Objective To verify the pattern characteristics of optical coherance tomography (OCT) images in diabetic maculopathy (DM). Methods OCT were performed in sixty cases of DM and 30 cases of normal control group,and in 54 cases of DM,fundus fluorescein angiography (FFA) was performed simutaneously.The results from 2 kinds of examinations were compared each other. Results The average retinal thickness at the central fovea was (314.54plusmn;154.13) mu;m in DM group.The macular edema in the cases of DM accounted to 57.1% on OCT examination. The rate of retinal swelling associated with cystoid macular edema (CME) was 38.5%,with retinal detachment (RD) 9.2%,and with both CME and RD was 16.9%Those with mormal macular thickness and mild macular edema primarily showed focal leakage in FFA exam,while those with moderate and severe macular edema showed diffuse leakage in FFA exam.The rate of CME was 28.6% presented in FFA and 58.9% in OCT examination (t= 3.39,Plt;0.05). Conclusion OCT images of DM reveal 3 kinds of morphological features：retinal welling,CME,and sensory retinals de tachment.OCT is superior to FFA in detecting CME. (Chin J Ocul Fundus Dis, 2001,17:184-186)
Double outlet right ventricle (DORV) is a complex cardiac malformation with many anatomic variations and various approaches for surgical repair. DORV is mainly defined as the congenital heart disease with ventriculoarterial connection in which both pulmonary artery and aorta arising primarily (>50%) from the right ventricle, associated with continuity or discontinuity between the aorta and mitral valve. DORV can be subclassified by various ways. Now subclassification is usually performed according to the relationship between the ventricular septal defect (VSD) and the great arteries. Various approaches for surgical repair of DORV ranging from single ventricle palliation to biventricular repair are reported from many centers. However, the high-grade guideline of surgical management of DORV is still absent. Hence, we developed the Chinese expert consensus on DORV as the evidence for surgical strategies.
ObjectiveTo explore the appropriate method of biventricular repair and analyze the risk factors for reoperation, by summarizing the 15-year treatment experience of biventricular repair for double outlet right ventricle with non-committed ventricular septal defect (DORVncVSD).MethodsClinical data of 162 consecutive patients with DORVncVSD who had biventricular repair from 2005 to 2019 in our center were retrospectively analyzed. The children were divided into two groups according to the path of intracardiac tunnel: 110 patients with ventricular septal defect rerouted to the aorta were recruited into a group A (75 males and 35 females aged 3.6±3.2 years); 52 patients with ventricular septal defect rerouted to the pulmonary artery were into a group B (30 males and 22 females aged 2.8±2.7 years). In order to establish a smooth intracardiac tunnel, enlargement of VSD, the resection of conus muscle and the transfer of tricuspid tendon or papillary muscle, etc were performed at the same time.ResultsIn the patients with biventricular repair, there were 9 (5.6%) early deaths and 6 (3.7%) early intracardiac baffle obstructions. During the follow-up of 7.5±7.0 years, and 8 (4.9%) late deaths occurred. The 1-year, 5-year, 10-year and 15-year survival rates of the group A were 92.7%, 91.1%, 91.1%, 85.4%, respectively and those of the group B were 92.2%, 85.2%, 85.2%, 85.2%, respectively. The difference between the two groups was not statistically significant (P=0.560). The follow-up results showed that 10 (6.2%) patients had late-onset intracardiac tunnel obstruction, and 8 patients underwent reoperation. There were more late-onset intracardiac tunnel obstruction patients and overall intracardiac tunnel obstruction patients in the group A than those in the group B (9 patients vs. 1 patient, P=0.017; 15 patients vs. 1 patient, P=0.001). No significant difference of early mortality and late mortality was noted for the group A (P=0.386) and the group B (P=0.223). Also it was noted that performing tricuspid valve operation at the same time in the group A had a significant impact to reduce the occurrence rate of intracardiac obstruction (1/46 vs. 15/64, P=0.004), without any tricuspid regurgitation or stenosis. The reoperation rate of patients with Rastelli after right ventricular outflow tract lesions was significantly higher than that of REV surgery and double root replacement surgery (5/14 vs. 0/38, P<0.001).ConclusionThe effect of biventricular repair for DORVncVSD is satisfactory. And concomitant tricuspid procedures can help reduce the occurrence of intracardiac obstructions. Reconstruction of right ventricular outflow tract with biological valved conduit is a risk factor for reoperation.
