Objective To introduce experience of switch operation applied to treat the transposition of the great arteries(TGA) and Taussing-Bing deformity.Methods Between June,2000 and Aug,2002, 27 consecutive patients underwent an arterial switch operation at our institution. The patients including TGA with intact ventricular septum in 5, TGA with ventricular septal defect in 18, Taussing-Bing deformity in 3, and corrected TGA in 1.Age ranged from 3 days to 6 years at operation (mean, 10 1?5 7 months), and the mean body weight was 6 3?2 81kg. Twenty patients were older than age 1 month. Ninteen patients had pre-operative catheterization. Seventy-four percents had severe pulmonary hypertention. Two patients had left ventricular outlet stenosis. Coronary type A distribution was recognized in 23 cases,type D in 4, and one of them had the origin of the left descending artery tunneled in the aortic wall. The great arteries were side by side in 3 cases. One patient underwent balloon atrial septostomy and another one underwent pulmonary banding and systemic to pulmonary shunt preoperatively. The great arteries were transected above the valvular commisures,the coronary ostia with all the adjacent sinus of Valsalva were excised and re-implanted to the proximal neo-aorta,then aortic anastomosis was carried out.The proximal neo-pulmonary trunk was reconstructed with a large autologous native pericardium as a posterior patch.The pulmonary anastomosis was completed,after the aortic cross clamp was released.The VSDs were repaired through the atrium or proximal aorta with Dacron patches.Results The hospital mortality was 7 4% (2 cases), and no death cases were directly related to any coronary artery problem. One perioperative death was a 5 day-old neonate with TGA and an intact septum who had refractory hypotension, hypoxemia, and acidosis preoperatively who underwent an emergency operation. The patient had a refractory low cardiac output syndrome postoperatively, and died after 20 hours. Another patient had a chylothorax and died of allergy from iodophor 22 days postoperation. The pulmonary pressure had gone down significantly in 20 patients who had severe pulmonary hypertension preoperatively (the mean pressure 46.7mmHg preoperation, and 31.3mmHg postoperation). Follow-up of 1 to 26 months was achieved in all survivors, with no late complications and death. Conclusions The arterial switch procedure for age over 1 month infants with severe pulmonary hypertention still has satisfactory efficacy.

Objective To report a new minimally invasive and cosmetic approach for atrial septal defect repair. Methods 46 patients ranged 3.6 to 32 (12.5?7 7) years underwent minimal right vertical infra axillary thoracotomy for atrial septal defect repairs under beating hearts from January 1997 to March 2000. One had a functional single atrum,two had an associated partial anomalous pulmonary venous connection,and three had the moderate pulmonary hypertension. Results The average bypass time was (30 3?7 8) min. There was no operative or late mortality and no morbidity directly related to the thoracotomy with beating heart. 37 patients had been Followed up for 3 months to 2 4 years(1 3?0 6) years. All of patients were free of symptoms. Conclusions The minimal right vertical infra axillary thoracotomy is a safe,cosmetic and minimal invasive approach to median sternotomy for repair of atrial septal defect or anomalous pulmonary venous connection.

Objective To suty DSA features of the splencin artery which provides blood supply to the tumor in the patients with hepatic carcinoma,to improve the clinical results of interventional therapy.Methods DSA was performed in 3 patients with hepatic carcinoma and the blood supply of tumors by splenic artery was found.The DSA features were analysed and the interventional embolization was carried out at the same time.Results After super-selective embolization of the splenic artery,obvious reduction of the tumor-feeding microvessels and marked shrinking of the lesion were observed in all cases.Conclusion Splenic artery as one of the supply arteria to the tumors in hepatic carcinoma is very important to familiarize that in transcatheter arterial chemoembolization for hepatic carcinoma.

Objective To assess the clinical value of interventional treatment for bone and soft-tissue tumors. Methods Selective angiography, transcatheter intra-arterial chemotherapy and/or embolization were performed in 28 patients with pathologically-proved bone and soft-tissue tumors. After treatment the clinical response and pathological changes were observed, and the results were analyzed. Results After transcatheter intra-arterial chemotherapy and/or embolization, relieving or even disappearing of the pain was seen in 23 patients, subside of soft-tissue swelling together with regression of the tumor was seen in 19 patients. Twenty-two patients underwent surgical resection of the lesion one week afte.r interventional treatment. Pathologically, cellular degeneration, necrosis and various degrees of liquefaction were demonstrated on the tumor specimen, which were more obvious in patients treated with embolization. Limp-sparing resection was adopted in 66.7% of patients (10/15). Conclusion lnterventional therapy is an effective method for bone and soft-tissue tumors and it is worth popularizing this technique in clinical practice.

