Objective: To evaluate the experience of surgical treatment of anastomotic recurrence following resection of esophageal carcinoma. Methods: Reoperation was performed in 11 patients with anastomotic recurrence. The surgical procedure performed included cervical esophagocolostomy in 5, cervical esophagogastrostomy in 3, esophagocolostomy and esophagogastrostomy at the top of chest in 2, respectively, and thoracotomy in 1. Results: There was one operative death with mortality rate of 9.1%. The cause of death was respiratory failure. 1-, 3-and 5-year survival rates were 77.8% (7/9), 44.4% (4/9) and 22.2% (2/9), respectively. Conclusion: Reoperation is still effective for some patients with anastomotic recurrence. Early diagnosis and prompt surgical treatment can improve the outcome.

Objective To investigate the relation between the changes d myocardial collagen content before and after ventricu-lar assist device (LVAD) application and the prognosis in dilated cardiomyopathy. Methods Patients was divided to two groups ac-cording to the prognosis (weaning or transplantation) after LVAD application. Left ventricular samples were collected from the patients (weaning group n= 10, transplanted group n=8) at the time the LVADs were implanted, and again during cardiac transplantation ( n = 8 ). The content of neutral salt soluble collagen (NSC) and acid soluble collagen (ASC) were measured by Sired collagen assay and total collagen and insoluble collagen (ISC) by quantification of hydroxyproline. Moreover, protein quantification of each collagen fraction was performed simultaneously. Results Before LVAD implantation all collagen fraction and their protein contents were higher in the weaning group than that in the transplanted group ( P <0.05), but the difference in the collagen fraction disappeared after LVAD support. Comparison of the pre- and post-LVAD subgroups of the transplanted group showed an increase of NSC and its protein content and total hydroxyproline after LVAD support (P<0.05). Conclusion The significances of myocardial intersititial remodeling in DCM are not identical. Some myocardial collagen and protein content increases may be related to good prognosis. The mechanism of LVAD improving cardiac function may be related to the changes of myocardial intersitial collagen.

Objective To investigat the safe time of SVC interruption in New Zealand rabbits, and help to find the safe time ofSVC interruption in chnical operation. Methods 25 New-Zealand rabbits were separated into 3 groups randomly. Bi-SVC was cross-clamped for one hour, two hours in animal models. The femoral artery or SVC pressures were monitored. The control group (sham op-eration group, 5) were opened chest both sides and monitored femoral artery pressure and SVC pressure for 2 hours. Samples of cere-brum, cerebellum and medulla of rabbits immediately post-operation were studied for water content, light and electric microscopies.The tiny change of brain cells in brain mantle, hippocampus and thalamencephal were observed under electron microscope. Results(1) The SVC pressure of rabbits varied regularly in occlusion groups, which displayed as "upgrade-degression- upgrade again-retain".(2) There was no obvious difference in water content of brain between the one hour group and the control group, both of which weremuch lower than two hours group. (3) The brain tissues were almost in normal construction in one hour group, but encephaledema wasobserved in two hours group. The pathological change of cony brain cells was light and reversible in one hour group. However, in twohours group, necrosis of neuron ceils in brain could be observed, which was irreversible. Concerto The animal model of acuteSVC obstruction was built successfully. Interruption of the SVC for 1 hour was proved safe, with longer interruption of SVC 2 hours,obvious encephaledema and necrosis of neuron cells can be observed.

ObjectiveTo evaluate the feasibility of constructing tissue engineering cardiac patch with photooxidationfixed acellular bovine pericardium.MethodsFresh bovine pericardia were treated by dye-mediated photooxidation after decellularization.Some of them were seeded with bone marrow stromal cells(MSCs) isolated from male SD rats to construct cardiac patches.Myocardial infarction(MI) model was made in female SD rats by left anterior descending coronary ligation(LAD).One week later, the confirmed MI rats were divided into three groups randomly, group MI (n = 15)without any treatment; group P (n = 18) with photooxidated pericardia implantation ; group P + C (n = 18) with seeded pericardia implantation.A sham group (n = 10) was also performed with opening and closing chest twice only.The heart were explanted at 2 or 4 weeks after implantation, and examined histologically and immunohistochemically.The heart function was evaluated by echocardiography at 4 weeks before excising the rats.ResultsThere were no cells or cell debris remained in bovine pericardium tissue.The fiber structure became condensed after photooxidation.The seeded cells formed a continuous layer on the surface of the tissue.The pericardial degradation level and newly formed microvessel density were larger in group P + C than in group P after 2 [ (13.7 ±5.2)个/mm2 vs (7.1 ±3.1)个/mm2, P＜0.05]and4 [(22.6 ±4.9)个/mrn2 vs (14.1 ±5.3)个/mm2, P＜0.05]weeks.Four weeks after transplantation, cardiac echocardiography showed left ventricular ejection fraction(LVEF) was lower in group MI (44.8 ± 4.4) ％ and group P (48.4 ± 5.0) ％ compared with group P + C (49.3 ± 4.8) ％, left ventricular fractional shorterning(LVFS) was lower in group MI (18.0 ± 2.2) ％ and group P (19.8 ± 2.5) ％ compared with group P + C (20.4 ±2.5) ％, the difference between P + C and MI was significant.ConclusionTransplantation of the tissue engineered bovine pericardial patches with dye-mediated photooxidation can improve heart function in MI rats.This kind of patches demonstrates a promising prospect in the future.

