Objective To evaluate the safety and early outcomes of hybrid coronary and peripheral artery revascularization.Methods From January 2008 to July 2008,peripheral artery stenting followed by off-pump coronary artery bypass grafting was performed on five patients under general anesthesia.Results The symptoms caused by the coronary artery disease and peripheral vascular artery disease were cured by the hybrid surgery in all the cases.No early complications occurred.The serum ALT and AST were(38.4?6.9) U/L and(28.0?8.2) U/L respectively after the surgery without significant difference comparing with those determined before the operation [ALT:(36.6?7.5) U/L,t=0.88,P=0.43;AST(26.4?7.2) U/L,t=1.73,P=0.16].Of the 5 patients,3 showed normal renal function before the surgery,and 2 had stenosis of the renal arteries;these two patients showed the postoperative level of BUN 7.3 and 6.8 mmol/L,and Scr value 61 and 82 ?mol/L respectively.In this series,the mean 24-hour chest drainage volume was(842?180) ml,mean ICU stay was(75.4?25.2) h,mean respirator time was(24.2?17.4) h,and mean postoperative hospital stay was(9.8?2.9) days.The patients were followed up for 2 to 9 months,none of them showed complications during the period.Conclusions For patients with both coronary heart disease and peripheral artery disease,hybrid surgery is a minimally invasive,safe,effective,and economic method.The method does not influence the liver and renal functions of the patients.Moreover,no significant difference exists in volume of chest drainage,ICU stay,respirator time,and postoperative stay between standard bypass grafting and this procedure.However,its long-term efficacy should be further investigated.

Objective To study the clinical features of traumatic mitral regurgitation and its surgical treatment methods and outcomes. Methods Clinical data of 16 patients with traumatic mitral regurgitation surgically treated from December 2000 to November 2008 were retrospectively analyzed. The cardiac thoracic ratio was 0.55 ±0.07 and the left ventricular ejection fraction (LVEF) was (51.2% ±23.2)%. According to the New York Heart Association (NYHA) functional classification, 10 patients were at grade Ⅰ - Ⅱ before operation. The surgical procedures consisted of mitral valvuloplasty in 14 patients and mitral replacement in two, when correction of other cardiac injuries was made at the same time.Of all, 14 patients obtained follow-up for (35.2 ± 25.7 ) months. Results The interval between trauma and appearance of mitral regurgitation was (23.3 ±50.90) months. Of 13 patients with echocardiography during follow-up, there were four patients with normal tricuspid hemodynamics, seven with trace tricuspid regurgitation and two with mild regurgitation. The value of LVEF was (66.8 ± 9.0)% at followup, significantly higher than preoperation (P ＜ 0. 05 ). There were 13 patients at grade Ⅰ - Ⅱ of NYHA,with a significant increase compared with preoperation ( P ＜ 0. 01 ). Conclusions Mitral regurgitation may emerge either immediately or several years after trauma. Traumatic mitral regurgitation patients can get satisfactory outcomes when comprehensive mitral valvuloplasty or mitral replacement is performed promptly.

0.05). However, compared with the parameter before operation, the size of the left atrium and left ventricular were obvious decreased, the value of EF was obvious increased for both groups (P

