Clinical Efficacy of Thoracic Endovascular Aortic Repair for Treating the Patients With Complicated Thoracic Aortic Dissection / 中国循环杂志

Objective: To investigate the clinical efifcacy of thoracic endovascular aortic repair (TEVAR) for treating the patients with complicated thoracic aortic dissection and to report the relevant clinical experiences. Methods: We retrospectively analyzed the records of 56 patients with complicated thoracic aortic dissection who received the operation of TEVAR in our hospital from 2011-02 to 2015-10 in order to analyze their operation methods with reasons. Results: There were 21 patients with complex anatomic conditions for aortic arch, 7 of them received TEVAR and 14 received TEVAR with covered left subclavian artery; 16 patients with complex shape of aortic dissection, 5 of them received TEVAR and 11 received TEVAR with covered left subclavian artery; 19 patients with aortic dissection involving aortic arch, 17 of them received hybrid procedures of aortic arch branch bypass surgery + TEVAR and 2 received TEVAR with fenestrated stent grafts. All operations were successful and no severe complications occurred. Conclusion: TEVAR is a fast and effective method for treating complicated thoracic aortic dissection, which may expand the application ranges as covering left subclavian artery, branch vessel bypass and modiifed stent grafting.

Clinical studying of thoracic endovascular aortic repair for treating multiple tears Stanford type B thoracic aortic dissection / 国际外科学杂志

Objective This study aims to analysis in the clinical features of Stanford type B thoracic aortic dissection with multiple tears,and to explore the clinical methods of thoracic endovascular aortic repair (TEVAR) treating this disease.Methods From February 2011 to May 2015,the cases that diagnosed with multiple tears (≥ two tears) Stanford type B thoracic aortic dissection and accepted operations with TEVAR at department of Thoracic Cardiovascular Surgery,Wuhan General Hospital of Guangzhou Command,were retrospective analyzed their clinical data.Except the first tear of proximal,cases were named for the treatment group whom used surgical methods treating distal aortic dissection tears.Otherwise,the cases were named non-treatment group.We compared the incidence of chest and back pain,the progress of distal aortic dissection,the changes of false lumen with aortic dissection,and the benefit of distal tears in two groups after 6 months after TEVAR.Results A total of 67 cases were recruited this retrospective study,successful operations with TEVAR were conducted in all patients,and no serious complications occurred postoperatively in all patients.7 cases with treatment group,60 cases with non-treatment group,no deaths within two groups in 6 months after TEVAR.There were no significance statistically in complained of the incidence of chest and back pain,and the rate of progress with distal aortic dissection (P ＞ 0.05).There was statistically significant in the rate of changes with false lumen with aortic dissection false lumen (P ＜ 0.05).Some cases with abdominal visceral artery blood flow from the distal tears of aortic dissection in the non-treatment (n =19).Conclusions TEVAR is an effective method for treating multiple tears Stanford type B thoracic aortic dissection.Distal tears should be individualized treatment according to the characteristics of Stanford type B thoracic aortic dissection or try not to deal with.

Investigation of a New Type Two-branched Stent Graft Releasing in Experimental Canine Thoracic Aorta Simulation System / 中国循环杂志

Objective: To investigate the feasibility for reconstructing an aortic arch by a new integrated two-branched stent graft releasing in experimental canine thoracic aorta simulation system. Methods: A new type of integrated two-branched stent graft was developed and placed in the canine thoracic aorta, the stent graft releasing in a simulated system was conducted under X-ray guidance to monitor the operating process and to explore the feasibility for invitro sent graft releasing. Results: The new two-branched stent graft was successfully deployed in canine thoracic aorta simulation system. The releasing process was smooth, two small stent grafts were well landing, and all stent grafts were fully expanded and properly positioned. Conclusion: Our new two-branched stent graft could successfully reconstruct the aortic arch in experimental canine. The thoracic aorta releasing system may better and truly simulate the whole process of endovascular aortic repairing, which provides a good foundation for further animal experiments.

Clinical different diagnosis value in complex heart disease between 320-slice computerized tomography and heart echocardiography / 国际外科学杂志

Objective To investigate clinical diagnosis value in complex heart disease of 320-slice computerized tomography.Methods Twenty-seven patients' imaging data of 320-slice computerized tomography and transthoracic heart echocardiography were taken retrospective analysis,all patients were diagnosed with complex heart disease on cardiothoracic surgery.And the authors compared the diagnostic accuracy of imaging diagnosis and operation diagnosis.Results The diagnostic of 27 patients with 89 cardiac anomalies with 320-slice computerized tomography and were diagnosed 83 cardiac anomalies with transthoracic heart echocardiography.However,92 cardiac anomalies were found on cardiothoracic surgery.The diagnostic accuracy of 27 patients had a statistical difference between 320-slice computerized tomography and transthoracic heart echocardiography with complex heart deformity disease (P ＜ 0.05).Conclusions Compared with transthoracic heart echocardiography,320-slice computerized tomography improved the diagnosis accuracy of the complex heart deformity disease.

