Aortic valve replacement: the experiences of 1026 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To study the changes in pathogenic causes and the prognosis of aortic valve replacement (AVR).</p><p><b>METHODS</b>The clinical data of 1026 patients undergoing AVR from December 1980 to December 2006 were analyzed retrospectively. The mortality, morbidity, changes in pathogenic causes and risk factors were analyzed.</p><p><b>RESULTS</b>The postoperative mortality and complication morbidity were 4.3% and 10.6% respectively within 30 days followed operation. Main causes of operative death were heart failure, multi organ failure and endocarditis. The major risk factors for operative death were left ventricle ejection fraction less than 0.4, endocarditis, valve regurgitation and emergency operation before AVR. Late mortality was 0.54% patient-year (3.4%), most of whom died of heart failure, endocarditis and arrhythmias. Patients underwent reoperation 0.22% patient-year (1.4%), with the causes of endocarditis and perivalvular fistula.</p><p><b>CONCLUSIONS</b>Morbidity of rheumatic damage in aortic valve has decreased, while valve degeneration has increased gradually in the recent years. Avoiding prosthesis-patient mismatch, good postoperatively guide and prevention of endocarditis can improve the prognosis of AVR.</p>

Surgical treatment of aortic coarctation under normothermia without cardiopulmonary bypass: a report of 15 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the early and mid-term outcome of surgical repair for post-ductal coarctation of the aorta (CoA) under normothermia without cardiopulmonary bypass.</p><p><b>METHODS</b>Clinical data from 15 patients (11 males, 4 females, mean age 18 +/- 10 years) undergoing surgical repair for post-ductal CoA under normothermia without cardiopulmonary bypass between January 1999 and December 2004 were analyzed retrospectively. There were 7 isolated cases, 7 cases associated with patent ductus arterious (PDA), 1 case with PDA and ventricular septal defects. Operation was performed under normothermia with partial cross-clamping of descending aorta in 8 cases, compete cross-clamping in 6 cases and temporary shunt in 1 case. Operative techniques adopted prosthetic bypass graft in 9 cases, Gore-Tex patch graft aortoplasty in 4 cases and stenosis resection with end-to-end anastomosis in 2 cases. PDA was ligated at single-stage in 8 cases. Ventricular septal defect was repaired at second stage in 1 case.</p><p><b>RESULTS</b>No early and late death. Hypertension occurred in 9 cases during early postoperative period but was normalized gradually in 5 cases without medication during follow-up period, from 6 months to 5 years. The arterial blood pressure of lower extremities increased significantly and no hoarseness, paraplegia occurred after operation. No recoarctation and aneurysm formation were found during follow-up.</p><p><b>CONCLUSION</b>Surgical repair of post-ductal CoA under normothermia without cardiopulmonary bypass is safe and effective, which is a procedure of choice for patients with isolated CoA, CoA associated with PDA, or with other intracardiac anomalies that are ready to be repaired at second-stage.</p>

Diagnosis and surgical management of primary cardiac neoplasms / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To review and summarize the experience in diagnosis and surgical management of primary cardiac neoplasms.</p><p><b>METHODS</b>112 patients with primary cardiac neoplasms were treated surgically from Jan. 1980 to Jan. 2005. Those tumors were grouped into three categories: myxomas (98), benign nonmyxomas (3), and malignant tumors (11). Five of 11 malignant tumor patients underwent biopsy or palliative operation, the other patients received complete excision. Mitral valve replacement were done simultaneously in 2 of these patients, mitral valve repair in 4 and tricuspid valvoplasty in 33. All patients' diagnosis was confirmed by echocardiography.</p><p><b>RESULTS</b>108 patients survived the operation and 4 patients died postoperatively. The hospital mortality was 3.6% (4/112). Two patients developed poor left ventricular function postoperatively and died at the third and the seventh postoperative day due to low cardiac output. One patient developed and died of progressive hepatic and renal function failure postoperatively. Another one patient died of severe arrhythmia. Mean follow-up of 76 myxoma patients who are still alive was 6.4 years (range, 3 month to 17 years). Fifty-five patients still had heart function in New York Heart Association class I and 21 in class II at the end of follow-up without any evidence of recurrance. The follow-up results of benign nonmyxomas were similar to those of myxomas. Mean follow-up of all survived malignant tumor patient was 6 months (range, 2 months to 12 months). Ten of them died of recurrence or metastasis within 1 year postoperatively except only one still alive.</p><p><b>CONCLUSION</b>Surgical resection, whenever possible, is the first treatment choice for all kinds of primary cardiac tumors. Surgical resection of myxoma and benign nonmyxoma can give excellent long-term results which may lead to eventual cure of myxoma and benign nonmyxoma. For malignant tumor patient, surgical treatment is only palliative and to prolong the life of patients.</p>

