Downward Displacement of the Aortic Annulus: Case Report and Literature Review.

Downward displacement of the aortic annulus is a very rare cardiac malformation, the etiology of which is not fully understood, while the surgical methods used for its correction are inconsistent. Herein is described a case of downward displacement of the aortic annulus, together with a review of the current relevant literature on the subject.

Endovascular repair of traumatic arteriovenous fistula between axillary artery and vein.

Traumatic arteriovenous fistula between the axillary artery and vein may present a difficult problem in treatment. There are few reports demonstrating the endovascular repair of this challenge. Herein, we present such a case of endovascular repair of traumatic arteriovenous fistula between the axillary artery and vein with false aneurysm formation. The patient was discharged 11 days after successful operation. Oral clopidogrel and aspirin were administered for 18 months. At one year follow-up, the patient was in good condition and showed no evidence of neurological deficit in the left upper limb.

Mitral valve replacements under on-pump beating heart and lung perfusion/ventilation using a minithoracotomy: an experience with 11 cases.

BACKGROUND: The primary aims of minimally-invasive cardiac valve surgery are to lessen the impact of the incision, extracorporeal circulation, myocardial ischemia, and pulmonary ischemia, to obtain satisfactory therapeutic results, and to allow a quicker rehabilitation. In this study, the feasibility of minimally-invasive mitral valve replacements without ascending aorta and vena cava cross-clamping under beating heart was evaluated by surveying 11 patients. METHODS: Preoperative risk factors, intraoperative techniques, and postoperative complications were surveyed and evaluated for one year (April 1, 2009 to March 30, 2010) in 11 patients who had undergone beating-heart mitral valve replacement surgery at The People's Hospital of Guangxi Zhuang Autonomous Region. Minithoracotomy and femoral arterial cannulation procedures were used in the surgeries for cardiopulmonary bypass (CPB) without ascending aorta and vena cava cross-clamping. RESULTS: The operations were performed successfully in all 11 patients. The CPB time was 52.80 ± 11.36 minutes; the mean postoperative mechanical ventilation assistance time was 8.20 ± 2.84 hours; and the mean transfusion volume of red cells was 2.20 ± 1.04 units. There were no cerebral complications, no periprosthetic leakage, no occurrence of permanent high-degree atrioventricular blockage, and no mortality. CONCLUSION: Mitral valve replacement on the beating heart using a minithoracotomy and femoral arterial cannulation for CPB without ascending aorta and vena cava crossclamping under pulmonary ventilation is feasible. A larger number of patients are required to further characterize the efficacy and safety of this procedure.

Successful therapy for a patient with aortic graft infection without graft removal.

BACKGROUND: Following Bentall surgery, aortic graft infection can be a serious complication with high mortality rates. The recommended treatment for aortic graft infection is to explant the graft; however, because of the high risk and costs involved, this might not always be an option. We report successful treatment of a case of aortic graft infection without removal of the infected graft. METHODS: A 43-year-old man with aortic graft infection was treated by local debridement, continuous antibiotic irrigation with intermittent fast irrigation, drainage, and nutritional support in combination with systemic antibiotics. RESULTS: The patient was discharged 24 days after the intervention and the laboratory test values were normalized. Three years after the surgery, the patient was in good condition and showed no signs of infection. CONCLUSION: The present case demonstrated that prompt debridement followed by continuous local irrigation, drainage, and nutritional support, in combination with systemic antibiotics, can be effective in the treatment of aortic graft infection. One of the most important aspects in such complicated situations is early diagnosis and optimal treatment. Our results are encouraging; however, because it was only a single case, we feel more research with a larger prospective randomized trial is warranted.

On-pump beating heart surgery.

On-pump beating heart surgery has been proposed as a superior technique for cardiac surgery, and is receiving renewed interest from cardiac surgeons. Here, we review the technique, focusing on the basic principles of myocardial protection, operative methodology, category, intraoperative concerns, current status, organ protection, advantages, disadvantages, indications, contraindications, unanswered questions, and future research.

