Objective To summarize the methods and experiences of aortic arch surgery. Methods In 75 aortic arch operations, 74 were performed by using deep hypothermic circulatory arrest (DHCA), including retrograde cerebral perfusion (RCP) in 54 cases and antegrade selective cerebral perfusion (SCP) in 20 cases. Surgical procedures included ascending aortic and hemiarch grafting in 53 cases, which concomitantly included stent placement intra decending aorta in 11, patching of arch intimal tear in 6 and of decending aortic one in 3. Ascending and total arch grafting in 20 cases,which concomitantly included traditional elephant trunk procedure in 12 and stent placement intra decending aorta in 4. Simple arch aneurysm resection in 1 and arch grafting in 1. Concomitant procedures included Bentall procedure in 17 cases, AVR in 12, Cabrol procedure in 3, mitral valvuloplasty in 5 and aortic valvuloplasty in 9. DHCA time ranged from 9 to 120 min (mean 42.3 min). Results Operative mortality was 6.7%. The most common complications were respiratory insufficiency(11 cases), renal insufficience(7 cases) and temporary mental anomaly(9 cases). Conclusion DHCA+RCP and DHCA+SCP are both effective while the latter is more suitable for complex aortic arch surgery. The choice of surgical procedures depends on the nature of lesion and location of intimal tear. Preoperative condition and surgical technique are the essential factors to success in aortic arch surgery.

Objective The aim of this study was to assess the expression of protein products of Hugl-1 (human lethal-giant-lavae 1)in non-small cell lung cancer(NSCLC), to estimate their possible expression and to correlate the results of immunohistochemical analysis with various clinicopathologic parameters. Methods The expression of Hugl-1 gene was detected by immunohistochemical S-P method in 50 cases of NSCLC tissues ,50 para-cancer tissues and 10 cases of lung benign lesion tissues as control. Results (1)The expression level of Hugl-1 gene was found to be significantly lower in NSCLC tissues than in para-cancer tissues and lung benign lesion tissues(P

Objective:To study the long-term inhibitory effect of external stent on atherosclerosis of autologous vein graft in hypercholesterolemic rabbit and the possible mechanism.Methods:Hypercholesterolemic model was established in 15 rabbits and their bilateral jugular veins were anastomosed with bilateral carotid arteries.One jugular vein graft was stented with a polytetrafluoroethylene tube(external stent group)and the other receiving no stenting served as control(unstent group).Ultrasound was used to evaluate the haemodynamics 12 weeks after operation.The grafts were harvested to examine the thickness and area of intima and media,the deposition of lipid in the vessel wall,and the distribution of VCAM-1 positive cells.Scanning electron microscope(SEM)was used to evaluate the regeneration of endothelium.Results:Ultrasound results showed that the stent group was laminar blood flow and the control group had vortex flow.The thickness and areas of intima and media were significantly lower in the stent group than in the control group(P

Objective To report the outcome of surgical treatment of prosthetic valve endocarditis (PVE). Methods From 1990 to Aug 2003, 21 patients with PVE were operated on, including 5 acute PVE and 16 subacute PVE. Blood culture was positive in 13 cases. Echocardiographic findings showed aortic and mitral valve leakage in 6 and 3 cases respectively. Aortic and mitral vegetation was found in 3 and 5 cases, respectively. Mechanical valve was used to replace mitral valve in 11 cases, aortic valve in 10 cases. Ascending aortic false aneurysm was resected, and ascending aorta repaired in one case. Vegetations were found in all cases, mitral annulus abscess in 7 cases and myocardial abscess in 3, aortic annulus abscess in 8 and myocardial abscess in 4. Results There were 5 early-death, 3 due to recurrence of infection, 2 due to multiorgans failure. One late death was due to fungus infection. The survivors were followed up from 4 months to 13 years, one case had recurrence of PVE and died after ineffective medical treatment. Conclusion Early diagnosis of PVE, optimal timing of surgery, radical debridement of infected tissue, and utilizing sensitive and high dose of antibiotics perioperatively, are the key factors to improve the surgical outcome.

