1例53岁急性Stanford A型主动脉夹层合并脑梗塞昏迷女患者，在严格控制血压和心率、脱水降颅压、密切监测有无心包积液、有无重度主动脉瓣关闭不全的基础上，等待接近2个月后行孙氏手术治疗，术中采用双侧脑灌注，术后顺利转出重症监护室并出院，随访1年，左侧肌力恢复3~4级，可独立行走。急性Stanford A型主动脉夹层合并脑灌注不良表现为颈总动脉假腔血栓压迫或真腔严重受阻的患者，在严格控制血压、心率的基础上可密切观察患者神志、四肢活动、心包积液、主动脉瓣启闭的综合判断下积极行手术治疗，术后加强呼吸道管理、营养支持、康复训练基础上，患者可获得满意的临床预后结局。

BACKGROUND:Acute type A aortic dissection complicated by limb malperfusion presents a risk of mortality to the patients. Debates exist regarding management, whether focused on reperfusion first or immediate repair. Here, we aimed to describe our experience with the management of acute type A aortic dissection (ATAAD) complicated by limb malperfusion.METHODS:From January 1, 2020 to December 31, 2021, 22 consecutive patients were admitted to Xiamen Cardiovascular Hospital, due to acute type A aortic dissection complicated by limb malperfusion. All perioperative variables were recorded and analyzed. Limb malperfusion was diagnosed, according to the clinical symptoms, computed tomography angiography, and laboratory test. We adopted the clinical categories of acute limb ischemia to stratify severity of limb ischemia. Surgery strategies are as follows: Reperfusion first followed by central repair, immediate central repair, and immediate central repair followed by stenting.RESULTS:There were 21 males and one female with an average of 53.3±11.7 years. Management strategies were as follows: immediate central repair using total arch replacement with frozen elephant trunk in 15 patients, endovascular stenting followed by central repair in four patients, and endovascular stenting after central repair in two patients. The average extracorporeal circulation time was 258.8 ± 70.5 min; the average aortic cross-clamp time was 177.9 ± 54.2 min; and the average circulatory arrest time was 45.5 ± 13.1 min. The early mortality rate was 13.6% (3/22). Two patients left the hospital voluntarily, due to cerebral infarction and bleeding. One patient underwent fasciotomy for osteofascial compartment syndrome and uneventfully was discharged. Six patients underwent continuous renal replacement therapy and hemoperfusion.CONCLUSION:Central repair is safe and feasible for ATAAD complicated with limb malperfusion. For serious limb malperfusion, endovascular stenting followed by central repair is a good choice with continuous renal replacement therapy (CRRT) and hemoperfusion. Hospital mortality rate is high in cases with multiple organ malperfusion.

Postoperative myocardial infarction (POMI) in acute type A aortic dissection rarely has been reported, we report a case of postoperative myocardial infarction in acute type A aortic dissection, and the clinical presentation and possible mechanisms are described. This case illustrates that postoperative myocardial infarction in acute type A aortic dissection is a rare fatal complication in patients without coronary lesions or coronary malperfusion before aortic repair. Type 2 myocardial infarction may account for POMI. Effective treatment may include anticoagulation therapy, volume adjustment, blood pressure support, administration of blood products, heart rate control, and individualized respiratory support.

