Objective To study the clinical features of traumatic mitral regurgitation and its surgical treatment methods and outcomes. Methods Clinical data of 16 patients with traumatic mitral regurgitation surgically treated from December 2000 to November 2008 were retrospectively analyzed. The cardiac thoracic ratio was 0.55 ±0.07 and the left ventricular ejection fraction (LVEF) was (51.2% ±23.2)%. According to the New York Heart Association (NYHA) functional classification, 10 patients were at grade Ⅰ - Ⅱ before operation. The surgical procedures consisted of mitral valvuloplasty in 14 patients and mitral replacement in two, when correction of other cardiac injuries was made at the same time.Of all, 14 patients obtained follow-up for (35.2 ± 25.7 ) months. Results The interval between trauma and appearance of mitral regurgitation was (23.3 ±50.90) months. Of 13 patients with echocardiography during follow-up, there were four patients with normal tricuspid hemodynamics, seven with trace tricuspid regurgitation and two with mild regurgitation. The value of LVEF was (66.8 ± 9.0)% at followup, significantly higher than preoperation (P ＜ 0. 05 ). There were 13 patients at grade Ⅰ - Ⅱ of NYHA,with a significant increase compared with preoperation ( P ＜ 0. 01 ). Conclusions Mitral regurgitation may emerge either immediately or several years after trauma. Traumatic mitral regurgitation patients can get satisfactory outcomes when comprehensive mitral valvuloplasty or mitral replacement is performed promptly.

BACKGROUND: Studies have demonstrated that intermittent high glucose can have a more severe impact on vascular endothelial function in comparison with persistent hyperglycemia.OBJECTIVE: To investigate the effect of intermittent high glucose on the proliferation and apoptosis of endothelial progenitor cells (EPCs) from human peripheral blood in vitro as well as the production of malondialdehyde (MDA) and antioxidant. METHODS: Total mononuclear cells were isolated from human peripheral blood by Ficoll density gradient centrifugation and then the cells were placed on fibronectin-coated culture dishes. After 7 days of culture, the adherent cells were identified as EPCs by laser scanning confocal microscope. The cells were synchronized and then stimulated with glucose 5.5 mmol/L (normal control group), 20 mmol/L (constant high glucose group), and 5.5/20 mmol/L (intermittent high glucose group, 5.5 and 20 mmol/L glucose culture solution was changed every 8 hours) for 72 hours. EPCs proliferation and apoptosis was measured by MTT assay and flow cytometry, respectively. The content of MDA and the activity of superoxide dismutase (SOD) in culture solution were detected with colorimetry.RESULTS AND CONCLUSION: After EPCs were exposed to constant high glucose (20 mmol/L) and intermittent high glucose (5.5/20 mmol/L) for 72 hours, proliferated cells were significantly reduced and the apoptosis rate was significantly increased compared with those exposed to normal glucose (P < 0.01). Furthermore, there was a significant increase in MDA contents as well as a significant reduce in SOD activities in the constant high glucose and intermittent high glucose group (P < 0.01), especially in the latter group. These findings indicated that both intermittent high glucose and constant glucose could inhibit the proliferation and promote the apoptosis of EPCs; however, intermittent high glucose appears to worsen the effects on EPCs. This is maybe due to the increased oxidative stress.

Objective To detect the expression of vascular endotheilal growth factor (VEGF), stromal cell-derived factor-1α (SDF-1α), and its receptor CXCR-4 in the retinopathy of diabetic rats, and to explore the relationship between those factors and diabetic-retinopathy(DR). Methods Diabetes was induced in 40 rats with a single intraperitional injection of streptozotocin(STZ). Experimental rats were randomly divided into M1 (diabetic for 1 month), M3 (diabetic for 3 months), and M5 (diabetic for 5 months) groups, and another 10 rats served as a normal control group (NC). Retinal vascular status was observed by transmission electron microscope. After retinal stretched preparation, VEGF, SDF-1α and CXCR-4 immunohistochemistry were done. Retinal VEGF, SDF-1α, and CXCR-4 mRNA were detected by semi-quantitative RT-PCR. Protein expression was measured by Western blot. Results Under transmission electron microscope, change in vascular status was found in M1 to M5 groups, but not in the NC group. The changes became increasingly serious with the prolongation of the disease. By immunohistochemistry, we found the expression of VEGF, SDF-1α, and CXCR-4 on the retina increased gradually. It increased after injecting STZ for 1 month and increased significantly after 5 months.VEGF, SDF-1α, and CXCR-4 mRNA expression increased obviously after injecting STZ for 1 month and increased significantly after 5 months. Western blot showed that protein of VEGF, SDF-1α, and CXCR-4 had no change after injecting STZ for 1 month. It began to increase in the M3 group and increased most in the M5 group. Conclusion The expression of VEGF, SDF-1α, and CXCR-4 on the retina in retinopathy of diabetic rats increases gradually with the prolongation of the disease. It is an important factor for diabetic retinopathy.

