An operative position of foot stepping and knee bending in toe replantation for avulsed and fractured great toe / 中华显微外科杂志

Objective:To summarise the advantages and disadvantages of applying the method of retrograde replantation with an operative position of foot stepping and knee bending for replantation of rotational avulsed and fractured great toes.Methods:From January 2016 to June 2021, 11 rotational avulsed and fractured great toes were replanted with the method of retrograde replantation in an operative position of foot stepping and knee bending. Of the 11 patients, 10 were males and 1 was female, aged 18 to 50 years old with an average of 32 years old. Causes of injury: 5 of driving belt, 4 of machinery crush and 2 of car accident. Injury sites: 4 on left great toes and 7 on right great toes. All of the injuries were with fracture and exposure of proximal tendons of flexor and extensor. Seven patients had the follow-up reviews by outpatient clinic visiting, 2 over mobile phone and 2 via WeChat.Results:After surgery, 9 great toes completely survived and 2 great toes had necrosis. The survival rate of toe replantation was 81.8%(9/11). The operation time was 2 to 3 hours, with an average of 2.5 hours. Postoperative X-ray film showed that 8 to 12 weeks after the operation, the fracture and joint fusion were healed at first stage in the survived toes. All patients were entered in follow-up for 3 to 18 months with 10.5 months in average. The survived great toes were plump and the toenail grown well. At the final follow-up, the static TPD at the toes was 8-12 mm, with an average of 10 mm. There was no effect shown on either walking or running.Conclusion:The retrograde replantation method with an operative position of foot stepping and knee bending for great toe replantation has the characteristics of a good field of view and convenient in operation under microscope, a short operation time, and a high survival rate of replantation.

The outcomes of operation for 237 patients with Ebstein anomaly / 中华外科杂志

Objective@#To evaluate the early and long-term outcomes cardiac surgery of patients with Ebstein anomaly.@*Methods@#The clinic data of 237 patients with Ebstein anomaly received surgical procedures from March 2004 to December 2017 at Department of Cardiac Surgery, First Hospital of Tsinghua University was analyzed retrospectively. There were 105 male and 132 female patients with age of (19.4±16.7) years (ranging from 3 months to 64 years). The surgical procedures include anatomical repair in 188 patients, one and a half ventricle repair in 37 patients, tricuspid valve repair in 4 patients, tricuspid valve replacement in 10 patients, and Fontan procedure in 3 patients (total cavopulmonary connection in 2 patients; Glenn procedure in 1 patient).@*Results@#The early mortality was 2.1% (n=5). One case of atrioventricular (0.4%) newly occurred. There were 228 patients available to follow-up. The range of follow-up duration was 3 to 168 months. Late survival was 99.1% (2 cases of late death) at 10 years. Three patients received reoperation (1.3%), including tricuspid valve repair of 1 patient and one and a half ventricle repair of 2 patients). Indication of tricuspid valve regurgitation improved from 3.6±0.3 to 1.5±0.4. Survival rate at 5 and 10 years was 98.6% and 98.2%, respectively.@*Conclusions@#The principle of the techniques is to reconstruct the tricuspid valve and right ventricle anatomically. For most cases, the anatomical repair was demonstrated with low mortality, less complications and excellent durability at long-term follow-up. If the tricuspid valve is severely hypoplastic, one and a half ventricle repair and valve replacement may be alternatie.

Prospective evaluation of the mid-term results of posterior mitral annuloplasty using autologous pericardium for mitral valve insufficiency / 中国医师杂志

Objective To prospectively evaluate the mid-term results of mitral annuloplasty using autologous pericardium for mitral valve insufficiency.Methods From April 2004 to December 2011,48 patients underwent mitral annuloplasty using autologous pericardium,the average length of pericardial strips was (51.9 ±2.8)cm.Carpentier classification was class Ⅰ in 5 cases,class Ⅱ in 41 cases,and class Ⅲ in 2 cases.The mitral valve repair techniques included quadrangular resection in 30 cases,valve repair in 7 cases,chordae transposition in 4 cases,edge to edge technique in 2cases,and artificial chordae tendineae in 3 cases.Concomitant procedures included one case arotic valve replacement,11 cases tricuspid valve repair,9 cases coronary artery bypass grafting,1 case coronary artery muscle bridge resection,and 1 case permanent pacemaker implant.Datum on long-term outcomes were obtained by questionnaires and by phone interview [average follow-up time (62.2 ± 21.3) months].Results Compared with preoperative datum,the diameters of left ventricular end diastolic diameter (LVDD) and left atrial diameter (LAD) examined by echocardiography show significant reduction in postoperative [(58.6 ± 1.7) mm vs (45.1 ± 1.3) ram,t =12.85,P ＜0.01 ; (50.6 ± 1.6)mm vs (38.0 ± 1.4)ram,t =9.58,P ＜0.01].There was early postoperative death in one case,cerebral infarction in one case,but none of patients died in late postoperative period.One patient had moderate mitral valve regurgitation in long-term follow-up.None of patients had redo operation and hemolytic complications.Conclusions Mitral annuloplasty using an autologous pericardium was an acceptable technique with low anticoagulation complications,permanent,well left ventricular function maintenance,and an economic method.

