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Objective: To evaluate the effect of mitral annuloplasty of anterior mitral valve prolapse with artificial chord and mitral annuloplasty ring., Methods: From March 2009 to December 2011, 32 patients having anterior mitral valve prolapse received mitral annuloplasty with artificial chord and mitral annuloplasty ring in our department, among which 27 simple anterior mitral valve plasty and 5 combine anterior-posterior mitral valve plasty were completed., Results: All patients survived. Postoperative echocardiography showed no or trivial mitral regurgitation in 28 patients and mild mitral regurgitation in the other 4 patients. The diameter of the left atrium (LA) and left ventricle (LV), left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) obviously decreased after the operation. During the follow up of 3 months to 3 years, the cardiac function of the patients improved at different degrees., Conclusion: Reparation of anterior mitral valve prolapse with artificial chord and mitral annuloplasty ring is simple, reliable and effective, and its early to midterm result after the operation proves good.

Objective: To explore the effect of a new triple-branched aortic arch covered stent graft on DeBakey Type I aortic dissection, and to assess its efficacy in comparison with traditional surgery., Methods: From January 2010 to November 2010, 38 patients of DeBakey Type I aortic dissection were treated surgically in the Second Xiangya Hospital of Central South University, in which 16 operations used triple-branched aortic arch covered stent grafts (stent graft group, SG group), 22 operations used traditional 4 sides branches aortic arch grafts (arch graft group, AG group)., Results: Compared with AG group, the cardiopulmonary bypass time[(138.1± 56.42) vs (179.21± 67.64) min], the clamp time [(98.56±28.08) vs (134.36±46.46) min] and the selective cerebral perfusion time[(27.3±14.76) vs (48.74±18.22) min] in SG group were obviously shortened(P<0.05). The volume of drainage 24 hours after operation in SG group also reduced[(608.93±308.15) vs (899.04±437.79) mL](P<0.05). The SG group had a lower rate of recurrent laryngeal nerve injury (6.25% vs 27.3%) and duration of hospitalization[(16.15±6.68) vs (21.18±12.69) d](P<0.05). During a following-up period of 14 to 24 months,reexamination of aortic CT angiography showed that the triple-branched aortic arch covered stent graft expanded well, and attached to the wall satisfactorily, while the corresponding false lumen of the aortic artery disappeared and the distal false lumen was filled with thrombus. The life quality of patients were good., Conclusion: The new triple-branched aortic arch covered stent graft is appropriated for most patients with DeBakey Type I aortic dissection. Its use can simplify the aortic arch procedure,decrease the operation risk and has satisfactory results in early and middle stage after operation.

Objective: To explore the effect of unidirectional valved patch (UVP) for congenital heart disease (CHD) with severe pulmonary hypertension (PH)., Methods: We retrospectively analyzed the treatment of 37 CHD patients with severe PH by UVP in the operation, and summarized its short-term to mid-term effect to find an optimum therapeutic regimen., Results: Before the operation, the ECG showed that the mean pulmonary artery pressure (MPAP) ranged 65-72 mmHg, and the cardiac catheterization showed the pulmonary artery pressure ranged 80-120 mmHg, P(P)/P(A) ranged 0.8-1.05,PVR ranged 8.5-19.2 (under oxygen inhalation 6.8-14.6) wood unit.After the operation, P(P)/P(A) ranged 0.4-0.72 on weaning-off CPB. Postoperative ECG showed the MPAP ranged 32-48 mmHg. No pulmonary hypertension crisis occurred and no patient died. Mechanical ventilation time ranged from 32 h to 8 d and the SaO₂ ranged 93%-96% at rest after the extubation.The right-to-left shunt situations by ECG were as follows:22 cases had shunt 5 d after the operation, 11 cases had shunt 1 month after the operation,4 cases 3 months after the operation, and none 1 year after the operation but one patient lost follow-up.However,there were no long-term follow-up data: 12 patients had a 1-year follow-up, 5 patients had a 3-year follow-up, and most patients had just 3-month follow-up., Conclusion: UVP can decrease the operative risk in CHD with severe PH at perioperative period. The short-term to mid-term effect is satisfactory, while long-term effect remains uncertain.

