The distinguishing cellular features of pulmonary artery smooth muscle cells from chronic thromboembolic pulmonary hypertension patients.

In chronic thromboembolic pulmonary hypertension (CTEPH), central thrombi are the most likely disease initiators, and progressive pulmonary vascular remodeling, which is characterized by marked proliferation of pulmonary artery smooth muscle cells (PASMCs), may also contribute to the long-term progression of CTEPH. This study was designed to investigate the cellular characteristics of PASMCs isolated from the organized thrombotic tissues of CTEPH. In the present study, analysis of PASMCs isolated from five CTEPH patients and three control subjects showed that cells from CTEPH patients had certain characteristics that distinguished them from control cells, including inferior or no cell-cell contact inhibition growth, increased sensitivity to hypoxia-induced proliferation, resistance to serum starvation-induced apoptosis, and mitochondrial metabolism disorder. These differences in the PASMCs in endarterectomized tissue of CTEPH patients may prove useful in understanding the pathobiology of CTEPH.

[Early, middle and long-term clinical outcomes of coronary artery bypass grafting for left main coronary stenosis].

OBJECTIVE: To evaluate the early, middle and long-term clinical outcomes of coronary artery bypass grafting (CABG) for a special subset of left main coronary stenosis (LMS). METHODS: A total of 626 LMS patients, recruited at our hospital between January 1998 and March 2008, were classified them into the statin therapy group (Group A, n = 322) or the non-statin therapy group (Group B, n = 304) according to whether or not taking statins pre-operatively. Then their clinical data were retrospectively analyzed. RESULTS: The inhospital mortality was 4.31% (n = 27). And the mortality was 1.90% (n = 6) for Group A and 6.91% for Group B (n = 21) (χ² test, χ² = 9.642, P = 0.002). Preoperative statin therapy could lower the all-cause mortality rate (1.90% vs 6.91%, P = 0.002), the prevalence of new atrial fibrillation or flutter (14.69% vs 19.61%, P = 0.016, χ ²= 5.780) and disabling stroke (2.50% vs 4.58%, P = 0.047, χ(2) = 3.94). Among 599 CABG survivors, 565 cases (94.3%) were actually followed up with a mean duration of 55.5 ± 26.1 months (range: 2 - 98). During the follow-up period, there were 29 (4.63%) cardiac events, including 12 deaths and 17 myocardial infarctions. There were 43 (7.18%) cases with relapsing angina pectoris. The univariate analysis showed that emergency procedure, abnormal C-reactive protein (CRP), abnormal troponin I(TnI), complicated LMS pathology, preoperative IABP (intra-aortic balloon pump) support, preoperative cardiac arrest, preoperative history of myocardium infarction and no preoperative statin therapy were the risk factors for perioperative death while complicated LMS pathology, preoperative IABP support, preoperative cardiac arrest, preoperative myocardium infarction and no preoperative statin therapy were the risk factor for late cardiac events. The multivariate binary logistic regression showed that emergency procedure, preoperative IABP support, no preoperative statin therapy and preoperative IABP support were independent predictors for peri-operative death. And preoperative IABP support, preoperative cardiac arrest, no preoperative statin therapy and complicated LMS pathology were independent predictors for late cardiac events. There was no statistical significance in inhospital mortality between on pump CABG and OPCAB (off pump coronary artery bypass). CONCLUSION: The CABG procedure for LMS carries a relative high mortality. However preoperative statin therapy may offer such protective effects as lowering the all-cause mortality rate and reducing the prevalence of new atrial fibrillation or flutter and disabling stroke.

The actuarial survival analysis of the surgical and non-surgical therapy regimen for chronic thromboembolic pulmonary hypertension.