Congenital coronary artery fistulae in adults: diagnosis and surgical treatment / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the clinical characteristics, diagnosis and surgical in-treatment results of congenital coronary artery fistulas (CAF) in adults.</p><p><b>METHODS</b>Fourteen patients (8 men, 6 women), aged from 18 to 60 years with a mean of 32 +/- 13 years, underwent surgical correction of CAF between March 1985 and April 2002. Eleven of the 14 patients (78.57%) were symptomatic. The diagnosis of CAF was made by echocardiography or angiocardiography preoperatively. The fistulae originated from the right, left and double coronary arteries in 10 (71%), 3 (21%) and 1 (7%) patient(s), respectively. The fistulae drained into the right ventricle (8 patients), left ventricle (4), right atrium (1) and pulmonary artery (1), respectively. The diameter of fistulae ranged from 0.30 to 1.80 cm with a mean of (1.16 +/- 0.49) cm. There were 6 CAF patients associated with coronary artery aneurysms and 4 CAF patients with other coexisting cardiac defects. The distal fistulae were closed in 10 patients with cardiopulmonary bypass (CPB) and 4 patients without CPB. The coexisting defects were corrected simultaneously.</p><p><b>RESULTS</b>There was no early and late death. One patient had low cardiac output syndrome and cured during early postoperative period. Twelve patients (85.71%) were followed up for a mean period of 3.35 +/- 4.28 years without myocardial ischemia or infarction and recurrent fistulae. Heart function was improved to NYHA functional class I in 11 patients and class II in 1 patient.</p><p><b>CONCLUSIONS</b>All adult patients with CAF who have demonstrable hemodynamic and cardiovascular morphological changes should be surgically treated as early as possible. The appropriate surgical management and reliable myocardial protection are key points of good surgical results.</p>

Long-term results of mitral-aortic valve replacement in 1,154 patients with rheumatic valvular disease / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the early and long-term results after mitral-aortic valve replacement for rheumatic valvular disease and the determinant factors involved and subsequent therapies.</p><p><b>METHODS</b>1 154 patients receiving combined mitral-aortic valve replacement for rheumatic valvular disease from May 1981 to May 2001 were reviewed. The mean age of the patients was 41.48 +/- 10.00 years. Concomitant valve plasty was performed for associated tricuspid organic or significant functional lesions. Lateral tilting disc or bileaflet valve prostheses were used for replacement. New York Heart Association functional status showed Class III or IV in 91.77% of the patients. Moderate to severe pulmonary hypertension occurred in 29.38% of the patients. The duration of follow-up varied from 8 months to 20 years.</p><p><b>RESULTS</b>The hospital mortality was decreased from 6.50% to 4.45%. The 5-, 10- and l5-year survival rates were 89.46% +/- 1.35%, 86.50% +/- l.91% and 67.86% +/- 6.16%, respectively. The 5-, 10- and l5-year thromboembolic event free rates were 97.80% +/- 0.74%, 88.31% +/- 2.20% and 94.08% +/- 2.29%, respectively. the 5-, 10- and l5-year anticoagulant related bleeding free rates were 94.80% +/- 1.09%, 89.32% +/- 2.10% and 83.12% +/- 3.57% respectively. Cardiac functional status returned to Class II in 98% patients and to Class III in 2% during follow-up.</p><p><b>CONCLUSIONS</b>Both left and right ventricular functions may be impaired as a result of rheumatic valvular disease. Tricuspid valve should be explored during surgery and any significant tricuspid annular enlargement and regurgitation showed be corrected in concomitance. Long-acting penicillin regimen is needed for 3 - 5 years for the prevention of rheumatic fever relapse. A low intensity anticoagulant regimen after valve replacement with prothrombin time targeting at 1.5 - 2.0 times is advisable in lessening anticoagulant related bleeding yet optimizing sufficient prevention against thromboembolic complications.</p>

