Long term evaluaction of cardiopulmonary function in 20 years after Fontan surgery / 中华胸心血管外科杂志

To evaluate the long term cardiopulmonary function after Fontan operation. Methods 10 patients who received Fontan operation were followed for(26 ±4) years in our hospital. 7 males and 3 females,(30. 7 ± 13. 2) years old(20 -60 years). All patients were diagnosed by echocardiography, CTA, 24 h ECG, cardiac catheterization, pulmonary angiography, radionuclide pulmonary blood perfusion and cardiopulmonary exercise test. Results Echocardiography shows: LVEF(0. 49 ± 0. 04), more than moderate atrioventricular valve regurgitation in 7 cases. CTA shows: there was no anastomotic stenosis, arteriovenous fistula in 4 cases. 24 h ECG shows: sinus rhythm in 7 cases, frequent paroxysmal atrial tachycardia in 1 case, atrial flutter in one and atrial fibrillation in one. Cardiac catheterization and pulmonary angiography show: the average pulmonary artery pressure(17. 8 ±2. 0)mmHg, average pulmonary resistance(4. 17 ±0. 56) woods. Radionuclide pulmonary blood perfusion shows: pulmonary blood of upper lung was reduced significantly with unbalanced distribution. Cardiopulmonary exercise test shows: both of lung ventilation function and heart reserve function decreased moderately or severely. Protein losing enteropathy was found in 1 case. Conclusion The decrease of cardiopulmonary function is found after Fontan operation during the long-term follow up for 20 years, especially for cardiac function. More attention should be paid to the early postoperative atrioventricular valve regurgitation. Unbalanced distribution of pulmonary blood is Found in long term. The incidence of arrhythmia after extra conduit Fontan operation is lower than other methods.

Safety and efficacy of Cox-maze Ⅲ procedure for atrial fibrillation associated with degenerative mitral regurgitation: a propensity-matched comparison to patients without atrial fibrillation / 中华胸心血管外科杂志

Objeetive We sought to compare the safety and efficacy of cut-and-sew Cox-maze Ⅲ procedure for atrial fi brillation associated with degenerative mitral regurgitation,by comparing with patients without atrial fibrillation.Methods From May 2013 to November 2015,217 patients underwent mitral valve repair were enrolled,including 145 without atrial fibrillation(control group) and 28 received concomitant cut-and-sew Cox-maze Ⅲ procedure (treatment group).Propensity scores were calculated on the basis of 16 known preoperative factors and yielded the best matched patients.Safety and outcomes were compared between the two matched groups.Results 28 pairs of patients were matched successfully.No hospital deaths occurred and the major complications showed no statistical differences (P ＞ 0.05).Cardiopulmonary bypass time and crossclamp time,proportion of amiodarone use and temporary pacemaker use,and postoperative hospital stay in the treatment group were higher than those in the control group(P ＜0.001).Patients were followed up from 6 months to 3 years,and no patients occurred deaths and strokes.After 6 months,there were no significant differences in the rates of sinus rhythm and drug free between the two groups (P ＞ 0.05).In both groups,left atrial diameter and left ventricular diameter decreased,and ejection fraction increased compared with those before operation.Atrial function in the treatment group recovered 3 years after operation.At the latest follow-up,patients in both groups were all at NYHA functional class Ⅰ.Conclusion The additional cut-and-sew Cox-maze Ⅲ procedure for treatment of degenerative mitral disease complicated by atrial fibrillation does not increase the operative risks of mitral valve repair,and had early and mid-term outcomes similar to that of patients without atrial fibrillation.

Safety and efficacy of Cox-maze Ⅲ procedure for atrial fibrillation associated with degenerative mitral regurgitation: a propensity-matched comparison to patients without atrial fibrillation / 中华胸心血管外科杂志

Objeetive We sought to compare the safety and efficacy of cut-and-sew Cox-maze Ⅲ procedure for atrial fi brillation associated with degenerative mitral regurgitation,by comparing with patients without atrial fibrillation.Methods From May 2013 to November 2015,217 patients underwent mitral valve repair were enrolled,including 145 without atrial fibrillation(control group) and 28 received concomitant cut-and-sew Cox-maze Ⅲ procedure (treatment group).Propensity scores were calculated on the basis of 16 known preoperative factors and yielded the best matched patients.Safety and outcomes were compared between the two matched groups.Results 28 pairs of patients were matched successfully.No hospital deaths occurred and the major complications showed no statistical differences (P ＞ 0.05).Cardiopulmonary bypass time and crossclamp time,proportion of amiodarone use and temporary pacemaker use,and postoperative hospital stay in the treatment group were higher than those in the control group(P ＜0.001).Patients were followed up from 6 months to 3 years,and no patients occurred deaths and strokes.After 6 months,there were no significant differences in the rates of sinus rhythm and drug free between the two groups (P ＞ 0.05).In both groups,left atrial diameter and left ventricular diameter decreased,and ejection fraction increased compared with those before operation.Atrial function in the treatment group recovered 3 years after operation.At the latest follow-up,patients in both groups were all at NYHA functional class Ⅰ.Conclusion The additional cut-and-sew Cox-maze Ⅲ procedure for treatment of degenerative mitral disease complicated by atrial fibrillation does not increase the operative risks of mitral valve repair,and had early and mid-term outcomes similar to that of patients without atrial fibrillation.