ObjectiveTo evaluate the mid- and long-term outcomes of different surgical techniques for subaortic stenosis.MethodsThe clinical data of 75 patients with subaortic stenosis who underwent surgery in our hospital from January 2008 to January 2018 were retrospectively analyzed, including 48 males and 27 females, with a median age of 72 (48, 132) months and mean weight of 21.35±15.82 kg. There were 40 (53.3%) patients combined with aortic regurgitation; 38 (50.7%) patients were the first time and 37 patients were the second time to receive the operation. According to the surgical techniques, 75 patients were divided into two groups: a group A (40 patients with simple subaortic membrane resection) and a group B (35 patients with subaortic membrane and muscle resection or modified Konno procedure).ResultsTwo (2.67%) patients died in hospital. There was one late death in the group B. The average preoperative and postoperative pressure gradient of all patients was 69.96±42.02 mm Hg and 7.44±12.45 mm Hg, respectively. All patients were followed up for 51 (12, 120) months. Pressure gradient at follow-up in the group A and the group B was 8.83±14.52 mm Hg and 5.86±9.53 mm Hg, respectively with no statistical difference (P=0.294). Four patients in the group A and 2 patients in the group B needed reintervention. However, there was no statistical difference in the long-term reintervention rate between the two groups (P=0.480).ConclusionFor the different degree of lesions in the left ventricular outflow tract, our management strategy is feasible. Although there is no statistical difference between two the groups in the long-term reintervention rate after simple valvular membrane resection, prolonged follow-up is necessary to examine the long-term outcomes of different surgical techniques.
Objective To investigate the cl inical appl ication and efficacy of lumbar vertebral canal expansion withpreservation of posterior l igaments complex, and to study its biomechanical properties. Methods Eight fresh lumbosacralcadaveric samples were divided into 3 groups. In group A, 8 intact lumbosacral cadaveric samples were used for biomechanical test. In group B, L3-5 laminectomy were, after the test in group A, performed and the posterior l igaments complex was preserved. In group C, the posterior l iagments complex was excised after the test in group B. In all 3 groups, the axial compression test, three-point bending test and torsional test were conducted. From June 2000 to June 2006, 309 patients (152 males and 157 females, aged 20-80 years with the average of 57.2 ) with lumbar canal stenosis received operation of the lumbar vertebral canal expansion with preservation of posterior l igaments complex. The course of disease was 3 months to 41 years. There were 55 patients suffering from pure lumbar canal stenosis, and 254 from lumbar canal stenosis combined with lumbar disc herniation, among which 105 were at L4, 5 level, 56 at L4-S1 level, 86 at L5, S1 level, and 7 at L2, 3 level. The therapeutic effect was assessed based on the JOA low back pain scoring system, the satisfaction degree of patient and radiographical observation. Results The axial compression test was performed. In the position of forward bending, stress, strain and axial displacement were smaller in groups A, B than those in group C, and axial stiffness in groups A, B was higher than those in group C, and the difference was significant(P lt; 0.01). In the position of backward extension, there was no significant difference among 3 groups (P gt; 0.05). Concerning the three-point bending test, under the same bending moment, there was a significant difference in deflection, dip and bending rigidity between group A and group C, and also between group B and group C (P lt; 0.01), but no significant difference between group A and group B (P gt; 0.05). In the torsional test, under the same torsional angle, the torque in group B was bigger than that in group C (P lt; 0.01). Under the same torque, the torsional angle in group B was smaller than that in group C (P lt; 0.01), and the torsional stiffness in group B was higher than that in group C (P lt; 0.01). The compl ications included 7 cases of distraction of nerve root, 5 leakage of cerebrospinal fluid and 4 wound infection. All compl ications were treated and restored completely. All patients were followed up for 1-7 years. According to the JOA low back pain scoring system, the improvement rate averaged 86.0%. Of all the 309 cases, 163 were excellent, 112 good, 34 fair, and the choiceness rate was 89%. The satisfaction rate of patient was 87%. There was no radiographic vertebral instabil ity postoperatively. Conclusion The lumbar vertebral canal expansion with preservation of posterior l igaments complex is conducive to maintaining the stabil ity of lumbar spine and have good cl inical outcomes.
