Treatment strategy of mechanical hemolysis after mitral valve repair / 医学研究生学报

Objective　In recent yaers, mitral valve repair has been widely used in the surgical treatment of congenital and secondary mitral valve lesions. To investigate the mechanism and treatment strategy of mechanical hemolysis after mitral valve repair.　Methods　A total of 451 consecutive patients registrated in general hospital of southern theatre command who underwent mitral valve repair surgery between August 2010 and June 2018,of whom 16(3.5%) had complicated mechanical hemolysis(hemoglobinuria, jaundice, anemia), were retrospectively analyzed. Echocardiographic examination showed that there were 3 cases of mild mitral regurgitation(MR), 9 cases of moderate MR and 4 cases of severe MR, among which 75% of mitral regurgitation flow were rapid regurgitant jets (Vmax>4m/s). According to the treatment strategy,all cases were divided into two groups: the aggressive reoperation group（n=10）,patients received re-repair procedures within 1 week after hemolysis diagnosis. The conservative treatment group(n=6), patients received symptomatic treatment of hemodialysis, blood transfusion, diuresis, alkalization of urine, liver protection and oral metoprolol et al. All patients were followed up for 2 to 36 months, with an average (16±7.5) months, and the postoperative echocardiographic results, hemolysis symptom improvement and cardiac function were compared.　Results　No death occurred in the two groups after operation. The symptoms of patients in the aggressive reoperation group receded rapidly and discharged from hospital. 4 patients in the conservative treatment group received reoperation 3~11 weeks after surgery due to poor treatment effect (1 patient underwent re-repair and 3 patients underwent replacement), the other 2 patients received long-term conservative treatment. The cardiac function of the patients undergoing reoperation was maintained at level I~II. Echocardiographic examination showed that mild MR(n=10), mild~moderate MR(n=3), and no recurrence of mechanical hemolysis. Two patients with long-term conservative treatment, mild~moderate anemia, urinogen +~++, moderate MR, cardiac function at level II, were in a subclinical hemolytic state.　Conclusion　Mechanical hemolysis frequently occurs immediately or soon after mitral valve repair. Hemoglobinuria, jaundice, anemia and postoper echocardiography found the mitral regurgitant flow with high-shear stress, these helpful to the diagnosis. Surgery is an important factor affecting hemolysis. Hemolysis can be a sign of surgical failure, re-repair operation is the best treatment as soon as possible after the hemolysis has been diagnosed.Conservative treatment is not the priority choice.

Sedative Effect of Dexmedetomidine in Patients With Type Ⅰ Aortic Dissection After Total Arch Replacement Surgery / 中国循环杂志

Objectives: To evaluate the sedative effect of dexmedetomidine (DEX) in patients with type I aortic dissection (AD) after total arch replacement surgery. Methods: A total of 237 AD patients with arch involvement received total arch replacement were enrolled; there were 199 (84.0%) male and the patient's mean age was (48.79±12.65) years. Based on post-operative application of sedatives during ICU stay, the patients were divided into 2 groups: DEX group, patients received load dose DEX 1μg/kg by slow intravenous injection, then (0.2-0.7) μg/(kg·h ) by continuous infusion, n=126 and Midazolam (MDZ) group, patients received load dose MDZ 0.05μg/kg by slow intravenous injection, then (0.02-0.1) mg/(kg·h ) by continuous infusion, n=111. Same surgical method was used in both groups, the mechanical ventilation time, incidence of delirium and other relevant indexes were compared between 2 groups. Results: Compared with MDZ group, DEX group had reduced mechanical ventilation time (3.97±1.28) d vs (4.99±1.58) d and ICU stay time (6.63±1.71) vs (7.24±2.56) d, less incidences of delirium (8.7% vs 18.9%) and permanent dysneuria (5.65% vs 13.5%), all P<0.05. Conclusions: Compared with MDZ, DEX may effectively reduce mechanical ventilation time, ICU stay time and the incidence of dysneuria in type I AD patients after total arch replacement surgery; it had positive role for patient's recovery.

Surgical treatment of aorta coarctation / 医学研究生学报

Congenital coarctation of the aorta is a complex and common congenital heart disease, which can be combined with other heart defects. The clinical symptoms vary from the severity of the disease. In 1944, Crafoord successfully performed surgical repair of coarctation of the aorta, along with the progress of surgical Methods and the advent of interventional techniques, the treatment effect is improved, But no matter what kind of treatment it is, restenosis, aortic aneurysm, hypertension and other complications cannot be avoided. From long-term analysis of the followup Results , the overall effect of surgical treatment is still better than interventional treatment. This article reviews the surgical treatment of coarctation of the aorta.

