Abstract: Objective To explore the inhospital mortalityrelated risk factors in the patients undergoing offpump coronary artery bypass grafting (OPCAB). Methods We retrospectively analyzed the clinical data of 215 patients undergoing OPCAB in our hospital from November 2007 to November 2008. There were 171 males and 44 females aged between 40 and 85 years old. Among them, there were 47 patients older than 70 years old. All of them were coronary artery disease (CAD) patients with triple vessel disease. We adopted univarialble analysis and logistic multivariable regression analysis to screen the risk factors for the mortality of OPCAB. Results Six patients died in hospital after OPCAB with a mortality rate of 2.79% (6/215). No renal dysfunction or respiratory failure occurred. The rate of reoperation for bleeding was 4.65% (10/215) and all the 10 patients having undergone reoperation were alive. A total of 209 patients were all alive after 1year follow-up. The results of logistic multivariable regression analysis showed that New York Heart Association (NYHA) Ⅲ and Ⅳ heart function (OR=42.116，95% CI 3.319 to 534.465，P=0.004) and mechanical ventilation duration (OR=1.007，95%CI 1.001 to 1.013，P=0.028) were independent risk factors for inhospital mortality of OPCAB. Conclusion OPCAB is an effective and safe treatment for CAD with triple vessel disease. NYHA Ⅲ and Ⅳ heart function and mechanical ventilation time after OPCAB are the risk factors for OPCAB inhospital mortality, yet, needs further study with large sample.
Objective To introduce the technique of esophageal intraluminal stenting and assess its effect on the prevention of development of stenosis in patients with esophageal burns. Methods Thirty-three patients were admitted less than 3 weeks after ingestion of caustic agents. The second-or third-degree injuries were confirmed by esophogoscopy in all cases, but one with esophageal perforation at admission. Esophageal stenting was performed in all patients and these stents were kept in place for 4 to 6 months. Results There was no death in the series. All patients had a normal intake of food after removal of the stents, and stricture was not found on barium swallow test. Follow-up from 1 to 60 months five cases developed esophageal stenosis from 2 to 3 months after extracting the stents. One of them responded to esophageal bougienage, the remaining 4 patients required esophageal reconstruction and took a normal diet postoperatively. The other 28 patients have a normal diet after the stent removal. Conclusion The esophageal intraluminal stenting is able to prevent the formation of stricture in the aftermath of esophageal burns and its effect will be enhanced plus administering isoniazid.
OBJECTIVE: To observe the architecture of elastic fiber of anastomosed artery. METHODS: The right femoral arteries of 60 Wistar rats were cut off transversely and end-to-end anastomosis were performed. On the 3rd, 7th, 14th, 21st, 30th and 90th days after operation, the anastomosed artery segments were harvested and fixed by 10% formalin. After routine processed, the architecture of elastic fiber of anastomosed artery was observed under scanning electronic microscope and was compared with that of normal artery. RESULTS: On the 3rd and 7th days after anastomosis, there was no the elastic fiber in the middle of the anastomosed area. From 14 to 90 days after anastomosis, the newborn elastic fiber connected the anastomosed area. The reconstruction of elastic fiber could be divided into quiescent stage, proliferation stage, and rebuilding stage. CONCLUSION: The reconstruction of elastic fiber occurs after arterious anastomosis and newborn elastic fiber originates from endoarterious layer. The structure of elastic fiber can return to normal 30 days after anastomosis.
Objective To compare the clinical results of different thoracic incision approaches for congenital heart disease in children. Methods Retrospective analyses of the clinical results of different thoracic incision approaches for 1 669 children with congenital heart disease was performed. All patients were divided into median sternotomy group(Med group), right thoracotomy group (Rat group),and lower partial median sternotomy group (Pt group) according to different thoracic incision. Two hundred and forty five children underwent atrial septal defect(ASD) repair, 1 005 children underwent ventricular septal defect(VSD) repair and 419 children underwent tetralogy of Fallot(TOF) correct repair from Jan. 1999 to Dec. 2001. Results In ASD repair the incidence of pulmonary complications after operation in the Rat group was significantly higher than that in Med group and Pt group ( P lt;0 05). The percentage of pulmonary hypertension before operation in Med group was significantly greater than th...更多at in the Rat group and Pt group ( P lt;0 05), but the incidence of pulmonary complications in Rat group was significantly higher than that in the Med group and Pt group in children with VSD( P lt;0 05). The concentration of hemoglobin , the oxygen saturation and the percentage of transannular patch in Med group were significantly higher, lower and greater respectively than those in the Pt group and in Rat group in children with TOF( P lt;0 05). Conclusion The approaches to be selected should guarantee to correct the cardiac anomaly satisfactorily, reduce the postoperative complications maximally and ensure success of their operations.