Diagnosis of aortic coarctation combined with hypoplastic aortic arch by echocardiography / 中华超声影像学杂志

Objective To study the diagnosis accuracy and features of echocardiography on aortic coarctation combined with hypoplastic aortic arch. Methods The echocardiographic characteristics of seven patients who were diagnosed as aortic coarctation combined with hypoplastic aortic arch were analyzed and compared with results of cardiac catheterization, CT scan and operation. The diagnostic features of echocardiography were summarized. Results Besides the echocardiographic characteristics of aortic coarctation,other specific echocardiographic characteristics of hypoplastic aortic arch were:distinct stenoses of transverse and decsending part of aortic arch were visualized in supra-sternal long-axis view; the range of hypoplastic part started from innominate artery beginning or left common carotid artery beginning; the ratio of diameter of hypoplastic aortic arch over that of descending aorta at diaphragm was less than 0. 5; the blood flow speed detected by Doppler at the site of aortic coarctation was in the normal range. The echocardiographic characteristics of the aortic coarctation combined with hypoplastic aortic arch were correspondent to the results of cardiac catheterization, CT scan and operation results. Conclusions There is high accuracy of echocardiography in diagnosis of aortic coarctation combined with hypoplastic aortic arch. Hypoplastic aortic arch should be paid more attention in diagnosis of aortic coarctation.

Value of transesophageal echocardiography in the operation of Ebstein' s anomaly / 中华超声影像学杂志

Objective To study the value of transesophageal echocardiography(TEE) in the operation of Ebstein's anomaly(EA).Methods The TEE characteristics of 69 patients with Ebstein's anomaly were retrospectivly analized.Results TEE could display the anatomic features of tricusipid valves(TV) clearly in all patients.Six cases were found having downward displacement of anterior leaflet before cardiopulmonary bypass,6 were found having hypoplasia of posterior leaflet, and posterior leaflets were absent in 3 cases.Ten cases were found middle regurgitation of TV by TEE after surgical correction during the operation, which had been improved satisfatorily by second time TV plasty.Conclusions TEE is useful in accurate diagnosis of the EA,and evaluation of operative effects during the operation, thus could help increase success rate of operation.

Echocardiographic diagnosis of juxtaposition of atrial appendage / 中华超声影像学杂志

Objective To study the value of echoeardiography for diagnosis of juxtaposition of atrial appendage(JAA) and to discuss its features. Methods Eehocardiographic characteristics of JAA in nine cases were compared with results of cardiac catheterization and operation. The diagnostic features of echocardiography were summarized. Results Seven cases had juxtaposition of left atrial appendage and two had juxtaposition of right atrial appendage. The nine cases were all associated with severe congenital heart disease and the most frequent malformations observed with JAA were double outlet right ventricle, transposition of great artery, single ventricle and so on. Direct visualization of the JAA in the parasternal short-axis view at the base of the heart and visualization of an unusual transverse orientation of the atrial septum were the most features of JAA. Echocardiographie characteristics of JAA cases were correspondent to the results of cardiac catheterization and operation. Conclusions There is high accuracy by echocardiography to diagnosis JAA. JAA should be alerted in severe congenital heart disease.

Detection of the anterior descending artery originating from the right coronary artery in tetralogy of Fallot by echoeardiography / 中华超声影像学杂志

malities should be alerted in TOF.

Clinical analysis of 164 cases of coronary artery bypass graft in high-risk patients with coronary heart disease / 中国医师杂志

Objective To summarize the experience of perioperative management of coronary artery bypass graft(CABG) in high-risk patients with coronary heart disease.Methods The clinical data of 164 patients underwent CABG from March 2004 to November 2005 were analyzed.Of 164 patients,151(92.05%) cases had severe coronary heart disease.Results Totally 144 artery-vessels and 353 venous-vessels were transplanted to patients.Combined operative procedures included 11 cases of ventricular aneurysm resect,5 cases of valve replacement,5 cases of valve repair,and 1 case of surgical repair of perforation of ventricular septum.Post-operative complications included 2 cases of low cardiac output,1 case of respiratory failure,1 case of renal failure,and 1 case of cerbral infarction.Two patients died and the operative mortality was 1.22%.Conclusion CABG procedure is safe in the treatment of high-risk patients with coronary heart disease.Proper preoperative and perioperative treatment can improve the curative effects significantly.