The midterm results of total Maze radiofrequency ablation procedure with vagal denervation in treatment of atrial fibrillation accompanied rheumatic heart valve disease / 中华胸心血管外科杂志

Objective To study the radiofrequency ablation (RA) and vagal denervafion (VD) in surgical treatment of long-standing atrial fibrillation (AF) associated with rheumatic heart disease (RHD).Methods Retrospective analysis the cardiac rhythm by 24-hour Holter monitoring during 5-year follow-up after total Maze procedure accompanied rheumatic mitral valve replacement.Between June 2006 and December 2007,a total of 173 consecutive patients with long-standing AF-associated RHD underwent mitral valve replacement and ablation maze procedure,92 cases had RA alone and 81 had RA + VD.Results Although Kaplan-Meier curve shows that the freedom from AF at 5 years follow-up time were similar(P =0.718),the percentage of antiarrhythmic drug therapy was significant higher in the RA group during early postoperative period(4th month,54.1％ vs.34.7％,P=0.017;5th month,39.2％ vs.21.3％,P=0.018;6th month,23.0％ vs.10.7％,P =0.044),and the percentage of those free by AF was significant lower(6th month,82.2％ vs.93.8％,P =0.023;1st year,76.1％ vs.89.9％,P=0.019).Conclusion Total maze procedure with bipolar radiofrequency ablation is effective to treat longstanding AF associated with rheumatic valve disease.Vagal denervation helped to maintain stable sinus rhythm and lower antiarrhythmic drug therapy at the early stage,but there was no additional benefit after the 1 st year of follow-up,it may be caused from the reactivation of vagal plexus electrical activity.

The analysis of results in the young children with tetralogy of Fallot: one-stage versus staged repair / 中华胸心血管外科杂志

Objective The study aimed to evaluate the short and middle term results in the patients with tetralogy of Fallot(TOF) after one-stage repair and staged repair.Methods A total of 459 TOF younger children less than five-year-old between January 2009 and December 2013 had received surgical repair,including 416 patients by one-stage repair(group Ⅰ)and 43 patients by staged repair(group Ⅱ).Among them,245 were male and 214 were female.The average repair surgical age was 27.8 ranged from 4 to 60 months,average palliation age was 15.4 ranged from 3 to 40 months.23 perioperative and follow-up parameters were assessed including sex,age,weight,preoperative clinic symptom,ratio of McGoon,pulmonary artery index,Z score of pulmonary annulus,cardiopulmonary bypass time,aortic cross-clamping time,type of VSD repair,type of RVOT procedure,Peak RV/LV pressure radio,RV-PA pressure grade,mortality,severely low cardiac output syndrome,hypoxemia,extubation time,ICU time,fellow-up time,left ventricular eject faction,RV index of myocardial performance (MPI),tricuspid annular plane systolic excursion(TAPSE) and pulmonary regurgitation.Results Compared with group Ⅰ,age and weight were significantly lower in patients in group Ⅱ[(19.1 ± 16.4) months vs.(21.1 ± 11.2) months,P ＜ 0.05) and(19.1 ±16.4) kgvs.(21.1 ±11.2) kg,P ＜0.01].The Z score of pulmonary annulus of patients in group Ⅱ were significantly less than those in group Ⅰ (-3.69 ± 2.36 vs.-2.50 ± 1.95,P ＜ 0.01).The ratio of repairing VSD by RV incision and using TAP in patient of group Ⅱ were significantly more than those in group(27/43 vs.71/413,P ＜0.01),(41/43 vs.221/413,P ＜0.01).There was no difference of mortality,complication,extubation time and ICU time bewteen two groups.All patients followed up 12-52 months,there was no difference of LVEF,MPI and TAPSE between two groups.However,the severity of pulmonary regurgitation in patients of group Ⅱ was significant more than those of group Ⅰ (47.6％ vs.32.1％,P ＜ 0.01).Conclusion The early and mid-term results in the the young children patients with TOF after one-stage repair or staged repair were good.Although the prior palliative shunt could promote the development of the hypoplasia pulmonary arteries in the young children patient,it may related to the technique of repairing operations and the postoperative pulmonary regurgitation.

