Objective To report the outcome of surgical treatment of prosthetic valve endocarditis (PVE). Methods From 1990 to Aug 2003, 21 patients with PVE were operated on, including 5 acute PVE and 16 subacute PVE. Blood culture was positive in 13 cases. Echocardiographic findings showed aortic and mitral valve leakage in 6 and 3 cases respectively. Aortic and mitral vegetation was found in 3 and 5 cases, respectively. Mechanical valve was used to replace mitral valve in 11 cases, aortic valve in 10 cases. Ascending aortic false aneurysm was resected, and ascending aorta repaired in one case. Vegetations were found in all cases, mitral annulus abscess in 7 cases and myocardial abscess in 3, aortic annulus abscess in 8 and myocardial abscess in 4. Results There were 5 early-death, 3 due to recurrence of infection, 2 due to multiorgans failure. One late death was due to fungus infection. The survivors were followed up from 4 months to 13 years, one case had recurrence of PVE and died after ineffective medical treatment. Conclusion Early diagnosis of PVE, optimal timing of surgery, radical debridement of infected tissue, and utilizing sensitive and high dose of antibiotics perioperatively, are the key factors to improve the surgical outcome.

BACKGROUND: Cell transplantation is a new technique to treat myocardial ischemic diseases in recent years. There are not many reports regarding smooth muscle cell(SMC) transplantation at moment.OBJECTIVE: To investigate the impact of autologous SMC transplantation on the survival and the restoration of cardiac function after myocardial infarct.DESIGN: An observatory comparative study based on experimental animals.SETTING: Institute of cardiothoracic surgery in a military medical university of Chinese PLA.MATERIALS: The study was conducted in the Institute of Cardiothoracic Surgery of the Second Military Medical University of Chinese PLA from January 2003 to June 2003. Totally 24 male adult SD rats in cleanness grade with a body mass of(300 ± 20) g were randomly divided into two groups,i. e. ,transplant group and control group with 12 rats each. All rats were fed in clean environment.METHODS: Autologous SMC was separated and extracted from the ductus deferens of SD rats by enzymic digestion for culture and amplification in vitro. BrdU-labeled autologous SMC was directly injected into the scarring tissues of cardiac infarct area induced by the ligation of anterior descending branch of left coronary artery 2 weeks ago in rats of transplant group. DMEM culture medium of same volume was injected into the rats of control group. Cardiac function was evaluated by ultrasound examination before and 4 weeks after transplantation. The survival of the transplanted SMC and its effect of vasoformation in myocardial scarring tissues were detected by immunohistochemical staining.soformation in myocardial scarring area after autologous SMC transplantation;after transplantation.RESULTS: Transplanted autologous SMC survived and formed muscle-like tissues in myocardial infarct area. Compared with control group, left ventricnlar end diastolic volume(LVEDV) of transplant group was significantly reduced( P < 0.01), left ventricular ejection fraction(LVEF) was significantly elevated( P < 0.01 ), and the vasoformation in myocardial scarring tissue was significant( P < 0.01 ).CONCLUSION: Autologous SMC transplantation can prevent ventricle enlargement after myocardial infarct, promote vasoformation in infarct area, and ameliorate cardiac function.

Objective:To investigate the effects of transplanting autologous smooth muscle cells on cardiac function after cardiac infarction. Methods:Autologous smooth muscle cells were isolated from the ductus deferens of SD rats, and cultured for 4 weeks before transplantation. Two weeks after the left coronary artery ligation, the cultured cells(4?10 6), labeled with 5 bromo 2' deoxyuridine(BrdU), were transplanted into the scar tissue in the left ventricular free wall by direct injection(transplant group, n =12). Control group were treated with culture medium alone(control group, n =12). Heart function was assessed by echocardiography 2 weeks after the left coronary artery ligation and 4 weeks after cell transplantation. Then the hearts were immunohistochemically processed using monoclonal antibodies against ? smooth muscle actin and BrdU for the identification of transplanted smooth muscle cells. Vascular endothelial cells were stained for factor Ⅷ using monoclonal antibodies. The blood vessels were counted on the tissue sections under light microscope. Results:The injected autologous smooth muscle cells survived in the infarcted scar tissue and formed muscle like tissue at the site of transplantation 4 weeks later. Left ventricular end diastonic volume(LVEDV) decreased [(0.78?0.16) vs (0.92?0.15) ml, P

Objective: To assess the hydrodynamic performance of C L pugestrut valve prosthesis in vitro . Methods: The leakage, steady flow and pulsatile flow of the valve prosthesis was tested in vitro with the C L standard valve and Medtronic Hall valve prosthesis as control. Results: The rate of leakage of the C L pugestrut valve was (298?66) ml/min, accorded with the demand of clinical use. The steady flow pressure drop across the C L pugestrut valve was significantly lower than the C L standard valve( P

Objective To investigate the feasibility in improving the heart function by smooth muscle cells transplantation into the ischemic myocardium model established by coronary artery ligation. Methods Myocardial infarct was produced by ligation of the left coronary artery. At 2 weeks after establishment of myocardial infarct, cultured fetal rat gatric smooth muscle cells marked with BrdU were transplanted into the ischemic myocardium by direct injection (transplantation group, n=10), or culture medium alone (control group, n=10). Heart function was assessed by echocardiography before and at 4 weeks after transplantation. At 4 weeks after transplantation, the hearts were harvested. The transplanted smooth muscle cells were assessed by immunostaining against BrdU and ?-SMA. Results The injected fetal smooth muscle cells survived in the infarcted regions and formed muscle-like tissues at the site of transplantation at 4 weeks after transplantation. The grafts thickened the wall of the left ventricle [(2.51?0.22) mm vs (1.32?0.16) mm, P