AIM: To characterize the in-hospital mortality and the actuarial survival of surgical and non-surgical therapy regimen in the treatment of chronic thromboembolic pulmonary hypertension (CTEPH). METHODS: A retrospective cohort study was conducted in 504 patients with CTEPH, who were treated surgically (n = 360), or non-surgically (n = 144) in Anzhen Hospital from February 1989 to August 2007. The patients in surgical group received a standard pulmonary thromboendarterectomy (PTE), while those in non-surgical group were given thrombolytic therapy. The actuarial survival of the two groups was determined with the Kaplan-Meier survival curves. Univariate analysis and multivariate binary logistic regression and Cox proportional hazard analysis were used to identify the risk factors for the in-hospital and late deaths. RESULTS: The in-hospital mortality for the surgical group and non-surgical group were 4.44% and 3.50%, respectively. For the proximal type of CTEPH, the actuarial survival at 10 and 15 years of the surgical group and non-surgical group were 94.60 +/- 2.38%, 90.96 +/- 4.24% and 81.4 +/- 7.14%, 56.43 +/- 14.7%, respectively (chi(2) = 12.33, P = 0.0004). For the distal type of CTEPH, the actuarial survival at 10 and 15 years of the surgical group and non-surgical group were 71.78 +/- 4.66%, 29.57 +/- 15.1% and 69.84 +/- 7.78%, 32.59 +/- 13.7%, respectively (chi(2) = 0.03, P = 0.874). CONCLUSION: The PTE procedure has statistically superiority over thrombolytic therapy for the proximal type of CTEPH in terms of actuarial survival; however, for the distal type of CTEPH, the PTE procedure provides no benefits with regard to actuarial survival.

[The actuarial survival analysis to the surgical and non-surgical therapy regime for congenital heart disease with severe pulmonary hypertension].

OBJECTIVE: To investigate the relationship between the long-term outcomes of surgical treatment and preoperative pulmonary vascular resistance (PVR) or pulmonary to systemic flow ratio (Qp/Qs) in patients of congenital heart diseases with severe pulmonary hypertension (CHDSPH). METHODS: From February 1990 to July 2008, 1212 cases of CHDSPH were treated non-surgically or surgically and were retrospectively classified as non-surgical group (n = 297) and surgical group (n = 915). Propensity score of inclusion into the surgical group were estimated and 245 tribes were get with the same propensity score +/- 0.05. The Kaplan-Meier survival curves were constructed for the 245 tribes with the PVR stratum at the level of 120 kPa x L(-1) x S(-1) or with the Qp/Qs stratum at the level of 1.25. RESULTS: With the follow-up of 97 +/- 57 months, there were 44 late deaths in the surgical group and 65 late deaths in the non-surgical group. In the 245 propensity score matched tribes, the Log rank test between non-surgical group and surgical group revealed chi(2) = 0.54, P = 0.4611 for the stratum of PVR > or = 120 kPa x L(-1) x S(-1), and chi(2) = 51.68, P = 0.000 for stratum of PVR < 120 kPa x L(-1) x S(-1); the Log rank test between non-surgical group and surgical group revealed chi(2) = 0.97, P = 0.3254 for the stratum of Qp/Qs < 1.25, and chi(2) = 62.77, P = 0.000 for stratum of Qp/Qs > or = 1.25. CONCLUSION: for CHDSPH patients, the indication of the surgical closure should be defined as PVR < 120 kPa x L(-1) x S(-1) and/or its Qp/Qs > or = 1.25.

[Clinical analysis of 62 cases of chronic thromboembolic pulmonary hypertension treated with pulmonary thromboendarterectomy without early and late deaths].

OBJECTIVE: To retrospectively evaluate the effects of pulmonary thromboendarterectomy (PTE) on chronic thromboembolic pulmonary hypertension (CTEPH). METHODS: Sixty-two cases of CTEPH operated with PTE from October 2002 to September 2008 at Anzhen Hospital were retrospectively reviewed and were assigned into either proximal CTEPH group (n = 46) or distal CTEPH group (n = 16). RESULT: No early death was reported. 15 had residual pulmonary hypertension and 23 had pulmonary reperfusion injury postoperatively. And reperfusion injury was recovered with the support of ventilation or ECMO. Between pre and post-procedure, the pulmonary artery systolic pressure changed from 91 +/- 38 mm Hg to 53 +/- 21 mm Hg, the pulmonary vascular resistance from 916 +/- 548 dynxsxcm(-5) to 368 +/- 302 dynxsxcm(-5) (t = 6.896, P = 0.0001), and the arterial partial pressure of oxygen (PaO(2)) from 51 +/- 7 mm Hg to 90 +/- 7 mm Hg and the arterial oxygen saturation (SaO(2)) from 87.0% +/- 3.9% to 96.1% +/- 3.3%, P < 0.05. With the follow-up of (24.8 +/- 14.6) months (cumulative follow-up was 121.6 patient-years), there was no late death and 38 were in NYHA functional class I, 20 class II, 2 class III and 2 class IV. According to Kaplan-Meier actuarial curve, the freedom from reembolism at 3 years was 96.7% +/- 2.8%. The linear bleeding rate related to anticoagulation was 2.47% patient-years, and the linear thromboembolic rate related to anticoagulation is 1.64% patient-years. CONCLUSION: The early and mid-long term survival rate of PTE procedure on CTEPH is acceptable and the complication rate related to anticoagulation with warfarin is relatively low.

