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Patients?with?acute?myocardial?infarction?(AMI)?complicated?with?acute?Stanford?type?A?aortic?dissection?after?percutaneous?coronary?intervention?(PCI)?are?critically?ill,?with?a?very?high?fatality?rate,?and?few?cases?are?successfully?treated?clinically.?A?case?with?AMI?admitted?to?the?First?Affiliated?Hospital?of?Zhengzhou?University?complicated?with?acute?left?cardiac?insufficiency?after?PCI,?Stanford?type?A?aortic?dissection,?pericardial?and?pleural?infection,?recurrent?AMI?was?reviewed.?In?the?condition?of?coexistence?of?many?diseases,?through?timely?adjustment?of?treatment?strategy?and?exploratory?application?of?drugs?to?improve?cardiac?function,?the?patient?successfully?received?operation?and?discharged?from?the?hospital.?By?presenting?the?successful?treatment?experience?of?this?case,?the?author?aims?to?improve?the?overall?treatment?of?AMI?patients?with?acute?Stanford?type?A?aortic?dissection?after?PCI.
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Objective: To document clinical experience of treating congenital heart disease combined with large patent ductus arteriosus with pulmonary artery closure in combination with patch technique
Methods: Thirty-six patients [8 males and 28 females] who suffered from congenital heart disease and underwent hybrid surgery in the First Affiliated Hospital of Zhengzhou University from October 2010 to February 2014 were selected for this study. They aged 14 to 39 years and weighed 32.20 to 61.50 kg. Diameter of arterial duct was between 10 mm and 13 mm; 28 cases were tube type, 4 cases were funnel type and four cases were window type. All patients had moderate or severe pulmonary arterial hypertension; besides, there were 28 cases of ventricular septal defect, 16 cases of atrial septal defect, eight cases of aortic insufficiency, four cases of mitral stenosis and insufficiency and four cases of infectious endocarditis. Cardz Pulmonary Bypass [CPB] was established after chest was opened along the middle line. With the help of Transesophageal echocardiography, large patent ductus arteriosus was blocked off through pulmonary artery. Pulmonary artery was cut apart after blocking of heart. Large patent ductus arteriosus on the side of pulmonary artery was strengthened with autologous pericardial patch
Results: Of 36 patients, 32 patients had patent ductus arteriosus closure device and four patients had atrial septal defect closure device. Pulmonary arteries of 36 cases were all successfully closed. Systolic pressure declined after closure [[54.86 +/- 19.23] mmHg vs [96.05 +/- 23.07] mmHg, p<0.05]; average pulmonary arterial pressure also declined after closure [[39.15 +/- 14.83] mmHg vs [72.88 +/- 15.76] mmHg, p<0.05]. The patients were followed up for one to fifty one month's [average 11.5 months]. Compared to before surgery, left atrial diameter, left ventricular diameter and pulmonary artery diameter all narrowed after surgery. Besides, clinical symptoms were relieved and cardiac function of the patients also improved
Conclusion: Hybrid surgery is feasible and safe in treating patients with large patent ductus arteriosus and congenital heart disease, which decreases surgical problems, shortens surgical time and lowers the incidence of complications
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OBJECTIVE@#To determine the use of septal plication with Dor or Cooley procedure for post infarction anterior and anterior-septal aneurysm of the left ventricle.@*METHODS@#A total of 23 patients with post infarction anterior and anterior-septal aneurysm of the left ventricle underwent septal plication and Dor or Cooley procedure along with coronary artery bypass grafting concomitantly. Data of NYHA grading, left ventricular end diastolic volume index (LVEDVI), left ventricular end systolic volume index (LVESVI) and left ventricular ejection fraction (LVEF) were recorded before the surgery, before discharge and 3 months after the surgery.@*RESULTS@#Compared with the preoperative data, the NYHA grading before the discharge and 3 months after the surgery improved from 3.21 ± 0.62 to 1.72 ± 0.31 and 1.57 ± 0.23(P<0.05); LVEDVI decreased from (102.31 ± 18.71) mL/m² to (62.11 ± 6.21) mL/m² and (54.63 ± 4.54) mL/m² (P<0.05); LVESVI decreased from (69.32 ± 17.48) mL/m² to (30.23 ± 3.25)mL/m² and (28.34 ± 3.12) mL/m²; while LVEF increased from (32.92 ± 8.12)% to (48.78 ± 4.51)% and (50.52 ± 4.68)% (P<0.05), respectively.@*CONCLUSION@#Ventricular septal plication combined with Dor or Cooley procedure can remarkably improve the left heart function in patients with post infarction ventricular aneurysm.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Coronary Artery Bypass , Methods , Heart Aneurysm , General Surgery , Heart Ventricles , Pathology , General Surgery , Myocardial Infarction , Ventricular Function, Left , Physiology , Ventricular Septum , General SurgeryABSTRACT