Context Concanavalin A (Con A) exhibited multiple roles in cancer cells. However, the role of Con A in endothelial cells was not reported. Objective Our present study investigated the potential angiogenic role of Con A in endothelial cells and ischaemic hind-limb mice. Materials and methods Human umbilical vein endothelial cells and Ea.hy926 cells were employed to determine the effect of Con A (0.3, 1, and 3 mu g/mL) or vehicle on angiogenesis and cell proliferation with tube formation, ELISA, flow cytometry, EdU, and western blot. Hind-limb ischaemic mice were conducted to determine the pro-angiogenic effect of Con A (10 mg/kg) for 7 days. Results Con A promoted tube formation to about three-fold higher than the control group and increased the secretion of VEGFa, PDGFaa, and bFGF in the medium. The cell viability was promoted to 1.3-fold by Con A 3 mu g/mL, and cell cycle progression of G0G1 phase was decreased from 77% in the vehicle group to 70% in Con A 3 mu g/mL, G2M was promoted from 15 to 19%, and S-phase was from 7 to 10%. Con A significantly stimulated phosphorylation of Akt and ERK1/2 and expression of cyclin D1 and decreased the expression of p27. These effects of Con A were antagonised by the PI3K inhibitor LY294002 (10 mu M) and MEK pathway antagonist PD98059 (10 mu M). Moreover, Con A (10 mg/kg) exhibited a repair effect in ischaemic hind-limb mice. Discussion and conclusions This study will provide a new option for treating ischaemic disease by local injection with Con A.

Objectives:Most patients with acute aortic dissection (AAD) have a history of hypertension. Diagnosis of AAD in patients with hypertension at an early stage is complicated and challenging. This study aimed to explore the distinctive metabolic changes in plasma samples of AAD patients with hypertension and patients with hypertension only and provide early identification and diagnosis of AAD in patients with hypertension.Materials and methods:We collected blood samples from 20 patients with type A AAD and hypertension admitted to the emergency department and physically examined other 20 patients with hypertension as controls. The plasma metabolomic profiles of these patients were determined using untargeted metabolomics with ultra-high-performance liquid chromatography-quadrupole time-of-flight mass spectrometry.Results:A total of 38 metabolites that differed between the AAD and hypertension groups were screened. In the positive ion mode, 12 metabolites were different between the two groups, and in the negative ion mode, 26 metabolites were different. Among the 26 different metabolites detected by the negative ion mode, 21 were significantly upregulated and five were downregulated in patients with AAD compared to patients with hypertension. Moreover, five metabolites were upregulated and seven were significantly downregulated in patients with AAD compared to those with hypertension, as detected by the positive ion mode. The metabolites differentially expressed in AAD were mainly involved in lipid metabolism (fatty acid biosynthesis, biosynthesis of unsaturated fatty acids, and linoleic acid metabolism), carbohydrate metabolism (galactose, fructose, and mannose metabolisms), and membrane transport (ATP-binding cassette transporters). Interestingly, plasma hydrocortisone and dimethylglycine concentrations were significantly increased in patients with type A AAD, with the highest area under the curve value (AUC = 0.9325 or 0.9200, respectively) tested by the receiver operating characteristic curve analysis.Conclusion:This study provides possible metabolic markers for the early clinical diagnosis of AAD in patients with hypertension.

Background Multiple miRNAs were reported to be associated with sarcoplasmic reticulum Ca 2+ -ATPase (SERCA2a) in mediating the process of heart failure. However, whether these miRNAs are relevant to chronic heart failure (CHF) is rarely reported. Methods This study was designed to explore a new biomarker from the SERCA2a related candidate miRNAs for CHF. A total of 195 blood samples from 84 CHF patients, 86 non-heart failure patients and 25 healthy subjects were collected. The circulating expression of SERCA2a related candidate miRNAs (let-7a-5p, miR-24-3p, miR-25-3p, miR-133a-3p, miR-137a-3p, miR-140-3p, miR-141-3p, miR-142-3p, miR-148a-3p, and miR-153-3p) were detected with qRT-PCR. The area under curve value, correlations between miRNAs and NT-proBNP were applied to determine the relationship between CHF and the candidate miRNAs. Results The results showed among the 10 candidate miRNAs, only let-7a-5p, miR-25-3p, and miR-140-3p were significantly increased of CHF patients. However, only miR-140-3p showed the high area under the curve (AUC) value (ROC = 0.8873) and strong positive correlations (r = 0.5113) between miR-140-3p levels and NT-proBNP concentration. The level of miR-140-3p in LVEF < 45% of CHF patients was higher than in LVEF > 45%. However, there was no significant difference between hypertension and non-hypertension of the levels of miR-140-3p in CHF patients. Interestingly, the level of miR-140-3p was higher in NYHA IV CHF patients than in NYHA II or III. More important, the miR-140-3p level also declined when the heart function of NYHA IV patients was improved after treatment. Conclusions These results indicated circulation levels of miR-140-3p is related to the severity of chronic heart failure, and miR-140-3p may be an important biomarker for heart failure with reduced ejection fraction.