The surgical strategy and outcomes for pulmonary valve preservation in repair of tetralogy of Fallot in young children / 中华胸心血管外科杂志

Objective To evaluate the surgical strategy for pulmonary valve preservation in repair of tetralogy of Fallot (TOF) and analyze the outcomes in young children patients.Methods A total of 211 TOF younger children less than threeyear-old between January 2009 and December 2015 had received pulmonary valve-sparing(PVS) surgical repair.At the end of the procedure,the peak RV/LV pressure ratio(PRV/PLV) and transannular pressure gradient were performed in all patients.114 patients had higher PRV/PLV rati ≥ 0.8.The former 54 patients,right ventricle infundubulum sparing (RVIS) stragery were made to relieve the RVOTO.However,only 8 patinets of the later 60 cases had received RVIS in TOF repair,whose systemic blood pressure was instable with the large dose of dopamine≥10 μg · kg-1 · min-1 and epinephrine≥0.05 μg · kg-1 · min-1 or the transannular pressure gradient≥30 mmHg (1 mmHg =0.133 kPa).114 patients were divided by two group(52 cases in PVS group and 62 cases in RVIS group) and compared by the early outcomes.Results The median cardiopulmonary bypass time of RVIS group was significantly more than that of PVS group[(110.3 ± 12.0)min vs(77.7 ± 10.0)min].The postoperative index of the patients in PVS group,including transannular pressure gradient [(21.0 ± 5.4) mmHg vs (16.0 ± 3.6) mmHg,P ＜ 0.05],PRV/PLV ratio(0.82 ± 0.03 vs.0.67 ± 0.12,P ＜ 0.01),median using time of dopamine and epinephrine[(6.03 ±9.60)days vs.(4.20 ±1.90)days,P＜0.01],median extubation time[(81.2 ±27.6)h vs.(38.5 ±33.0) h,P ＜ 0.01],ICU stay time [(6.3 ± 1.7) days vs.(4.3 ± 1.9) days,P ＜ 0.01],using of peritoneal dialysis (8/52 vs 4/62,P ＜ 0.01)were more than those in RVIS group.There was no difference of mortality between two groups.Fellow up 12-50 months,there was no difference of LVEF,MPI and TAPSE between two groups.However,the severity of pulmonary regurgitation in patients of PVS group was significant less than those of RVIS group.Conclusion PVS and RVIS in TOF repair could decrease the severity of pulmonary regurgitation after operation.

Short-term outcome of surgical treatment of moderate ischemic mitral regurgitation / 中华胸心血管外科杂志

Objective To evaluate the short-term-outcome of MVP in the treatment of moderate IMR patients with CABG.Methods Data from 129 patients with moderate IMR who underwent surgical treatment in our department from June 2007 to September 2011,57 patients(44.2％) underwent CABG combined with MVP,and 72 patients(55.8％) underwent CABG.Postoperative follow-up of patients with heart function NYHA grade to evaluate the clinical status of patients,with LVESD,LVEF,LVEDD to evaluate the reverse of left ventricular remodeling;The postoperative residual mitral regurgitation and major cardiac cerebral vascular events were recorded.Results There was no significant difference between two groups in the preoperative data(P ＞ 0.05).The mortality rate was 3.9％ (5 cases),2 cases (2.8 ％) died in CABG group,3 cases (5.3 ％) died in the combined surgery group.The average follow-up was 24 months,9 cases of late death (5 in CABG group,4 in CABG + MVP group),the cumulative survival rate(P =0.645) and the major cardiovascular events(P =0.761) of the two groups were not statistically different.The degree of mitral regurgitation(P ＜ 0.01) was significantly decreased in the combined surgery group.Compared with the preoperative state,the two groups of left ventricular remodeling indicators such as LVESD,LVEF,LVEDD were significantly improved(P ＜0.05),but the difference between two groups was not significant(P ＞0.05).NYHA heart function classification was significantly improved (P ＜ 0.001).Conclusion MVP can effectively improve the reverse flow of patients with moderate IMR,but CABG combined with MVP can not bring more benefits in the reversal of left ventricular remodeling,short-term survival and cardiac function.

Analysis of the results of a central end-to-side shunt between the ascending aorta and pulmonary arteries in children with pulmonary atresia, ventricular septal defect and diminutive pulmonary arteries / 中华胸心血管外科杂志