Objective To compare the efficacy of one kind of modified De Vega technique and traditional De Vega technique. Methods From January 2002 to August 2005, 70 patients were treated with tricuspid valve plasty. These patients were divided into modified De Vega annuloplasty group and traditional De Vega annuloplasty group randomly before operation. The tricuspid regurgitation （TR） were functional and secondary in all patients. The grade of TR and New York Heart Association（NYHA） functional class of two groups were analyzed by Ridit analysis. The changes of right ventricular end-diastolic dimension of two groups were analyzed by paired-sample t test. Results There was no statistically difference between two groups about preoperative characteristics. The follow-up time of modified De Vega annuloplasty group was 12.91±8.84 months and that of traditional De Vega annuloplasty group was 13.61±11.21 months. There was no significant difference between two groups. The outcome of follow-up was satisfactory. In modified De Vega annuloplasty group, there were 12 patient with no TR, 17 patient with mild TR, and 6 patients with moderate TR. There was no patient with severe TR. In traditional De Vega annuloplasty group, 7 patients were observed with no TR, 19 patients mild TR, 7 patients moderate TR and 2 patients severe TR. In modified De Vega annuloplasty group, 32 patients were in NYHA class Ⅰ, 2 patients in NYHA class Ⅱ and only 1 patient in NYHA class Ⅲ. As for traditional De Vega annuloplasty group, 31 patients were in NYHA class Ⅰ, 2 patients in NYHA class Ⅱ and 2 patients in NYHA class Ⅲ. The Ridit analysis showed that there was no significant difference about NYHA class between two groups. However, the difference of TR between two groups was statistically significant （P〈0.05）. The outcome of modified De Vega annuloplasty was superior to that of traditional De Vega technique. Paired-sample t test demonstrated that the modified De Vega annuloplasty could reduce the right ventricular end-diastolic dimension significantly （P〈0.05）. However, the right ventricular end-diastolic dimension of traditional De Vega annuloplasty groups did not change significantly （P 〉 0.05）. Conclusion The efficacy of modified tricuspid De Vega technique is superior to that of traditional De Vega technique in patients with secondary TR.
Objective To assess the variation and its significance of messenger ribonucleic acid(mRNA) expression of endothelial nitric oxide synthase (eNOS) in allografts of common carotid transplantation model in white rabbits. Methods To establish an animal model of common carotid transplantation in vivo, 30 rabbits were divided into four groups with random number table. Group A (n=3): autografts; group B (n=9): allografts with the least treated; group C (n=9): allografts treated by penicillin/streptomycin and preserved under room temperature; group D (n=9): allografts treated by penicillin/streptomycin and cryopreserved in liquid nitrogen. All the transplanted grafts were harvested 1-3 weeks later, then compared and evaluated the histomorphological variation and eNOS mRNA expression. Results The vascular structures of autografts in group A were kept approximately normal, only a few infiltration of inflammatory cells could be found. The structural variations of allografts in other trial groups behaved similarly as, intima proliferation in the 1st week, intima hyperplasia in the 2nd week, and both intima and media hypertrophy in the 3rd week. And also there seemed that luminal thrombosis could be found in all the allografts. Allografts in group B were destructed utmost the worst in all the groups. The expression of eNOS mRNA in allografts of group B was significantly less than that in other groups (Plt;0.05). Conclusion The down-regulation of eNOS mRNA expression might lead to intima hyperplasia and thrombosis of allografts.