Coarctation of the aorta with hypoplastic aortic arch :Analysis of midterm and longterm outcomes with autologous pulmonary patch aortoplasty / 医学研究生学报

Objective Previously we have reported the early and midterm benifit of autologous pulmonary patch in repairing aortic coarctation of hypoplastic aortic arch.This study aimed to assess its reliability and midterm and longterm outcomes.Methods We retrospectivly analyzed 42 pediatric patients with coarctation of the aorta (CoA) with hypoplastic aortic arch undergoing surgical repair with autologous pulmonary patch from May 2009 to May 2017 in General Hospital of Guangzhou Military Command of PLA.All the patients were allocated into either senior group (＞ 1 years) or junior group (≤1 years) according to the age of operation.The trans-coarctation gradient,pulmonary pressure and aortic Z value change were compared between two groups before and after the repair.Results There were 8 cases had early postoperative complications.However,no death had been reported during the postoperative time and the followed up period ranged from 4 months to 106 months (40.0± 15.5) months).The average pressure gradient of coarctation segment for all the patients was (11.9±6.4) mmHg,including 5 cases more than 25 mmHg.The pressure gradient and mean pulmonary arterial pressure after operation were significantly lower than those before operation (P＜0.05),The postoperative aortic arch Z value was greater than the preoperative value (P＜0.05).Compared with the preoperative period,the Z value of proximal transverse arch increased significantly(-0.64±0.44) vs (1.27±0.66),P＜0.05.Compared with junior group,the senior group had higher preoperative and postoperative pulmonary artery pressure (P＜0.05),and longer CPB time,aortic block time,ventilation time,ICU time and hospital stay time (P＜0.05).However,patients in the junior group had a higher pressure gradient through the aorta arch(P＜0.05) and a smaller Z value transverse arch aortic proximal and isthmus(P＜0.05) during the long-term period.The time of selective cerebral perfusion had no statistical difference between the two groups (P＞ 0.05).Conclusion Early surgery for coarctation of aorta with hypoplastic aortic arch,autologous pulmonary patch aortoplasty is a relatively ideal option with better midterm and longterm outcomes.

Bone marrow mesenchymal stem cells/biphasic calcium phosphate ceramics for cartilage repair in juvenile rats / 中国组织工程研究

BACKGROUND: The pathogenesis of pediatric femoral head necrosis is associated with cartilage injury of the hip joint induced by stress and inflammation. OBJECTIVE: To observe the effect of bone marrow mesenchymal stem cells (BMSCs)/biphasic calcium phosphate ceramics (B-CPC) on cartilage repair in juvenile rats. METHODS: Thirty male Sprague-Dawley rats, aged 1 week, were randomized into three groups. No intervention was done in blank group. A juvenile rat model of articular cartilage injury was made using improved Hulth's method in control and observational groups, followed by implantation of BMSCs/hydroxyapatite and BMSCs/B-CPC,respectively. Four weeks later, the rat articular cartilage was observed pathologically, and MTT and flow cytometry were employed to detect chondrocyte proliferation and apoptosis, respectively. RESULTS AND CONCLUSION: The articular cartilage of the rats in the blank group was smooth and complete. In the control group, articular cartilage damage was obvious, presenting with rupture, defect and irregularity of the articular cartilage surface, as well as unclear four-layer structure of the cartilage. In the observational group, articular cartilage injury was repaired to some extent. At the same observation time, the cell viability was significantly increased in the observational group compared with the control group (all P < 0.05), and the proportion of apoptotic cells was significantly decreased (all P < 0.05). To conclude, BMSCs/B-CPC composite can promote the cartilage repair in juvenile rats.

