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find Keyword "人工血管" 45 results
  • Adult Diameter Artificial Vascular for Right Pulmonary Artery Originated from Ascending Aorta

    ObjectiveTo summarize our experience of surgical treatment for right pulmonary artery originated from the ascending aorta by using adult diameter artificial vascular and study the operative indication, design, method, and therapeutic efficacy. MethodsWe retrospectively analyzed clinical data of 11 patients with right pulmonary artery originated from ascending aorta in The Second Affiliated Hospital of Harbin Medical University from May 2008 through December 2013, who were treated by using adult diameter artificial vascular. The patients ranged from 4 months to 25 months old, weighted 4-15 kg. Among of them, 4 patients had persistent truncus arteriosus and 7 had aortopulmonary septal defect. All patients were complicated with moderate pulmonary hypertension. All the patients underwent one stage surgical repair under extracorporeal circulation and cardiac arrest. During the surgery, end to side anastomosis was done between the right pulmonary artery and 16-18 mm diameter artificial blood vessels. And artificial blood vessel was connected to the main pulmonary artery or right ventricle outflow tract incision from the aorta above. ResultsThe average operation time was 179-325 (224±68) min. The average cardiopulmonary bypass (CPB) time was 81-208 (117±54) min. The average aortic clamping time was 29-63(42±21) min. The mean residence time in ICU was 71-197 (109±42) hours. The average assisted mechanical ventilator time was 59-191 (91±26) hours. The average length of stay in hospital was 21-39 (28±11) days. Low cardiac output syndromes caused by pulmonary arterial hypertension occurred in 5 patients including 2 deaths and 3 patients with good recovery by reducing the pulmonary arterial pressure and peritoneal dialysis. The result of postoperative cardiac color ultrasound examination of 9 survival patients showed vascular prosthesis, no distortion, no stenosis of the anastomosis, deformity correction satisfaction. Nine patients were followed up for 3-60 months. The results of echocardiography showed no anastomosis and artificial vascular stenosis, and the pulmonary arterial pressure decreased significantly. ConclusionThe right pulmonary artery originated from the ascending aorta in children should be operated as soon as possible. Compared the adult diameter artificial vascular treatment for one stage repair of right pulmonary artery from the ascending aorta with other operation methods, both short-term and long-term effects are good. Postoperative low cardiac output syndrome is a common complication.

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  • 胸腹主动脉瘤Ⅳ型行外科及腔内微创术围手术期护理

    【摘要】 目的 总结对胸腹主动脉瘤IV型行血管外科和腔内微创术治疗患者的护理要点及经验。 方法 2007年11月-2008年1月对收治的1例胸腹主动脉瘤IV型行血管外科和腔内微创术患者,术前做好心理护理,控制血压,完善术前相关检查等;术后做好生命体征的监测、预防术后吻合口出血、支架移位、内漏、肠坏死、肾功能衰竭等并发症发生的各项护理工作。 结果 患者无并发症发生,痊愈出院,治疗和护理效果满意。 结论 围手术期实施正确恰当的护理是保证手术和治疗效果的关键。

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  • Development and Current Status of Vascular Surgery in China

    我国血管外科在布加综合征的研究和治疗、血管腔内技术、人工血管内皮化、干细胞移植治疗肢体缺血等方面均达到国际水平[1,2]。现就我国血管外科的进展和特点分述如下。......

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  • Advances in Vascular Prosthesis in Which Lined with Genetically Modified Endothelial Cells

    Objective To discuss the endothelial cell which was modified by exogenous anticoagulant genes contribute to the increase of antithrombosis activity of lined vascular prosthesis and the influence to other physiological functions of endothelial cells. Methods This summarized paper was made on literature review of recent years. Results The transfection of genes, including plasminogen activator (tPA, uPA, Urokinase), thrombomoduline (TM) and hirudin, etc, to endothelial cells resulted in not only the increase of antithrombosis activity of local vascular, but also the decrease of endothelial cell function in adherence and proliferation. Conclusion The increase of antithrombosis activity of lined vascular prosthesis has been done by exogenous genes. However, this technique ought to be studied, intensively.

    Release date:2016-08-28 04:43 Export PDF Favorites Scan
  • STUDY ON THE CHANGES OF cAMP AND cGMP WITHIN PLATELET AND IN SERUM IN THE COURSE OF CANINE INFERIOR VENA CAVA RECONSTRUCTION

    The Dacron grafts seeded with autologous venous fragments were implanted into IVC of 13 canines as seeded group and the control grafts (8 cases), which were only preclotted with fresh blood. The amounts of cAMP and cGMP in serum and within platelet were measured. All of the specimens explanted at exsaguination were observed morphologically. The results shown that the total patency rate were 61.5% in seeded group, but 25.0% in control one and new endothelial lining formed at two weeks after implantation of the seeded grafts. The amounts of cAMP in serum and within platelet were higher in seeded group, but the amounts of cGMP were lower in serum and within platelet. These were in accordance with the results that the endothelialization of the grafts were complete in seeded group but not complete in control one. The results indicate that seeding Dacron with autologous venous fragment makes new endothelium formed at two weeks after implantation, increases the amounts of cAMP in serum and within platelet, but reduces the amounts of cGMP and thus improves graft patency rate.