[Diagnosis and treatment of aortic origin of the right pulmonary artery: analysis of 14 cases].

OBJECTIVE: To investigate the diagnosis of aortic origin of the right pulmonary artery (AORPA) and evaluate the efficacy of surgical treatment therefore. METHODS: The clinical data of 14 AORPA patients, 9 male and 5 female, aged 4 (60 days-23 years), hospitalized from May 1992 to March 2007, twelve of which were surgically treated through 5 different procedure, and two of which were denied surgical procedure due to Eisenmenger syndrome. Follow-up was conducted for (5.15+/-3.48) years. RESULTS: The diagnosis of 12 out of the 14 patients was confirmed before operation, and 2 of them were misdiagnosed by echocardiography. Two patients died during the peri-operational period due to low output syndrome or pulmonary hypertension crisis. One patient died from right cardiac failure 4 yrs after the surgical procedure. Of the 9 surviving patients, 5 were in NYHA functional class I, and 4 in class II. CONCLUSION: In diagnosis of AORPA right ventriculography and aortic angiography or multi-sliced CT angiography or MRI are necessary to avoid misdiagnosis. The early and mid-long term effects of surgical treatment for AORPA are good, but it was imperative to adopt these procedures as early as possible to heighten the cure efficacy.

[The early and middle-long term clinical results of surgical treatment for ventricular septal rupture].

OBJECTIVE: To explore the way of promoting the efficacy of surgical treatment for ventricular septal rupture (VSR) after acute myocardium infarction in terms of perioperative and long term survival. METHODS: The clinic data of 37 VSR cases underwent surgical treatment from October 1994 to October 2007 were analyzed retrospectively. There were 24 male and 13 female, and the age was (63.4 +/- 7.6) years old. The whole group was divided into the VSR repair plus revascularization group (group A, 26 cases) and simple VSR repair group (group B, 11 cases). RESULTS: There were 4 operative deaths in group A (15.4%), 7 deaths in group B (63.6%), P = 0.006. With the follow-up of (34.0 +/- 29.8) months ranged from 2 to 103 months of the 26 operational survivors, there were 5 late deaths, of which 2 deaths in group A and 3 deaths in group B. According to the Kaplan-Meier survival curve, the actuarial survival rate at 6 to 8 year was (64.3 +/- 21.0)% for group A and the actuarial survival rate at 4 year was (25.0 +/- 21.7)% for group B, P = 0.011. Of the 21 mid-long term survivors, 17 cases were in NYHA class I to II and 4 cases in NYHA class III to IV. There were 4 cases suffered from VSR recurrence. According to Logistic regression, the risk factors for the early death were not adoptive of revascularization, cardiogenic shock and emergency surgical procedure, while the risk factors for late death were not adoptive of revascularization and low cardiac output after the procedures. CONCLUSIONS: VSR repair plus revascularization could improve the perioperative and mid-long term survival for the surgical treatment of VSR. The appropriate timing and procedures of the surgical operation are very important to promote perioperative survival and to prevent VSR recurrence.

[The anatomic pathological classification for intracardiac leiomyomatosis and the choice of its surgical strategy].

