ABSTRACT
<p><b>BACKGROUND</b>Double outlet right ventricle (DORV) is a group of complex congenital heart abnormalities. Preoperative pulmonary hypertension (PH) is considered an important risk factor for early death during the surgical treatment of DORV. The aim of this study was to report our experience on surgical treatment of DORV complicated by PH.</p><p><b>METHODS</b>From June 2004 to November 2016, 61 patients (36 males and 25 females) aged 2 weeks to 26 years (median: 0.67 years and interquartile range: 0.42-1.67 years) with DORV (two great arteries overriding at least 50%) complicated by PH underwent surgical treatment in our center. All patients were categorized according to surgical age and lesion type, respectively. Pulmonary artery systolic pressure (PASP), pulmonary artery diastolic pressure (PADP), and mean pulmonary artery pressure (mPAP) were measured directly before cardiopulmonary bypass (CPB) was established and after CPB was removed. An intracardiac channel procedure was performed in 37 patients, arterial switch procedure in 19 patients, Rastelli procedure in three patient, Senning procedure in one patients, and Mustard procedure in one patient. The Student's t-test and Chi-squared test were performed to evaluate clinical outcomes of the surgical timing and operation choice.</p><p><b>RESULTS</b>Fifty-five patients had uneventful recovery. PASP fell from 55.3 ± 11.2 mmHg to 34.7 ± 11.6 mmHg (t = 14.05, P < 0.001), PADP fell from 29.7 ± 12.5 mmHg to 18.6 ± 7.9 mmHg (t = 7.39, P < 0.001), and mPAP fell from 40.3 ± 10.6 mmHg to 25.7 ± 8.3 mmHg (t = 11.85, P < 0.001). Six (9.8%) patients died owing to complications including low cardiac output syndrome in two patients, respiratory failure in two, pulmonary hemorrhage in one, and sudden death in one patient. Pulmonary artery pressure (PAP) dropped significantly in infant and child patients. Mortality of both infants (13.9%) and adults (33.3%) was high.</p><p><b>CONCLUSIONS</b>PAP of patients with DORV complicated by PH can be expected to fall significantly after surgery. An arterial switch procedure can achieve excellent results in patients with transposition of the great arteries type. Higher incidence of complications may occur in patients with ventricular septal defect (VSD) type before 1 year of age. For those with remote VSD type, VSD enlargement and right ventricle outflow tract reconstruction are usually required with acceptable results. The degree of aortic overriding does not influence surgical outcome.</p>
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Male , Young Adult , Cardiac Surgical Procedures , Methods , Double Outlet Right Ventricle , General Surgery , Heart Septal Defects, Ventricular , General Surgery , Heart Ventricles , General Surgery , Hypertension, Pulmonary , Pulmonary Valve Stenosis , General Surgery , Risk Factors , Transposition of Great Vessels , General Surgery , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To observe the influence of endoscopic radial artery harvesting techniques on the prevalence of complications after coronary artery bypass grafting, and to assess the potential trauma to the radial artery through the histological changes.</p><p><b>METHODS</b>From August 2003 to June 2008, 87 patients undergoing CABG had radial artery harvested by endoscopic harvesting system. About 4 mm proximal and distal radial artery end segment of 10 patients undergoing endoscopic and conventional harvesting were examined with light and electro-microscope.</p><p><b>RESULTS</b>The endoscopic harvest time was 42 to 98 min, with a mean of (57.6 +/- 17.3) min. The harvested conduit length was 15 to 20 cm, with a mean of (17.5 +/- 1.6) cm. Objective dorsal thenar numbness remained in 7 patients, none complained of forearm numbness at 3-month follow-up. The result of light and electro-microscope had no differences in the intima, media, or adventitia between endoscopically and conventionally obtained radial artery segments.</p><p><b>CONCLUSION</b>The use of endoscopic radial artery harvesting in coronary artery bypass grafting can be performed safely with infrequent complications. This method results in excellent patient satisfaction, particularly regarding the cosmetic outcome.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Coronary Artery Bypass , Endoscopy , Radial Artery , Transplantation , Tissue and Organ Harvesting , Methods , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To investigate the gene expression of matrix metalloproteinases (MMP-2, MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in proliferative and mature hypertrophic scars.</p><p><b>METHODS</b>Total RNA from 8 normal skin samples and from 16 human hypertrophic scar samples of different maturing stage was respectively extracted, and then mRNA was isolated. The gene expressions of MMP-2, MMP-9 and TIMP-1 in these samples were examined with reverse transcription-polymerase chain reaction (RT-PCR).</p><p><b>RESULTS</b>The gray scale ratio of MMP-2, MMP-9 and TIMP-1 transcription in normal skin were (3.8 +/- 0.7)%, (5.8 +/-4.4)%, (30.3 +/- 3.0)%, respectively, which were obviously higher than those in proliferative hypertrophic scar [(14 +/- 5)%, (18 +/- 5)%, (38 +/- 4)%, P < 0.05]. The expression of MMP-2 and MMP-9 genes in mature hypotrophic scar returned to normal level, but that of TIMP-1 remained high when compared with that of normal level (P < 0. 05).</p><p><b>CONCLUSION</b>The increase in MMP-2, MMP-9 and TIMP-1 gene expression might be involved in the formation of hypertrophic scars, while the lowering of MMP-2 and MMP-9 gene expression might be associated with the maturation of hypertrophic scars.</p>
Subject(s)
Female , Humans , Male , Cicatrix, Hypertrophic , Genetics , Metabolism , Pathology , Gene Expression , Matrix Metalloproteinase 2 , Genetics , Metabolism , Matrix Metalloproteinase 9 , Genetics , Metabolism , RNA, Messenger , Metabolism , Skin , Metabolism , Pathology , Tissue Inhibitor of Metalloproteinase-1 , Genetics , MetabolismABSTRACT
<p><b>OBJECTIVE</b>To investigate the relation of heparanase gene and angiogenesis with the progress of gastric carcinoma (GC).</p><p><b>METHODS</b>Expression of heparanase mRNA in 52 GC tissue was detected by in situ hybridization assay. Microvessel density (MVD) was examined by immunohistochemical method. MVD and heparanase mRNA expression were analysed with their relation to histological grade, invasion depth,lymph node metastasis and organ metastasis.</p><p><b>RESULTS</b>MVD was 73.2 +/- 22.8 in 25 (48.1%) tissue with positive heparanase mRNA. It was 44.8 +/- 11.9 in 27 (51.9%) tissues with negative heparanase mRNA, between which the difference was significant (P < 0.001). MVD and heparanase mRNA expression were related with lymph node metastasis and depth of serosal invasion in GC (P < 0.005).</p><p><b>CONCLUSION</b>Heparanase, being related to angiogenesis in gastric cancer, promotes growth, invasion and metastasis. Heparanase mRNA expression is an important predictor of the biological behavior of human gastric carcinoma.</p>