Background Previous studies have demonstrated that human cardiac c-Kit(+) progenitor cells (hCPCs) can effectively improve ischemic heart disease. However, the major challenge in applying hCPCs to clinical therapy is the low survival rate of graft hCPCs in the host heart, which limited the benefit of transplanted hCPCs. Bradykinin (BK) is a principal active agent of the tissue kinin-kallikrein system. Our previous studies have highlighted that BK mediated the growth and migration of CPCs by regulating Ca2+ influx. However, the protective effect of BK on CPCs, improvement in the survival rate of BK-pretreated hCPCs in the infarcted heart, and the related mechanism remain elusive. Methods HCPCs were treated with H2O2 to induce cell apoptosis and autophagy, and different concentration of BK was applied to rescue the H2O2-induced injury detected by MTT assay, TUNEL staining, flow cytometry, western blotting, and mitoSOX assays. The role of autophagy in the anti-apoptotic effect of BK was chemically activated or inhibited using the autophagy inducer, rapamycin, or the inhibitor, 3-methyladenine (3-MA). To explore the protective effect of BK on hCPCs, 3-MA or BK-pretreated hCPCs were transplanted into the myocardial infarcted rats. An echocardiogram was used to determine cardiac function, H&E and Masson staining were employed to assess pathological characteristics, HLA gene expression was quantified by qRT-PCR, and immunostaining was applied to examine neovascularization using confocal microscopy. Results The in vitro results showed that BK suppressed H2O2-induced hCPCs apoptosis and ROS production in a concentration-dependent manner by promoting pAkt and Bcl-2 expression and reducing cleaved caspase 3 and Bax expression. Moreover, BK restrained the H2O2-induced cell autophagy by decreasing LC3II/I, Beclin1, and ATG5 expression and increasing P62 expression. In the in vivo experiment, the transplanted BK- or 3-MA-treated hCPCs were found to be more effectively improved cardiac function by decreasing cardiomyocyte apoptosis, inflammatory infiltration, and myocardial fibrosis, and promoting neovascularization in the infarcted heart, compared to untreated-hCPCs or c-kit(-) cardiomyocytes (CPC- cells). Conclusions Our present study established a new method to rescue transplanted hCPCs in the infarcted cardiac area via regulating cell apoptosis and autophagy of hCPCs by pretreatment with BK, providing a new therapeutic option for heart failure.

Abstract Background Acute Stanford type A aortic dissection is often fatal, with a high mortality rate and requiring emergency intervention. Salvage surgery aims to keep the patient alive by addressing severe aortic regurgitation, tamponade, primary tear, and organ malperfusion and, if possible, prevent the late dissection-related complications in the proximal and downstream aorta. Unfortunately, no optimal standard treatment or technique to treat this disease exists. Total arch replacement with frozen elephant trunk technique plays an important role in treating acute type A aortic dissection. We aim to describe a modified elephant trunk technique and report its short-term outcomes. Methods From February 2018 to August 2019, 16 patients diagnosed with acute Stanford type A aortic dissection underwent surgery with the modified frozen elephant trunk technique at Xiamen Heart Center (male/female: 9/7; average age: 56.1 ± 7.6 years). All perioperative variables were recorded and analyzed. We measured the diameters of the ascending aorta, aortic arch, and descending aorta on the bifurcation of the pulmonary and abdominal aortas and compared the diameters at admission, before discharge, and 3 months after discharge. Results Fifteen patients (93.8%) had hypertension. The primary tears were located in the lesser curvature of the aortic arch and ascending aorta in 5 (31.3%) and 9 patients (56.3%), respectively, and no entry was found in 2 patients (12.5%). The dissection extended to the iliac artery and distal descending aorta in 14 (87.6%) and 2 patients (12.5%), respectively. The duration of cardiopulmonary bypass (CPB), cross-clamping, and antegrade cerebral perfusion were 215.8 ± 40.5, 140.8 ± 32.3, and 55.1 ± 15.2 min, respectively. Aortic valve repair was performed in 15 patients (93.8%). Bentall procedure was performed in one patient (6.3%). Another patient received coronary artery repair (6.3%). The diameters at all levels were greater on discharge than those on admission, except the aortic arch. After 3 months, the true lumen diameter distal to the frozen elephant trunk increased, indicating false lumen thrombosis and/or aortic remodeling. Conclusions The modified frozen elephant trunk technique for acute Stanford type A aortic dissection is safe and feasible and could be used for organ malperfusion. Short-term outcomes are encouraging, but long-term outcomes require further investigation.

