Objective To investigate the effect of sirolimus (SRL) on the expression of integrin ανβ3 mRNA in vascular smooth muscle cells of cardiac allografts in rats, and the possible mechanism of SRL in the prevention of cardiac allograft vasculopathy. Methods Heterotopic heart transplantation models were established. Hearts from Wistar rats were heterotopically transplanted to SD rats (allograft) or Wistar rats (isograft). All rats were randomly divided into four groups:SRL group, SRL 1.25 mg/kg every day,oral intubation after cardiac transplantation; cyclosporine (CsA) group,CsA 10mg/kg every day, subcutaneous administration ; isograft group, no immunosuppressant administration;control group, normal hearts of Wistar rats. All of the animals were killed at 60 day after transplantation. Angiostenosis degree was analyzed by Mias system 4.1 after the cardiac tissues were stained with Van Gieson stain. Reverse transcription-polymerase chain reaction (RT-PCR) assay was used to detect the expression of integrin ανβ3 mRNA in cardiac allografts. The relationship between the expression of integrin ανβ3 mRNA and the area of vascular stenosis was analyzed. ResultsIn control group, there was no thickened vascular intima and no vascular stenosis. In allograft group,the thickness of vascular intima was slightly increased but no vascular stenosis was detected. In CsA group, the vascular intima was obviously thickened, the lumen was narrowed, and some small arteries had obstruction. In SRL group, vascular intima proliferation and angiostenosis degree were obviously milder than in CsA group. Semiquantitative RT-PCR analysis revealed that the relative expression of integrin ανβ3 mRNA in CsA and SRL groups was increased significantly as compared with control group and isograft group (2.51±0.43 or 1.17±0.12 vs 0.28±0.08 or 0. 38 ± 0. 05, P＜0. 01). The relative expression of integrin ανβ3 mRNA in SRL group was decreased significantly as compared with CsA group (1.17±0.12 vs 2.51±0.43, P＜0.05). A positive correlation was found between vascular stenosis and the expression of integrin ανβ3 mRNA (r = 0. 654, P＜0. 01) in allografts. Conclusion SRL may down-regulate the expression of integrin ανβ3 mRNA in cardiac allografts in rats, which was probably associated with classic cardiac allograft vasculopathy.

Objective To observe the effect of smoking on the great saphenous vein tension. Methods The rings of great saphenous vein in 3mm long of selected from 31 patients with coronary artery bypass grafting were divided into three groups :smoking over 10 years( group A, n = 12 ), ex-smoking over 1 years ( group B, n =9 ) and non-smoking( group C, n =10). The changes of the tone were measured in organ chamber at 37℃ with a constant supply of oxygen when vasoconstriction induced by phenylephrine ( 10 -9 - 10 -5 mmol/L), and vasodilatation by acetylcholine ( 10 -9 - 10 -5 mmol/L) or nitroglycerin( 10 -9 - 10 -4 mmol/L)after the rings were precontracted by 10 -5 mmol/L phenylephrine. Results Vasoconstriction induced by phenylephrine and vasodilatation by nitroglycerin is no significant difference among three groups. Compared with group A, vasodilatation by acetylcholine was significantly increased in group B or C, while there is no significant difference between group B and C. Conclusion Smoking has a deleterious effect on the endothelial function of great saphenous vein, however, smoking cessation over 1 year may help to restore the endothelial function impaired by smoking.

Objective To investigate the availability and usefulness of echocardiography in piglet of experimental carotid-jugular shunting pulmonary hypertension.Methods Fifty-one 1-month-old piglets were randomly divided into surgical shunt group(CA-JV,n =45) and sham group(n =6).In shunt group,left CA-JV shunt was esteblished by end-to-side vascular anastomosis from left carotid artery to jugular vein.Piglets in sham group received a sham operation.Periodic hemodynamic evaluation of the carotidjugular shunt and heart were performed by ultrasound examination post-surgery.Tricuspid regurgitation and pulmonary regurgitation were monitored for evaluating pulmonary systolic pressure and mean pressure.Results In CA-JV group,32 piglets survived to end point of experiment and 27 maintained a persistent shunting (success rate 60％).Tricuspid regurgitation and pulmonary regurgitation occurred increasingly and pulmonary pressure had risen gradually since 4 months post-surgery (P ＜ 0.05).Those were coincided with the results of right catheterization and pulmonary pathology.Conclusions Ultrasound can monitor experimental carotid-jugular shunting pulmonary hypertension that shows practical value for further study in the mechanism and treatment of pulmonary hypertension due to increased pulmonary blood flow.

