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Objective Konno-Rastan procedure is one option to cope with complex multilevel left ventricular outflow tract obstruction (LVOTO),which continues to pose a serious challenge to cardiac surgeons.The aim of this study is to retrospectively analyse indications for Konno-Rastan procedure,and to review the safeguards and pitfalls.Methods Between January 1996 and August 2012,totally 13 children with multilevel LVOTO underwent Konno-Rastan procedure.There were 8 boys and 5 girls.Age at surgeries ranged from 5 to 13 years,and weight from 12 to 51 kg with median of 21 kg.The pathology of this cohort includes:8 cases of congenital aortic valvular stenosis,3 cases of congenital aortic valvular stenosis combined with supravalvular stenosis,1 case of congenital aortic stenosis combined with VSD,coarctation and RVOT obstruction,1 case of aortic stenosis s/p percutaneous balloon aortic valvuloplasty.All patients have secondary diffuse tunnel LVOTO.Diameter of aortic ring ranges from 12.0 to 16.4 mm,and pressure gradient across the stenotic region ranges from 90-151 mm Hg.8 cases were implanted with St.Jude AG19 while 5 cases implanted with St.Jude AG17.Results All 13 cases survived.The 4th patient was implanted permanent epicardial pacemaker for transient Ⅲ AVB.The 4th and 5th patients were found residual ventricular septal repture at the nadir of ventricular incision,one underwent redo procedure while another is being followed up.All cases take cumadine to sustain INR at 1.8-2.5.No death emerges during follow-up period.The motality is 0％,the incidence rate of B is 7.7％,residual VSD 15.4％ and endocarditis 7.7％.Conclusion Konno-Rastan procedure is a promising techi.to relieve LVOTO.However,this complex procedure may lead to several fetal complications.Success of the surgery demands perfect operations.
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Objective Background and objective The Cox maze Ⅲ procedure has been considered the gold standard for the surgical treatment of atrial fibrillation (AF) and the modified Cox maze use bipolar radiofrequency ablation instead of the cut-and-sew technique,while also reducing the connecting lines in left atrium.This study was to understand whether completely isolation the posterior left atrium by increasing left atrium ablation lines can enhance the survival after modified Cox maze procedure.Methods From Jan 2009 to Dec 2009,all the patients underwent the Cox maze procedure,following the same examination,were divided into two groups (case-control): box lesion group (n =60),which is means the right and lefi pulmonary vein lesions were connected inferiorly by adding ablation lines,thereby completely isolating the posterior left atrium and the non-box lesion group (n =60).Similar interventions were given during the perioperative periods.Comparing the risk factors before surgeries,then follow-up was 100％ complete,and the mean follow-up was 9 ± 8.4 months.Results Except the box lesion had long time of extracorporeal circulation,the characteristics of the 2 groups were similar because there were no differences in age,AF duration,left atrial diameter,left ventricular ejection fraction or homochronous operation between the groups and there was no operative death.No patient was lost to follow-up.In the mean follow-up duration,a patient was died of intracerebral hemorrhage at 2 months postoperationly in the box lesion group and a patient suffered from stroke at 12 months postoperationly in the non-box lesion.The overall freedom from AF recurrence was higher in the box lesion group at 1 (70％ vs 51.2％,P =0.039) and 3 (78.3％ vs 60％,P =0.030) months.While it was 80％ vs 71.7％ (P =0.286) at 6 months.Eight patients wrere readmitted because of the recurrence of AF,4 and 2 patients underwent catheter ablation in box and non-box group respectively,one patient in each group underwent electrical conversion.After treatment,all of the patients were recovered to sinus rhythm and continued to take cordarone.Conclusion Compared to the single connecting between right and left pulmonary vein,isolating the entire posterior left atrium by creating a box lesion showed higher freedom from AF in the earlier months (1-3months).However,half a year after the surgery,there were no significant differences between the two groups.