Bone marrow mesenchymal stem cells/biphasic calcium phosphate ceramics for cartilage repair in juvenile rats / 中国组织工程研究

BACKGROUND: The pathogenesis of pediatric femoral head necrosis is associated with cartilage injury of the hip joint induced by stress and inflammation. OBJECTIVE: To observe the effect of bone marrow mesenchymal stem cells (BMSCs)/biphasic calcium phosphate ceramics (B-CPC) on cartilage repair in juvenile rats. METHODS: Thirty male Sprague-Dawley rats, aged 1 week, were randomized into three groups. No intervention was done in blank group. A juvenile rat model of articular cartilage injury was made using improved Hulth's method in control and observational groups, followed by implantation of BMSCs/hydroxyapatite and BMSCs/B-CPC,respectively. Four weeks later, the rat articular cartilage was observed pathologically, and MTT and flow cytometry were employed to detect chondrocyte proliferation and apoptosis, respectively. RESULTS AND CONCLUSION: The articular cartilage of the rats in the blank group was smooth and complete. In the control group, articular cartilage damage was obvious, presenting with rupture, defect and irregularity of the articular cartilage surface, as well as unclear four-layer structure of the cartilage. In the observational group, articular cartilage injury was repaired to some extent. At the same observation time, the cell viability was significantly increased in the observational group compared with the control group (all P < 0.05), and the proportion of apoptotic cells was significantly decreased (all P < 0.05). To conclude, BMSCs/B-CPC composite can promote the cartilage repair in juvenile rats.

Protective effects of high-dose ulinastatin on vital organs in patients receiving total arch replacement for type A aortic dissection / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the protective effects of high-dose ulinastatin on the vital organs in patients undergoing total arch replacement for type A aortic dissection.</p><p><b>METHODS</b>Between September 2014 and March 2016, 66 patients with type A aortic dissection underwent total arch replacement at our center. Thirty-six of the patients received ulinastatin treatment at 300 000 U/8 h from admission to 3 days postoperatively and at 300 000 U/2 h during cardiopulmonary bypass surgery (UTI group), and the other 30 patients did not receive perioperative ulinastatin treatment (control group). The surgical data and blood biochemistry profiles on days 1, 3, and 5 postoperatively were compared between the two groups, and the postoperative ICU stay, re-operation for bleeding, ventilation for over 7 days, ultrafiltration for postoperative renal failure, tracheotomy, incidences of pulmonary and neurological complications and hospital death were also compared.</p><p><b>RESULTS</b>s The operating time, cardiopulmonary bypass time, ACP time, cardiac arrest time, the lowest rectal temperature and frequency of bilateral and unilateral antegrade selective cerebral perfusion were similar between the two groups (P>0.05). Compared with those in the control group, patients in UTI group had lower lactate, S-100 and neuron specific enolase levels on the first postoperative day and higher OI on the 1st, 3rd, and 5th postoperative days (P<0.05), but serum creatinine, blood urea nitrogen, total bilirubin, and alanine aminotransferase levels were comparable between the two groups (P>0.05). No significant differences were found in the frequency of re-operation for bleeding, ultrafiltration for renal failure, tracheotomy, neurological complications or hospital death after the operation between the two groups, but the patients in UTI group had a shorter ICU time, a less frequent long-term ventilation and a lower incidence of pulmonary infection (P<0.05).</p><p><b>CONCLUSION</b>High-dose ulinastatin offers protection on pulmonary function and lowers the specific brain injury markers in patients with type A aortic dissection after total arch replacement, but its protective effects on brain is uncertain.</p>

Clinical analysis of complications in endovenous laser treatment for patients with varicose veins of the lower extremities / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the causes and therapies for the complications induced by endovenous laser treatment (EVLT) in patients with varicose vein of lower limbs.</p><p><b>METHODS</b>From December 2003 to October 2009, 283 cases (totally 361 lower limbs) treated by the endovenous laser treatment or combined with other treatment were analyzed retrospectively. There were 108 male and 175 female patients, with a mean age of 52 years (ranging from 17 to 83 years). The varicose vein occurred in left limb for 112 cases, right limbs for 93 cases and both limbs for 78 cases.</p><p><b>RESULTS</b>The patients were followed up for average 18 months, during which 142 limbs showed skin bruises and/or hematoma, 47 limbs showed skin burns, 7 limbs showed phlebitis; all of these cases were cured. In addition 91 limbs appeared abnormal skin sensation, 87 of them were recovered and 4 improved. Two limbs were found with deep vein thrombosis in this series, after treatment one case was obviously improved and other was alleviated.</p><p><b>CONCLUSIONS</b>EVLT is a effective therapy for varicose vein of lower limbs. But it may lead to some complications without right manipulations.</p>

Surgical treatment of DeBakey type II aortic dissection combined with true aneurysm in the distal aortic arch: a case report / 南方医科大学学报

DeBakey type II aortic dissection combined with true aneurysm in the distal aortic arch is a very rare condition, and due to the complicated pathology, its surgical intervention can be difficult and risky. We report a case with this pathology in a 23-year-old man, who received a previous open heart surgery for ventricular septal defect at the age of 6 years. Aortic valve, ascending aorta and total aortic arch replacements were performed. Cardiopulmonary bypass (CPB) including deep hypothermic circulatory arrest with selective antegrade cerebral perfusion was used. No postoperative complications occurred, and the follow-up examination at 6 months after the operation showed good therapeutic results.