ObjectiveTo detect level of circulating tumor cells (CTCs) in peripheral venous blood of fasting patients with gastric cancer (GC) and to analyze relationships between CTCs and clinicopathologic features and prognosis of patients with GC.MethodsOne hundred patients with GC were selected (GC group), who underwent the surgery and confirmed by the histopathology in the 940 Hospital of Joint Service of PLA, from August 2015 to December 2016. Thirty-eight patients with gastric benign lesions who were treated in this hospital at the same time were selected as the control group. The 7 mL peripheral venous blood of the elbow in the morning was taken from the fasting patients and the CTCs were detected by the immunomagnetic microparticle negative enrichment combined with immunofluorescence in situ hybridization within 24 h. The positive rate of CTCs was calculated and its relationships with the clinicopathologic features (tumor location, tumor invasion depth, degree of differentiation, TNM stage, lymph node metastasis, and vascular tumor thrombus) and the progression-free survival of the patients with GC were analyzed.ResultsThe positive rate of peripheral venous blood CTCs in the GC group was 89.0% (89/100), which was higher than that in the control group (10.5%, 4/38), and the difference was statistically significant (P<0.001). The levels of CTCs in the patients with GC were significantly correlated with the tumor invasion depth (P=0.017), lymph node metastasis (P=0.038), and TNM stage (P=0.016), which were not associated with the age, gender, tumor location, degree of differentiation, and vascular tumor thrombus (P>0.050). The predictive value of CTCs for the diagnosis of GC was significantly superior to that of the tumor markers CEA, CA19-9, or CA125. The progression-free survival of patients with low CTCs expression was significantly longer than that in the patients with high CTCs expression (χ2=5.172, P=0.023).ConclusionsDetecting CTCs of patients with GC by immunomagnetic particle negative enrichment combined with immunofluorescence in situ hybridization has a high sensitivity. And it can improve early diagnosis of patients with GC. Preoperative CTCs detection has a certain value in guiding staging of GC and predicting prognosis of patients with GC.
ObjectiveTo explore the operative strategy after palliative shunt for correcting congenitally corrected transposition of great artery (cTGA) patients with left ventricular outflow tract obstruction (LVOTO) and cardiac malpostion.MethodsWe retrospectively analyzed the clinical data of 54 patients with onsecutive cTGA with LVOTO and cardiac malpositon from June 2011 to May 2019. The patients were devided into two groups. There were 24 patients (16 males and 8 females at mean age of 5.4±2.2 years) who underwent one and a half ventricle repair as a one and half ventricle group. And there were 30 patients (19 males and 11 females at age of 8.6±6.2 years) who underwent one ventricle repair operation as a one ventricle group. Follow-up data were collected by telephone interviews.ResultsThere was no statistical difference in systemic atrioventricular valve regurgitation and systemic ventricular ejection fraction between the two groups (P>0.05). Compared with one and a half ventricle group, the cardiopulmonary bypass time (CPB) time, mechanical ventilation time and intensive care unit stay were significant shorter than those in the one ventricle group (P<0.05), but prolonged pleural effusions developed more frequently in the one ventricle repair group (P<0.05). There was no in-hospital death but 1 follow-up death in each group. The follow-up time was 49 (17-38) months in the one and half ventricle group at follow-up rate of 93.9%, and 47 (12-85) months at follow-up rate at 90.9% in the one ventricle group. One and a half ventricle group had better systemic ventricular ejection fraction (EF) than that in the one ventricle repair group. And the rate of heart function (NYHA) class Ⅲ and class Ⅳ in one and a half ventricle group was lower than that in the ventricle group. No significant difference of survival and freedom from re-intervention probability between the two groups was found.ConclusionFor patients of correction of cTGA with LVOTO and cardiac malposition after palliative shunt, the one-and-a-half ventricular repair procedure is ideal operative strategy.