Objective To evaluate the clinical significance of operative indication in patients with lung cancer accompanied by lung dysfunction using cardiopulmonary exercise test (CPET). Methods Before operation, using CPET with step program, work rate(W%), maximal oxygen uptake(VO2%P), maximal oxygen uptake per kilogram(VO2/kg) and other indexes were tested in the end of load exercise in 195 patients with lung cancer accompanied by lung dysfunction. Chi-square test and logistic regression analysis were performed for the abnormal rate of indexes mentioned above in patients with or without postoperative respiratory failure. Results After pneumonectomy, W%,VO2%P, VO2/kg, metabolic equivalent (MET), minute ventilation(VE) and respiratory frequency(BF) in patients with postoperative respiratory failure were lower than those in patients with non-postoperative respiratory failure (Plt;0.05 or 0.01). Logistic regression analysis showed that VElt;30 L/min and (BFlt;30) times/min were more related to the morbidity of postoperative respiratory failure than other indexes. As for the patients with lung dysfunction treated by lobectomy, this indexes didn’t show any significant difference between patients with or without postoperative respiratory failure. However, this indexes decreased in patients with postoperative respiratory failure whose ratio of forced expiratory volume in one second to forced vital capacity (FEV1%) were lower than 60%(Plt;0.05 or 0.01). Logistic regression analysis showed that VO2%Plt;60% related to the morbidity of postoperative respiratory failure. Conclusion CPET is useful to evaluate the operative indication in patients with lung cancer accompanied by lung dysfunction. VO2%Plt;60% should be selected as a evaluating index.
Abstract: Objective To investigate the clinical results of the coronary artery bypass grafting (CABG) for coronary artery disease (CAD) patients with completed hypothyroidism. Methods Twentyone CAD patients with hypothyroidism (hypothyroidism group) operated by a single surgeon from September 2002 to June 2009 in our department were enrolled in this study. Among them, there were 6 males and 15 females. Their average age was 60.4 years old. Three patients underwent CABG with onpump beating heart; one underwent CABG with onpump arrested heart; and 17 patients underwent CABG with offpump beating heart. All patients on thyroxine replacement therapy underwent CABG after free triiodothyronine（FT3）,free thyroxin（FT4）, thyroidstimulating hormone（TSH）, total triiodothyronine（TT3） and total thyroxin（TT4） were obviously improved. At the same time, twenty CAD patients without hypothyroidism were chosen as the control group (control group). Among them, there were 6 males and 14 females with an average age of 62.1 years old. The data of thyroid gland function and clinical prognostic indicator were observed after the operation. Results For the hypothyroidism group, one patient with pericardial effusion, heart failure and low thyroxine before surgery died during the onpump operation. Among the 20 survivors who had undergone CABG with beating heart, 17 were offpump CABG patients. Followup was done for 230 months. Postoperative eject factor of the survivors were significantly higher than their preoperative eject factor (55%±21% vs. 48%±17%). Twenty patients in the control group all survived. There was no significant difference in cardiac index ［2.7±1.4 L/(min·m2) vs. 2.8±1.5 L/(min·m2), t=0.530, P=0.530］, hospital stay (12.2±4.7 d vs. 10.1±3.9 d , t=0.170, P=0.170), or mechanical ventilation time (17.6±9.1 h vs. 15.1±13.7 h, t=0.120, P=0.120) between the hypothyroidism group and the control group. Perioperative thyroxine examination showed that there was no profound impact on thyroxine by offpump CABG. Conclusions With full preparation made before operation, CABG with beating heart is comparatively safe for CAD patients with hypothyroidism. The key of the treatment is perioperative thyroxine replacement therapy. There is much risk to perform onpump CABG on patients with severe hypothyroidism.
