Chinese perfusion practice survey results in 2021: current situation and challenge / 中华胸心血管外科杂志

Objective:To investigate the current situation of cardiopulmonary bypass(CPB) in China and analyze the causes, to guide the formulation and implementation of technology standard.Methods:The survey task force sent out a nationwide survey to obtain up-to-date information on perfusion practice by ChSECC(Chinese Society of Extracorporeal Circulation). The unit of analysis for the survey was the medical center performs CPB. The survey consisted 48 questions covering four topics of qualifications, including certification and education, policies and practices, device and equipment, techniques used.Results:There were 540 of the 714 centers for an overall response rate of 76%. According to the annual number of CPB, they were divided into 4 groups: group A(≤50 cases/year), group B(50-100 cases/year), group C(100-500 cases/year) and group D(≥500 cases/year). The response rate of center with more than group D last year was 100%. Most of the perfusionists had certification issued by ChSECC. Although there were more than 80% of group D performed regular training and assessment of perfusionist, the result was still not ideal enough. Low utilization of safety equipment was not depend on the annual operation volume in most of responding centers. Ultrafiltration and blood protection technology had high application rate in group D compared with group A and B.Conclusion:The certification rate of perfusionists are high. Lower the number of annual CPB cases, lower the proportion of regular evaluation and training, and lower rate of standards performance. No matter the amount of CPB, the application rate of safety equipment is not ideal. Higher the number of CPB cases, higher the utilization rate of CPB related technologies.

Intensity of Intraoperative Spinal Cord Hyperechogenicity as a Novel Potential Predictive Indicator of Neurological Recovery for Degenerative Cervical Myelopathy

Objective@#To analyze the correlations between intraoperative ultrasound and MRI metrics of the spinal cord in degenerative cervical myelopathy and identify novel potential predictive ultrasonic indicators of neurological recovery for degenerative cervical myelopathy. @*Materials and Methods@#Twenty-two patients who underwent French-door laminoplasty for multilevel degenerative cervical myelopathy were followed up for 12 months. The Japanese Orthopedic Association (JOA) scores were assessed preoperatively and 12 months postoperatively. Maximum spinal cord compression and compression rates were measured and calculated using both intraoperative ultrasound imaging and preoperative T2-weight (T2W) MRI. Signal change rates of the spinal cord on preoperative T2W MRI and gray value ratios of dorsal and ventral spinal cord hyperechogenicity on intraoperative ultrasound imaging were measured and calculated. Correlations between intraoperative ultrasound metrics, MRI metrics, and the recovery rate JOA scores were analyzed using Spearman correlation analysis. @*Results@#The postoperative JOA scores improved significantly, with a mean recovery rate of 65.0 ± 20.3% (p < 0.001). No significant correlations were found between the operative ultrasound metrics and MRI metrics. The gray value ratios of the spinal cord hyperechogenicity was negatively correlated with the recovery rate of JOA scores (ρ = -0.638, p = 0.001), while the ventral and dorsal gray value ratios of spinal cord hyperechogenicity were negatively correlated with the recovery rate of JOA-motor scores (ρ = -0.582, p = 0.004) and JOA-sensory scores (ρ = -0.452, p = 0.035), respectively. The dorsal gray value ratio was significantly higher than the ventral gray value ratio (p < 0.001), while the recovery rate of JOA-motor scores was better than that of JOA-sensory scores at 12 months post-surgery (p = 0.028). @*Conclusion@#For degenerative cervical myelopathy, the correlations between intraoperative ultrasound and preoperative T2W MRI metrics were not significant. Gray value ratios of the spinal cord hyperechogenicity and dorsal and ventral spinal cord hyperechogenicity were significantly correlated with neurological recovery at 12 months postoperatively.

