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find Author "王东进" 28 results
  • 同种肺动脉瓣治疗肺动脉瓣缺如综合征一例

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  • Prognostic significance of test of cardiac troponin T and renal function in acute type A aortic dissection

    Objective To measure the rate of changes of the cardiac troponin T (cTnT) and serum urea nitrogen (N), serum creatinine (Cr), estimated glomerular filtration rate (eGFR) of acute type A aortic dissection (AAAD) patients before and after surgery, and to explore the prognostic significance of the rate of changes. Methods We retrospectively analyzed 77 AAAD patients' clinical data between August 2015 and March 2016 from the department of the cardiothoracic surgery in Nanjing Drum Tower Hospital. There were 57 males and 20 females with an average age of 51.1±13.1 years. The test results of cTnT, N, Cr, eGFR were recorded. Patients were divided into three groups based on the duration of ventilation: less than 48 hours, 48 hours to 7 days, longer than 7 days, and divided into two groups based on whether postoperative dialysis was performed: dialysis group and non-dialysis group. Results In the groups with different duration of ventilation, the rate of cTnT change differed significantly. The rate of Cr and eGFR change in the group with the duration of ventilation longer than 7 days showed significantly different compared to other two groups. We found that the rate of Cr and eGFR change were statistically significant between the dialysis group and the non-dialysis group. In the receiver operating characteristic curve (ROC), the optimal cut-off value of the Cr growth rate for predicting postoperative dialysis therapy was 58.1%, and the optimal cut-off value of the eGFR decline rate was 45.5%. Conclusion The rate of changes in cTnT, N, Cr and eGFR can be used as a reliable mean to evaluate respiratory and renal function for AAAD patients in the early stage, which will facilitate an early assessment of the prognosis of AAAD patients.

    Release date:2017-03-24 03:45 Export PDF Favorites Scan
  • Advances of aortic valve repair for aortic regurgitation

    The first aortic valve repair was performed in 1958, but the clinical outcome was limited. Since the invention of prosthetic valves, aortic valve replacement has become and still maintained the dominated surgical treatment option. As the impact of the prosthetic valve-related event to quality of life of the patients and the studies of the mechanism of aortic regurgitation and the functional anatomy of aortic root grow, the application of aortic valve repair gets more popular, and the short- and mid-term outcomes are good.

    Release date:2018-01-31 02:46 Export PDF Favorites Scan
  • Risk Factor Analysis of Delayed Recovery of Consciousness after Aortic Arch Surgery

    Objective To determine risk factors of delayed recovery of consciousness after aortic arch surgery underdeep hypothermic circulatory arrest (DHCA) and antegrade selective cerebral perfusion (ASCP). Methods We retrospectively analyzed clinical data of 113 patients who underwent aortic arch surgery under DHCA+ASCP in the Affiliated Drum Tower Hospital, Medical School of Nanjing University from October 2004 to April 2012. According to whether they regained consciousness within 24 hours after surgery, all the 113 patients were divided into normal group (73 patients including 55 males and 18 females with their average age of 48.1±10.9 years) and delayed recovery group (40 patients including 29 males and 11 females with their average age of 52.2±11.4 years). Risk factors of delayed recovery of consciousness after surgery were evaluated by univariate analysis and multivariate logistic regression analysis. Results Nine patients (8.0%) died postoperatively, including 5 patients with multi-organ failure, 2 patients with heart failure, 1 patient with mediastinal infection, and 1 patient with pulmonary hemorrhage. There were 7 deaths (17.5%) in the delayed recovery group and 2 deaths (2.7%) in the normal group, and the in-hospital mortality of the delayed recovery group was significantly higher than that of the normal group (P=0.016). A total of 94 patients (including 65 patients in the normal group and 29 patients in the delayed recovery group) were followed up for 4-95 months. Eight patients (including 5 patients in the normal group and 3 patients in the delayed recovery group) died during follow-up, including 2 patients with stroke, 3 patients with heart failure, 2 patients with pulmonary hemorrhage and 1 patient with unknown cause. Ten patients were lost during follow-up. Univariate analysis showed that age (P=0.042), hypertension (P=0.017), emergency surgery (P=0.001), cardiopu- lmonary bypass (CPB) time (P=0.007), aortic cross-clamp time (P=0.021), and blood transfusion(P=0.012)were risk factors of delayed recovery of consciousness after aortic arch surgery. Multivariate logistic regression showed that emergency surgery (P=0.005) and CPB time>240 minutes (P=0.000) were independent risk factors of delayed recovery of consciousness after aortic arch surgery. Conclusion Delayed recovery of consciousness after aortic arch surgery is attributed to a combination of many risk factors. Correct patient diagnosis, lesion site and involved scope should be made clear preoperatively in order to choose appropriate surgical strategies. During the surgery, strengthened brain protection, shortened operation time, improved surgical techniques, and perioperative stable circulation maintenance are all important measures to prevent delayed recovery of consciousness after aortic arch surgery.

