Objective To summarize the experience of extraanatomic aortic bypass grafting through median sternotomy for onestage treatment of aortic coarctation and associated cardiac diseases, and to improve surgical effect of the diseases. Methods Between July 1997 and July 2008, 31 consecutive patients(20 male,11 female; age 31.9±11.7 years) with aortic coarctation and associated cardiac anomalies underwent onestage surgical repair through median sternotomy. The associated cardiac anomalies included: aortic valve insufficiency or stenosis(n=22); mitral valve insufficiency or stenosis (n=9); patent ductus arteriosus (n=5); ascending aortic aneurysm (n=4); ventricular septal defect (n=3); coronary artery disease (n=2). Extra-anatomic aortic bypass grafting was used to repair the coarctation. Routing of the grafts was: ascendingto posterior pericardial descending aorta (n=9) and ascendingtoinfrarenal abdominal aorta (n=22). Concomitant cardiac procedures included: aortic valve replacement in 16; Bentall procedures in 6; mitral valve repair or replacement in 9; ascending aortic replacement or aortoplasty in 4; patent ductus arteriosus closure in 5; ventricular septal defect closure in 3 and coronary artery bypass grafting in 2. Results One patient died of septic shock 39 days after operation with an inhospital mortality of 3.2%. Mean systolic blood pressure gradient between upper and lower extremities decreased from 64.2±25.3 mm Hg preoperatively to 13.7±10.2 mm Hg postoperatively (Plt;0.05). Twentyseven patients were followed up from 4 to 73 months, there were no late deaths，reoperations or graftrelated complications. Conclusion Extraanatomic aortic bypass grafting can be performed simultaneously through median approach in patients with aortic coarctation and associated cardiac diseases. It is an effective and safe treatment option for onestage surgical repair in adults and adolescents. Both ascendingto posterior pericardial descending aorta and ascendingtoinfrarenal abdominal aorta bypass have favorable results.
Objective To analyse the characteristic of hemodynamic changes during off-pump coronary artery bypass grafting （OPCAB）. Methods One hundred consecutive patients received OPCAB and the hemodynamic changes were monitored during the grafts was anastomosed. They were anastomosis of the left internal mammary artery （LIMA） to left anterior descending （LAD） in 97 patients, the anastomosis of saphenous vein （SV） or radial artery（RA） to right coronary artery （RCA） including posterior descending artery （PDA） and posterior left branch （PLB） in 84 patients, to left circumflex coronary artery （LCX） in 50 patients, to optuse marginal artery（OM） in 27 patients, to diagonal artery （DG） in 25 patients. The grafts number in each patient was 3. 1±0. 7. Results Hemodynamics changed when LAD and DG were anastomosed with significantly increase of heart rate （HR）, significantly decrease of mean arterial pressure （MAP） and left ventricular stroke work index （LVSWI, P〈0.05）. Hemodynamics changed when LCX,PDA,PLB,OM were anastomosed with significantly increase of HR and center veinous pressure （CVP, P 〈 0. 05）, significantly decrease of MAP, cardiac index （CI）, stroke index （SI）, right ventricular ejection fraction （RVEF）, right ventricular end-diastolic volume （RVEDV）, LVSWI and right ventricular stroke work index （RVSWI,P〈0.05）. Hemodynamics tended to be stable and CI improved at the end of operation. Conclusion There are no or little hemodynamic changes during the LAD and DG were anastomosed in OPCAB, while hemodynamics changed significantly during LCX, PDA, PLB and OM were anastomosed. Hemodynamics become stable and CI improves after operation.
