Objective To investigate the clinical significance of small incision thoracotomy cardiac surgery in the management of heart diseases.Methods A retrospective analysis was made on clinical data of 115 cases of heart diseases treated with small incision thoracotomy surgery from September 2001 to October 2004 in this hospital.Results There were 108 cases of operation through a right small thoracic incision, 5 cases of robot-assisted operations,and 2 cases of occlusion of atrial septal defect(ASD) through a right small thoracic incision.The extracorporeal circulation time was 21~155 min(mean,145?26 min) and the aorta occlusion time was 8~108 min(mean,28?19 min).No operation-related death was seen.Postoperatively,a re-operation of open surgery was required for stopping bleeding in 1 case(0.9%,1/115),pulmonary atelectasis occurred in 3 cases(2.6%,3/115),and cerebral infarction happened in 2 cases(1.7%,2/115).Follow-up checkups in 82 cases for 6~24 months(mean,18 months) revealed no thoracic deformity.Conclusions With advantages of minimal injury,less bleeding,and quick closure of thoracic incision,right small incision thoracotomy is a good approach for the correction of cardiac deformities.

Forty-seven patients with congenital heart disease and pulmonary hypertension were treated surgically. Among them, 31 were male and 16 female. The age ranged from 2 to 47(13. 7? 11. 2) years. Gongenital heart abnormalities included ventricular septal defect (VSD) in 20, huge atrial septal defect (ASD) in 1, VSD+ASI) in 12, VSD with patent ductus arteriosus (PDA) in 6, endocardial cushion in 2, VSD with aortopulmonary septal defect (APSD) in 1, double outlet right ventricle with PDA in 1 and total anomalous pulmonary venous connection in 1. Right heart catheterization was performed in 15 cases. The mean pulmonary artery pressure was (73 ? 24)mmHg, total pulmonary resistance was (78. 0 ?61. 2)kPa/(L/s). There were 7 cases examined in operation. Their mean pulmonary artery pressure was (55?13)mmHg. The others were examined by echocardiography. The mean pulmonary artery pressure was (49?15)mmHg. All patients were treated pre-op-eratively with oxygen inhalation therapy, hyperbaric oxygenation, prostaglandin E1 , respectively according to the degree of pulmonary hypertension. During cardiopulmonary bypass, pulmonary artery perfusion was performed with protective solution containing aprotinin for lung protection. Vasoactive drugs were routinely administrated postoperatively. There were 2 operative deaths with hospital mortality rate of 4. 3%. The cause of deaths was severe low cardiac output syndrome. The postoperative morbidity rate was 4. 3%. Our conclusion is proper peri-operative management could reduce post-operative mortality and morbidity for congenital heart disease with pulmonary hypertension.

Objective To share the experience of heart thransplantation. Methods 3 recipients with terminal myocardiosis were reviewed. The transplantation was performed with inferior and superior vena anastomofic technique. During perioperative period, we selected and maintained the recipients, protected donor-isolated heart, supported circulation,decreased immune reaction and controlled infections. Results All the 3 patients survived. Heart function improved from NYHA class 1V before heart transplant to NYHA class Ⅰ, Ⅱ. The follow-up time was 19 months ,28 months and 49 months respectively. Rejection occurred in two cases due to non-compliance to medication. Conclusions Suitable recipient, proper donor heart procurement and preservation, suitable maintenance of circulation, proper managements of anti-immunitive reaction, prevention of infections are critical for successfal heart transplantation. Medicine-take required may avoid or reduce rejection.