主动脉-心室通道的外科治疗

主动脉-心室通道罕见,包括:主动脉-左心室通道和主动脉-右心室通道.主动脉-左心室通道的病理形态最先由Edwards于1957年描述[1],1963年正式命名[2].随着对该疾病的病理生理进一步认识和一些主动脉-右心室通道的临床报道的出现,逐步认识到主动脉和左、右心室之间均可存在异常通道,主动脉-心室通道由Mckay等[3]于2002年正式命名.     

升主动脉成形术中期效果分析

Objective Reduction ascending aortoplasty is an alternative procdure to the replacement of the ascending aorts in case of ascending aorta dilation. However,its applicabikity is still under debate.This retrospective study was designed to evaluuate the midterm follow-up of unsupported ascending reduction aortoplasty for of the ascending aorta in petients with aortic valve dis- ease.Methods From October ,1996 to April,2007, a total of 54 patients with aortic valve disease and dilatation of the ascending aorta underwent unsupported reduction aortoplasty in combination with aortic valve replacement at our institution The diameter of the ascending aorta was measyred before and early after sugery and then later between 13 and 96 menths [mean (23 ±16)months] posto- perativeiy using echocardiography.Results Two patients were dead with thean overall perioperative mortality rate was of 3.7%. The reduction aortoplasty decreased the diameter of the aorta from (45.77±6.02) mm p～eope～afive]y to (34.67 ～4.81) mm early after surgery (P<0.01). During follow-up, the diameter d aorta increased from (34.67±4.81) mm early after surgery to (37.65± 6.35) mm after a mean follow-up of (23±16) months (P<0.01), including the diameters are greater than > 45 mm within 5 pa- tients. Aortic stenosis and an early postoperative diameter greater than 40 mm m'e independent risk factors for redilatation. Conchusion Because of the unsatisfied midterm follow-up redilation of unsupported reduction aortoplasty for dilation of the ascending aorta with aortic valve disease, this group of patients needs continued intimate fallow-up or even reoperation. The patients of stenosis is the surtable indication for RAA, and it is necessary to reduce the diameter of aorta to be lees than 40 mm to prevent redilation.     

微创心脏外科学的概念和发展

心脏外科是一门在20世纪50年代才起步的新兴学科.随着医学的发展,一方面不仅心脏外科技术日趋成熟,另一方面介入治疗等的兴起给心脏外科带来了前所未有的巨大挑战.正是有鉴于此,一种使用有别于传统心脏外科的手术方式,以达到降低手术创伤、加快患者恢复和降低医疗费用为目的新的心脏外科学分支“微创心脏外科”（minimally invasive cardiac surgery,MICS）应运而生,并得到了很大的发展.     

心外医生：挑战与前景

心脏外科向何处去？当国内心内科专家为支架技术泛滥而焦虑时，心外科专家也在为学科发展走向而担忧。专业学科建设与发展是一个极其重要的问题，需要深谋远虑的专家们不断进行认讨论，规划和指引。在此，我们刊出我国心脏外科领域名专家——中国医科院阜外心血管病医院教授胡盛寿教授关于心脏外科目前面临的挑战与未来发展方向的精辟论，希望给大家以启迪。[编按]     

杂交技术与心脏外科的发展

自20世纪50年代Gibbon等为一名房间隔缺损的姑娘施行医学史上第一例成功的体外循环手术以来，心脏外科的发展速度可以说是日新月异。由于基础理论的发展、医用设备、器械和药物品质的改善，外科技术、麻醉和体外循环技术的不断创新进步，心脏外科学的快速发展获得了坚实的基础，人工瓣膜、人工心脏或辅助动力装置、心脏移植、肺移植和心肺移植使许许多多器质性病变严重的患者长期存活；在左心辅助泵的支持下，许多终末期心脏病人延长了生命或获得接受器官移植的机会；在电视胸腔镜下完成各种心胸血管手术，已获得令人满意的效果。用机器人进行手术、远程控制手术开始应用于临床。     

单宁酸处理带瓣牛颈静脉的生物学评价

目的从生物学角度评价单宁酸处理的带瓣牛颈静脉是否符合国家医用材料的要求。方法带瓣牛颈静脉经单宁酸处理后按国家医用材料的要求进行浸提液的制备、细胞毒性试验、过敏试验、皮内刺激试验、原发性皮肤刺激试验、溶血试验、急性全身毒性试验及热原试验等生物学评价试验。试验方法均参照《医用有机硅材料生物学评价试验方法》GB／T16175-1996。结果培养的L-929小鼠成纤维细胞经含浸提液的培养基培养后形态良好，增值旺盛，材料细胞毒性评级为0～1。无皮肤刺激反应和过敏反应，皮内刺激试验PⅡ（原发性刺激指数）为0．4，和阴性对照组差异无统计学意义。全身毒性实验受试动物未出现毒性症状。溶血试验溶血率0．7％，符合国家标准（〈5％）。热原试验经中国药品生物制品检定所检定，单宁酸处理后带瓣牛颈静脉无热原（样品批号：060802017）。结论单宁酸处理的带瓣牛颈静脉符合国家医用材料的要求，可以植入人体。     

