Influence factors of long-term outcomes of mitral valve repair for moderate and severe mitral regurgitation due to myxomatous degeneration / 中华胸心血管外科杂志

Objective To explore and conclude the influence factors of long-term outcomes of mitral valve repair for moderate and severe mitral regurgitation due to myxomatous degeneration.Methods To review the in-patient data and followup outcomes of 261 patients after mitral valve repair for moderate and severe mitral regurgitation due to myxomatous degeneration from Jan 1993 to Jan 2008 in Changhai Hospital of Second Military Medical University.Results There were 7 perioperative deaths and 254 survivors who obtained satisfactory perioperative outcomes.During the follow-up,24 patients were lost and 230 patients were followed up from 36 months to 174 months (77.3 ±30.3) months and follow-up rate was 90.6％.Multivariate Cox regression shows age ≥ 60 years old,left ventricular ejection fraction ＜ 0.50,undergoing combined coronary artery bypass grafting were the independent risk factors for long-term death after operations and left ventricular ejection fraction ＜ 0.50,New York Heart Association functional classification Ⅲ-Ⅳ,anterior leaflet prolapse were the independent risk factors for long-term recurrent moderate or severe mitral regurgitation after operations and prosthetic ring or band annulopasty was a protective factor.Conclusion The age ≥60 years old,left ventricular ejection fraction ＜ 0.50,undergoing combined coronary artery bypass grafting,New York Heart Association functional classification Ⅲ - Ⅳ,anterior leaflet prolapse,and prosthetic ring or band annulopasty were closely related with long-term adverse events after operations.

Giant left atrium combined with mitral valvular disease: morphologic classification and its clinical significance / 中华外科杂志

<p><b>OBJECTIVE</b>To study the morphologic classification and its clinical significance of giant left atrium (GLA) combined with mitral valvular disease.</p><p><b>METHODS</b>Between January 1993 and December 1999, a total of 62 consecutive patients with mitral valvular disease, whose preoperative left atrial endodiastolic volume index >/= 300 ml/m(2) or endosystolic diameter >/= 6.0 cm, were enrolled as research candidates. Morphologically, GLA was classified by Q Hierarchical cluster analysis according to the right or left side cardiothoracic ratio of the left atrium (r- or l-LATR) on an anteroposterior chest roentgenogram and the ratio of the distant diameter of the left main bronchus to the approximate diameter of the left main bronchus (LBDd/Dp) or to the trachea (LB/TR) on an left anterior oblique chest roentgenogram.</p><p><b>RESULTS</b>According to r-LATR and l-LATR, the morphology of GLA was classified clinically into three types: type L (l-LATR >/= 0.6 and r-LATR < 0.58), type R (r-LATR >/= 0.58 and l-LATR < 0.6) and type B (r-LATR >/= 0.58 and l-LATR >/= 0.6). According to LBDd/Dp and LB/TR, GLA in type L and B was further classified into two subtypes, respectively: left posterior downward type (L(I) and B(I)), in which LBDd/Dp is equal or exceeds 0.38 or LB/TR is equal or exceeds 0.33, and left posterior upward type (L(II) and B(II)), in which LBDd/Dp is less than 0.38 or LB/TR less than 0.33.</p><p><b>CONCLUSION</b>The morphologic classification of GLA may represent the main pathophysiological changes of GLA and might be a guideline for the selection of the optimal plication procedures of GLA in patients with valve diseases.</p>

Clinical study of staged repair for tetralogy of Failot with pulmonary artery hypoplasty / 中华胸心血管外科杂志

Objective To evaluate the effect of staged repair for tetralogy of Fallot (TOF) associated with pulmonary artery hy- poplasty.Methods From June 1996 to June 2006,37 patients with TOF were operated on.There were 26 males and 11 females. Their age was 5 months to 17 years(mean 3.6 years) and weight was 4.6～38.0 kg.All patients were diagnosed as TOF with pulmo- nary artery hypoplasty by cardiac catheterization.The mean pre-operative arterial saturation of the patients was (68.2?6.5) %,Mc- Coon ratio was 0.95?0.26 (0.81～1.17) and Nakata index was 82.7?21.6(71.6～97.5) mm~3/m~2.At the time of the first surgi- cal procedure,17 patients underwent central aortopulmonary shunt,13 patients received modified Blalock-Taussig shunt in the left side and 7 patients had modified Blalock-Taussig shunt in the right side.Results There were no easly operative deaths and no late deaths after the first stage repair.Pleural effusion after shunt occurred in 5 patients.The mean arterial saturation was significantly increased to (91.3?10.4) %,P

