Effect of small incision versus traditional incision thoracotomy for aortic valve replacement: A case control study / 中国胸心血管外科临床杂志

@#Objective    To compare the clinical efficacy of small incision with traditional thoractomy for aortic valve replacement. Methods    We retrospectively analyzed the clinical data of 78 patients with heart valve replacement in our hospital between May 2014 and June 2016. The patients were divided into a small incision group and an open chest group with 39 patients in each group. In the small incision group, 18 males and 21 females, aged 56.4±10.8 years, underwent cardiac surgery with a small incision. And in the open chest group, 17 males and 22 females, aged 57.1±9.7 years, underwent cardiac surgery by thoracotomy. Results    The extracorporeal circulation time, aortic cross clamping time of the small incision group were longer than those of the open chest group (P<0.05). But the amount of intraoperative blood transfusion and postoperative 24 h drainage volume of the small incision group were significantly less than those of the open chest group (P<0.05). Postoperative mechanical ventilation time, and postoperative hospitalization time of the small incision group were significantly shorter than those of the open chest group (P<0.05). Pain score of the small incision group was significantly lower than that of the open chest group significantly (P<0.05). There was no statistical difference in complications rate between the two groups after 6 months (P>0.05). Conclusion    Compared with traditional open chest cardiac surgery, small incision cardiac surgery is effective and safe, and is worth popularizing in clinic.

Acquired Fungal Infection in Cardiosurgery Intensive Care Unit / 中华医院感染学杂志

OBJECTIVE To explore the reason, characteristic,prevention and treatment measures of acquired fungal infection in cardiosurgery intensive care unit(CSICU). METHODS A total of 153 patients who were admitted to our CSICU ward and had perfect microorganism materials from Jan 1999 to Jul 2002 were investigated with retrospective method,in which 34 cases were acquired fungal infection. RESULTS The rate of fungal infection was 21.52%.The most common infection site was lower respiratory tract.The patients after cardiac injury were easy to be infected.The Candida were the main pathogens,especially Candida tropicalis.The cardiopulmonary bypass(CPB) time,the time stayed in ICU,mechanical ventilation time, urinary dwelling tracheal intubation or tracheotomy,fiber bronchoscope and central venous intubation were the risk factors. CONCLUSIONS The reason of acquired fungal infection in CSICU is that CPB decreases patient′s immunity and every invasive exam or treatment can break the normal immunity.

Síndrome de Holt-Oram. Un caso clínico por mutación de novo

Introducción. El objetivo de este trabajo es informar el diagnóstico clínico del síndrome de Holt-Oram (SHO), el ecocardiográfico, el tratamiento neonatal endovascular y la cirugía cardiovascular. Caso clínico. Se informa un caso del SHO "por mutación de novo" en un lactante del sexo femenino con malformación ósea (MO); sindactilia en mano derecha, asociada con cardiopatía congénita (CC), hipoplasia de ventrículo derecho y estenosis pulmonar infundibular con persistencia del ducto arterioso y comunicación interauricular tipo ostium secundum. La mejoría neonatal fue obtenida por plastia endovascular de la arteria pulmonar. Al octavo mes de edad se realizó plastia del tracto de salida del ventrículo derecho; infundibular-anular, con buena evolución. Los antecedentes familiares en consanguíneos, 3 generaciones investigadas con MO y CC única o asociadas, fueron negativos. Se discute la importancia de genes, cromosomas y factores ambientales en la etiopatogenia del SHO por mutación de novo. Conclusión. La cirugía endovascular temprana y la "cardiocirugía electiva-paliativa", permiten en la actualidad una supervivencia en mejores condiciones clínicas y hemodinámicas con pronóstico vital a mediano y largo plazo más favorable.

Introduction. We inform the clinical and echocardiographic findings in a patient with Holt-Oram syndrome (HOS) and the evolution after treatment with cardiovascular surgery. Case report. It was a the novo clinic case of HOS, in a newborn girl with a bone malformation in the right hand, sindactilia in 2 fingers associated with congenital heart disease: hipoplasia of the right ventricle and lung arterial stenosis, with persistency of the arterial duct and interauricular communication type ostium secundum. The improvement in the newborn was obtained with endovascular plastia of the lung artery and palliative elective surgery at the 8 month of age. Conclusions. Early endovascular and palliative elective surgery permit a better prognosis in the infants with HOS.

Heat shock protein and cardioprotection / 医学研究生学报

The defense mechinism of heat shock protein(HSP)acting as moleculars chaperons requires heat shock transcription factors as the primary mediators of the heat shock response.Increased expression of HSP may protect the heart.Overexpression of HSP can inhibit cardiomyocyte apoptosis,protect the integrity of the microtubules and the actin cytoskeleton in cardiac myocytes and endothelial cells exposed to ischemia,participate in the folding and activation of protein kinases and transcription factors such as HIF-1? and HSF1,bind to endothelial nitric oxide synthase(Enos) and stimulate its activity,and downregulate cytokine production.Hence,it is of benefit to efficiently elevate HSP expression in myocardium using pharmacological and/or gene therapy procedures without any adverse effect.

Clinical Value of Percutaneous Dilatational Tracheotomy in Cardiosurgery / 中国微创外科杂志

Objective To discuss the value of percutaneous dilatational tracheotomy(PDT) for cardiosurgery in intensive care unit by comparing its outcomes with that of open tracheotomy(OT).MethodsA prospective study was conducted on 40 severe patients undergoing cardiosurgery.The patients were divided into PDT(treated from January 2002 to July 2003) and OT groups(treated from August 2003 to February 2008) with 20 cases in each.The operation time,length and heal time of the incision,blood loss,vital signs,and postoperative complications were compared between the two groups.ResultsThe operation time,length and heal time of the incision in the PDT group were significantly different from that in the OT group [(8.8?2.2) min vs(21.5?5.3) min,t=-9.897;(1.3?0.2) cm vs(3.4?0.5) cm,t=-17.440;and(3.9?0.9) d vs(5.9?1.2) d,t=-5.963;P=0.000].One patient in the PDT group(5%) had Ⅱ degree blood loss during the operation that was significantly less than those in the OT group(13 patients,65%,?2=15.824,P=0.000).The level of the vital signs change in the PDT group was significantly milder than those in the OT group [MAP: 1-5 mm Hg(median 2) vs 1-20 mm Hg(median 3.5),Z=-2.959,P=0.003;heart rate: 3-12 beats/min(median 5.5) vs 7-70 beats/min(median 10),Z=-3.956,P=0.000;SpO2: 0-4%(median 2%) vs 0-31%(median 3.5%),Z=-3.548,P=0.000].Furthermore,the rate of incisional leakage of sputum and overall rate of complications in the PDT group were significantly lower than those in the OT group.[1(5%) vs 8(40%),?2=5.161,P=0.023;and 1(5%) vs 12(60%),?2=13.789,P=0.000].ConclusionsPDT is a safe and minimally invasive technique with a high rate of success and low rate of complications.The method is easy to operate,and thus could be a good choice for severe patients after cardiovascular surgeries.