVEF less than 30%) in 7 patients, heart valve disease in 13, postinfarction giant LV aneurysm in 6, aged 75 years or older patients with hypertension, diabetes, and renal or severe lung dysfunction in 8, and emergent CABG because of insufficient blood supply from left coronary artery during cardiac valve replacement or ascending aortic aneurysm operation in 5. Among all the patients, pure CABG was performed in 20, and CABG with other simultaneous procedures in 25. Each of 45 patients received l to 4 bypass grafts with a mean of 2 9. During the early stage of postoperation,there were low cardiac output syndrome in 6 patients, renal failure in 3, pulmonary failure in 2, and MOSF in 1.With the application of IABP, 5 from 6 LCDS patients recovered.Three patients were complicated with renal failure, and they also recovered with the use of peritoneal or blood dialysis postoperatively. During the early stage of postoperation,two patients (4 4%) died of LCOS and MOSF, respectively. One died of arrhythmia 15 months later after operation .The experiences suggest that control of hypertension,heart rate and diabetes before operation, perfect revascularization of ischemic myocardium and effective myocardial protection during operation,prevention of LCOS and renal failure after operation could improve the results of CAD patients undergoing CABG.

Objective:To examine the sodium-hydrogen exchanger(NHE-1) m RNA expression in lung of patients with congenital heart disease,and to explain the cause of pulmonary vascular remodeling.Methods:Twenty-two patients with congenital heart disease were divided into 2 groups:non-pulmonary-hypertension group(s PAP