Abstract Objective The percutaneous closure of a single secundum atrial septal defect (ASD) under transesophageal echocardiography guidance as an accepted alternative to the transcatheter closure with fluoroscopy has been proven. However, the technique has not been routinely used. This study was to present and share our experience in comparing the clinical outcomes of the percutaneous and intra-operative device closure (IODC) of atrial septal defects without fluoroscopy. Methods From January 2013 to December 2016, 103 patients with maximum diameters of ASD of less than 30 mm were allocated to groups taking either the percutaneous closure of atrial septal defects approach (PASD group, n = 53) or the intra-operative device closure approach (IODC Group, n = 50). They were operated on using the minimally invasive Amplatzer duct occluder under the guidance of transesophageal echocardiography without cardiopulmonary bypass. Echocardiography was performed to obtain an en face view of the ASD and important surrounding structures before the operation. Patient characteristics, perioperative data, and follow-up data were retrospectively documented and analyzed. Results Patient characteristics were comparable between the two groups. These were no differences in the maximum diameters of defects and the size of the occluders in each group (16.4 ± 5.3 mm vs16.4 ± 5.2 mm, P = 0.98; 22.4 ± 5.8 mm vs 21.3 ± 6.6 mm, P = 0.38). Intracardiac manipulation time was 20.72 ± 7.70 min in the PASD group and 6.01 ± 1.03 min in the IODC group (P < 0.001). The procedure time was 28.70 ± 10.41 min in the PASD group and 39.13 ± 6.03 min in the IODC group (P < 0.001). The successful closure defect was 100% in both groups when the maximum diameter of defect less than 25 mm. Four patients the PASD groups with maximum diameters between 25 mm and 30 mm were transferred to the IOCD group after unsuccessful device implantations. The total occlusion rate was 82% immediately after deployment, 98% at 3 months, and 100% at 6 months. No cardiac-related complications occurred during the follow-up period of between 3 to 65 months (mean 21.4 ± 9.8 months). Conclusions Percutaneous device closures of Secundum atrial septal defects showed safety and high efficiency in patients under guidance by transesophageal echocardiography when compared with intra-operative device closures and are especially suited for women and children.

目的 对主动脉壁内血肿患者的临床特点进行分析,探讨治疗方案及预后.方法 选取厦门大学附属心血管病医院2013年1月至2017年12月间收治的78例主动脉壁内血肿的患者作为研究对象,对患者的临床资料进行回顾分析,做好疾病类型的分型,并结合其病情、个人意愿选择合理的治疗方法,观察患者的治疗效果.结果 保守治疗的患者60例,其中2例在院死亡,1例出院后自行停止服用降压药物,于出院3个月后活动时突然死亡;接受主动脉腔内隔绝术的患者共16例,其中1例为首次住院后选择保守治疗,出院后规律服药,但2个月后再发胸痛,复查主动脉CTA提示主动脉病变进展为典型的Stanford B型夹层,再次入院行腔内隔绝术,接受介入治疗的16例患者,术后随访恢复良好,无支架移位、内漏及神经系统并发症等情况;2例患者接受外科开胸手术治疗,其中1例为经保守治疗后5个月再发胸痛,主动脉病变进展为Stanford A型夹层.结论 主动脉壁内血肿是一类特殊类型的主动脉疾病,在做好临床诊断的前提下,根据患者的病变分型、合并症发生情况、临床表现、高危影响因素及患者的意愿选择个体化治疗方案,以期获得理想的治疗效果.

