Cardiopulmonary protection of ischemic postconditioning in cardiac surgery in children with tetralogy of Fallot / 中国当代儿科杂志

<p><b>OBJECTIVE</b>Ischemic postconditioning effectively minimizes the ischemic/reperfusion injury, and the large series of case reports on its protective effects in cardiac surgery are limited. A randomized trial was conducted to investigate the effect of ischemic postconditioning on cardiopulmonary protection in children undergoing cardiac surgery for tetralogy of Fallot.</p><p><b>METHODS</b>One hundred and five-children with tetralogy of Fallot undergoing surgery were randomly assigned to control (n=58) and ischemic postconditioning groups (n=47). Ischemic postconditioning was performed by intermittent aortic clamping after reperfusion. After surgery, the duration of intensive care unit (ICU) stay, capacity of blood transfusion, hemodynamics, inotropic scores, respiratory function, and release of blood lactate were assayed.</p><p><b>RESULTS</b>There was a significant decrease in the ICU stay in the postconditioned group compared with the control group (37+/-21 hrs vs 54+/-26 hrs; P<0.05 ). The capacity of blood transfusion (308+/-230 mL vs 526+/-515 mL; P<0.05) and the inotropic scores (5.9+/-5.0 vs 10.3+/-7.7; P<0.05) in the postconditioned group were significantly reduced compared with those in the control group. Blood lactate contents in the postconditioned group was significantly lower that those in the control group 1, 3, 6, 9, 12 and 20 hrs after surgery. The postconditioned group showed more improved hemodynamics and respiratory function than the control group.</p><p><b>CONCLUSIONS</b>Ischemic postconditioning may provide clinical benefits with respects to myocardial and pulmonary protections in children undergoing repair for tetralogy of Fallot.</p>

Clinical study of lung mucoepidermoid tumors / 中南大学学报(医学版)

OBJECTIVE@#To investigate clinical and pathological characteristics of lung mucoepidermoid tumors and summarize methods for diagnosing and treating it.@*METHODS@#Records of a total of 2,751 consecutive patients with lung cancer were reviewed and 10 of whom with mucoepidermoid tumors were identified. Chest radiographs, computer tomographs, and bronchoscopes were performed to all of them. Eight of them underwent thoracotomy and some also received chemotherapy and/or radiotherapy. One patient received Chinese herb therapy only while another did not receive any therapy.@*RESULTS@#Pathological examination showed that the 10 patients had low-grade mucoepidermoid tumors. All patients were alive. Seven patients who received thoracotomy did not recur. One patient whose tumor was located in trachea recurred 5.2 years after the operation.@*CONCLUSION@#Bronchoscope can play an important role in the process of diagnosis. Pathological staging is vital for prognosis. Lung mucoepidermoid tumors should be treated with complete surgical resection with lymph node sampling and dissection and close follow-up.

Dynamic monitoring of arterial blood lactic acid in the prognosis of heart operation / 中南大学学报(医学版)

OBJECTIVE@#To determine the clinical value of arterial blood lactic acid monitoring in patients after cardiac surgery.@*METHODS@#Relationship between dynamic blood lactic acid level and the prognosis of 200 patients (9 patients in the dead group, and 191 patients in the healing group) was analyzed after cardiac operation.@*RESULTS@#The level of blood lactic acid was (1.2+/-0.3) mmol/L in the healing group,and (5.6+/-0.9) mmol/L in the death group. The level of blood lactic acid in the healing group descended to normal in 24 hours, while that in the death group rose persistently. The dynamic change of lactic acid indicated more sensitively the prognosis of the disease than pH and BE.@*CONCLUSION@#The higher the arterial blood level of lactic acid, the longer the duration, the more critical the condition, the higher the mortality rate. Blood lactic acid level can be used as an excellent prognosis index for patients after cardiac surgery.

Fifty-three cases of valve repair for mitral insufficiency / 中南大学学报(医学版)

OBJECTIVE@#To summarize the experience of mitral vavuloplasty for mitral insufficiency in 53 patients.@*METHODS@#Between January 2001 and September 2006,53 patients (31 males and 22 females) with mitral insufficiency underwent mitral valve repair at our hospital. The mean age was (23.8+/-10.4) years, and the mean weight was (43+/-12) kg,including 29 cases of mitral prolapse,17 congenital mitral insufficiency, 5 rheumatic mitral insufficiency,and 2 other etiology. All operations were performed under cardiopulmonary bypass,moderate hypothermia and under the surveillance of transesophagus echocardiography.@*RESULTS@#There were 2 early postoperative deaths,and another patient failed to repair and received valve replacement afterward. Postoperative echocardiography indicated that mitral insufficiency was completely corrected in 42 patients, and residual mitral regurginitation in the other 8 patients. During the follow-up with mean period 13.8 months,41 patients revealed 28 in NYHA classI,13 in Class II.@*CONCLUSION@#Mitral valve repair should be the preferred modes of surgical correction for regurgitate mitral valves. With proper vavuloplasty technique, patients with selective mitral insufficiency patients may achieve satisfactory effect.

