Objective To review and summarize the experiences of mitral valve replacement in the children aged less than five years.Methods Twelve patients with moderate to severe mitral valve regurgitation (MR) or/and severe mitral valve stenosis (MS) were retrospectively study from January 2008 to December 2011,all of them suffered from severe heart failure and underwent mechanical mitral valve replacement.There were 9 males and 3 females.They aged from 4 to 58 months [mean (26.2 ± 18.1) months] and weighted from 5.6 to 13.0 kg [mean (9.6 ± 3.8) kg].Three patients underwent unsuccessful mitral valve repair before mitral valve replacement.17 to 23 mm aortic bileaflet mechanical prosthesis were reverse directional implanted in nine patients and 25 to 27 mm mitral bileaflet mechanical prosthesis were implanted in three patients.Results One patient died,the operative mortality rate was 8.3％.2 patients were complicated by cardiac arrhythmia and 2 patients complicated by mild hemolysis,all recovered after symptomatic treatment.The heart function of servived 11 patients improved significantly,none of them were complicated by haemorrhage or thromboembolic.Conclusion Severe mitral valve lesion injure heart function significantly for the young children and timely surgical intervention is the only option.Mitral valve replacement is the ultimate option for the patients failed in mitral valve annuloplasty.The introduction of aortic bileaflet mechanical prosthesis which smaller size is available and reverse directional implantation resolve the difficulty of prosthesis-patient mismatch essentially,most children with a small prosthesis has to redo mitral valve replacement with a larger size prosthesis.The compliance of permanent anticoagulation of young children is favourable and more intensively follow-up is essential to avoid the incidence of bleeding and thromboembolic.

Objective To analyze and summarize the applicative experience and operative effective of the diaguostictreatment-repair strategy in the transpossion of great arteries(TGA) infants with ventricular septal defect and severe pulmonary hypertension more than 6 months.Methods From January 2010 to October 2011,17 TGA cases with ventricular septal defect and severe pulmonary hypertension.There were 13 male and 4 female.≥0.5-＜ 1.0 years old 6 cases,≥ 1.0-＜ 3.0 years old 3,≥3.0 years old 8 cases.Combine anomalies: patent ductus arteriosus in 6 cases,atrial septal defect in 5 cases,valve insufficency in 2 cases.All preoperative cases were performed echocardiography,right-sided heart catheterization 3 cases,coronary CT examinationll cases.After diagnostic-treatment 2-4 weeks,all cases performed arterial switch operation under compound intravenous and inhaled anesthesia.Results No operative death.After diagnotic-treatment,SPO2 improved 10％-21％,and mPAP decreased 10-20 mm Hg.Follow-up 11.2 (6,20) months,one dead.Postoperative residual pulmonary arterial hypertension in 35.29％,6/17cases,all of them were ≥3 years old.Continue to pulmonary arterial hypertension targeted drugs treatment for 6-20 months later,pulmonary artery pressure decreased obviously.Conclusion The TGA infants with ventricular septal defect pulmonary arterial hypertension more than 6 months,can be selectively performed arterial switch operation under went diagnostic-treatment-repair strategy,continue to pulmonary arterial hypertension targeted drug therapy postoperation,the effect is good.

Objective To review the surgical methods and mid-term results of mitral valve repair in pediatric patients with moderate to severe mitral regurgitation (MR).Methods 132 children with moderate to severe MR,aged (18.9 ± 7.2)months,weighted(11.3 ±4.8) kg.The etiology for mitral regurgitation is congenital heart disease in 126 cases,infective endocarditis in 5 cases and Marfan syndrome in 1 case.Mitral valvuloplasty(MVP) was performed with cardiopulmonary bypass under moderate systemic hypothermia.The methods of MVP included annuloplasty,annuloplasty ring,cleft closure,reconstruction of posterior leaflet.The coucomitant cardiac anomalies were treated at the same time.The results of repair were evaluated by saline injection test and transesophageal echocardiography (TEE) during operation.Results Intra-operative TEE results: 131 cases had none to mild MR,and only one case had moderate MR.The patient underwent second repair immediately,subsequent TEE was mild.Mean cardiopulmonary bypass (CPB) time was (80.0 ± 31.1) minutes.Mean aortic clump time was (48.0 ± 17.9) minutes.The in-hospital mortality was 2.3％ (3 cases died).One died of heart failure on postoperative day 7,the other died of low cardiac output syndrome resulting on postoperative day 2.Another one was large ventricular septal defect(VSD) with pulmonary hypertension (PH),died of pulmonary infection.Mean postoperative ventilation time was (34.4 ± 31.9) hours,and mean postoperative inhosptial time was (9.0 ± 5.4) days.The average follow-up period was (40.5 ± 8.3) months (2 to 74 months).122 cases were fully followed up.Echocardiography showed that moderate MR was in 7 patients,and 3 patients had severe MR.4 patients underwent re-do mitral valve repair or mitral valve replacement.There was no late death.The overall survival rate at 5 years was 97.7％ and the overall freedom from reoperation at 5 years was 92.0％.Conclusion Pediatric patients with moderate to severe MR need early surgical treatment,the early and mid-term results were satisfactory.Individualized treatment protocol based on specific pathology was the keypoint of surgical therapy.

