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Objective: To investigate the clinical efifcacy of thoracic endovascular aortic repair (TEVAR) for treating the patients with complicated thoracic aortic dissection and to report the relevant clinical experiences. Methods: We retrospectively analyzed the records of 56 patients with complicated thoracic aortic dissection who received the operation of TEVAR in our hospital from 2011-02 to 2015-10 in order to analyze their operation methods with reasons. Results: There were 21 patients with complex anatomic conditions for aortic arch, 7 of them received TEVAR and 14 received TEVAR with covered left subclavian artery; 16 patients with complex shape of aortic dissection, 5 of them received TEVAR and 11 received TEVAR with covered left subclavian artery; 19 patients with aortic dissection involving aortic arch, 17 of them received hybrid procedures of aortic arch branch bypass surgery + TEVAR and 2 received TEVAR with fenestrated stent grafts. All operations were successful and no severe complications occurred. Conclusion: TEVAR is a fast and effective method for treating complicated thoracic aortic dissection, which may expand the application ranges as covering left subclavian artery, branch vessel bypass and modiifed stent grafting.
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Objective To investigate effects of penehyclidine hydrochloride (PHC)protects a-gainst acute lung injury (ALI)in heart valve replacement patients with cardiopulmonary bypass (CPB).Methods Thirty rheumatic heart disease patients,eighteen males and twelve females with NYHA Ⅱ or Ⅲ,with cardiac valve replacement undergoing CPB were enrolled in the study.All pa-tients were randomly divided into group P and group C (fifteen in each group).Patients in group P re-ceived an intravenous injection of 0.03 mg/kg PHC before anesthesia induction and those in group C received the same volume of normal saline.Blood samples were collected to monitor the concentrations of IL-6,TNF-αand NF-κB at the following time points:before anesthesia induction (T0 ),the end of the operation (T1 ),6 hours (T2 ),12 hours (T3 )and 24 hours(T4 )postoperatively,arterial blood gas analyses were detected and oxygenation index (OI)was calculated at the time of T0 ,T1 and T4 , as well as lung dynamic compliance of patients adopt at the time of soon after anesthesia induction and the end of the operation.The outcomes included duration of intubation (DOI),length of intensive care unit stay (LOI)and length of hospital stay after the surgery (LOH).Results The DOI,LOI and LOH in group P were shorter than those in group C,but there was no statistical significance between groups.The plasma levels of IL-6,TNF-α and NF-κB were higher at T1-T4 than T0 in both groups (P <0.05),and those in group P were statistically lower than group C at T1-T4 (P <0.05).The val-ues of OI at T0 and T1 were obviously lower than T4 in both groups (P <0.05),and that in group P was slightly higher than group C at T4 but without statistical significance.The lung dynamic compli-ance of patients in group P at the end of operation was obviously higher than that in group C (P <0.05).Conclusion PHC inhibits systemic inflammatory response,improves lung compliance,amel-iorates tissue oxygen supply and encourages postoperative rehabilitation in valve heart replacement pa-tients with CPB,and its mechanisms is relevant to the regulation of NF-κB signal way on the produc-tion of such proinflammatory cytokines as IL-6 and TNF-α.
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Objective This study aims to analysis in the clinical features of Stanford type B thoracic aortic dissection with multiple tears,and to explore the clinical methods of thoracic endovascular aortic repair (TEVAR) treating this disease.Methods From February 2011 to May 2015,the cases that diagnosed with multiple tears (≥ two tears) Stanford type B thoracic aortic dissection and accepted operations with TEVAR at department of Thoracic Cardiovascular Surgery,Wuhan General Hospital of Guangzhou Command,were retrospective analyzed their clinical data.Except the first tear of proximal,cases were named for the treatment group whom used surgical methods treating distal aortic dissection tears.Otherwise,the cases were named non-treatment group.We compared the incidence of chest and back pain,the progress of distal aortic dissection,the changes of false lumen with aortic dissection,and the benefit of distal tears in two groups after 6 months after TEVAR.Results A total of 67 cases were recruited this retrospective study,successful operations with TEVAR were conducted in all patients,and no serious complications occurred postoperatively in all patients.7 cases with treatment group,60 cases with non-treatment group,no deaths within two groups in 6 months after TEVAR.There were no significance statistically in complained of the incidence of chest and back pain,and the rate of progress with distal aortic dissection (P ＞ 0.05).There was statistically significant in the rate of changes with false lumen with aortic dissection false lumen (P ＜ 0.05).Some cases with abdominal visceral artery blood flow from the distal tears of aortic dissection in the non-treatment (n =19).Conclusions TEVAR is an effective method for treating multiple tears Stanford type B thoracic aortic dissection.Distal tears should be individualized treatment according to the characteristics of Stanford type B thoracic aortic dissection or try not to deal with.