    Release date:2016-08-29 03:18 Export PDF Favorites Scan
  • Choice of Conduit Size and Material for Palliative Right Ventricle-to-Pulmonary Artery Shunt

    Objective To assess clinical results of three different conduit materials (Gore-Tex synthetic graft,bovinejugular vein and autologous pericardium)for palliative right ventricle-to-pulmonary artery (RV-PA) shunt,and explore the correlation between suitable conduit size and patients’ body weight and McGoon ratio. Methods We retrospectively analyzed clinical data of 24 patients with congenital heart diseases who underwent palliative RV-PA shunt in Department of Pediatric Cardiovascular Surgery of Fu Wai Cardiovascular Hospital from July 2010 to July 2012. There were 11 males and 13 females with their age ranging from 60 days to 6 years and body weight of 10.22±7.41 kg. There were 22 patients with pulmonary atresia and ventricular septal defect (PAVSD),1 patient with tetralogy of Fallot (TOF) and 1 patient with doubleoutlet right ventricle (DORV). Among different conduit materials,autologous pericardium was used for 17 patients,Gore-Texsynthetic graft was used for 5 patients,and bovine jugular vein was used for 2 patients. Conduit size and children’s body weight were analyzed with linear regression,then the equation was corrected with McGoon ratio. Results There was no perioperative death. Postoperative percutaneous saturation (SpO2)of the 24 children was 20.37%±28.33% higher than preoperative SpO2 . Electrocardiogram showed sinus rhythm in all the patients. Twenty-three patients were NYHA classⅡ,and 1 patient was NYHA classⅢ. Postoperative mechanical ventilation time of patients with autologous pericardium were significantly shorter than those of patients with other 2 materials (P=0.017). Sixteen patients were followed up from 10 months to 2 years after discharge,including 12 patients with autologous pericardium,3 patients with Gore-Tex synthetic graft and 1 patient with bovine jugular vein. During follow-up,McGoon ratio of patients with autologous pericardium,Gore-Tex synthetic graft and bovine jugular vein were 1.98±0.46,1.83±0.33 and 1.68 respectively,all of which weresignificantly higher than preoperative McGoon ratio (P<0.05). Six patients underwent radical corrective surgery,including5 patients with autologous pericardium and 1 patient with Gore-Tex synthetic graft. There was no complication directly related to surgery during follow-up. Linear regression was performed to form an equation between suitable conduit size and patients’ body weight:conduit diameter (mm)=0.327×body weight (kg)+4.599. McGoon ratio,conduit size and equationresult were compared to find a practical choice of conduit size. If McGoon ratio<0.8,the first integer greater than the equation result could be chosen. If McGoon ratio>1.2,the first integer less than the equation result could be chosen. If 1.2>McGoon ratio>0.8,the first integer either less or greater than the equation result could be chosen. Group analysis showed that patients who recovered better postoperatively were those whose conduit sizes were closer to equation results as well as equation results corrected with McGoon ratio. Conclusion All the 3 materials can be conventionally chosen for RV-PA shunt. Appropriate conduit size can be decided upon patients’ body weight and McGoon ratio for RV-PA shunt.

    Release date:2016-08-30 05:47 Export PDF Favorites Scan
  • Ring Annuloplasty Using Prosthetic Vascular Graft for the Treatment of Tricuspid Regurgitation:Experience in 56 Patients.

    Abstract: Objective To evaluate the surgical effect of ring annuloplasty using prosthetic vascular graft for the treatment of tricuspid regurgitation. Methods From July 2000 to July 2010, ring annuloplasty using prosthetic vascular graft was performed to a total of 56 patients with tricuspid regurgitation in Changhai Hospital of Second Military Medical University. There were 24 male patients and 32 female patients. Their mean age was(45.7±21.8)years (ranging from 14 to 73 years). All the patients were diagnosed as moderate to severe tricuspid regurgitation by color Doppler echocardiography examination, including 47 patients with rheumatic heart valve diseases, and 9 patients with congenital heart disease (Ebstein’s anomaly). All the 56 patients underwent ring annuloplasty using prosthetic vascular graft instead of Carpentier annuloplasty ring for the treatment of tricuspid regurgitation. Results There was no in-hospital death. Postoperatively, one patient had acute respiratory failure, one patient had acute kidney failure, and one patient had re-exploration for bleeding. All patients had none or mild tricuspid regurgitation by echocardiography examination one month after surgery. Forty eight patients were followed up from 1.0 to 9.5 years with a median follow-up time of 3.8 years. During follow-up, there was no late death, but one patient had brain embolism as an anticoagulation complication. Sixteen patients were in New York Heart Association (NYHA) functional classⅠ, 26 patients in NYHA classⅡ, and 6 patients in NYHA class Ⅲ. Thirty six patients had no tricuspid regurgitation, 10 patients had mild tricuspid regurgitation, and 2 patients had moderate tricuspid regurgitation by echocardiography examination during follow-up. Conclusion The early and mid-term follow-up results of ring annuloplasty using prosthetic vascular graft instead of Carpentier annuloplasty ring for the treatment of tricuspid regurgitation are satisfactory. It is a good choice for the surgical treatment of tricuspid regurgitation.