Objective To studiy the surgical outcomes of children with congenital aortic stenosis (AS),and summarized the experience of surgical procedures.Methods From February 2006 to November 2011,a total of 49 consecutive children with AS underwent surgical treatments.Twenty-nine patients were male and 20 patients were female.The median age was 17 months (1 month to 14 years),and median weight was 15.6 kg (3.2-47.0 kg).Peak AS gradients was (74.9 ±20.4)mmHg (45-123 mm Hg) before surgery.Fourteen patients had isolated congenital AS,4 had combined moderate-to-severe aortic insufficiency (AI).Thirty-Three patients had associated cardiac anomalies,including ventricular septal defect,atrial septal defect,patent ductus ateriosus,coarctation of aorta,subaortic stenosis,and supravalvular mitral stenosis.Thirty-one patients underwent aortic valvotomy,9 valvuloplasty,2 Aortic valve replacement (AVR),1 Ross procedure,2 Ross-Konno procedure,and 4 Konno/AVR.Median follow-up was 20 months (2-55 months).Clinical and echocardiographic follow-up data were analyzed.Results There was 1 postoperative death who died of heart failure due to severe mitral valve insuffciency.Latest follow-up data showed that the survivals performed in satisfactory cardiac function.Left ventricular ejection fraction (LVEF)was 0.69 ±0.10,and fraction shortening (FS) was 0.38 ±0.09.Peak AS gradients decreased significantly after surgery to (38.6 ± 15.8) mm Hg (20-73 mm Hg),P ＜ 0.001.One patient needed reintervention because of severe recurrence of adhesion in the commissure 3 months after the previous surgery.Totally 31 patients underwent simple valvotomy procedure.Postoperative AI was none or trace in 5,mild in 20,and moderate in 6.Two surgical techniques were used to repair the aortic valve according to the anatomy of the valve and the cause of insufficiency,including commissuroplasty in 6 and pericarial casp extension in 3.Nine patients underwent valvuloplasty procedure,post-operative AI was none or trace in 3,mild in 5,and moderate in 1.We put more attention to the 7 patients who had moderate AI valvotomy or valvuloplasty,and the latest follow-up showed that these patients were in good condition and there was no deterioration the degree of AI.Conclusion Long-term outcomes show that aortic valvotomy and valvuloplasty are reliable and effective approaches for congenital AS in children.When moderate-to-severe AI exists,other procedures such as Ross,Ross-Konno,AVR,or Konno/AVR are preferred.

