Abstract: Objective To evaluate the longterm results of surgical treatment of tetralogy of Fallot (TOF) in adults and discuss the perioperative treatment skills. Methods From January 2000 to March 2008, 149 patients older than 14 years with tetralogy of Fallot received surgical treatment in Changhai Hospital. Among the patients, there were 78 males and 71 females with ages ranged from 14 years to 53 years and the average age was 26.3 years. Twenty patients had previous pulmonary arterial shunts before radical treatment. A total of 129 patients underwent primary radical treatment. Thirtyeight patients received a right ventricular outflow tract patch, 107 patients had transannular patch, and 4 patients had homograft aorta with valves. Results Hospital mortality was 4.0%(6/149). Four patients died of low cardiac output syndrome (LCOS), and multiple organ failure, and 2 patients died of acute renal failure. The postoperative complications included pleural effusion in 11 patients, pulmonary edema in 10 patients, severe LCOS in 9 patients, severe cardiac arrhythmia in 7 patients, reoperation for excessive bleeding in 7 patients, reintubation in 6 patients, and residual ventricular septal defect (VSD) in 5 patients (two of them had reoperation for residual VSD repair and 2 received transcatheter closure of VSD). One hundred and thirtyfour patients were followed up for 3 to 102 months (47.2±28.6 months) with a followup rate of 93.7%(134/143). Late death occurred in 2 patients, one of whom died of secondary infective endocarditis and the other had a sudden death 29 months after operation. During the followup, one patient had residual VSD (2 mm), but had a normal life. The peak systolic right ventricletopulmonary artery pressure gradient exceeded 40 mmHg in 4 patients. Two patients had severe pulmonary regurgitation. A total of 132 patients survived and had an improved life. One hundred and twentyone patients had class Ⅰ heart function (NYHA), and 11 patients in class Ⅱ. Conclusion The pathophysiologic conditions of the patients with tetralogy of Fallot in adults are very complicated due to longterm right ventricle outlet stricture and chronic hypoxia. Preoperative evaluations and postoperative treatment of complications are necessary. The systemicpulmonary arterial shunts should be performed when hypotrophy of the pulmonary arteries or left ventricles exists. Repair of tetralogy of Fallot in adults has acceptable morbidity and mortality rates with goodlongterm outcomes.
Objective To investigate the treatment and prognosis of moderate ischemic mitral regurgitation (IMR) in coronary artery disease(CAD). Methods From January 1998 to May 2006, 28 patients of CAD with moderate IMR underwent coronary artery bypass grafting (CABG) and mitral valve plasty(MVP, 24) or mitral valve replacement (MVR,4). The Reed method were used in 9 cases, the annuloplasty ring were used in 15 cases. Mechanical valve were implanted in 1 case and biological valve in 3 cases. Results There was no operative or hospital death. Twentysix patients were followed up to a mean period of 41 months. There were two late death(one was MVP, the other was MVR). In MVP cases, nineteen patients were in New York Heart Association (NYHA) functional class Ⅰ and Ⅱ, 3 in class Ⅲ, which was better than that of preoperative one. Ultrasonic cardiography (UCG) examination showed no mitral regurgitation in 5 cases, mild in 7, light in 6, moderate in 3, severe in 1. Left atrial volume (LAV) and left ventricular enddiastolic volume (LVEDV) were 54.1±12.7ml and 60.9±14.8 ml, decreased more significantly than that preoperatively (Plt;0.05). In MVR cases, 2 cases were survival and followed. One patient was in NYHA functional class Ⅰ, 1 in class Ⅱ, which was better than that of preoperative one. Conclusion Moderate IMR with CAD should be treated carefully. MVP with annuloplasty ring have better early results. For patients with bad heart function and abnormal left ventricular wall motion, the late results need more studies.
ObjectiveTo explore the factors that affect the accuracy of percutaneous thermal ablation of lung metastases and coping strategies.MethodsWe retrospectively analyzed the clinical data of 31 patients who met the conditions for thermal ablation of lung metastases in Ninth People’s Hospital affiliated to Shanghai Jiao Tong University School of Medicine between October 2019 and December 2020. There were 19 males and 12 females with a mean age of 40-81 (62.8±10.3) years. A total of 33 metastases tumors were thermally ablated, 12 were radiofrequency ablation and 19 were microwave ablation.ResultsOf the 33 metastatic tumors, 5 targets showed significant puncture deviation, 4 of them completed the ablation after adjustment and 1 failed. The result of the univariate logistic regression showed the distance within the lung parenchyma (P=0.043) and the maximum diameter of the tumor (P=0.025) were independent risk factors for the accuracy of percutaneous thermal ablation. In terms of correlation, there was a positive correlation between the accuracy of percutaneous thermal ablation and the distance within the lung parenchyma (P=0.033), and a negative correlation between the maximum diameter of metastases tumor (P=0.004) and hemoptysis (P=0.015). Complete ablation rate was 87.8% (29/33).ConclusionWhen we perform CT-guided percutaneous thermal ablation of lung metastases, we must fully prepare the deviation plan for the small diameter tumor, the long travel distance in the lung parenchyma, and hemoptysis during puncture. Complete ablation can be achieved by fully identifying the anatomical features of the tumor and its surrounding structures, shortening the travel distance in the lung parenchyma and increasing the ablation range.
Objective To evaluate whether minimally invasive (MI) cardiac surgery has advantages over conventional median sternotomy (MS), so as to provide evidence for clinical diagnosis and therapy. Methods We searched CBM, VIP, CNKI, PubMed, and Elsevier databases from 1995 through 2008. The literature about the therapeutic effect of minimally invasive cardiac surgery and conventional median sternotomy was identified. The data was extracted, and the methodological quality was evaluated by two reviewers independently. The Meta-analyses were performed using RevMan 4.2 software. Results A total of 8 studies involving 492 MI patients and 712 MS patients met the inclusion criteria. Of these eight studies, two studies were randomized trials and the other six studies were retrospective cohort studies. The results of meta-analyses showed that the MI group had a better postoperative effect, and the cardiopulmonary bypass time (WMD=16.45, 95%CI 2.56 to 30.35, P=0.02), chest-tube drainage (WMD= –132.63, 95%CI –208.53 to –56.72, P=0.0006) and hospitalization stay (WMD= –1.22, 95%CI –2.14 to –0.30, P=0.009) of MI group were less than those of MS group, but the aorta clamping time (WMD=0.47, 95%CI –1.35 to 2.29, P=0.61) and operating time (WMD=26.67, 95%CI –8.91 to 62.25, P=0.14) were not significantly different between the two groups. Conclusion The minimally invasive cardiac surgery has a better postoperative therapeutic effect than conventional median sternotomy cardiac surgery.