Continuous perfusion of donor hearts with oxygenated blood cardioplegia improves graft function.

Donor hearts cannot be preserved beyond 6h using cold storage (CS). Improving preservation methods may permit prolonged storage of donor heart. We compared graft function in large animal model after prolonged preservation (8h) using continuous perfusion (CP) and CS method. Twenty-four miniature pigs were used as donors and recipients. Donor hearts were either stored in University of Wisconsin solution (UW solution) for 8h at 0-4°C (CS group, n=6) or were continuously perfused with oxygenated blood cardioplegia at 26°C for 8h (CP group, n=6). After preservation, hearts were transplanted into recipients and reperfused for 3h. Left ventricular (LV) function, cardiac output (CO), malondialdehyde (MDA) and adenosine triphosphate (ATP) levels, and water content were measured. Although water content of CP hearts was higher than that of CS, LV contractility and diastolic function of CP hearts were superior to those of CS. In addition, CP hearts performed better than CS hearts on CO in working heart state. ATP was better preserved and MDA levels were lower in CP hearts compared with those of CS (P<0.0001). Donor hearts can be preserved longer using continuous perfusion with oxygenated blood cardioplegia and this method prevents time-dependent ischemic injury.

Cost-effective homemade automatically opening endobag for video-assisted thoracic surgery.

Because specimen removal is often required during video-assisted thoracic surgery, an easily produced, simple-to-use and cost-effective endobag is necessary to avoid wound metastasis. However, commercial endobags are expensive. Here I describe a homemade automatically opening, cost-effective, safe and easily produced endobag for video-assisted thoracic surgery that is suitable for use in low-income locations with limited health budgets.

Effect of Shenfu Injection on Isolated Empty Beating Hearts from Miniature Pigs.

OBJECTIVE: To investigate the effect of Shenfu (SF) injection on donor heart preservation. METHODS: Twelve pigs were randomly divided into SF group (n=6) and control group (n=6). After eight hours of perfusion, the differences in hemoglobin, the expression of Bcl-2 and BAX, and changes in the myocardial ultrastructure were compared to illustrate the effects of SF injection in heart preservation. RESULTS: The differences in free hemoglobin between the SF group and the control group were statistically significant (P=0.001), and there was significant interaction of groups with times (P=0.019), but the perfusion time may not be associated with the hemoglobin concentration (P=0.616). According to Western blotting analysis, the expression of Bcl-2 was higher in the SF group than in the control group, while the expression of BAX was not different between the two groups. As to ultrastructural changes, both groups exhibited mitochondrial swelling and myofilament lysis, but the degree of damage in the SF group was smaller. CONCLUSION: Our study suggests that the application of SF injection for heart preservation may protect against cardiomyocytes and erythrocytes apoptosis, and Bcl-2 protein may play a role in these physiological processes.

Low-cost of uniportal thoracoscopic surgery for primary spontaneous pneumothorax.

OBJECTIVE: Single-incision thoracoscopic surgery is a favorable treatment choice for primary spontaneous pneumothorax, and manual ligation of the bleb during thoracoscopic surgery appears to offer better economic results. In this study we undertook ligation of the bleb by hand under uniportal thoracoscopic surgery for primary spontaneous pneumothorax. METHODS: Between June 2015 and December 2016, a series of 26 patients with primary spontaneous pneumothorax underwent hand ligation of blebs using the technology of uniportal thoracoscopy, followed by pleural abrasion as necessary. RESULTS: No case was converted to two- or three-port video-assisted thoracoscopic surgery during the operation. No patients experienced prolonged (>5 days) air leakage. No other complication was recorded. No recurrence of pneumothorax was encountered during 29-47 months follow-up. Compared with the group treated by bullectomy using stapler, we found a significant reduction in medical costs in the group with bleb ligation. CONCLUSIONS: Ligation of the bleb by hand under uniportal thoracoscopic surgery for primary spontaneous pneumothorax is a safe and offers better economic results, which is applicable for low income family.