Effect of terminal warm blood cardioplegia on the changes of tubulin in myocardial cells after hypothermic ischemia and reperfusion / 第二军医大学学报

Objective: To elucidate the possible mechanism responsible for the improved protection of terminal warm blood cardioplegia (TWBC) after hypothermic cardiopulmonary bypass (CPB) through analysis of tubulin (TB) components changes in myocardial cells exposed to TWBC. Methods: Stable animal models of CPB were established in cats, which were then randomly divided into 2 groups. Group Ⅰ was subjected to intermittent cold blood cardioplegia (ICBC) whereas group Ⅱ to ICBC followed by TWBC before uncross-clamping. Left ventricular performance was then monitored and evaluated by LVSP, LVEDP, ±dp/dtmax and t-dp/dtmax in both groups and semi-quantitive analysis was conducted with Western blot method as to the content and constitution of TB in myocardial cells at 15 min, 120 min after aortic crossclamping (ACC) and 5 min,15 min, 60 min,120 min after reperfusion. Results: Within 120 min after reperfusion, systolic and diastolic functions decreased significantly in group Ⅰ as compared with group Ⅱ(P<0.05). At 115 min after ACC and 15 min after reperfusion, the content of free and polymerized TB in both groups had no difference (P>0.05). At 120 min after ACC and 5 minutes after reperfusion, there was a significant difference between groupⅠ andⅡ (P<0.01). Conclusion: TWBC accelerates the repolymerization of myocardial TB during hypothermic CPB, which may mediate the improved cardiac performance in the early stage of myocardial reperfusion.

Effect of terminal warm blood cardioplegia on the changes of tubulin in myocardial cells after hypothermic ischemia and reperfusion / 第二军医大学学报

Objective: To elucidate the possible mechanism responsible for the improved protection of terminal warm blood cardioplegia (TWBC) after hypothermic cardiopulmonary bypass (CPB) through analysis of tubulin (TB) components changes in myocardial cells exposed to TWBC. Methods: Stable animal models of CPB were established in cats, which were then randomly divided into 2 groups. Group Ⅰ was subjected to intermittent cold blood cardioplegia (ICBC) whereas group Ⅱ to ICBC followed by TWBC before uncross-clamping. Left ventricular performance was then monitored and evaluated by LVSP, LVEDP, ±dp/dtmax and t-dp/dtmax in both groups and semi-quantitive analysis was conducted with Western blot method as to the content and constitution of TB in myocardial cells at 15 min, 120 min after aortic crossclamping (ACC) and 5 min,15 min, 60 min,120 min after reperfusion. Results: Within 120 min after reperfusion, systolic and diastolic functions decreased significantly in group Ⅰ as compared with group Ⅱ(P<0.05). At 115 min after ACC and 15 min after reperfusion, the content of free and polymerized TB in both groups had no difference (P>0.05). At 120 min after ACC and 5 minutes after reperfusion, there was a significant difference between groupⅠ andⅡ (P<0.01). Conclusion: TWBC accelerates the repolymerization of myocardial TB during hypothermic CPB, which may mediate the improved cardiac performance in the early stage of myocardial reperfusion.