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OBJECTIVE:To investigate the effect of clinical pharmacist intervention on prophylactic application of antibiotics in cardiothoracic surgery. METHODS:Medical records of patients underwent cardiothoracic surgery were collected from our hospi-tal during Mar. to Apr. in 2014 (before intervention) and during Jun. to Jul. in 2014 (after intervention). Those were divided into pre-intervention group(n=115)and post-intervention group(n=119). The prophylactic application effect of antibiotics was com-pared before and after intervention. RESULTS:After intervention,the rates of prophylactic application were decreased significantly from 96.5% to 72.3%;the rationality rate of antibiotics selection was improved significantly from 27.9% to 94.2%;The course of prophylactic medication decreased significantly from(5.4±2.8)days to(2.3±1.8)days;the difference had statistical significance before and after intervention(P<0.01). The postoperative infection rate was decreased from 13.0% to 5.9%,the difference had no statistical significance(P=0.074). The average hospitalization time,average drug costs,and average hospitalization expenses were decreased significantly,the difference had statistical significance(P<0.05 or P<0.01). CONCLUSIONS:Clinical pharmacist inter-vention to prophylactic application of antibiotics in cardiothoracic surgery can control the infection effective and guarantee reason-able and safe use of drugs during perioperative period.
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Objective To evaluate the effects of ulinastatin on hemorrhagic shock and resuscitation ( HS∕R)?induced acute lung injury in rats. Methods Fifteen SPF adult Sprague?Dawley rats, aged 2-3 months, weighing 300-400 g, were divided into 3 groups ( n=5 each) using a random number table:sham operation group ( group S ) , HS∕R group and ulinastatin group ( group U ) . Carotid arteries were cannulated for blood pressure monitoring and blood?letting. HS∕R was induced by blood?letting and maintained for 1 h, followed by resuscitation with autologous blood transfusion and infusion of normal saline. After cannulation of carotid arteries ( T0 ) , at 5 min after hemorrhagic shock ( T1 ) , before resuscitation ( T2 ) , at 5 min after the expected blood pressure was achieved following resuscitation ( T3 ) , and at 30 min, 1?5 h and 2?5 h after resuscitation ( T4?6 ) , arterial blood samples were collected for determination of interleukin?6 ( IL?6 ) and tumor necrosis factor?α ( TNF?α) concentrations ( by enzyme?linked immunosorbent assay) . Arterial blood samples were collected at T0 , T2 and T6 for blood gas analysis. The pH value, partial pressure of arterial carbon dioxide ( PaCO2 ) , HCO-3 and base excess ( BE) value were recorded, and oxygenation index ( PaO2∕FiO2 ) was calculated. Lungs were removed at T6 , and pulmonary specimens were obtained for examination of pathological changes which were scored, and nucleus was extracted for determination of nuclear factor?kappa B ( NF?κB ) p65 expression by enzyme?linked immunosorbent assay. Results Compared with group S, the pH values, HCO-3 , BE values and OI were significantly decreased, and PaCO2 , plasma IL?6 and TNF?α concentrations, expression of NF?κB p65 in lung tissues, and pathological scores were increased in U and HS∕R groups. Compared with group HS∕R, the plasma concentrations of IL?6 and TNF?α, expression of NF?κB p65 in lung tissues, and pathological scores were significantly decreased, and no significant changes were found in parameters of blood gas analysis in group U. Conclusion Although ulinastatin can alleviate HS∕R?induced acute lung injury, it is insufficient to improve lung oxygenation in rats.