OBJECTIVE: To approach an anatomic pathological classification scheme for the intracardiac leiomyomatosis (ICL), and to guide the choice of the surgical strategy for ICL treatment. METHODS: Retrospectively reviews the data of 13 cases of ICL from February 1995 to March 2007 in Anzhen Hospital. They were surgically treated under the CPB with different surgical strategy, and a quaternary classification scheme was used to classify them according to their anatomic pathological features of ICL. RESULTS: There was no operative death. One patient with YBOR type of ICL died from recurrence due to the incomplete excision 5 months after the primary operation. The 5 yrs survival rate calculated by the Kaplan-Meier survival curve was 93% +/- 5%. Of the surviving 12 patients, 9 were in NYHA functional class I, and 3 in class II. CONCLUSION: The surgical treatment of ICL can get a good mid-long term survival rate and living quality, and a quaternary classification scheme for ICL can be used to guide the choosing of surgical strategy and to understand the symptoms of ICL.

[Repair of anterior leaflet mitral valve prolapse: the comparison between chordal replacement and chordal shortening].

OBJECTIVE: To compare the relative merits between chordal shortening and artificial chordae to repair the anterior leaflet prolapses (ALP). METHODS: The clinic data of 50 cases underwent repair of ALP from March 1990 to March 2008 were analyzed retrospectively. There were 29 male and 21 female patients with a mean age of (42.6 +/- 11.3) years old. There were 23 patients in chordal shortening group and 27 patients in artificial chordae group. RESULTS: There were 3 operative deaths in chordal shortening group (13.0%), and 1 death in artificial chordae group (3.7%, P = 0.199). With a mean follow-up of (5.8 +/- 4.8) years and a total follow-up of 278 patient-years, there were 3 late deaths respectively in each group. According the Kaplan-Meier survival curve, the actuarial survival rate at 5-8 years was 70.0% +/- 18.2% for chordal shortening group and 86.8% +/- 9.2% for artificial chordae group (chi(2) = 8.17, P = 0.046). There were 5 reoperations, of which 4 in chordal shortening group and 1 in artificial chordae group. According to the Kaplan-Meier freedom from reoperation curve, the freedom from reoperation at 5 years was 83.3% +/- 15.2% for chordal shortening group and 100% for artificial chordae group (chi(2) = 12.06, P = 0.007). The COX proportional hazard regressions revealed that chordal-shortening technique was the independent risk predictor for the late cardiac event after ALP surgical repair. CONCLUSION: Artificial chordae techniques has a relative superiority to chordal shortening for repair of mitral valve ALP.

[The clinical analysis of 54 cases for the surgical treatment of pulmonary embolism].

OBJECTIVE: To evaluate the results of surgical procedures for pulmonary embolism. METHODS: Fifty-four patients of pulmonary embolism received surgical treatment from October 1994 to June 2007, of which 9 were acute pulmonary embolism underwent pulmonary embolectomy and 45 patients were chronic thromboembolic pulmonary hypertension (CTEPH) underwent pulmonary thromboendarterectomy. RESULTS: The mortality rate was 44.4% in acute pulmonary embolism group and 13.3% in CTEPH group (P < 0. 05). Thirteen patients had residual pulmonary hypertension and 23 patients had severe pulmonary reperfusion injury postoperatively. The pulmonary artery systolic pressure changed from (89.4 +/- 36.3) mm Hg (1 mm Hg =0.133 kPa) preoperative to (55.6 +/- 22.4) mm Hg postoperative. The pulmonary vascular resistance changed from (89. 7 +/- 56.7) kPa L(-1) S(-1) preoperative to (38.9 +/- 31.1) kPa L(-1) S(-1) postoperative. The arterial partial pressure of oxygen changed from (52. 3 +/- 6.7 ) mm Hg preoperative to (87.6 +/- 6.5) mm Hg postoperative. The arterial oxygen saturation changed from (88.9 +/- 4.5)% preoperative to (95.3 +/- 2.8 )% postoperative (P < 0.05). With the follow-up of (41.8 +/- 36.4) months, there were 4 patients died. According to NYHA, there were 28 patients for class I , 10 patients for class II and 2 patients for class III. According to Kaplan-Meier survival curve, the 3-year, 4-year, 5-year and 8-year survival rate were (97.1 +/- 2.8 )%, (94.0 +/- 4.1)%, (90.8 +/- 5.2)% and (85.0 +/- 7.3)% respectively. Linear rate of bleeding and thromboembolic related to anticoagulation were 0. 63% patient-years and 0. 62% patient-years respectively. CONCLUSIONS: The operational mortality of acute pulmonary embolism is significantly higher than CTEPH, and the mid-long term survival rate is agreeable and the complication rate related to anticoagulation is relatively low.