ObjectiveTo explore the expression of MRP1 and CD34 in colorectal carcinoma tissue and the relationship with clinicopathological factors.MethodsImmunohistochemical streptavidin-perosidase method was used to examine the expression of MRP1 and CD34 in 53 cases with colorectal carcinoma and normal colorectal tissue.The correlation between the levels of MRP1and CD34 expression and clinicopathological factors were analyzed.ResultsThe positive expression rates of MRP1 in the carcinoma group and normal colorectal tissue group were 49.1％ and 15.1％ respectively,and there was a significant difference of the positive expression between the two groups( x2 =14.029,P ＜ 0.01 ).The expression of MRP1 had no correlation with the degree of differentiation,the depth of invasion,the metastasis of lymph node and all the other clinicopathological factors ( P ＞ 0.05 ).CD34 value in the carcinoma group and normal colorectal tissue group were ( 35.63 ± 12.23 ) MVD/HP and ( 6.12 ± 0.97) MVD/HP,respectively,and there was a significant difference between the two groups (t =17.565,P ＜ 0.01 ).CD34 was not correlated with age,sex,tumor size,localization of the primary tumor ( P ＞ 0.05 ),but correlated with Dukes staging,lymph node metastasis,differentiation of the tumor,depth of invasion( all P ＜ 0.05).ConclusionThe overexpression of MRP1 and CD34 protein may involve in colorectal carcinogenesis;MRP1 may involve in the primary multidrug resistance in colorectal carcinoma.; CD34 may involve in the colorectal carcinoma invasion and metastasis.Investigating the expression of MRP1 and CD34 in colorectal carcinoma simultaneously can provide new referential indexes for the treatment and prognosis of colorectal carcinoma.
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Objective To compare the mid- and long-term results of tricuspid valve (TV) repair with or without an annuloplasty ring. Methods Two hundred seventy-seven patients underwent TV repair at our division (Sep. 2001 to Sep. 2008) ,of which 203 had, predominantly, a De Vega or Kay procedure (non-ring group) and 74had an annuloplasty with an artificial ring (ring group). TV pathology mainly was functional (secondary) and several with rheumatic leaflets involvement. Concomitant procedures consisted of mitral valve surgery in all patients,aortic valve surgery in 81 ,and coronary bypass in 19. Clinical and echocardiographic data followed for 1.5 to 3.5years were obtained. Results Postoperationally,the mid-term(1.5 years) follow-up was 100% completed and the long-term follow-up for 3. 5 years was 89. 9%. The recurrence of TV regurgitation (TR) of moderate and lower degree was not significantly different(χ2 = 1.3128, P= 0.26) in the 1.5 years follow-up between the two group,whereas the recurrence of TR of moderate to severity degree was significantly less in the ring group (χ2 =5. 8159,P =0.023).In the long term follow up,the TR in the ring group (25%) was significantly lower than that of 15% in the non-ring group (χ2 = 4. 9328, P = 0.036) . There are higher proportion of patients developing to moderate TR in the non ring group(34%) than in the ring group (10%) (χ2 =7. 9120,P =0.005). The TR developed fast in the ring group,increasing from 18% at 1.5 years follow up to 10% at 3.5 years follow up (χ2 = 2. 1327, P = 0.016),whereas it was relatively stable in the non-ring group,with 7% at 1.5 year follow up and 10% at 3.5 year follow up. Conclusions Placement of an annuloplasty ring in patients undergoing TV repair could remarkably improved the mid and long terum outcome. In clinic practice, we should be more positive to the functional TR and prefer to the procedure with annuloplasty ring.
