Correlation between radial artery graft patency and the degree of native coronary stenosis in coronary artery bypass grafting / 中国医师进修杂志

Objective To study the correlation between radial artery graft patency and the degree of native coronary stenosis in coronary artery bypass grafting. Methods The clinical data of 290 patients who had underwent off-pump coronary artery bypass grafting were retrospectively analyzed. The left internal mammary artery, radial artery and saphenous veins were as grafts. The patients were divided into 3 groups according to the stenosis of right coronary artery before operation:group Ⅰ(right coronary artery stenosis 50%-75%, 85 cases), groupⅡ(right coronary artery stenosis 76%-89%, 95 cases) and group Ⅲ (right coronary artery stenosis 90%-100%, 110 cases). The patients were followed up for 2 to 5 years, and the graft patency was assessed using CT coronary angiography. Results There was no death and serious complications in 3 groups. Among the 3 groups, the total graft patency rate of left internal mammary artery grafts was 93.3% (270/290), the total graft patency rate of saphenous veins grafts was 70.2%(433/617), and the total graft patency rate of radial artery grafts was 69.7%(202/290). There was no statistical difference in the graft patency rate of radial artery grafts between group Ⅱ and group Ⅰ(P>0.05). The graft patency rate of radial artery grafts in group Ⅲwas significantly higher than that in groupⅡand group Ⅰ:85.5%(94/110) vs. 68.4%(65/95) and 50.6%(43/85), and there was statistical difference (P0.05). Conclusions The correlation between radial artery graft patency and the degree of native coronary stenosis is significant in coronary artery bypass grafting. Patients with severe proximal right coronary artery stenosis (≥90%) may have better patency rates at mid-term follow up after using radial artery grafts.

Reasons and treatment methods of high transprothetic pressure gradient after aortic valve replacement / 中国医师进修杂志

Objective To analyze the reasons and treatment methods of high transprothetic pressure gradient after aortic valve replacement. Methods The clinical data of 45 patients with high transprothetic pressure gradient after aortic valve replacement were retrospectively analyzed. The patients were followed up for average 24.6 (12 - 40) months. The postoperative effective orifice area (EOA) of artificial valve was measured by transthoracic color Doppler ultrasound. Compared with published referred EOA of different artificial valve, there were 2 kinds results:measured EOA=referred EOA and measured EOA0.85 cm2/m2 and EOAI<0.85 cm2/m2. The reasons of high transprothetic pressure gradient were analyzed according to the above different standard. Results In the 45 patients with high transprothetic pressure gradient after aortic valve replacement, prosthesis-patient mismatch (PPM) was in 33 cases, and prosthetic dysfunction was in 10 cases, among whom 5 cases were because of thrombus (3 cases improved after increasing the dosage of warfarin, 2 cases underwent re-aortic valve replacement), 3 cases were because of severe bioprosthetic calcification (underwent re-aortic valve replacement), and 2 cases were because of prosthetic ring pannus and influenced movement of the leaflets (underwent re-aortic valve replacement). High flow in the left ventricular outflow tract occurred in 2 cases. The patients had no obvious discomfort, and did not receive special treatment. Four cases died, among whom 2 cases were because of severe PPM, and the other 2 cases were because of noncardiac. Conclusions Many reasons can result to the high transprothetic pressure gradient, and the PMM is the most common reason. Choosing the right treatment plan can improve the survival rate of patients.

Value of diagnosis with the 256-slice spiral CT in severe tetralogy of Fallot of infant / 中国医师进修杂志

ObjectiveTo approach the value of diagnosis with the 256-slice spiral CT in severe tetralogy of Fallot of infant.MethodsFrom January 2008 to December 2010,48 cases (severe tetralogy of Fallot of infant) were examined with 256-slice spiral CT preoperatively.All cases were then analyzed in workspace with maximum intensity projection(MIP),multiplanar reconstruction(MPR) and volume rendering (VR),while compared with transthoracic echocardiography (TTE) and surgical results.Results CT examination found that TTE misdiagnosis 4 cases of patent ductus arteriosus and 6 cases of aortic coarctation.Meanwhile,CT showed 6 aorta pulmonary collateral arteries in 5 cases.In 48 cases,surgical results confirmed 47 cases by 256-shce spiral CT,while 33 cases by TTE.The diagnosis accuracy rate of 256-slice spiral CT and TTE was 97.9％ (47/48) and 68.8％ (33/48) respectively.There was statistically significant difference of the two inspections in diagnostic accuracy (P ＜ 0.05).ConclusionThe inspection of 256-slice spiral CT can benefit the preoperative diagnosis and operation program in severe tetralogy of Fallot of infant.

A comparative study of postoperative early nutritional supports in esophageal carcino- ma patient / 肠外与肠内营养

Fifty postoperative patients who suf- fered esophageal carcinoma were divided randomly into two groups.They received either enteral nutrition(Group EN,n=2 7) or parenteral nutrilion(Group PN,n=2 3) . The provisions of calorie and nitrogen were equal in the two groups.Nutrition support was started on the first postoperative day and continued for8days.The weight plas- ma proteins,immunological parameters and nitrogen balance were evaluated.The re- sults showed that there was no significant difference in body weight and serum albu- min level between the two groups.The pos- itive nitrogen balance were reached in both groups on the8th day.The CD4+percents age,the ratio of CD4+/ CD8+and NK cell activity were elevated,The conclusion is that the values of both EN and PN are sati- factory.In contrast with PN,EN has the advantages of physiological concordance and low cost.