Abstract： Objective To summarize and evaluate the clinical effect of “modified” ascending aorta and hemiarch replacement combined with stent-graft elephant trunk technique, a new surgical approach for patients with Stanford type A aortic dissection. Methods Between December 2009 and January 2011, the “modified” ascending aorta and hemiarch replacement combined with stent-graft elephant trunk technique was performed to a total of 47 patients suffering from Stanford type A aortic dissection in the First Affiliated Hospital of China Medical University. There were 35 male patients and 12 female patients. Their mean age was（57.9±16.0）years （ranging from 29 to 86 years）. Preoperative computedtomography angiography（CTA） imaging was analyzed using three-dimensional （3D） reconstruction to clarify their diagnosis.All these patients underwent their procedures under cardiopulmonary bypass（CPB）, hypothermic circulatory arrestand right axilary artery cannulation for selected cerebral perfusion. The treatment of proximal end to heart included： ascending aorta replacement in 29 patients, Bentall procedure in 11 patients, Wheat procedure in 4 patients, and David procedure in 3 patients. Five patients underwent concomitant coronary artery bypass grafting. Results Their average CPB time was （136±32） min, average aortic cross-clamp time was （97±28） min, and average selected cerebral perfusion andlower body arrest time was （27±11） min. The in-hospital mortality was （4.25% , 2/47）. Postoperatively, two patients had transient neurological disorder, 1 patient had irreversible paraplegia, and 4 patients underwent reoperations for bleeding. All the 45 surviving patients underwent 3D CTA before discharge and 6 months after operation. The stented elephanttrunk-elastic metal stent were all well exhibited in the true lumen of the descending aorta, and the true lumens distal to the stent graft were also significantly enlarged compared with their preoperative diameters（P ＜ 0.05）. All the patients were followed up from 1 to 13 months. There was no aneurysm rupture and no reoperation related to residual dissected aorta wascarried out during follow-up. Conclusions “Modified” ascending aorta and hemiarch replacement combined with stentgraftelephant trunk technique is a safe and effective approach to treat patients with Stanford type A aortic dissection without involvement of 3 vessels of the arch. The main advantage of this approach is to simplify the surgical procedure, shorten the procedure time and CPB time, and reduce morbidity with a satisfying short-term result.
Abstract： Objective To evaluate the effect of a surgical method for treating mild- to moderate-ischemic mitral regurgitation（IMR） using a self-designed device during off-pump coronary artery bypass grafting（OPCAB）. Methods From September 2009 to August 2011, six patients（4 males, 2 females； age was 52-73 years） with mild- to moderate-IMR underwent OPCAB and concomitant mitral valvuloplasty using a self-designed device in Beijing An Zhen Hospital. Their degree of IMR, anteroposterior diameter of mitral annulus, left ventricular long-axis diameter, left ventricular short-axis diameter and left ventricular spherical index（left ventricular short-axis diameter/left ventricular long -axis diameter）were measured using transesophageal Doppler echocardiography before and after mitral valvuloplasty. Their mean aorta pressure, mean pulmonary artery pressure and central venous pressure were also measured via Swan-Ganz catheter before and after mitral valvuloplasty. Perioperative cardiac function indexes were compared. Results There was no in-hospital death. IMR of all patients disappeared postoperatively. After mitral valvuloplasty their anteroposterior diameter of mitral annulus（3.43±0.08 cm vs.3.68±0.08 cm；t=5.430, P=0.001）, left ventricular short-axis diameter（4.80±0.21 cm vs.5.53±0.11 cm；t=7.530, P=0.001）and left ventricular spherical index（0.64±0.02 vs.0.74±0.01；t=11.110, P=0.002）significantly decreased than those before mitral valvuloplasty . But their left ventricular long-axis diameter and hemodynamic indexes did not change significantly after mitral valvuloplasty. All the six patients were followed up at the out-patient department 3 months postoperatively without autonomous symptoms. Their heart function improved to I class（New York Heart Association）. Echocardiography showed 4 patients without IMR and 2 patients with trace of minimalIMR. Conclusion Off-pump surgical therapy for mild- to moderate- IMR during OPCAB can help the patients reverseremodeling of the left ventricle, avoid the risks of cardiopulmonary bypass and improve cardiac function with good short-term effects. This method may be a good choice for treating patients with IMR.
