Clinical evaluation of percutaneous atrial septal defect closer guided by transthoracic echocardiography and/or transesophageal echocardiography / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the safety and efficacy of percutaneous closure of the single secundum atrial septal defects (ASD) guided by transthoracic echocardiography (TTE) and/or transesophageal echocardiography (TEE).
@*METHODS@#From January, 2014 to December, 2014, thirty-two patients with single secundum ASD from Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, were treated with percutaneous closure of ASD guided by TTE or TEE.
@*RESULTS@#Thirty-two patients underwent ASD closure successfully, except one patient showed trivial residual shunts, which disappeared one month later. The remaining 31 patients were subjected to TTE. At once or at the 1st or 3rd month after the procedure, no ASD migration or residual shunts were observed.
@*CONCLUSION@#Percutaneous closure of ASD guided by TTE or TEE is a safe and effective surgery method with minimal invasion and can avoid the chest incision and radioscopy.

Total aortic arch reconstruction with open placement of triple-branched stent graft for Stanford type A aortic dissection / 中华胸心血管外科杂志

Objective To report the primary experience of open placement of triple-branched stent graft for acute Stanford type A aortic dissection. Methods Between June 2008 and September 2009, 20 well-selected patients with acute Stanford type A aortic dissection underwent open placement of triple-branched stent graft for total arch reconstruction. When core cooling to a 20℃ nasophageal temperature, perfusion to the lower body was discontinued and the ascending aorta was transected at the base of the innominate artery. Through a transverse incision, the triple-branched stent graft was inserted into the true lumen of the arch and descending aorta, and each side arm of the stent graft was positioned one by one into the arch branches.The transected stump of the ascending aorta was reconstructed by inner proximal stent-free dacron tube of the main graft and outer teflon felt, and subsequently continuous anastomosis to the 1-branched dacron tube graft was made. Results Open placement of triple-branched stent graft was technically successful in all patients. The mean cardiopulmonary bypass time, aortic cross-clamp time and lower body arrest time were (163.2 ±19.2) min, (89.4 ±10.0) min and (32. 7 ±6. 6)min, respectively. Transient postoperative neurological dysfunction was observed in 1 patient and acute renal failure in 1 patient. All patients were discharged from the hospital. Their computed tomographic scans at 3 months postoperatively showed that all stent grafts were fully opened without distortion. In the vascular stent implantation site the dissected false lumen was eliminated. The false lumen of the descending aorta distal to the stent graft was closed with thrombus in 16 cases. Conclusion Open placement of triple-branched stent graft is a new effective technique for total arch reconstruction in acute type A aortic dissection. Patients have the indications of the extensive primary repair of the thoracic aorta without primary intimal tears in the arch may be the best candidates for this new technique. The size of the stent graft, the distances between two neighboring side arm grafts and the prevention of the intimal trauma during the placement are crucial for successful open placement of triple-branched stent graft.

Effect of cardiomyopeptidin for injection on energy metabolism in isolated hearts of young rats after ischemia-reperfusion injury / 中南大学学报(医学版)