Thoracic aortic replacement with concomitant endoluminal stent grafting for DeBakey type I aortic dissection / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the therapeutic effect and safety of thoracic aortic replacement with concomitant endoluminal stent grafting in the treatment of DeBakey type I aortic dissection.</p><p><b>METHODS</b>From September 2007 to January 2010, 6 patients with DeBakey type I aortic dissection (including one with aortic dissection relapse) received ascending aortic (or Bentall) and total aortic arch replacement and simultaneous stent graft implantation into the descending aorta. Multi-slice spiral CT scans (MSCT) were performed in each patient regularly after the surgery. Cardio-pulmonary bypass including deep hypothermic circulatory arrest with selective antegrade cerebral perfusion were used during the surgery.</p><p><b>RESULTS</b>All the patients recovered smoothly after the surgical procedure without serious complications. The time of cardiopulmonary bypass ranged from 208 to 291 min (mean 242 min), arrest time of the ascending aortic was 112-194 min (mean 145 min), and selective cerebral perfusion time was 63-102 min (mean 76 min). The patients were followed up for 4-32 months (mean 15.5 months), and MSCT revealed smooth blood flow in the prosthesis, complete thrombus formation in the false lumen in the perigraft space and shrinkage of the distal false lumen without internal fistula or stent dislocation.</p><p><b>CONCLUSION</b>Thoracic aortic replacement with concomitant endoluminal stent grafting is a safe and effective treatment of DeBakey type I dissection.</p>

Risk factors for early postoperative death after total correction of tetralogy of Fallot: analysis of 20 cases / 南方医科大学学报

<p><b>OBJECTIVE</b>To identify the risk factors of early postoperative death after total correction of tetralogy of Fallot (TOF).</p><p><b>METHODS</b>A retrospective analysis was conducted among 356 patients undergoing total correction of TOF by opening heart surgery and cardiopulmonary bypass. Of these patients, 20 died in the early postoperative period, and the possible risk factors for early postoperative death were analyzed in view of the surgical indication, surgical approaches, myocardial protection and postoperative management.</p><p><b>RESULTS</b>Of the 20 fatal cases, death occurred due to low cardiac output syndrome in 11 cases, respiratory failure in 4 cases, kidney failure or multiple organ failure in 3 cases, acute left heart failure in 1 case, and cerebrovascular accident in 1 case.</p><p><b>CONCLUSION</b>Young age at repair and poor development of the pulmonary vessels and left ventricle are high risk factors for postoperative low cardiac output syndrome. Postoperative death following surgical correction of TOF is associated mainly with the surgical skills and approaches. Appropriate cardiopulmonary bypass and effective measures for myocardial protection are critical to ensure the surgical success, and proper postoperative management and close monitoring may help reduce postoperative death in surgical patients with TOF.</p>

Time course change in the high mobility group box-1 after myocardial infarction in rats / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the time course change in myocardial high mobility group box-1 (HMGB1) after myocardial infarction in rats.</p><p><b>METHODS</b>Myocardial infarction (MI) was induced in SD rats by ligation of the anterior descending coronary artery. At 1, 2, 4, and 8 weeks after MI, the cardiac function of the rats was examined, and the expressions of HMGB1 at mRNA and protein levels in the myocardium were detected using real-time RT-PCR and Western blotting, respectively.</p><p><b>RESULTS</b>Cardiac function test confirmed that the MI model was successfully induced. The expression of HMGB1 mRNA was increased in early stage (1 week) after MI, while significantly down-regulated in later stage (4-8 weeks after MI). HMGB1 protein showed a similar biphasic pattern of changes, and was up-regulated early (1-2 weeks) after MI (P<0.05) and decreased markedly (P<0.01) at 8 weeks.</p><p><b>CONCLUSIONS</b>As an inflammatory regulator, HMGB1 can modulate inflammatory response early time after MI and functions later as a transcriptional modulator, thus contributing to the myocardial repair after MI. Interventions targeting HMGB1 in different stages after MI may prove helpful in reducing the complications, improving the prognosis and promoting long-term survival.</p>