Abstract: Objective To evaluate the clinical efficacy of sequential bilateral internal mammary artery grafting combined with selective coronary venous bypass graft (CVBG) during offpump coronary artery bypass surgery. Methods We retrospectively analyzed the clinical data of 38 patients with diffuse right coronary arteriostenosis undergoing operation in Anzhen Hospital of Capital Medical University from March 2004 to August 2010. Based on the operation method, the patients were divided into two groups. In the CVBG group, there were 17 patients including 11 males and 6 females with an average age of 46.1±6.2 years who underwent off-pump sequential bilateral internal mammary artery grafting combined with CVBG. In the control group, there were 21 patients including 14 males and 7 females with an average age of 45.9±5.7 years, and they underwent the off-pump sequential bilateral internal mammary artery grafting without CVBG. Blood flow of bridged vessels was measured. The perioperative parameters including number of grafts, tracheal intubation time, hospitalization time, complications, results of echocardiography, myocardial nuclide imaging and coronary angiography were compared between the two groups of patients. Results There was no hospital mortality or complications such as cerebral events, sternal and mediastinal infections. There was statistical difference in graft number between CVBG group and control group (3.3±1.1 vessels vs. 2.2±1.6 vessels, Plt;0.05). There were no statistical differences in internal mammary artery trunk blood flow (81.5±32.7 ml/min vs. 76.8±28.4 ml/min), left internal mammary artery trunk blood flow (32.5±18.8 ml/min vs. 28.1±167 ml/min) and right internal mammary artery trunk blood flow (39.6 ±19.0 ml/min vs. 35.9±18.3 ml/min) between CVBG and control group (Pgt;0.05). Followup was done for all the 38 patients with a follow-up rate of 100%. Follow-up time was 3.55 months (37.4±9.8 months). No angina symptoms occurred in CVBG group and myocardial blood supply of inferior wall in this groups improved obviously based on the results of electrocardiogram, while there were 8 cases of angina in the control group with inferior wall myocardial ischemia and ST-T changes according to the results of electrocardiogram (Plt;0.05). Heart functions were significantly improved in both groups three months after surgery. Through myocardial nuclide imaging, we found that myocardial blood supply of inferior wall was obviously improved in CVBG group. Coronary angiography in CVBG group showed that there was blood flow to myocardium in the arterialized vein. Conclusion Sequential bilateral internal mammary artery grafting combined with selective arterialization of the coronary venous system can be performed during offpump coronary artery bypass surgery. Cardiac functions and quality of life are improved after the surgery. This provides a new surgical method for diffuse right coronary lesions.
Abstract: Objective To build a rat model of right ventricular failure （RVF） by subcutaneous injection of Monocrotaline. Methods Forty Wistar rats were equally divided into four groups, 10 rats each group. Exp4 group: four weeks after Monocrotaline injection, experimental results were observed; Exp6 group: six weeks after Monocrotaline injection, experimental results were observed; Con4 group: four weeks after normal saline injection, experimental results were observed; Con6 group: six weeks after normal saline injection, experimental results were observed. Four and six weeks after Monocrotaline or normal saline injection respectively, the hemodynamic indexes of each pair of groups were measured. Their hearts and livers were excised to measure physiological indexes and had pathological examinations. Results Mean pulmonary arterial pressure (MPAP), maximal rate of change of right ventricular pressure (RV dp/dtmax) and right ventricular ypertrophy index in Exp4 group were higher than those in Con4 group（Plt;0.05,0.01）. Compared with Con6 group, there were obvious symptoms of RVF in Exp6 group which included the increases of heart rate, increases of central venous pressure (CVP) and MPAP, the decreases of RV dp/dtmax, the decreases of weight, the increases of liver weight/body weight ratio and right ventricular hypertrophy index, significant pleural and peritoneal effusions（P＜0.05,0.01 ）. Pathological examination of Exp6 group showed disordering and bifurcated cardiac muscle fibers, large and thickly dying cell core, enlarged transverse diameter of the cardiac muscle fibers and stroma fibrosis. Vacuolar degeneration and dissolved carcoplasm could be seen. The vessel wall of the lung arteriole thickened, intercellular layer smooth muscle cell hyperplasied, elastic fibers increased, vessel wall arteriosclerosised, lumens stenosized. Conclusion This model is simple to build and successful rate is high. It is valuable for further research.
