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Objective It is still controversial how to deal with the congenital heart disease with advanced pulmonary hypertension.The choices of treatment for these patients must depend on the character and degree of pulmonary vascular change.The pulmonary vascular change correlates well with hemodynamics and acute pulmonary vasoreactivity test.Therefore,it will play an important role to obtain accurately these evaluations.Methods This paper studies 85 cases (38 males and 46 females) with congenital heart disease complic ated with advanced pulmonary hypertension and bidirectional shunt,which are diagnosed by echocardiography.Whose age range is (22.8 ± 16.5 ) and weight range (46.4 ± 12.1 ) kg.Among those cases,42 are VSD,11 are ASD,9 are VSD with patent ductus arteriosu,7 are patent ductus arteriosu,5 are ASD with VSD,and 11 are the others.With congenital heart disease complicated with advanced pulmonary hypertension and bidirectional shunt,which are diagnosed by echocardiography.There were floating catheter retention of 4 to 13 days ( average 7.5 days).Through the right subclavian vein or jugular vein,floating catheter is inserted into pulmonary artery.Pulmonary artery pressure is recorded continuously and analyzed.Hemodynamics,acute pulmonary vasoreactivity test and drug sensitivity test are evaluated.Differences of the hemodynamics are analyzed between echocardiography and floating catheter examination.Results Compared with floating catheter examination,there are not significantly difference for the diagnosis of advanced pulmonary hypertension(98.8％ vs.100％,P ＞ 0.05),less accurately diagnosis (64.3％ vs.100％,P ＜ 0.05 ) and higher (H)false positive rate (8.4％ vs.0,P ＜ 0.05) for Eisenmenger syndrome in echocardiography examination.Floating catheter examination shows that mean systolic pulmonary artery pressure(PAP)/mean systolie body artery blood pressure (BP) and mean PAP / mean BP were equal to 1.22 ± 0.35 and 1.07 ± 0.11 respectively.The patients presented total pulmonary vascular resistance of ( 17.6 ± 8.3) Wood units.Bidirectional shunt volume is more than 30％ cardiac outputs in 7 cases.Apart from 14 cases with Eisenmenger syndrome,total pulmonary vascular resistance is ( 11.3 ± 3.7) Wood units.Acute pulmonary vasoreactivity test presents positive in 67 cases.After drug sensitivity test,14 cases with Eisenmenger syndrome underwent medical treatment and waited lung transplantation or heart-lung transplantation.Floating catheter examination happened hematoma(2/85 ) in 2 patients.71 cases underwent surgical treatment.Operative complications included right heart failure (6/71) and pulmonary infection (5/71).Operative mortality was 5.6％ (4/71).The main causes of death were right heart failure.Compared with preoperative arterial oxygen saturation,postoperative arterial oxygen saturation increased by (9.7 ± 4.1 ) ％ ( P ＜ 0.05 ).Conclusion Floating catheter examination can evaluate accurately pulmonary hypertension,hemodynamics,acute pulmonary vasoreactivity test,drug sensitivity test and bidirectional shunt volume.All the patients,who were diagnosed as advanced pulmonary hypertension with bidirectional shunt by echocardiography,should undergo floating catheterization.Floating catheter examination can provide reliable,objective theoretical basis for the choice of treatment in the congenital heart diseases with advanced pulmonary hypertension.
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Adenosine receptor agonists can activate adenosine receptors A 1 and A 3, thus trigger delayed preconditioning signal pathway and induce high expression of protective proteins and some ionic channel opening in myocardial cells, which reduces myocardial ischemia/reperfusion injury.
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Objective To compare the myocardial protective effect between off pump coronary artery bypass(OPCAB) and on pump coronary artery bypass in the aged. Methods Four five patients were randomly divided into 3 groups:off pump coronary artery bypass (n=15),tepid blood cardioplegia group(n=15) and cold blood cardioplegia group (n=15).There was no statistical difference in heart function,sex,age and lesion of coronary artery .Venous blood samples were taken for determineing the serum concentration of creatine kinase MB isoenzyme(CK MB),troponin I perioperatively and the clinical situations were observed postoperatively. Results CK MB,troponin I release in beating group during and after bypass was lower than that in on pump groups( P
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Objective: To review the experience of the esophageal replacement with colon. Methods: The data from 548 patients were summarized and analyzed, including the diseases type, operations type, selection of the colon segment, colon blood supply and pathway for pulling-up of transplanted colon. Results: Postoperative complications occurred in 86 cases (15。69%), with 10 deaths (mortality rate 1。82%). The 1,3,5 years survival rate were 85。6%, 60。8% and 32。4%, respectively. All the patients in the group of benign esophageal diseases survived well with normal lives and activities, after 2～25 years of follow-up. Conclusion: There are several keys to ameliorate the results and reduce the complications rate to 15。69% and mortality rate to 1。82%. The keys are choosing of isoperistaltic transposition, ascending branch of left colica artery, retrosternal tunnel, a single-row suturing by cervical esphagocolostomy and prevention of complications (injury of recurrent laryngeal nerve, thoracic colon syndrome and esophageal pouch syndrome).
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Objective: To investigate the etiological factors and treatment for a rare evacuation disturbance and severe dilatation syndrome of transplanted colon for esophagus diseases. Methods: From 1962 to 1999, 548 patients with colon replacement for esophagus were studied. 425 patients were followed-up for 0 5 to 10 years. 9 patients with thoracic colon syndrome were operated on from 1970 to 1980. The clinical sign, experiment test, etiological factor and method of treatment were reviewed. Results: 5 patients had large anastomotic stoma of colon-stomach, 2 had angulation of abdominal part colon, and 2 had mechanical obstruction. 7 patients were cured after reoperation. Clinical symptoms of other 2 patients were remission after drug treatment. No thoracic colon syndrome occurred after 1980. Conclusion: The etiological factors of thoracic colon syndrome were too large colon-stomach anastomotic stoma, angulation of long-winded colon in abdomen part colon and mechanical obstruction. Colon-stomach stoma should be 1/2 to 2/3 of intestinal luminal diameter and anti-reflux operation should be done at the same time. The pyloroplasty is essential when truncal vagotomy has been done during the operation.