Protective effects of pretreatment with Radix Paeoniae Rubra on acute lung injury induced by intestinal ischemia/reperfusion in rats.

OBJECTIVE: To investigate the effect of pretreatment with Radix Paeoniae Rubra (RPR) on acute lung injury induced by intestinal ischemia/reperfusion in rats and its protective mechanism. METHODS: Thirty-two Wistar rats were randomly divided into four groups: Sham-operation group, ischemia/reperfusion group (I/R group), RPR-pretreatment group and hemin group. The model of intestinal ischemia/reperfusion was established by clamping the superior mesenteric artery for 1 hour followed by 2-hour reperfusion. The effect of RPR on the expression of heme oxygenase-1 (HO-1) in lung tissues was detected by immunohistochemistry and morphometry computer image analysis. Arterial blood gas analysis, lung permeability index, malondialdehyde (MDA) and superoxide dismutase (SOD) contents in lungs were measured. The histological changes of lung tissue were observed under light microscope. RESULTS: The expression of HO-1 in RPR-pretreatment group and hemin group was obviously higher than that in sham-operation group and I/R group (P < 0.01). The level of MDA and lung permeability index in RPR-pretreatment and hemin group were significantly lower than those in I/R group (P < 0.01 or P < 0.05), while the activity of SOD in RPR-pretreatment and hemin group was obviously higher than that in I/R group (P < 0.01). Under light microscope, the pathologic changes induced by I/R were significantly attenuated by RPR. CONCLUSION: Intestinal ischemia/reperfusion may result in acute lung injury and pretreatment with RPR injection can attenuate the injury. The protective effect of RPR on the acute lung injury is related to its property of inducing HO-1 expression and inhibiting lipid peroxidation.

[Management and outcome of 47 patients with acute myocardial infarction complicating cardiogenic shock].

OBJECTIVE: To evaluate the clinical outcomes of patients with acute myocardial infarction (AMI) complicating cardiogenic shock underwent various treatments. METHODS: From January, 2002 to May, 2007, 47 AMI patients with cardiogenic shock were treated in our department by optimal medication (dopamine, epinephrine, norepinephrine, etc.), intra-aortic balloon pump (IABP), mechanical ventilation when indicated, percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). Outcome and factors related to mortality for these patients were analyzed in this retrospective study. RESULTS: Besides optimal medication and IABP in all patients, 31 patients underwent PCI (66.0%), 6 patients received emergency CABG (12.8%). The overall in-hospital mortality rate was 36.2% (17/47), 6 patients (14.9%) died before coronary revascularization and 11 patients (21.3%) died after revascularization. Nine patients died of pump failure and 8 patients died of renal and (or) respiratory failure. Regression analysis showed that acute renal failure (r = 0.734, P = 0.000), acute respiratory failure (r = 0.606, P = 0.000) and diabetes (r = 0.372, P = 0.012) were positively related to in-hospital mortality. CONCLUSION: Despite improvements in treatment options for AMI patients complicating cardiogenic shock, in-hospital mortality remained high, especially for patients complicating further with acute renal failure and acute respiratory failure.

Pericardiectomy for a patient with constrictive pericarditis and multivessel coronary artery disease.