Objective To observe the expression of Caspase-12 and GRP78 of endoplasmic reticulum stress (ERS) in cardiac arrest and beating heart mitral valve replacement Methods Thirty patients with rheumatic heart disease mitral stenosis were randomly divided into beating heart group (BH,n=15) and cardiac arrest group(CA, n = 15). Both groups accepted MVR by beating heart surgery and cardiac arrest surgery under cardiopulmonary bypass (CPB) respectively. Right atrial myocardial tissues were collected at prior the start of CPB (T0), after aortic cross-clamping 30 minutes (BH group 30 minutes after CPB, T1) and stitched right atrium (T2) respectively. The method of reverse transcriptase polymerase chain reaction (RT-PCR) was applied to detect the expression level of Caspase-12 and GRP78 in two groups and positive staining of Caspase-12 and GRP78 of myocardial tissue slices in both groups was observed by immunohistochemical method. Results The expression of Caspase-12 in CA group heightened at T1and significantly increased at T2 (P < 0.05) but the expression of Caspase-12 in BH group had increased in T2 only (P < 0.05). Caspase-12 in CA group expressed higher than that in BH group at T1 and T2. The expression of GRP78 had increased at T1 in two groups but it in CA group expressed higher than that inBH group at T2. The number of positive staining of Caspase-12 and GRP78 in CA group was higher than that in BH group at T2. Conclusion MVR of beating heart can reduce the reaction of ERS to enhance the myocardial protection under CPB.

Objective: To analyze the risk factors of acute kidney injury (AKI) after isolated heart valve prosthesis implantation (HVPI) in relevant patients. Methods: We retrospectively studied 400 patients who received isolated HVPI in our hospital. The demographic characteristics and pre-, intra-, post-operative information were collected to conduct uni- and multi-variantanalysis. Results: The pre-operative serum creatinine level in 400 patients was 85.0 (72.0, 98.0) μmol/L and post-operative level was 104.5 (80.0, 146.3) μmol/L, the elevation was 20.9% (1.6%, 57.9%),P<0.05. Multi Logistic regression analysis indicated that age>50years (OR=2.12, 95% CI 1.13-3.95),hypertension history (OR=4.07, 95% CI1.23-13.47), cardiopulmonary bypass time>180 minutes (OR=5.38, 95% CI 1.63-17.77), post-operative hemoglobin<70 g/L (OR=0.20, 95% CI 0.06=0.74), serum glutamic-pyruvic transaminase>100 u/L (OR=12.10, 95% CI 2.28-64.23), pleural fluid drainage at the day of operation> 500 ml (OR=2.12, 95% CI 1.13-3.95), extubation after 24 hours of operation (OR=3.94, 95% CI 2.07-7.52), combining low cardiac output syndrome (OR=4.64, 95% CI 1.06-20.29) were the independent risk factors for AKI occurrence in patients after HVPI, allP<0.05. Conclusion: Post-HVPI AKI was associated with many factors. At prior operation, it was mainly related to the age and hypertension; during theoperation, it was mainly related to cardiopulmonary bypass time; at post-operation, it was mainly related to delayed extubation, low cardiac outputsyndrome, anemia, increased pleural lfuid drainage and serum glutamic-pyruvic transaminase.

Objective:To report a rare type of aortic arch aneurysm. Methods: Three cases of aortic arch aneurysm derived from the fourth aortic arch were retrospectively analyzed. The pathogenesis and treatment of this type of aortic arch aneurysm were investigated. Results:Most of the aneurysm body was located in the Z2 zone, which was the stem from the fourth aortic arch in the embryonic development period. All of the 3 cases could not be explained by common etiology. We speculated that the cause might be developmental anomaly of the fourth aortic arch. All the 3 aortic arch aneurysms were totally ex-cluded with a covered stent. The technical success rate was 100%. Endoleak of typeⅠwas seen in one case, which was resolved in a later open surgery. During the follow-up, no type of complications was found. Conclusion:To the best of our knowledge, this is the first report of this type of aortic arch aneurysm. The cause may be developmental anomaly of the fourth aortic arch. Endovascular treatment of this type of aortic arch aneurysm is feasible.