Intensity of Intraoperative Spinal Cord Hyperechogenicity as a Novel Potential Predictive Indicator of Neurological Recovery for Degenerative Cervical Myelopathy

Objective@#To analyze the correlations between intraoperative ultrasound and MRI metrics of the spinal cord in degenerative cervical myelopathy and identify novel potential predictive ultrasonic indicators of neurological recovery for degenerative cervical myelopathy. @*Materials and Methods@#Twenty-two patients who underwent French-door laminoplasty for multilevel degenerative cervical myelopathy were followed up for 12 months. The Japanese Orthopedic Association (JOA) scores were assessed preoperatively and 12 months postoperatively. Maximum spinal cord compression and compression rates were measured and calculated using both intraoperative ultrasound imaging and preoperative T2-weight (T2W) MRI. Signal change rates of the spinal cord on preoperative T2W MRI and gray value ratios of dorsal and ventral spinal cord hyperechogenicity on intraoperative ultrasound imaging were measured and calculated. Correlations between intraoperative ultrasound metrics, MRI metrics, and the recovery rate JOA scores were analyzed using Spearman correlation analysis. @*Results@#The postoperative JOA scores improved significantly, with a mean recovery rate of 65.0 ± 20.3% (p < 0.001). No significant correlations were found between the operative ultrasound metrics and MRI metrics. The gray value ratios of the spinal cord hyperechogenicity was negatively correlated with the recovery rate of JOA scores (ρ = -0.638, p = 0.001), while the ventral and dorsal gray value ratios of spinal cord hyperechogenicity were negatively correlated with the recovery rate of JOA-motor scores (ρ = -0.582, p = 0.004) and JOA-sensory scores (ρ = -0.452, p = 0.035), respectively. The dorsal gray value ratio was significantly higher than the ventral gray value ratio (p < 0.001), while the recovery rate of JOA-motor scores was better than that of JOA-sensory scores at 12 months post-surgery (p = 0.028). @*Conclusion@#For degenerative cervical myelopathy, the correlations between intraoperative ultrasound and preoperative T2W MRI metrics were not significant. Gray value ratios of the spinal cord hyperechogenicity and dorsal and ventral spinal cord hyperechogenicity were significantly correlated with neurological recovery at 12 months postoperatively.

Simultaneous Determination of Seven Active Components in Guo-Ming-Xing Bi-Yan Granules by HPLC under Multiple UV Wavelengths / 世界科学技术-中医药现代化

This study was aimed to establish a simultaneous determination method of chlorogenic acid,liquiritin,rosmarinic acid,arctiin,glycyrrhizic acid,schisandrin,menthone in Guo-Ming-Xing Bi-Yan(GMXBY) granules by HPLC under multiple UV wavelengths.Waters Symmetry C18 column (4.6 mm× 250 mm,5μm) was used as the chromatographic column.Acetonitrile-0.1% phosphoric acid water solution was used as the mobile phase with gradient elution.The detection wavelength of chlorogenic acid and rosmarinic acid was 327 nm; that of liquiritin and arctiin was 280 nm; that of glycyrrhizic acid,schisandrin and menthone was 250 nm.The column temperature was 25℃.The injection volume was 10μL.Chlorogenic acid showed a good linear relationship in the range of 1.19-59.50μg?mL-1 (r = 0.999 8).The average recovery rate was 100.95%.Liquiritin showed a good linear relationship in the range of 1.51-150.70μg?mL-1 (r = 0.999 1).The average recovery rate was 100.38%.Rosmarinic acid showed a good linear relationship in the range of 3.40-68.08 μg?mL-1 (r = 0.999 9).The average recovery rate was 101.02%.Arctiin showed a good linear relationship in the range of 56.15-1 123.00μg?mL-1 (r =0.999 9).The average recovery rate was 100.39%.Glycyrrhizic acid showed a good linear relationship in the range of 21.54-430.80μg?mL-1 (r = 0.999 8).The average recovery rate was 97.09%.Schisandrin showed a good linear relationship in the range of 2.57-51.34μg?mL-1 (r = 0.999 9).The average recovery rate was 99.19%.Menthone showed a good linear relationship in the range of 0.50-10.00μg?mL-1 (r = 0.999 9).The average recovery rate was 100.35%.This established method was simple and reliable with good reproducibility,which can be used as the determination method of active components in GMXBY granules.