The Relationship of Left Atrial Size of Rheumatic Heart Disease to Myocardial Pathology and Its Clinical Implications / 第二军医大学学报

The relation between left atrial (LA) size and myocardial pathological changes, and clinical implications were studied in 25 patients with- rheumatic mitral stenosis. The results showed that LA size was significantly correlated with pathological severity of myocardium (P 100 ml/m2 and accompanied by moderate or severe pathological changes easily suffered from Af (P200ml/m2 and severe pathological changes. The results suggest that occurence of Af may be predicated based on the LA volume and Af cardioversion should be selectively performed to obtain better results.

Clinical significance of liver pathological changes in patients with rheumatic heart valve disease / 第二军医大学学报

Objective: To study the clinical significance of liver pathological changes in patients with rheumatic heart valve disease (rheumatic heart disease, RHD). Methods: Forty one patients with RHD and tricuspid valve incompetence in 30 patients underwent heart valve replacement. Light microscopy and H 800 transmission electron microscopy were used to observe liver tissue harvested by biopsy performed before institution of cardiopulmonary bypass. Results: Typical pathological changes of liver as the following: (1) Changes of liver intercellular substance including sinusoid widening, blood stasis, liver fibroplasia. (2)Hepatocyte changes: hepatocyte swollen, mitochondria swollen, crest disappearence, hepatocyte degeneration and necrosis. There was correlation between liver pathological changes and magnitude of tricuspid valve regurgitation. Conclusion: To improve liver pathological changes, it is important to operate on patients with rheumatic heart diseases and tricuspid valve incompetence as early as possible and to eliminate tricuspid valve regurgitation.

Alterations of Myocardial Mitochondrial Function Subjected to Ischemia/Reperfusion Injury in Cats / 第二军医大学学报

The effect of myocardium subjected to 60 min ischemia and 60 min reperfusion on the level of lipid peroxides (LPO) and function of myocardial mitochondria and activity of superoxide dismutase (SOD) was studied in cat cardiopulmonary bypass. Myocardial mitochondrial function was slightly depressed after 60 min ischemia but significantly depressed after 60 min reperfusion. Increased lipid peroxides content and decreased SOD activity were observed at 60 min ischemia. After reperfusion, the SOD activity continued decreasing, but LPO elevated apparently. These results support a hypothesis that the free radicals may contribute to the myocardial mitochondrial reperfusion injury.

Protective Effect of Controlled Reperfusion with Warm Blood Cardioplegic Containing Mannitol on Mitochondrial Function after Myocardial Ischemia / 第二军医大学学报

This study tested the hypothesis that controlled reperfusion with warm blood cardioplegia containing mannitol would result in more effectively improved recovery of myocardial mitochondrial function by preventing or reducing a potentially harmful component of reperfusion. Myocardial mitochondrial function was significantly depressed after 60 min reperfusion, but slightly depressed in the controlled reperfusion group. Significantly increased MDA content and decreased SOD activity were observed after 60 min reperfusion. Hearts in the controlled reperfusion group had low MDA content and might protect the activity of SOD. The- results indicate that controlled reperfusion after ischemia provides benefit in avoiding myocardial mitochondrial reperfusion injury.

POSTOPERATIVE COMPLICATIONS AFTER RESECTION OF ESOpHAGEAL AND CARDIAC CARCINOMA IN 575 CASES / 第二军医大学学报

of the 575 cases undergoing resection of carcinoma of esophagus and cardia,48 cases were associated with 56 postoperative complications (9.73%) which were mainly anastomatic leakage (15),paralysis of recurrent laryngeal nerve (6),colonic obstruction (5),empyema (5),pneumonia (5),and bowels through diaphragmatic incision into pleural cavity (4),and which were rarely paralysis of radial nerve,injury of colonic medium artery or chylothorax.There were 34 cured,5 permanent functional disturbances and 5 died in the 48 cases.The causes and prophylactic measures of the major complications including anastomotic leakage,pulmonary complications,bowels through diaphragmatic incision into pleural cavity and colonic obs-ruction were discussed.