【Abstract】ObjectiveTo summarize the study on the feasibility of celiac axis ligation. Methods Literatures about celiac axis ligation were reviewed retrospectively. ResultsCeliac axis branches included common hepatic artery， splenic artery， left gastric artery which had many variation and collateral flow between celiac and mesenteric vessels by gastroduodenal artery and pancreaticoduodenal artery. Celiac axis could be possibly ligated without obvious complications in patients who had celiac axis injuries, celiac artery aneurysms, upper gastrointestinal haemorrhage, excision of carcinoma around the celiac axis and portal hypertension. However, gallbladder necrosis or perforation, focal infarction of the liver even higher mortality had also been reported. ConclusionCeliac axis ligation should not be performed routinely, but it is surgically possible and may be a life saving approach in certain circumstances.
摘要:目的:探讨改良De Vega环缩术与经典De Vega环缩术相比对于治疗重度三尖瓣返流是否具有更好的成形效果。方法: 2007年12月至2009年3月对29例重度三尖瓣返流的患者行De Vega环缩术。其中16例行改良De Vega环缩术,13例行经典De Vega环缩术,随访比较两组患者三尖瓣返流程度,右心室舒张期末内径,EF值及心功能分级。以秩和检验分析研究两组患者三尖瓣返流程度和心功能分级的差异,以t检验研究两组患者右心室舒张末期内径及EF值变化。结果:术前两组患者一般指标无显著差异。两组患者随访时间无显著差异。随访经典De Vega组重度返流1例,中度返流5例,轻度返流5例,微量及无返流2例;改良De Vega组无中、重度返流,轻度返流8例,微量及无返流8例。经分析显示两组患者三尖瓣返流程度结果差异有统计学意义(Plt;0.05)。经典De Vega组心功能分级I级5例,II级7例,III级1例;改良De Vega组I级7例,II级8例,III级1例,两组患者心功能差异无统计学意义(Pgt;0.05)。两组患者右室舒张期末内径及EF值组内比较随访与术前差异均有统计学意义(Plt;0.05),随访时组间比较差异有统计学意义(Plt;0.05), 改良De Vega环缩术随访时右室舒张期末内径缩小更显著,射血分数改善更明显。结论:改良De Vega环缩术治疗重度三尖瓣返流效果优于经典De Vega环缩术。Abstract: Objective: To compare the efficacy of one kind of modified De Vega technique and traditional De Vega technique for the correction of severe tricuspid regurgitation. Methods: From December 2007 to March 2009, 29 patients were treated with tricuspid valve annuloplasty. These were 16 patients in modified De Vega annuloplasty group and the others (13 patients) in traditional De Vega annuloplasty group. The grade of tricuspid regurgitation、New York Heart Association (NYHA) functional class、ejection fraction (EF) and the right ventricular enddiastolic dimension of two groups were followed and reviewed. Results: There was no statistically difference between two groups about preoperative characteristics and followup time. There was 1 patient with severe TR, 5 patients with moderate TR, 5 patients with mild TR and 2 patients without TR in traditional De Vega annuloplasty group after the operations. In modified De Vega annuloplasty group, no patient was observed with severe or moderate TR, 8 patients with mild TR, and 8 patients without TR. At interval time, there was significant difference in the grade of tricuspid regurgitation between two groups (Plt;0. 05). Both tricuspid valve plasty techniques could reduce the right ventricular enddiastolic dimension and improve ejection fraction significantly (Plt; 0. 05), and there was significant difference in the right ventricular enddiastolic dimension and ejection fraction at interval time between two groups (Plt;0.05). Conclusions: The outcome of modified tricuspid De Vega technique is superior to that of traditional De Vega technique in correcting severe tricuspid regurgitation.