BACKGROUND: Cell transplantation is a new technique to treat myocardial ischemic diseases in recent years. There are not many reports regarding smooth muscle cell(SMC) transplantation at moment.OBJECTIVE: To investigate the impact of autologous SMC transplantation on the survival and the restoration of cardiac function after myocardial infarct.DESIGN: An observatory comparative study based on experimental animals.SETTING: Institute of cardiothoracic surgery in a military medical university of Chinese PLA.MATERIALS: The study was conducted in the Institute of Cardiothoracic Surgery of the Second Military Medical University of Chinese PLA from January 2003 to June 2003. Totally 24 male adult SD rats in cleanness grade with a body mass of(300 ± 20) g were randomly divided into two groups,i. e. ,transplant group and control group with 12 rats each. All rats were fed in clean environment.METHODS: Autologous SMC was separated and extracted from the ductus deferens of SD rats by enzymic digestion for culture and amplification in vitro. BrdU-labeled autologous SMC was directly injected into the scarring tissues of cardiac infarct area induced by the ligation of anterior descending branch of left coronary artery 2 weeks ago in rats of transplant group. DMEM culture medium of same volume was injected into the rats of control group. Cardiac function was evaluated by ultrasound examination before and 4 weeks after transplantation. The survival of the transplanted SMC and its effect of vasoformation in myocardial scarring tissues were detected by immunohistochemical staining.soformation in myocardial scarring area after autologous SMC transplantation;after transplantation.RESULTS: Transplanted autologous SMC survived and formed muscle-like tissues in myocardial infarct area. Compared with control group, left ventricnlar end diastolic volume(LVEDV) of transplant group was significantly reduced( P < 0.01), left ventricular ejection fraction(LVEF) was significantly elevated( P < 0.01 ), and the vasoformation in myocardial scarring tissue was significant( P < 0.01 ).CONCLUSION: Autologous SMC transplantation can prevent ventricle enlargement after myocardial infarct, promote vasoformation in infarct area, and ameliorate cardiac function.

Objective: To assess the hydrodynamic performance of C L pugestrut valve prosthesis in vitro . Methods: The leakage, steady flow and pulsatile flow of the valve prosthesis was tested in vitro with the C L standard valve and Medtronic Hall valve prosthesis as control. Results: The rate of leakage of the C L pugestrut valve was (298?66) ml/min, accorded with the demand of clinical use. The steady flow pressure drop across the C L pugestrut valve was significantly lower than the C L standard valve( P

Objective To assess the Chinese System for Cardiac Operative Risk Evaluation (SinoSCORE) model in patients undergoing heart valve surgery at our center.Methods From January 2009 to December 2011,2098 consecutive adult patients who underwent heart valve surgery at our center were collected and scored according to the SinoSCORE model.All patients were divided into three risk subgroups.The entire cohort and each risk subgroup were analysed.Calibration of the SinoSCORE model was assessed by the Hosmer-Lemeshow(H-L) test.Discrimination was tested by calculating the area under the receiver operating characteristic (ROC) curve.Results Observed mortality of all 2098 patients was 3.00％.Despite there were significant differences between the SinoSCORE population and our own population sample,the SinoSCORE model showed good calibration(Hosmer-Lemeshow:P =0.783) and discriminative power (area under the ROC curve of 0.752)in predicting in-hospital mortality at the entire cohort.Conclusion The SinoSCORE model give an accurate prediction for individual operative risk in heart valve surgery patients at our center.

Objective:To investigate the effects of transplanting autologous smooth muscle cells on cardiac function after cardiac infarction. Methods:Autologous smooth muscle cells were isolated from the ductus deferens of SD rats, and cultured for 4 weeks before transplantation. Two weeks after the left coronary artery ligation, the cultured cells(4?10 6), labeled with 5 bromo 2' deoxyuridine(BrdU), were transplanted into the scar tissue in the left ventricular free wall by direct injection(transplant group, n =12). Control group were treated with culture medium alone(control group, n =12). Heart function was assessed by echocardiography 2 weeks after the left coronary artery ligation and 4 weeks after cell transplantation. Then the hearts were immunohistochemically processed using monoclonal antibodies against ? smooth muscle actin and BrdU for the identification of transplanted smooth muscle cells. Vascular endothelial cells were stained for factor Ⅷ using monoclonal antibodies. The blood vessels were counted on the tissue sections under light microscope. Results:The injected autologous smooth muscle cells survived in the infarcted scar tissue and formed muscle like tissue at the site of transplantation 4 weeks later. Left ventricular end diastonic volume(LVEDV) decreased [(0.78?0.16) vs (0.92?0.15) ml, P

Objective:To evaluate whether off pump coronary artery bypass grafting (OPCABG) has advantages over conventional coronary artery bypass grafting(CCABG). Methods:A total of 362 patients undergoing coronary artery bypass grafting were divided into 2 groups: OPCABG group:152 cases undergoing OPCABG and beating heart via sternotomy; CCABG group,210 cases undergoing CCABG with extracorporeal circulation. Preoperative and postoperative variables of 2 groups were compared. Results:There were no significant differences in sex, age, weight, acute or remote myocardium infarction, hypertension, diabetes and type of bypass grafts between 2 groups.The numbers of bridge vessels were not significantly different between the 2 groups; the incidences of low cardiac output syndrome, atrial fibrillation and atelectasis in OPCABG group were significantly less than those of CCABG group( P

Objective:To evaluate the therapeutic effectiveness of peritoneal dialysis(PD) for acute renal failure(ARF) following cardiac surgery with cardiopulmonary bypass and its effect on hemodynamics. Methods:Retrospective data from 88 patients with ARF following cardiac surgery undergoing PD were analyzed. Results:The renal function of the patients recovered within 3 to 39 d of PD, K +] declined to normal level within 1 d, HCO 3 -] declined to normal level within 1 4 d, and BUN and Cr declined by 49.2% and 42.6% respectively within 4 6 d of PD( P