Objective To introduce a new technique:minimally invasive transthoracic closure of ventricular septal defects (VSD) without cardiopulmonary bypass (CPB) under guidance of transepicardial echocardiography (TECE).Methods A total of 41 patients with VSD,5 months to 6 years,averaging (15.1 ± 18.5) months,underwent transthoracic device closure.The weight of these patients ranged from 5 to 26.0 kg with an average weight of (10.78 ± 6.87) kg.The diameter of their VSD ranged from 3 to 8.5 mm with an average of (5.2 ± 1.13) mm.After small median sternotomy incision,an appropriately sized VSD occluder was inserted into the left ventricle via VSD,then the occluder was released and the VSD was closed.TECE was used to monitor the whole procedure to guide the device positioning and evaluate the cursive effect instantly after operation.Results The procedure was successful in 38 patients.Three cases failed,including two cases whose guiding wire could not pass through VSD and one case whose occluder could not fix well.Three patients had tiny residual shunt after operation,two vanished during the follow-up period,and one case still had small amount residual shunt because of the occluders shifting.In 6 to 36 months follow-up,neither complete atrioventricular heart block nor aortic insufficiency was found in any patient.Conclusions The transthoracic closure of ventricular septal defects without cardiopulmonary bypass under guidance of transepicardial echocardiography is easy,safe,and efficient.

对先天性心脏病术后肺动脉高压采用西地那非进行治疗，观察分析其临床效果。将接受治疗的22例先天性心脏病术后肺动脉高压患者按照随机投掷的方法分成治疗组与对照组，每组11例，对照组采用常规药物治疗，治疗组在对照组的基础上联合西地那非治疗。治疗后，治疗组总有效率（90.91%）明显高于对照组（54.55%），差异具有统计学意义（P＜0.05）；治疗后治疗组PAP、PaO2与氧合指数均优于对照组，差异具有统计学意义（P＜0.05）。采用口服西地那非治疗先天性心脏病术后肺动脉高压的临床效果优于常规治疗，可有效控制肺动脉压，提高患者的生活质量，建议广泛应用。

Objective In this retrospective study,we compared three different procedures,including open-heart surgery,transcatheter closure and minimally invasive surgery,to analyze which technique is possiblely the best option for treatment of ventricular septal defect. Method 65 patients were enrolled in this study.Specifically 33 patients were treated by open-heart surgery(group A),21 by transcatheter closure (group B) and 11 by mini-invasive surgery (groupC).The mean age of three groups was(9.99±9.8),(10.86±8.48)years old respectively.Meanwhile the diameters of ventricular septal defect were(9.94±5.31),(6.62±3.72)mm respectively. Result There was no perioperative death in each group .The success rate of treatment was 100%for group A,90.47%for group B,90.9%for group C.The mean operation time, bleeding and length of hospital stay of group A was significantly higher than group B and group C,but there was no significant difference between group B and group C as far as these three indexes are concerned.The duration of postoperative ventilation of group A Was significantly longer than group C.As far as the using of domestic occluder ,The cost of three groups was no significant.Conclusion The Minimally invasive surgery is more superior to the other two techniques.

A 50-year-old woman suffered dyspnea for 6 months. Chest radiography and computed tomography showed a large mass in the pericardial cavity and massive pleural effusion (Figure 1). There was no border between the tumor and the cardiac tissue, and the heart was compressed by the tumor (Figure 2a). After subtotal resection, cardiac liposarcoma was identified by histology (Figure 2b). Funding This research received no specific grant from any funding agency in the public, commerical, or not-for-profit sectors.