Objective To summarize the experience of l iving donor l iver transplantation using cryopreserved il iac vein for middle hepatic vein reconstruction. Methods Between July 2006 and June 2009, right l iver transplantation without middle hepatic vein was performed in 37 cases of 85 patients undergoing l iving donor l iver transplantation; of 37 cases, 30 received middle hepatic vein reconstruction using cryopreserved il iac vein. There were 27 males and 3 females, aged from 10 to 57 years (median, 44 years). Thirty cases included 11 hepatocellular carcinoma, 10 hepatic cirrhosis, 2 Wilson’ sdisease, 1 cholangiocarcinoma, 1 hepatoblastoma, 1 congenital hepatic fibrosis, 1 chronic severe hepatitis, and 1 congenital bil iary atresia. Il iac veins harvested from donors were put into 0-4℃ mixed antibiotics sal ine and transported to the operating room. The il iac veins were trimmed, placed into sterile bags (containing RMPI 1640 + 20% DMSO + 10% calf protein solution) and frozen at —70 . In l iving donor l iver transplantation process, the veins were melt and used for middle hepatic vein reconstruction. After operation, the patency of veins was monitored by regular Doppler ultrasound examination or enhanced CT for 3 months. Results In 30 patients, 30 il iac veins were used. The average cryopreserve time was 14 days (range, 3-44 days). Anastomosis were all successful; after cryopreservation, the blood vessels texture and elasticity were fit for surgery. No easily tearing or severe suture bleeding was observed. In 30 patients, 6 had segment V veins reconstruction; 3 had segment VIII; and 21 had both segments V and VIII. The patency rate of reconstructed vessels was 93% at 1 week, 90% at 2 weeks, 90% at 1 month, and 67% at 3 months. No serious compl ication was observed in donors. The prognosis was good with no small-for-size syndrome. Conclusion Cryopreserved il iac vein is an ideal material for the right hepatic l iving donor l iver transplantation in the reconstruction of middle hepatic vein.
OBJECTIVE: To summarize the importance of surgical management to repair vascular injury in limbs salvage, and to analyze the influence factors in the management. METHODS: From 1993 to 2000, 42 cases of 58 vascular injuries were reviewed; there were 37 males and 5 females, aging from 12 to 70 years old. Emergency operations were performed in 38 cases and selective operations in 4 cases from 1 hour to 45 days after injury. There were 22 cases of complete rupture in 32 blood vessels, 5 cases of partial rupture in 6 blood vessels, and 15 cases of vascular defect in 20 blood vessels, with 5 cm to 10 cm defect. The operation management included end-to-end anastomosis in 22 cases, side-to-end anastomosis in 1 case, vascular repair in 5 cases and vascular grafting in 14 cases. All of the cases were followed up for 6 months to 7 years. RESULTS: In those received emergency operations, it was successful in 35 cases, with amputation in the other 3 cases; after operation, there were 5 cases of post-operative angio-crisis, 1 case of hematoma and 1 case of pseudoaneurysm. In those received selective operation, all succeeded but 1 case of post-operative angio-crisis. After the follow-up, except for 3 cases of amputation, the other limbs survived; and function of the survived limbs recovered satisfactorily after operation except poor recovery in 7 cases of replantation of the limbs. CONCLUSION: To repair vascular injury immediately, to manage angio-crisis and to remove influence factors is the key to save the injured limbs and to maintain the function of them.
OBJECTIVE: To study the effect of color doppler flow imaging(CDFI) technique in the design of axial pattern flap. METHODS: From April 1996 to June 1999, 10 patients with residual wound were adopted in this study. Among them, there were seven males and three females, the area of wounds ranged from 6 cm x 8 cm to 15 cm x 20 cm. Before operation, the axial pattern flaps were designed by traditional method, then CDFI technique with high frequency(5.0-7.5 MHz) was used for examining the major supply artery of the flap. At last, the modified flaps were transferred to cover the wounds. RESULTS: All the patients except one case completed the operation successfully. The cosmetic and function of the flaps were excellent. CONCLUSION: CDFI is a simple, direct and accurate method for detecting the supply artery of axial pattern flap. This technique should be popularized to avoid the blindness of flap design.
OBJECTIVE To investigate the mechanism of electrothrombosis by copper needle, in order to supply the referential data for clinical treatment of vessel deformity. METHODS The mechanism and condition of thrombus formation by copper needle were studied in vivo and in vitro using electrophysics, atom absorption spectrophtometry, histological, and histochemical methods. RESULTS Great deal of copper ion was dissociated, and agglutination of red blood cells(RBC) in blood could be observed in vitro after the current applied by copper needles. Formation of stable thrombus was related to voltage and time of application of electric current. CONCLUSION Dissociation of copper ion and agglutination of RBC are the basic principle of electrothrombosis with copper needle. A 4V direct current and 17.5 minutes are the safe and effective conditions for thrombus formation in the blood vessels.
OBJECTIVE: To discuss the approaches of tissue engineered blood vessels (TEBV) reconstruction. METHODS: The recent literatures about TEBV were widely reviewed. We summarized various types of biomaterials served as scaffold for TEBV and evaluated the construction model of TEBV. And the biological properties of some TEBV were compared. RESULTS: Although the final model of construction of TEBV was not clear, reports in the last two years had shown several important advances in this exciting field. CONCLUSION: Mimicry of some or all of the properties of three layers of natural healthy blood vessels has been the strategy of all TEBV approaches.
