Objective To study the value of three internal fixation devices (interlocking intramedullary nail, cloverleaf type intramedullary nail ,compression plate) in treatment of fractures of femural shaft. Methods All the patients were divided into three groups randomly. 32 patients were treated with the interlocking intramedullary nail , 67 patients with the cloverleaf type intramedullary nail, and 47 patients with the compression plate. Results After the three internal fixation devices were used in the fractures of femural shaft. All the patients were followed up for 6 months to 144 months. The total rates of postoperative deformity healing and delayed healing and nonunion were 3.1%, 6.0%and 10.6%respectively. The rates of the internal fixation failure were 0%, 4.5%and 17.0%respectively. The rates of excellent function recovery of lower limbs were 81.3%, 70.1%and 59.6%. Conclusions The data show that the curative effects of the interlocking intramedullary nail is better than those of the cloverleat type intramedullary nail and the plate in treatment to fracture of femural shaft.

Objective analysis the pathogenesis and the treatment strategies of the hypertrophic obstructive cardiomyopathy (HOCM) with the concomitant mitral valve abnormalities. Methods From October 1996 to June 2009, 62 patients suffered from HOCM underwent surgical treatment. There were 41 males and 21 females with age ranging from 6 to 68 ( 34.05 ±15.26) years old. The body weight were 27 -83 kg [mean (60. 42 ± 12.71 ) kg]. Detected by preoperative echocardiography, all patients had the systolic anterior movement of the mitral leaflet ( SAM ) and 50 patients had mitral regurgitation (MR). Ventricular septal myomectomy was performed under general anesthesia and cardiopulmonary bypass (CPB) with a moderate systemic temperature and low volume blood flow. The concomitant operations included mitral valve replacement ( MVR 12 cases), mitral valve plasty ( MVP9 cases). During the perioperative period the patients were evaluated by echocardiography. Left ventricle ( LV ), left ventricular outflow tract ( LVOT), left atrium ( LA ), left ventricalar ejection fraction ( LVEF), mitral valve construction and function were evaluated. Results The time of CPB and the sortic occlusion were (104.23 ±47.14) (402290) min and (66.76 ±36.32) (20-195) min, respectively. The endotracheal intubation time was ( 13.23 ± 11.76 ) ( 5 -21 ) h and ICU stay was (42.53 ± 37.41 ) ( 11 ～ 183 ) h. Comparing with the parameters before operation: the sizes of the LA were (43.46 ± 7.21 ) mm vs. ( 34.56 ± 6.45 ) mm, pressure gradients through LVOT ( 103.84 ±44.04) mm Hg vs. (23.54±17.78) mm Hg and the thickness of the septal (26.93±5.23) mm vs. (17.12±5.67) mm.All parameters were significantly decreased( P ＜0.05 )postoperatively. All surviving patients had no or only trivial MR and SAM. Four patients (6.4% ,4/62 ) died during the perioperative period. The cause of death included severe low cardiac output, heart failure, severe ventricular arrhythmias and severe acute renal failure. The main complications were: left bandle branch block in 33 cases, intraventricular conduction block in 7, complete AV block in 6, anterior hemiblock in 5, type Ⅰ artioventricular conduction block in5, atrial fibrillation in 4. All surviving patients were in New York Heart Association functional class Ⅰ or Ⅱ during the follow-up from 1 month to 10 years. Cardiac symptoms were markedly relieved. Mitral valve construction and function were significantly improved. There were no death, no complications and none required additional mitral valve or myecomy surgery. Conclusion Ventricular septal myomectomy alone is sufficient to eliminate or significantly reduce the severity of MR and SAM. In patients with HOCM and MR due to the congenital mitral valve disease, concomitant MVP may be the first choice. Considering the inherent risks of prosthetic valves and anticoagulation complications, MVR should be the second choice.

Abstract:Objective To evaluate the outcome of surgical treatment for congenital coronary artery fistulas (CAF) in 52 patients seen between May 1988 and July 1999.Methods Fifty-two patients ranging in age from 9 months to 58 years (mean 15.7±16.4 years) were studied. Thirty-six patients had no other cardiac defects, 9 of those patients were more than 20 years old and presented with symptoms. Only one of 36 patients less than 20 years old had clinical findings before surgery. Sixteen patients had associated cardiac lesions. The site of fistula origin was the right coronary artery in 37 patients (71.2%), and the left coronary artery in 15 patients (28.8%). The sites of CAF drainage were the right ventricle, right atrium, left ventricle, left atrium and pulmonary artery in 22 (42.3%), 16 (30.8%), 6 (11.5%), 3 (5.8%), and 5 (9.6%) patients, respectively. The mean diameter of the fistula in 43 patients with single ostium was 7.34±4.12?mm.Results Cardiopulmonary bypass was used in all patients and no patient died. An arteriotomy was made on the anomalous coronary artery and the proximal opening of a fistula was closed within the vessel in 10 patients. Closure of the distal opening of a fistula draining into a cardiac chamber or pulmonary artery was performed in 26 patients. In 16 patients, both the proximal and distal opening were closed. Two and 3 distal opening of a fistula were found in 6 and 3 patients, respectively. No residual shunt was found before patients were discharged from the hospital. Forty patients were followed up for a mean period of 3.14±1.84 years. The remaining 12 patients could not be contacted during follow-up. No clinical symptoms were found in those patients during follow-up but one patient still presented with ST-T change. Conclusion Early and properly surgical management is safe and effective for congenital coronary fistula.

Objective    To assess mid- and long-term outcomes and share our clinical method of reduction ascending aortoplasty (RAA) in adult patients undergoing aortic valve replacement (AVR). Methods    We retrospectively analyzed clinical data of 41 adult patients with aortic valve disease and ascending aortic dilatation before and after operation of RAA+AVR in Fuwai Hospital from January 2010 to July 2017. There were 28 male and 13 female patients aged 28-76 (53.34±12.06) years. Twenty-three patients received AVR+RAA using the sandwich technique (a sandwich technique group), while other 18 patients received AVR+ascending aorta wrap (a wrapping technique group). Ascending aorta diameter (AAD) was measured by echocardiography or CT scan preoperatively and postoperatively. Results    There was no perioperative death. The mean preoperative AAD in the sandwich technique group and the wrapping technique group (47.04±3.44 mm vs. 46.67±2.83 mm, P=0.709) was not statistically different. The mean postoperative AAD (35.87±3.81 mm vs. 35.50±5.67 mm, P=0.804), and the mean AAD at the end of follow-up (41.26±6.54 mm vs. 38.28±4.79 mm, P=0.113) were also not statistically different between the two groups. There were statistical differences in AAD before, after operation and at follow-up in each group. All 41 patients were followed up for 23-108 (57.07±28.60) months, with a median follow-up of 51.00 months. Compared with that before discharge, the AAD growth rate at the last follow-up was –1.50-6.78 mm/year, with a median growth rate of 0.70 mm/year, and only 3 patients had an annual growth rate of above 3 mm/year. Conclusion    Mid- and long-term outcomes of RAA in adult patients undergoing AVR with both methods are satisfying and encouraging.