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<p><b>OBJECTIVE</b>To summarize the experience with surgical correction of tetralogy of Fallot in adults over 40 years of age.</p><p><b>METHODS</b>From November 1985 to July 2008, 9 male and 11 female patients aged 41-53 years (mean 46.3±3.5 years) underwent total surgical correction for tetralogy of Fallot. Twelve patients had preoperative NYHA class III cardiac function. The common comorbidities included infective endocarditis, cerebral abscess, cerebral infarction, renal dysfunction, and tricuspid insufficiency. Surgical corrections were carried out at the anatomical or physiological level.</p><p><b>RESULTS</b>Nineteen patients received right ventriculotomy to relieve right ventricular outflow obstruction and for ventricular septal defect closure, and 1 patient had Fontan operation. Two patients died after the surgery for heart failure and ventricular fibrillation. The average cardiopulmonary bypass time, aortic clamp time, and postoperative ventilation time was 142.9±36.3 min, 89.9±25.1 min, and 72.0±17.5 h, respectively. Postoperative low cardiac output syndrome occurred in 5 cases, septic shock in 1 case, secondary renal failure in 1 case, and bleeding in 2 cases. Echocardiography showed a significant postoperative reduction of the mean right ventricular outflow tract velocity from 4.29±1.36 m/s to 2.13±0.83 m/s (P<0.01); the right ventricular longitudinal dimension exhibited no significant changes postoperatively (57.1±6.7 mm vs 55.1±7.0 mm, P=0.65).</p><p><b>CONCLUSIONS</b>Surgical correction of the tetralogy of Fallot in patients over 40 years is highly risky and requires appropriate management of cardiac failure, careful myocardial protection, and thorough intracardiac lesion correction to decrease surgical complications.</p>
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Adult , Female , Humans , Male , Middle Aged , Tetralogy of Fallot , General Surgery , Treatment OutcomeABSTRACT
Objective To validate of the Chinese system for cardiac operative risk evaluation (SinoSCORE) in Cantonese surgery patients. Methods Data from Guangdong Cardiovascular Institute in the period January 2004 through December 2008 were analyzed on 2462 Cantonese heart surgery patients. First, compared risk factors of this series and database of SinoSCORE, and then calculated the additive score of each patients and evaluate the discrimination and calibration of sinoSCORE in Cantonese patients. Results There were some differences between the risk factors of patients from two groups. The gender,smoking, diabetes, hyperlipemia, hypertension, chronic pulmonary diseases, stroke, cardiovascular surgery history, left main disease, atrial fibrillation/atrial flutter, pulmonary arterial hypertension, concomitant coronary surgery and concomitant valve surgery in Cantonese patients were different between two groups. However, The SinoSCORE was able to predict the in-hospital mortality of senior patients with good discrimination ( Hosmer-Lemeshow test, P = 0. 34 ) and calibration ( the area under the receiver operating characteristic curve, 0.84, P ＜ 0.01 ). Conclusion SinoSCORE was able to predict the in-hospital mortality of Cantonese heart surgery patients.
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[Objective] To study the apoptosis after long time of heart preservation,and the barrier of caspase (Ac-DEVD-CHO) in prolonged heart transplantation.To improve the techniques on the preservation of donor heart.[Methods] Donor rat hearts were subjected to group A (non-Ac-DEVD-CHO-treated),group B (Ac-DEVD-CHO-treated) of hypothermic storage,after 9 hours of heart preservation,then performed heterotopic heart transplantation,followed by 60 min of normothermic reperfusion (n ＝ 6 in each group).[Results] After 60 min reperfusion,compared with group A,① a significant improvement in the percent recovery of HR was observed in group B (P ＜ 0.05);② Caspase-3 activity was decreased in group B (P ＜ 0.01);③ an apparent decline in the expression of infarct area was observed in group B (P ＜ 0.01);④ an apparent decline in the expression of TUNEL-positive cardiomyocyte was observed in group B (P ＜ 0.01);⑤ Group B shows the least disease.[Conclusion] ① After preservation and reperfusion,cardiomyocyte apoptosis was observe evidently,which led to irreversible heart dysfunction.② The administration of caspase-3 inhibition after reperfusion attenuates ischemia-reperfusion injury by suppressing apoptosis in heart transplantation.Furthermore,the use of caspase inhibition was investigated as a strategy for the preservation donor heart in transplantation.③ The relationship of dose-response and time-effect is still unknown.
