Objective To analyze the reasons of perioperative hypoxia in Stanford A aortic dissection,and summarize its management strategies.Methods From Dec.2005 to Jul.2011,sixty four patients underwent surgery for acute type A aortic dissection,of which 9 cases were with chronic dissection and 55 cases with emergent ones.Preoperative oxygen fraction ratio( PaO2/FiO2 )in 51 cases was lower than 200 mm Hg.All of them underwent the surgery with the help of deep hypothermia cardiac arrest technique.Results Three cases died.Thirty-three cases could not live without ventilation during the first 72 h because of continuous hypoxia ( PaO2/FiO2 ＜ 200 mm Hg).One case underwent tracheotomy and auxiliary ventilation for 9 days.The rest were live without ventilation after auxiliary ventilator for 72 - 120 hrs.The data showed that postoperative hypoxia was related to preoperative hypoxia (oxygen fraction ratio ＜ 200 mm Hg),BMI,acute onset,hypothermia cardiac arrest time,and transfusion more than 3000 ml ( P ＜ 0.05 ).Conclusion Great attention should be paid to the perioperative hypoxia-related factors in Stanford A dissection,which will be helpful to improve prognosis.

Objective To evaluate the diagnostic value of 128-slice spiral CT angiography( MSCTA)for bypass grafts in patients after coronary artery bypass grafting(CABG).Methods One hundred and thirty-three bypass grafts (44 IMA grafts,89 saphenous veins grafts) of 46 patients after CABAG operation for 12 to 76 months were examined by MSCTA.Then the coronary angiography(CAG) was performed on those patients 3 - 10 days after MSCTA examination.The MSCTA results were compared with the angiography results.Results Among the 133 bypass grafts,MACTA examination showed that 17 grafts were occluded and 20 grafts were severe restenosis( restenosis degree ＞ 50％ ).There was also 17 occluded grafts showed in CAG examination as in MSCTA results.But 21 restenosis ( restenosis degree ＞ 50％ ) bypass grafts were identified by CAG.Compared with the CAG results,there was 1 false positive and 2 false negative in the MSCTA results.The overall sensitivity and specificity of MSCTA on evaluating the bypass grafts were 94.7％ and 98.9％.The positive predictive value and the negative predictive value were 97.3％ and 97.9％,respectively.Conclusion As a noninvasive examination,128-slice spiral CT could accurately identify and evaluate the bypass grafts lesions after CABG.

OBJECTIVE: To study the influence of auto messenchymal stem cells(MSCs)transplant into the infracted area on the ventricle reconstruction in mini pig model of acute myocardial infarction. METHODS: The bone marrow of mini pig was collected and centrifuged in vitro for MSCs. Then after cultivation, transformation and labeling MSCs were injected into the ligated left anterior descending coronary artery and myocardium of mini pig,while the control group was administered with DMEM of the same dose. Doppler ultrasonography was performed separately at 3 weeks and 6 weeks. RESULTS: The left ventricular ejection fraction, shortening fraction, lateral thickening , and interventricular thickening in the experimental group were significantly improved, as compared with the control group, while the ventricular chamber in the experimental group was smaller than that in the control group. CONCLUSION: MSCs transplant can help to regenerate the myocardial issue in the infarcted area, thicken the myocardium, lessen the thinningz and cardiac muscle chamber, hence to slow down the process of ventricular reconstruction .

Objective To review the experience of treatment for prosthetic valve endocarditis(PVE)after mitral valve replacement(MVR)in 16 cases.Methods From September 1979 to December 2010,16 patients were diagnosed as PVE after MVR by modified Duke University diagnostic criteria.There were 10 males and 6 females.Their ages ranged from 19 to 55 years old(mean 28 years old).The incidence of PVE was 0.97％(16/1657)after MVR.Blood culture positive was in 5 cases.Medical treatment alone was performed in 10 patients who were treated by using Penicillin or Vancomycin with other broad-spectrum antibiotics,using Fluconazole and Amphotericin if necessary.Combined medical and surgical management were performed in 6 cases.One emergency case was operated because of obstinate heart failure.Five cases underwent operation after adequate antibiotics treatment and general condition improvement.The infective tissue and vegetation were aggressively debrided after the infective prosthetic valve removed.Before the new valve was replaced paravalvular tissue must be flushed with diluted iodine solution and large quantities of normal saline.Tricuspid valve repair (TVR)was performed during the same period in 3 cases.Results Hospital death occurred in 8 patients and only 2 patients were recovery in group with medical treatment only.The main reasons of death were infective shock and cardiac failure in 4 patients,cerebral complications(embolism or bleeding)and multiple organs failure in 4 cases.While 6 patients cured after combined medical and surgical management.Follow-up had been carried out in 8 cases for 1.7 to 15 years(mean 5.1 years).Eight years later one patient was re-operated because of severe tricuspid regurgitation and paravalvular leak.There was no PVE recurrence in others.Conclusion Combined medical and surgical management for PVE get a better result than medical treatment alone.Good prognosis lies in timely diagnosis,adequate antibiotics,aggressive debridement of infective tissue and better myocardium protection during operation.

Objective To summarize our experience in endovascular repair of 83 cases with type B aortic dissection.Methods A retrospective analysis was performed in 83 cases of type B aortic dissections who were treated in our hospital.Results The surgical procedure was successful for all the patients.Two patients died peri-operatively.One case encountered a coma,but no post-operative paraplegia occurred.Conclusion Endovascular repair for type B aortic dissection is a micro-invasive,safe and effective technique.Long-term follow-up is required to give a comprehensive evaluation.