Simultaneous Determination of Echinacoside, Acteoside and Isoacteoside in Total Cistanchis glycosides Capsules by HPLC / 世界科学技术-中医药现代化

This study was aimed to establish an HPLC method for simultaneous determination of the content of echinacoside, acteoside and isoacteoside in Total Cistanchis glycosides Capsules. Waters C18 column (4.6 mm ×150 mm, 5 μm) was used with the mobile phase of methanol-0.1% formic acid at a flow rate of 1.0 mL·min-1. The detection wavelength was set at 330 nm. The column temperature was maintained at 30℃ . The results showed that the linear ranges of echinacoside, acteoside and isoacteoside were in the range of 27.792-277.92 μg·mL-1 (r = 0.9996,n = 6), 2.4184-24.184 μg·mL-1 (r = 0.9996, n = 6), 5.106-51.06 μg·mL-1 (r = 0.9998, n = 6). The average recoveries of three components were in accordance with the determination requirement. It was concluded that the method was simple and accurate, which can be used in the content determination of echinacoside, acteoside and isoacteoside in Total Cistanchis glycosides Capsules.

Determination of Ambrisentan Reference Substance by 1 H-Nuclear Magnetic Resonance Spectroscopy / 中国药师

Objective:To develop a method for the quantitative determination of ambrisentan. Methods: 1 H NMR spectra were obtalned with a Bruker AscendTM 400 superconducting NMR spectrometer. For each sample, DMSO-D6 was used as the solvent, the pulse width was 10. 0 μs, the delay time was 5 s and the scanning time was 16. Results: The proton peaks of ambrisentan at δ6. 16 ppm and maleic acid atδ6. 28 ppm were used as the quantitative peaks. The linear regression equation of peak area and quality ratio was Y=0. 140 7X+0. 034 8 with the correlation coefficient of 0. 999 4. RSD was 0. 2%(n=6)in the repeated experiments. The absolute content of ambrisentan reference substance was 99. 9%. Conclusion: The results showed that 1 H NMR can be used in the quantitative determination of ambrisentan without reference substance. The method is reliable, rapid, accurate and simple.

The Analysis Methodology for Multiple Elements in Four Herbs ofSanjie Zhentong Capsules / 世界科学技术-中医药现代化

To develop a method for the determination of 18 elements such as Pb, Cu, As, Hg, Mn, Ni, & Tl in Panax notoginseng,Bulbus fritillariae thunbergii,Coix seed, Resina draconis, and to control the contents of heavy metal elements in Sanjie Zhentong Capsule, the samples were digested by microwaves and then analyzed by appropriate determination parameters through ICP-MS, with the internal standard method to improve the matrix effect and interference. The correlation coefficientR2≥ 0.999 2. The lowest limits of quantification were from 0.002 8 to 0.54 μg·L-1. The experiments had better repeatability, while the recovery values ranged from 73.01% to 109.13%. The method is simple, accurate and high sensitive, and it can be used for the determination of rapid monitoring the multi-elements inPanax notoginseng, Bulbus fritillariae thunbergii, Coix seed,and Resina draconis.

Simultaneous Determination of Seven Anions and Organic Acids in Huo-Xue Tong-Luo Injection by HPCE / 世界科学技术-中医药现代化

This study was aimed to establish a method for simultaneous determination of seven anions and organic acids in Huo-Xue Tong-Luo (HXTL) injection by HPCE. With tartaric acid as the internal standard, separation was performed on an uncoated fused silica capillary (50 μm × 64. 5 cm, 56 cm of effective length). The 14 mmol·L-1 potassium acid phthalate and 0.1 mmol·L-1 hexadecyl trimethyl ammonium chloride were selected for the running buffer solution (pH 5.6). The separation voltage was -16 kV. The detection wavelength was set at 210 nm. The column temperature was maintained at 25 ℃ . The sample was injected at 50 mbar×4 s. The results showed that calibration curves of chloride ion, sulfuric acid root ion, formate ions, malic acid, succinic acid, iodate ion and acetic acid ions showed good linear relationship 41.4-248.2 μg·mL-1 (r = 0.999 3), 12.5-74.8 μg·mL-1 (r = 0.999 8), 18.2-109.1 μg·mL-1 (r = 0.999 8), 20.3-121.6 μg·mL-1 (r = 0.999 5), 17.2-103.1 μg·mL-1 (r=0.999 1), 17.6-105.6μg·mL-1 (r=0.999 6), 51.6-309.6μg·mL-1 (r=0.999 7), respectively. The average recoveries were 102.6%, 97.3%, 102.2%, 99.0%, 99.2%, 97.8%, and 103.4%, respectively. The RSD were 1.7%, 2.0%, 1.6%, 2.6%, 2.1%, 2.9%, and 1.0%, respectively (n = 6). It was concluded that the method was accurate and reproducible. It was suitable for the determination of anions and organic acids in HXTL injection.

