Objective To review the experience of surgical repair of aortic origin of pulmonary artery.Methods Fifteen patients underwent surgical correction for aortic origin of pulmonary artery.All of the patients had anomalous origin of right pulmonary artery,and 11 were associated with patent ductus arteriosus,6 with patent foramen ovale,3 with atrial septal defect,2with aortic pulmonic window,1 with ventricular septal defect,1 with interruption of aortic arch,1 with coarctation of aorta and 1 with pulmonary vein stenosis.All patients were associated with severe pulmonary hypertension.All patients were operated on with the implantation of the AORPA to the main pulmonary artery derectly.Results All 15 patients were cured and no died.1 lost follow-up and the other 14 were survivable during a follow-up 3 months to 81 months.one patient recepted pacemaker implantation 2 years after operation because of sinus arrest,no other patients required reoperation.Conclusion Echocardiography combined with spiral ct angiography is a good method for AOPA diagnosis.Good surgical outcome and low reoperation rate of aortic origin of pulmonary artery can be achieved by direct anastomosis.

The neurovascular unit (NVU) consists of neurons,gllal cells and microvessels,etc.There were complex interactions among the various cellular components,which form as a uniform entirety preferably.Anong the various cellular components of NVU,the signal transduction occurred disorders during cerebral ischemia,resulting in neuronal and extracellular ratrix destruction,and thus occurring cerebral infarction and hemorrhagic transformation.Therefore,the treatment of ischemic sttroke should be based on the protection of the overall function of NVU.This article describes the changes and protection of NVU after cerebral ischemia.

Objective To summarize the nursing methods for patients with chronic congestive heart failure treated with local renal nerve block. Methods 10 cases of patients with chronic congestive heart failure were treated with renal nerve block. The blood and urine electrolytes, plasma neuroendocrine hor-mones, the 24-hour urine volume were measured before and after the renal nerve block to calculate the rate of excretion of urinary sodium. The changes of the heart rate and blood pressure and the improvement of the dyspnoea, swelling and other symptoms of heart failure were monitored continuously before and after the re-nal nerve block. Results There was a significant increase in the 24-hour urine volume and the rate of excretion of urinary sodium in the patients with heart failure after the renal nerve block (P<0.05),and there was a significant decrease in the amount of plasma neuroendocrine hormones after the renal nerve block (P<0.01);there was no signifieant changes in the heart rate and the average blood pressure with improvement of dyspnoea, swelling and other symptoms of heart failure. No significant complications were found. Conclusions The nursing measures taken by the nurses in the clinical application of local renal nerve block as a new treatment modality to the treatment of patients with chronic congestive heart failure are safe, effective and feasible.

OBJECTIVEThis study aimed to investigate the expression of midkine (MK) and microvessel density (MVD) in patients with salivary adenoid cystic carcinoma (SACC) and its clinical significance, as well as detect the correlation between the expression of MK and MVD in SACC.

METHODSImmunohistochemistry analysis (SP method) for MK and MVD were performed on 60 cases of SACC and 26 cases of normal salivary gland tissue. The expression of MK and MVD, as well as the correlation between the expression of MK and MVD in SACC were detected.

RESULTSIn SACC, the MK expression rate was 70.0% (42/60), and MK was not expressed in normal tissue. Statistical significance was found between SACC and normal tissue (P<0.05). The MVD values in SACC and normal salivary gland tissues were 38.73 +/- 8.96 and 11.15 +/- 3.33, respectively. These values were statistically significant (P<0.05). The expression levels of MK and MVD were unrelated to age, gender, and type in SACC (P>0.05), but correlated with tumor size, lymph node metastasis, and tumor-node-metastasis in SACC (P<0.05). The expression of MK and MVD was positively correlated with SACC (r=0.560, P<0.05).

CONCLUSIONSACC is correlated with the expression of MK protein and the increase in MVD, which may be some of the early diagnostic markers in SACC.