ObjectiveTo analyze the results of surgical treatment of severe aortic stenosis in infants.MethodsFrom August 2012 to December 2019, 28 infants undergoing aortic valvuloplasty in our hospital were selected, including 22 males and 6 females, aged 62.00 (47.00, 82.50) d. The baseline characteristics of the patients, postoperative complications and follow-up results were analyzed.ResultsTwenty (71.43%) patients had bicuspid aortic valves. Five (17.86%) patients had heart failure and two (7.14%) patients used prostaglandin before surgeries. Postoperative mechanical ventilation time was 25.00 (17.00, 62.75) h, ICU stay was 3.50 (2.00, 8.50) d and postoperative hospital stay was 10.00 (7.00, 16.50) d. Four (14.29%) patients got delayed recovery (ICU stay>14 d). One (3.57%) perioperative death was observed. The follow-up time was 55.00 (43.25, 82.25) months. No death was found during follow-up. Four (14.81%) patients underwent a second operation, including three (11.11%) patients with severe aortic stenosis, and one (3.70%) patient with severe regurgitation.ConclusionInfants with severe aortic stenosis are seriously ill and have a long postoperative recovery time, requiring early surgery. The postoperative follow-up results are satisfactory.
ObjectiveTo summarize the surgical experience of patients with anomalous left coronary artery from the pulmonary artery (ALCAPA) and intramural left coronary artery and analyze the early and mid-term clinical outcomes. Methods The infants with ALCAPA and intramural left coronary artery who underwent surgical treatment in Fuwai Hospital from January 2014 to September 2020 were retrospectively enrolled, and the clinical data of the patients were analyzed. Results A total of 10 patients were included. There were 8 males and 2 females, with a median age of 7.5 (3-46) months at surgery. The surgical techniques included coronary unroofing in 7 patients, coronary unroofing with coronary reimplantation in 2 patients, and coronary unroofing with ligation of left coronary artery ostium in 1 patient. Seven infants received additional procedures, including 5 mitral valve repair. Delayed chest closure was required in 2 infants, and no operative death or major complications occurred in the whole group. Postoperative chest radiograph showed that the mean cardiothoracic ratio was lower than that before surgery (0.62±0.05 vs. 0.67±0.06, P=0.006). Postoperative echocardiography indicated that the mean left ventricular ejection fraction was increased than that before surgery, but there was no statistical difference (38.7%±15.9% vs. 30.0%±16.1%, P=0.066). The follow-up was available for all 10 survivors, with an average follow-up time of 13-92 (46.6±25.0) months. During the follow-up period, the patients had no obvious symptoms, death, coronary complications or other major complications. The chest radiograph at last follow-up showed that the mean cardiothoracic ratio was further decreased (0.60±0.07 vs. 0.62±0.05, P=0.024). The echocardiography at last follow-up showed that the mean left ventricular ejection fraction was further improved (60.1%±9.3% vs. 38.7%±15.9%, P=0.002). Conclusion ALCAPA with intramural left coronary artery is a rare malformation. It can be treated with different surgical techniques with satisfactory early and mid-term outcomes.
ObjectiveTo analyze the mid-long-term outcomes of surgical balloon valvuloplasty (SBV) for right ventricular decompression in the treatment of pulmonary atresia with intact ventricular septum (PA/IVS).MethodsClinical data of consecutive 91 patients who were diagnosed with PA/IVS and underwent SBV in our institution from January 2005 to December 2017 were retrospectively analyzed, including 52 (57.1%) males and 39 (42.9%) females. The median age was 3 months (1 d, 24 months) and the median weight was 4.1 (2.5, 12.0) kg.ResultsThe SBV was performed in all patients, and 62 of whom received other simultaneous surgeries, including ligation of patent ductus arteriosus (PDA, 33 patients), ligation of PDA with modified Blalock-Taussig shunt (23 patients), ligation of PDA with bidirectional Glenn shunt (6 patients). There was no early postoperative death. The median follow-up time was 8.8 (2.5, 13.4) years, 4 patients were lost. There were 7 (8.0%) deaths and 1 (1.1%) patient with a re-SBV for pulmonary stenosis. The one and a half ventricular repair was performed in 5 (5.7%) patients and Fontan procedure in 2 (2.3%) patients. In addition, the mean Z-value of tricuspid valve annulus was −1.7±1.5, which was significant bigger than that before the operation (t=5.587, P<0.001).ConclusionSBV via right ventricular outflow tract for right ventricular decompression in the treatment of PA/IVS is safe and reliable. The majority of patients can receive biventricular repair instead of single ventricular palliation by SBV with individually customized shunt.