Objective The aim was to evaluate the development of pulmonary arteries(PA) in patients with pulmonary atresia,ventricular septal defect and diminutive pulmonary arteries by using a central end-to-side shunt between the ascending aorta and pulmonary arteries and to identify the associated factors for the results.Methods 51 consecutive patients(37 male,14 female) with pulmonary atresia,ventricular septal defect and diminutive pulmonary arteries received a central end-to-side shunt between PA and the ascending aorta from May 2004 to June 2013.Ages and weight ranged between 2-86 months and 2.5-21.5 kg,respectively.39 patients with main PA diameters less than 4 mm received the central end-to-side shunt between the ascending aorta and PA,and 14 patients with main pulmonary arteries absence received a modified shunt.Results There were no deaths during operation and follow-up.Compared with preoperative measures,total pulmonary artery index increased from a mean value of(68.8 ± 11.4) mm2/m2 to(129.1 ± 24.9) mm2/m2 (P ＜ 0.001) at the time of six months or the final repair after shunt.The increased pulmonary artery index change was(87.7 ± 27.4) ％ (27.0％ to 150.0％).By multivariate regression analysis,age at shunt,shunt procedure and number of major aortopulmonary collateral arteries were correlated with increasing pulmonary artery index change.Conclusion The central end-to-side shunt between the ascending aorta and pulmonary arteries promoted sufficient growth of the diminutive central pulmonary arteries.Due to the risk of a distortion of pulmonary branches,we interposed a modified procedure for patients with main pulmonary arteries absence.It is technically easy to perform,warrants low risk of shunt thrombosis in the early postoperative period.

Artificial valve ring implantation and Cox Maze IIIprocedure in treatment of degenerative mitral annulus dilatation complicated by atrial fibrillation / 中国组织工程研究

BACKGROUND:For patients with degenerative mitral annulus dilatation complicated by atrial fibrilation, atrial fibrilation is needed to be treated concomitant with artificial valve ring implantation. Although Cox maze III procedure is the gold standard for treatment of atrial fibrilation, its safety has been questioned. OBJECTIVE:To evaluate the safety of artificial valve rings implantation and Cox Maze III procedure for treatment of degenerative mitral annulus dilatation complicated by atrial fibrilation. METHODS: A total of 43 patients with degenerative mitral annulus dilatation and atrial fibrilation were enroled and were randomly divided into test group (n=21) and control group (n=22). Patients in the test group were treated with mitral valvuloplasty and Cox Maze III procedure. Patients in the control group were only treated with mitral valvuloplasty. RESULTS AND CONCLUSION: (1) Intraoperative safety indexes: the durations of cardiopulmonary bypass and aortic clamping. and the incidence of hemoglobinuria in the test group were higher than those in the control group (P < 0.001). There was no significant difference in the urine output between these two groups. (2) Postoperative safety indexes: the incidence of atrial dysrhythmia (i.e., any atrial dysrhythmia other than atrial fibrilation), proportion of patients requiring a temporary pacemaker and hospital stays in the test group were higher than those in the control group (P < 0.05). There were no significant differences in the secondary-thoracotomy bleeding rate and incidence of stroke between these two groups. (3) Postoperative outcomes: the rates of cardioversion to achieve sinus rhythm at the day of surgery and at discharge in the test group were significantly higher than those in the control group (P < 0.001). At discharge, patients in both groups were al at NYHA functional class Ior II. Echocardiography showed trace to mild mitral regurgitation and complete closure of the tricuspid valve. There were no significant differences in the left atrial diameter, left ventricular diameter, left ventricular volume, and ejection fraction between these two groups. However, the proportions of mitral and tricuspid valve peak A-waves were significantly higher than those in the control group (P < 0.001). These results show that artificial valve ring implantation and Cox Maze III procedure is a safe and effective method for treating degenerative mitral annulus dilatation complicated by atrial fibrilation during operation.

Effect of Cardiac Ischemic Preconditioning on Myocardium With its Mechanism in Aged Rats / 中国循环杂志

Objective: To explore the impact of Ischemic preconditioning (IPC) in aged experimental rats after myocardial ischemia-reperfusion (I/R) with its mechanism. Methods: A total of 32 Wistar rats at the age of (21-23) months were divided into 4 groups, n=8 in each group.①Control group, the rats received cardiac perfusion for 180 min. ②I/R group, the rats received cardiac perfusion for 30 min, followed by ischemia for 30 min, then reperfusion for 120min.③IPC group, the rats received cardiac perfusion for 10 min, followed by ischemia and reperfusion 2 times (5 min in each time), then ischemia 30 min and reperfusion 120 min. ④ Enhanced IPC group, rats received cardiac perfusion for 10 min, followed by ischemia and reperfusion 4 times (5 min in each time), then ischemia 30 min and reperfusion 120 min. The recovery rate of cardiac output (CO), left ventricular developed pressure (LVDP) and the recovery rate of maximum rise and fall of left ventricular pressure (±dp/dtmax) at (30, 60, 90, 120) min after reperfusion were recorded respectively. The creatine kinase (CK-MB), superoxide dismutase (SOD) activity and malondialdehyde (MDA) content were examined before ischemia and 120 min after reperfusion. The apical peroxisome proliferator-activated receptorγco-stimulatory factor 1α(PGC-1α) was examined by immuno-histochemistry. Results: The MDA content, CK-MB, SOD activities LVDP and (±dp/dtmax) recovery were similar between IPC group and I/R group, P>0.05. While compared with I/R group, the Enhanced IPC group showed decreased CK-MB activity and MDA content, increased SOD activity and CO, LVDP and (±dp/dtmax) recovery rate, all P0.05. While compared with I/R group, the Enhanced IPC group had increased PGC-1αexpression, P Conclusion: The cardiac IPC was weakened in aged rats which might be because of decreased PGC-1αexpression, the enhanced IPC may up-regulate PGC-1αexpression and therefore, protect the cardiac tissue in aged experimental rats.