目的 探讨使用生物型非骨水泥假体治疗髋臼内陷症的近期疗效。 方法 2007年6月－2010年5月，对11例12髋髋臼内陷患者行生物型假体全髋关节置换术。男2例，女9例；年龄38～57岁，平均47.3岁。其中继发于类风湿性关节炎7例，创伤4例；病程1～18年，平均8.9年；轻度髋臼内陷6髋，中度髋臼内陷6髋。采用Harris评分标准进行临床疗效评估，摄X线片进行影像学评估。 结果 术后第2天X线片示，人工股骨头距Kohler’s线外移（1.42 ± 2.27）mm，较术前股骨头内陷（?5.17 ± 2.04）mm明显改善（P＜0.05）。术后1周，患者Harris评分为（85.75 ± 4.73）分，较术前（39.75 ± 5.24）分显著提高（P＜0.05）。术后1年X线片示髋臼假体与髋臼内侧壁无透亮线，已骨融合。术后患者获随访2～5年。髋臼假体均无松动移位、脱位或移植骨的吸收。 结论 使用生物型非骨水泥假体结合自体骨移植治疗髋臼内陷症，能有效恢复髋臼运动中心的解剖位置，近期临床疗效满意。
Objective To explore the clinical efficacy and safety of percutaneous kyphoplasty (PKP) in the treatment of Kummell disease. Methods We retrospectively analyzed the clinical data of 11 patients with Kummell disease treated by PKP between January 2013 and January 2016. There were 8 males and 3 females with an average age of 72.3 years old ranging from 64 to 78. The injured vertebra was located at T11 in 2 patients, T12 in 3, and L1 in 6. All the patients suffered from lower back pain for 2.5-15.0 months averaging 7.6 months. Preoperative CT and MRI examinations showed that there were clear signs of intravertebral vacuum cleft and abnormal fluid signals. The Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and the height and kyphotic angle of the injured vertebral body were measured to evaluate the clinical outcomes before and after surgery. Results Follow-up was conducted for all 11 patients. Cement leakage occurred in 4 patients with no symptoms. The vertebral height, Cobb angel of the injured vertebra, VAS and ODI improved significantly after surgery and during the latest follow-up. Compared with those parameters after surgery, only VAS score was different during the latest follow-up. Conclusion PKP is safe and effective in the treatment of Kummell disease.
Objective To evaluate the outcome and explore the mechanism of coronary vein bypass grafting （CVBG） performed by anastomosing the right internal mammary artery with the middle cardiac vein via off-pump surgery. Methods Twelve Chinese experimental miniswines （either male or female, age from 7 to 10 months, body weight 40±5 kg） with severely diffuse stenosis in the right coronary artery were randomly divided into control group and experiment group with 6 miniswines in each group, using a random number table method. CVBG was performed in the experiment group and sham surgery was performed in the control group. To assess cardiac function, graft flow, graft patency and micro-circulation reperfusion of ischemia myocardium, following measurements were conducted. Eight weeks after right coronary endarterectomy, transthoracic echocardiography was performed for both groups. Coronary angiography, graft flow and echocardiography were performed or measured 6 hours and 3 months after CVBG or sham surgery. Measurement of myocardial blood flow with non-radioactive colored microspheres was also conducted 3 months after surgery for two groups. Results There was no statistical difference in cardiac function 8 weeks after right coronary endarterectomy between the two groups. There were significant improvements in cardiac systolic and diastolic function （ejection fraction 3 months after operation: 52%±6% vs. 44%±5%, t=-2.500, P=0.031） in the experiment group after CVBG compared with the control group. Graft flow of the experiment group 6 hours and 3 months after CVBG were 44.50±5.86 ml/min and 43.33±5.01ml/min respectively （P=0.718）, and pulsatility index （PI） was 0.73±0.14 and 0.80±0.14 respectively（P=0.858）. Internal mammary artery grafts and the anastomoses were all patent without stenosis, documented by coronary artery angiography for the experiment group 6 hours and 3 months after CVBG. Myocardial flow in all aspects especially in the subendocardial layer, estimated by non-radioactive colored microsphere injection, was significantly higher in the experiment group after CVBG than that of the control group, transmural flow was 0.33±0.05ml/（g • min） vs. 0.19±0.03 ml/（g • min） （P＜0.05）. Conclusion Ischemic conditions of the myocardium can be relieved by CVBG using internal mammary artery in a short-term to medium-term period. The mechanism may be due to improvement of the myocardial micro-circulation.