Objective To review retrospectively the experience of surgical treatment of Ebstein anomaly in 45 adult patients.Methods Between January 2008 and December 2011,45 adult patients underwent surgery for Ebstein anomaly.There were 14 male and 31 female patients aged 18 to 61 years (mean,39 years).The main symptoms included chest tightness,shortness of breath,palpitation.25 patients had cyanosis,while 6 patients with Wolff-Parkinson-White syndrome.Preoperative echocardiography: The septal downward from 2.5 cm to 7.5 cm,average 4.2 cm; the posterior leaflet downward 3.0 cm to 8.0cm,average 5.1 cm.Tricuspid incompetence was moderate in 6 patients and severe in 29.According to Carpentier classification,5 cases of type A,30 type B,type C in 6 cases.Preoperative New York Heart Association(NYHA) functional class Ⅱin 14 cases,Ⅲ 30 cases,Ⅳ in 1 cases.Surgical procedures included modified Danielson's in 15 patients,modified Carpentier's in 23,and 7 patients underwent tricuspid valve replacement(incloud 4 secondary operations).The ratio of tricuspid valve repair was 84.4％.Autologous pericardium patch was used to reconstruct the septal and posterior leaflets in 5 cases.Intraoperative use of annuloplasty rings in 21 cases.Results There were 2 hospital deaths with a postoperative mortality of 4.4％.The main causes of death were low cardiac output and right heart failure.Operation to discharge time was (8.0 ± 3.8)days.The follow up time was 2 to 46 months.Echocardiography examination: Within the 32 patients of severe tricuspid regurgitation before tricuspid valve plasty,16 patients’ tricuspid regurgitation disappeared,13 patients with mild regurgitation,3 moderate regurgitation.Within 5 patients of moderate tricuspid regurgitation before tricuspid valve plasty,4 cases tricuspid regurgitation disappeared after operation,1 case tricuspid valve mild regurgitation.Tricuspid valve leaflets were at normal levels,the atrialized portion of the ventricular disappeared.The heart function improved to be NYHA class Ⅰ to Ⅱ in 95 ％ of the survived patients.Conclusion Operative method of Ebstein anomaly sould be selected according to the type of pathoanatomies.Tricuspid valve repair should be performed to the best of our ability.

Objective Acute kidney injury (AKI) is a common complication after cardiac surgery,especially in elderly patients,and related with poor prognosis.Although much advances in therapies of AKI have been obtained,the prognosis of patients did not improved.In the absence of proven interventions,a reasonable strategy would be to identify modifiable risk factors for AKI.The objective of the present study was to explore modifiable risk factors of acute kidney injury after cardiac surgery with cardiopulmonary bypass in elderly patients.Methods Data from 457 consecutive elderly patients (age ≥60 years old)who underwent cardiac surgery with cardiopulmonary bypass in the Guangdong General Hospital between January 2007 and December 31,2009 were analyzed in this retrospective research.The primary outcome was AKI according to the serum creatinine criteria of the RIFLE (renal Risk,Injury,Failure,Loss of renal function and End-stage renal disease) classification as an increase in serum creatinine ＞ 50％ from baseline to peak value within the first seven postoperative days.The baseline serum creatinine was defined as the latest serum creatinine before cardiac surgery.Univariate anadysis was carried out for patients'demographics data and multivariate analysis by logistic regression was used to obtain the independent risk factors for AKI.Results Among 457 elderly patients,patients mean age was (65.22 ± 4.17) years and they comprised 253 (55.4％) men and 204 (44.6％) women.AKI occurred in 313 (68.5 ％) participants.Compared with patients without postoperative AKI,the media length of intensive care unit was longer in patients with postoperative AKI,4.0 (2.0-7.5) days versus 2.0 (1.0-3.0) days,respectively.In logistic regression model,malc (odds ratio[OR] 1.894,95％ confidence interval[CI] 1.136-3.157),age above 65 years (OR 2.391,95％ CI 1.381-4.142),hypertension (OR 2.286,95％ CI 1.249-4.184),estimated glomerular filtration rate less than 60 ml/min (OR 1.933,95％ CI 1.111-3.362),preoperative uric acid ＞ 450 μ mol/L (OR 2.938,95％ CI 1.633-5.285),use of angiotensin converting enzyme inhibitors/angiotensin receptor inhibitors (ACE1/ARB) before cardiac surgery (OR 2.196,95％ CI 1.283-3.759),use of ACEL/ARB after surgery (OR 0.329,95％ CI 0.156-0.691),use of diuretics (OR 0.149,95％ CI 0.068-0.326),time of cardiopulmonary bypass above 120 min (OR 5.228,95％ CI 3.023-9.041) and prolonged mechanical ventilation (OR 2.921,95％ CI 1.527-5.586) were independent factors of AKI after cardiac surgery with cardiopulmonary bypass.Conclusion Preoperative uric acid above 450μmol/L was a modifiable risk factor of AKI after cardiac surgery with cardiopulmonary bypass in elderly patients.Therapies aimed at mitigating high preoperative uric acid may offer protection against this complication.