Effect of Gui-Zhi Fu-Ling Capsule on Endometriosis Rat Model / 世界科学技术-中医药现代化

This study was aimed to observe the therapeutic effect onendometritis rat model by Gui-Zhi Fu-Ling (GZFL) capsuleand its mechanism. Endometritis rat model was replicated. After 15 days, rats were randomly divided into six groups, which were the sham operation group, model group, lowdosage (0.5 g·kg-1) of GZFL capsule group, middle dosage (1.0 g·kg-1) of GZFL capsule group, large dosage (2.0 g·kg-1) of GZFL capsule group, and Fu-Ke Qian-Jin (FKQJ) capsule (1.2 g·kg-1) group. After 28-day intragastric administration of medication, pathological changes of endometrium were observed. The contents of monocyte chemoattractant protein-1 (MCP-1), interleukin-1β (IL-1β), interleukin-10 (IL-10) were determined in blood serum.The expression of TGF-β1 in endometritis rats were measured by immunohistochemistry. The results showed that GZFL capsule canobviously alleviate the pathologi-cal damage of endometrium in rat model. In comparison with sham operation group, the serum IL-10 content in the model group was significantly decreased, contents of MCP-1and IL-1β were significantly elevated; the TGF-β1 pro-tein expression was significantly elevatedin the uterus tissues. After the treatment of GZFL capsule, compared with the model group, the serum IL-10 was obviously elevated in the treatment group. The contents of MCP-1 and IL-1βwere obviously decreased. The expression of TGF-β1 in the uterus tissues was obviously decreased. It was concluded that GZFL capsule had treatment effect on endometritis. The mechanism may be related to the regulation of inflam-matory cytokines.

Emergency coronary artery bypass grafting for acute coronary syndrome: mid-term follow-up results / 南方医科大学学报

<p><b>OBJECTIVE</b>To summarize the experience with emergency coronary artery bypass grafting (ECABG) for management of acute coronary syndrome and analyze the mid-term follow-up results.</p><p><b>METHODS</b>Forty-five ECABG surgeries were performed in 34 male and 11 female patients (aged 65.6∓5.8 years) for cardiogenic shock (5 cases), acute heart failure (6 cases) and refractory unstable angina (34 cases). Twenty patients received the operation within one week after acute myocardial infarction (AMI) and 18 were preoperatively supported by intra-aortic balloon pumping (IABP). All patients had triple-vessel disease and 15 had left main stenosis. Ten patients experienced two myocardial infarctions and 6 had chronic renal dysfunction including two requiring hemodialysis. On-pump operations were performed in all cases with a mean CPB time of 104.2∓29.7 min and cross clamping time of 69.0∓21.3 min. Cold blood or HTK cardioplegia was used for myocardial protection. The left internal mammary artery (LIMA) was routinely anastomosed to the left anterior descending artery (LAD), and the great saphenous vein (GSV) to other target vessels. The mean number of grafts was 2.9∓0.6.</p><p><b>RESULTS</b>Forty-one patients were cured and discharged and 4 patients died with an in-hospital mortality of 8.9%, including one associated with cardiac event (2.2%). IABP was weaned off within 28.5∓10.6 h after surgery except for one patient who died of multiple organ and system failure (MOSF). Thirty-eight patients (92.7%) were followed up for a mean of 37.3∓16.7 months, during which 2 patients died with a mid-term survival rate of 94.7%. Thirty-five (92.1%) patients had New York Heart Association (NYHA) class I and II. The freedom from cardiac event was 90.5%. Follow-up echocardiography showed significantly improved left ventricular dimension and ejection fraction in these cases (P<0.05), and graft patency was 95.8% for the LIMA and 90.5% for the GSV.</p><p><b>CONCLUSION</b>Despite a slight increase of the in-hospital mortality, ECABG can improve the mid-term survival, freedom from cardiac event, and cardiac function when the indications and timing for surgery are well controlled with optimal perioperative management.</p>

Fingerprint and Multi-components Determination of Saponins in Sanjie-zhentong Capsule / 世界科学技术-中医药现代化

