With the in-depth research on the electrophysiological mechanism of atrial fibrillation(AF) and development of new mapping and ablation techniques, breakthroughs were frequently achieved in the surgical intervention for atrial fibrillation. From the complex Cox maze procedure to the left atrial maze procedure and radial maze procedure, the high successful rate and elimination of trauma have become the objective in the surgical intervention of atrial fibrillation. In this review we summarized the principle of all kinds of surgical procedures for atrial fibrillation and the application of new ablation technique for radical cure of AF and the effectiveness evaluation of these treatments.

From April 1990 to February 1991, 7 cases of complex congenital cardiac malformations were treated with transplantation of aortic valved homograft sterilized and preserved in our department. Conduit-constructing from right ventricle to pulmonary arteries and from left ventricles to pulmonary artries was performed in 2 and 5 cases repectiredly. When the bore between aortic homograft and artificial blood vessel was 2-4mm, good result could be achieved in clinical hemodynamics and pressure difference was seldom found. No death occurred in these cases. The follow-up with color Doppler echocardiography and cineangiography proved that anastomosis was unobstracted, extracardiac conduits had no distortion and compression, and no stenosis and incomptence were found in homograft valves.

14 cases of postoperative pulmonary embolism were reported. The incidence of this postoperative complication was 0.47‰ during a 5-year period. The main source of embolus was ileo-fomoral venous thrombosis (confirmed in 9 cases). 10 patients died of this complication, autopsy in 6 of them revealed the embolism occurred in a main pulmonary artery on one or both sides. With a review of recent literatures, the authors discussed the causes, diagnosis, treatment and prevention of this fatal complication, and pointed out the diagnostic value of a comprohensive study of clinical manifestations, arterial blood gas analysis, EKG and plain chest film findings. A more aggressive attitude towards the acceptance of pulmonary embolectomy was suggested in those patients who failed to respond rapidly to medical managment.

Objective To observe functional changes of the right ventricle (RV) during off-pump coronary bypass grafting (OPCABG) by using a continuous cardiac output (CCO) monitoring. Methods The study included 178 patients with 2~3 vessel disease requiring a coronary bypass grafting. Preoperative cardiac functions were classified as New York Heart Association (NYHA) class Ⅱ in 72 patients, class Ⅲ in 84 patients and class Ⅳ in 22. The ejection fraction of the left ventricle was 0.35~0.82. The mean number of bypassed vessel was 3.3. A Swan-Ganz catheter was inserted for continuous monitoring of cardiac output by thermodilution. Parameters measured were heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), mean pulmonary artery pressure (MPAP), right atrial pressure (RAP), pulmonary capillary wedge pressure (PCWP), cardiac output (CO), cardiac index (CI), stroke volume index (SVI), systemic vascular resistance index (SVRI), pulmonary vascular resistance index (PVRI), mixed venous saturation value (SvO_2), right ventricular ejection fraction (RVEF), right ventricular end-systolic volume (RVESV), right ventricular end-diastolic volume (RVEDV), right ventricular end-systolic volume index (RVESVI), and right ventricular end-diastolic volume index (RVEDVI). The hemodynamic parameters were measured at time-points when a stable hemodynamics was obtained after the induction of general anesthesia and before the heart would be moved (T1), when the anterior descending branch would be anastomosed (T2), when the circumflex branch or the diagonal branch would be anastomosed (T3), when the right coronary artery or the posterior descending branch would be anastomosed (T4), and when the heart had been repositioned before the thoracic cavity would be closed (T5), respectively. Results There were 4 fatal cases: 2 patients received an emergency surgery for acute myocardial infarction and died with severe low cardiac output syndrome 3 days after the surgery, 1 patient ended with severe respiratory failure 7 days after the surgery, and 1 succumbed to acute pulmonary embolism 4 days after the surgery. As compared with the time-point of T1: the MPAP, PCWP, RAP and PVRI were significantly elevated and the SvO_2 was significantly reduced at the time-point of T2; the MPAP, PCWP, RAP, PVRI and SVRI were significantly elevated and the SvO_2, CI, SVI and RVEF were significantly depressed at the time-point of T3; the HR and RAP significantly went up and the SvO_2 significantly dropped at the time-point of T4; the parameters didn’t recover to normal levels at the time-point of T5. Conclusions When the obtuse marginal (OM) branch is anastomosed, right ventricular functions may decrease, particularly in CI and RVEF levels, while when the left anterior descending branch or right coronary artery is anastomosed, hemodynamics of the right ventricle vary within narrow limits. Therefore, a monitoring of right ventricular functions during OPCABG is of great significance, especially for those with right ventricular insufficiency.

Objective To review the experience of treatment of atrial fibrillation (AF) after coronary artery bypass grafting (CABG), and to analyze its risk factors. Methods 110 patients were subjected to CABG. AF occurred in 26 of them after surgery. All these patients were treated with drugs or direct current. AF group and non-AF group were studied retrospectively, with an analysis of risk factors of AF. Results The incidence of AF after CABG was 23.6%. 19 patients were treated with Amiodarone, and 17 of them had sinus rhythm restored to normal (84.2%). In 3 of 4 patients, who were treated with Esmolol, sinus rhythm restored to normal (75%). All 3 patients who were treated with direct current had their sinus rhythm restored. The occurrence of AF was related to age, volume of left atrium, pathological change in proximal-median segment of right coronary artery, and the administration of ?-receptor blockade before surgery. It was indicated by logistic regression multiple factors analysis that both advanced age and abstinence of administration of ?-receptor blockade before surgery were individual risk factors for AF. Conclusion Ventricular rhythm should be controlled positively when AF occurred after CABG. Amiodarone, Esmolol and direct current were safe and effective treatment modalities. Patients with advanced age, large left atrium and pathological change in proximal-median segment of right coronary artery, should be treated with ?-receptor blockade to prevent AF.