The influence of atrial fibrillation on prognosis after mitral valve surgery in rheumatic mitral valve stenosis and mitral valve prolapse patients / 中华胸心血管外科杂志

Objective Atrial structure remodeling is the important pathologic basis of generate and development in chronic atrial fibrillation(AF) of valvular heart disease.To analyze the changed feature of AF in rheumatic mitral valve stenosis (MS) and mitral valve prolapse(MVP) after mitral valve surgery,along with fundamental change of hemodynamics in left atrial.Methods Firstly,divided into sinus rhythm (SR) group and AF group according to cardiac rhythm postoperative 6 months,and then divided into MS and MVP two subgroups with age matched,namely rheumatic sinus rhythm group (RS group),MVP sinus rhythm group(PS group),rheumatic AF group(RAF group) and MVP AF group(PAF group),30 patients in each group.Independent sample t test andx2 test were used in comparison among groups,and matched t test in preoperative and postoperative comparison of each group.Results There are 15 (50％) AF patients before surgery and 10 (33.3％) AF patients postoperative 1 month in RS group.But cardiac rhythm of MVP patients has no significant change.Left atrial diameter(LAD) in AF group was larger than in SR group significantly preoperative and postoperative 1 month and 6 months(P ＜ 0.05),and LAD have no significant difference between RAF and PAF group,P ＞ 0.05 ; LAD in RS group preoperative and postoperative 1 month was larger than in PS group(P =0.008 and 0.018,respectively),but there is no significant difference between RS and PS groups postoperative 6 months(P =0.558).Systolic peak velocity(Smm) at valve ring with PWTDI were(6.0 ± 1.4) cm/s,(6.7 ± 1.8) cm/s and (6.2 ± 1.6) cm/s preoperative and postoperative 1 month and 6 months,lower than normal range obviously; Smm before surgery in PAF group was(9.3 ± 3.7)cm/s,but reduced obviously after surgery 1 month and 6 months and near the level of rheumatic patients.Conclusion Generate and development mechanism of AF in MS and MVP patients exist some extent difference,the rhythm of partial MS patients with chronic AF will turn to and maintain sinus rhythm along with LAD decreased,there is no this characteristic in MVP patients.

The analysis of right ventricular outflow tract procedures for repair of tetralogy of Fallot and postoperative right ventricular function / 中华胸心血管外科杂志

Objective To analyze the relation of right ventricular outflow tract (RVOT) procedures for repair of tetralogy of Fallot and postoperative right ventricular function in order to improve the postoperative results at mid-long term follow-up.Methods A total of 125 patients for data collection with repair of TOF between January 2003 and January 2006 were prospectively enrolled in the study.Among them,66 were male and 59 were female.The ages ranged from 1 to 5 (3.4 ± 1.1) years,weight from 7 to 26 (15.2 ± 5.7) kg.20 healthy controls with a similar age and body weight were included.The type of RVOT procedure included transannular patch repair (M1) in 67 patients,patch to infundibulum (M2) in 6 patients,tranright-ventricle (RV) no patch repair (M3) in 18 patients and transatrial-transpulmonary no patch repair (M4) in 34 patients.Doppler echocardiogram and tissue Doppler imaging were performed to evaluate RV function.RV systolic function was evaluatedusing tricuspid annular plane systolic excursion (TAPSE) and index of myocardial performance (MPI).RV diastolic function was evaluatedusing ratio of Em/Am and E/Em.Unvariate and logistic regression analysis were used to identify the affective factors.Results In five years fellow-up,MPI and E/Em were higher in patents with M1 and M2 than those in the patients with M3 and M4.Univariate analysis revealed Nakata index,previous shunt operation,operative techniques、postoperative pulmonary regurgitation and during of QRS as risk factors for MPI.In the multivariate analysis,operative techniques and during of QRS were risk factors for MPI.Univariate analysis revealed Nakata index,operative techniques,PR and during of QRS as risk factors for E/Em.In the multivariate analysis,PR was the risk factor for E/Em.Conclusion RV dysfunction is associated with the type of RVOT procedure,diastolic dysfunction is correlative with postoperative PR and systolic dysfunction is correlative with enlarge of RVOT with patch and during of QRS.Echocardiographic imaging is a simple and reliable method for assessment of RV function after repaired TOF.

