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Objective To summarize the preservation measures of the donor's heart and lung, and the postoperative immunotherapy, as well as the clinical experience of discrimination and management for graft rejection.Methods The clinical data of 2 cases of heart-lung transplantation in our department were retrospectively analyzed. Two different protective liquids were used for donor's lung lavage of 2 cases: Perfadx solution (1000 mL containing tris 0.3 mL and ilomedin 25 μg); Euro Collins solution (1000 mL containing tris 0.3 mL and PGE1 100 μg). UW solution was used for donor's heart lavage. Surgical procedure for heart-lung transplantation was classic technique in situ. The schedule of immunosuppression was induced by Basiliximab, and combined with cyclosporine+ mycophemolate mofeil+corcal hommone after operation. recipient's blood count, organ's functions, the sizes of every cavity of heart, IVSPW and LVPW were observed during early post-operation. The recipients were subjected to chest CT scan, fiberoptic bronchoscope and tissue pathological study when necessary to find the signs of rejection promptly. When the rejection occurred in the recipient, cortical hormone's impulse therapy was given and the dose of immunosuppression was adjusted in time.Results Two patients discharged in 80 days and 141 days after operation. The patients were followed up for 54 months and 50 months respectively, and their life qualities were very well. Acute rejections occurred on the 10th and 26th day in one case, and in another case, acute rejections occurred on the 29th and 87th day after operation. All were conversed by cortical hormone's impulse therapy and adjusting the dose of immunosuppressants. When acute rejection occurred, the blood count had significant change, and IVSPW and LVPW were increases. They were returned the normal range after corresponding therapy.Conclusion Perfidx solution and Euro-Collin solution may play good protective roles for donor's lungs. UW solution may play good a protective role for donor's heart. To discriminate the clinical graft rejection and infection in time and administrate correct management will have large benefits for the patients' rehabilitation.
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Objective Both underuse and overuse of anticoagulant therapy may lead to severe adverse effects. Emerging portable monitering devices, which provides reliable and accurate measurements, were reported to be potential alternatives to tra-ditional monitering recta-analysis regimens. This study was intended to evaluate the effects of serf-monitoring or serf-management (self-testing and serf-dosing) of anticoagulant as compared with that of traditional monitoring. Methods Relevant trials reported before October 2008 were identified in a number of electronic database and analyzed with software RevMan 4.2. The primary out-comes included death from any cause, major bleeding event, thromboembolic event and the proportion of patients whose interna-tional normalized ratio (INR) were within the therapeutic range. Results Seventeen RCT of serf-monitoring were identified.Pooled estimates revealed significant reductions in the thromboembolic events (odds ratio 0.46, 95% CI0.33 -0.64), all-cause mortality (0.61,0.40 -0.93), and major haemorrhage (0.80, 0.58 - 1.10) with self-monitoring as comparing with traditional monitoring. No difference was noted in minor haemorrhage. 15 trials reported improvements in the mean proportion of patients whose INR were within target range. Conclusion Self-management regimen is superior to traditional monitoring in the outcomes of oral anticoagulation. Patients capable of self-monitoring and serf-adjusting have fewer thromboembolic events and lower mortali-ty than those undergoing self-monitoring alone. However, self-monitoring requires education and training for patients.
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objective To compare cardiac function early after cardiac valve replacement with and without atrial fibrillation radiofrequency ablation(RFA).Methods Thirty-eight patients who underwent RFA Cox-Maze Ⅳ procedure combined with rheumatic valve replacement were discharged as cured from March 2007 to August 2009 (RFA group). Their postoperative recovery time, troponin T (cTnT) and ultrasonic cardiogram data were compared with those of 38 patients with atrial fibrillation matchad for age,sex, preoperative NYHA class and types of rheumatic valve replacement (control group). Results Although the cardiopulmonary bypass time and aortic cross-clamping time of RFA group were longer [( 152.8 ± 46.1 ),(91.0 ± 26.1 ) min] than those of control group [( 104.7 ± 40.8), (68.0 ± 30.3) min] (P ＜ 0.01 ), the postoperative recovery time and perioperative changes of LVEF of both groups were similar. Compared with control group, the RFA group's postoperative elevated cTnT was more marked [( 1.8 ± 0.6) μ g/L vs.(0.8 ±0.4) μg/L],their left atrial diameters was generally decreased (P＜0.05). Among them who underwent combined aortic and mitral valve replacement had increased posterior wall thickness of left ventricle and decreased fractional shortening. Conclusions Compared to patients having simple valve replacement, those undergoing valve replacement with RFA Cox-Maze Ⅳ procedure have generally better recovery of cardiac function early after operation, may have more potential threaten, and more attention should be paied to their perioperative myocardial preservation and preventive maintenance of cardiac function.
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Objective To discuss the timing of extubation in patients of congenital heart disease (CHD)with severe pulmonary hypertension (PH) undergoing connective surgery with cardiopulmonary bypass(CPB).Methods A retrospective study of 40 patients of CHD with severe PH Was completed.According to whether the duration of mechanical ventilation (MV)>24 hours,patients were divided into two groups,early extubafion group(19 patients) and late extubation group(21 patients).Perioperative variables that might influence duration of MV were compared between the two groups.Multivariate statistical analysis with Logistic regression was used for these patients to analyze the perioperative variables to determine risk factors for prolonged MV (MV≥72 hours).Results Between the two groups,preoperative NYHA class,Pp/Ps at the time of coming off bypass,CPB duration,and CPB temperature were significantly different (P<0.05 or<0.01).Anofic spell (OR=0.022,95%CI0.001-0.580)and severe hypoxemia(OR=0.031,95%CI0.002-0.568)in the early postoperative period were the risk factors for prolonged MV.Conclusions The timing of extubation in these patients should be determined individually.Late extubation may fit those with advanced NYHA class,high Pp/Ps at the time of coming off bypass,prolonged CPB duration,or hypothermic cardiography and pulmonary artery catheter monitoring help to guide treatment for pwlonged MV.For else patients who with postoperative stable cardiopulmonary function,early extubation maybe feasible.