Objective To summarize the experience of the surgical treatment of total anomalous pulmonary venous connection (TAPVC) in 31 cases，so as to elevate the operative effect. Methods The total corrected operation under moderate hypothermic cardiopulmonary bypass were performed in 31 cases with TAPVC. Site of drainage was supracardiac (n=16),cardiac(n=13)and mixed(n=2). Other accompanying congenital cardiac malformations were diagnosed such as atrial septal defect(n=31), patent ductus arteriosus(n=4), pulmonic stenosis(n=1), mitral regurgitation(n=1), tricuspid regurgitation (n=15)，etc. Results No hospital death was observed in the early period of operation (30 d). Complication occurred in 8 cases (25.8%), such as paroxysm of nodal rhythm(n=1), Ⅰ° atrial ventricular block(n=1), frequently atrial premature beats and paroxysm of auricular tachycardia(n=1),pulmonary infection(n=2),atelectasis(n=1), pneumatothorax (n=1), left diaphragmatic paralysis and pulmonary infection with tracheal reintubation (n=1),etc. All of them discharged after active therapy. All of 31 cases was followed up, followup time was 2.8±1.5 years. 30 cases were living (96.7%) and 1 case died of heart failure 8 months after operation. 2 cases had auricular arrhythmia with a bad medical effect. 28 cases(93.3%) had normal heart function and they could work and live normally after discharged. Conclusion Surgical procedure should be based on individual abnormality for TAPVC.Surgeons should take care not only of the stenosis of anastomotic stoma,but also of the arrhythmia after operation.Satisfied correction of the abnormality is important and the curative effect of those cases is approving.
Objective To investigate the possible effects of phosphorylated signal transduction and activator of transcription3 (STAT3) in the formation of choroidal neovascuarization (CNV) induced by photocoagulation in rats. Methods The CNV model in rats induced by photocoagulation was established, and the expression of phosphorylated STAT3 at the early stage in CNV were observed by immunofluorescence. To set up the hypoxia model, the specific inhibitor of Janus kinase 2 (JAK2), AG490 was mixed into cell culture fluid and then cultured for 0,1 hour,3,6,12,and 24 hours.Retinal pigment epithelial (RPE) cells proliferation activity were detected by flow cytometry (FCM).the expression of hypoxiainducible factor (HIF)1α and vascular endothelial grow factor (VEGF) mRNA were detected by reverse transcriptase polymerase chain reaction (RT-PCR); the expression of HIF1α protein was detected by Western blot; the content of VEGF in the supernatant of cell culture fluid was measured by enzyme linked immunosorbent assay (ELISA). Results Phosphorylated STAT3 highly expressed in CNV areas in rats 3 days after the photocoagulation. The proliferation activity of human RPE cells under hypoxia condition significantly decreased after inhibition of JAK2/STAT3 signal transduction pathway (t=1.472, 3.566,2.391,6.420; P=0.054,0.038,0.042,0.016). The expression of HIF-1α and VEGF mRNA increased gradually with increasing time of hypoxia;while the expression of HIF1α and VEGF mRNA and the activation of HIF1α protein in cultured human RPE cells with the JAK/STAT3 signal transduction pathway blocked by AG490 were suppressed obviously under hypoxia condition (t=0.07,0.02,0.01, P<0.05); the content of VEGF in RPE cells supernatant decreased significantly (t=1.330,1.106,2.828,7.742,5.610,6.894; P=0.082,0.063,0.014,0.002,0.016,0.011). Conclusion STAT3 may be involved in CNV formation, which may partly dependent on JAK2/STAT3 signal transduction pathway regulating the expression of HIF-1α and VEGF in RPE cells.
Objective To explore a new surgical treatment of patients with severe congenital heart disease associated with tracheal or bronchial stenosis. Methods We retrospectively analyzed clinical data of 32 patients with severe pulmonary blood increased congenital heart disease complicated with tracheal or bronchial stenosis in our hospital between June 2010 and June 2014. There were 18 males and 13 females with an average age of 14.6±4.0 months and a weight of 8.8±3.0 kg. Results Average hospital stay was 12 days. Duration of intraoperative cardiopulmonary bypass was 65.0±21.0 min. Duration of aortic interruption was 42.0±16.0 min. Duration of postoperative ventilator was 25.0±18.0 h. ICU retention time was 4.0±1.8 d. All patients were survived. On the 9th day after surgery, the X-ray chest film revealed that the cardio-thoracic ratio was reduced compared with pre-operation but no statistical significance (P>0.05). Left ventricular end-diastolic dimension (LVEDD) was decreased (P<0.05). Pulmonary artery pressure was lower (P<0.01). The velocity of bloodstream in pulmonary artery was approximately normal. The computed tomography angiography (CTA) on the 9th day after surgery revealed that diameter of pulmonary artery in all patients reduced compared with that of pre-operation (P<0.01). Tracheal diameter of 28 patients returned to normal level and 3 patients had residual mild tracheal stenosis. All preoperative atelectasis recovered to normal level. All patients recovered completely. When the patients were followed up for 6 months to 4 years, the patients grew healthily and no abnormity occurred. Conclusion For the patients with tracheal or bronchial stenosis related to severe congenital heart disease,it is necessary to adopt surgical procedure to relieve the pressure of trachea or bronchus.The bronchial decompression surgery is a perfect and effective method for the patients with tracheal or bronchial stenosis related to severe congenital heart disease.