Objective To review our clinical experience with 41 reoperatioas of prosthetic heart valve dysfunction be-tween October 1996 and October2008. Methods There were 16 malas and 25 females with an average age of (44.5±12.6)years. All 41 patients underwent reoperation under hypothermic cardiopulmonary bypass, including 38 heart valve replace-ments, 2 disc rotations and cut of the excessive knot in 1 case. There were 13 emergency and 28 elective procedures. Results The median time for extubation was 15.3 hours and tracheostomy was needed in 5 cases. There were 6 deaths, all of which occurred in emergency cases, with a mortality rate of 15.4%. No death occurred in patients implanted with a bioprosthetic valve previously. Postoperative complications included 1 infective endocarditis, 1 intractable hiccup and 1 wound infection. Conclusion Prosthetic heart valve dysfunction is catastrophic. Early diagnosis and reoperation is mandatory.

Objective To analyze the clinical characteristics of children massive cerebral infarction after traumatic brain injury. Methods The clinical data of 33 children with massive cerebral infarction after traumatic brain injury were retrospectively analyzed. Results Among the 33 children, 24 cases suffered from falling, 10 cases were involved in traffic accidents, 1 case suffered from violence and 1 case was hit by falling object. The massive cerebral infarction occurred in all objects: 9 cases in 1 day after head trauma, 14 cases in 1 - 3 days, 7 cases in 4 - 7 days, and 3 cases after 7 days. Eighteen patients were performed operation to evacuate the intracranial hematoma and decompression. Antiplatelet agents, calcium antagonist and low molecular dextran were administered in all patients after exclusion of bleeding tendency. The follow-up period of all children ranged from 6 months to 24 months. According to Glasgow outcome score (GOS):18 cases showed a good outcome, 6 cases were moderately disabled, 1 case was severely disabled, 1 case survived in a permanent vegetative state and 7 cases died. Conclusions The main causes of children massive cerebral infarction with traumatic brain injury are falling and traffic accident. With proactive treatment, the prognosis of children survivors is acceptable.

Objective To review the experience of the surgical treatment of adult patients with anomalous left coronary artery from the pulmonary artery(ALCAPA).Methods A retrospective,single institution review was conducted on nineteen adult patients with ALCAPA surgical treatment from February 2006 to October 2012.Of these patients,five were males and fourteen were females.The age was(35.3 ± 11.7) years.The weight was (61.2 ± 9.4) kg.Most patients showed some evidence of myocardial infarction or ischemia with either abnormal Q waves (4) or ST-T abnormality (13).Twelve patients with coronary angiography and four patients with coronary CT scan showed good coronary collateralization.The preoperative UCG showed the mean left ventricular ejection fraction(LVEF) was 0.60 ± 0.07,and the mean left ventricular end-diastolic dimension(LVEDD) was(52.4 ± 4.4) mm.Severe mitral regurgitation(MR) was seen in two patients,moderate in three patients and mild in four patients.The operative procedures included Takeuchi operation in seven patients,ligation of left coronary artery concomitant with coronary artery bypass graft in two patients,coronary artery re-implantation in ten patients.Of the ten patients with coronary artery re-implantation,two patients underwent mitral valve repair.Results There was no operative mortality.The mean cardiopulmonary bypass time was (144.5 ± 66.9) min and cross-clamp time was (96.4 ± 38.8) min,respectively.The mean mechanical ventilation time was(12.9 ± 3.7) h and intensive care unit time was(39.2 ± 12.5) h,respectively.The mean postoperative LVEF was 0.62 ± 0.04.No significant reduction in LVEDD (45.8 ± 5.5) mm,P ＞ 0.05.Mild and trivial MR were observed in one and four patients,respectively.Sixteen patients(84.2％) completed the follow up with a mean time of 19.2 months.All the patients survived with New York Heart Association class Ⅰ or Ⅱ.During the follow up period,no patient required reoperation or readmission.At the latest echocardiography,the mean LVEF of 0.63 ± 0.05 and mean LVEDD of(49.2 ± 4.6) mm did not significantly improved compared with the data preoperatively or postoperatively.Mild MR was detected in six patients,trivial in three patients during the follow-up period.Conclusion The adult patients with ALCAPA have a dormant disease process.Surgical treatment has been recommended at the time of diagnosis and the coronary re-implantation could be the first choice.As for the concomitant MR,the guideline for the adult MR should be followed.

