Objective: To evaluate the clinical application of total cavopulmonary connection with off-pump technique. Methods: Between May 2000 and December 2002, 9 patients underwent total cavopulmonary connection without cardiopulmonary bypass. The patients were 5 males and 4 females, mean age (10.3?6.4) years, ranged 4～24 years and mean body surface area (0.95?0.35) m 2, range 0.65～1.66 m 2. SpO 2 before operation was (73?6)% (60%～80%). Pulmonary pressure was (12.7?2.4) mmHg (10～16 mmHg) at operation. Results: Patient died after surgery. Chylothorax occurred in 1 patient. 2 patients were reoperated for fenestration between the extracardiac conduit and right atrial during the early postoperative period. All survivors were noncyanotic, the average SpO 2 on breathing air was (94?3)% (89%～97%). On d ischarged. Conclusion: Total cavopulmonary connection with off-pump technique is a useful procedure in management of patients with a functional univentricular heart. It is easy to perform. However, much remains to be studied about this unique physiologic status.

Objective To investigate the changes in systemic and pulmonary hemodynamics in patients with liver cirrhosis and portopulmonary hypertension(PPH)during liver transplantation.Methods Eight patients with liver cirrhosis and PPH(5 male,3 female)aged 50-63 yr weighing 45-80 kg were included in PPH group. Another 8 liver-cirrhotic patients without PPH served as control group.The patients were premedicated with intramuscular phenobarbital 0.1 g and atropine 0.5 mg.Anesthesia was induced with midazolam 3-5 mg,fentanyl 0.15-0.2 mg,propefol 1 mg?kg~(-1) and vecuronium 0.1 mg?kg~(-1) and maintained with 0.5%-3% isoflurane inhalation and intermittent Ⅳ boluses of fentanyl and vecuronium.The patients were mechanically ventilated after tracheal intubation.P_(ET)CO_2 was maintained at 30-45 mm Hg.Right subclavian vein was cannulated for fluid and drug administration and blood transfusion.Radial artery was cannulated for BP monitoring.Swan-Ganz catheter was placed via right internal jugular vein.BP,CVP,MPAP,PAWP,CI,PVRI and SVRI were monitored and recorded before operation(baseline),during preanhepatic phase,at 3 and 30 min of anhepatic phase and 3,7, 15,60 min of neohepatic phase and at the end of operation.Results(1)The two groups were comparable with respect to fluid balance,the amount of vasoactive drugs used during anhepatic and neohepatic phase,duration of anhepatic phase and operation.(2)MPAP and PVRI were significantly higher before operation in PPH group than in control group.(3)CI,MPAP, PAWP and CVP were siguificanfly decreased during anhepatic phase as compared to the baseline values(before operation)in both groups and then gradually returned to and even exceeded the baseline values during neohepatic phase.(4)During neohepatic phase PVRI in PPH group was significantly increased as compared to the baseline value and was significantly higher than that in control group.Conclusion MPAP and PVRI are significantly increased during neohepatic phase in patients with PPH and need to be treated.

Objectlve investigate the role of Toll-like receptor 2 (TLR2) on polymorphonuclear neutrophil (PMN) during perioperative period in the development of postoperative systemic inflammatory response syndrome (SIRS) in patients undergoing orthotopic liver transplantation (OLT).Methods Twenty patients (18 male and 2 female, aged 33-58 yr and weighing 52-73 kg) with ASA Ⅲ or Ⅳ (NYHA Ⅱ or Ⅲ )undergoing OLT were studied. Blood samples were collected from the central vein for determination of TLR2 expression on PMN and plasma TNF-α, IL-1β and IL-8 concentrations before induction of anesthesia (T1, baseline), at 25 min of anhepatic phase (T2), 3 h (T3) and 24 h after beginning of reperfusion of the allograft (T4). The expression of TLR2 was measured by flow cytometry and the serum concentrations of TNF-α, IL-1β and IL-8 were measured by enzyme linked immunosorbant assay (ELISA). The patients were divided into SIRS and non-SIRS group depending on whether the patients developed SIRS or not within 7 days after operation. The diagnosis of SIRS was based on the criteria laid down by ACCP and SCCM in 1992.Results Ten patients developed SIRS within 7 days after operation. There was no significant difference in Child-Turcotte-Pugh (CTP) scores between the two groups. Compared with non-SIRS group, the TLR2 expression on PMN and the serum IL-1β concentration were significantly increased at T4 and the serum IL-8 concentration was significantly increased at T3 in SIRS group.There was positive correlation between serum TNF-α concentration and TLR2 expression on PMN in SIRS group ( r= 0.607, P ＜0.05).Conclusion The expression of TLR2 on PMN increases significantly at 24 h after beginning of reperfusion of allograft and may play an important role in the development of postoperative SIRS.