Carcinoma, Adenoid Cystic ; enzymology ; pathology ; Cytokines ; genetics ; metabolism ; Humans ; Immunohistochemistry ; Lymphatic Metastasis ; Microvessels ; Nerve Growth Factors ; Salivary Gland Neoplasms ; enzymology ; pathology ; Salivary Glands ; enzymology

Objective To investigate the effects and mechanism of different dosage of fluvastatin on the prevention of heart muscle ischemia reperfusion injury in rabbits.Method Thirty-five rabbits were randomly divided into 5 groups with 7 rabbits in each: sham group,myocardial ischemia reperfusion control group,low dosage of fluvastatin pretreatment group (2 mg/kg,Group F1),middle dosage of fluvastatin pretreatment group(5 mg/kg,Group F2) and large dosage of fluvastatin pretreatment group(20 mg/kg,Group F3).The left ventricular systolic pressure(LVSP),the max rate of rise of left ventricular pressure(?dp/dt_(-max)) and left ventricular end-diastolic pressure(LVEDP) were detected during the experiment.At the end of reperfusion,the infarct size and area at risk were defined by Evans blue and TTC staining,and the levels of myocardial nitrogen monoxidum(NO) and nitricoxide synthase(NOS) were measured.Result Compared with the ischemia reperfusion group,the indexes of heart function improved significantly,the level of myocardial NO was increased significantly and the myocardial infarct size was decreased significantly in the groups F2 and F3.There was no significant difference between the group F1 and ischemia reperfusion group.Conclusion Fluvastatin exerts a cardioprotective effect against myocardial ischemia reperfusion injury in rabbits.NO is likely involved in this protective mechanism.

Objective Norwood StageⅠis the standard procedure to cope with hypoplastic left heart syndrome(HLHS), which continues to be the most challenging congenital heart disease .The aim of this study is to retrospectively analyse the perio-perative management of Norwood StageⅠ.Methods Between June 2010 and August 2014, totally 5 small infants with HLHS underwent the standard Norwood StageⅠprocedure.They were all boys.Age at surgeries ranged from 29 to 75 days, and weight from 2.57-3.50 kg with median of 3.13 kg.Case 1, 2 and 3 received standard medical regimen after accessing NICU, which included intravenous prostaglandin E1 and mechanical ventilation.The 3 infants underwent emergent operations because of unstable hemodynamics.Case 4 and 5 received no medical intervention before the urgent surgeries.All 5 cases underwent the standard Norwood StageⅠprocedure under deep hypothermic circulatory arrest, including 4 cases of modified Blalock-Taus-sig shunt( MBTS) and 1 case of Sano shunt.Results The case with Sano shunt died from severe hypoxemia and persistent aci-dosis 32 hours after the operation, another case died from low cardiac output syndrome after cardiopulmonary bypass.The first case underwent bidirectional Glenn procedure 12 months after Norwood Stage I, the postoperative heart function was NYHA I and the oxygen saturation was 0.90-0.95 in room air, but he died from accidental brain injury 3 months after stage Ⅱ.The second case was followed up 3 months after stage I procedure with NYHA I and oxygen saturation of 0.78-0.83 in room air, and lost the follow-up after.The fifth case was followed up 3 months after stageⅠprocedure with NYHAⅠ, confluent MBTS and oxygen saturation of 0.84, the patient is being followed up and waiting for further evaluation for stageⅡprocedures.Con-clusion The standard Norwood StageⅠprocedure is a complex procedure, which demands multidisplinary cooperation, to pal-liatively correct HLHS .Sharing expericences on perioperative managements of Norwood Stage I between heart centers in China will be helpful to decrease the mortality and morbidity in relatively short period .