Objective The long-term effects of cell transplant on cardiac function are unknown. Therefore, we tested the survival and functional impact of rat autologous smooth muscle cells up to 12 weeks after transplant into infracted hearts. Methods Autologous smooth muscle cells were acquired from the ductus deferens of adult Sprague-Dawley rats(weight,300g), and cultured for 4 weeks before transplant. 4 weeks after left coronary artery ligation, the cultured cells(4?10 6 , n=10), marked with 5-bromo-2'-deoxyuridine(BrdU), or culture medium alone(n=10) were injected directly into infarcts of the heart. Cardiac function was assessed by echocardiography before and 12 weeks after transplantation. BrdU in the cells and smooth muscle cells were identified by immunohistochemical staining technique using monoclonal antibodies against BrdU and ?-smooth muscle actin. Results Grafted autologous smooth muscle cells were presented in infarcts and formed musclelike tissue. They thickened the wall of the left ventricle〔(2.36?0.31) vs (1.03?0.11)mm,P

BACKGROUND: Secretion of various neurotrophic factors by Schwann cells plays important roles in neural regeneration. However, the secretion capability is affected by many factors. To seek a feasible method for promoting nerve growth factor secretion by Schwann cells is a key of regeneraion following neurologic defect.OBJECTIVE: To explore the effects of methylprednisolone(solu-medrol) on the secreted function of Schwann cells of cultured rats.METHODS: Schwann cells were isolated and cultured by enzyme digestion method. Cell growth was observed under an inverted phase contrast microscope. Following passage, purity of some Schwann cells was identified using S-100 protein immunity. Other Schwann cells were regulated using cell counting plate into 1×10~9/L, and incubated in a 6-well culture plate (15 wells) for further incubation. Following 4 days of culture, different concentrations of solu-medrol (10~(-3), 10~(-4), 10~(-6), 10~(-8) mol/L) were administrated to the cell, while blank control group (1 well) was given no drug. 24, 48 and 72 hours after administration, reverse trancription-polymerase chain reaction (RT-PCR) was used in the detection of the levels of nerve growth factor mRNA.RESULTS AND CONCLUSION: Number of primarily cultured cells was significantly increased at day 7, and 80% cells were confluent. Subcultured cells were spindle-shaped, with 2 thin long processes, showing positive fluorescence staining. Fibroblasts were round or flat, showing negative reaction of fluorescence staining. Reserve transcription-polymerase chain reaction demonstrated that nerve growth factor number at 72 hours affected by 10~(-8) mol/L radiosone was increased compared with the blank control group and other concentrations and other time points (P < 0.05). Number of nerve growth factor was reduced following treatment of 10~(-3) mol/L radiosone compared with the blank control group and other concentrations (P < 0.05). These results suggested that high concentration of solu-medrol prohibits secreted function of Schwann's cells, but long time and low dosage solu-medrol promotes secreted function of Schwann's cells.

Objective To investigate the surgical technique and clinical outcomes of reconstruction of the annulus and the intervalvular fibrous body during valve replacements. Methods Fifty-nine patients underwent reconstruction of the annulus or the intervalvular fibrous body during the valve replacement. Indications for the operation were small aortic annulus which may cause patient/prosthesis mismatch in 43, active infective endocarditis with the abscess in the periannulus tissue in 13, extensive calcification of the aortic annulus in 2 and an active bleeding complication of the aortic root after aortic and mitral valve replacement in 1. The reconstruction was done with fresh autologous pericardium. Results The aortic clamping time in reconstruction of the intervalvular fibrous body with double valve replacement was longer than that of the regular double valve replacement. Four patients died in the perioperative period, giving an overall in- hospital mortality of 6.7%. Postoperative complication were: re-sternotomy for bleeding in 2, Ⅲ degree A-V block in 2, respiratory dysfunction in 2, and acute renal failure in 2. Patients were followed up for 6 months by echocardiography study, and no periannular leakage was found. Conclusion Reconstruction of the annulus is an effective technique for patients with a small aortic annulus, extensive calcification of the interventricular fibrous body and active infective endocarditis with abscess. Although the operative procedure is challenging and taking more time, the technique is safe and reproducible.

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 explore the effect of exercise preconditioning (EP) on pathological cardiac hypertrophy and heart failure (HF) in pressure over-loaded experimental rats.
Methods:A total of 60 SD rats at the age of 6 weeks were randomly divided into 3 groups, n=20 in each group. Sham-operation group, Transverse aortic constriction (TAC) group and EP + TAC group. The cardiac function and structure were evaluated by echocardiography, patholgical changes and HF biomarkers were examined for EP effect at 4 and 8 weeks after TAC.
Results:Compared with Sham-operation group, the cardiac function and structure had obvious changes in the other 2 groups. Compared with TAC group, the ejection fraction in EP+ TAC group increased 15%, the heart weight index and left ventricular weight index decrease 15.7%and 20%respectively at 8 weeks after TAC, all P<0.05. Compared with Sham-operation group, the mRNA and protein expressions of ANP and BNP increased in TAC group at 4 and 8 weeks after TAC, increased in EP+TAC group at 8 week after TAC. Compared with TAC group, the mRNA expressions of ANP and BNP in EP+TAC group decreased 47%and 62%at 4 weeks after TAC, decreased 44%and 28.1%at 8 weeks after TAC, all P<0.05;the protein expression of ANP and BNP in EP+TAC group decreased 22.3%and 48%at 4 weeks after TAC, decreased 21.5%and 38.3%at 8 weeks after TAC, all P<0.01.
Conclusion: EP may improve cardiac pathological hypertrophy in pressure over-loaded rats at the early stage, and delay the heart failure process.