[Diagnosis and therapy of primary malignant tumors of the heart and pericardium].

OBJECTIVE: To summarize and analyze the experience in diagnosis and treatment of primary malignant tumors of the heart and pericardium. METHODS: The clinical data of 24 patients with malignant tumors of the heart and pericardium treated in our hospital between Jun. 1980 and Mar. 2008 were retrospectively analyzed and the related literature was reviewed. RESULTS: All 24 patients received surgical treatment. Radical resection in 10 cases and partial resection in 6 cases were performed, and the remaining 8 patients received only surgical exploration due to unresectable tumors. One patient died of cardiopulmonary failure in early postoperative stage and all the other patients died within 4 years after operation due to recurrence or metastases. CONCLUSION: Echocardiography, CT, MRI, 3D-CT, CT of coronary artery and cardiac angiography are helpful for the diagnosis and selection of operation mode. Histological examination is necessary for the final diagnosis. Early diagnosis and surgical resection of the tumor as complete as possible, and combination with post-operative radiotherapy and/or chemotherapy may improve the survival of the patients.

[Incidence and risk factors of acute kidney injury post off-pump and on-pump coronary artery bypass grafting].

OBJECTIVE: To investigate the incidence and risk factors of acute kidney injury (AKI) within the first postoperative week after off-pump or on-pump coronary artery bypass (OPCAB or CCAB) surgery. METHODS: Consecutive patients underwent CABG between January 1990 and August 2006 in our institution and had normal serum creatinine (Scr) and estimated creatinine clearance (Ccr) values before operation were retrospectively analyzed. Multivariate logistic regression analysis was performed to identify risk factors for the development of AKI defined as Scr 130 - 199 micromol/L or Ccr 30 - 60 mlxmin(-1)x1.73 m(-2). RESULTS: Incidence of AKI was significantly higher in patients underwent CCAB compared to those underwent OPCAB (63/331 vs. 61/518, P < 0.01). Peak Scr value was seen at 12th hour post OPCAB and 24th hour post CCAB, respectively. The rapid recovering of Scr occurred between 24th hour to 48th hour in patients underwent OPCAB and 48th hour to 72th hour in patients underwent CCAB surgery. Multivariate forward stepwise logistic regression analysis showed that LVEF < 30%, pulse pressure >/= 60 mm Hg (1 mm Hg = 0.133 kPa), peripheral vascular disease, diabetes, emergent procedure, triple-vessel disease, higher body mass index (kg/m(2)), intraoperative and postoperative IABP, NYHA class III or IV and cardiopulmonary bypass were risk factors for the development of postoperative AKI following CABG, while LVEF > 50% and intraoperative and postoperative IABP were associated with lower incidence of AKI (OR < 1). CONCLUSION: AKI is not a rare complication post OPCAB or CCAB surgery, especially in patients with reduced LVEF, increased pulse pressure, peripheral vascular disease, diabetes, emergent procedure, triple-vessel disease, higher body mass index, intraoperative and postoperative IABP.

[Anatomical basis and short-term effect of in situ coronary venous arterialization].

OBJECTIVE: To study the anatomical basis of in situ coronary venous arterialization (ICVA) and to observe the short-term clinical outcome thereof. METHODS: Five recently isolated pig hearts underwent ligation of the posterior descending artery and the proximal end of middle cardiac vein (MCV), solution of Indian ink was perfused into this vein, and slices of heart were made to observe the distribution of ink through microscope. From January 2002 to December 2005, 64 consecutive patients with diffuse lesion and distal occlusion of right coronary artery received coronary artery bypass grafting (CABG) were randomly divided into 2 equal groups to undergo ICVA during CABG (ICVA group) and conventional CABG only (control group) respectively. The pre- and post-operation clinical data, including ECG, SPECT and ultrasonic cardiograph (UCG) were analyzed. RESULTS: Indian ink was distributed in the intercellular spaces and capillaries of the myocardium and appeared in the micro-arteries in all 5 pig hearts. The mean hospitalization time of the ICVA patients was 16.5 +/- 7.7 days. The mortality rate was 0. After the ICVA the ECG recovery rate in ST segment was 98.88%, and the improvement rate in the grade of the angina was 100%. SPECT and UCG both showed great improvement post-operatively (P < 0.05). CONCLUSION: After the ligation of the proximal end of MCV, the related myocardium can be perfused effectively by distal arterialization in situ. ICVA, fitting to patients with diffused lesion and distal occlusion of coronary artery, can be performed safely with satisfactory clinical outcomes.

Diagnosis and treatment of traumatic tricuspid valve insufficiency.

Traumatic tricuspid valve insufficiency (TTVI) is a relatively uncommon disease. To summarize the experience in the diagnosis and treatment of TTVI, we have analyzed the clinical data of 3 patients with TTVI who were admitted to the department of cardiac surgery of our hospital between April 1997 to April 2002. Relevant literatures have also been reviewed.