ObjectiveAn out-thoracic paraaortic counterpulsation device(PACD) developed in the Reseach Center of our hospital was evaluated for its hemodynamic effects in an animal model with induced acute heart failure.MethodsEight healthy adult sheep with a weight of 38.5 to 54.5 kg were used as models for acute heart failure by snaring branches of coronary arteries.Thoracotomy was performed through the space under the left 4th rib.A Satinski clamp was used for partially clamping the descending aorta, and the Dacron vascular graft of out-thoracic PACD was sutured end-to-side to the descending aorta.The out-thoracic PACD used in this study had a blood chamber that was separated from the gas chamber by a movable polyurethane membrane .A stroke volume of 60 ml could be pumped when it was fully inflated.A 4F multipurpose catheter was inserted through the left ventricular apex for measuring and recording left ventricular pressures.A standard 40-ml intraaortic balloon was inserted into the descending aorta via the surgically exposed left femoral artery.Baseline hemodynamic data were collected after the model for acute heart failure was created without mechanical support.Mechanical support was randomly initiated either by the IABP or by the out-thoracic PACD in each experimental phase.Both devices were driven by the same console and synchronization with electrocardiogram was performed.Hemodynamic indexes and left carotid artery flow were calculated at baseline (device off) and during the period of 1 : 2 support for the 60-ml out-thoracic PACD and 40-ml IABP in the same animal.Baseline and support modes for devices were maintained for 15 minutes individually to ensure that a steady-state was achieved.ResultsBoth out-thoracic PACD and IABP resulted in a increase in the cardiac output (17.79％ with out-thoracic PACD vs.13.46％ with IABP, P =0.803) and the mean diastolic aortic pressure (29.48％ with out-thoracic PACD vs.15.01％ with IABP, P = 0.001).The use of out-thoracic PACD also led to a greater reduction in left ventricular end-diastolic pressure (35.09％ with out-thoracic PACD vs.15.79％ with IABP, P = 0.004).Meanwhile the out-thoracic PACD increased left carotid artery flow (14.52％ with out-thoracic PACD vs.6.70％ with IABP, P =0.006).No evidence of hemolysis, thrombus formation or major organ injury was identified during the experiment.ConclusionThe study indicated that a 60-ml out-thoracic PACD, which providing an improved mechanical circulatory support, was superior to a 40-ml IABP in the setting of experimental acute heart failure.This device may be used as a desirable alternative for the long-term mechanical support in patients with severe heart failure or those waiting for a heart transplantation, owing to its properties of low cost,easily to be implanted and removed, as well as a high biocompatibility.

ObjectiveTo study the impact of type 2 diabetes mellitus on endothelium of great saphenous vein in patients with coronary heart disease.MethodsPatients undergoing coronary artery bypass grafting were selected, 20 with type 2 diabetes mellitus (experimental group) and another 20 patients without (control group).The rings of great saphenous vein in I cm length were taken from those patients and then divided into 3 segments.The structure of endothelium was evaluated by the microscope and the changes of venous tone were measured in organ chamber at 37C with a constant supply of oxygen.Venous vasoconstriction was induced by phenylephrine (10-5 mol/L) and vasodilatation induced by nitroglycerin or acetylcholine (10-9 ～ 10-5 mol/L).ResultsMore damages of ultrastructure of the endothelium of saphenous vein were found in experimental group than in control group.There were no significant differences regarding the venous tone between the two groups (P ＞0.05) when vasoconstriction induced by phenylephrine and vasodilatation by nitroglycerin.However, the vasodilatation induced by acetylcholine was significantly decreased in experimental group than in control group (P ＜ 0.05).Conclusion Type 2 diabetes mellitus can aggravate the damage of endothelium of saphenous vein in patients with coronary artery disease.