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Objective: To evaluate the mitral, aortic and tricuspid valve replacement for rheumatic heart disease. Methods: From June 1990 to June 2001, 941 patients underwent valve replacement. Among them, 24 patients underwent simultaneously mitral, aortic and tricuspid valve replacement. There were 17 females and 7 males, with mean age of 36 years (ranged from 18 to 59 years). Eight patients had previous closed mitral valvotomy. Eleven patients complicated with left atrium thrombus, 16 with hapotomeglia, and 8 with ascites. The X ray results showed that the C/T ratio was 0.66 to 0.91. The heart function (NYHA) was class III in 9, and class IV in 15. All patients had combined mitral, aortic valve lesions associated with severe tricuspid valve regurgitation. Results: One patient died postoperatively with an operative mortality of 4.2%. 23 patients followed up from 20 to 36 months (mean, 26.4 months). There was no thrombolism and anticoagulant related hemorrhage. The echocardiography demonstrated the diameter of left atrium right ventricle, and LVDd significantly decreased after operation. The heart function was also significantly improved. Conclusion: The combination of mitral, aortic and tricuspid valve replacement could achieve a satisfactory result with low mortality and better recovery of heart function.
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Objective: To evaluate the phenomenon of post-coronary artery bypass graft (CABG) supply-dependent oxygen consumption and the critical level of oxygen delivery. Methods: 53 patients undergoing CABG were randomized selected for this study. The oxygen delivery, oxygen consumption, and oxygen extraction were studied 1,4,12,24, and 48 hours post-operatively. Data were analyzed by SPSS. Results: The oxygen delivery of post-op 1 hour was the lowest (363.88ml?min -1 ?m -2 ). The 4th and 12th hour post-operatively oxygen deliveries were 396.02 ml?min -1 ?m -2 and 412.92 ml?min -1 ?m -2 respectively, lowers than that post-op 24 hour. After post-op 24 hour, the oxygen delivery was relatively stable, and the value was 468.78 ml?min -1 ?m -2 . The oxygen consumption of post-op 12 hour was the highest (143.02 ml?min -1 ?m -2 ), which closed to the normal value. The oxygen extraction of post-op 1 hour was the highest (35.6%). The oxygen extraction of post-op 12 hour was 32.6%, slightly lower than that post-op 1 hour. The oxygen extraction of after post-op 24 decreases obviously to be relatively stable, the value was 30.2%. Conclusion: 1, Postoperative 1 to 4 hour of CABG, hypoxia exists and oxygen delivery should be increased by maintain a higher pulmonary capillary wedge pressure and cardiac index. 2,There is a pathologic oxygen supply dependency for critical patients of post-CABG, the patients is still in hypoxia post-CABG 48 hour. Therefore, it is very important to keep oxygen supply and decrease oxygen consumption. It is better that the assistant ventilation is kept about 24 hours postoperatively. The pulmonary complications should be controlled as soon as possible. 3, The critical level of oxygen delivery is between 363.88 ml?min -1 ?m -2 and 396.02 ml?min -1 ?m -2 .
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Objective To explore the characteristics of infection after cardiac-lung transplantation.Methods March 23th 2006,one patient received orthotopic heart-lung transplantation,the clinical data were observed and analyzed.Results Depend on etiology,antibioti and antifungul were selected,the patient recoved.Conclusion It is very important to early etiology diagnosis and reasonable selection of antibiotic.
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Objective To weight the proper treatment for ischemic mitral regurgitation (IMR) patients who require coronary artery bypass grafting (CABG). Patients and Methods 37 CABG patients with IMR during January 2001 and October 2003 were analyzed retrospectively. Results 24 patients underwent CABG alone, there were no operation mortality. The left ventricular diastolic diameter decreased from 52 95 mm to 48 18 mm (P=0 001), LVEF increased from 0 46 to 0 55 (P