INTRODUCTION: Pericardiectomy for patients with constrictive pericarditis and multivessel coronary artery disease is rare. Therefore, there is limited experience of pericardiectomy in these patients. PRESENTATION OF CASE: We performed only pericardiectomy under the support of intra-aortic balloon pumping (IABP) for a patient with tuberculous constrictive pericarditis and multivessel coronary artery disease who refused to accept revascularization. The postoperative course was uneventful. DISCUSSION: There is limited experience of pericardiectomy in patients with constrictive pericarditis and coronary artery disease, especially in those who want to perform only pericardiectomy and refuse to accept revascularization. There has only been one case report of a patient who had constrictive pericarditis and coronary artery disease, and hemodynamic instability postoperatively who did not have revascularization performed. Cardiopulmonary bypass facilitates dissecting grossly thickened pericardium off the heart and coronary artery exposure, but is associated with higher mortality and reoperation rates, renal failure, and atrial fibrillation. In our patient, cutting grossly thickened pericardium to expose the coronary artery under cardiopulmonary bypass was unnecessary because he refused to accept revascularization. Therefore, we performed only pericardiectomy under the support of IABP to avoid hemodynamic instability. CONCLUSION: Performing only pericardiectomy under the support of IABP for a patient with constrictive pericarditis and multivessel coronary artery disease is safe and effective as long as the left ventricular ejection fraction is normal.

TK1 overexpression is associated with the poor outcomes of lung cancer patients: a systematic review and meta-analysis.

AIM: The study aimed to unveil the effect of TK1 expression on the clinicopathological significance and prognosis in patients with lung cancer. Results & methodology: Studies for meta-analysis were selected according to a thorough literature search in databases (PubMed, EMBASE and Chinese databases). Ten studies containing 1393 lung cancer patients were investigated in our analysis. The TK1 overexpression was associated with poorer overall survival(OS) in lung cancer patients (hazard ratio = 1.881; 95% CI:1.318-2.684, Z = 3.48; p = 0.001). Furthermore, The TK1 expression is associated with the clinicopathological features of lung cancer patients (tumor type, age, lymph node metastasis, distant metastasis and tumor, node, metastasis [TNM] stages).  Discussion & conclusion: The TK1 expression might have a supportive implication in assessing biological behavior and prognosis of lung cancer patients.

Mitral valve replacement in a dialysis-dependent patient.

Patients with end-stage renal disease have a higher risk of morbidity and mortality than those without end-stage renal disease in cardiovascular surgery. Poor outcomes are especially found in patients who undergo valve surgery. We report successful mitral valve replacement (MVR) in a dialysis-dependent patient. The patient recovered well at postoperation and had the complication of anticoagulation at follow-up. Based on this successful case, we believe that myocardial protection, prevention of infection, nutritional support, and close monitoring of blood coagulation function are important in dialysis-dependent patients undergoing valve replacement.

Surgery for posterior mediastinal dumbbell tumors: A case report.

INTRODUCTION: Mediastinal dumbbell tumors are rare, and special cases provide valuable knowledge to the existing literature. PRESENTATION OF CASE: A 57-year-old woman was diagnosed with a recurrent dumbbell-shaped nerve sheath tumor with intrathoracic and intraspinal components. We attempted to resect the tumor via combined biport thoracoscopy and laminectomy with the patient in a prone position. However, copious bleeding prevented complete removal of the intraspinal component of the tumor. Pathological examination of the operative specimens showed a mixed hemangioma. DISCUSSION: The first report on the use of triportal thoracoscopy for treatment of a posterior mediastinal dumbbell tumor with the patient in the prone position was published in 1995. However, this technique is not widely used. The technique used in our case is unique only in that biportal rather than triportal thoracoscopy was used to resect the intrathoracic component of the tumor. The differential diagnoses of posterior mediastinal dumbbell-shaped tumors include neurogenic tumors, meningiomas, and hemangiomas. Very rarely, cavernous and capillary hemangiomas also present as dumbbell-shaped lesions. To our knowledge, a mixed hemangioma presenting as a dumbbell-shaped lesion has not been previously reported. CONCLUSION: The intrathoracic component of a posterior mediastinal dumbbell tumor can be resected by biportal thoracoscopy with the patient in a prone position, reducing the operative time. If the diagnosis of a dumbbell tumor is inconclusive, an endoscopic biopsy should be performed before removing the tumor.

