Objective To evaluate the effect of HTK solution on myocardial protection during valve replacement surgery.Methods 42 patients with rheumatic heart disease were randomized to receive 4∶1cold blood (control group,n =21 ) and HTK ( protective gronp,n =21 ) cardioplegic solution during valve replacement.The changes of CO and CI were collected at different time points including pre-operation,postoperative 6 hours,12 hours and 24 hours.Aortic clamping time,the ratio of spontaneous cardiac rhythm recovery and inotropic drugs application were calculated,and mechanical ventilation support time and the incidence of arrhythmia were recorded.Results The measurements of CO and CI showed that there was significant higher level in protective group at postoperative 12 hours and 24 hours [ 12 h:(4.82 ± 0.18 ) L/min vs ( 3.50 ± 0.32 ) L/min,( 3.80 ± 0.48 ) L/( min · m2 ) vs (2.79 ± 0.39) L/( min · m2 ) ;24 h:(4.97±0.45)L/min vs ( 3.81 ±0.19)L/min,(4.22±0.17)L/(min · m2) vs (2.91 ±0.21)L/(min·m2 ),P ＜ 0.05].The clinical parameters including aortic clamping time,incidence of cardiac arrhythmia,inotropic support,duration of mechanical ventilation and length was lower than in control group [ (53.6 ±24.3 ) min vs ( 68.9 ± 26.1 ) min ; ( 1.8 ± 1.3 ) min vs ( 2.3 ± 1.2 ) min ; ( 33 ± 11 ) min vs ( 42 ± 13 ) min ;(10.2±2.1) μg/(kg · min) vs (15.7 ±3.8) μg/(kg · min);(14.6 ±4.8)h vs (20.7 ±5.1)h,P ＜0.05].The auto-beating rate was higher than in control group (90％ vs 67％,P ＜0.05).Conclusions HTK solution is better than classical blood cardioplegia in myocardial protection during valve replacement.

Objective To investigate the expression and significance of bone sialoprotein and matrix metalloproteinase-9 in calcified mitral valves in patients with rheumatic heart disease.Methods A total of 150 mitral valves were divided into the rheumatic group (n =120) and the non-rheumatic group (n =30 ).Expressions of bone sialoprotein and matrix metalloproteinase-9 were determined by immunohistochemistry.Results Expressions of bone sialoprotein ( 91.6％,x2 =56.6354 ) and matrix metalloproteinase-9 ( 90.8％,x2 =59.4272) in the rheumatic group increased significantly than in the non-rheumatic group (P ＜ 0.01).Conclusion Both bone sialoprotein and matrix metalloproteinase-9 are highly expressed in the calcified rheumatic group.This suggests that caficify of rheumatic mitral valves is related with the degradation and remodeling of extra cellular matricx by matrix metalloproteinase-9,as well as osteoblastlike bone formation by bone sialoprotein.

Objective To investigate the myocardial protective effects of trimetazidine by observing the changes of peripheral B-type natriuretic peptide (BNP),cardiac troponin I (cTnI) level in patients undergoing off-pump coronary artery bypass graft (OPCAB), and the clinical significance of peripheral cTnI and BNP in cardiac surgery. Methods One hundred and three OPCAB patients were divided into trimetazidine group (52 cases) and control group (51 cases) by random digits table. The serum levels of BNP and cTnI preoperatively,postoperatively of 24 h, 72 h and 7 d were detected. Results The serum levels of BNP [(224.5 ± 12.0), (331.2 ±22.6), (82.4 ±3.3) ng/L] and cTnI [(0.21 ±0.04), (1.32 ±0.49), (0.26 ±0.04) μ g/L] in trimetazidine group were lower than those in control group [(294.7 ± 11.8 ), ( 383.9 ± 28.3 ),( 112.4 ± 12.5 ) ng/L and ( 1.20 ± 0. 13 ), (2.35 ± 0.54), (0.75 :± 0.21 ) μ g/L] postoperatively of 24 h, 72 h and 7 d (P＜ 0.05 ). The serum levels of BNP and cTnI increasedd at 24 h after operation. The peak level was found at 72 h and remained higher level until 7 d after operation. The baseline levels of BNP were positively correlated with cTnI (r = 0.635,P ＜ 0.05), but negatively correlated with left ventricular ejection fraction (LVEF) (r =-0.674,P ＜ 0.01 ). Conclusion Trimetazidine can obviously reduce serum levels of BNP and cTnI in patients undergoing OPCAB. So the united application of serum BNP and cTnI may be as a monitor marker to reflect the cardiac function in patients after OPCAB.

ObjectiveTo observe the expression of bone sialoprotein(BSP) and matrix metalloproteinase-9 (MMP-9) in calcified valves of patients with rheumatic heart disease.MethodsA total of 150 mitral valves which were resected by surgery were divided into rheumatic group ( 120 valves) and nonrheumatic group (30 valves).Immunohistochemical staining was taken by SP method and the expressions of BSP and MMP-9 in two groups were observed and compared.ResultsThe positive expressions of BSP and MMP-9 in rheumatic group were 91.7％(110/120) and 90.8％(109/120),respectively,which were significantly higher than those in non-rheumatic group [23.3％(7/30) and 20.0％(6/30) ](P＜ 0.01 ).Conclusions The expressions of both BSP and MMP-9 are higher in the valves of patients with rheumatic heart disease.The calcification of rheumatic mitral valves is closely related with the degradation and remodeling of extracellular matrix caused by MMP-9,and osteoblast-like bone formation induced by BSP.