Objective To investigate the effect on motility function of remnant esophagus and intrathoracic stomach after esophagectomy for esophageal and cardiac carcinoma. Methods Thirty nine patients with esophageal and cardiac carcinoma were divided into two groups according to surgical procedure. Group of anastomosis above aortic arch （n = 21）： esophagogastrostomy was performed above the aortic arch in patients with esophageal carcinoma of the middle third; group of anastomosis below aortic arch（n= 18）： esophagogastrostomy was performed below the aortic arch in patients with esophageal carcinoma of the low third and cardiac carcinoma. Six health volunteers without gastroesophageal reflux were recruited as control group. Esophageal manometry and upper alimentary tract roentgenography were performed in all patients. Results There was a high pressure zone at the anastomotic orifice in parts of patients of both anastomosis groups. The resting pressure of remnant esophagus was higher than that in control group （P〈0. 05）, and similar to the resting pressure of intrathoracic stomach （P〉0. 05）. There was no significant difference in resting pressure of remnant esophagus and intrathoracic stomach between two anastomosis groups （P〉0.05）. The amplitude and number of primary peristalsis in remnant esophagus of group of anastomosis above aortic arch were significantly reduced in comparison with control group. The number of primary peristalsis in remnant esophagus of group of anastomosis above aortic arch was significantly lower than that of group of anastomosis below aortic arch （P〈0. 05）. The motility in the body of intrathoracic stomach was not observed. Weak motor activity of the gastric antrum was observed with upper alimentary tract roentgenography after surgery and evidently recovered 1 year after surgery. Conclusions The resting pressure of remnant esophagus and intrathoracic stomach is not influenced by the site of anastomosis. Esophagogastric anastomosis at the upper thorax is likely to result in poor motility of remnant esophagus. The motor activity of intrathoracic stomach becomes weak after esophagectomy and then recovers gradually over time, hut still fail to return to normal level.
Objective To insure early detection and hence efficient prevention of allograft rejection in transplanted heart, investigate possible applications of NAD(P)H fluorescence components analysis at the level of living cardiac cells to propose new approaches for diagnosis of rejection. Methods NAD(P)H was studied for noninvasive fluorescent probing of the mitochondrial function. Human cardiomyocyte were isolated from one additional endomyocardial biopsy (EMB) of 14 pediatric patients with heart ransplantation. Rat cardiomyocyte (n=5, 13-14 week old) were also isolated by the same approach for human myocytes. Autofluorescence(AF) was recorded in living cardiomyocytes following excitation with 375 nm UVlight and detection by spectrallyresolved time correlated single photon counting (TCSPC), based on the simultaneous measurement of the fluorescence spectra and lifetimes. Rat cardiac cells were divided into four groups: normoxic condition, normoxia with Rotenone, ischemic condition and ischemia with Rotenone. Comparison of cardiomyocyte AF between human and rat; compared kinetics of rat cardiomyocytes AF in normoxic conditions to ischemiamimicking ones, induced at physiological temperatures by reducing cell pH and oxygen content; comparison of cardiomyocyte AF dynamic changes in transplanted pediatric patients presenting either no rejection (R0) or mild rejection (R1). Results We have achieved appropriate isolation of living cardiomyocytes from human biopsies, as well as from rat cardiac tissues and determined their AF. At least a 3-exponential decay with 0.5-0.7ns, 1.9-2.4 ns and 9.0-15.0 ns lifetime pools is necessary to describe human cardiomyocyte AF within 420560 nm spectral range. Rat cardiomyocyte steadystate AF in ischemiamimicking condition was significantly increased when compared normoxic ones (Plt;0.05); application of Rotenone induced a significant increase in AF intensity in ischemic and normoxic condition, however no significant difference between the two groups (Plt;0.05).Human cardiomyocyte AF was found significantly lower in comparison to experimental rat model in the same condition(Plt;0.05). A correlation between changes in steadystate NAD(P)H fluorescence and rejection grades was found when comparison of R1 to R0. R1 showed significantly increased fluorescence intensity (Plt;0.05), without change in the spectra shape, results can be comparable to the effect of ischemiamimic conditions. Conclusion Our studies clearly demonstrated that spectrallyresolved fluorescence spectral analysis coupled to fluorescence lifetime are high sensitive approaches to examine mitochondrial metabolic oxidative state directly in living human cardiomyocytes with good reproducibility. Human cardiomyocytes are more metabolically active than the rat ones, while this activity (and thus ATP production) seems lowered during rejection process. In perspective, the advantage of this method is the possibility of its combination to multiphoton confocal microscopy, which can result in the adaptation of this approach directly to tissue biopsy, as well as in vivo directly via cardiac catheterization without the necessity of cell isolation. This approach provides promising new tool for clinical diagnosis and treatment of allograft rejection, and will enhance our knowledge about cardiomyocyte oxidative metabolism and/or its dysfunction at a cellular level.