ObjectiveTo summarize clinical experience and early to mid-term results of modified aortoplasty with external wrap for aneurysmal dilatation of the ascending aorta with or without heart valve disease. MethodsClinical data of 27 patients with aneurysmal dilatation of the ascending aorta who underwent modified aortoplasty with external wrap in Department of Cardiovascular Surgery, Fujian Provincial Hospital from January to October 2003 were retrospectively analyzed. There were 19 male and 8 female patients with their age of 35-71 (57±9)years and body weight of 42-90 (59±11)kg.There were 23 patients with aortic valve disease including 3 patients with bicuspid aortic valve. There were 4 patients in New York Heart Association function class Ⅰ, 9 patients in class Ⅱ, 12 patients in class Ⅲ, and 2 patients in class Ⅳ. Preoperative ascending aortic diameter (AAOD)was 40.0-59.1 (46.4±4.8)mm, left ventricular end-diastolic diameter was 42.5-70.7 (56.9±8.3)mm, and left ventricular ejection fraction (LVEF)was 57.7%±8.0%. Patients were followed up with echocardiography to examine changes of AAOD and left ventricle. ResultsCardiopulmonary bypass (CPB)time was 121.2±52.6 minutes, and aortic cross-clamping time was 70.6±29.7 minutes. Two patients received modified aortoplasty without CPB. There was no in-hospital death.Among the 25 patients who received modified aortoplasty under CPB, 1 patient had cerebral infarction and another patient had hypotension and arrhythmia postoperatively.Postoperative AAOD (36.3±3.4 mm)was significantly smaller than preoperative AAOD (46.4±4.8 mm, t=1.675, P < 0.05). Twenty-four patients were followed up from 1.0 to 120.5 months (average, 35.5 months). During follow-up, no cardiac-related death or reoperation was found. Two patients died of pneumonia, and another 2 patients died of cerebral hemorrhage. One patient had upper gastrointestinal bleeding. Aneurysmal dilatation of the ascending aorta recurred in 1 patient 3 years after discharge with AAOD of 49.9 mm. AAOD at 1 year (40.3±4.3 mm)and 3 years (40.3±5.6 mm)after discharge were significantly smaller than preoperative and postoperative AAOD (P < 0.05). ConclusionModified aortoplasty with external wrap is a good surgical procedure for aneurysmal dilatation of the ascending aorta with or without valve disease, and early to mid-term results are satisfactory.
ObjectiveTo explore the effects of CO2 pneumoperitoneum and posture on circulation function for elderly patients with rectal cancer during laparoscopic operation. MethodsRetrospective analysis of clinical data of 48 elderly patients with rectal cancer was performed, and the data included the heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), cardiac output (CO), cardiac index (CI), central venous pressure (CVP), pH, partial pressure of oxygen (PaO2), and partial pressure of carbon dioxide (PaCO2) at before anesthesia (T1), after anesthesia (T2), after the establishment of CO2 pneumoperitoneum (T3), placement in trendelenburg position after operation (T4), 30 minutes after operation (T5), 60 minutes after operation (T6), 90 minutes after operation (T7), and 120 minutes after operation (T8). ResultsThe levels of HR, SBP, DBP, MAP, CO, CI, pH, PaO2, and PaCO2 at 8 time points didn't statistically differed with each other (P>0.05), but the levels of CVP at T7 and T8 time point were significantly higher than those of T1 and T2 time point (P<0.05). ConclusionsDuring laparoscopic operation period for the elderly patients with rectal cancer, the CVP will gradually increase. If the preoperative assessment and administration are done well during peri-operation period, laparoscopic operation is safe for the elderly patients with rectal cancer.