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中国心脏瓣膜外科的发展与现状
Heart valve surgery in China dates back to 4 to 5 decades ago. In 1954, the first closed mitral commissurotomy was successfully performed in a patient with mitral stenosis. In 1960, with the advent of transventricular dilator and by the route of left ventricle, the efficacy of mitral commissurotomy was improved. The procedure was rapidly adopted by many centers in this country[1]. In 1958, the first open heart surgery using cardiopulmonary bypass was performed in China. This was an epoch-making event, which opened up a new era in the field of cardiac surgery in China. Thereafter, in cities like Beijing and Shanghai, direct repairs of mitral lesions under CPB were made with good results. In 1965, the development of the first totally home-made ball valve prosthesis and its successful application in mitral valve replacement was another landmark in the history of heart valve surgery in China. In 1976, aortic valve replacement with glutaraldehyde-preserved bovine pericardial valve prosthesis was carried out successfully. The next year, the first porcine aortic valve prosthesis was produced and introduced to clinical use, which greatly accelerated the progress of heart valve surgery in China. During the last 2 decades, heart valve surgery and its techniques have been widely applied throughout China.
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干细胞--心脏组织工程瓣种植细胞的新来源
心脏组织工程瓣(tissue-engineering heart valve,TEHV)的研究是组织工程和"再生医学(regeneration of medical science)"的一个分支领域.TEHV的先决条件是种植类似于天然瓣膜的内皮细胞(endothelial cells,ECs)和成纤维细胞,由于ECs具有强烈的同种异体免疫原性[1],因此种植细胞来源应是宿主的自体细胞.寻找一种经济、便捷、有效地获取种植细胞的方法,是TEHV体外构建应首先解决的核心问题.
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RGD肽联合转化生长因子-β1对组织工程瓣膜构建的影响
细胞对支架的黏附和生长是构建组织工程心脏瓣膜(tissue engineering heart valve,TEHV)的关键环节.去细胞瓣被认为是一种较理想的TEHV支架[1,2],本实验率先采用RGD肽(精-甘-天冬氨酸,Arg-Gly-Asp)表面修饰以促进细胞黏附[3,4],联合种植转化生长因子-β1(TGF-β1)基因转染细胞以促进细胞及细胞外基质(ECM)增生,观察两种生物活性分子对去细胞瓣体外构建TEHV的影响.
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心脏瓣膜置换术病人的健康教育
心脏瓣膜置换术是瓣膜病变严重,经内科治疗效果不明显,而选择的一种外科治疗方法.患者由于病程长,长期受疾病折磨对手术预后有较重心理负担,表现为焦虑、恐惧.因此,做好患者的健康教育,使患者顺利度过手术期和手术后恢复具有重要意义[1].
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心血管组织构建生物反应器
由于目前临床应用的心脏瓣膜替代物存在不足,近年来,探索以合适的方法构建具有生长活性的组织工程化心脏瓣膜(tissue engineering heart valve,TEHV)一直是该领域各国学者研究的焦点,但由于心脏瓣膜所处力学环境的复杂性,体外培养心脏瓣膜比较困难,尽管有一些成功的实验但依然存在诸多问题.
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组织工程心脏瓣膜构建的研究新进展
在全球范围内每年约280 000个瓣膜置换术需进行[1],并且逐年增长,有研究预测到2050年需瓣膜置换术的人数将达850 000[2].我国每年也有近10万例患者接受瓣膜置换术,机械瓣膜和生物瓣膜在瓣膜置换术中的使用数量相当.然而目前的瓣膜假体存在许多问题:机械瓣有感染和血栓栓塞并发症的发生,为了防止血栓形成,需要终身抗凝治疗(如华法林),由此而造成的出血发生率大大增加;生物瓣寿命只有10~15年,而且瓣膜开裂、瓣膜变性、瓣膜钙化等一系列问题还没有十分有效的预防措施;并且由于机械瓣和生物瓣再生、成长能力及耐用性的不足,尤其在儿童和年轻人中应用受到限制.为克服目前假体瓣膜在临床上的局限性,组织工程心脏瓣膜(tissue engineered heart valve,TEHV)应运而生.TEHV因其优良的组织相容性、耐久性及可生长性,不良反应小,具有非常大的临床应用潜能.现就TEHV的支架材料改性、种子细胞、支架材料与种子细胞的相互作用、生物反应器、临床研究以及微创TEHV植入等方面作如下综述.