[Prognosis of patients with chronic thromboembolic pulmonary hypertension receiving conservative or operative treatments according to a new clinical classification scheme].

OBJECTIVE: To compare the efficacy of conservative or pulmonary thromboendarterectomy (PTE) therapy for chronic thromboembolic pulmonary hypertension (CTEPH) patients according to a new clinical classification scheme. METHODS: This retrospective study analyzed 63 cases of CTEPH admitted to our hospital from February 1995 to October 2007 and 45 cases were treated surgically (Group A) and 18 cases received conservative therapy (Group B). Results were analyzed using Fisher exact test and t test according to San Diego medical center quartering classification scheme and Anzhen Hospital modified bifurcate classification scheme. RESULTS: There were 6 operational deaths in Group A and 2 deaths during hospital stay in Group B. During follow-ups (mean 3.6 +/- 2.5 years), there were 4 deaths in Group A and 9 deaths in Group B. the totality survival rate is significantly higher in Group A than that in Group B (P < 0.05). For patients with San Diego Type I CTEPH, survival rate was significantly higher in Group A compared with Group B (P = 0.009) and was similar for patients with type II and III and IV CTEPH between the two groups (P = 0.338, 0.455, 0.800). Survival rate was significantly higher in Group A than that in Group B for patients with Anzhen central type CTEPH (P = 0.009), but was similar between the two groups for patients with Anzhen peripheral type CTEPH (P = 0.125). The Kaplan-Meier survival curve 5 years survival rate in the Group A was (91.7 +/- 8.0)% for Anzhen central type and (76.0 +/- 8.5)% for Anzhen peripheral type (P = 0.04), and the 5 years Kaplan-Meier survival rate in the Group B was (42.9 +/- 18.7)% for Anzhen central type and (56.2 +/- 10.8)% for Anzhen peripheral type (P = 0.851). CONCLUSION: Anzhen Hospital modified bifurcate classification scheme is a simple and effective classification to predict the prognosis and choose treatment method of CTEPH.

[Treatment of chronic thromboembolic pulmonary hypertension through pulmonary thromboendarterectomy and the effect of deep hypothermia circulation arrest thereon].

OBJECTIVE: To evaluate the role of the pulmonary thromboendarterectomy (PTE) in the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) and the effect of the deep hypothermia circulation arrest (DHCA) thereon. METHODS: The clinical data of 40 cases of CTEPH, 25 cases of central type and 15 cases of peripheral type, 29 males and 11 females, aged 46 +/- 12 (20 - 70), underwent PTH, 17 under deep hypothermia circulatory arrest (DHCA, Group A) and 23 not under DHCA (Group B), from February 1995 to October 2006. Follow-up was conducted for 41.8 +/- 36.4 months. RESULTS: In the peri-operative period, no patient died in Group A and there were 6 deaths in Group B. 9 suffered with residual pulmonary hypertension and 18 with severe pulmonary reflux injury. 72 h after the PTE, the pulmonary artery systolic pressure (PASP) was 58.3 +/- 30.7 mm Hg, significantly lower than that before PTS (91.4 +/- 38.4 mm Hg, P < 0.05), the pulmonary vascular resistance (PVR) was 357 +/- 278.7 dynes x sec(-1) x cm(-5), significantly lower than that before PTE (978 +/- 675.6 dynes x sec(-1) x cm(-5), P < 0.01); the partial pressure of oxygen in the arterial blood (PaO(2)) was 89.9 +/- 7 mm Hg, significantly higher than that before the PTE (54.5 +/- 7.7 mm Hg, P < 0.01),; and the arterial oxygen saturation (SaO(2)) was 96.5 +/- 1.8%, significantly higher than that before the PTE (90 +/- 4.3%, P < 0.05). During the follow-up there were 2 late deaths, and the cardiac function was graded as NYHA class I in 22 patients, as NYHA class II in 9 patients, and as NYHA class III in 1 patient. CONCLUSION: DHCA is a necessary and elementary condition for PTE, and it is a key factor in promoting the effect of PTE to treat the pulmonary reflux injury and residual pulmonary hypertension properly.

