Abstract： Objective To investigate the clinical results of offpump anatomic surgical repair for complex coarctation in adults. Methods We retrospectively analyzed the clinical data of 7 patients with complex coarctation who underwent onestage anatomic surgical repair between January 2005 and December 2008 in Fu Wai Hospital. There were 5 males and 2 females with the age ranged from 16 to 41 years, average at 24.4 years. Among all the patients, there were 2 patients of coarctation with hypoplastic aortic arch, 1 of coarctation with aortic arch aneurysm, 3 of coarctation with descending thoracic aortic aneurysm, and 1 of coarctation with B type aortic dissection. All patients were diagnosed by color echocardiography, CT or agnetic resonance imaging（MRI）. All off-pump operations were performed under general anesthesia and ambient temperature. Median sternotomy was performed in 1 patient and left thoracotomy in 6 patients. Aortic arch patching enlargement was performed in 4 patients and descending thoracic aorta replacement in 3 patients (including 1 combined with abdominal aorta replacement and 1 case of Stanford B type aortic dissection, trunk stent was transplanted at the same time). Results There was no hospital mortality or severe surgical complications. Seven patients were followed up for a period ranged from 6 to 49 months with an average time of 20.1 months. No late death or recoarctation occurred. Hoarseness occurred in one patient and presented no improvement during the 11 months follow-up. Conclusion Onestage offpump anatomic surgical repair is safe and feasible in treating adult patients with complex coarctation, and it shows a good immediate and longterm result.
Abstract: Objective To summarize the clinical experiences of treatment of pulmonary artery dissection, in order to improve the diagnosis and treatment of the disease. Methods We retrospectively analyzed the clinical data of 4 patients including 3 males and 1 female with pulmonary artery dissection who were treated in Fu Wai Hospital between October 1996 and May 2009. Their age ranged from 17 to 45 years with an average age of 31 years. One patient with pulmonary artery dissection with aortic root aneurysm and chronic type Ⅱ aortic dissection was treated with Bentall’s surgery, total arch replacement and pulmonary artery angioplasty under deep hypothermic circulatory arrest. One patient with pulmonary artery dissection with patent ductus arteriosus (PDA) and severe pulmonary hypertension after a failed PDA transcatheter closure was treated with conservative strategy. For the one patient with pulmonary artery dissection with ventricular septal defect (VSD) and severe pulmonary arterial hypertension, VSD was repaired under cardiopulmonary bypass while left pulmonary artery dissection was left untreated. And conservative treatment was carried out for another patient with pulmonary artery dissection with VSD, PDA and Eisenmenger’s syndrome. Results Three patients recovered and 1 patient died of acute pericardial tamponade due to rupture of the dissection within 60 hours after onset of dissection. Followup was done in 3 cases with 1 lost. The followup time was 3 months and 4 years respectively. The New York Heart Association was class Ⅰ and Ⅱ. Conclusion Dissection of the pulmonary artery is a rare disease with a tendency of rupture and bad prognosis. Symptoms of pulmonary artery dissection are nonspecific, which can cause missed diagnosis. In patients with chronic pulmonary hypertension, the sudden seizure of chest pain, exertional dyspnea, and cyanosis, or worsened hemodynamics and cardiac shock may indicate pulmonary artery dissection which can be easily detected with echocardiography, CT scan and magnetic resonance imaging. Corrective surgery or conservative treatment can prevent rupture and possible death based on different causes of pulmonary artery dissection.
Objective To investigate the optimal timing for surgical treatment of infants less than six months of age with tetralogy of Fallot (TOF), and to improve surgical results and reduce early mortality. Methods Clinical material of 108 consecutive patients with TOF who were less than six months of age undergoing early surgery from Oct.1996 to Dec. 2006 were retrospectively reviewed. There were 70 males and females with mean age of 4.70 months (9 d-6 months). 104 patients underwent complete repair and four patients underwent BlalockTaussig (B T) shunt. Emergency procedures have been performed in 5 patients. Results Five patients (4.63%) died of low cardiac output syndrome (3 patients), pulmonary infection and acute respiratory distress syndrome (1 patient), and acute necrotizing enteritis (1 patient).82 patients were followed up, followup period was 31.17±40.00 months.21 patients lost to followup. One patient(0.92%) required additional intervention for pulmonary valve stenosis 6 months after operation. Heart functional class(New York Heart Association) recovered toⅠ-Ⅱgrading in other patients. Echocardiography shows: no residual ventricular shunt, no stenosis in right ventricular outflow tract and pulmonary valve, pressure difference≤50 mm Hg. No late deaths. Conclusion Early definitive repair of TOF can be performed safely on infants less than six months of age, the results of low mortality is acceptable.
Objective To investigate the effect on expression of c-myc and proliferating cell nuclear antigen （PCNA） of vein grafts transferred by c-myc antisense oligodeoxynucleotides（ODN） of soluble stent. Methods A rabbit model of common carotid arteries grafted by external jugular veins was constructed in 50 New Zealand rabbits and were randomly divided into five groups, 10 rabbits each group. Control group： no stents ; group 1： soluble stent ; group 2： soluble stent with sense-ODN; group 3： soluble stent with antisense-ODN; group 4.. soluble stent with mismatch-ODN. At 7 d, 28 d and 90 d after surgery, vein grafts were harvested. The expression of c-myc and PCNA were identified by immunochemistry methods. Results At 7d, 28d, 90d after surgery, the expression of c-myc and PCNA of the intima and media of vein grafts in control group, group 1, group 2, group 4 were higher significantly than that in group 3 （P〈0. 01）. At 28d, 90d after surgery, the expression of c-myc in five groups were higher than that in the same group at 7d after surgery （P〈0. 01）. Conclusion Soluble stent can transfer ODN effectively. C- myc antisense-ODN transferred by soluble stent can inhibit significantly the expression of c-myc and PCNA in the intima and media of vein grafts.