Objective To investigate the diagnostic value of EBUS imaging features for metastatic mediastinal/hilar lymph node enlargement in lung cancer.Methods The lung cancer patients with a pathological diagnosis and without preoperative anti-tumor treatment who got the EBUS-TBNA examination from October 2009 to September 2011 were retrospectively analysis.422 lung cancer patients with 683 mediastinal / hilar lymph nodes were enrolled in this study,including 335 males and 87 females; the median age is 61 years old (range 24-82),EBUS lymph node ultrasound image and the final pathological or follow-up results were compared by the statistical analysis.Homogeneity in the lymph node EBUS image feature was defined as:uniform echo in the ultrasound images,cortex existed in the peripheral areas,medulla existed in lymph central with a slightly stronger echo and represent as a small strip.Heterogeneity was defined as: the ultrasound image was defined as uneven echo involved with coagulation necrosis sign,which was the hypoechoic areas without blood flow in the lymph nodes and represent no blood flow in the CDPI mode.The coagulation necrosis was associated with necrosis within the lymph node.In addition,if the CNS region occupied more than 11％ of the entire lymph node in a complete lymph node or just a part of huge lymph nodes in the EBUS imaging window frame,we also regard it as heterogeneity.If a complete lymph node was seen in the EBUS imaging window frame,we measured the longest diameter to the long axis and its vertical maximum diameter to the short axis.If the lymph node was huge and extended the EBUS imaging window frame,we measured the longest diameter in the frame as the long axis of its vertical maximum diameter to be the short axis.As to the EBUS-TBNA negative lymph nodes,we regarded it was malignant lymph node if the diameter of the lymph node increased by 20％ in the patients who did not received any chemotherapy or radiotherapy or the diameter of the lymph node increased or decreased by 20％ in the patients who received any chemotherapy or radiotherapy six month later in the chest enhanced CT scan,otherwise,it was identified as benign lymph node.We used the RECIST 1.1 solid tumors criteria to evaluate the efficacy of the chemotherapy.Results 422 patients were enrolled this study including 93 squamous carcinomas,137 adenocarcinomas,97 small cell lung cancer,42 poorly differentiated non-small cell lung cancer,29 adenosquamous carcinoma and 24 other malignant tumors (including large cell carcinoma,sarcomatoid carcinoma,carcinoid tumors,etc).The sensitivity of the EBUS-TBNA was 93.8％ (396/422).The diagnostic methods and results in the 683 lymph nodes were as the following: 506/683 (74.1％) was confirmed as cancer by the EBUS-TBNA while 177/683 (25.9％) was diagnosed as benign disease.Among these,32/683 (4.7％) was confirmed as cancer and 57/683 (8.3％)was confirmed as benign disease by surgery,9/683 (1.3％) was confirmed as cancer and 79/683 (11.6％) was confirmed as benign disease by the method of follow-up.the sensitivity for the EBUS-TBNA to be malignant was 506/547 (92.5 ％),specificity was 136/136 (100％),positive predictive value was 506/506 (100％),negative predictive value was 136/177(76.8％) and accuracy was 642/683 (94.0％).The short axis diameter in the 683 lymph nodes ranged from 0.40cm to 4.60cm with an average diameter of (1.58 ± 0.68) cm.Among them,the short axis diameter in the malignant lymph node was (1.75 ± 0.63) cm,and in the benign lymph nodes was (0.92 ± 0.40) cm.527 lymph nodes presented heterogeneity under the ultrasound imaging,in which,519/527 (98.5 ％)were malignant lymph nodes.While,156 lymph nodes presented homogeneity and 28/156 (17.9％) were malignant lymph nodes (x2 =489.5,P ＜0.01).In the heterogeneous lymph node with a short axis diameter more than 1.0cm,the sensitivity to be malignant was 89.4％,specificity was 100％ and accuracy was 89.6％.In the homogeneous lymph node with a short axis diameter less than 0.8cm,the sensitivity to be benign was 43.8％,specificity was 67.8％ and accuracy was 48.1％.Conclusion EBUS-TBNA is new biopsy method for the mediastinal / hilar lymph node.The classification based on EBUS imaging-based lymph node ultrasound image features was helpful to identify the procedure for the diagnostic purposes and could help to distinguish the benign or malignant mediastinal / hilar lymph node in lung cancer patients.