Mechanical valve replacement in children with heart valve diseases / 中南大学学报(医学版)

OBJECTIVE@#To determine the surgical point and technique of artificial mechanical valve replacement in children with heart valve diseases.@*METHODS@#From Jan. 1989 to Oct. 2005, 63 children under 15 years received mechanical cardiac valve replacement with cardiopulmonary bypass (CPB).@*RESULTS@#The valve replacement included aortic valve replacement in 20 children, mitral valve replacement in 37 children and combined aortic valve and mitral valve replacement in 6 children.@*CONCLUSION@#The operation mortality was 7.94%(5/63). The follow-up periods were from 4 months to 204 months. The late mortality was 10.34%(6/58). All the other children were in NYHA class I - II. The operation mortality of children with heart valve replacement is higher than that of adults, but it was very effective.

Applied anatomy of inferior epigastric artery in coronary artery bypass grafting / 中南大学学报(医学版)

OBJECTIVE@#To measure the inferior epigastric artery(IEA),coronary artery and arterial bridge to supply the anatomic and hemodynamic data of IEA in coronary artery bypass grafting for clinicians.@*METHODS@#Anatomic method was adopted to measure the length of IEA, arterial bridge, the outer diameter of IEA and coronary arteries. Colour doppler ultrasound instrument was adopted to measure the caliber and the blood flow rate of IEA and coronary artery.@*RESULTS@#In the anatomic method, the length of IEA was (13.00+/-2.58)cm and the caliber of original IEA was (2.95+/-0.21)mm, the caliber of IEA intersecting with abdomen rectus was (2.51+/-0.32)mm, and (1.60+/-0.26)mm at 1.0 cm below the umbilicus. In color doppler ultrasound method, the caliber of original IEA was (2.98+/-0.37)mm, and at 5 cm from the original spot was (2.60+/-0.27)mm. The blood flow rate was (57.00+/-6.78)cm/s. The main stem caliber of the left coronary artery was (4.90+/-0.76)mm, and that of the right coronary artery was (3.58+/-0.63)mm; the blood flow rate was (48.50+/-7.72)cm/s. The length of the arterial bridge was (10.95+/-1.35) approximately (15.30+/-2.82)cm.@*CONCLUSION@#IEA can bridge the aorta and the coronary artery branches including the left anterior descending branch, the left circumflex branch and the right main coronary artery in free grafting. Its caliber and blood flow rate can match with those of the coronary artery. Before the operation of applying color doppler ultrasound instrument, the safety of IEA in the coronary artery bypass grafting can be evaluated to provide a new safe method in clinical follow-up.

Effect of cortisol on ischemic preconditioning in rabbit hearts / 中南大学学报(医学版)

OBJECTIVE@#To determine the effects of reacting cortisol on ischemic preconditioning (IPC).@*METHODS@#Thirty rabbits were randomized into ischemic preconditioning (IPC) group, etomidate (Etom) group, ischemic/reperfusion (IR) group, methylprednisolone (MP) group and a control group. The ratios of infarction size versus risk area (Infarct/Risk) were calculated. The elevations of serum CK activity and cTnI concentrations as well as serum cortisol concentrations were measured.@*RESULTS@#The ratios of Infarct/Risk were 5.9%+/-2.8% for IPC, 11.3%+/-3.6% for Etom, 26.8%+/-4.5% for IR and 18.2%+/-3.7% for MP. The elevations of serum CK activity (U/L) were 255+/-89 for IPC, 314+/-160 for Etom, 855+/-371 for IR and 768+/-404 for MP, the elevations of serum cTnI concentrations (microg/L) were 3.6+/-0.6 for IPC, 5.9+/-2.0 for Etom, 8.1+/-3.6 for IR and 6.1+/-2.3 for MP. Those indicators among groups are all significantly different (P<0.01). Cortisol reacting was markedly diminished in Etom group.@*CONCLUSION@#A blunted cortisol reaction can markedly undermine the benefit of ischemic preconditioning, methylprednisolone show a certain myocardial protection. Cortisol may play an important role in the IPC process.

Surgical treatment of cor triatriatum in 15 patients / 中南大学学报(医学版)

OBJECTIVE@#To review the clinical data of pathological morphology, diagnosis, surgical treatment of cor triatriatum in 15 patients.@*METHODS@#Fifteen patients with a mean age of (14.6+/-10.3) years (range from 6 months to 40 years) were performed operations under extracorporeal circulation. Fourteen of the patients had cor triatriatum sinister, and 1 had cor triatriatum dexter; 12 of the 15 patients had other cardiac abnormalities. The excision of the fibromuscular membrane was accomplished through a right atrial incision in all of the 14 cases, and the associated abnormalities were corrected at the same time.@*RESULTS@#One patient died after the operation, and the other survivors had good outcome.@*CONCLUSION@#Operation is necessary if the diagnosis is clear. The patients generally have good prognosis. Surgical results of cor triatriatum depend on the complexity of associated defects and the adequacy of the repair.

