Objective　To investigate the changes of free triiodothyronine (FT3) and its therapeutic effects on heart dysfunction after thoracic trauma.　 Methods　Eighteen rabbits were assigned randomly into 3 groups. The rabbits in Group A were served as a control, that in Group B were shot at the left thoracic wall passing through the cardiac region with small diameter rifle, that in Group C were treated by FT3 into veins (10 ng/kg) after thoracic trauma. 　Results　In Group B, MAP was much lower than that in Group A after trauma (P<0.05). In Group B, LVEDP and CVP respectively was much higher than that in Group A. Plasm concentration of cTnT in Group B was much higher than that in Group A. But level of FT3 was in Group B decreased more markedly than that in Group A after trauma. In myocardial interstitium, many red cells were leaked out of vessel. In Group C, MAP was much higher than that in Group B, no significant difference was found. CVP and LVEDP in Group C were much lower than that in Group B. Level of FT3 was near to normal and much higher than that in Group B. Edema of myocardial cells and hemorrhage of myocardial interstitium were alleviated markedly. 　Conclusions　Rabbits shot dead at the left thoracic wall passing through cardiac region with small diameter rifle can contribute to an animal model establishment of heart dysfunction. Reduction of FT3 is in correspondence with heart dysfunction. Correcting thyroid sick syndrome after trauma can improve significantly the heart function.

30 mm in 100 patients.The ASD was associated with atrial septal aneurysm in 2 patients.An incision 2~3 cm in length was made in the 4th intercostal space of the right parasternum to expose the right atrium,at which a purse-string suture was placed.A double-lumen delivery catheter was then punctured into the right atrium,and passed through the defect to the left atrium under the guidance of transesophageal echocardiography.An occluder made of a nickel-titanium metal alloy and 4 mm bigger than the defect was released to engage on the defect.The delivery catheter was then withdrawn.Results The operation was successfully accomplished in all the 206 patients.The operation time was 18~32 min(mean,26?7 min). No surgery-related death happened and no occluder dislodgment occurred.Mechanical ventilation was stopped at 5 hours after operation,and all the patients got out of bed on the operation day.Colour Doppler imaging 3 days after operation showed complete occlusion of the ASD without residual shunt.The length of hospitalization was 4?2 days.Follow-up examinations for 6 months in 186 patients and for 3~4.5 years in 57 patients by using Colour Doppler imaging revealed no residual shunt and normal cardiac functions.Conclusions Mini-incision transthoracic occlusion of atrial septal defect is safe and reliable in patients contraindicated to transcatheter closure.

Objective To observe the clinical effects of endoscopic great saphenous vein harvesting(ESVH) in coronary artery bypass grafting. Methods Endoscopic great saphenous vein harvesting was performed in 89 patients undergoing coronary artery bypass grafting(CABG) from April 2004 to May 2005.An incision 2 cm in length was made on the knee joint and the great saphenous vein was harvested using the VasoView-5 system.Clinical data of the 89 patients(Endoscopic Group) were compared with another 38 patients undergoing conventional great saphenous vein harvesting for CABG from April 2003 to March 2005(Conventional Group) in respect of complications of the leg, the recovery time to walking,and the patency rate at 6 postoperative months.Results The number of harvested vein grafts in the Endoscopic Group was 2~3(mean,2.6).Complications of the leg were significantly less in the Endoscopic Group(6/89) than in the Conventional Group(8/38)(?~2=4.197,P=0.040).The occurrence of pain and numbness of the leg was 7/89 in the Endoscopic Group and 36/38 in the Conventional Group(?~2=89.740,P=0.000).The occurrence of swelling of the leg was 9/89 in the Endoscopic Group and 30/38 in the Conventional Group(?~2=59.299,P=0.000).The recovery time to walking was significantly shorter in the Endoscopic Group(2.3?0.9 d) than in the Conventional Group(3.4?1.6 d)(t=-4.952,P=0.000).There was no significant difference in the patency rate at 6 postoperative months between the Endoscopic Group(96.0%,48/50) and the Conventional Group(95.3%,19/20)(?~2=0.000,P=1.000).Conclusions Use of endoscopic vein harvesting in coronary artery bypass grafting decreases the incidence of postoperative leg-wound infections,post-operative pain,and length of hospital stay.

