Objective To assess the results of Fluoro Jade-c (FJC) staining in brain injury after deep hypothermia circulatory arrest (DHCA). Methods First, animal model of DHCA were established. We performed DHCA on six Chinese experimental minipigs and made sure all the pigs were alive after operation. Second, pathological examination was carried out on the brain tissues of these animals. After FJC staining, we respectively took out the positive and negative tissueparts and performed Hematoxylineosin (HE) staining, Nissl staining and Terminal deoxynucleotidyl Transferase BiotindUTP Nick End Labeling (TUNEL). Finally, the results of FJC was compared with TUNEL, Nissl staining, HE staining, to verify the accuracy and reliability of FJC in assessing brain injury after DHCA. Results Postoperative FJC staining discovered positive disease focuses on the experimental pigs. The comparative results of FJC were consistent with TUNEL (Kappa=0.526, Plt;0.01), Nissl staining (Kappa=0.555, Plt;0.01) and HE staining (Kappa=0.491, Plt;0.01). However, FJC staining image was much clearer and easier in identifying brain injury. Conclusion FJC is a reliable and convenient method to assess brain injury after DHCA.
Objective To summarize the clinical experiences of using selfpericardial patch heightening to treat aortic valve prolapse. Methods From May 2000 to July 2007, seventeen patients with aortic valve prolapse were treated by selfpericardial patch heightening. Fifteen cases had right coronary cusp prolapse, one had left coronary cusp prolapse, and one had no coronary cusp proplapse. There were 10 cases with moderate aortic regurgitation and 7 with severe regurgitation. Autologous pericardium was continuously sutured on the proplapsed cusp by 5-0 or 6-0 Prolene suture. The transesophageal echocardiography(TEE) showed that there was few or mild aortic regurgitation during operation. Preoperative and postoperative echocardiography results were compared. Results The comparison between preoperative and postoperative echocardiography results showed that postoperative left ventricular enddiastolic diameter reduced obviously(38.3±9.6 mm vs. 47.2±10.3 mm，P=0.013)；postoperative aortic valve systolic pressure difference reduced（9.8±5.6 mm Hg vs. 10.3±5.3 mm Hg，P=0.792）; postoperative aortic valve diastolic pressure difference reduced obviously(45.7±13.6 mm Hg vs. 78.4±19.9 mm Hg，P= 0.000). Echocardiographic examination before discharge showed that 4 cases had no obvious aortic regurgitation, 9 had mild aortic regurgitation and 4 had moderate aortic regurgitation. The average followup time was 32 months(4.74 months). One case underwent aortic valve replacement because of severe aortic regurgitation 4 months later after the operation, and the rest needed no second operation. Conclusion Using selfpericardial patch heightening to treat aortic valve prolapse is a simple operative method, and it is good for young patients or small aortic annulus.
Objective To analyze the causes of mechanical valve dysfunction and the reconstructive surgical procedure, and summarize the treatment experiences in perioperative period. Methods From October 1996 to October 2008, 12 276 patients underwent mechanical valve replacement in Fu Wai Hospital. Thirtytwo of them were reoperated because of mechanical valve dysfunction. There were 12 male and 20 female aged from 1661 years with an average age of 43.8 years. All the reoperations were performed under hypothermic cardiopulmonary bypass, including 16 mitral valve replacement, 8 aortic valve replacement, 3 aortic and mitral valve replacement, 3 tricuspid valve replacement, 2 disc rotation and 1 excision of an excessive knot. There were 13 emergency operation and 19 elective operation. Results The time of ventilator assistant respiration was 5.1-144.0 hours.The median time was 15 hours and tracheostomy was needed in 2 cases. Six patients died after reoperations, the mortality rate was 18.8%(6/32). Three died of low cardiac output syndrome, 2 died of multiple organ failure and 1 died of malignant arrhythmia. Three cases had complications. There were 1 infective endocarditis, 1 intractable hiccup and 1 incisional infection, respectively. They were all cured and discharged. Conclusion Prosthetic valve dysfunction is one of the serious complications after mechanical valve replacement. Early detection, early diagnosis and early reoperation are needed.
Objective To compare the effects of two kinds of cannulation sites on the myocardial oxygen metabolism during left ventricular assistance to provide experimental basis for clinical selection of proper cannulation sites. Methods Twelve mongrel dogs were randomized equally into the left atrium to aorta group （LA group） and left ventricle to aorta group （LV group）, and underwent left ventricular assistance. At different times before and during left ventricular assistance, the heart rate, coronary sinus flow rate and blood gas were determined and coronary sinus oxygen saturation, arteriovenous oxygen difference and myocardial oxygen consumption were calculated. Results There was no statistical difference of heart rate in both groups（P〉0. 05）. The coronary sinus flow rate and mean myocardial oxygen consumption reduced in both groups after left ventricular assistance, whereas the effect was more remarkable in the LV group （P〈0.01）. Conclusion Both cannulation methods could reduce the myocardial oxygen consumption during left ventricular assistance, and the effect is more apparent in left ventricular cannulation.