Objective To determine the factors affecting valve replacement through mini - sternotomy. Methods 35 patients underwent mitral valvular replacement (MVR, 23 cases) or bivalvular replacement (BVR, 12 cases) through minimal sternotomy. 19 cases were male and l6 cases were female. The age ranged from 21 to 62 years with an average(44 ? 9) years. The factors affecting the aorta clamped time (ACT) and the cardiopulmonary by- pass time (CPBT) ware analyzed. Results When the left ventricular diastolic diameter was more than 60mm, ACT and CPBT were longer in MVR and were shorter in BVR. ACT and CPBT were almost significantly longer in MVR and AVR when superior margin of manubrium was lower than the fifth thoracic vertebra. Height of aortic node, cardiotho- racic ratio, diameter of left artia and aortic root were not related with ACT and CPBT. Conclusion Larger left ventricular and lower manubrium may be the related factors that affecting the operation of valvular replacement.

Objective To review the experience of 162 cases of coronary artery bypass grafting (CABG) via a lower median ministernotomy. Methods CABG through a lower median ministernotomy was conducted in 162 cases from April 1998 to June 2003, including 77 cases of CABG under extracorporeal circulation, 13 cases of CABG concomitant with intracardiac surgery, and 72 cases of off-pump coronary artery bypass grafting (OPCABG). Results There were 1 case of surgery-related death (0.6%) and 1 case of re-operation (0.6%). Postoperative complications occurred in 9 patients (5.6%). In conventional CABGs, the aortic cross-clamp time, cardiopulmonary bypass time, and operation time were 74.8?23.1 min, 113.6?31.3 min, and 255.5?54.5 min, respectively. The operation time of OPCABG was 195.6?50.6 min. The number of anastomoses ranged 1~5 (2.4?0.7). The length of postoperative tracheal intubation was 0~364 h (median, 11 h). The length of postanesthesia care unit (PACU) stay and hospital stay were 1~28 d (median, 3 d) and 5~60 d (median, 10 d), respectively. The chest drainage volume was 607.2?443.0 ml, or 8.6?6.0 ml/kg. A blood transfusion was required in 38 cases, with a transfusion amount of 1161.3?741.2 ml. Conclusions A less invasive approach is possible in coronary artery bypass grafting via a lower median ministernotomy. This procedure provides satisfactory outcomes and good cosmetic results, during which a complete revascularization for multiple vessels and concomitant intracardiac operations are available.

Objective To review the experience of 460 cases of cardiac operations through a lower median ministernotomy. Methods A total of 460 cardiac operations via a lower median ministernotomy route were carried out between January 1997 and August 2003 in this hospital, involving 100 operations for congenital heart diseases, 178 valve operations, 168 coronary operations, 12 operations for aneurysms, and 2 other operations. On operation no special instruments were required. Results Within the hospitalization period 4 patients died (0.9%) and 3 underwent a re-operation (0.7%). Postoperative complications occurred in 29 patients (6.3%). Off-pump operations were employed in 73 patients, while in the remaining 387 patients the cardiopulmonary bypass time was 25~1 115 min (median, 80 min) and the aortic cross-clamp time was 0~164 min (55.8?31.9 min). Of the 460 patients, the length of postoperative tracheal intubation was 0~364 h (median, 10 h), and the postoperative chest drainage was 20~3 290 ml (median, 350 ml), or 0.3~42.2 ml/kg (median, 5.8 ml/kg). Blood transfusion were required after surgery in 280 patients with an amount of 951.1?644.6 ml. The postoperative ICU and hospital stay were 1~28 d (median, 2 d) and 1~60 d (11.6?6.0 d), respectively. A follow-up for 7~80 months (59.2?29.6 months) in 371 patients was conducted. No long-term deaths were noted and symptoms were significantly improved. Heart function was classified as grade Ⅰ in 169 patients, grade Ⅱ in 135 patients, and grade Ⅲ in 67 patients, respectively, with significant difference as compared with that in pre-operation ( Z =-12.57 , P =0.000). No significant difference was observed in the cardiothoracic ratio (0.50?0.11, 0.41~0.67) between postoperative and preoperative period ( t =-1.63, P =0.104). The left ventricular ejection fraction was significantly higher postoperatively (0.36~0.71, 0.606?0.113) than preoperatively ( t =3.43, P =0.001). Conclusions In properly selected cases, heart operations through a lower median ministernotomy provides many advantages including mini-invasion, high reliability, excellent cosmetic results, simplicity to performance, and good surgical outcomes.

Objective To establish a standardized mouse myocardial infarction model,and non-invasively evaluate its cardiac function by using the echocardiography.Methods A total of 20 wild male mice were enrolled into this study.The left anterior descending coronary was ligated through the left fourth intercostal space after intubation.The echocardiographic assessment of myocardial infarction and heart function was performed 3 days preoperatively and 2 weeks postoperatively.The shortening fraction(FS),end systolic dimension(ESD),and end diastolic dimension(EDD) was recorded and analyzed.Results The acute and one-week mortality rates were 20%(4/20) and 40%(8/20),respectively.The echocardiography showed that the myocardial infarction model was successfully established in 10 mice.The heart function of the mice was markedly impaired.The FS significantly decreased from(50.23?8.36)% to(25.41?0.97)%(t=16.18,P

