The open anastomosis technique has become more popular since it was first used in hemiarch replacement; however, hypothermic circulatory arrest is unavoidable. This institution performed a novel surgical technique called the arch-clamping technique. It has been used in the treatment of patients with ascending aortic aneurysm extending to the proximal aortic arch and avoids the use of hypothermic circulatory arrest. Thirty patients had a hemiarch replacement with the arch-clamping technique from 2021 to 2022; all of them were discharged uneventfully.

目的 通过计算流体力学数值模拟对主动脉瓣二叶畸形合并巨大升主动脉瘤患者进行分析,并描述其血流动力学特点,预测可能的生物力学机制.方法 基于2017年8月5日就诊于首都医科大学附属北京安贞医院的1例38岁男性无症状的主动脉瓣二叶畸形合并直径为10.5 cm升主动脉瘤患者的磁共振成像及流体数据,建立计算流体力学模型并分析其流速、压力及壁面切应力.结果 通过与瞬时速度矢量的切线绘制巨大动脉瘤模型一个心动周期的3个时间点的流线,相比正常的主动脉入口速度(1.0～1.7 m/s),入口流速变快,最高可达2.4 m/s.高速的中心血流进入巨大的瘤腔后速度迅速下降,瘤腔外围的血流速度始终很慢;升主动脉压力较正常三叶瓣增加;瘤腔内的壁面切应力降低,其分布较为均匀,未出现突然增高或降低区域.结论 患者均匀分布的壁面切应力可能是巨大动脉瘤破裂的保护因素.计算流体力学有助于解释二叶式瓣主动脉瓣可能在升主动脉中引起巨大动脉瘤的生物力学机制,并为我们提供巨大动脉瘤治疗的策略信息.

马方综合征(Marfan syndrome,MFS)是常染色显性遗传的结缔组织病,同时累及心血管、肺、眼、骨骼肌肉等多个系统[1].90％的MFS患者在10～12年内发生主动脉事件.主动脉扩张形成动脉瘤或夹层导致破裂成为MFS患者的最常见死因.如果未接受有效治疗,平均寿命不超过45岁.有效的外科干预改善了MFS患者的预后[2].随着研究的深入,应用药物预防MFS主动脉扩张成为当前的研究热点.我们回顾了现有的临床随机对照研究(randomized control trial,RCT),对目前临床应用的药物的有效性进行总结,为未来的研究提供新的观点.

Objective:Acute type A dissection with mitral regurgitation was very rare. To sum up our experience of surgical treatment of acute type A dissection with mitral regurgitation.Methods:From October 2010 to January 2017, 17 patients with acute type A dissection with mitral regurgitation underwent surgical treatment. There were 12 males, 5 females; mean age, (38±11) years(range, 18-59 years). Hypertension was noted in 9 patients, Marfan syndrome in 2 patients, renal dysfuction in 3 patients, cardiac dysfunction in 3 patients, lower limb ischemia was observed in 2 patients and dilated cardiomyopathy in one patient. Preoperative abdominal aortic replacement was observed in one case.Results:Concomitant procedures included Bentall procedure in 16 patients, aortic arch operation in 15 patients, tricuspid valve plasty in 3 patients, coronary artery bypass grafting in 2 patients and asceding aorta - femoral artery bypass in one patient. 11 patients required mechanical ventilation for <24 hours, 3 cases for <48 hours and 3 subjects for > 48 hours. Continuous renal replacement therapy was required in 3 patients, re-operation in one patient and partial pericardial excision in one patient. One patient was out of follow-up. The remaining had a normal life during follow-up.Conclusion:Repair of acute type A dissection with mitral regurgitation carried with a relatively high mortality and morbidity. Under better protection of heart and cerebrum, it obtained accepted surgical results in patients with this lesion

目的 回顾性总结采用左锁骨下动脉(LSCA)-左颈总动脉(LCCA)转流术联合支架象鼻植入治疗慢性Stanford B型主动脉夹层累及远端主动脉弓的临床经验.方法 2011年1月至2015年9月,26例慢性Stanford B型主动脉夹层累及远端主动脉弓患者在首都医科大学附属北京安贞医院心脏外科中心接受支架象鼻植入联合LSCA-LCCA转流术,对此部分患者临床资料行回顾性分析.其中男21例、女5例,平均年龄(48±10)岁.结果 26例患者中院内死亡2例(7.7％).同期手术包括Bentall+冠状动脉旁路移植术1例,主动脉瓣置换术+二尖瓣置换术+三尖瓣成形术1例,二尖瓣成形术1例.3例患者术后呼吸机辅助时间超过24 h,平均呼吸机辅助时间和住重症监护病房时间分别为(18±8)、(40±27)h.随访期间,1例患者于术后21个月死亡,死亡原因不明.随访期间1例患者行胸腹主动脉替换.结论 应用支架象鼻植入术联合LSCA-LCCA转流术治疗慢性Stanford B型主动脉夹层累及远端弓,避免了介入治疗的相关并发症,获得了满意的临床效果.

目的 分析胸主动脉腔内修复术(TEVAR)术后近端(Ⅰa型)内漏治疗的技术特点.方法 自2009年8月至2016年5月,共治疗TEVAR术后Ⅰa型内漏29例:其中外科手术15例(外科组)、复合手术(Hybrid)6例(Hybrid组)、Cuff术(Cuff组)8例.男25例、女4例,平均年龄41～ 86 (56±10)岁.高血压25例,糖尿病3例,冠心病3例,肺部感染1例,主动脉根部瘤1例,迷走右锁骨下动脉1例.结果 外科组无院内死亡,1例术后心包积液行心包开窗引流,1例肺部感染二次气管插管,肾功能不全行肾脏替代治疗.Hybrid组术后残余Ⅰa型内漏1例.Cuff组1例患者术后左颈总动脉血栓,行腋动脉-腋动脉-左颈总动脉转流,脑梗塞死亡,院内总死亡率为3.4％ (1/29);1例患者术后左上肢缺血,行腋动脉-腋动脉转流后恢复;1例患者残余微量内漏.随访死亡率为14.2％ (4/28).外科组无严重并发症,Hybrid组发生内漏1例,Cuff组内漏1例.结论 根据患者具体状况选择手术方式,近端锚定区足够,可采用Cuff术;如近端锚定区不足,合并心脏和主动脉弓部病变,外科手术可获得满意疗效;如患者高龄不能耐受手术,行Hybrid术可获得满意的近中期临床疗效.

Objective: To observe the effect of rhein and emodin on the proliferation of human renal tubular epithelial cell line( HK-2) and the activities of TGF-β1gene promoter. Methods: Effects of rhein and emodin on proliferation of HK-2 were analyzed by MTT; different lengths of human TGF-β1gene and CAT as reporter gene were constructed and were transferred into HK-2 RMC by transfection reagent. The effects of rhein and emodin( 1 μg / ml,10 μg / ml,50 μg / ml and 100 μg / ml) on the plasmid were determined by CAT-ELISA. Results: Rhein and emodin of different concentrations had regulatory effect on the proliferation of HK-2( P < 0. 01),and with dose compliance; rhein and emodin at 1 μg / ml and 10 μg / ml didn't inhibit the activities of phTGF 2. 14. Rhein and emodin at 50 μg / ml markedly inhibited the activities of ph TGF 2. 14,and the inhibition ratio was 38. 0% and 36. 0%,was different from the control group( P < 0. 01). Conclusion: Rhein and emodin have regulatory effect on the proliferation of HK-2. Rhein and emodin at 50 μg / ml have regulatory effect on the activity of TGF-β1gene promoter.