Operability assessment in CTEPH: Lessons from the CHEST-1 study.

Pulmonary endarterectomy is the gold standard treatment for chronic thromboembolic pulmonary hypertension and is potentially curative, although some patients are unsuitable for pulmonary endarterectomy and require alternative management. Lack of standardized assessment of pulmonary endarterectomy eligibility risks suboptimal treatment in some patients. We discuss the implications for future clinical trials and practice of a unique operability assessment in patients who have chronic thromboembolic pulmonary hypertension and were initially screened for inclusion in the CHEST-1 (Chronic Thromboembolic Pulmonary Hypertension Soluble Guanylate Cyclase Stimulator Trial-1) study. The CHEST-1 study evaluated riociguat for the treatment of inoperable chronic thromboembolic pulmonary hypertension (CTEPH) or persistent/recurrent pulmonary hypertension after pulmonary endarterectomy. Screened patients who were initially considered "inoperable" underwent central independent adjudication by a committee of experienced surgeons, or local adjudication in collaboration with an experienced surgeon. Operability decisions were based on accessibility of thrombi and the association between pulmonary vascular resistance (PVR) and the extent of obstruction, using pulmonary angiography/computed tomography with ventilation/perfusion scintigraphy as the minimum diagnostic tests. Of 446 patients screened for CHEST-1, a total of 188 and 124 underwent central and local adjudication, respectively, after being initially considered to be "inoperable." After a second assessment by an experienced surgeon, 69 of these 312 "inoperable" patients were deemed operable. Rigorous measures in CHEST-1 guaranteed that only technically inoperable patients, or patients who had persistent/recurrent pulmonary hypertension, were enrolled, thus ensuring that only patients for whom surgery was not an option were enrolled. This study design sets new standards for future clinical trials and practice in CTEPH, helping to ensure that patients who have CTEPH receive optimal treatment.

Post-conditioning through lower limb ischemia-reperfusion can alleviate lung ischemia-reperfusion injury.

OBJECTIVE: Operation on the infrarenal aorta could cause ischemic-reperfusion (IR) injury in local tissues and remote organs (e.g. the lung). We aim to explore the method of reducing lung ischemia-reperfusion damage after lower limb IR with post conditioning (LIPC). METHODS: Bilateral lower limb ischemia was performed in Sprague-Dawley (SD) rats, and then animals were divided into 4 groups: IR-Sham-operated, IR, post conditioned-IR (LIPC) and bilateral lower limb ischemia (LIR). The serum free radical, histological changes, Wet/Dry (W/D) ratio, levels of TNF-α, IL-6, cytokines and chemokines were tested and compared. RESULTS: Post-conditioning could ameliorate histological injuries in the lung when compared to IR group. The serum free radical is significantly lower in LIPC group than IR groups. W/D ratio in LIPC groups is significantly lower. LIPC also could reduce the expression of cytokines and chemokines. CONCLUSION: post conditioning could reduce long-term damages of the lung after lower limb ischemic-reperfusion injury.

[Ross procedure in treatment of aortic disease: clinical experience of 15 cases].