Objective To review the experience of 162 cases of coronary artery bypass grafting (CABG) via a lower median ministernotomy. Methods CABG through a lower median ministernotomy was conducted in 162 cases from April 1998 to June 2003, including 77 cases of CABG under extracorporeal circulation, 13 cases of CABG concomitant with intracardiac surgery, and 72 cases of off-pump coronary artery bypass grafting (OPCABG). Results There were 1 case of surgery-related death (0.6%) and 1 case of re-operation (0.6%). Postoperative complications occurred in 9 patients (5.6%). In conventional CABGs, the aortic cross-clamp time, cardiopulmonary bypass time, and operation time were 74.8?23.1 min, 113.6?31.3 min, and 255.5?54.5 min, respectively. The operation time of OPCABG was 195.6?50.6 min. The number of anastomoses ranged 1~5 (2.4?0.7). The length of postoperative tracheal intubation was 0~364 h (median, 11 h). The length of postanesthesia care unit (PACU) stay and hospital stay were 1~28 d (median, 3 d) and 5~60 d (median, 10 d), respectively. The chest drainage volume was 607.2?443.0 ml, or 8.6?6.0 ml/kg. A blood transfusion was required in 38 cases, with a transfusion amount of 1161.3?741.2 ml. Conclusions A less invasive approach is possible in coronary artery bypass grafting via a lower median ministernotomy. This procedure provides satisfactory outcomes and good cosmetic results, during which a complete revascularization for multiple vessels and concomitant intracardiac operations are available.

Objective To review the experience of 460 cases of cardiac operations through a lower median ministernotomy. Methods A total of 460 cardiac operations via a lower median ministernotomy route were carried out between January 1997 and August 2003 in this hospital, involving 100 operations for congenital heart diseases, 178 valve operations, 168 coronary operations, 12 operations for aneurysms, and 2 other operations. On operation no special instruments were required. Results Within the hospitalization period 4 patients died (0.9%) and 3 underwent a re-operation (0.7%). Postoperative complications occurred in 29 patients (6.3%). Off-pump operations were employed in 73 patients, while in the remaining 387 patients the cardiopulmonary bypass time was 25~1 115 min (median, 80 min) and the aortic cross-clamp time was 0~164 min (55.8?31.9 min). Of the 460 patients, the length of postoperative tracheal intubation was 0~364 h (median, 10 h), and the postoperative chest drainage was 20~3 290 ml (median, 350 ml), or 0.3~42.2 ml/kg (median, 5.8 ml/kg). Blood transfusion were required after surgery in 280 patients with an amount of 951.1?644.6 ml. The postoperative ICU and hospital stay were 1~28 d (median, 2 d) and 1~60 d (11.6?6.0 d), respectively. A follow-up for 7~80 months (59.2?29.6 months) in 371 patients was conducted. No long-term deaths were noted and symptoms were significantly improved. Heart function was classified as grade Ⅰ in 169 patients, grade Ⅱ in 135 patients, and grade Ⅲ in 67 patients, respectively, with significant difference as compared with that in pre-operation ( Z =-12.57 , P =0.000). No significant difference was observed in the cardiothoracic ratio (0.50?0.11, 0.41~0.67) between postoperative and preoperative period ( t =-1.63, P =0.104). The left ventricular ejection fraction was significantly higher postoperatively (0.36~0.71, 0.606?0.113) than preoperatively ( t =3.43, P =0.001). Conclusions In properly selected cases, heart operations through a lower median ministernotomy provides many advantages including mini-invasion, high reliability, excellent cosmetic results, simplicity to performance, and good surgical outcomes.