Objective: To evaluate the surgical results of aortic regurgitation caused by aortitis. Methods: Results: Between 1990 and 2002, 20 patients with aortic regurgitation caused by aortitis underwent surgery. The surgical procedures included aortic valve replacement in 12 patients and aortic root replacement in 8 (Bentall type operation in 5, Cabrol type operative in 2, and David type operation in one). Conclusion: There was no operative death. The follow-up duration ranged from 2 to 61 months (mean, 24 months). Postoperative perivalvular leakage and/or detachment of the prosthetic valve occurred in 7 patients after aortic valve replacement. 7 patients required re-operation, and 3 patients underwent third operation due to perivalvular leakage. There were 4 later deaths (20%). Conclusion: The timing for the operation, selection of operative procedure, and preoperative control of active inflammation were essential for successful treatment of aortic regurgitation caused by aortitis.

Objective: To compare the quality of life before and after artificial mechanical heart valve replacement. Methods: From February to June 1998, 115 patients (56 males, 59 females) underwent mechanical valve replacement. The investigation table was filled in one week before the operation and three months postoperatively. Results: There was a notable improvement in patient's physical strength, activity ability, emotion aspect and society home life after operation (P=0.000). In patients with valve-related complications, 64% complained inconvenience in purchasing anticoagulant medicines in the locality, while in patients without valve-related complications, only 39% have such experience. There was significant difference between two groups (P=0.034). 86% of patients with complications worry about the possibility bleeding, while in those with no complications only 55% (P=0.006). Conclusion: Mechanical prosthetic valve replacement significantly improves patient's physical strength, activity ability, emotion and society-home life.

Objective To establish a method for the isolation and culture of bone marrow derived mesenchymal stem cells (MSCs) from patients with coronary artery disease and investigated its biological characteristics. Methods Bone marrow was extracted from patients' sternum when they were operated for coronary artery bypass graft. MSCs were separated from bone marrow by density gradient centrifugation in Percoll solution and seeded in culture medium supplemented with 10% fetal bovine serum. The morphology and growth characteristic of MSCs were observed in primary and passage generation culture with inverted microscope. The cell phenotype and cell cycle of MSCs were analyzed by flow cytometry. The growth curves were compared between different passages and ages. Results Most adherent MSCs showed spindle morphology whatever passages they were. The MSCs could be expanded for 15 passages. The proliferative potential of MSCs over the fifth passage or from old patients decreased gradually. The MSCs in primary and passage were positive for CD29 and CD44, but negative for CD34 and CD45. Analysis for cell cycle showed most MSCs in G_0/G_1 phase. Conclusion The method of isolation and culture of sternum bone marrow derived MSCs from patients with coronary artery disease is feasible, the MSCs have self-renewal capacity and might be ideal for cellular cardiomyoplasty.

Objective To summarizes the clinical experience of the arterial switch operation (ASO) for the complex congenital heart defects with ventriculoarterial connection anomaly. Methods Between January 2000 and August 2004, 60 consecutive neonatal and infants, aged 2 days to 11 years with mean body weight (6.5?4.3)kg (2.6～22 kg), underwent the arterial switch operation at Fu Wai hospital, including 42 patients in early years (2000.1～2003.5), and eighteen patients in recent years (2003.6～2004.8). Primary cardiac diagnoses included transposition of the great arteries (TGA, n=49) and Taussing-Bing anomaly (TBA, n=7), and the congenitally corrected transposition of the great arteries (ccTGA, n=4). The operation was performed under general anesthesia and extracorporeal circulation with the low temperature and low volume blood flow. The great arteries were transected above the valvular commissures; the coronary ostia with all the adjacent sinus of valsalva were excised and reimplanted to the proximal neo-aorta. The proximal neo-pulmonary trunk was reconstructed with a large autologous native pericardium as a pantatoon patch. The pulmonary anastomosis was completed after the aortic cross-clamp was released. The VSDs were repaired through the atrium or proximal aorta with dacron patches. For the patients with ccTGA, double switch operation included Senning procedure and ASO were performed. Results The total operative mortality rate was 16.7% (10 cases), 9 cases in early years (21.4%, 9/42) and 1 case in recent year (5.6%, 1/18), two groups had significant difference (P

Objective To report the surgical technique and clinical results for surgical treatment of ischemic mitral regurgitation, and midterm follow-up results. Methods From December 1996 to April 2002, 55 patients underwent surgical treatment of ischemic mitral regurgitation. There were 45 males, 10 females with a mean age of (56.63?9.31) years . The cardiac function were NYHA class I～II 7 cases and class III～IV 48 cases. There were 9 mild MR, 28 moderate MR and 18 severe MR. Forty-six patients treated with CABG and concomitant mitral valve correction. Results No operative and postoperative death, No postoperative severe complications. Fifty-three patients were followed up for a mean duration of (45.3?18.7) months, At 5 years and 10 years, survival and event-free survival rates were 85.2% and 72.4%,freedom from reoperation were 82.7% and 70.6%. Conclusion Mitral valve surgery is indicated in patients undergoing coronary artery bypass graft surgery who have moderate or severe ischemic mitral regurgitation,the mitral valvuloplasty was the first select, and the midterm follow-up outcome are satisfactory.

0.05). However, compared with the parameter before operation, the size of the left atrium and left ventricular were obvious decreased, the value of EF was obvious increased for both groups (P