This study was aimed to establish a HPLC fingerprint of saponins in Sanjie-zhentong Capsule in order to make a quantitative analysis of the quality of Sanjie-zhentong Capsule. The Waters Symmetry ShieldTM RP18 (4.6 mmí 250 mm, 5 μm) column was used with a mobile phase of acetonitrile-water gradient elution. The flow rate was 1.2 mL/min. The column temperature was 30℃. The detection wavelength was 203 nm. The results showed that the fingerprint chromatography included 9 mutual peaks. The similarity among batches was more than 0.95. Compared with reference substance, five characteristic components were recognized. The five components are notoginsenoside R1, ginsenoside Rg1, ginsenoside Re, ginsenoside Rb1 and ginsenoside Rd. It was concluded that this method was rapid, simple and accurate and can be used as one of the effective methods for the quality control of Sanjie-zhen-tong Capsule.

Management of extracorporeal circulation for totally robotic assisted cardiac surgery / 中华胸心血管外科杂志

Objective To discuss the way and management of extracorporeal circulation (ECC) for totally robotic assisted cardiac surgery. Methods A Total of 226 patients underwent cardiac surgery using da Vinci S robotic surgical system, including 111 patients underwent atrial septal defect repair ( ASDR) , 9 patients underwent ventricular septal defect repair ( VSDR) ,51 patients underwent mitral valvuloplasty ( MVP) , 20 patients underwent mitral valve replacement( MVR) , 27 patients underwent left atrial myxoma excise and 4 patient underwent right atrial myxoma excise. ECC for most of patients was achieved with femoral arterial cannula, femoral venous cannula and right internal jugular venous cannula, except for 1 patient underwent MVP with femoral arterial cannula and femoral two-stage venous cannula. In all the cases, vacuum-assist venous drainage ( VAVD) , continuous blood gas monitoring and ultrafiltration were used during ECC. myocardial protection was pertic cross-clamp time was 40 ～219 (105.9+38. 8)min and 21 ～166 (69.5±30.0)min respectively. During ECC, the mean urine volume was 100-2100 (771.7±477.6) ml, ultrafiltration volume was 1000-4800 (2495.4 ±811.6) ml, and the total fluid balance was subzero-balanced (172 cases) or zero-balanced(13 cases) in most of patients. Conclusion The establishment of ECC system through peripheral vessels, using VAVD and continuous blood gas monitoring are the key points of ECC for totally robotic assisted cardiac surgery, also certain learning curve of perfusion technique and close communication between the surgical team are essential during ECC.

Intraoperative transesophageal echocardiography in robot-assisted minimally invasive cardiac surgery / 中华胸心血管外科杂志

Objective To delineate the utility and results of intraoperative transesophageal echocardiography (TEE) in the evaluation of patients undergoing robot-assisted cardiac surgery. Methods Intraoperative TEE was performed in 193 patients undergoing robot-assisted procedures in cardiac surgery over a period of 4 years. (1) Before CPB, a comprehensive TEE was performed to document the lesions and their precise localization. ( 2 ) During establishment of peripheral CPB, a arterial cannula was placed percutaneously into the right internal jugular vein and passed into the superior vena cava; a venous cannula was inserted into the right common femoral vein and passing it into the inferior vena cava with its tip just inferior to the inferior vena cava-right atrium junction; a arterial perfusion cannula was passed into the ascending aorta with its tip approximately 3 cm from the aortic valve under TEE guidance. (3) After weaning from CPB, TEE was performed to evaluate the efficiency of the procedure. Results (1) The concordance with surgical findings concerning the lesions and precise localization was 100% and 98. 8% among all the patients, respectively. (2) All cannulae were located in the correct position. (3) TEE confirmed successful procedures with no concomitant complication in all the patients. Conclusion Intraoperative TEE is a valuable adjunct in the assessment of robot-assisted cardiac surgery.

Treatment of multiple vessel coronary artery diseaseby robotic bypass surgery on the beating heart and stent placement in distinct hybrid session / 中华胸心血管外科杂志