Objective: To summarize the characteristics of reoperative valve surgery after previous open-heart valve surgery., Methods: From 1996 to 2010, 155 patients who underwent reoperative valve surgery, either valve replacement or tricuspid annuloplasty or the repair of perivalvular leakage were included in the study. The reoperative interval was 1-266 (94.82 ± 85.37) months. All surgeries were carried out with extracorporeal circulation under moderated hypothermia. The cardioplegic solution in cold crystal or blood was used if heart beating was stopped during the surgery., Results: The total in-hospital mortality was 5.81%, while it was 2.75% from 2005 to 2010. The end-diastolic dimension, size of atrium and ventricles were reduced after the reoperation. Ventricular arrhythmia and low cardiac output were the most frequent complications., Conclusion: The success rate of reoperative valve surgery can be improved by the distinctive therapeutic strategies based on the clinical characteristics and therapy principles obtained from practice experiences.

Myocardial infarction (MI) remains a common fatal disease all over the world. The adult cardiac myocytes regenerative capability is very limited after infarct injury. Heart transplantation would be the best therapeutic option currently but is restricted due to the lack of donor organs and the serious side effects of immune suppression. The emerging of tissue engineering has evolved to provide solutions to tissue repair and replacement. Engineering myocardial tissue is considered to be a new therapeutic approach to repair infarcted myocardium and ameliorate cardiac function after MI. Engineering myocardial tissue is the combination of biodegradable scaffolds with viable cells and has made much progress in the experimental phase. However, the largest challenge of this field is the revascularization of the engineering constructs to provide oxygen and nutrients for cells. This review will give an overview on the current evolution of engineering myocardial tissue and address a new method to improve the vascularization of myocardium tissue in vivo.

Regeneration deficiency is one of the main obstacles limiting the effectiveness of tissue-engineered scaffolds. To develop scaffolds that are capable of accelerating regeneration, we created a heparin/chitosan nanoparticle-immobilized decellularized bovine jugular vein scaffold to increase the loading capacity and allow for controlled release of vascular endothelial growth factor (VEGF). The vascularization of the scaffold was evaluated in vitro and in vivo. The functional nanoparticles were prepared by physical self-assembly with a diameter of 67-132 nm, positive charge, and a zeta potential of ∼30 mV and then the nanoparticles were successfully immobilized to the nanofibers of scaffolds by ethylcarbodiimide hydrochloride/hydroxysulfosuccinimide modification. The scaffolds immobilized with heparin/chitosan nanoparticles exhibited highly effective localization and sustained release of VEGF for several weeks in vitro. This modified scaffold significantly stimulated endothelial cells' proliferation in vitro. Importantly, utilization of heparin/chitosan nanoparticles to localize VEGF significantly increased fibroblast infiltration, extracellular matrix production, and accelerated vascularization in mouse subcutaneous implantation model in vivo. This study provided a novel and promising system for accelerated regeneration of tissue-engineering scaffolds.

Background Aims: Circulating monocytes have been exploited as an important progenitor cell resource for hepatocytes in vitro and are instrumental in the removal of fibrosis. We investigated the significance of monocytes in peripheral blood stem cells (PBSC) for the treatment of liver cirrhosis., Methods: Rat CD14+ monocytes in PBSC were mobilized with granulocyte-colony-stimulating factor (G-CSF) and harvested by magnetic cell sorting (MACS). Female rats with carbon tetrachloride (CCl₄-induced liver cirrhosis were injected CM-DiI-labeled monocytes, CD14⁻ cells (1 x 10⁷ cells/rat) or saline via the portal vein., Results: Rat CD14+ and CD11b+ monocytes in PBSC were partly positive for CD34, CD45, CD44, Oct3/4 and Sox2, suggesting monocytes with progenitor capacity. Compared with CD14⁻ cell-infused and saline-injected rats, rats undergoing monocyte transplantation showed a gradually increased serum albumin level and decreased portal vein pressure, resulting in a significantly improved survival rate. Meanwhile, monocyte transplantation apparently attenuated liver fibrosis by analysis for fibronectin, α2-(1)-procollagen, α-smooth muscle aorta (SMA) and transforming growth factor (TGF)-β. Transplanted monocytes mainly clustered in periportal areas of liver, in which 1.8% cells expressed hepatocyte marker albumin and CK18. The expression level of hepatocyte growth factor (HGF), TGF-α, extracellular matrix (EGF) and vascular endothelial growth factor (VEGF) increased, while monocyte transplantation enhanced hepatocyte proliferation. On the other hand, the activities and expression of matrix metalloproteinases (MMP) increased while tissue inhibitor of metalloproteinase (TIMP)-1 expression significantly reduced in monocyte-transplanted livers. Some transplanted monocytes expressed MMP-9 and -13., Conclusions: The data suggest that CD14+ monocytes in PBSC contribute to hepatocyte regeneration and extracellular matrix (ECM) remodeling in rat liver cirrhosis much more than CD14⁻ cells, and might offer a therapeutic alternative for patients with liver cirrhosis.