Objective To estimate the value of aortic valves and combined mitral valve replacement with retrograde perfusion in beating hearts.Methods Continuous retrograde coronary sinus perfusion with beating hearts was used in 83 patients undergoing aortic valve or aortic valve combined with mitral valve replacement,without application of cardioplegia.After aortic valve replacement,the retrograde perfusion wes changed to antegrade perfusion for mitral valve replacement or correction of the other deformities(group A).Cold blood cardioplegia solution(15℃)was infused at intervals in 20 cases(group B).The following parameters were tested:lactate,ET,CTn-T and MDA in blood;myocardial ultra-structure;and cardiac rhythm and cardiac output (co).Results All biochemical values increased after cardiopulmonary bypass(P ＜ 0.05 - 0.01).Empty and beating heart sinus rhythm was maintained in group A.Myocardial ultrastructure did not change significantly.The pump was stopped smoothly as the surgical procedure finished.No postoperative low cardiac output syndrome or arrhythmia was observed.Eight-one patients recovered smoothly,two died from renal failure or infective shock.When the pump stopped,all patients in group B were supported by 5 - 10 μg· kg-1· min-1 dopamine.Transient pacing was used in 9 patients.One patient died from low cardiac output syndrome.Conclusion This method is a good myocardial protection which simulates physiologic status.It is applicable to aortic valve and combined mitral valve replacement of patients with large heart or heart failure and long time aortic cross-clamping.Ideal clinical effect can be achieved.

Coronary artery disease is currently one of the leading cause of death from disease,and coronary artery bypass grafting(CABG) is an effective treatment for it.Saphenous vein graft(SVG) is one of the most commonly employed conduits for CABG.However,the long-term patency of SVG harvested by conventional technique is poor.No-touch SVG harvesting technique can provide better structural,morphological and functional protection of the vein wall,also can receive satisfied longterm patency rate.

As a congenital anomalous coronary artery anatomy , the myocardial bridging of the left anterior descending ar-tery has a high incidence and detection rate.Traditionally, myocardial bridgings are considered to be benign anatomical vari-ants.However, as medical research progresses, more and more cardiac events have been found to be associated with myocardial bridgings.By summarizing recent literature reports, this review describes the anatomy and pathophysiology, classification and diagnosis of the left anterior descending artery myocardial bridgings .

Objective:To evaluate the safety of total artery coronary artery bypass grafting(CABG) in patients with coronary heart disease and the short- and mid-term clinical outcomes.Methods:A retrospective analysis of the clinical data of 100 patients who underwent CABG treatment in the First Affiliated Hospital of Guangxi Medical University from January 2016 to July 2021. Of these, 50 patients were selected for comparison(TACR) with the left internal thoracic artery and radial artery(RA) as grafts. However, the left internal thoracic artery and the great saphenous vein were used as grafts in other 50 patients were selected as controls(NCR). The clinical data of preoperative, perioperative, and postoperative(3 months, 6 months, 1 year and 5 years) for two groups were compared.Results:In the perioperative period, TACR group was inferior to the control in both operation time and 24 h postoperative drainage. But the peak value of hypersensitive troponin T was lower than that of NCR. There was no significant difference between the two groups in terms of mechanical ventilation time and perioperative mortality. There was no significant difference between the two groups in terms of left ventricular ejection fraction(LVEF), recurrent angina, left ventricular end-diastolic diameter and recurrent myocardial infarction at 3 and 6 months after operation. LVEF in TACR was better than that in NCR at 1 year and 5 years postoperatively.Conclusion:The clinical effect of CABG with RA as bridge vessel carried out in our center is obvious. TACR is safe and feasible due to its good mid-term efficacy and is not likely to cause postoperative complications.