Objective Surgical treatment of lung cancer needs to follow strict quality control standard for the aims of accuracy of pathological staging and potentially improved prognosis.However,there are short of studies related to surgical quality analysis.Methods One hundred and twelve patients were enlisted with the diagnosis of lung cancer and received surgical intervention in 2007.Surgical quality of these cases were retrospectively analyzed in compliance with three international standards,National Comprehensive Cancer Network (NCCN),American College of Surgeons’ Oncology Group (ACOSOG),and International Association for the Study of Lung Cancer (IASLC).Results No surgical death was reported in this group.According to NCCN,ACOSOG and IASLC standards,qualified operations were 82 cases (80.4％),73 cases (71.6％),45 cases (44.1％) in 102 cases with R0 resection,respectively.The median total lymph nodes,median mediastinal nodes,and N1 nodes were 27 (range 0-63),16.5 (range 0-43),and 10.5 (range 0-26),respectively.The median mediastinal node stations resected were 4 (range 0-6).In the mediastinum,stations of 4R,5,6 and 7 presented the highest frequency of receiving lymph node dissection.For N1 stations,10 and 12 were among the top list.For the whole group,1-year survival,3-year survival and 4-year survival were 92％ (95％ CI,89-95),67％ (95％ CI,62-72),57％ (95％ CI,52-62),respectively.Conclusion Quality control is the essential part of surgical treatment of lung cancer,which will facilitate the baseline standardization of clinical research.Since IASLC provides the strictest standard for lung cancer surgery,we suggest that all thoracic surgeons need to follow this standard to secure the accuracy of pathological diagnosis and for a potential better prognosis.

Objective To analyze the reasons for in-hospital mortality after a surgical resection for esophageal and cardial cancer and countermeasures.Methods From 1999.1 to 2010.12,7,225 patients with esophageal and cardial cancer were performed surgery in Cancer Institute and Hospital.Retrospectively analyzing the clinical datas of patients in-hospital mortality of these patients.Results 71 cases of 7,225 patients with a surgical resection for esophageal and cardial cancer died in-hospital after surgery.Conclusion Strictly mastering the operative indications,treating the acompaning diseases actively,choose the appropriate surgical approach,careful operation in surgery,reducing surgical time,intensice care after surgery and timely treatment of postoperative complications correctly may play a significant role in the decrease of in-hospital mortality after surgery.

Objective To evaluate the effects of hyperbaric oxygen (HBO) and cisplatin (DDP) on inhibition of A549/DDP cells in vitro and to explore the impacts of HBO on cell cycle and apoptosis.Methods The cytotoxicity of HBO and DDP was determined by Methyl thiazolyl tetrazolium (MTF) assay; flow cytometry (FCM) was used to investigate the impacts on cell cycle and apoptosis of cell line A549/DDP.Results Hyperbaric oxygen alone significantly suppressed A549/DDP cells proliferation (P ＜ 0.05),compared with control group of normal oxygen,and the inhibition ratio was 2.90％.DDP at concentrations ranging from 3 μg/ml to 24 μg/ml significantly inhibited the proliferation of A549/DDP cells in a dose dependent manner,that was concentrations of 3,6,12 and 24 μg/ml brought inhibition ratio of 1.87％,4.62％,11.15％ and 30.45％ ; Hyperbaric oxygen can enhance the inhibition effect of DDP to A549/DDP cells,when hyperbaric oxygen affiliated with DDP of concentrations above,the inhibition ratios were 4.37％,8.92％,21.88％ and 48.71％,respectively,which has significant difference with the single DDP groups.FCM analyses showed that HBO arrested A549/DDP cells at the S phase,that was cell number of G0/G1 phase reduced significantly and of S phase raised significantly,compared with normal oxygen group(P ＜0.01),that was the percentages of cells in S phase of control group were 9.5％ and HBO group were 20.9％,while the percentages of cells in G0/G1phasc were 82.2％ and 66.3％,respectively.In addition,there were more apoptotic cells in the HBO group with the percentage of 7.9％,while the percentage was 2.8％ in the normal oxygen group.Conclusion Hyperbaric oxygen could play together with DDP to inhibit A549/DDP cells proliferation.HBO could block the cell cycle at S period and induce apoptosis.