Objective To evaluate the changes in the expression of small intestinal thioredoxin 2 (Trx2) during different periods after orthotopic liver autotransplantation (OLAT) in rats.Methods Forty Sprague-Dawley rats,aged 8-10 weeks,weighing 210-260 g,were randomly divided into 2 groups using a random number table:sham operation group (group S,n =8) and OLAT group (n =32).Intestinal tissues were removed at 4,8,16 and 24 h after OLAT for microscopic examination and for determination of the levels of superoxide anion (O2--),hydrogen peroxide (H2 O2),glutathione peroxidase (GSH-Px),reduced glutathione (GSH) and Trx2.Intestinal damage was assessed and scored according to Chiu.Results Compared with S group,the Chiu's score and O2--activity at 4,8 and 16 h after OLAT and H2O2 content at 4 and 8 h after OLAT were significantly increased,and the levels of GSH-Px and GSH and expression of Trx2 at 4 and 8 h after OLAT were decreased in OLAT group (P ＜ 0.05).Chiu' s score at 4,16 and 24 h after OLAT and H2O2 content at 16 and 24 h after OLAT were significantly lower than those at 8 h in OLAT group (P ＜ 0.05).Conclusion The rats undergo decreased antioxidant capacity in the early phase and recovery in the late phase mediated by small intestinal Trx2 after OLAT.

Objective Summarizing single clinical experience with extracorpomreal membrane oxygenation(ECMO) as a supplement to extracorporeal cardiopulmonary resuscitation(ECPR) in adult patients with cardiac arrest to explore new ideas.Methods We retrospectively analyzed the characteristics of 17 patients who underwent ECMO as part of ECPR from July 2005 to September 2014 at Fuwai Hospital,and analyzed the differences between the survival group(n =6) and the in-hospital death group.Results The mean CPR time was(44.53 ± 21.39) min.The support duration of ECMO was(106.38-± 70.43) h.12 patients of all were successfully weaned from ECMO,and 6 patients survived to hospital discharge.There were significant differences between the two groups in terms of the last serum creatinine and blood lactate acid level before ECMO,and the time to lactate normalization.11 patients died,7 patients developed bleeding,and 8 cases developed infection.Conclusion Single-center data showed that applying ECMO as a means of ECPR improved the survival rate in cardiac arrest patients.Additionally,creatinine and lactic acid were good indicators for assessing prognosis.Refractory circulatory dysfunction and neurologic complications have an adverse impact on the survival of cardiac arrest patients.

OBJECTIVETo investigate the effect of peritoneal dialysis on fluid balance and outcome in children who receive cardiac operation.

METHODSFrom July to Dec. 2000, 12 (2.08%) patients of 576 consecutive children who underwent heart operation required peritoneal dialysis because of acute renal failure. The mean age of these 12 patients was (2.9+/-2.0) years (range, 5 months-7 years) and the mean body weight was (12+/-3) kg (range, 7.4-18.5 kg).

RESULTSThe interval between the operation and the initiation of peritoneal dialysis was (21.2+/-11.4) hours (4.4-42 hours). The duration of peritoneal dialysis was (6.3+/-4.8) days (0.47-15 days). Mortality in these 12 patients was 25%. Fluid removed by peritoneal dialysis was (34.7+/-17.8) ml x kg(-1) x day(-1). Asymoptomatic hypokalemia, thrombocytopenia and hyperglycemia were frequent complications, which were easily managed. Hemodynamics and pulmonary function improved during the study period.

CONCLUSIONThe early initiation of peritoneal dialysis is an effective and safe method to treat acute renal failure after cardiac operation in children.