Objectives: To analyze clinical characteristics with the early and late prognosis in elder patients with combined aortic valve replacement (AVR) and coronary artery bypass grafting (CABG).
Methods: A total of 232 patients≥65 years of age who received AVR-CABG in our hospital from 2004-02 to 2014-09 were retrospectively analyzed. The risk factors affecting the early and late prognosis in those patients were studied by multivariate Logistic regression analysis and Cox proportional hazards model.
Results: The in-hospital death happened in 7/232 (3.0%) patients, early post-operative complication with prolonged mechanical ventilation time was 28 (12.1%) and bleeding was 14 (6.0%). The follow-up study was conducted in 225/232 (97.0%) survived patients from 3 months to 10 years at the mean of (41.2 ± 29.0) months; 6 (2.7%) patients had cardiac death, the major late post-operative adverse events were cardiac dysfunction (III to IV) or recurrence of angina (8.9%). Multivariate Logistic regression analysis revealed that female (P=0.019, OR=2.576), pre-operative atrial ifbrillation (AF) (P=0.012, OR=3.541) and CPB time (P=0.000, OR=3.781) were the independent risk factors affecting early post-operative outcome. Cox proportional hazards model presented that hyperlipidemia (P=0.025, HR=2.535), smoking (P=0.009, HR=3.414) and the history of PCI (P=0.013, HR=3.562) were the independent risk factors inlfuencing late prognosis of AVR-CABG.
Conclusion: The overall effect of AVR-CABG in elder patients was satisfactory. Female, pre-operative AF, CPB time may affect the early post-operative outcome, while hyperlipidemia, smoking and PCI history could inlfuence the long-term prognosis in relevant patients.

ObjectiveTo evaluate the mortality and morbility of children with severe traumatic brain injury (sTBI) following treatment with decompressive craniectomy and further analyze its long-term outcomes.Methods Seventeen children with sTBI undergone decompressive craniectomy between 2004 and 2010 were retrospectively studied.Quality of life of the patients who survived the operation was assessed by using the King' s outcome scale for childhood head injury (KOSCHI).ResultsOf 17 children with sTBI,the mean preoperative Glasgow Coma Scale (GCS) score was 5.27.Five children (29％) died postoperatively,of whom three children were died of cerebral infarction.Twelve children who survived the operation were followed up for average 4.6 years,which showed the mean KOSCHI score of 4.75.Among the 12 survivors,five patients (42％) experienced posttraumatic shunt-dependent hydrocephalus and four (33％) suffered ipsilateral and/or contralateral hygroma.ConclusionsAlthough a high mortality rate is observed in the children with sTBI after decompressive craniectomy,the survived patients have satisfactory outcomes. Posttraumatic hydrocephalus and hygroma are two common complications after decompressive craniectomy for children with sTBI.

ObjectiveTo assess the prognostic efficiency of three different risk socres in patients underwent redo-coronary artery bypass grafting (redo-CABG).MethodsFrom January 1997 to July 2011,57 patients underwent redo-CABG in Fu Wai Hospital.All patients were prospectively scored for operative mortality using EuroScore,STS Score and Sinoscore.The overall expected mortality were compared with the observed mortality.Discrimination was evaluated by receiver operating characteristic (ROC) cures and area under a ROC curve (AUC).ResultsFour patients died in the whole group,the observed mortality was 7％.The overall predicted mortality of EuroScore,STS Score and SinoScore were 5.6％,2.2％ and 1.5％,all lower than the observed mortality.The AUC of the three kinds of score were respectively 0.495,0.557 and 0.535,which indicated that the discrimination of the three kinds of score are poor.ConclusionThe predictive value of EuroScore,STS Score and SinoScore for early postoperative mortality in patients undergoing redo-CABG is poor.Surgical technology is an important predictor for early postoperative mortality.

Objective To analyze the risk factors for in-hospital mortality in patients aged over 65 years undergoing heart valve surgery combined with coronary artery bypass grafting(CABG).Methods Between February 2002 and September 2014,540 patients aged over 65 years undergoing heart valve surgery combined with CABG in our institute were retrospectively studied.Univariate analyses and multivariate logistic regression analyses were performed to explore risk factors associated with in-hospital mortality.Results Overall in-hospital mortality was 4.26％.Univariate analysis depicted that chronic obstructive pulmonary disease (COPD) (P =0.001),last serum creatinine (P =0.043),unstable angina(P =0.046),Canadian Cardiovascular Society 111-ⅣV (P =0.005),number of diseased coronary vessels (P =0.043),cardiopulmonary bypass time-delayed (P =0.003),post-operative morbidity (P =0.000) had a significant impact on in-hospital mortality.Multivariate logistic regression analysis revealed that COPD (P =0.005,OR =5.598),CPB time-delayed (P ＜ 0.001,OR =1.011),re-exploration (P ＜0.001,OR =15.813),malignant arrhythmia (P =0.014,OR =4.900) were independent risk factors of in-hospital mortality.Conclusion The present research demonstrates that COPD,CPB time-delayed,re-exploration and malignant arrhythmia dramatically impacted the in-hospital mortality of patients aged over 65 years undergoing combined heart valve surgery and CABG.