ObjectiveTo observe the activity and safety of a novel combination therapy for patients with recurrent or refractory aggressive non-Hodgkin lymphoma (NHL).MethodsSix consecutive patients with recurrent or refractory aggressive NHL were treated with B-VIP regimen,boanmycin (5 mg/m2 on Days 1,4,8,12 and 15),vincristine (1.4 mg/m2 on Days 1,8 and 15),ifosfamide (1.2 g/m2 on Days 1,2,3 and 15,16,17) and prednisone (50 mg on Days 1 to 10),every 21 days.All the patients had received ≥5 cycles (average 8.3 cycles) of previous chemotherapy.ResultsSix patients (100 ％) were evaluable for response.The overall objective response rate was 66.7 ％ (4 patients),including 1 case complete (CR) and 3 cases partial responses.Myelosuppression was the most frequent serious complication of this regimen.ConclusionIn the current study,B-VIP was a highly active and safe combination therapy for patients with refractory disease with a poor prognosis or for patients with multiply recurrent aggressive NHL.

The treatment of heart failure is a common clinical problem faced by the medical community all over the world. It is also the only cardiovascular disease in the world that is on the rise. Although drug therapy for heart failure has made great progress in recent years, there are still many problems. Therefore, reversing ventricular remodeling, assisting or even replacing the function of the damaged heart and improving the prognosis and quality of life of patients with heart failure through surgical treatment will become the main battlefield for the future treatment of heart failure. As a transitional support therapy or permanent replacement therapy before heart transplantation, ventricular assist device can significantly improve the survival and quality of life of patients with heart failure, and is becoming an important treatment method for patients with end-stage heart failure. This paper aim to review the history and prospect of ventricular assist devices after heart failure.

Objective: To analyze the clinical efficacy of coronary artery bypass grafting(CABG)in patients of advanced age with left main coronary artery disease(LMCAD). Methods: From 2005 to 2014, 101 elderly patients(≥80 years)with LMCAD underwent off-pump CABG in our hospital.Among them, 82 were male and 19 were female, with an average age of(81.4±1.7)years.Seventy-six cases(75.2%)had significant left main stenosis(≥70%)and twenty-five cases had left main stenosis less than 70%.The average left ventricular end diastolic diameter was(48.2±8.3)cm; left ventricular ejection fraction was more than 50% in 89 cases and 30% to 50% in 12 cases.Fourteen cases had mitral insufficiency and one had ventricular aneurysm.In addition, 56 patients had New York Heart Association functional classification Ⅰ to Ⅱ, and 45 patients had classification Ⅲ to Ⅳ.Ninety-nine patients had Canadian Vascular Society(CCS)classification of angina pectoris Ⅰto Ⅲ, two had classification Ⅳ and thirteen had acute myocardial infarction.Six patients were implanted with intra-aortic balloon counterpulsation before CABG. Results: The average operation time was(3.9±0.8)h, the average number of bridging vessels were(3.0±1.0)roots, ICU monitoring time was(50.2±46.0)h, and ventilator assisted breathing time was(42.9±68.5)h.Six patients(5.9%)had secondary thoracotomy hemostasis, five(4.9%)had secondary tracheal intubation, and four(4.0%)had continuous dialysis.Intra-aortic balloon counterpulsation was implanted in 3cases(2.9%)during operation and in 11 cases(10.9%)after operation.Two cases(2.0%)had perioperative myocardial infarction and 8 cases(7.9%)died after operation during hospitalization.The median follow-up time was 6(1-11)years, and 17(16.8%)had all-cause mortality. Conclusions Although the two independent high-risk factors, old age and left main stenosis often coexist, off-pump CABG and perioperative management are still safe and effective treatments.