OBJECTIVE To analyze the risk factors of surgical site infection(SSI) in adult patients undergoing cardiac surgery with cardiopulmonary bypass(CPB).METHODS A total of 1743 patients who had major heart surgery at our cardiac surgical department between Jan 2001 and Jun 2009 were included in this study.The patients were assigned into SSI group(n=50) and control group(n=1693).Clinical characteristics of two groups were collected and compared.Univariate regression and multivariate logistic regression analysis were used to identify the risk factors of the development of SSI.RESULTS The overall incidence of SSI was 2.87%.Compared to the control group,the SSI group had longer length of postoperative stay and higher rates of hospital readmission.Univariate risk factors included: NYHA≥Ⅲ,diabetes mellitus,renal insufficiency,low level of plasma albumin,coronary artery bypass surgery,duration of cardiopulmonary bypass time,operation time,blood products usage,the methods of incision suture,re-operation for stopping bleeding,the mean blood sugar level within 12 hours after operation,the duration of stay in CSICU(P<0.01 or 0.05).Four variables were found to be significantly related to the development of SSI by multivariate analysis: coronary artery bypass grafts operation(odds ratio ,4.724,P=0.014,operation time(OR=1.008,P=0.024),and the mean blood sugar level within 12 hours after operation(OR=1.023,P=0.000).22 pathogens were obtained by 27 culture samples in 50 patients.There were 16(72.7%) cases of gram positive cocci and 6 cases(27.3%) Gram negative bacilli.CONCLUSION This study shows that the coronary artery bypass operation,long operation time and high level of blood sugar the are risk factors most likely associated with SSI development.Improving suture method can reduce the morbidity of SSI.

AIM:To observe surgical techniques and therapeutic effects of endovascular stent graft exclusion in DeBakey type Ⅲb aortic dissecting aneurysm.METHODS:Fifteen patients with thoracic aortic dissection(TAD)were treated by endovascular graft exclusion(EVGE).Clinical and computed tomography outcome were analyzed during follow-up.RESULTS:Successful operation was performed in all cases with compete disappearance of the false lumen or remarkable decrease of the endoleak on the angiograms after stent placement.At 2-37 months follow-up,there was one death and one left limb palsy,with no other significant complications in the remaining patients.CONCLUSION:EVGE,with fewer complications and quicker recovery,has good therapeutic effects in treating patients with DeBakey type Ⅲb aortic dissection.

Objective To evaluate the multidetector-row computed tomography angiography (MUCTA) used in diagnosis and treatment of children with Tetralogy of Fallot (TOF).Methods Between December 2004 and December 2008,38 patients with TOF were assessed using eeho-doppler (TTE) and MUCTA.Three dimensional images were constructed to assess the pulmonary artery anomalies,anomalies of the coronary artery and aorta-pulmonary collateral arteries.McGoon and Nakata indiees were obtained in preparation for corrective surgery.Results A total of 38 patients were scanned using MUTCA and anomalies were diagnosed as TOF with ventricular septal defects (VSD).Two of these patients also had atrial septal defects (ASD) and three had patent ductus arteriosus (PAD).Seven had right ventricular outlet stenosis.Thirty-one patients with arterial stenosis including pulmonary arterial branch stenosis,six with left sided and eight with right sided stenosis all of which developed pulmonary arterial branch enlargement.Two had coronary artery anomalies,nineteen had aorta-pulmonary anomalies which three of these had enlarged collaterals.With the use of MUCTA and TTE,we were able to plan the surgieal procedures pre-operatvely.This was otherwise not possible.Thirty-five of the patients recovered while the remaining three patients died peri-operatively.Conclusions MUCTA is a more accurate imaging than other modalities for the assessment of pulmonary artery.

患者 男性,38岁.主因"突然声音嘶哑50d,开胸探查术后20 d"入院.患者因"突然声音嘶哑30 d"于外院行胸部CT提示"纵隔占位,肿瘤?",行"上纵隔占位切除术".

微创是当前外科手术的发展趋势,2005年3月至2006年3月,我们使用微创封堵术对14例房间隔缺损（ASD）患儿进行治疗,取得良好效果。