In the human heart there is a sequential contraction of the systemic veins, systemic venous sinus and the pectinated right atrium, 'the systemic waltz', and sequential contraction of the pulmonary veins, pulmonary venous sinus and pectinated left atrium, 'the pulmonary waltz'. The systemic veins contract earlier than the pulmonary veins creating a 'duet. We hypothesise that this waltz and duet point to a complex extracardiac control of the cardiac rhythm on a beat-to-beat neural basis. 相似文献
Background: There is an increasing tendency towards minimally invasive valve surgery and various surgical techniques have been proposed to realise this goal. The aim of the present study was to describe our current surgical technique and clinical experience with respect to an endoscopic technique that allows the surgeon to perform an operation through a series of small intercostal ports.
Methods: After a learning experience with thoracoscopic left internal mammary to left anterior descending coronary artery bypass surgery, we adopted the endocardiopulmonary bypass technique to perform mitral valve surgery. The technique requires exclusive use of video-assisted surgery and control by transoesophageal echocardiography (TEE). Surgery requires long instruments and extra-corporeal knot tying. Between February 1997 and November 2001, 259 patients were operated on. Mitral valve repair was performed in 190 of them. One patient had a redo procedure using this approach to correct a paravalvular leak, but all other procedures were primary interventions.
Results: In all patients, surgery was performed using a 2 inch working port and two additional half-inch trocar-ports. Five patients required a conversion to median sternotomy: three because of inadequate size of the femoral vessels and two because of intraoperative aortic dissection. Hospital mortality included two patients, and seven patients required late reoperation (four of these were as a result of endocarditis).
Conclusions: Endoscopic mitral valve surgery is demanding, but feasible. Once the appropriate skills are acquired, both patient and surgeon can enjoy the benefits of this exciting new technique. 相似文献
Coeliac disease associated with cutaneous sarcoidosis granuloma.Coeliac disease can be associated with numerous internal, skin and mucosa involvments: their physiopathology is often obscure. We report the case of a 14-year old female patient who suffered from a coeliac disease diagnosed in 1988 with considerable improvement with a gluten-free diet. Her two daughters also presented coeliac disease and her sister suffered from nevoid basal cell carcinoma syndrome. Four years later, she presented non pruriginous small nodules over both lower extremities. Skin biopsy revealed a non-caseating granuloma into the derm: we only could evocate sarcoidosis affecting the skin. The dermatological lesions improved during the following weeks with a gluten free diet and relapsed each time this diet was stopped. Many clinical associations with coeliac disease have been described with numerous visceral and skin-mucosa involvments. Eight cases of coeliac disease associated with sarcoidosis affecting the lung have been reported: in five cases, coeliac disease preceded sarcoidosis and in one case sarcoidosis relapsed each time gluten was reinlroduced like in our case. This two diseases seem to share immunological and genetic disturbances.相似文献
Cardiovascular diseases are common in ageing communities globally. This fact is most striking in the industrialised world where the aged population makes up a large proportion of society. Elderly patients are frequently treated surgically with grafts to replace damaged tissues and vessels. The number of human-donated components is insufficient and synthetic surrogates are sought. These might be wholly mechanical, wholly biological, or tissue engineered complexes of cells and their products growing in a scaffold. At present, many such composites exist with potential for use as substitutes for specific blood vessels. The challenges of producing tissue engineered heart valves are now being widely explored. Neotissues must provide an effective, durable, non-thrombogenic and non-immunogenic substitute that will fulfil the purpose of the natural tissue. The aims and scope of this paper are to review current and novel concepts in the field of tissue engineering of biological cardiovascular system surrogates. Mechanical stresses and strains on cardiovascular cells in vitro have been recognised and can be measured by a culture force monitor. Physiological stresses can be generated by a tensioning culture force monitor and applied to engineered tissue, aligning the cells and mimicking arterial wall architecture. The hydrostatic forces a vessel experiences and mechanical parameters of blood vessels can be studied in the tubular culture system of a multi-cue bioreactor. 相似文献