    Release date:2016-08-30 05:49 Export PDF Favorites Scan
  • Extraanatomic Aortic Bypass Grafting Through Median Sternotomy for Onestage Treatment of Aortic Coarctation and Associated Cardiac Diseases

    Objective To summarize the experience of extraanatomic aortic bypass grafting through median sternotomy for onestage 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 onestage 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: ascendingto posterior pericardial descending aorta (n=9) and ascendingtoinfrarenal 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 inhospital 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). Twentyseven patients were followed up from 4 to 73 months, there were no late deaths,reoperations or graftrelated complications. Conclusion Extraanatomic 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 onestage surgical repair in adults and adolescents. Both ascendingto posterior pericardial descending aorta and ascendingtoinfrarenal abdominal aorta bypass have favorable results.

    Release date:2016-08-30 06:06 Export PDF Favorites Scan
  • 全主动脉弓置换加支架象鼻手术治疗A型主动脉夹层

    目的 介绍全主动脉弓置换加支架象鼻手术治疗A型主动脉夹层的方法,总结其治疗经验。 方法 2007年1月至2008年11月,采用四分支人工血管行全主动脉弓置换加覆膜支架象鼻手术治疗A型主动脉夹层10例,其中急性夹层8例,慢性2例。10例均在深低温停循环及选择性脑灌注下完成手术,对5例合并主动脉瓣中至重度关闭不全的患者同期行Bentall手术,余5例行升主动脉置换术。 结果 1例于术后26 d因多器官功能衰竭死亡; 余9例均顺利康复出院,无严重神经系统并发症。术后随访2~25个月,均生存,心功能Ⅰ~Ⅱ级。 结论 采用四分支人工血管行全主动脉弓置换加覆膜支架象鼻手术是治疗A型夹层的有效手术方式,手术操作技术和脑保护措施是决定手术效果的关键。

    Release date:2016-08-30 06:05 Export PDF Favorites Scan
  • Analysis of Mid Term Results of Total Thoracoabdominal Aortic Replacement: Report of 63 Cases

    Objective To investigate the further results of thoracoabdominal aortic aneurysm (TAAA) repair, and analyze the midterm results of 63 cases treated by total thoraco abdominal aortic replacement with a tetrafurcate graft. Methods From August 2003 to October 2007,total thoracoabdominal aortic replacement with a tetrafurcate graft was performed in 63 consecutive patients with Crawford Ⅱ TAAA in Fu Wai Hospital. There were 46 male and 17 female with a mean age of 39.98 years (17-71 years). All the procedures were performed through combined thoracoabdominal incision via the retroperitoneal approach and underwent profound hypothermia with shorttime interval circulatory arrest. T6 to T12 intercostal arteries were reconstructed by arterial tube technique. The celiac artery, superior mesenteric artery and right renal artery were joined into a patch and anastomosed to the end of the main graft. Left renal artery was anastomosed to an 8 mm branch or joined to the visceral arterial patch. The other 10 mm branches were anastomosed to iliac arteries. KaplanMeier method was used to perform survival analysis. Results All the cases were followed,and the mean followup time was 36.57(8-57) months. No patient died during the operation. Early mortality rate was 7.94%(5/63). Among them, 4 patients died of multiple organ failure. Two of them were caused by neurological complications, and the other 2 of them were caused by renal failure. One patient died of low cardiac output syndrome after surgery because of coronary artery disease. This patient underwent coronary artery bypass grafting (CABG) emergently, but couldn’t wean from cardiopulmonary bypass. The incidence of stroke and temporary neurological dysfunction was 9.52%(6/63), 4 of them were temporary neurological dysfunction and were cured before discharged from hospital. Paraplegia and paraparesis occurred in 2 and 1, respectively. They were all [CM(158.3mm]cured before leaving hospital. Pulmonary complication was 25.40%(16/63), and12 of them were cured. Pseudoaneurysmal change was observed in reconstructed intercostal arteries in 2 patients with Marfan syndrome, but neither of them underwent paraplegia or paraparesis. One patient died at 20th, 23rd, 30th month after discharge, respectively. The survival time of this group was 50.64±2.13 months(95%CI:46.47,54.84 months) with a survival rate of 92.06% after 1 year, 88.38% after 2 years, 86.11% after 3 years. Conclusion Using tetrafurcate graft is a reliable method in total thoracoabdominal aortic replacement and has a satisfactory midterm survival rate. The intercostal arteries reconstruction by arterial tube technique in total thoracoabdominal replacement is simple, and it is helpful in spinal cord protection.

    Release date:2016-08-30 06:06 Export PDF Favorites Scan
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