Objective To improve short-and mid-term surgical outcomes ofter the tricuspid ring annuloplasty,and to provide theoretic basis for strategy making among patients with tricuspid regurgitation secondary to left-sided heart diseases.Methods Tricuspid regurgitation secondary to left-sided heart diseases ( including mitral valve diseases and aortic valve diseases) were treated by using tricuspid ring annuloplasty techniques.Patients'age averaged (47.3 ± 12.0) years old,there were a total of 84 female patients(53.2％ ).The average systolic pulmonary pressure was (53.4 ± 19.8) mm Hg.From August 2002 to December 2007,a total of 158 consecutive patients underwent tricuspid ring annuloplasty in Fuwai Cardiovascular disease Hospital.Among this group of patients,there were 66 mild tricuspid regurgitation(41.8％ ),54 moderate(34.2％ ),and 38 severe tricuspid regurgitation(24.0％ ).The average age was (47.3 ± 12.0) years old and female accounted for 53.2％ of the whole cohort.The indications for the tricuspid ring annuloplasty included:moderate to severe tricuspid regurgitation or moderate to severe pulmonary hypertension ( systolic pulmonary hypertension ＞40 mm Hg).In the current study,the ring annuloplasty techniques were modified in the following aspects:selection of undersized ring and partial fixation of tricuspid septal segment.In all the patients,we chose Cosgrove-Edwards ring for tricuspid annuloplasty.The surgical outcomes were evaluated through multivariate regression and Cox analysis.Results Compared with moderate and severe tricuspid regurgitation groups,mild regurgitation group had the smallest ring diameter,mild group ( 38.2 ± 4.9 ) mm,moderate group(47.0 ± 11.6 ) mm,severe group(44.5 ± 8.9) mm,P ＜0.001.No significant differences were noted in terms of ejection fraction among three groups (0.59 ± 0.08,0.59 ± 0.06 and 0.58 ± 0.09,P =0.73 ).Compared with mild and moderate tricuspid regurgitation groups,severe regurgitation group had the highest systolic pulmonary pressure.The diameter reduction was most significant in severe regurgitation group,diameter reduction in mild,moderate and severe regurgitation groups were ( 12.4 ±5.6) mm,(20.8 ± 11.5 ) mm,( 18.6 ± 8.3 ) mm,respectively,P ＜ 0.00 1.An in-hospital death occurred in moderate regurgitation group.157 patients discharged alive.The median follow-up time was 49.1 months.During follow up,three moderate to severe regurgitation occurred,among which one was in moderate regurgitation group,two in severe regurgitation group ( P =0.06).There were three deaths in mild regurgitation group,two in moderate regurgitation group,and four in severe regurgitation group.No significant differences were found in terms of mid-term morality,P =0.10.Conclusion For patients with tricuspid regurgitation secondary to left-sided heart diseases,the mid-term outcomes of modified Cosgrove-Edwards ring annuloplasty were satisfactory.The taking home messages include:positive recommendation for patients with pulmonary hypertension to accept tricuspid annuloplasty,use of undersized ring,and partial fixation of septal segment.

Objective:To explore the intermedial to long term surgical management in aortic valve insufficiency(AI)after ventricular septal defect(VSD)repair.Methods:A total of 22 consecutive patients with AI after VSD repair in our hospital from January 1996 to December 2007 underwent surgical treatment were enrolled in this study. Valve perforation was mainly pathological changes. Aortic valve replacement was performed in 13 patients and aortic valvuloplasty was done in 9 patients.Results:One patient died after the operation.Post operative X-ray and echocardiogram revealed that both cardio-thoracic ratio(0.57±0.07 vs. 0.52±0.04 P<0.05)and left ventricular end diastolic diameter(54.5±10.2 mm vs. 46.7±5.8mm P<0.05)decreased markedly. 3 patients suffered from mild aortic regurgitation after valvuloplasty.Conclusion:The iatrogenic injury of aortic valve during VSD repair could be corrected satisfactorily by valve replacement or valvuloplasty.

Objective The purpose of this study was to assess the incidence,treatment and prognosis of silent pulmonary embolism (PE) after off-pump coronary artery bypass graft (CABG).Methods From December 2009 to September 2012,582 consecutive patients underwent off-pump CABG by a same surgeon.Their age ranged from 16 to 86 years with a mean age of (61.4 ± 9.3) years.Left internal mammary artery and saphenous vein were harvested routinely.A dose of 20 mg unfractionated heparin was given intravenously every 6 hours on the operative day after postoperative pleural fluid less than 50 ml per hour.All patients received aspirin 100 mg daily starting on postoperative day 1.The 64-slice coronary MDCT was performed to assess the graft patency on postoperative day 5 ～ 7.Results There were no in-hospital death.PE,which involved the lobar or more proximal arteries,was detected on the CT images of 10 patients (1.7％).In these 10 patients,there were no significant dyspnea or hypoxemia postoperatively ; echocardiography and ECG showed no specific signs of PE ; all bypass grafts were patent in CT images except a LIMA to LAD graft with LAD endarterectomy.PE involved both lungs in 6 patients,and only the right lung in 4 patients.All patients received anticoagulation with warfarin for 3 to 6 months except one.All patients were with good quality of life during 6 to 18 months of follow-up.Three to six months after discharge,8 patients received repeated MDCT,which showed diminish of PE.Conclusion Acute PE after off-pump CABG was an uncommon complication and was difficult to diagnose.MDCT played an important role in examining the patency of graft vessels and helped detect silent PE in CABG patients.The prognosis of acute PE after off-pump CABG was acceptable.PE diminished after 3 months of anticoagulation with warfarin.