Surgical treatment of left ventricular rupture after mitral valve replacement / 中华胸心血管外科杂志

Objective To evaluate the causes,treatment,and prevention of left ventricular rupture after mitral valvereplacement.Methods From May 1981 to November 2010,11 cases occurred in 4 male and 7 female patients aged 28 - 71 years old.There were 2 cases of New York Heart Association (NYHA) functional class Ⅱ and 9 cases of class Ⅲ.Echocardiography showed that the left ventricular end diastolic internal diameter (LVEDI) was 32 -62 mm.Results Rupture probably occurs after endocardial damage to a thin myocardium that has lost the internal buttress of the subvalvar apparatus.With the rise in intraventricular pressure at the end of bypass blood dissects into the myocardium,resulting in a large haematoma and eventual rupture.According to the onset of ruptures,there were 4 cases of delayed rupture which occured at several hours till days post operation after the patients had been back in the ICU,and 7 cases of early ruptur,which occured at the early stage of surgery,while the patient was still in the operation room.There were no cases of ruptures.The types of the ruptures were identified by operation or necropsy as 5 cases of type Ⅰ,4 cases of type Ⅱ,and 2 cases of type Ⅲ.Four patients were saved after emergency treatment,and 7 died.Conclusion It is difficult to repair left ventricle rupture,but effective prevention for onset can decrease its occurrence.The risk factors for left ventricular ruptures are female,advanced age,pathological changes characterized by mitral stenosis,small left ventricle (LVEDD ＜ 35 mm),and low weight( ＜50 kg ).The following actions raise the risk of let ventricular rupture.Isolated replacement of the mitral valve than after double valve replacement or mitral valve replacement and coronary artery bypass graft; aggressive removal of calcification at the mitral valve; undue selection and replacement of mitral valve prostheses; large size of prosthetic valve with a high bioprosthetic angle in particular; deep sutures at the valve ring; aggressive traction or removal of papillary muscle,hematoma,and heart move.Also we should continue correcting unstable hemodynamic especially with very high blood pressure.Once left ventricular rupture occurs,extracorporeal circulation should be established as soon as possible,and direet suture or intracardiac and extracardiac repair suited to actual conditions are reliable ways to save the patient's life.

The study of pulmonary arterial development in patients after 5 years of extracardiac tota cavopulmonary connection / 中华胸心血管外科杂志

ObjectiveTo study the pulmonary arterial development over five years in patients underwent extracardiac total cavopulmonary connection (ETCPC).Methods43 survived patients,who had undergone ETCPC were examined with pulmonary perfusion at one month and five year following the operation.Central venous pressure (CVP) and arterial oxygenation saturation (SatO2 ％ ) were measured by right cardiac catheter,pulmonary arterial index (PAI) and pulmonary vascular resistance (PVR) were calculated.Pulmonary blood distribution were measured and calculated by 99m Tc-MAA perfusion imaging.ResultsThe PAI and PVR of the follow-up group reduced significantly ( t =2.41,P ＜ 0.05 ; t =2.08,P ＜ 0.05 ),CVP also reduced significantly ( t =2.69,P ＜ 0.05 ),but SatO2 ％ did not changed significantly.Total radionuclide counts and the ratio of rightorleft pulmonary perfusion did not change significantly.( t =0.38,P ＞ 0.05 ;t =1.12,P ＞ 0.05 ),but the ratio of the superior and inferior lobe decreased significantly( t =2.54,P ＜ 0.05 ).ConclusionThe weak pulsation and low dynamic of Fontan circulation also can promote pulmonary vascular development.However,the improvement of hemodynamic in pulmonary circulation at mid-term follow will not lead to an increased amount of pulmonary perfusion or oxygen supply,which is probably due to the massive opening of the arteriovenous shunt and increased futile circulation.

The results of the Fontan procedure in patients with visceroatrial heterotaxy syndrome and complex cardiac anomalies / 中华胸心血管外科杂志