OBJECTIVE: To summarize the clinical experience of Ross procedure in treatment of aorta valve diseases. METHODS: The clinical data of 15 patients with aorta valve diseases, 12 men and 3 women, aged 30 +/- 14, including 13 cases of congenital aorta valve disease, 1 case of senile degenerative aortic valve disease, and 1 case of subacte bacterial endocarditis complicated by aortic stenosis (AS), with the heart function (NYHA) of class II in 11 cases and class III in 4 cases, underwent Ross procedure from October 1994 to September 2002 in Anzhen Hospital. Before operation, ultrasound cardiography showed moderate to severe AS and/or aortic insufficiency (AI) with an average aortic valve annulus diameter (AVD) of 2.4 +/- 0.4 cm and normal pulmonary valve. Operation was performed on all patients under cardiopulmonary bypass and moderate hypothermia. The operation procedure was as follows: (1) to take off the auto-pulmonary artery valve; (2) to remove the dysfunctional aortic valve and auto-transplant the pulmonary valve on the aortic root; and (3) to put a pulmonary homograft so as to re-establish on the right ventricular outflow tract. RESULTS: The perieoperative mortality is 0. After the operation, the mean pressure gradient of aortic valve was in the normal limitation (7.23 +/- 0.14 mm Hg), the left ventricular diastolic diameter decreased significantly (P < 0.001), the left ventricular ejection fraction was 0.48 +/- 0.22, and the heart function (NYHA) was at the classes I - II in all the patients. All cases received follow-up of 1 - 9 years, their heart function was all in Class I, and the function of their aortic and pulmonary valves remained well. CONCLUSION: Ross procedure is a kind of effective alterative operation in treating patients with aortic valve disease.

[Experience on transplantation of auto-pulmonary graft treating with congenital aortic disease].

OBJECTIVE: To summarize the experience on auto-pulmonary transplantation (Ross procedure) treating with congenital aortic disease. METHODS: From October 1994 to November 2003, 20 cases of Ross procedure were performed to treat with congenital aortic disease, Male: 15 cases; Female: 5 cases; age: 25 years; DIAGNOSIS: congenital heart disease (CHD), aortic abnormalities: 12 cases; aortic valve prolapse: 5 cases; aortic valve hypogenesis: 3 cases; combined with subacute bacterial endocarditis (SBE): 4 cases, and ventricle septal defect (VSD): 2 cases; UCG showed aortic stenosis(AS) and/or aortic insufficience (AI) (moderate to severe), Left ventricle diastole diameter (LVDD): (60.51 +/- 11.87) mm, the grade pressure across aortic valve: (27.04 +/- 6.80) mmHg, heart function (NYHA): Class II: 13 cases; Class III: 3 cases; all cases were performed under CPB and moderate hypothermia, the operation procedure was following: (1) taking off auto-pulmonary artery valve; (2) removing dysfunctional aortic valve and auto-transplantation of pulmonary valve on aortic root; (3) putting a pulmonary homograft to rebuild right ventricular outflow tract. RESULTS: The mortality was 0 during stay at hospital, aortic valve function were all normal, LVDD decreased significantly (t = 3.4007, P = 0.0008), the grade pressure across aortic valve was in normal limitation, (6.8 +/- 0.19) mmHg. Follow-up showed heart function was in Class I (NYHA), aortic and pulmonary valve function was very well. CONCLUSION: Ross procedure is a kind of effective alterative operation for treating with congenital aortic valve disease, with good short and middle term results.

Patients with congenital systemic-to-pulmonary shunts and increased pulmonary vascular resistance: what predicts postoperative survival?

BACKGROUND: We carried out a retrospective data review of patients with systemic to pulmonary shunts that underwent surgical repair between February 1990 and February 2012 in order to assess preoperative pulmonary vascular dynamic risk factors for predicting early and late deaths due presumably to pulmonary vascular disease. METHODS AND RESULTS: A total of 1024 cases of congenital systemic-to-pulmonary shunt and advanced pulmonary vascular disease beyond infancy and early childhood were closed surgically. The mean follow up duration was 8.5±5.5 (range 0.7 to 20) years. Sixty-one in-hospital deaths (5.96%, 61/1024) occurred after the shunt closure procedure and there were 46 late deaths, yielding 107 total deaths. We analyzed preoperative pulmonary vascular resistance index (PVRI), pulmonary vascular resistance index on pure oxygen challenge (PVRIO), difference between PVRI and PVRIO (PVRID), Qp∶Qs, and Rp∶Rs as individual risk predictors. The results showed that these individual factors all predicted in-hospital death and total death with PVRIO showing better performance than other risk factors. A multivariable Cox regression model was built,and suggested that PVRID and Qp∶Qs were informative factors for predicting survival time from late death and closure of congenital septal defects was safe with a PVRIO<10.3 WU.m(2) and PVRID>7.3 WU.m(2) on 100% oxygen. CONCLUSIONS: All 4 variables, PVRI, PVRIO, PVRID and Qp∶Qs, should be considered in deciding surgical closure of congenital septal defects and a PVRIO<10.3 WU.m(2) and PVRID>7.3 WU.m(2) on 100% oxygen are associated with a favorable risk benefit profile for the procedure.