Objective To investigate the prevalence and the related factors of female breast disease in Zhengzhou City, Henan Province, and to provide a targeted prevention guide for female breast disease. Methods A total of 6310 women were enrolled in this study. In addition to breast ultrasound, mammography and pathology assays were performed. Finally, the prevalence and influencing factors for female breast disease were analyzed. Results The prevalence of breast cancer and the total prevalence of breast diseases was 0.06% and 24.94%, respectively. The prevalence of female breast diseases was significantly correlated to age, educational level, occupa-tion, menstruation, reproductive age and a history of abortion. Logistic regression analysis showed that the occupa-tional type had a significant effect on the prevalence of female breast. Conclusion The prevalence of female breast disease is relatively high in Zhengzhou City, and it is affected by many factors. The targeted surveys and breast dis-ease screening should be conducted, and the secondary prevention of female breast disease should be strengthened.

Objective To review the experience of the surgical treatment of adult patients with anomalous left coronary artery from the pulmonary artery(ALCAPA).Methods A retrospective,single institution review was conducted on nineteen adult patients with ALCAPA surgical treatment from February 2006 to October 2012.Of these patients,five were males and fourteen were females.The age was(35.3 ± 11.7) years.The weight was (61.2 ± 9.4) kg.Most patients showed some evidence of myocardial infarction or ischemia with either abnormal Q waves (4) or ST-T abnormality (13).Twelve patients with coronary angiography and four patients with coronary CT scan showed good coronary collateralization.The preoperative UCG showed the mean left ventricular ejection fraction(LVEF) was 0.60 ± 0.07,and the mean left ventricular end-diastolic dimension(LVEDD) was(52.4 ± 4.4) mm.Severe mitral regurgitation(MR) was seen in two patients,moderate in three patients and mild in four patients.The operative procedures included Takeuchi operation in seven patients,ligation of left coronary artery concomitant with coronary artery bypass graft in two patients,coronary artery re-implantation in ten patients.Of the ten patients with coronary artery re-implantation,two patients underwent mitral valve repair.Results There was no operative mortality.The mean cardiopulmonary bypass time was (144.5 ± 66.9) min and cross-clamp time was (96.4 ± 38.8) min,respectively.The mean mechanical ventilation time was(12.9 ± 3.7) h and intensive care unit time was(39.2 ± 12.5) h,respectively.The mean postoperative LVEF was 0.62 ± 0.04.No significant reduction in LVEDD (45.8 ± 5.5) mm,P ＞ 0.05.Mild and trivial MR were observed in one and four patients,respectively.Sixteen patients(84.2％) completed the follow up with a mean time of 19.2 months.All the patients survived with New York Heart Association class Ⅰ or Ⅱ.During the follow up period,no patient required reoperation or readmission.At the latest echocardiography,the mean LVEF of 0.63 ± 0.05 and mean LVEDD of(49.2 ± 4.6) mm did not significantly improved compared with the data preoperatively or postoperatively.Mild MR was detected in six patients,trivial in three patients during the follow-up period.Conclusion The adult patients with ALCAPA have a dormant disease process.Surgical treatment has been recommended at the time of diagnosis and the coronary re-implantation could be the first choice.As for the concomitant MR,the guideline for the adult MR should be followed.