Objective To assess the results of the Fontan procedure in patients with visceroatrial heterotaxy syndrome and complex cardiac anomalies.Methods From April 2002 through December 2010,25 patients (male 10,female 15) had undergone the Fontan procedure for heterotaxy syndrome or atrial isomerism and complex congenital heart disease 28 times.Median age at operation was (9.1 ± 5.5) years (2 to 18 years).Heterotaxy syndrome were associated with right atrial isomerism (n =18) or left atrial isomerism (n =7),asplenia (n =13) or polysplenia (n =7),double inlet of left ventricle (n =15),double inlet and outlet of left ventricle (n =5),double outlet right ventricle with pulmonary atresia (n =2) and with pulmonary stenosis (n =1),tricuspid or mitral atresia (n =2).A bidirectional cavopulmonary shunt was performed in 8 patients (bilateral in 3 patients).A cavopulmonary shunt placement,so-called Kawashima operation,was performed in 4 patients.An extracardiac conduit Fontan connection was pefformed in 15 patients and intracardiac lateral tunnel Fontan connection in one patient.Results 2 patients died in hospital caused by ventricular failure.Five patients developed early postoperative atrial arrhythmias and 2 patients had sinus node dysfunction.Mean arterial oxygen saturation at discharge was 0.86 ± 0.07 (range,0.78 to 1.00).Follow-up (range,0.5 to 7 years) was available on 15 patients.Mean arterial oxygen saturation was 0.82 ±0.08 (range,0.68 to 0.97).Ventricular function was normal in 13 patients (EF range,0.50 to 0.66) and depressed in 2 patients.Four patients had a junctional rhythm.Conclusion The Fontan procedure was still the main procedure for patients with visceroatrial heterotaxy syndrome and complex cardiac anomalies,which can reach satisfactory early and medium-term results.The choice of Fontan procedure,extracardiac conduit Fontan connection,aggressive treatment of concomitant malformations were essential to improve the outcomes.

Early hemodynamic evaluation of aortic valve replacement with Hancock Ⅱ Ultra valve / 中华胸心血管外科杂志

Objective To study the aortic valve replacement with Hancock Ⅱ Ultra valve and its early hemodynamic results.Methods The 30 patients who received Hancock Ⅱ Ultra aortic valve replacement at our hospital were matched 1 ∶1 with 30 patients who received Hancock Ⅱ on variables known to affect hemodynamic measurements:size of valve,age,sex,and body surface area.Early postoperative transthoracic echocardiography was performed in all patients.Results 3 months postoperatively,Hancock Ⅱ Ultra valves had significantly lower transvalular gradients,velocity,left ventricle mass index and larger effective orifice area.Compared with Hancock Ⅱ valves,in ≤22 mm group,Hancock Ⅱ Ultra valves had significantly lower transvalular velocity[ (2.26 ± 0.05 ) vs ( 2.57 ± 0.06 ),t =2.07,P ＜ 0.05 ],lower transvalular mean gradients [(11.4 ±1.3) vs (13.1 ±1.5),t =2.09,P＜0.05],higher effective orifice area[ (0.79 ±0.13)vs(0.71 ±0.02),t =2.06,P＜0.05],lower left ventricle mass index[ (119.1 ± 11.1)vs(133.2 ±16.4),t =2.67,P ＜0.05] and bigger left ventricle outflow tract (20.4 ±0.3 vs 18.9 ±0.2,t =2.23,P＜0.05).Conclusion The Hancock Ⅱ Ultra valve has more favorable early postoperative hemodynamics than the Hancock Ⅱ,especially for the small aortic ring patients.

The surgical strategy for tetralogy of Fallot with pulmonary atresia / 中华胸心血管外科杂志

Objective To evaluate the indication and surgical technique for treating tetralogy of F allot with pulmonary atresia (TOF-PA).Methods From June 1984 to June 2009,66 patients with TOF-PA underwent 69 operations.Among them,34 were males and 32 females.Their age ranged from 6 months to 29 years.The anatomic characteristics of TOF-PA included 31 cases of Type Ⅰ,14 Type Ⅱ,12 Type Ⅲ and 9 Type Ⅳ.The operations included palliative aorto-pulmonary shunts in 11 cases,one-stage unifocalization with unpatched VSD in 2 cases,one stage complete repair in 40 cases,one-stage unifocalization with VSD repair in 13 cases,and delayed intracardiac repair after shunt procedures in 3 cases.Results There were 6 early deaths,including 1 death happened after aorta-pulmonary shunt and 5 after complete repair.The causes of death were severe low cardiac output in 3 cases,respiratory failure in 1,multiorgan function failure in 1 and severe wound infection with endocarditis in 1 after aorta-pulmonary shunt.The postoperative oxygen saturation of the patients undergone shunt and one stage unifocalization with unpatched VSD increased to 82％ ～ 91％.The postoperative ratio of right ventricular pressure/left ventricular pressure after complete repair was ＜ 0.5 in 31 cases,18 cases were between 0.5 and 7 cases ＞ 0.75.47 patients were followed up from 3 months to 15.5 years.The heart function(NYHA) of 44 patients were in class Ⅰ or Ⅱ and 3 in class Ⅲ or Ⅳafter operation.Conclusion The surgical strategy for TOF-PA mainly depends on the anatomic characteristics of the pulmonary and aortopulmonary collateral arteries.An individualized approach based on the anatomy of the pulmonary circuits permits a better result in the patients with TOF-PA.Patients with well developed pulmonary arteries should undergo one stage complete repair as early as possible.

