Objective To investigate the effect of prostaglandin E1 (PGE1) on serum vascular endothelial growth factor(VEGF) in patient with pulmonary hypertension secondary to congenital heart disease and its relation to different pathologic gradings of pulmonary arterioles. Methods Fifty three patients suffering from pulmonary hypertension secondary to congenital heart disease were chosen at random to undergo active tissue test of lung, including 6 patients suffering from severe cyanosis. All of them were intravenously dripped with PGE 1 for 15 days at the speed of 10 15 ng /kg·min, 12 hours a day. Venous blood was taken for study in the morning on the day before infusion, on the 5th day, the 10th day, and the 15th day after infusion. Then the concentration of VEGF was measured by enzyme linked immunosorbent assay (ELISA). Lung biopsy was taken from each patient and pathologic grading performed according to Heath and Edwards pathologic grading. Results Fifty three patients were classified into Grade Ⅴ:9 of them belonged to Grade Ⅰ, 14 to Grade Ⅱ, 19 to Grade Ⅲ, 5 to Grade Ⅳ, the other 6 with severe cyanosis belonged to Grade Ⅴ or even severe than Grade Ⅴ. Before administration of PGE 1, serum VEGF reached the peak while the pathologic grading of pulmonary arteriole was Grade Ⅲ, VEGF level markedly decreased in Grade Ⅳ and Ⅴ. After administration of PGE 1 serum VEGF in Grade Ⅰ showed no difference with that before administration of PGE 1( P gt;0.05), VEGF decreased in GradeⅡ and Ⅲ ( P lt;0.01), slightly decreased in Grade Ⅳ ( P lt; 0.05), while patients greater or equivalent to Grade Ⅴ showed no VEGF change during the course of PGE 1 administration ( P gt;0.05). Conclusions PGE 1 can lower the VEGF level, but the extent closely relates to the degree of pathologic change in pulmonary arteriole. It might be a pre operative parameter for pathologic grading of pulmonary arteriole.
ObjectiveTo asses the clinical result of left ventrical total artery revascularization with "T"-type anastomosis of left internal mammary artery (LIMA) and radial artery on pump. MethodsWe retrospectively analyzed the clinical data of 40 patients who underwent left ventrical total artery revascularization with "T"-type anasmtomosis of LIMA and radial artery on pump in our hospital between December 2013 and December 2015 year. There were 27 males and 13 females at age of 46-70 (55.0±10.2) years. The radial artery anastomosis was made sequentially to the left obtuse artery, intermediate artery, diagonal artery and left anterior descending artery. LIMA anastomosis was made to the radial artery closed to the left anterior descending artery. Saphenous vein (SV) anastomosis was made to right coronary artery. LIMA blood flow was measured with coronary artery Butterfly Flowmeter when LIMA was in suit and after operation. cTnI was measured at different time points. Complications after operation were studied. ResultsThe blood flow of LIMA after operation was significantly different from that in suit (P < 0.05). The plasm cTnI postoperation was higher than that preoperation, but the difference was not significant. All the patients were survival. Atrial fibrillation occurred in 2 patients and low cardiac output occurred in 1 patient after operation, but they recovered quickly after proper treatment. There was no myocardial infraction or hand ischemia during postoperation. There was no recurrence of mycardial infarction within 6 months to 1 year follow-up. Graft patency was assessed using 128-slice CT coronary angiography in 25 patients. Cumulative graft patency rates were 96.0% in LIMA and 90.4% in SV grafts. ConclusionLeft ventrical total artery revascularization with "T"-type anasmtomosis of LIMA and radial artery on pump is safe and effective.