    Release date:2016-08-30 05:45 Export PDF Favorites Scan
  • 华法林抗凝过量致自发性后腹膜出血一例

    Release date:2016-08-30 05:51 Export PDF Favorites Scan
  • 右腋下直切口在体外循环心脏直视手术中的应用

    目的 介绍使用右腋下直切口进行体外循环心脏手术的临床结果及治疗体会,总结临床经验。 方法 使用右腋下直切口对2 058例先心病和心脏瓣膜病施行手术,其中先心病1 466例,心脏瓣膜疾病592例,所有患者均行气管内插管,静脉复合或吸入麻醉;取左侧卧位60. ~90. ,切口上端起自腋中线第3肋,下端止于腋前线第5肋,在腋中线第7肋间切 一1.5cm小口备用,沿第4肋骨上缘或第3肋进胸;沿右膈神经前切开心包并悬吊利于升主动脉及心脏显露;以长扁桃钳夹住主动脉插管前端,帮助完成主动脉插管。经手术切口内置入上腔静脉直角插管,从第7肋间小切口导入直角下腔静脉插管。阻断升主动脉,经主动脉根部插管灌注心脏停搏液,切开右心房或肺动脉和右心室流出道切口进行先天性心脏病手术。 体外循环结束后,拔除主动脉插管,缝合心包上段大部分,经第7肋间小切口放置胸腔引流管。 结果 全部患者中二次开胸止血23例(1.12%) ,切口感染或愈合不良14例(0.68%) ,发生其他各种并发症65例(316%) ,均经对症治疗后痊愈,随访时无异常。2 058例中共死亡6例,总死亡率为0.29% (6/2 058) ,其中先心病患者3例,死亡率为0.20% (3/1 466) ;心脏瓣膜病患者3例,死亡率为0.5% (3/592) .结论 右腋下直切口本身固有的美观效果、较宽的手术适应证以及与常规切口相比具有的优点,值得并适于在临床应用。

    Release date:2016-08-30 06:16 Export PDF Favorites Scan
  • 主动脉瓣成形术治疗先天性主动脉瓣关闭不全12例

    Release date:2016-08-30 06:18 Export PDF Favorites Scan
  • 同种瓣的制作与临床应用

    目的报告液氮深低温下保存同种带瓣血管的制作方法、组织活性及临床应用效果。方法制作同种瓣24个、抗生素灭菌、梯度降温后置于液氮中保存,并测定冷冻保存后同种瓣的组织活性。同种瓣临床应用5例,其中法洛四联症、肺动脉闭锁2例,先天性主动脉瓣狭窄1例,法洛四联症术后发生室间隔缺损残余漏伴肺动脉瓣重度关闭不全1例,Bentall术后发生感染性心内膜炎1例。结果抗生素灭菌、液氮深低温技术保存同种瓣具有良好的组织活性,糖代谢测定24h葡萄糖消耗大于16mg/dl,组织培养见成纤维细胞生长良好。临床移植5例均成功,术后随访3~8个月,同种瓣无狭窄或关闭不全。结论液氮深低温保存同种瓣安全可靠,临床应用早期效果良好。

    Release date:2016-08-30 06:25 Export PDF Favorites Scan
  • APPLICATION AND RESEARCH PROGRESS OF ARTIFICIAL CHORDAE TENDINEAE

    Object ive To summar ize recent advance in the appl icat ion and research of ar t i f icial chordae tendineae. Methods The cl inical and experimental research l iterature was extensively reviewed and analyzed. Results The follow-up results showed that artificial chordae tendineae replacement was superior to other operation methods in valve repair. But, it was compl icated and difficult-to-learn. In recent years with the development of many surgical skills and new techniques, good cl inical results were achieved. Conclusion With the development of surgical equi pment, chordae material, and implanting skills, artificial chordae tendineae implanting will be easier and the scope of appl ication will be larger.

    Release date:2016-08-31 05:42 Export PDF Favorites Scan
  • LEFT VENTRICULAR RECONSTRUCTION IN PATIENTS WITH LEFT VENTRICULAR ANEURYSM AFTER MYOCARDIAL INFARCTION

    Objective To discuss left ventricular reconstruction methods and effectivness in patients with left ventricular aneurysm after myocardial infarction. Methods Between June 2003 and August 2008, 23 patients with left ventricular aneurysm after myocardial infarction were treated. Of them, 13 were male and 10 were female with an average age of 61.2 years (range, 47-74 years). According to New York Heart Association (NYHA) criteria for cardiac function, there were 3 cases of grade I, 6 cases of grade II, 10 cases of grade III, and 4 cases of grade IV. The coronary arteriongraphy showed singlevesseldisease in 2 cases, double-vessel disease in 5 cases, triple-vessel disease in 16 cases. The locations of ventricular aneurysm were the apex cordis in 18 cases, antetheca and parieslateral is in 4 cases, and interior wall in 1 case. The left ventricular ejection fraction was 36.52%± 12.15%, and left ventricular diastol ic final diameter was (62.30 ± 6.52 ) mm. Nine patients received standard l inear repair, 6 patients received standard l inear repair after endocardial ring shrinkage, and 8 patients received patch suture after endocardial ring shinkage. Results Two cases died perioperatively, and re-thoracotomy was performed to stop bleeding in 1 case. Incisions healed by first intention in the other patients without early compl ication. Twentyone patients were followed up 7-48 months (median, 19 months). At 6 months after surgery, the left ventricular ejection fraction 46.52% ± 9.41% were significanly improved when compared with that at preoperation (t=2.240, P=0.023); the left ventricular diastol ic final diameter (52.23 ± 5.11) mm were significantly decreased when compared with that at preoperation (t=2.170, P=0.035). The cardiac function according to NYHA criteria was at grade I in 8 cases and at grade II in 13 cases. One patient died of cerebral hemorrhage at 18 months after operation and the activities of daily l iving recoverd in the others. Conclusion Individual theraputic methods are used according to patients’ different conditions for left ventricular aneurysm after myocardial infarction.

    Release date:2016-08-31 05:44 Export PDF Favorites Scan
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