Objective: To investigate the expression of the matrix metalloproteinase-1, -9 (MMP-1,9), and tissue inhibitor of metalloproteinase-4 (TIMP-4), extracellular matrix metalloproteinase inducer (EMMPRIN) in the myocardium of congestive heart failure in patients with rheumatic heart diseases., Methods: The papillary muscle specimens of the left ventricle were obtained from 18 patients with heart failure during rheumatic heart valve replacement, and the normal specimens were obtained from the autopsy of 10 adults without heart disease. The specimens were stained to examine the expression of MMP-1, MMP-9, TIMP-4, and EMMPRIN by the EnVision immunohistochemical assays., Results: The expressions of MMP-1, MMP-9, and EMMPRIN in the myocardium of the patients with the cardiac function classes III and IV (NYHA III and IV) were significantly higher than those the normal cardiac function (NYHA I) (P<0.05) except MMP-1 expression between NYHA III and I. The TIMP-4 level was significantly lower in patients with NYHA III and IV than that of the NYHA I ( P<0.05). The expression of MMP-1, MMP-9, and EMMPRIN was significantly higher in patients with atrial fibrillation than those in the control group with regular sinus rhythm (P<0.05), whereas the TIMP-4 level was obviously lower in patients with atrial fibrillation than that in the control group with regular sinus rhythm (P<0.05). The expressions of MMP-1, MMP-9, and EMMPRIN were positively correlated with each other, but were negatively correlated with TIMP-4., Conclusion: MMPs, TIMP, and EMMPRIN were significantly unbalanced in the myocardium of congestive heart failure patients with rheumatic heart diseases. They may play an important role in congestive heart failure through myocardial remodeling.

Hepatocellular carcinoma (HCC) represents a worldwide health problem. F1F0 ATPase, one of the most unique supermolecule enzymes in the inner mitochondrial membrane, was recently found located also on the plasma membrane of some tumor and epithelial cells. Ecto-F1F0 ATPase might play the major role in maintaining the normal average intracellular pH in those cells relative to tumor acidic extracellular microenviroment. Inhibiting the extracellular F1F0 ATPase on tumor exhibits both antiangiogenic and antitumorigenic activities. We found previously a strain of murine mAb, mAb6F2C4, which binds with beta-catalytic subunit of F1F0 ATPase. Immunofluorescence and flow cytometry assay showed that mAb6F2C4 could bind with plasma membrane of diverse hepatoma cells and HUVEC. Moreover, it could markedly block extracellular ATP generation of SMMC-7721 cells under extracellular acidic condition. In vitro, mAb6F2C4 retarded not only the proliferation and colony forming ability of SMMC-7721 cells, but also the proliferation and tube formation ability of HUVEC. mAb6F2C4 was located on plasma membrane of some hepatoma cells and attenuated dramaticly tumor growth in tumor xenograft models in nude mice. Therefore, we concluded that mAb6F2C4 binding with ecto-beta-subunit of F1F0 ATPase, could inhibit extracellular ATP synthesis and exhibit both antiangiogenic and antitumorigenic activities, which could be further developed for HCC therapy.