Measures for decreasing the early mortality after atrial septal defect and ventricular septal defect with unsuccessful interventional treatment / 中国医师进修杂志

Objective To probe the effective measures for decreasing the early mortality after unsuccessful interventional treatment for atrial septal defect(ASD)and ventricular septal defect(VSD).Methods A total of 16 patients who underwent surgical treatment of unsuccessful interventional treatment for ASD and VSD from January 2000 to December 2007 were included in this retrospective analysis.Surgical indication was the occluder abscission(7 cases),cardiac perforation(3 eases),the third degree atrioventricular conduction block(3 cases),valvular regurgitation(2 cases,1 case accompanied with the third degreeatrioventricular conduction block),residual shunt(1 case),unsuecesflful interventional treatment(1 case).An of 16 cases underwent surgical treatment including removal of the displaced occluder and/or the congenital heart disease repaired on cardiopulmonary bypass.After surgical treatment.all patients were transferred into ICU for further supervision and treatment.Results There Was no hospital mortality.Twelve ASD cases were performed after the interventional treatment,which included 5 cases with central ASD and 7 CaseS with inferior sinus venous ASD.Coincidental rate between operating exploration and preoperative diagnosis was 41.7%(5/12).Misdiagnostic rate between them was 58.3%(7/12).The diameter of ASD (31.0 ±1.0)mm by operating exploration after interventional therapy of ASD obviously increased compared with that(26.0±2.3)mm before preoperative diagnosis(P<0.05).The diameter of VSD(5.0±0.8)mm by operating exploration after intervenfional therapy of VSD obviously increased compared with that(4.0±0.3)mm before operative diagnosis(P>0.05).,The third degree atrioventricular conduction block(3 cases)restored sinus rhythm after operation.Procedure was successful in all patients.Conclusion It is necessary to monitor severe complications of unsuccessful interventional treatment for ASD and VSD to assure the successes of the operations.

Clinical analysis for 241 cases of subpulmonic ventricular septal defect / 中国医师进修杂志

Objective To summarize the clinical features and treatment experience of subpulmonic ventricular septal defect (SPVSD). Method The clinical data of 241 cases of SPVSD were analyzed retrospectively. Results Two hundred and fifteen cases were confirmed by echocardiography before operation, while other 26 cases were misdiagnosed (10.79%, 26/241), 42 cases with aortic valve prolapsed,ECG showed left ventricular hypertrophy. All patients underwent surgical repair of VSD. Other procedures had been done in the same stage including aortic valve replacement (AVR) in 8 cases, aortic valvuloplasty (AVP) in 6 cases and other operations. The size of VSD was larger than the value echocardiography measured before operation. There were no perioperative death and no complete atrioventricular block. Two hundred and thirty cases (95.44%, 230/241) were followed up for 3 months to 5 years. The cardiac function (NYHA) in 189 cases were grade Ⅰ and 41 cases were grade Ⅱ. There was no residual shunt of VSD. Among patients who underwent AVP or AVR, 1 case developed mild insufficiency, others developed well. Others underwent another operations all developed well. Conclusion To achieve satisfactory results, it should enhance the overall understanding of SPVSD, improve the diagnostic accuracy of SPVSD, take positive surgical repair of VSD and reasonable treatment with aortic valve disease, and other malformation or disease.

Treatment strategy of supraventricular tachycardia after coronary artery bypass graft / 中国医师进修杂志

Objective To summarize the treatment experience of supraventricular tachycardia (SVT) after coronary artery bypass graft (CABG). Methods The clinical data of 136 patients who had occurred SVT after CABG between January 2008 and December 2009 were analyzed retrospectively. Results Among 136 patients,no perioperative mortality,atrial fibrillation (AF) occurred in 110 cases (80.88%),paroxysmal supraventricular tachycardia (PSVT) occurred in18 cases ( 13.24% ), atrial flutter occurred in 8 cases (5.88%),112 of 136 cases occurred in 1-3 days after surgery,accounting for 82.35% ,24 cases occurred in 4-7 days after surgery,accounting for 17.65%. Given amiodarone in the treatment of 105 cases,100 cases reverted to sinus rhythm (cardioversion rate of 95.24% ),given esmolol in the treatment of 11 cases, 9 cases reverted to sinus rhythm( cardioversion rate of 81.82% ), synchronous direct current cardioversion in 20 cases, all transferred to sinus rhythm, all patients with improved symptoms. The remaining failed to transfer to sinus rhythm, had got normal ventricular rate, and symptoms improved significantly. Conclusions It is necessary to take effective measures to prevent SVT within 3 days after CABG. Amiodarone, esmolol and synchronous direct current cardioversion can be used effectively and safely to control SVT after CABG.