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Objective To investigate clinical diagnosis value in complex heart disease of 320-slice computerized tomography.Methods Twenty-seven patients' imaging data of 320-slice computerized tomography and transthoracic heart echocardiography were taken retrospective analysis,all patients were diagnosed with complex heart disease on cardiothoracic surgery.And the authors compared the diagnostic accuracy of imaging diagnosis and operation diagnosis.Results The diagnostic of 27 patients with 89 cardiac anomalies with 320-slice computerized tomography and were diagnosed 83 cardiac anomalies with transthoracic heart echocardiography.However,92 cardiac anomalies were found on cardiothoracic surgery.The diagnostic accuracy of 27 patients had a statistical difference between 320-slice computerized tomography and transthoracic heart echocardiography with complex heart deformity disease (P ＜ 0.05).Conclusions Compared with transthoracic heart echocardiography,320-slice computerized tomography improved the diagnosis accuracy of the complex heart deformity disease.
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Objective To evaluated clinical effects and effectiveness of dual-port video-assisted thoracic surgery(VATS)for secondary spontaneous pneumothorax.Methods The clinical data of 48 pa-tients with secondary spontaneous pneumothorax who underwent open thoracotomy(n =18)or dual-port VATS(n =30)were reviewed retrospectively.Mean operation time,mean postoperative drainage period and mean postoperative hospital stay between the two groups were compared.Results All surgeries were suc-cessfully performed without reoperation and severe complications.No patient was converted to thoracotomy in the VATS group.There were significant differences in mean operation time [(67.9 ±7.2)min vs (73.3 ±6.4)min],mean postoperative drainage period [(3.2 ±0.9)d vs(5.0 ±1.3)d],and mean postoperative hospital stay [(7.2 ±1.4)d vs(8.7 ±1.5)d]between the dual-port VATS and open thora-cotomy(P <0.05 ).Conclusion Dual-port video-assisted thoracic surgery can reduce postoperative drainage period and postoperative hospital stay and increase satisfaction.It has little influence on upper limb movement and improves postoperative recovery.
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Objective: To investigate the feasibility for reconstructing an aortic arch by a new integrated two-branched stent graft releasing in experimental canine thoracic aorta simulation system. Methods: A new type of integrated two-branched stent graft was developed and placed in the canine thoracic aorta, the stent graft releasing in a simulated system was conducted under X-ray guidance to monitor the operating process and to explore the feasibility for invitro sent graft releasing. Results: The new two-branched stent graft was successfully deployed in canine thoracic aorta simulation system. The releasing process was smooth, two small stent grafts were well landing, and all stent grafts were fully expanded and properly positioned. Conclusion: Our new two-branched stent graft could successfully reconstruct the aortic arch in experimental canine. The thoracic aorta releasing system may better and truly simulate the whole process of endovascular aortic repairing, which provides a good foundation for further animal experiments.
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Thoracic aortic dissection was a catastrophic disease with change quickly,and the characteristic of thoracic aortic dissection was acute onset,complex,progress rapidly,difficult to diagnosis,and highly misdiagnosis rate.So the fatality rate of thoracic aortic dissection was high,which easy caused medical disputes.Even so,the cause of the formation of thoracic aortic dissection in detail is not clear,and many risk factors associated with the occurrence of thoracic aortic dissection.These including high blood pressure,gender (male),aortic normal aging,drug using,atherosclerosis,genetic disease and inflammatory diseases,etc.
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Objective To investigate the clinical significance of relationship between the myasthenia gravis and WHO histological types & Masaoka clinical stage of thymoma.Methods Retrospective analysis of resection specimen in thymoma and complete medical records in 81 cases from December 2004 to September 2009,using the analysis of statistical software between myasthenia gravis and both thymoma Masaoka clinical stages & the WHO histological types.Results The difference of merger with MG of thymoma Masaoka among different clinical stages was statistically significant (P ＜ 0.05).The difference of merger with MG Thymoma WHO among different histological types was statistically significant (P ＜ 0.05).The difference of thymoma Masaoka between the WHO histological type and Masaoka clinical stages was statistically significant (P ＜ 0.05,kappa =0.580,C =0.503).Conclusions There are some relationships between thymoma Masaoka clinical stages and MG,so had some relationships between thymoma WHO histological types and MG.At the same time,the thymoma WHO histological types reflects the Masaoka clinical stages in a certain extent.This relationship would be used as one of the important indicators to evaluate the prognosis of patients at some extent.
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Artery aneurysm occurred in the aortic arch involving branches of vital organs is the difficulty of the endovascular repair.In recent years,experts have made a few researches,and have obtained some effects. We reviewed the present situation this technique in this paper.