Direct observation of the effect of mitral valvuloplasty on beating heart / 中南大学学报(医学版)

OBJECTIVE@#To summarize the method and experience of direct observation of the effect of mitral valvuloplasty on beating heart.@*METHODS@#Twelve patients with mitral regurgitation underwent mitral valvuloplasty. When the heart was beating slowly before releasing the aorta, the morphology and function of the mitral valve were evaluated by direct observation. If the results were unsatisfactory, further techniques were used to reach the goal.@*RESULTS@#During the operation 2 patients needed further techniques to make the mitral valve work well. No operative death and only 1 complication (low cardiac output syndrome) occurred. After 1 month follow-up later, mild regurgitation was found in 5 patients, moderate regurgitation in 1 and no obvious regurgitation in 6.@*CONCLUSION@#Evaluating the effect of mitral valvuloplasty by direct observation on beating heart is practicable.

The protective effect of aminophylline on myocardium during cardiopulmonary bypass / 中华急诊医学杂志

Objective To evaluate the protective effect of aminophylline on myocardium in the patients undergoing prothetic valve replacement operation of heart.Mothods Thirty patients undergoing prothetic valve replacement operation of heart were randomized to be treated either with aminophylline(n=15)or without aminophylline treatment(n=15). Aminophylline(5mg/kg)was injected intravenously at 15 minutes after induction of anesthesia.Cardiac troponin I(cTnI), cyclic adenosine monophosphate(cAMP),myeloperoxidase(MPO),ratio of aortic blood neutrophil count to coronary vein sinus blood neutrophil count,hemodynamics,time of aortic cress-clamping and other clinical data were recorded during the operation.Results There were no differences between the two groups in the major perioperative variables.Plasm cTnI concentration in both groups increased after off-clamping than that before CPB,however,it was lower in aminophylline group than that in control group.Concentration of cAMP in both groups after off-clamping was lower than that before CPB, however cAMP concentration in aminophylline group after off-clamping was higher than that in control group.Myocardial MPO activity and neutrophil count ratio after aortic off-clamping in aminophylline group was significantly lower than that in control group.Conclusion These results suggest that aminophylline is helpful to unprotection of myocardial and decreases the sequestration of neutrophil in myocardium.The mechanism of the protection may be related to the cAMP increased in myocardium.

Aortic Valvuloplasty in Treatment of Ventricular Septal Defect with Aortic Valve Insufficiency in Children / 实用儿科临床杂志

Objective To explore the clinical effects of aortic valvuloplasty in treatment of ventricular septal defect(VSD)with moderate or severe aortic valve insufficiency(AI)in children.Methods Thirteen children less than 14 years old underwent open heart surgery as well as aortic valvuloplasty for VSD with moderate or severe AI.There were 9 cases of subpulmonary VSD,perimenbranous VSD in 4 cases.AI was mo-derate in 4 cases,severe in 9 cases.Results There was no hospital death.Post-operative echocardiogram and X-ray revealed that both cardiothoracic ratio and left ventricular end diastolic diameter decreased markedly(P

Protective mechanism of ischemic preconditioning to the lung ischemia-reperfusion injury / 中南大学学报(医学版)

OBJECTIVE@#To determine the protective mechanism of preconditioning to the lung injury induced by ischemia-reperfusion.@*METHODS@#Twelve pigs were randomly divided into 2 groups: control group ( Group C) and ischemic preconditioning group ( Group IP). The concentration of superoxide distrautase (SOD) and malondialdehyde (MDA) in circuit were checked before and after the perfusion to reflect the lipid peroxidation in the lungs. Left lung biopsies were performed immediately after the perfusion and 1 hour postperfusion for histologic examination. The ICAM-1 expression was assessed by immunohistochemical analysis with Envision method and the mRNA expression of ICAM-1 was analyzed by RT-PCR.@*RESULTS@#SOD in Group IP was much higher than that in Group C (P < 0.01 ). MDA in Group IP was much lower than that in Group C ( P < 0.01 ). The lung histologic examination showed that Group C was significantly more serious than Group IP in pulmonary edema, inflammatory cell infiltration, mild focal hemorrhage, and alveolar disruption. The expression of ICAM-1 of lung tissue obviously decreased in Group IP than that in Group C (P <0.01 ). The expression of ICAM-1 mRNA of lung tissue was significantly lower in Group IP than that in Group C (P < 0.01 ).@*CONCLUSION@#Lung ischemic preconditioning can reduce the lung injury. The mechanisms of the protective effects of the IP may be related to the increase of SOD and the decrease of MDA. The preconditioning down-regulated the ICAM-1 expression is one of the mechanisms in reducing the lung injury.