Abstract： Objective To summarize the clinical characteristics of young patients with Stanford type A aortic dissection. Methods We retrospectively analyzed 54 patients with Stanford type A aortic dissection who received surgical treatment in General Hospital of PLA between March 2004 and June 2011. All the patients were divided into two groups: a young patient group with patients’ age less than 40 years and a control group with patients’ age more than or equal to 40 years. There were 23 patients including 17 males and 6 females with an average age of 34.2±6.3 years in the young patient group and 31 patients including 27 males and 4 females with an average age of 51.5±6.8 years in the control group. The clinical characteristics and surgical treatment outcomes of the two groups were compared. Results There was no statistical difference in cardiopulmonary bypass（CBP）time（224.4±83.1 min vs. 215.0±88.0 min, t=0.39, P=0.69） and aortic cross-clamping time（152.3±60.8 min vs. 130.9±51.2 min, t=1.34, P=0.18）between the two groups. Compared with the patients in the control group, young patients were more likely to have congenital malformations with rate at 34.7%（8/23） vs. 6.4%（2/31） with χ2=5.27, P=0.02, such as Marfan syndrome and bicuspid aortic valve. The mortality of the young patients was similar to patients in the control group at rate of 13.0%（3/23）vs.12.9%（4/31） with χ2=0.15 and P=0.69, but postoperative mental and neurological complications rate in the young patient group were less frequent than those in the control group at 4.3%（1/23）vs. 32.2%（10/31） with χ2=5.32 and P=0.02. Conclusion Young patients with Stanford type A aortic dissection have fewer cardiovascular risk factors for aortic dissection but are more likely to have congenital malformations. The surgical methods are more active for young patients with less frequency of postoperative mental and neurological complications.
Objective To summarize our experience of using rigid bronchoscopy in the managent of patients with tracheobronchial disease. Methods From Sep.2002 to Nov.2007, 44 patients of tracheobronchial disease（31 men，13 women, median age 51.9 years) underwent rigid bronchoscopic operations. All procedures were carried out under general anesthesia with high frequency jet ventilation. After the rigid bronchoscope was placed in the main trachea through the mouth , the airway was checked out firstly, and then the lesion was removed by repeated freezing, argon plasma coagulation, cauterization or mechanical ablation, and a stent maybe implanted while needed. Results All 54 procedures were accomplished endoscopically without mortality or major morbidity (16 clearence,19 core out,8 scar clearance,3 foreign body removal, 8 stent insert or removal).The lesion located at trachea in 19 cases, at carina in 4 cases,at left main bronchus in 11 cases and at right main bronchus in 10 cases. There were 17 benign diseases and 27 malignant diseases. There were 3 slight complications. 16 patients compliating with benign disease were followed-up and 1 patient was missed,there was no tumor recurrence except 3 patients complicating with tracheal scar who received reoperations during 4-44 (mean 23.0) months follow-up period. Of the 27 malignant cases,23 patients were followed-up and 4 patients were missed, the follow-up period were 5-58(mean 27.1)months.3 patients died in one months after operation of other disease; the other patients all survived more than one month,especially 7 patients who received radical resection of the tumor survived more than one year. Conclusions These data show that rigid bronchoscope can be applied safely and effectively in the management of tracheobronchial disease.
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.
Objective To improve surgical results, the experience of surgical management of Ebstein anomaly in 36 cases is reported and reviewed. Methods Surgical procedures included tricuspid valve replacement (6 cases), Danielson’s operation (28 cases), Carpentier’s operation (2 cases), among them, there were 5 cases of ablation of right atrioventricular accessory pathway. Results Four patients died early after operation in the hospital, 3 from right heart failure (1 case of tricuspid valve replacement and 2 cas...