Objective Summary the first group of robotic bypass surgery on the beating heart and stent placement in distinct hybrid session in China. Methods 163 cases patients accepted selective operation of robotic coronary bypass grafting on the beating heart form April 2007 to January 2011. 12 cases had multi coronary vessels stenosis accepted stent placement after robotic surgery in a hybrid manner. The average age of patients was ( 56. 0 ± 9.74 ) years old. 3 case was female and 9 cases were male. All the patients had a medical history of angina. The coronary arterioangiography showed sever left anterior descend ing or diagonal branch stenosis in all patients. And 4 cases had myocardial infarction history. All the patients had good lung function and had no medical history of pleurisy. Without sternotomy, through 3 ports about 1 cm in left thorax, the left internal mammary artery was obtained and simultaneously single vessel coronary artery bypass grafting through small thoracotomy or totally endoscopic coronary bypass (TECAB) was performed on beating heart. The bridge patency and revascularization was accessed by arterioangiography. Results All cases successfully accepted robotic bypass surgery on the beating heart and stent placement in distinct hybrid session without complication. Conclusion Hybrid coronary artery revascularization enable adequate revascularization of patients with multivessel coronary artery disease without sternotomy and with the advantage of the most durable option.

The choise of port access for robotic minimally invasive heart surgery using da Vinci S system / 中华胸心血管外科杂志

Objective Subject To summary the port placement and system set-up for robotic minimally invasive heart surgery using da Vinci S system in China. Methods 400 patients accepted selective robotic minimally invasive heart surgery from January 2007 to January 2011. We conducted a retrospective review of port placement and system set-up for all the surgeries. During the surgery 3-4 ports were made in the lateral thoracic wall and the position of ports were modulated according to the types of diseases, the procedure and patients' habitus. The surgeon completed the procedure before the surgeon console.The arms of da Vinci S system was adjusted according to surgery procedure. Results The right lateral ports were suitable for the intracardiac operation with extracorporeal circulation. And the left lateral ports can be used in the inner thoracic artery harvesting and coronary bypass graft on beating heart. Except for 1 case changed to sternotomy because of sever pleural adhesions,no arms collision and mechanical malfunction during the surgery that leaded to surgical conversion. Conclusion Robotic minimally invasive heart surgery can be safely applied to partial cardiac surgeries. The port position and system set-up should be adjusted according to the habitus of patients and surgical requirement.

A novel method for fast determination of components in Guizhi Fuling capsule by near infrared spectroscopy / 中国中药杂志

<p><b>OBJECTIVE</b>To develop a new method to rapidly determine and identify Guizhi Fuling capsule by portable acousto-optic tunable filter-near infrared spectroscopy.</p><p><b>METHOD</b>The qualitative model was set up using principal component analysis. The correlation models between the NIR spectra and the reference values of five major constituents were obtained with partial least squares method.</p><p><b>RESULT</b>The identifying model accurately identified Guizhi Fuling capsule, and quantitative analytical models could precisely predicted the content of ellagic acid, baicalin, benzoylpaenoniflorin, cinnamaldehyde, and paeonol. The correlation coefficients of the calibration models were 0.924 2, 0.938 4, 0.924 2, 0.933 6, 0.934 7, the validation set coefficients of the calibration were 0.924 2, 0.938 4, 0.924 2, 0.933 6, 0.934 7, and the RMSEP were 1.138%, 3.014%, 0.751%, 0.625%, 3.455%, 1.363%, respectively. The results of external validation showed no significant difference between the predictive and the determining values by t-test.</p><p><b>CONCLUSION</b>The method is accurate, rapid and non-destructive, and can be used for determining and identifying Guizhi Fuling capsule.</p>

Application of quantitative fingerprint technique for in-process quality control of Guizhi Fuling capsules / 中国中药杂志

<p><b>OBJECTIVE</b>To investigate an evaluation mode FOR in-process quality control for traditional Chinese medicines by adopting quantitative fingerprint technique as the main mean.</p><p><b>METHOD</b>Regarding Guizhi Fuling capsules as an example, the stability and repeatability were observed by tests of quantitative fingerprint of 90% ethanol extract, aqueous extract, the final mixing extract, soft material and products during the production process.</p><p><b>RESULT</b>The fingerprint similarities of four kinds of intermediates and products from 10 batches of Guizhi Fuling capsules were in the range of 0.966-0.999, respectively. The RSD of quantitative results of marked components, which included gallic acid, paeoniflorin, benzoic acid, cinnamic acid, benzoyl paeoniflorin, cinnamic aldehyde, paeonol, etc, were less than 15% in the products.</p><p><b>CONCLUSION</b>This method is accurate, feasible and could be an effective way to be applied to in-process quality control of traditional Chinese medicine.</p>