OBJECTIVE@#To investigate the effect of cardiomyopeptidin for injection on energy metabolism in isolated hearts of young rats after ischemia-reperfusion injury.@*METHODS@#Fifty young healthy SD rats(aged 20 +/- 3 days and weighing 50-70 g) were randomly divided into 5 groups: a normal control group (NC group, n = 10 ): the isolated hearts were stable for 20 min, and then 150 min continuous perfusion; a normal + cardiomyopeptidin group (NCMP group, n = 10): the same as the normal control group, but K-H buffer solution was added with 50 mg/L cardiomyopeptidin, and 3 ischemia-reperfusion injury model groups, including a model control group (n = 10): the isolated rat hearts were perfused with K-H buffer and then arrested with cardioplegic solution; a CMP1 group (n = 10): the ST.Thomas'II cardioplegic solution was added with 100 mg/L cardiomyopeptidin; CMP2 group (n=10): K-H buffer and ST.Thomas'II cardioplegic solution was added with 50 mg/L and 100 mg/L cardiomyopeptidin respectively. The cardiac functional indexes were monitored, including heart rate, myocardial contractility and diastolic function, peak systolic and diastole myocardial velocities and coronary flow. In the 3 ischemia-reperfusion injury model groups, myocardial ultrastructure was observed through transmission electron microscopy; the creatine kinase isoenzyme (CK-MB) concentration was measured in the fluid outflow of coronary; the content of Na+-K+ ATPase, Ca2+-Mg2+ ATPase, total ATPase, superoxide dismutase (SOD), malondialdehyde (MDA), nitric oxide(NO), total nitric oxide synthase (TNOS), inducible nitric oxide synthase (iNOS) and aldosereductase were measured in the myocardium tissue; the relative expression levels of iNOS, eNOS, and Akr1b4 mRNA in the myocardial tissue were also detected by real-time fluorescence quantitative PCR.@*RESULTS@#In the NC group, after prolonged perfusion, the cardiac function of isolated hearts had no significant change. Cardiomyopeptidin for injection had no significant effect on normal isolated hearts. Compared with the model control group, the cardiac function indexes and coronary flow in the groups treated with cardiomyopeptidin decreased much less. Cardiac myofibrillar fragmentation and mitochondrial swelling were observed in the control group, while in the CMP groups, the myocardial structure was nearly complete, and only mild mitochondria swelling and degeneration could be seen. After the reperfusion, the content of CK-MB was increased in the control group. Compared with the model control group, the CK-MB content was lower in the CMP1 and CMP2 groups. There was a slight decline in the contents of Na+-K+ ATPase, Ca2+-Mg2+ ATPase, and Total ATPase in the CMP1 and CMP2 groups, and an increase in SOD activity (P < 0.01 or P < 0.05). The concentration of NO and MDA produced after the ischemia-reperfusion injury was much lower in the CMP1 and CMP2 groups. The activity of iNOS and aldosereductase was inhibited, the expression levels of iNOS, and Akr1b4 mRNA were significantly down-regulated in the CMP1 and CMP2 groups. These changes were more prominent in the CMP2 group (P < 0.01 or P < 0.05). The eNOS mRNA levels in the CMP2 group was up-regulated (P < 0.05).@*CONCLUSION@#Cardiomyopeptidin for injection may improve the energy metabolism, improve coronary blood flow and cardiac function after the reperfusion, thus protecting immature myocardial against ischemia-reperfusion injury in young rats. Administration of it in both K-H buffer and ST.Thomas'II cardioplegic solution is better than adding it in cardioplegic solution alone. The mechanism may be associated with the inhibition the mRNA expression of iNOS and Akr1b4 in cardiomyocytes, the inhibition activity of iNOS and aldosereductase, and the decrease of NO production.

Microinvasive surgical occlusion for ostium secundum atrial septal defects:A report of 43 cases / 中国微创外科杂志

Objective To summarize the experience of microinvasive surgical occlusion for ostium secundum atrial septal defects (ASD). Methods A total of 43 patients with ostium secundum ASD was given microinvasive surgical occlusion. The diameter of ASD was 9.8~36.3 mm. An incision 2~3 cm in length was made on the right anterior chest. A special occluder was inserted to close the ostium under the guidance of transesophageal echocardiography. Results All of the patients were successfully occluded. Transient third degree AV block happened in 2 patients during the procedure. Moderate amount of pleural effusion occurred in 3 patients (cured). Echocardiography at 3 months after operation showed significant relief of pulmonary artery hypertension (from 52?21 mm Hg to 38?16 mm Hg; t=2.917, P=0.005). The patients were followed for 3~21 months (13.6?8.3 months), no dislocation of the device or atrial shunt was found. Conclusions Microinvasive surgical occlusion is safe and efficient for the closure of ostium secundum ASD. It is suitable for all patients in various age ranges.