ObjectiveThe present study was designed evaluate the aspirin effectiveness in the inhibition of platelet aggregation in patients after OPCAB.Methods290 patients were recruited.145 patients underwent first time OPCAB (surgery group).Arachidonic acid induced platelet aggregation and urine 11-dehydro thromboxane B2 (11-dehydroTxB2) were measured before operation and on aspirin re-administered days 1,4, 10, and 6 months after surgery.The same tests were also detected in 145 patients from the cardiology department (non-surgery group) received medicine therapy as controls.Results Ninety-nine patients were defined as aspirin sensitive after OPCAB (AS Group).Postoperative aspirin resistance was identified in 46 (32％) patients at the first day after aspirin treatment started (AR Group).19 (13％) and 5 (3％) patients remained as AR at day 4 and 10 after aspirin re-administration, respectively.Patients in the AR group had higher 11-dehydroTxB2 levels than those in the AS group (P = 0.049).Six months follow-up showed ARA-induced platelet aggregation was (11.5 ± 3.4) ％.Urine level of 11-dehydroTxB2 was (50.3 ± 15.4) ng/L.No resistance was found.All cardiologic patients were identified as aspirin sensitive, the change of platelet aggregation and 11-dehydroTxB2 were similar as those in the AS group.Weight ＞75 kg and postoperative drainage ＞500 ml were risk factors of aspirin resistance after OPCAB.ConclusionAnti-platelet effect of aspirin was reduced during the early postoperative period in certain patients undergoing OPCAB.In case of resistance,antiplatelet treatment strategy should be intensified or modified.

ObjectiveTo analyze the perioperative risk factors of right heart failure (RHF) in human heart transplantation, and to summarize the efficacy of targeted agent especially on pulmonary hypertension.Methods Patients underwent heart transplantation were selected by exclusion criteria : (1) acute heart or other organ failure, or supported by mechanical assist device ; (2) the difference between the body weight of donor and recipient was ＞ 20％ ; (3) the ischemic time of donor was＞ 6 h; (4) acute rejection episode after transplantation; (5) perioperative death.The clinical data of 96 patients were collected, including gender, age, body weight, protopathy, history of heart failure, preoperative systolic pulmonary arterial pressure (SPAP), left ventricle end diastolic diameter (LVEDD), preoperative ejection fraction(LVEF), preoperative blood creatinine, donor ischemic time and preoperative application of 5-PDEs.The diagnosis standard of RHF was established.The risk factors were analyzed through Logistic Regression.Patients were divided into two groups according to the systolic pulmonary arterial pressure (SPAP).In group A, SPAP was ＜40 mm Hg, and in group B with SPAP≥40 mm Hg.The correlation between two groups was tested byχ2 test.ResultsIn the multivariable analysis, age, history of valve disease, length of heart failure,and preoperative SPAP were the risk factors of RHF with the coefficient of 1.051, 1.351, 1.712 and 6.725, respectively.SPAP seems to be the most important risk factor.Coronary artery disease and preoperative application of 5-PDEs-I were the favorable factors with the coefficient of 0.056 and 0.034, respectively.Parameters regarding age, history of valve disease, length of heart failure between the two groups were significantly different.There were no significant differences in gender, body weight, diagnosed as dilated cardiomyopathy or coronary artery disease and other etiologies, preoperative LVEDD, preoperative EF, preoperative blood creatinine, isehemic time and RHF, though the incidence of RHF in group B was higher than in group A (67.6％ vs 45.8％).There was also no statistic difference in using of ECMO and the mortality rate between two groups.ConclusionPreoperative PAP was the main risk factor of the RHF after heart transplantation.Although there was no statistic difference, the incidence of RHF in patients with SPAP≥40 mm Hg was higher than in patients with SPAP ＜40 mm Hg .The application of targeted agent therapy and ECMO may be helpful in treating RHF after heart transplantation.