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Objective To investigate the feasibility and effect of intentional occlusion of the left subclavian artery (LSA) in endovascular aortic repair EVAR of thoracic aortic disease.Methods The cases,who needed occlusion of the LSA in EVAR of thoracic aortic disease,were examined cerebral circulation,carotid artery,vertebral basilar artery and circle of Willis.If the vertebral artery had a good blood pathway,and carotid artery and circle of Willis had no stenotic,we occluded the LSA directly in EVAR,and observed the brain and upper limb ischemia complications postoperation.Results Among 40 cases who were occluded the LSA directly in EVAR,28 cases were successful with no neurological complications and left upper limb ischemia symptoms postoperation,12 patients with mild symptoms of subclavian steal syndrome and neurdogical complications,but none required and secondary surgical intervention.Conclusions Prior to intentional LSA occlusion,attention must be paid to potential supraaortic variants and pathologies.Only in this way,it was safe and effective to occlude the LSA in EVAR of thoracic aortic disease.
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Objective To provide vessel anatomical materials guidance for endovascular aortic repair,the branches artery of thoracic aortic was studied by CT angiography (CTA).Methods From January 2008 to February 2012,739 adult cases' CTA data were collected,all cases performing thoracic CTA in Wuhan General Hospital of Guangzhou Command.We measured the diameter and/or leugth of the ascending aorta,aortic arch and branches artery of aortic arch,and made an analysis.Results The aortic arch includes standard and variant types.Standard type is common,which accounted for 91.1％ of the total number,while variant type accounted for 8.9％.In the standard aortic arch of patients,the diameter of aortic arch above the opening of coronary artery (CA) was (35.7 ±4.3) mm,the diameter of ascending aortic arch at the opening of brachiocephalic trunk (BCT) was (33.6 ±4.2) mm,the diameter of aortic arch between the BCT and the left common carotid artery (LCCA) was (29.4 ± 5.7) mm,the diameter of aortic arch between the LCCA and the left subclavian artery (LSA) was (27.6 ± 4.2) mm,the diameter of descending aortic at the opening of the LSA was (25.4 ± 4.5) mm,the diameter of the head BCT from aortic arch was (12.9 ±0.9) mm,the diameter of the head LCCA from aortic arch was (8.5 ± 0.7) mm,the diameter of the head LSA from aortic arch was (10.4 ± 1.1) mm,the length of aorta between the CA and the BCT was (53.3 ±12.5) mm,the length of aortic between the BCT and the LCCA was (4.7 ± 1.5) mm,the length of aortic between the LCCA and the LSA was (7.9 ± 2.6) mm,the length between the opening of BCT and the right subclavian artery (RSA) was (41.1 ± 8.2) mm,the length between the opening of LSA and the opening of left vertebral artery was (38.5 ±5.7) mm,the angle between the horizontal of BCT and the LCCA and the sagittal plane was (71.2 ± 7.2) °,the angle between the plane of LCCA and the LSA and the plane of sagittal was (31.1 ± 2.9)°.Conclusions The CT data of the thoracic aorta can be used as reference for production of stents and guide releasing the stents in endovascular repair.
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Objective To discuss the experience of open heart operation on beating in complex and severe congenital heart diseases. Method This kind of operation was put to use in 48 cases of the heart diseases in order to observe the effect of myocardial protection, prevention from air embolism,exposure of the operative field, and cardiopulmonary bypass. Results Operation field exposure was clear enough to finish the manipulation. One cases was eventiful postoperatively and died(2.08%). Conclusion Open heart operation on beating with slight hypothermia might have much feasibility in the part of complicated and severe congenital heart diseases.