Objective:To analyze the composition, the changes of expense structure and the influencing factors of hospitalization expenses, for reference in optimizing the cost control of day surgery.Methods:Collection of the first page data of patients with the top three diseases(varicose veins of lower limbs, chronic cholecystitis and varicocele)in the day surgery volume ranking in three tertiary general hospitals in a city in 2020. The confounding factors were eliminated through propensity matching. The structural change of hospitalization expenses was analyzed by structural change degree, and the influencing factors of hospitalization expenses were analyzed by grey correlation degree and multiple linear regression.Results:After 1∶1 propensity matching of the first page data of 752 patients with day surgery and non day surgery, 98 patients with lower extremity varicose veins, 356 patients with chronic cholecystitis and 38 patients with varicocele were finally included. Compared with non day hand, the total hospitalization cost of day surgical instruments decreased, and the cost structure changes of chronic cholecystitis, varicocele and varicose veins of lower limbs were 14.59%, 6.20% and 16.20% respectively. Among them, the general medical service fee, nursing fee and examination and laboratory fee showed a downward trend, and the fees of materials and drugs showed an upward trend. General medical service fee, nursing fee, examination and laboratory fee, clinical diagnosis fee, treatment fee, drug fee, material fee and other expenses presented a high correlation with the cost of day surgery(grey correlation>0.90). The payment method, wound healing type and discharge diagnosis can influence the cost of day surgery( P<0.05). Conclusions:Compared with non daytime surgery, the total hospitalization cost of day surgery has a certain cost control effect, but it can not reduce the cost of all projects. The main influencing factors are the internal composition of the cost, payment method and so on. The hospitals should focus on tapping the internal cost control potential of day surgery and further expanding the coverage of day surgery diseases.

Objective To analyze the clinical characteristics,treatment regimens and influencing factors of prognosis of patients with mantle cell lymphoma(MCL).Methods The clinical data of 41 patients with MCL was collected.These patients were initially diagnosed and treated in the Fifth Medical Center of Chinese PLA General Hospital between August 2004 and December 2019.The clinical features,therapeutic efficacy and prognosis-related factors were clarified.Results The median duration of follow-up was 68(1-165)months.The 3-year progression free survival(PFS)and overall survival(OS)were 37.29%and 62.75%respectively.Based on univariate analysis,B symptoms,Eastern Cooperative Oncology Group(ECOG)scores,the mantle cell lymphoma international prognostic index(MIPI),relapse and refractory state and the therapeutic effect were statistically significant for progression free survival.B symptoms,R-chemotherapy and therapeutic effect were statistically significant for overall survival.In multivariate analysis,B symptoms and the MIPI were statistically significant for progression free survival.B symptoms,R-chemotherapy and therapeutic effect were statistically significant for overall survival.There were statistically significant differences in 3-year OS between patients with different MIPI and MIPI-C scores.Conclusion Mantle cell lymphoma mostly occurs in elder males,and is more likely to be detected in late the stage.B symptoms,R-chemotherapy and therapeutic effect are independent prognostic factors for patients with MCL.The MIPI and MIPI-C scores have clinical guidance significance for patient survival.

Objective:To investigate short-term and long-term outcomes of off-pump coronary artery bypass grafting(OPCABG)in patients aged 80 years and over.Methods:In this retrospective study, clinical data were collected, from June 2005 to July 2014, of 31 patients aged 80 and over years with left ventricular dysfunction who had received OPCABG in Beijing Anzhen Hospital and a follow-up of 3-12 years after discharge.Results:Ages of the patients ranged from 80 to 88 years with a mean age of(82.0±2.1)years.There were 25 males(80.6%). The mean left ventricular ejection fraction(LVEF)of patients was(42.0±6.5)% before operation, and 15 patients had LVEF less than 35%(48.4%). The average operation time was 4 hours.Three patients died in hospital(9.7%), of whom, one died from acute respiratory failure and the two others from low cardiac output syndrome.Perioperative complications included myocardial infarction(1 case, 3.2%), acute cerebral infarction(2 cases, 6.5%), tracheal intubation(3 cases, 9.7%), secondary thoracotomy and hemostasis(1 case, 3.2%), continuous renal replacement therapy(3 cases, 9.7%)and perioperative intra-aortic balloon pump(IABP)(8 cases, 25.8%). Twenty-eight patients were followed up for 3-12 years(median, 8.0 years), and no one had withdrawn.There were 10 all-cause deaths(35.7%), including 5 cardiogenic deaths(17.9%), 2 lung cancer deaths(7.1%), 2 deaths due to sepsis from systemic infection(7.1%), and 1 death from unknown causes.Besides, 2 patients had re-admission(7.1%), 2 patients suffered angina(7.1%)and 1 patient(3.6%)had recurrent myocardial infarction(3.6%). No patient received re-revascularization.Coronary computed tomography angiography(CTA)was performed on all surviving patients 1 year after surgery, and the patency rate of vascular bridges was 100%.Conclusions:Both short-term and long-term clinical outcomes of OPCABG are fair in patients aged over 80 years with left ventricular dysfunction, but the mortality and risk of complications are still high, and comprehensive preoperative evaluation is needed for these patients.