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Objective To review the experience of aortic root internal drainage in the operation of type A aortic dissection.Methods This was a prospective and observational study.Clinical data were available from 20 cases of type A aortic dissection patients (A group) from March 2003 to March 2008,and anothcr 36 cases of type A aortic dissection patients (B group) from March 2008 to May 2013.All of patients received the operation of replacement of ascending aortic aneurysm and aortic arch replacement and descending aortic stented elephant trunk implantation in our hospital.The additional inside drainage were made between the aortic root aneurysm sac and right atrial appendage in B group.Perioperative and postoperative data including the operation time,the amount of bleeding,cardiopulmonary bypass time,the amount of red cell transfusion,number of postoperative cases re-operated for hemostasis,total drainage volume in 24 hours,amount of postoperative red blood cell transfusion,number of cases of postoperative pulmonary complications,and postoperative mortality rate were analyzed retrospectively.The data was analyzed using SPSS version10.0 software.The chi-square test was used for constituent ratios,whilest was applied to analysis of differences in above variables betweens two groups.Results There were significant differences in the amount of bleeding during surgery,cardiopulmonary bypass time,the amount of red cell transfusion,rate of postoperative re-operation,total drainage volume in 24 hours,amount of postoperative red blood cell transfusion,number of cases of postoperative pulmonary complications and postoperative mortality between the two groups (x2/t =2.658,2.381,2.265,3.056,6.862,2.896,2.316,7.215,7.668,P =0.012,0.034,0.007,0.016,0.013,0.032,0.008,0.008,respectively).Conclusions The method of aortic root internal drainage in the operation of type A aortic dissection could reduce the amount of bleeding and improve the success rate of operation.
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Objective To investigate the effects of sevoflurane pretreatment on the inflammatory response in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB) and the mechanism of myocardial protection.Methods Twenty NYHA class Ⅱ or Ⅲ patients of both sexes,aged ＜ 60 yr,undergoing cardiac valve replacement with CPB,were randomly divided into 2 groups (n=10 each): sevoflurane group (group S) and control group (group C).The patients were premedicated with intramuscular morphine 0.1 mg/kg and scopolamine 0.3 mg.Anesthesia was induced with iv injection of midazolam 0.05-0.08 mg/kg,fentanyl 10-15 μg/kg and pipecuronium 0.08-0.10 mg/kg.The patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with intermittent iv boluses of midazolam0.03-0.06 mg/kg,fentanyl 5-10μg/kg and pipecuronium 0.04-0.08 mg/kg.Sevoflurane was inhaled before aortic clamping and the end-tidal concentration was rapidly adjusted to 1.0％ and maintained at this level for 30 min in group S.Blood samples were taken from the central vein before skin incision,immediately after aortic clamping,immediately after aortic unclamping and at 30 min after aortic unclamping,at 2,6,12 and 24 h (T1-8) after operation for determination of the concentrations of plasma tumor necrosis factor-α (TNF-α),interleukin-6 (IL) and interleukin-8 (IL-8),intercellular adhesion molecule-1 (ICAM-1),cardiac troponin I (cTnI) and activity of creatine kinase MB (CK-MB).The requirement for cardiovascular drugs was recorded after release of aortic cross clamp.Results Compared with group C,the plasma concentrations of TNF-α,IL-6 and IL-8 were significantly decreased at T3-8,the plasma concentrations of ICAM-1 and cTnl were significantly decreased at T4-8,the activity of plasma CK-MB was significantly decreased at T8,and the requirement for cardiovascular drugs was significantly reduced after release of aortic cross clamp in group S (P ＜0.05).Conclusion Sevoflurane pretreatment can inhibit the inflammatory response and provide myocardial protection to some extent in patients undergoing cardiac valve replacement with CPB.
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Objective To investigate the effects of sevoflurane pretreatment on the myocardial injury in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Twenty NYHA class Ⅱ or Ⅲ patients,aged ＜ 60 yr,undergoing cardiac valve replacement with CPB,were randomly divided into 2 groups (n =10 each):sevoflurane group (group S) and control group (group C).The patients were premeditated with intramuscular morphine and scopolamine.Anesthesia was induced with iv injection of midazolam 0.05-0.08 mg/kg,fentanyl 10-15 μg/kg and pipecuronium 0.08-0.10 mg/kg.Anesthesia was maintained with intermittent iv boluses of midazolam,fentanyl and pipecuronium and in addition sevoflurane was inhaled before aortic clamping and the end-tidal concentration was rapidly increased to 1.0％ and maintained at the level for 5 min in group S.Blood samples were taken from the central vein before skin incision (T1),immediately after aortic clamping (T2 ),at 0 and 30 min after aortic unclamping (T3-4),and at 2,6,12 and 24 h after operation (T5-8) for determination of the concentration of serum cardiac troponin Ⅰ (cTnI) and activities of creatine kinase (CK) and creatine kinase isoenzyme-MB (CK-MB).Myocardial specimens were taken from right auricle before aortic clamping and at 10 min after aortic unclamping for electron microscopic examination.Results The concentration of serum cTnI and activities of CK and CK-MB were significantly increased at T4-8 in both groups ( P ＜ 0.05).The serum cTnI concentration at T4-8 and the activities of CK and CK-MB at T8 were significantly lower in group S than in group C ( P ＜0.05).Different degrees of mitochondrial swelling were observed after aortic unclamping in both groups,but the changes were milder in group S than in group C.Conclusion Sevoflurane pretreatment can attenuate the myocardial injury in patients undergoing cardiac valve replacement with CPB.
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Objective: To review the results with an approach of primary repair for tetralogy of Fallot (TOF) and double-outlet right ventricle (DORV) with anomalous coronary arteries. Methods: From June 1995 to June 2002, 12 patients with TOF and DORV associated with anomalous coronary arteries crossing an obstructed right ventricle outflow tract underwent primary surgical repair. To avoid injury of the anomalous coronary arteries, some modified surgical techniques were used. Main pulmonary artery translocation in 2 patients, repair under a mobilized left anterior descending coronary artery in 3, displaced ventriculotomy with subcoronary suture lines in 5, and the right ventricle outflow tract was repaired via the arteriotomy and/or pulmonary incision in 2. Results: There were no early or late death, and no myocardial infarction. Follow-up ranged from 3 months to 6 years, there were no residual leakage and obstruction of right ventricle outflow tract. Conclusion: Primary repair of TOF with anomalous coronary arteries can be done with excellent results. A proper surgical technique should be used during operation.