Acute Kidney Injury ; etiology ; therapy ; Child ; Child, Preschool ; Female ; Heart Defects, Congenital ; surgery ; Humans ; Infant ; Male ; Peritoneal Dialysis ; Postoperative Complications

ObjectiveTo investigate the occurrence rule and mechanism of ischemia-reperfusion injury (IRI)-induced gastric oxidative damage during perioperative period of liver transplantation.Methods Twenty-eight SD rats were randomized into 4 groups according to the random number table. The modelof orthotopic autologous liver transplantation was established in 3 groups, which were 4 h, 8 h, 16 h group according to the reperfusion time of the liver grafts. The other group was set as Sham group. Gastric tissues were stained with HE to observe pathological changes of gastric mucosal injury. Superoxide anion (O2-), malondialdehyde (MDA), glutathione (GSH) and glutathione peroxidase (GSH-PX) in gastric tissues were detected. The expression of thioredoxin (Trx)-2 in gastric tissues was detected by Western blot. The comparison on experimental data was conducted using one-way analysis of variance and LSD-t test.Results In 4 h group, congestion, edema and hemorrhage were observed in deep stratum and submucous stratum of stomach, as well as disorganized glands, regional hemorrhage and necrosis, and erosion was observed deep to the muscularis mucosa. In 8 h group and 16 h group, gastric mucosal injury was alleviated, and only congestion and edema in superifcial and deep layer were observed. In Sham group, the epithelium structure of most gastric mucosa was intact. The O2- and MDA of 4 h group were respectively (185±26) U/mg and (0.4±0.1) nmol/mg and those of 8 h group were respectively (192±59) U/mg and (0.5±0.1) nmol/mg, which were signiifcantly higher than (102±34) U/mg and (0.2±0.1) nmol/mg of Sham group (LSD-t=4.99, 4.23 and 6.37, 4.52;P<0.05). GSH and GSH-PX of 4 h group were respectively (17±6) mg/g and (781±174) U/mg and those of 8 h group were respectively (15±4) mg/g and (750±160) U/mg, which were signiifcantly lower than (30±6) mg/g and (1 162±215) U/mg of Sham group (LSD-t=-3.26,-4.01 and-3.78,-4.36;P<0.05). The O2-, MDA, GSH and GSH-PX of 16 h group were respectively (169±27) U/mg, (0.3±0.1) nmol/mg, (25±8) mg/g and (1 108±183) U/mg, and signiifcant difference was observed comparing with 8 h group (LSD-t=-2.85,-3.46, 2.66, 3.69;P<0.05). The relative expression of Trx-2 in 4 h group and 8 h group were respectively 52±10 and 43±8, which were signiifcantly lower than 125±16 of Sham group (LSD-t=-5.34,-6.23;P<0.05). The expression of Trx-2 in 16 h group was 160±18, which was signiifcantly higher than that of 8 h group (LSD-t=4.75,P<0.05). ConclusionIRI causes gastric oxidative damage in the early phase after liver transplantation in rats, which may be associated with the decrease of Trx-2 expression, increase of active oxygen and decrease in organic antioxidative ability.

OBJECTIVETo assess the safety and efficacy of off-pump technique with normothemia to extend thoracoabdominal aortic aneurysm replacement compared with traditional hypothermic circulatory arrest.

METHODSFrom January 2004 to December 2013, 128 consecutive patients underwent surgical repair of thoracoabdominal aortic aneurysm (type Crawford Ⅱ) in Fuwai Hospital. The mean age was (37±11) years. The patients included 74 cases (57.8%) with chronic Stanford A dissection, 34 cases (26.6%) with chronic Stanford B dissection, 20 cases (15.6%) with thoracoabdominal aortic true aneurysm. There were 71 patients who underwent hypothermic circulatory arrest surgery (cardiopulmonary bypass (CPB) group) and 57 patients who underwent off-pump surgery with normothermia (off-pump group). The clinic data was compared between the 2 groups using paired t tests and χ(2) test. Kaplan-Meier survival analysis was used for postoperative survival stays.