Feasibility of intentional occlusion of the left subclavian artery in endovascular aortic repair of thoracic aortic disease / 国际外科学杂志

Objective To investigate the feasibility and effect of intentional occlusion of the left subclavian artery (LSA) in endovascular aortic repair EVAR of thoracic aortic disease.Methods The cases,who needed occlusion of the LSA in EVAR of thoracic aortic disease,were examined cerebral circulation,carotid artery,vertebral basilar artery and circle of Willis.If the vertebral artery had a good blood pathway,and carotid artery and circle of Willis had no stenotic,we occluded the LSA directly in EVAR,and observed the brain and upper limb ischemia complications postoperation.Results Among 40 cases who were occluded the LSA directly in EVAR,28 cases were successful with no neurological complications and left upper limb ischemia symptoms postoperation,12 patients with mild symptoms of subclavian steal syndrome and neurdogical complications,but none required and secondary surgical intervention.Conclusions Prior to intentional LSA occlusion,attention must be paid to potential supraaortic variants and pathologies.Only in this way,it was safe and effective to occlude the LSA in EVAR of thoracic aortic disease.

CT-study on branches artery thoracic aorta / 国际外科学杂志

Objective To provide vessel anatomical materials guidance for endovascular aortic repair,the branches artery of thoracic aortic was studied by CT angiography (CTA).Methods From January 2008 to February 2012,739 adult cases' CTA data were collected,all cases performing thoracic CTA in Wuhan General Hospital of Guangzhou Command.We measured the diameter and/or leugth of the ascending aorta,aortic arch and branches artery of aortic arch,and made an analysis.Results The aortic arch includes standard and variant types.Standard type is common,which accounted for 91.1％ of the total number,while variant type accounted for 8.9％.In the standard aortic arch of patients,the diameter of aortic arch above the opening of coronary artery (CA) was (35.7 ±4.3) mm,the diameter of ascending aortic arch at the opening of brachiocephalic trunk (BCT) was (33.6 ±4.2) mm,the diameter of aortic arch between the BCT and the left common carotid artery (LCCA) was (29.4 ± 5.7) mm,the diameter of aortic arch between the LCCA and the left subclavian artery (LSA) was (27.6 ± 4.2) mm,the diameter of descending aortic at the opening of the LSA was (25.4 ± 4.5) mm,the diameter of the head BCT from aortic arch was (12.9 ±0.9) mm,the diameter of the head LCCA from aortic arch was (8.5 ± 0.7) mm,the diameter of the head LSA from aortic arch was (10.4 ± 1.1) mm,the length of aorta between the CA and the BCT was (53.3 ±12.5) mm,the length of aortic between the BCT and the LCCA was (4.7 ± 1.5) mm,the length of aortic between the LCCA and the LSA was (7.9 ± 2.6) mm,the length between the opening of BCT and the right subclavian artery (RSA) was (41.1 ± 8.2) mm,the length between the opening of LSA and the opening of left vertebral artery was (38.5 ±5.7) mm,the angle between the horizontal of BCT and the LCCA and the sagittal plane was (71.2 ± 7.2) °,the angle between the plane of LCCA and the LSA and the plane of sagittal was (31.1 ± 2.9)°.Conclusions The CT data of the thoracic aorta can be used as reference for production of stents and guide releasing the stents in endovascular repair.

Endovascular repair for aortic arch aneurysm: current study status / 国际外科学杂志

Artery aneurysm occurred in the aortic arch involving branches of vital organs is the difficulty of the endovascular repair.In recent years,experts have made a few researches,and have obtained some effects. We reviewed the present situation this technique in this paper.

Experience of beating heart surgery in complex and severe congenital heart diseases / 中国医师进修杂志

Objective To discuss the experience of open heart operation on beating in complex and severe congenital heart diseases. Method This kind of operation was put to use in 48 cases of the heart diseases in order to observe the effect of myocardial protection, prevention from air embolism,exposure of the operative field, and cardiopulmonary bypass. Results Operation field exposure was clear enough to finish the manipulation. One cases was eventiful postoperatively and died(2.08%). Conclusion Open heart operation on beating with slight hypothermia might have much feasibility in the part of complicated and severe congenital heart diseases.

Surgical Treatment of Ebstein's Anomaly with a Modified Carpentier's Repair Technique / 中国医师杂志

Objective To evaluate the efficacy of surgical treatment of Ebstein's anomaly with modified Carpentier's repair technique. Methods ⑴Enlarging the anterior leaflet with a pericardium patch; ⑵The edge of posterior leaflet was sewed to the edge of anterior leaflet or septal leaflet in favor of enlarging the area of leaflet; ⑶Annulus was reinforced with the terylene ring covered with pericardium; ⑷Adjustable Devega's procedure. Results 31 patients with Ebstein's anomaly underwent modified Carpentier's repair operation from Jan 1992 to May 2003 in our institution. There was one patient died after operation because of a fatal cardiac dysfunction, and no late deaths. During the followed-up period of 6～94 months, all surviving patients had a marked improvement of heart function, and 6 cases were in class I, 21 in class II and 3 in class III. There were no postoperative rhythm disturbances. Conclusion The modified Carpentier's repair technique is feasible and possesses a good outcome.