Summary： The effects of L-carnitine, as an ingredient of cardioplegia solution, on cardiac function and cardiomyocyte apoptosis in patients undergoing heart valve replacement operation were investigated. Twenty-three...Summary： The effects of L-carnitine, as an ingredient of cardioplegia solution, on cardiac function and cardiomyocyte apoptosis in patients undergoing heart valve replacement operation were investigated. Twenty-three cases undergoing heart valve replacement with cardiopulmonary bypass （CPB） were randomly allocated into two groups： L-carnitine group （n=12, 12 g/L L-carnitine was put in the ST. Thomas cardioplegia） and control group （n=11, identical to the L-carnitine group except that normal saline was administered instead of L-carnitine）. Serum cardial troponin I （cTnI） levels, the left ventricular ejection fraction （LVEF）, and cardiac index （CI） were measured perioperatively. A bit of myocardial tissue obtained from right atria was taken before CPB and by the end of intracardiac procedure to undergo electron microscopy examination and estimate apoptosis by terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling （TUNEL）. From the end of CPB to 3 days after operation, the serum levels of cTnI in the L-carnitine group was significantly lower than that in the control group （P〈0.05）. Heart color ultrasonogram showed that the CI index and LVEF at 7th day postoperatively in the L-carnitine group were significantly higher than in the control group （P〈0.05）. Compared to the control group, L-carnitine significantly alleviated the morphologic changes of cardiac muscle cells （electron microscopy examination） and decreased the amounts of apoptotic cardiac muscle cells （TUNEL）. Furthermore, the dosage of vasoactive drugs used after operation was significantly less in the L-carnitine group （P〈0.01）. It was concluded that L-carnitine cardioplegia solution could improve cardiac function in patients undergoing heart valve replacement operation and alleviate CPB-mediated apoptosis of cardiac muscle cells.展开更多
Left ventricular contractility was measured using Doppler echocardiography in 37 pa-tients with rheumatic mitral valve disease.Myocardial pathological lesions were studied quanti-tatively by means of the image analysi...Left ventricular contractility was measured using Doppler echocardiography in 37 pa-tients with rheumatic mitral valve disease.Myocardial pathological lesions were studied quanti-tatively by means of the image analysis system and light microscopic examination.The resultsshowed that attenuated cardiac function is due to pathological change of the mitral valve andpathological lesions of the left ventrieular myocardium including increased interstitial fibrosis,thickened intramyocardial arterial wall leading to concentric narrowing of the lumen,hyper-trophic myocardial fiber and endocardial proliferation.Since mitral valve replacement can notcorrect the irreversible myocardial pathological lesions,perioperative protection of the my-ocardium should be emphasized,and intraoperative injury to the myocardium should be mini-mized as far as possible.展开更多
Objective： To summarize the clinical experiences of 21 patients treated with tricuspid valve replacement （TVR） and investigate the surgical indications and methods. Methods： Data from 21 patients who underwent TVR...Objective： To summarize the clinical experiences of 21 patients treated with tricuspid valve replacement （TVR） and investigate the surgical indications and methods. Methods： Data from 21 patients who underwent TVR from December 2002 to March 2009 were retrospectively collected and analyzed. The mean age was 48.86± 15.37 years （range： 20-72 years）. The underlying disease of the patients was classified as rheumatic （n = 10）, congenital （n = 8）, endocarditis （n = 2） or chest trauma （n = 1）. Previous cardiac surgery had been performed in 12 patients （57.14%）. Results： In-hospital death occurred in two patients （9.52%）. Postoperative morbidities included cardiac failure （n = 2）, bleeding related re-operation （n = 1）, and plural effusion （n = 2）. Conclusion： The early outcomes of TVR were acceptable. At the present time TVR can be performed through optimal perioperative management.展开更多
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...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.展开更多
文摘Summary： The effects of L-carnitine, as an ingredient of cardioplegia solution, on cardiac function and cardiomyocyte apoptosis in patients undergoing heart valve replacement operation were investigated. Twenty-three cases undergoing heart valve replacement with cardiopulmonary bypass （CPB） were randomly allocated into two groups： L-carnitine group （n=12, 12 g/L L-carnitine was put in the ST. Thomas cardioplegia） and control group （n=11, identical to the L-carnitine group except that normal saline was administered instead of L-carnitine）. Serum cardial troponin I （cTnI） levels, the left ventricular ejection fraction （LVEF）, and cardiac index （CI） were measured perioperatively. A bit of myocardial tissue obtained from right atria was taken before CPB and by the end of intracardiac procedure to undergo electron microscopy examination and estimate apoptosis by terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling （TUNEL）. From the end of CPB to 3 days after operation, the serum levels of cTnI in the L-carnitine group was significantly lower than that in the control group （P〈0.05）. Heart color ultrasonogram showed that the CI index and LVEF at 7th day postoperatively in the L-carnitine group were significantly higher than in the control group （P〈0.05）. Compared to the control group, L-carnitine significantly alleviated the morphologic changes of cardiac muscle cells （electron microscopy examination） and decreased the amounts of apoptotic cardiac muscle cells （TUNEL）. Furthermore, the dosage of vasoactive drugs used after operation was significantly less in the L-carnitine group （P〈0.01）. It was concluded that L-carnitine cardioplegia solution could improve cardiac function in patients undergoing heart valve replacement operation and alleviate CPB-mediated apoptosis of cardiac muscle cells.
基金Supported by the Youth Foundation of the General Logistics Department of PLA
文摘Left ventricular contractility was measured using Doppler echocardiography in 37 pa-tients with rheumatic mitral valve disease.Myocardial pathological lesions were studied quanti-tatively by means of the image analysis system and light microscopic examination.The resultsshowed that attenuated cardiac function is due to pathological change of the mitral valve andpathological lesions of the left ventrieular myocardium including increased interstitial fibrosis,thickened intramyocardial arterial wall leading to concentric narrowing of the lumen,hyper-trophic myocardial fiber and endocardial proliferation.Since mitral valve replacement can notcorrect the irreversible myocardial pathological lesions,perioperative protection of the my-ocardium should be emphasized,and intraoperative injury to the myocardium should be mini-mized as far as possible.
文摘Objective： To summarize the clinical experiences of 21 patients treated with tricuspid valve replacement （TVR） and investigate the surgical indications and methods. Methods： Data from 21 patients who underwent TVR from December 2002 to March 2009 were retrospectively collected and analyzed. The mean age was 48.86± 15.37 years （range： 20-72 years）. The underlying disease of the patients was classified as rheumatic （n = 10）, congenital （n = 8）, endocarditis （n = 2） or chest trauma （n = 1）. Previous cardiac surgery had been performed in 12 patients （57.14%）. Results： In-hospital death occurred in two patients （9.52%）. Postoperative morbidities included cardiac failure （n = 2）, bleeding related re-operation （n = 1）, and plural effusion （n = 2）. Conclusion： The early outcomes of TVR were acceptable. At the present time TVR can be performed through optimal perioperative management.
基金ThisworkwassupportedbyagrantfromtheGuangxiProvincialEducationCommittee (No 95 0 62 )
文摘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.