RESULTSThe mean CPB time in CPB group was (251 ±87) minuets and the circulatory arrest time was (45±24) minuets. Spinal cord ischemia time in the two groups was (21±12) minuets and (18±10) minuets (t=5.68, P=0.51). The operation time, ventilator time, length of ICU stay and length of hospital stay of off-pump group were shorter than CPB group ((408±114) minuets vs.(630±156) minuets, t=-7.67, P=0.05; (18±13) hours vs. (113±89) hours, t=-3.86, P=0.00; (4±2) days vs.(10±9) days, t=-4.19, P=0.00; (15±7) days vs.(25±14) days, t=-4.47, P=0.00). The intraoperative blood loss in off-pump group and CPB group was (900±750) ml and (1 400±400) ml (t=-2.23, P=0.04). The mortality was 1.7% and 9.8% in the off-pump group and CPB groups (χ(2)=3.544, P=0.05). The cerebral complication rate in the normal temperature group was 1.7% vs. 22.6% in extracorporeal group (χ(2)=9.35, P<0.05). A total of 113 patients were followed up, with a follow-up rate of 88.2%. Duration of follow-up was (78±54) months. Five patients died during the follow-up period, including 2 who died of cerebral infarction and 3 paraplegia patients who died of infection. Eight patients had phase Ⅱ aortic arch replacement after a mean time of 6 months. The overall postoperative survival rate was 97%, 93% and 87% at 3 years, 5 years and 7 years, respectively.

CONCLUSIONOff-pump technique with normothemia was associated with a lower risk of a composite outcome of mortality and major adverse cardiac and cerebrovascular events during repair of extensive thoracoabdominal aortic aneurysm.

Adult ; Aorta ; surgery ; Aortic Aneurysm, Thoracic ; surgery ; Blood Vessel Prosthesis Implantation ; methods ; Cardiopulmonary Bypass ; Heart Arrest, Induced ; methods ; Humans ; Length of Stay ; Survival Rate

The purpose of the current treatment about the aortic intramural hematoma(IMH)is to prevent aortic rupture or conversion to typical dissection. Due to the different influence of human race,IMH type,severity and progression factors on this disease,the management of IMH remains controversial. Therefore,we reviewed current therapy of Aortic intramural hema-toma(IMH). And we provided a reference for further study on this disease by analyzing and comparing the relatively radical strategies and the close follow-up treatment(wait-and-watch strategy)strategies.

Objective: To investigate the technical method for harvesting and application of the descending branch of the lateral circumflex femoral artery (DBLCFA) in the coronary artery bypass grafting (CABG) operation. Methods: Between December 2016 and April 2017, 19 patients were arranged to use DBLCFA and got CT angiography (CTA) of pelvic and femoral arteries pre-operative at Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. Finally, DBLCFA was harvested in 16 patients (including 2 female patients, with a mean age of (47.4±8.5) years) through the anterior thigh incision (13 cases on the left side, 3 cases on the right side). The CABG operations were performed under the cardiopulmonary bypass support (in 10 cases) or under the beating heart condition (in 6 cases), and the DBLCFA conduit was used combining with bilateral internal thoracic artery (in 12 cases), radial artery (in 7 cases) and saphenpous vein (in 3 cases). Results: Due to anatomical variations such as short length and anomalous branch, or due to silent atherosclerosis stenosis of femoral artery, DBLCFA in 3 patients was considered inappropriate for use and was not harvested after CTA examination. In another 16 patients, DBLCFA was safely and quickly harvested and successfully used. On average, 3.4±0.6 anastomosis was built up in CBAG, no adverse effects were exhibited. The length of the harvested DBLCFA was (10.3±1.8) cm, with average lumen diameter of (1.9±0.5) mm. DBLCFA was used as free graft in 15 patients (7 to the first diagonal branch, 6 to the ramus intermedius branch, 1 to the left anterior descending branch and 1 to the second obtuse marginal branch). In 1 patient, the DBLCFA was firstly implanted end-to-side to the internal thoracic artery as a "Y" type composite graft, and then anastomosed to the third obtuse marginal branch. Conclusions The descending branch of the lateral circumflex femoral artery is an option conduit in CABG. It can be harvested easily and safely. However, pre-operative CTA examination is necessary to exclude the variation and appropriate strategy for graft establishment should be considered during the operation.