Objective To investigate the localization and expression of endothelial nitric oxide synthase (eNOS) within the wall of the human internal mammary arteries (LMA), radial arteries (RA) and the great saphenous veins (SV) using immunohistochemistry method. Methods Specimens were harvested from 20 patients undergoing coronary artery bypass grafting and submitted to light microscope analysis using immunohistochemistry method. Results The expression of eNOS was evident in the intima of LIMA, RA and SV and in the media of muscular LIMA and RA. No eNOS expression was found in the media of great saphenous veins. Semiquantitative and the imaging analysis indicated by gray level values revealed a higher eNOS expression in the wall of internal mammary artery, particularly at the level of the media. Conclusion Different expression of eNOS in the intima and media of LIMA, RA and SV may provide a histological explanation for the better results of the LIMA when used for coronary artery bypass grafting.

Objective To study the relationship between ? 1-aderenergic receptor (? 1-AR) and cardiac function in hypoxic newborn guinea-pig myocardia undergoing ischemic reperfusion, and the effects of St. Thomas Hospital cardioplegic solution Ⅱ (STS) and cold blood cardioplegia (CBC) on the ? 1-AR and cardiac function. Methods Normobaric hypoxic guenia-pig model and isolated perfused working heart preparation were established. Cardiac functions were recorded by a multichannel biologic signal analyzer. Myocardial ? 1-AR density (B max ) and affinity (K d) were investigated by radial ligand binding. Results Significant decrease of B max was found in hypoxic newborn guinea-pig myocardia suffering from hypothermic (20 ℃)-ishemic reperfusion (P0.05). Conclusion The impairment of cardiac function in hypoxic newborn guinea-pig undergoing myocardial ischemic reperfusion might be associated with the decline of B max , but not with K d. Different effects of STS and CBC on cardiac function may result from their different influences on B max .

Objective: To summarize the experience of corrective surgery for Ebstein's anomaly. Methods: 139 patients with Ebstein's anomaly were operated on from June, 1980 to January, 2000. Among them, 111 cases received atrialized ventricle plication, tricuspid valve plasty and Devega tricuspid annuloplasty, 27 cases undergoing tricuspid valve replacement. One case of right ventricular hypoplasia received extra total cavopulmonary connection (ETCPC). Results: In the whole group, there were 12 operative deaths, with mortality rate of 8.6%. While in the later 10 years, operative mortality rate was reduced to 3.3%. In the group of plastive operation, 10 cases were re-operated with valve replacement and all were survived. Conclusion: Operative method of Ebstein's anomaly should be decided according to the pathologicoanatomic feature. For mild type, tricuspid valve plasty should be chosen. For medium A type, plastic operation should be performed. For medium B type, plasty or valve replacement should be cautiously selected. For severe type, valve replacement should be considered.

Objective: To summarize the experience of clinical application of extracardiac valved tubes in complex congenital heart disease. Methods: From September 1979 to December 2001, 131 patients with complex congenital heart disease underwent surgical treatment by using extracardiac valved tubes, including 22 cases of aortic valved homografts, 73 cases of swine pulmonary valved tubes and 36 cases of extracardiac tubes with anti-calcified swine pericardium valve. Results: The overall mortality rate was 17.5%. The mortality rate has decreased to 10.7% in the late 10 years, and 4.5% in recent 5 years, respectively. Conclusion: It was suggested that aortic and pulmonary valved homograft preserved by liquid nitrogen is the first choice for extracardiac valved tubes. Extracardiac tubes with anti-calcified swine pericardium valve can also be used and they easily available. A better postoperative haemodynamic effect can be achieved by proper placement of the tubes, choice of suitable size and positioning in good geometrical figure.

Ovbective To summarize the clinic data of pathological morphology,diagnosis,surgical treatment and associated anomalies of cor triatriatum from 37 patients enlisted in this study. Methods Thirty-seven patients,21 males and 16 females with a mean age of (9.8?8.6) years were studied. Clinical pathologic anatomy of cor triatriatum was type I in 2 cases,type IIa in 9,type IIb in 24,and type III in 2. Complete cor triatriatum in 31 cases and incomplete cor triatriatum in 6. Thirty-two cases (86%) accompanied with other cardiovascular anomalies. Diagnosis was made in 16(43%) cases preoperatively. All patients had excision of the fibromuscular membrane through the right atrial transseptal approach. Results The mortality rate in this group was 8.11% (3 of 37 cases). Thirty-four cases were followed up after surgery from 3 months to 15 years was satisfactory. Conclusion Cor triatriatum is a rare congenital cardiac anomaly. Treatment of associated deformities was a committed step in cor triatriatum surgical correction. Result of surgical treatment was satisfactory.