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To investigate the mechanism and correlated factors of systolic anterior motion (SAM) phenomenon after aortic valve replacement, 48 patients with severe aortic valvular stenosis were studied. Tested by echo-Doppler one week after aortic valve replacement, the patients were divided into two groups: SAM group and non-SAM group. The data of the left ventricular end-diastolic diameters, the left ventricular end-systolic diameters, the left ventricular outflow diameters, the thickness of the interventricular septum, the posterior wall of left ventricle, the blood velocities of left ventricular outflow and intra-cavitary gradients were recorded and compared. The results showed that no patients died during or after the operation. The blood velocities of left ventricular outflow was increased significantly in 9 patients (>2.5 m/s), and 6 of them developed SAM phenomenon. There was significant difference in all indexes (P0.05) between two groups. These indicated that the present of SAM phenomenon after aortic valve replacement may be directly related to the increase of blood velocities of left ventricular outflow and intra-cavitary gradients. It is also suggested that smaller left ventricular diastolic diameters, left ventricular systolic diameters, left ventricular outflow diameters and hypertrophy of interventricular septum may be the anatomy basis of SAM phenomenon.
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To investigate the mechanism and correlated factors of systolic anterior motion (SAM) phenomenon after aortic valve replacement, 48 patients with severe aortic valvular stenosis were studied. Tested by echo-Doppler one week after aortic valve replacement, the patients were divided into two groups: SAM group and non-SAM group. The data of the left ventricular end-diastolic diameters, the left ventricular end-systolic diameters, the left ventricular outflow diameters, the thickness of the interventricular septum, the posterior wall of left ventricle, the blood velocities of left ventricular outflow and intra-cavitary gradients were recorded and compared. The results showed that no patients died during or after the operation. The blood velocities of left ventricular outflow was increased significantly in 9 patients (＞2.5 m/s), and 6 of them developed SAM phenomenon. There was significant difference in all indexes (P＜0.05 or P＜0.01) except the posterior wall of left ventricle (P＞0.05) between two groups. These indicated that the present of SAM phenomenon after aortic valve replacement may be directly related to the increase of blood velocities of left ventricular outflow and intra-cavitary gradients. It is also suggested that smaller left ventricular diastolic diameters, left ventricular systolic diameters, left ventricular outflow diameters and hypertrophy of interventricular septum may be the anatomy basis of SAM phenomenon.
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Objective To evaluate the value of thoracotomy through small right subaxillary oblique incision for pediatric ventricular septal defect(VSD). Methods From November 2001 to December 2008,1539 children with VSD underwent thoracotomy through small right subaxillary oblique incision in our hospital.At the fourth intercostal space between the anterior and middle axillary lines,a straight or oblique incision was made,then along the inferior edge of the fourth rib the chest was opened,and the right edge of the pericardium was fixed at the thoracic retractor.Afterwards,off-pump circulation was established and minimally invasive cardiac surgery was carried out.Results The procedure was completed successfully in all the 1539 patients.The cross-clamp time was(22.8?11.4) min(11 to 48 min),and CPB time was(33.0?14.9) min(27 to 64 min).Two patients(0.13%,2/1539) died in 24 hours after the operation.One of them died of severe allergic reaction to protamine.And the other died of severe low cardiac output in 4 hours after the surgery,because of an injury to the left coronary artery.In this series,the postoperative complications included incisional infection in 3 cases,atelectasis in 9,perfusion lung in 5,low cardiac output in 5,infectious endocarditis in 3 and acute renal failure in 4.These 29 cases were discharged after the complications being cured.Follow-up was available in 1446 cases for(47.0?11.2) months(range,6~91 months).During the period,small residual shunts in the VSD were detected in 5 cases,and other cases showed no abnormalities.Conclusions Thoracotomy through small right subaxillary oblique incision is minimally invasive,safe and effective for pediatric VSD.