The importance of intraoperative transesophageal echocardiography in totally endoscopic atrial septal defect repair with robotic assistance / 中华超声影像学杂志

Objective To explore the importance of intraoperatlVe transesophageal echocardlography(TEE) in totally endoscopic atrial septal defect(ASD)repair.Methods Twenty four patients underwent repair of ASD by a totally endoscopic approach，utilizing the da Vinci S robotic system.After induction of general anesthesia and a left-sided double-lumen endotracheal tube was positioned，a TEE probe was inserted.①Before cardiopulmonary bypass(CPB)，TEE examination was conducted to document the types and size of ASD.The procedures were predetermined by the operator according to the TEE diagnosis.②CPB was achieved peripherally.With TEE guidance，a 19-or 21-Fr.femoral venous cannula was inserted into the right common femoral vein and passing it into the inferior vena cava(IVC)，with its tip just inferior to the IVC-right atrium junction；a 15-or 17-Fr.femoral arterial eannula was placed percutaneously into the right internal jugular vein and passed into the superior vena cava(SVC).The bypass circuit was completed by inserting a 14G arterial perfusion cannula into the ascending aorta(AAO)，with its distal tip passing over the center of the AAO，approximately 3 cm from the aortic valve.③ After weaning from CPB，TEE examination was performed again.Results①Surgical confirmation was obtained in all the patients and no operative procedures were changed.②All venous，arterial and arterial perfusion cannula were located in correct position.③In all patients，TEE after weaned from CPB confirmed successful repair.Conclusions Intraoperative TEE is essential for totally endoscopic ASD repair.

Septal anterior ventricular exclusion operation for left ventricular anterior aneurysm:effects on left ventricular shape,volume and function by intraoperative transesophageal echocardiography / 中华超声影像学杂志

Objective To assess the effects of septal anterior ventricular exclusion(SAVE)procedure on left ventricular(LV)shape,volume and function in patients with post-infarction LV anterior aneurysm by intraoperative transesophageal echocardiography(TEE).Methods Twenty patients with LV anterior aneurysm underwent surgical ventrieular restoration(SVR)with the SAVE procedure.Intraoperative TEE was performed before cardiopulmonary bypass(CPB)and after weaning from CPB.LV volume and ejection fraction(EF)was measured using the biplane Simpson's method.LV end-diastolic and end-systolic volumes,indexed by body surface area(EDVI and ESVI,respectively)were calculated.To estimate the shape of LV,end-diastolic sphericity index(SI)of LV was determined.Results Compared with pre- CPB,after SVR,LV shape became more elliptical:SI increased from 0.76±0.04 to 0.84±0.05,P＜0.001.LV size became more normal:EDVI decreased from(121.51±16.91)ml/m2 to(60.27±9.93)ml/m2,P＜0.001,and ESVI decreased from(85.81±15.02)ml/m2 to (32.44±5.36)ml/m2,P＜0.001,respectively.EF was increased significantly:(46.02±3.90)% vs(29.52±6.0)%,P＜0.001.Conclusions The SAVE technique is easy to reshape LV to ellipsoid fogln and normal size and the resultant improved configuration may contribute to improving EF for patients with post-infarction LV anterior aneurysm.

Anesthetic management for clipping giant intracranial basilar artery aneurysm under deep hypothermic circulatory arrest / 第三军医大学学报

Objective To study the performance of deep hypothermic circulatory arrest and the anesthestic management for giant intracranial basilar artery aneurysm. Methods Seven patients undergoing resection of giant intracranial basilar artery aneurysm were included in the study. By monitoring cerebral oximetry (rSO_2), body temperature and electrocardiogram (ECG), brain and other vital organs were guaranteed to maintain oxygen supply/demand balance in perioperative management, especially during the circulatory arrest period under deep hypothermia. The measured parameters, the outcome of patients and the complications were observed and recorded. Results Even in profound hypothermic condition, rSO_2 was degraded significantly during circulatory arrest, and recovered after in circuit. Low flow perfusion maintained cerebral oxygen supply/demand balance better than circulatory arrest. In all 7 cases, cerebral anoxia caused by circulation arrest after operation were not observed. Conclusion Deep hypothermic circulation arrest could be applied effectively in the resection of giant intracranial basilar artery aneurysm with brain protective measure and monitoring. To improve the outcomes of the patients, avoiding cerebral anoxia and of local vessel injuries is important.