目的:探讨带膜支架腔内隔绝术治疗B型主动脉夹层的技术方法及疗效。方法:对近年我院收治的40例主动脉夹层进行分析。40例患者均行股动脉穿刺插管至升主动脉造影，了解主动脉真假腔、夹层裂口及其与重要血管分支位置关系。切开右或左侧股动脉置入覆膜血管内支架，封堵原发破口，置入支架后重复造影检查。观察真假腔血流变化、主动脉分支供血的情况。结果:40例患者支架置入定位准确，术后即刻造影显示真腔血流恢复正常。手术成功率100%，无术中转开胸手术，无截瘫及瘤体破裂等严重并发症，无围手术期死亡。所有患者术后3～6个月复查增强CT，假腔不再显影，支架通畅，无扭曲、移位。结论:带膜支架腔内隔绝术治疗B型主动脉夹层具有创伤小，术后恢复快，手术死亡率低，手术成功率高的优点，但远期效果有待进一步观察。
Objective To summarize the experience of surgical treatment for 84 patients with aortic dissection, investigate the surgical technique and perioperative treatment, and to improve surgical results. Methods The operations were performed in 50 patients with aortic dissection of Stanford A， Bentall or Cabrol operations were performed in 24 patients, graft replacement of ascending aorta in 8 patients, Trusler operation in 5 patients, Wheat operation in 5patients, operation of ascending aorta and aortic arch in 8 patients.Stentgraft were used in 34 patients with aortic dissection of Stanford B. Results There were 11 hospital death,the hospital mortality was 13.1%.There were 3 operative deaths.One patient with ascending aortic and hemiarch grafting died of aortic root bleeding;one patient with replacement of ascending aorta died of failure to restart heart beating；one patient with ascending aortic and hemiarch grafting died of rapture of aortic dissection. There were 8 postoperative deaths, including low cardiac output syndrome in 2 patients, lung infection in 2 patients, renal failure in 2 patients， respiratory failure in 1 patient and permanent mental anomaly in 1 patient. The complications were occurred in 16 patients. The followup period was 3 months to 10 years, and carried out in 62 patients（84.9%，62/73).One died of endocarditis, another one died of sudden death. Conclusion The surgicaltreatment of aortic dissection could be carried out safely based on the accurate diagnosis， specific surgical strategy and fine surgical technique.
Objective To design a novel stentless porcine aortic bioprosthesis and test the feasibility and its function in vitro after the valve was implanted by a modified method. Methods Six stentless porcine aortic bioprosthesis were divided into two groups according to different implantation, single layer suture group: new improvement stentless porcine aortic bioprosthesis sutured with single layer was implanted; double layer suture group: stentless porcine aortic bioprosthesis developmented by our laboratory used double layer suture was implanted. Each group contained three scales: 23 mm ,25 mm and 27 mm. Analogue ex vivo aortic valve replacement was performed , the feasibility of the new implantation was detected. Effective orifice area, transvalvular pressure gradient and regurgitation ratio were recorded at the cardiac output of 2.0 L/min, 3.5 L/min, 5.0 L/min and 7.0 L/min under the guideline of International Organization for tandardization （ISO）5840. Results The average aortic valve implantation time used for single layer suture and tradition double layer suture were 50 min and 70 min respectively. The transvalvular pressure gradient in the single layer suture group were significantly lower than those in double layer suture group under the flow of 5.0 L/min in 23 mm valve and 27 mm valve （13.51±0.51 mm Hg vs. 14.44±0.99 mm Hg, 7.36±0.19 mm Hg vs. 7.53±0.28 mm Hg；P＜0.01）;and the effective orifice area in the single layer suture group were larger than those in double layer suture group in the same case(1.87±0.06 cm2 vs. 1.76±0.08 cm2, 2.26±0.07 cm2 vs. 2.16±0.05 cm2；P＜0.01). There was no statistically difference in other parameters between both groups. Conclusion The novel design of new improvement stentless porcine aortic bioprosthesis used single layer suture has good hemodynamic characteristics as the nature structure . The modified suture method decrease the implantation time.Nemerical data of the evaluation in vitro show that the difference between single layer suture group and double layer suture group in effective orifice area,transvalvular pressure gradient and regurgitation ratio haveno statistical significance. This experiment is the foundation of the animal and clinical experiment in the future.