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Objective To summarize the clinical experience of video-assisted thoracoscopic surgery (VATS) for thoracic diseases. Methods Clinical data of 207 patients receiving VATS form October 1997 to March 2004 were retrospectively analyzed. Among them, there were 155 cases of spontaneous pneumothorax treated by pulmonary bubble ligation or resection, 30 cases of spontaneous or traumatic hemopneumothorax treated by urgent exploration, 14 cases of pulmonary benign diseases undergoing pulmonary wedge resection and biopsy, and 8 cases of mediastinal tumor resection. Results Surgical procedures were completed thoracoscopically in 190 patients and were accomplished under thoracoscope with an additional mini-thoracotomy in 12 patients, while conversions to open surgery were required in 5 patients. The time of surgical procedures was 20~180 min (mean, 56 min). The postoperative hospital stay was 5~52 d (mean, 9 d). Postoperative complications occurred in 17 cases (8.2%, 17/207), including 9 cases of persistent air leakage, 6 cases of re-expansion pulmonary edema, and 2 cases of infection of thoracic cavity. Spontaneous pneumothorax reoccurred in 2 patients 3~4 months postoperatively. Conclusions VATS offers more advantages over traditional thoracotomy for the treatment of spontaneous pneumothorax pulmonary bubble, traumatic hemopneumothorax and selected chest benign diseases. The combination with mini-thoracotomy under certain circumstance may contribute to assuring the safety of this procedure.
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Objective: To study the effect and mechanism of delayed preconditioning induced by adenosine A 1 receptor. Methods: Male Wistar rats in group A, C,D,K were preconditioned with CCPA, normal salt, Pyrrolidin diethyldi thiocarbamate(DDTC), DDTC +CCPA, respectively. The hearts were isolated and perfused with H-K buffer solution on the Langendorff apparatus 24 hours later,the isolate heart was perfused modified St.Thomas solution for 180 minutes at 4℃, and then reperfused with the H-K buffer for 60 minutes at 37℃. Results:The left ventricular function (+dp/dt max ,%) and myocardial ATP level in group A were better than those of C, D, K groups (P
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Adenosine receptor agonists can activate adenosine receptors A 1 and A 3, thus trigger delayed preconditioning signal pathway and induce high expression of protective proteins and some ionic channel opening in myocardial cells, which reduces myocardial ischemia/reperfusion injury.
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Objective To study the feasibility of additive improvement of heart protection by preconditioning with MLA and adenosine.Methods Rabbits of group A were injected with MLA, then 24?h later the hearts were isolated, mounted on a Langendorff apparatus, preconditioned with adenosine, perfused with filtered modified Krebs-Henseleit(K-H) buffer through left atria, instrumented left ventricular function monitor system and paced ventricularly at 180 beat/min. Hearts were arrested with 4?℃ modified St.Thomas solution, stored for 4?h at 4?℃ in this solution, and reperfused with K-H buffer. Left ventricular function, myocardial CK-mb leakage and tissue levels of adenosine triphosphate were measured. Groups B and C were only preconditioned with MLA or adenosine, respectively, while group D was only preserved with the modified St.Thomas solution in 4?℃.Results The left ventricular function recovery as percentage (+dp/dt max) in groups A, B, C was 70.97 ? 17.92 , 65.54 ? 22.62 , 64.36 ? 16.10 , respectively. If compared with group D ( 39.07 ? 13.78 ), the differences were significant ( P
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Objective To discuss the feasibility of open heart operation on beating in the congenital heart diseases.Method This kind of operation was put to use in 181 cases of the congenitalheart diseases in order to observe the effects of myocardial protection, prevention from air embolism,et al.Results Operation field exposure was clear enough to finish the manipulation. All but one case was uneventiful postoperatively,especially without air embolism. Conclusion Open heart operation on beating with slight hypothermia is highly feasible in the common congenital heart diseases.
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Objective To study the potential improvement of donor heart storage by A1 adenosine receptor-induced delayed preconditioning and the mechanism.Methods Male Wistar rats were randomly divided into 8 groups. Group A was pretreated with 2-chloro-N6-cyclopen-tyladenosine (CCPA),and 24 h later,the hearts were stored in St.Thomas solution for 4 h at 4 ℃ and reperfused with K-H buffer for 1 h,while group B was only injected with vehicle of CCPA. Similarly,group C was administered with CCPA,and 24 h later,subjected to 3 h of hypothermial ischemia and 1 h reperfusion,while groups D,E,F received antisense ODN (AS),sense ODN and scrambled ODN to the initiation site of rat Mn-SOD mRNA before preconditioning with CCPA,respectively. In the meantime,groups G and H were only administered with AS or vehicle of CCPA,respectively. Left ventricular function,myocardial CK-mb leakage,tissue levels of adenosine triphosphate and Mn-SOD were measured.Results The recovery percentage of ?dp/dt max of left ventricle in groups A,C,E and F were much higher than in groups B,D,G and H ( P