ObjectiveTo retrospectively analyze clinical data of patients who has left-side valvular disease combined with severe tricuspid regurgitation and evaluate the effect of our modified tricuspid annuloplasty with enforcement of artificial felt strip.Methods76 patients who had left-side valvular disease combined with severe tricuspid regurgitation received operations between Jan.2008 and Jun.2010.The average age of the patients was 53.5 years old (32 male and 44 female).Besides the severe tricuspid regurgitation, other combined cardiac impairments included mitral valvar disease (52 cases), aortic valvar disease(5 cases), double valvar disease(19 cases) and left atrial thrombosis(22 cases).6 patients had grade II cardiac function according to the NYHA criteria, while 47 and 23 were in grade III and IV, respectively.Other signs included cyanosis(5cases), jaundice(11 cases), neck vein engorgement(48 cases) , ascites(22 cases), hepatomegaly(41 cases) and pitting edema in the lower limbs(68 cases).The concomitant operative procedures included mitral valve replacement in 52 patients,aortic valve replacement in 5 patients, double valve replacement in 19 patients, removal of left atrial thrombus in 22 patients,left atrium folding in 21 patients and left atrium appendage suture in 68 patients.Left-sided valve disease were corrected first,TAP was performed on the beating heart after the heart had been defibrillated.The anteroseptal commissure was plicated first.A double-armed 3-0 pledgeted suture was taken through the base of the septal leaflet, 5-6 mm from the commissure, extending along the annulus, and out from the point in the anterior annulus 10-12 mm from the anteroseptal commissure.Both ends of the suture was tied until the two Teflon pledgets approximated each other near the commissure.Then a semicircular De Vega type of plicating with a 3-0 prolene was taken, starting just from the anterior annulus near the anteroposterior commissure, and extending clockwise to a point just cephalad to the posteroseptal commissure.The suture was tied with positioning a 27-29 mm valve siser across the tricuspid valve.At last, a 3-5 mm width felt strip was prepared and was sutured to the plicated posterior annulus region with interrupted mattress sutures of 2 to 3 2-0 prolene.A favorable result was considered when TR was not marked by saline injection.Echocardiography was routinely examined one week postoperatively and patients were followed up 6 month after discharge.ResultsThere is no death in all patients.The CVP diminished significantly from 16mmHg preoperatively to 8mmHg postoperatively (P = 0.0021).The systomic pulmonary pressure diminished from 59 mmHg preoperatively to 41 mmHg postoperatively (P = 0.038).Echo one week postoperative showed no tricuspid regurgitation in 56 patients and mild in 18 patients, while 2 had moderate tricuspid regurgitation.The diameter of right atrium diminished significantly postoperatively, too.The ejection fraction was improved even though there was not significant difference as compared with preoperative data.The cardiac function of all patients improved and the signs of right heart failure were alleviated or disappeared.Follow up 1 to 36 months showed no change of the regurgitation except for one become moderate from mild when discharged.No hepatic congestion or edema was observed in all patients.ConclusionThese new modifications make the technique more selective in the remodeling of the tricuspid annulus.It could achieve better coaptation of the anterior leaflet with the others, successful annular reduction, better maintenance of the contractile property of the tricuspid ring, better distribution of pursing force in the more dilated region.It could prevent the tear of the endocardium in the posteroseptal region in the long period of time postoperatively.

ObjectiveAnalyze the results of distal aortic reoperation in Marfan syndrome patients after proximal aortic surgery.MethodsBetween January 2000 and January 2010, 28 Marfan patients underwent surgical repair of distal aortic disease after aortic root surgery at our institution.There were 20 males and 8 females.Age ranged from 23 to 52 years [ mean (38.5 ± 8.7) years ].First time operations were Bentall procedure in 24, David procedure in 4.There were 8 cases of Stanford A dissection and 20 cases of aortic root aneurysm.The second time operations included 1 partial aortic arch replacement, 2 total arch replacements, 7 total arch replacements combined with stent elephant trunk, 6 descending thoracic aorta replacements,10 thoracoabdominal aorta replacements and 2 total aorta replacements.The interval between the lst and 2nd operation was 1 to 12 years [mean (6.43 ±3.07) years].The surgical technique used for distal procedures was dependent on the pathology of the aorta.Median repeat sternotomy was used for surgical exposure in 10 patients, who required an arch/proximal descending aortic procedure.Cardiopulmonary bypass (CPB) was established through the right axillary perfusion and right femoral venous drainage in all of these patients.16 patients were operated on through a left-sided incision, namely, a posterolateral thoracotomy, or a thoracoabdominal incision, depending on the distal extent of aortic replacement.For such patients, the left femoral vessels were cannulated for CPB in 14 patients and the rest 2 patients were operated on without CPB.Two patients with total aorta replacement were operated on through a median sternotomy combined with thoracoabdominal incision.22 patients underwent deep hypothermic circulatory arrest because of the replacement of anrtic arch or the extensive aneurismal arch.Reconstruction of intercostal arteries (T8-L1) was performed in 16 patients for the protection of spinal cord.ResultsTwo patients (7.1％) died postoperatively.Neurological morbidity included 1 patient with stroke, 1 paraplegia and 2 temporary paraparesisThree patients required temporary tracheotomy for prolonged weaning form the respirator.All patients were followed up for 10-118 months [mean (40.8 ±29.5) months].Two patients died during follow-up.The survival rate was (94.5 ± 1.3)％,(90.6 ± 1.4) ％ at 1-and 5-year, respectively.ConclusionDistal aortic reoperation in Marfan patients can be performed with good short-and long-term results.Complete aortic arch replacement with elephant trunk technique, if safely performed,should be considered for Marfan patients presenting with type A dissection.