ObjectiveTo review the research progress of different ways of stem cells generation and cells dedifferentiation induced by reversine. MethodsThe papers related to reversine inducing cells dedifferentiation and stem cells generation were reviewed. ResultsTo obtain stem cells, there are always some disadvantages via somatic cell nuclear transfer or gene transfection. However reversine, a small molecule, can induce cells dedifferentiation which has unique advantage. But its mechanism is still unclear. ConclusionThe chemical approach for generation of induced pluripotent stem cells by reversine may take the place of other methods.
ObjectiveTo evaluate the safety and efficacy of second central venous catheterization in tunnel cuffed dialysis catheter (TCC) dysfunction with fibrin sheath.MethodA total of 14 maintenance hemodialysis patients who required second central venous catheterization were enrolled in West China Hospital of Sichuan University from June 2016 to June 2017 and the clinical information and procedure-related complications were recorded.ResultsAll of the 14 patients were successfully performed with second central venous catheterization, of whom 4 cases had superior vena cava cannulation, 7 cases had right brachiocephalic vein cannulation, 2 cases had internal jugular vein cannulation, and 1 case had external jugular vein cannulation. No procedure-related major complication occurred. During the follow-up, catheter malfunction occurred in 2 cases, which improved by urokinase seal and catheter change, respectively. The rest patients’ catheter function remained normal.ConclusionsWith increasing difficult to construction and maintenance of vascular access, preservation of central vein resource is of high importance. For patients with TCC dysfunction with fibrin sheath, second central venous catheterization based on percutaneous brachiocephalic vein or superior vena cava cannulation is a safe and effective method to establish the lifeline for hemodialysis patients.
Objective To investigate the use of intraoperative transit time flow measurement （TTFM） to accuratelyevaluate graft patency during sequential coronary artery bypass grafting （CABG）. Methods Clinical data of 131 patientsundergoing sequential off-pump coronary artery bypass grafting （OPCAB） with the great saphenous vein （with or without internal mammary artery） as graft vessels in Beijing Anzhen Hospital from April 2012 to January 2013 were retrospectivelyanalyzed. There were 92 male and 39 female patients with their age of 61.35±8.24 years. During the operation，2 methods were used to measure mean blood flow volume，pulsatility index （PI） and diastolic filling （DF） of the graft vessels. For thenon-blocking method，blood flow in graft vessels was maintained，and TTFM was applied 2 cm proximal to the anastomoticsite in graft vessels to record above parameters. For the blocking method，blood flow in graft vessels was temporally blockedby clipping distal graft vessels with an atraumatic bulldog clamp，and TTFM was applied 2 cm proximal to the anastomotic site in graft vessels to record above parameters. Results Blood flow volumes of the diagonal branch （27.43±15.22 ml/minvs. 59.28±30.13 ml/min），obtuse marginal branch （26.14±19.74 ml/min vs. 47.19±24.27 ml/min） and posterior left ventr-icular branch （19.16±8.92 ml/min vs. 38.83±20.11 ml/min） measured by the blocking method were significantly smallerthan those measured by the non-blocking method （P＜0.05） . PI values of the diagonal branch （2.93±1.30 vs. 2.31±0.91），obtuse marginal branch （2.62±1.17 vs. 2.01±0.87） and posterior left ventricular branch （2.33±0.92 vs. 1.80±0.73） meas-ured by the blocking method were significantly higher than those measured by the non-blocking method （P＜0.05）. There was no statistical difference in DF values measured by 2 methods at respective anastomotic sites，and all DF values were higher than 50%. Non-blocking method identified 1 anastomotic site and blocking method identified 3 anastomotic sites that were not patent，and these anastomotic sites became patent after graft reconstruction. Conclusion Blood flow velocity of sequential grafts is higher than that of single grafts，indicating that sequential grafts have the advantages of high blood flow volume and low risk of thrombosis. Blocking method can more accurately evaluate graft patency at the anastomotic sites and sensitively identify graft vessels that are not patent，which is helpful for anastomotic site reconstruction in time and enhancement of successful rate of CABG.