Effect of shenfu injection on isolated empty beating hearts from miniature pigs

Abstract Objective: To investigate the effect of Shenfu (SF) injection on donor heart preservation. Methods: Twelve pigs were randomly divided into SF group (n=6) and control group (n=6). After eight hours of perfusion, the differences in hemoglobin, the expression of Bcl-2 and BAX, and changes in the myocardial ultrastructure were compared to illustrate the effects of SF injection in heart preservation. Results: The differences in free hemoglobin between the SF group and the control group were statistically significant (P=0.001), and there was significant interaction of groups with times (P=0.019), but the perfusion time may not be associated with the hemoglobin concentration (P=0.616). According to Western blotting analysis, the expression of Bcl-2 was higher in the SF group than in the control group, while the expression of BAX was not different between the two groups. As to ultrastructural changes, both groups exhibited mitochondrial swelling and myofilament lysis, but the degree of damage in the SF group was smaller. Conclusion: Our study suggests that the application of SF injection for heart preservation may protect against cardiomyocytes and erythrocytes apoptosis, and Bcl-2 protein may play a role in these physiological processes.

Low-cost biportal endoscopic surgery for primary spontaneous pneumothorax.

BACKGROUND: Like many other countries, including the United States, China faces the problem of rising health care costs, which have become a heavy burden on the state and individuals. Endoscopic surgery offers many benefits. However, the need for more expensive endoscopic consumables brings further high medical costs. Therefore, the development of video-assisted thoracic surgery with no disposable consumables will help to control medical cost escalation. METHODS: Between October 2011 and September 2014, a series of 66 patients with primary spontaneous pneumothorax underwent hand ligation of blebs under biportal video-assisted thoracoscopic surgery or bullectomy with stapler during triportal video-assisted thoracoscopic surgery. After treatment of blebs, pleural abrasion was performed with an electrocautery cleaning pad. RESULTS: Compared with the group treated by bullectomy with stapler, we found a significant reduction in postoperative costs in the group with bleb ligation. There was no difference in operating time, chest tube drainage, and postoperative stay between the two groups. The follow-up period varied from 1 to 35 months and six cases of recurrence were noted. CONCLUSIONS: The technique that we described appears to offer better economic results than bullectomy with a stapler under three-port video-assisted thoracoscopic surgery for treating primary spontaneous. The clinical outcomes are similar.

Surgical correction of ruptured aneurysms of the sinus of Valsalva using on-pump beating-heart technique.

BACKGROUND: Rupture of aneurysms of the sinus of Valsalva results in abrupt onset of congestive heart failure. On-pump beating-heart surgery may reduce cardiac impairment by maintaining coronary blood flow and avoiding cardioplegia. Herein, we report the operative correction of thirty-one patients of ruptured aneurysms of the sinus of Valsalva, using the on-pump beating-heart technique. METHODS: Thirty-one patients with ruptured aneurysms of the sinus of Valsalva underwent operative corrections using the on-pump beating-heart technique. In patients with fistula diameter less than 1 cm and no aortic regurgitation, the aorta was unclamped throughout cardiopulmonary bypass(CPB) while receiving antegrade heart perfusion. In remainder of patients, retrograde perfusion was used. RESULTS: After intracardiac manipulation was complete and the nasopharyngeal temperature was raised to 36-37 degrees C, the patients were smoothly weaned off CPB. There were no early or late postoperative deaths. All patients were in New York Heart Association functional class I at follow-up (range, 0.5-1 year). Mild-to-moderate aortic valve regurgitation was observed in one patient. No recurrence of the left-to-right shunt from ruptured aneurysms of the sinus of Valsalva was observed. CONCLUSIONS: Beating heart on pump allows adequate examination of the aortic lesion under near-physiologic conditions, allows decrease in ischemia-reperfusion injury and potentially decreases the risk of serious or fatal rhythm disturbances. On-pump beating-heart technique for repair of ruptured aneurysm of sinus of Valsalva is feasible and promising. Antegrade heart perfusion is suitable for patients with a fistula diameter <1 cm and no aortic regurgitation, and retrograde perfusion is suitable for the others.