Objective To describe the treatment experience of post-operative complications after total arch replacement for acute type A aortic dissection in 34 cases.Methods The subjects were 34 consecutive patients (Twenty-eight males and 6 females,age 34.0 -60.0 yrs) who received total arch replacement for acute Stanford type A aortic dissection from Jan.2005 to Oct.2010 in our hospital.The duration from the onset of the symptoms to the hospitalization ranged from 4 - 18 hrs.Pre-operative 2-D Echo revealed aortic valve regurgitation in 8 patients and mitral valve regurgitation in 1 patient.Results Three patients died after operation ( mortality 8.8％ ).Severe complications included acute kidney injury in 13 cases,respiratory dysfunction in 12 cases,paraplegia in 1 case,mental disorder in 10 cases and excessive post-operative bleeding in 2 cases.Conclusion The incidence of the complications after total arch replacement is still high and severe.Intensive care should be stressed peri-operatively and early diagnosis and treatment for post-operative complications are important procedures.

Objective To evaluate the clinical significance of the change of serum matrix metalloproteinases (MMP)-1,-2,-3 and -9 in acute and chronic aortic diseases and acute myocardial ischemia.Methods The blood serum levels of MMP-1,-2,-3 and -9 were detected in 30 patients with acute aortic dissection,19 patients with chronic aortic dissection,19 patients with aortic aneurysm and in 12 patients with acute myocardial ischemia,as well as in 16 healthy individuals who served as the control group.Serum MMP levels were measured by using an ELISA technique.Results There were significantly higher levels of MMP-3 in patients with acute myocardial ischemia as compared to acute aortic dissection ( [19.10 ± 3.11 ] μg/L vs [11.89 ± 1.31 ] μg/L,P =0.02).Significantly lower levels of MMP-1 were found in healthy controls compared to the groups of patients ( [1.30 ± 0.56 ] μg/L vs [2.99 ± 0.78 ] μg/L in acute aortic dissection,P =0.03,[3.12 ±0.78] μg/L in chronic dissection,P =0.02,[3.01 ± 1.01 ] μg/L in thoracic aortic aneurysm,P =0.03 and [5.01 ± 0.98 ] μg/L in acute myocardial ischemia,P =0.01 ).Higher levels of M MP-1 and MMP-3 were detected on males.There was a positive correlation between MMP-1 and increasing age ( r =0.38,P ＜ 0.05 ).In patients operated for acute type A aortic dissection,the levels of MMP-1,MMP-3 and MMP-9 increased immediately after surgery,while the levels of MMP-2 decreased.Twenty-four hours after surgery levels of MMP-1,-2 and -9 were almost equal to the preoperative ones( P ＞ 0.05 ).Conclusion Measurement of serum MMP levels in thoracic aortic disease and acute myocardial ischemia is a simple and relatively rapid laboratory test that could be used as a biochemical indicator of aortic disease or acute myocardial ischemia,when evaluated in combination with imaging techniques.

Objective To describe the follow-up data of 34 patients receiving total arch replacement with an open stent graft for acute type Ⅰ aortic dissection.Methods The subjects were 34 consecutive patients with type Ⅰ acute aortic dissection ( Twenty-eight males and 6 females,aged 34.0 - 46.0 yrs) who received total arch replacement with an open stent graft in our hospital from Jan.2005 to Oct.2010.Thirty of the 34 patients were followed up for 2 - 70 months.CT scanning was performed at the 3 and 12 months and then yearly after operation to detect the thrombus formation,absorption of thrombus,and obliteration of the false lumen after its exclusion by the stent graft.Results Three patients died peri-operatively with the mortality of 8.8％.One patient died during the follow-up period.Obliteration was recognized in all the patients at the distal side of the stent graft during the follow-up period.The false lumen remained in 10 patients at the distal part of descending aorta,but the diameter of the false lumen was not enlarged.Conclusion In patients with acute type Ⅰ aortic dissection,it is relative safe to perform extensive primary repair of the thoracic aorta by stent grafting.This method may enhance the obliteration of the false lumen and reduce the possibility for further operations to manage a residual false lumen.

Objective To retrospectively analyse the clinical data of off-pump coronary artery bypass grafting surgery(OPCAB)in our department and summarize the clinical experience of peri-operative management.Methods From January 2007 to May 2008,253 patients underwent OPCAB.Seventy-six cases with left main disease(including 18 cases of single left main lesion and 58 cases of complex lesion);13 cases had single vessel disease;32 cases had double vessels disease and 190 cases had triple vessels disease.Eighteen cases received emergency OPCAB.All vessel anastomosis were performed with coronary artery stablizer and shunt through median sternotomy.Resuits Three cases died after operation(1.2%).Intra-aortic balloon pump was used in 11 cases.Mechanical ventilation time was 3-168 h[(24.1±22.3)h],and ICU stay time was 1-14 day[(2.8±2.0)d].Postoperative hospital stay time was 8-42 days[(15.6±6.3)d].Conclusion OPCAB is reliable for most bypass cases.With appropilate peri-operative management,a satisfied result will be acceptable.

Objective To summarize the clinical experiences of 1386 patients undergoing off-pump coronary artery bypass grafting(OPCAB)during Jan 2002 to Mar 2008.Methods OPCAB was done through midsternumtomy under ordinary-temperature anesthesia after radial artery,left breast artery and vena saphena magna were taken.Patients over 70 years old accounted for 32.35%,and the oldest was 99 years old.Emergency and subemergency OPCAB was done in 111 cases,re-do CABG with off-pump technique was done in 52 patients.Results 24 cases died during perioperation,with mortality of 1.73%and all other patients discharged from the hospital.Following operation,the symptoms of angina pectoris were relieved and the life quality was much beaer than that before operation.Conclusion OPCAB is feasible for older patients,who are complicated with other chronic diseases for elder patients.Skillful technique of surgeon,right indications for OPCAB and management of peri-and postoperation are key to success of operation.