Preoperative transcatheter occlusion of bronchopulmonary collateral artery reduces reperfusion pulmonary edema and improves early hemodynamic function after pulmonary thromboendarterectomy.

OBJECTIVE: The present study assessed the effectiveness of preoperative transcatheter occlusion of the bronchopulmonary collateral artery (PTOBPCA) in reducing reperfusion pulmonary edema after pulmonary thromboendarterectomy (PEA). METHODS: The data from 155 patients with chronic thromboembolic pulmonary hypertension at Anzhen Hospital, treated from January 2007 to August 2013, with PEA were retrospectively reviewed. The patients were classified into a control (group A, n = 87) and treated (group B, underwent PTOBPCA, n = 68) group. The reperfusion pulmonary edema incidence, mechanical ventilation and intensive care unit hospitalization duration, and hemodynamic function were compared between the 2 groups. RESULTS: Of the 87 patients in group A, 5 died in-hospital (5.7% mortality); no patient in group B died (0% mortality; P = .035). In group A, 9 patients (10.3%) required extracorporeal membrane oxygenation (ECMO) after PEA; 1 patient (1.5%) in group B required ECMO (chi-square test, P = .026, χ(2) = 4.980). Group B had shorter intubation and intensive care unit hospitalization times, lower mean pulmonary artery pressures and pulmonary vascular resistance, higher partial pressures of oxygen in arterial blood and oxygen saturation, and decreased medical expenditure compared with group A. During a mean 37.1 ± 21.4 months of follow-up, 3 patients in group A and 2 in group B died; however, the difference in the actuarial survival at 3 years postoperatively between the 2 groups was not statistically significant. CONCLUSIONS: PTOBPCA can reduce the incidence of reperfusion pulmonary edema, shorten intensive care unit hospitalization and intubation duration, improve early hemodynamic function, and reduce ECMO usage after PEA.

The wall eclipsing sign on pulmonary artery computed tomography angiography is pathognomonic for pulmonary artery sarcoma.

BACKGROUND: The objective of this study was to evaluate the imaging characteristics of pulmonary artery sarcoma (PAS) on pulmonary artery computed tomography angiography (PACTA) that can be used to differentiate between PAS and pulmonary thromboembolic diseases, including chronic thromboembolic pulmonary hypertension (CTEPH) and acute pulmonary embolism (APE). METHODS: The clinical data and imaging characteristics of 12 patients with PAS, 156 patients with CTEPH, and 426 patients with APE who were treated at Beijing Anzhen Hospital from January 2007 to August 2013 were retrospectively analyzed. All patients underwent PACTA before treatment, and the diagnoses of PAS and CTEPH were all confirmed by surgical biopsy. RESULTS: All 12 PAS patients were initially misdiagnosed and received inappropriate thrombolytic and/or anticoagulant therapy before they were referred for surgical intervention. The mean time from PACTA to surgical intervention was 5.5±3.7 months (range 2-11 months). On PACTA, the PAS lesion always eclipsed the wall of the pulmonary artery before infiltrating outside the pulmonary artery, which was termed the wall eclipsing sign. This sign was observed in all PAS patients but was not observed in any CTEPH or APE patients. CONCLUSIONS: PAS is a rare neoplasm with a poor prognosis, and is easily misdiagnosed as thromboembolic disease. The wall eclipsing sign on PACTA is pathognomonic for PAS, and patients with this sign should be investigated to confirm the diagnosis and should undergo surgical intervention as soon as possible, rather than receiving thrombolytic or anticoagulant therapy.