Ross术后中远期主动脉瓣反流的危险因素分析

Objective To analyze the risk factors of the postoperative mid- and long-term aortic valvular regurgitation after ROSS procedure(pulmanary valve homograft transplantation). Methods Between March 1998 and July 2007,47 patients[25male, 22 female, mean age (13.31±5.79) years, ronge 1-34 years] with aortic valvular disease underwent the Ross procedure at our insti tution. There were 6 patients suffering fron rheumatic heart disease and 41 patients suffering from congenital heart disease. The aver age aortic blood flow velocity was (4.67±3.47) m/s, the average pressure gradient across aortic valve (88.26±58.06)mm Hg, LVEDD (45.53 ±10.78) mm, EF 0.69±0.08. All the patients were followed up in out-patient departement by ultrasonic cardio gram. Multiple logistic regression analysis was performed to find out the risk factors of the postive aortic valvular regurgitation. Results There was no poetoperative death in hospital. The mean follow-up periods was (36.15±22.1) months, rasnge from 12 to 110 months and none long-dated death. Compared with the data recorded in hospital, the diamenters of the aortic sinus and aortic annu lus enlarged significantly, respectively from (26.16±5.10) mm to (32.37±6.84) tam and from (19.41 ～3.98) mm to (23.45± 5.86) mm. The average flow velocity d the homograft (new aortic valve) was(1.39±0.48) m/s, graclient pressure (8.17+6.16) mm Hg. Mild aortic regurgitstion was present in 5 patients (10.6%), moderate aortic tegmgitafion in 2 pmieats (4.3%) and aevere aortic regurgitation in 1 petient (2.1%). The rate of free from regurgitation was 82.9%. Multiple logistic analyses identified the per esence of bicuspid aortic valve, enlargement of aortic annulus and age above 14 years as the risk factors for posterative aortic regurg itation. Conclusion The Ross procedure is a safe and effective procedure with good clinical results in mid-and long-term follow-up. However, the presence of bicuspid aortic valve, enlargement of aortic annulus and age above 14 years preoperatively were identified as the risk factors for postoperative aortic regurgitation.     

静态与动态下脱细胞猪主动脉瓣种植人成纤维细胞初步研究

目的 探索在脱细胞猪主动脉瓣膜材料上种植人成纤维细胞的方法与效果；材料和方法 采用在脱细胞猪主动脉瓣膜材料上静态与动态种植人成纤维细胞，并对其结果进行比较研究。结果 静态种植不能在猪主动脉瓣叶的两侧形成完整的单层人成纤维细胞融合层；而经过动态种植，在一定条件下可以在猪主动脉瓣叶两侧形成完整的单层人成纤维细胞融合层；结论 动态种植较之静态种植易达到形成完整均匀的细胞种植效果。     

心室辅助装置治疗心力衰竭现状和未来思考

心力衰竭(心衰)是目前心血管疾病领域唯一呈增长趋势的疾病, 全球范围内已成为日益严重的医疗负担, 对医疗保健系统产生重大影响[1]。流行病学资料显示, 成年人群心衰患病率为1%～2%, 而 70 岁以上人群中可达10% 以上, 全球范围内有近2200万心衰患者[2]。我国人口基数大, 成年心衰患者约有890万, 患病率特点北方高于南方, 男性多于女性, 城市高于农村[3]。为改善症状和提高生存率, 利尿药、β受体阻滞剂及血管紧张素转化酶抑制剂(angiotensin converting enzyme inhibitor, ACEI)类药物是早期心衰的首选内科治疗手段。由于现有药物靶点并未逆转心肌重构, 仍有10%心衰患者进展到终末期, 表现为生活质量差、反复住院和死亡率高的特点[4]。如发展为急性心衰、慢性心衰失代偿期或合并心原性休克, 住院死亡率可高达50%[5]。心脏移植是心衰患者治疗的"金标准", 但如合并肿瘤、肥胖、高龄、肾功能不全或肺动脉高压, 每年有移植适应证患者是实际接受移植的3倍。由于供体来源的受限, 候选移植心衰患者等待期间死亡率可达21.7%[6]。心室辅助装置(...     

心肌再血管化机制的对比实验研究

目的观察研究钬激光和True-cut活检针心肌再血管化近、远期的机制和效果。方法利用经静脉注射造影剂对犬缺血心肌模型进行心肌超声微泡造影。结果部分结扎犬的冠状动脉前降支,建立缺血模型后,缺血区超声微泡密度明显降低,分别用2种方法再血管化后,2组犬缺血区超声微泡密度较缺血时均明显增加,接近其缺血前的微泡密度;再血管化区超声微泡较其他部位提前显影。远期超声微泡检查显示心肌灌注较急性缺血时也有一定改善。结合组织学方法发现,远期心肌灌注的改善得益于隧道周围新生循环结构如心肌窦和新生血管的增加。结论钬激光和True-cut活检针隧道均可即刻使缺血心肌灌注改善,并逐渐闭塞,新生循环结构使缺血区得到有限的灌注。应用新一代经静脉注射造影剂超声心肌微泡造影结合组织学方法可作为研究心肌再血管化机制的可靠手段。