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Objective: To investigate the mechanism and correlative factors of SAM syndrome after aortic valve replacement. Methods: 48 patients with severe aortic valve stenosis were studied, echo-Doppler study was performed one week after aortic valve replacement, and the patients were divided into two groups with or without SAM Syndrome. The left ventricular end-diastolic dimensions, the left ventricular end-Systolic dimensions, the left ventricular outflow tract the thickness of septum and posterior wall, the maximal left ventricular velocities and left intra-ventricular dynamic gradients were recorded and compared. Results: There was no operative mortality. The maximal left ventricular velocities were increased significantly in 9 patients (more than 2。5 m/s) and six of them had SAM syndrome. There were statistic significance (P
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<p><b>OBJECTIVE</b>To evaluate the methods used to diagnose and surgically treat ruptured aneurysm in sinus of Valsalva (RASV).</p><p><b>METHODS</b>Thirty-seven hospitalized patients with ruptured aneurysms in the sinus of Valsalva from September 1981 to April 2001, including 21 cases (56.7%) of RASV associated with ventricular septal defects (VSD) and 11 (29.7%) with aortic valvular prolapse were given surgical interventions. Under hypothermia and extracorporeal circulation, we successfully performed the surgical correction of RASV for all 37 patients VSD repair in 21 patients, aortic valvuloplasty in 6 and aortic valvular replacement in 2.</p><p><b>RESULTS</b>There was no hospital deaths among these patients, although residual shunting occurred in two patients and acute renal failure was found one. Follow-up study of one month to 20 years in the patients undergoing repair of RASV revealed that the mostly individuals treated with operation obtained satisfactory cardiac function.</p><p><b>CONCLUSION</b>Correct diagnosis of ruptured aneurysm in sinus of Valsalva should be confirmed immediately and surgical correction should be carried out as soon as possible.</p>
Subject(s)
Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Aortic Aneurysm , Diagnosis , General Surgery , Aortic Rupture , Diagnosis , General Surgery , Sinus of ValsalvaABSTRACT
AIM: To determine the combined effect of transmuscle laser revascularization (TMR) and endothelial progenitor cells(EPCs) treatment on ischemic hindlimb of nude rats.METHODS: Mononuclear cells (MNCs) isolated from human umbilical cord-blood (HUCB) by density gradient centrifugation were expanded in vitro. Immunocytochemistry and flow cytometry studies were performed. EPCs were labeled with 1, 1'- dioctadecyl-1 to 3, 3, 3', 3'- tetramethyl-indocarbocyanine perchlorate (DiI) before injected into the laser induced channels or ischemic region. Acute ischemic limb was created in 4 groups of nude rats by ligating right external iliac artery. All animals were divided randomly into the following four groups: TMR+EPCs group: local transplantation of EPCs into laser channels; TMR group: transmuscular channels were created without EPCs; EPCs group: EPCs were injected into ischemic hindlimb; control group: ischemic model without TMR or EPCs. All rats underwent femoral artery ultrasonic blood flow measurements of the ischemic and nonischemic limbs to obtained a flow ratio [femoral artery flow index (FAFI): right femoral artery flow /left femoral artery flow] at baseline (after ligating artery immediately) and 28 days postoperation, and then the samples of ischemic limb muscle underwent histochemical and immunohistologic analysis. RESULTS: The attached cells expressed endothelial cell (ECs) markers (KDR, CD34, CD31, AC133 and von Willebrand factor) and exhibited function similar to that of ECs judged by Ac-LDL incorporation. Flow cytometric analysis disclosed that AT cells were positive for CD34 (62%?7%) and AC133 (57.2%?9.8%) at day 7 of culture. 28 days after therapy, FAFI was significantly higher in the TMR +EPCs (0.66?0.09, P0.05). FAFI in the control group was unchanged and no difference was found between TMR group and control group. TMR+EPCs (5.66?0.77), TMR (4.96?0.31) as well as EPCs (4.68?0.44) treatment resulted in an increased number of capillaries in the treated regional area compared with control group (2.60?0.31, P