Objective: To establish the transfection method of vascular endothelial growth factor (VEGF) gene into mesenchymal stem cells (MSCs), to investigate the effect of this gene-transfected MSCs for heart function restoration and angiogenesis after myocardial infarction, and to compare the therapeutic differences among cell therapy, gene therapy, and combined therapy., Methods: Ischemic heart models were constructed in inbred Wistar rats by ligation of the left anterior descending coronary artery. MSCs of Wistar rats were isolated by density gradient centrifugation and purified on the basis of their ability to adhere to plastic, and identified by checking the surface markers and their differentiation capacity, and then followed by transfection of pcDNA(3.1)-hVEGF(165) using the liposome-mediated method. The expression of hVEGF(165) in the transfected cells was detected by Enzyme-Linked Immunosorbent Assay, Reverse Transcription-Polymerase Chain Reaction (RT-PCR) and Western Blot Analysis. The ligated animals were randomly divided into four groups (12 in each) and, after 2 weeks, were injected at the heart infarct zone with hVEGF(165)-transfected MSCs (Combo group), MSCs (Cell group), liposome-hVEGF gene plasmid (Gene group), or medium (Control group). And other six ligated rats (without any injection) were used as Model-assessment group for the baseline heart infarcted size evaluation, and other 12 non-ligated rats (Non-ischemic group) were used as the normal control. Four weeks after the injection, the rats' cardiac function was measured by the Buxco system. Brdu and Troponin-T double labeling and factor VIII were identified by immunohistochemical staining to demonstrate the survival and differentiation of engrafted cells or to evaluate the angiogenesis in the injured heart area; heart infarcted size was calculated by Evan's blue staining. VEGF expression was evaluated by RT-PCR., Results: MSCs can be successfully isolated and cultured by density gradient centrifugation followed by adherence-separation. The cultured MSCs were CD34-, CD45-, CD44+ and SH+. They can differentiate into osteoblasts and adipocytes successfully. The expression of hVEGF(165) in the transfected MSCs was demonstrated with Enzyme-Linked Immunosorbent Assay, RT-PCR and Western Blot Assay. Four weeks after the cells were transplanted, among all groups but the Non-ischemic group, the Combo group had the smallest heart infarcted size and the best heart function. The capillary density of the Combo group was significantly greater than those of both Cell and Control groups. The heart infarcted size, heart function and capillary density of both Cell and Gene groups were similar with each other and smaller, better and greater than those of the Control group, respectively. Brdu and Troponin-T double staining detected a varied increase in the number of survived cardiomyocytes at the heart infarcted area, some of which were double stain positive. RT-PCR showed that the hVEGF(165) gene was expressed in the Combo and Gene groups, and that the former was higher than the latter., Conclusions: Eukaryotic expression vector pcDNA(3.1)-hVEGF(165) can effectively be expressed in MSCs. Transplantation of VEGF gene-transfected MSCs can bring better improvement in myocardial perfusion and in restoration of heart function than either cellular or gene therapy alone.

Objective: To summarize the experience of a single treatment using molecular adsorbent recirculating system (MARS) in patients with acute-on-chronic liver failure., Methods: Twenty-five eases treated by MARS-artificial liver were followed up and reviewed., Results: The levels of serum total bilirubin, non-conjugated bilirubin and blood ammonia were significantly decreased from (618.51 200.68) mmol/L to (390.81 146.02) mmol/L (t=2.729, P<0.01), (490.03 163.39) mmol/L to (303.28 113.06) mmol/L (t =2.516, P<0.01), and (152.44 82.62)mmol/L to (84.80 13.30)mmol/L (t=2.174, P<0.05), respectively. Prothrombin activity was significantly increased from 70.55% 32.39% to 93.63% 14.20% (t=1.728, P<0.05) in patients during a single 6 h treatment with MARS. No difference was presented in the markers of liver zymogram, serum protein, kidney function, electrolyte, blood routine and blood gas analysis before and after the MARS. Thirteen of 17 patients have been cured or improved, 4 died, and the survival rate was 76.5%., Conclusions: MARS is a safe and an effective treatment for patients with liver failure.