Objective To summarize the critical point of diagnosis and endovascular repairment (EVR) to thoracic aortic aneurysm (TAA), thoracic pseudoaneurysm (TPA) and aortic dissection (AD), by comparison the computerized tomography angiography (CTA) images before and after EVR to observe effects, so as to explore a unique index of imageology to assess the pathological development and evaluate therapeutically effect in dynamic and systemic reviews in pre, intra, postEVR and followup period. Methods Fortyeight patients involving aneurysm or dissection of thoracic aorta were treated with EVR based on the preoperative CTA imaging. Before and after the introducing of stentgraft, digital substation angiography (DSA) was taken place and sequential enhanced CTA was followed to evaluate the effects of the treatment. All imagings of CTA and DSA were collected and induced into e-FilmTM database to select key sections for analyses and measurement. Results Fortynine EVR were preformed and 54 stent grafts were implanted in 48 cases, with endothelial tears sealed in 42 cases of dissection, aneurismal cavities excluded in 2 cases of aortic aneurysm, and rupture site closed in 4 cases of pseudoaneurysm. Endoleakage happened in 9 cases, which were treated successfully by appropriate measures. One case suffered hemorrhage from introducing artery (iliac) which was controled by surgery, but he died of disseminated intravascular coagulation and then multiple organs failure. Fortyseven cases were followed up in 6-51 months with a satisfied clinical effect. Conclusion EVR is favorable in the effect of repairment to true, false and dissection of thoracic descending aorta. Chest pain and CTA scan is the key of early diagnosis of aortic dissection. Certain sections and leftanterior oblique viewing are the crucial profile for assessment and evaluation before and after operation.
Abstract: Percutaneous balloon pulmonary valvuloplasty (PBPV) has become the first choice for the treatment of pulmonary valve stenosis (PS). PBPV is used not only in the independent way to relieve Milo-Ⅰ amp; Ⅱ type of PS as an alteration of surgery, but also in the combination way with surgical treatment to some multiple or complex congenital heart defect,where it plays a part as a pre-operative appeasement or a co-operative procedure, even a supplementary expedience to some failed surgery post-operatively. In this paper, the anatomic classification of PS, the usage of ultrasounic examination, the indication and contraindication, the method and skill during operation, and the effect evaluation of PBPV are reviewed.
Objective To investigate the gastrointestinal(GI) protective effect of Omeprazole on children undergoing thoracoscopic heart surgery with cardiopulmonary bypass (CPB). Methods One hundred and twenty seven patients who were scheduled for cardiac surgery with CPB were randomly equally divided into three groups. Group A and B underwent thoracoscopic heart surgery, while the control group underwent conventional heart surgery by sternotomy. Before CPB, group A was treated with Omeprazole 10mg added to the priming solution.? Group B and the control group were treated by adding the same amount of normal saline (to the priming solution). pH and red blood cell count of gastric secretion and serum gastric level (Assay Designs ELISA) were measured at the following intervals: before CPB, 30 minutes into CPB, at termination of CPB,4 and 24 hours after termination of CPB. Results Compare to prior to CBP, the value of the gastric pH in group A was significantly higher (Plt;0.01), and that of group B was significantly lower (Plt;0.05)at the end of CPB. The same value in the control group was significantly lower (Plt;0.05)4h, after the end of CPB. Compared to prior CPB, the mean red blood cell count of gastric secretion and serum gastric level were significantly descent (Plt;0.01) in all there group post CBP. Compare to the control group, the mean gastric pH level in group A was significantly elevated at all time intervals post CBP; while the mean gastric secretin red blood cell count was significantly decreased. The mean serum level in group A 30 min post CBP was significantly lower than that in group B and the control group. Compared to the control group, the mean gastric pH level was significantly lower in group B but returned to the pre-CPB level in 24 h. The mean gastric secretin red blood cell amount and serums gastric level in group B at all time intervals were significantly decreased compare to those of the control group. Conclusion Thoracoscopic heart surgery of children with CPB
OBJECTIVE: To modify the surface of poly(D,L-lactide) film by anhydrous ammonia gaseous plasma treatment. METHODS: The changes of contact angles were measured and surface energy were calculated. Mouse 3T3 fibroblast cells were cultured on plasma modified and control poly(D,L-lactide) films. RESULTS: It was found that the hydrophilicity and surface energy of the materials have been increased after plasma treatment. Cell culture results showed that ammonia plasma treatment could promote the cell attachment and cells growth. After 4 days culture, the cells on the plasma treated films were 2-folds quantitatively compared with that of the control films. CONCLUSION: Ammonia plasma treatment can improve the cell affinity to poly(D,L-lactide).
Objective To summarize the relationship of diabetes and its complications with microRNA. Methods Domestic and international researches were collected by searching to summarize the role of microRNA in diabetes and its complications. Results MicroRNA could affect the secretion of insulin and interfer metabolism of gulcose in fat cells， muscle cells， and liver cells， which resulting in insulin resistance. At the same time， the microRNA also played an role in damage of vascular endothelial cells and myocardial cell in diabetes. Conclusion MicroRNA acts an important role in the process of diabetes and its complications.