OBJECTIVE: To measure the length and extent of the injured blood vessels in an avulsion amputation model. METHODS: Twenty rabbits were randomly divided into 2 groups. Group A was a sharp amputation group, and group B was an avulsion amputation group. The length and extent of the injured blood vessel was observed with naked eye, operation microscope and electron microscope, and the limbs were replanted. Group A and B were explored at three days and ten days after the replantation respectively. The patency rate and healing process were compared. RESULTS: All the severed ends of vessels in group A were neat with almost the same injured range in the three layers of the vessel wall about 1 mm away from the severed end. The vessels of group B were damaged seriously, the endothelial cells were deleted. The "jumping-like" damage could be observed in the elastic fibers. The injury of 2 to 3 mm away from the normal vessel wall could be observed by operation microscope. CONCLUSION: The damage of avulsion amputation vessels was irregular, 2 to 3 mm or more tissues should be excised under the microscope in the process of operation in order to ensure the healthy intact blood vessel walls.
Objective To evaluate the influence of the location of retinal vessel trunk on neuroretinal rim width of inferior and superior sectors of optic disc, and explore its role in the diagnosis of glaucomatous optic nerve lesion. Methods The photographs of ocular fundus from 459 patients with clear location of retinal vessel trunk, including large disc in 131, medium disc in 145, horizontally oval disc in 75, and small disc in 108 were evaluated. Independent-sample t test was used to compare the difference of the superior and inferior rim widths between the higher-vessel group and the lower-vessel group, and to compare the difference of superior and inferior vessel distances between the narrow-superior-rim-width group and the narrow inferior-rim-width group. Results In most of the patients, or the ones with large and small disc, the ratio of superior rim width to summation of superior and inferior rim widths in the higher-vessel group（0.467plusmn;0.051，0.445plusmn;0.040，0.508plusmn;0.056）were less than which in the lowervessel group（0.500plusmn;0.066，0.474plusmn;0.062，0.546plusmn;0.048）, and the differences were significant（P=0.000, 0.045, 0.018）; the ratio of superior vessel distance to summation of superior and inferior vessel distance in the narrow-superior-rim-width group（0.510plusmn;0.051，0.508plusmn;0.055，0.512plusmn;0.036）were less than which in the narrow-inferior-rim-width group（0.528plusmn;0.045，0.533plusmn;0.048，0.534plusmn;0.045）, and the differences were significant（P=0.000, 0.046, 0.022）. Conclusions The position of optic disc vessel trunk influences its superior and inferior rim width. The rim closer to vessel trunk position has narrower width than which comparatively far away from the position. In patients with large, medium, horizontally oval optic disc, glaucoma optic nerve lesion would be considered if the optic disc has the shape of narrower inferior rim, broader superior rim, and vessel location in the superior half of the disc. In the ones with small disc, the optic disc with the shape of narrower superior rim, broader inferior rim, and vessel location in the inferior half of the disc may suggest glaucoma optic nerve lesion. (Chin J Ocul Fundus Dis, 2007, 23: 118-121)
Objective To study the feasibility of transplanting human saphanous vein endothelial cells to luminal surface of blood vessel prosthesis and to play a theoretical foundation for the clinical application of autologous endothelial cell transplantation. Methods Human saphanous vein endothelial cells were harvested with 0.1% collagenase and cultivated in vitro for 13.08±1.24 days. The cultures were confirmed as endothelial cells with the fourescent linked anti-Ⅷ antigen antibodies. The content of both 6-keto-PGF1α and Von Willebrand factor (vWF) in the supernatant were detected with ELISA and radioimmunoassay. The multiplied cells were lined in vitro onto the luminal surface of expanded polytetraflouroethylene (ePTFE) grafts precoated with fibrin glue and fibronectin, then cultivated again for 9 days. Results 11.46±2.69×１０６ of available endothelial cells could be regularly obtained, the number of endothelial cells increased 147.93±88.68 times when culture were terminated. All the cells diploid cells with a purity of 99%. The content of both 6-keto-PGF1α and vWF in the media showed no significant difference between the primary and subculture passages. The luminal surface of grafts was covered completely by a spindlelike endothelial monolayer and an even fibrin glue matrix could be seen underneath. Conclusion Endothelial cells derived from human saphanous veins might be feasible to be transplanted onto the luminal surface of ePTFE and present a potential clinical application.