Objective To summarize the feasibility of the application of the self-made bipolar venous cannulae to repair atrial septal defect(ASD)totally through thoracoscope in children.Methods Twenty-eight children,aged 4.2?1.3 years in average and weighed 14.6?3.9kg,were diagnosed as congenital ASD.Among these patients 3 were complicated by moderate to severe pulmonary hypertension,4 by partial pulmonary venous teratosis and 3 by tricuspid valve insufficiency.During the operation,patients were placed in a supine position,and the right shoulder was padded 30? higher than the left.A tracheal cannula was inserted and air was given with high frequency jet ventilation.Three small thoracotomies with a diameter of 2 to 3 cm were made in the 4th intercostal space on the right side of the sternum and the 4th and 7th intercostal spaces on the right middle axillary line.The cardiopulmonary bypass(CPB)was set up through the right femoral artery and femoral vein with bipolar femoral venous cannulae.The ASD was repaired through the thoracoscope.Results In all the 28 patients,the mean extracorporeal circulation time was 53.5?17.8min,and cross-clamp time was 25.2?7.9min.Automatic heart beat recovered after the declamping of the aorta in all the patients.No serious complication occurred.Heart murmur vanished,and ultrasonic examination was negative.Half a year after operation,ECG showed that the size of right ventricle and right atrium became maller in size,the diameter of pulmonary artery diminished,and the cardiac function was improved(P

0.05).Compared with group A,the aortic occlusion time,ventilation time and the length of stay in ICU were shorter in groups B and C(P0.05)were found between group B and C in the aortic occlusion time,ventilation time and length of stay in ICU.Conclusion TTS is a safe and reliable surgical madality for the treatment of pediatric cardiac diseases.Patients weighed over 20kg are strong enough to withstand TTS and may recover sooner.

0.05),while the levels of IL-8 and IL-6 declined,but were still significantly higher than that at immediately after induction of anesthesia(P

To promote the understanding and practice of evidence-based medicine (EBM) in coronary artery bypass grafting (CABG). The transition of CABG graft materials from saphenous vein to arterial conduits were perceived using the principles of EBM. The arterial conduits were increasingly performed based on the principles and practice of EBM, therefore the postoperatively long-term graft patency rate, survival rate, and free cardiac event rate were significantly improved. CABG outcomes can be significantly improved by using arterial conduits based on principles of EBM.

Objective To summarize the clinical data of cardiac transplantation in 28 patients of our hospital,and study the effectiveness of operation and the methods of immunosuppressive regime.Methods From January 2000 to May 2005,in our center,28 patients were subjected to orthotopic cardiac transplantation.In early stage(before 2003) ciclosporin A and mycophenolate mofetil were used for immunosuppression.In late stage(after 2003) Daclizumab and mycophenolate mofetil were used for immunosuppression.Results Orthotopic cardiac transplantations were done successfully in 28 patients.There was no haemorrhage,twist and right heart insufficiency postoperatively.In the patients before 2003,the complications of hepatic-renal inadequacy to varying degrees occurred in 6 cases and infection in 3 cases respectively.In the patients after 2003,there were no complications of hepatic-renal inadequacy and infection.Conclusions Cardiac transplantion is an effective way for end stage cardiomyopathy.Immunosuppressive effect of Daclizumab and mycophenolate mofetil is satisfactory.

Objective:To investigate the effect of neonatal dog peripheral mononuclear cells on left ventricular function, haemodynamic, and infarcted size when transplanted into infarcted myocardium. Methods: Mononuclear cells from neonatal dogs were isolated and purified. The descending coronary arteries of adult dogs were ligated and the cells were injected into the border zone of the infarcted region. The control group was injected with non serum culture medium. Left ventricular pressure, d p /d t max , and power of LV were measured during and 30 d after operation. Echocardiogram(HP Sonos 5500, 2.5 MHz) were performed promptly and 30 d after operation to determine the changes of left ventricular function. Infarcted size, capillary density and cardiac muscle width were measured 30 d after operation. Results: LV pressure decreased in both groups, there were no marked differences between the 2 groups. LV pressure and d p /d t max of transplant group were greater than those of control group 30 d after operation. The systolic and diastolic functions were preserved after mononuclear cell transplantation. Infarcted sizes were lower and capillary density was greater in transplant group than those of control group. Conclusion: Transplantation of neonatal dog peripheral mononuclear cells into the infarcted regions can increase the capillary density and decrease infarcted size, preserving left ventricular function.

Objective To evaluate the safety and efficacy of transcatheter closure of perimembranous ventricular septal defects(VSD) using domestic symmetric double-disk occluders.Methods From March 2003 to July 2007,689 VSD patients were treated with transcatheter intervention using domestic symmetric double-disk occluders and received clinical follow up at 1 month,3 months,6months after the procedure and annually thereafter.Complications including residual shunt,heart rhythm changing,shape of the occluder and the presence of tricuspid/aortic regurgitation were observed thoroughly.Results The overall technical success rate was 98.8%.One patient died of cerebral bleeding 7 days after intervention.One patient suffered complete A-V block and required permanent pacemaker implantation and another patient conversed to open surgery because of moderate tricuspid regurgitation.Asymmetric Amplatzer occluders were used in 6 patients but the intervention failed in 2 patients whom required an open conversion.Comorbidities such as atrial septum defect,patent foramen ovale were treated concomitantly.No other complications were observed during the follow-up period.Conclusion Complication associated with transcatheter closure of perimembranous VSD using domestic symmetric double-disk occluders was relatively low.The procedure was safe and applicable.Meanwhile,it is necessary to stick to the procedural indications and avoid complications such as tricuspid regurgitation etc.