Objective To compare the results of transcatheter intervention (TI) and surgical operation (SO) in the pri-mary treatment for pulmonary atrcsia with intact ventricular septum (PA/IVS). Methods From January 2006 to May 2009, 25 patients (20 male,5 female) with PA/IVS were treated. The age at treatment was from 2 days to 8 months. The body weight was from 2.1 kg to 6.7 kg. All patients had mild to moderate hypoplasia of the right ventricle (the Z-valvue of the tricuspid valve: from -2 to 1.5) with tripatite right ventricle and without coronary artery-right ventricular fistula. Eight patients under-went TI and 17 patients underwent SO. Results The primary procedure was successful in 7 patients (88%) in TI group and in 16 patients (94%) in SO group. There were 2 deaths (1 in each group). There was no significant difference regarding re-sidual pulmonary stenosis between two groups. The ventilation time and the days of hospital stay were shorter in TI group than in SO group. All the survivors were followed up for 3-36 months. One patient required repeat balloon dilation in TI group. While in SO group, one required reoperation and one required balloon dilation for PS, and 2 patients were waiting for balloon dilation. Twenty-one patients have achieved complete biventricular circulation. Two patients were scheduled for Glenn shunt operation later (1 in each group). Conclusion For PA/IVS patients with mild or moderate right ventricle hypoplasia, tran-scatheter intervention is a better alternative than surgical operation in the primary treatment.

Objective In order to optimize the Fontan circulation,a technique for direct total cavopulmonary connection was devised.To evaluate its surgical feasibility as well as surgical outcomes,our clinical experience was retrospectively reviewed.Methods From August 2005 to March 2012,23 consecutive patients underwent modified extracardiac Fontan operation with direct total cavopulmonary connection.Clinical profile of the patients,and procedural variables were examined and analyzed.Results All patients had adequately developed main and branch pulmonary arteries.Inferior caval vein was contralateral to the pulmonary trunk main pulmonary artery in 7 cases,ipsilateral in 8,and others in 8.There was 1 hospital death.The other 22 patients remained hemodynamically stable postoperatively.Prolonged effusions (n =13,62％) was a challenging problem.No obvious stenosis was found at the direct cavopulmonary anastomosis.Conclusion we are convinced that a direct total cavopulmonary connection is feasible in select subset of patients.This modified Fontan procedure retains the advantage of extracardiac connections together with the avoidance of prosthetic materials.

Objective Konno-Rastan procedure is one option to cope with complex multilevel left ventricular outflow tract obstruction (LVOTO),which continues to pose a serious challenge to cardiac surgeons.The aim of this study is to retrospectively analyse indications for Konno-Rastan procedure,and to review the safeguards and pitfalls.Methods Between January 1996 and August 2012,totally 13 children with multilevel LVOTO underwent Konno-Rastan procedure.There were 8 boys and 5 girls.Age at surgeries ranged from 5 to 13 years,and weight from 12 to 51 kg with median of 21 kg.The pathology of this cohort includes:8 cases of congenital aortic valvular stenosis,3 cases of congenital aortic valvular stenosis combined with supravalvular stenosis,1 case of congenital aortic stenosis combined with VSD,coarctation and RVOT obstruction,1 case of aortic stenosis s/p percutaneous balloon aortic valvuloplasty.All patients have secondary diffuse tunnel LVOTO.Diameter of aortic ring ranges from 12.0 to 16.4 mm,and pressure gradient across the stenotic region ranges from 90-151 mm Hg.8 cases were implanted with St.Jude AG19 while 5 cases implanted with St.Jude AG17.Results All 13 cases survived.The 4th patient was implanted permanent epicardial pacemaker for transient Ⅲ AVB.The 4th and 5th patients were found residual ventricular septal repture at the nadir of ventricular incision,one underwent redo procedure while another is being followed up.All cases take cumadine to sustain INR at 1.8-2.5.No death emerges during follow-up period.The motality is 0％,the incidence rate of B is 7.7％,residual VSD 15.4％ and endocarditis 7.7％.Conclusion Konno-Rastan procedure is a promising techi.to relieve LVOTO.However,this complex procedure may lead to several fetal complications.Success of the surgery demands perfect operations.