Objective To evaluate the efficacy of ventricle septal defect(VSD) occluder through lower ministernotomy for patients with perimembranous VSD. Methods From January 2007 to August 2008,41 patients with perimembranous VSD(14 male,27 female,weighed 9.0 to 71 kg with a mean of 46.3?16.1) underwent a closure of perimembranous VSD through lower ministernotomy using Amplatzer occluder.Before the operation,all the cases had been confirmed as having a 3-to 8.5-cm perimembranous VSD by transthoracic echocardiography(TTE).Under general anaesthesia,a small incision was made at the lower sternum to expose the right ventricle,and then occluder was placed in the right ventricle.TEE,electrocardiography and chest X-ray were performed before discharge and 1 month after the operation.Results The procedure was completed successfully in all the patients with a mean operation time of(6.2?3.3) hours(ranged from 2.5 to 17 hours).The ICU stay was(15.1?4.3) in average(8-21 hours).The mean drainage volume after the surgery was(80?33) ml(35-210 ml).Follow-up was available in all the cases for(7.9?4.1) months(range,3-15 months).During the period,no A-V block,new AI,occluder displacement,embolization,tricuspid incompetence or residual occurred. Conclusions VSD occluder is feasible and safe for closure of perimembranous ventricular septal defects through lower ministernotomy.

Objective To analyze the feasibility and superiority of off-pump coronary artery bypass grafting(OPCAB) in patients with left main coronary lesions.Methods A retrospective study was carried out to review our experience on 392 cases with left main coronary lesions,who underwent CABG in our hospital.Among the cases,279 patients(71.2%) underwent OPCAB and 113 cases received CCABG.The early postoperative mortality and complications of the two groups were compared.Results The number of bypass grafts was(4.17?0.86) in Group OPCAB and(4.24?0.94) in Group CCABG,showing no significant difference between them(t=-0.710,P=0.478).No significant difference was detected in peri-and post-operative morbidity between the two groups [atrial fibrillation: 31(11.1%) vs 8(7.1%),?2=1.459,P=0.227;perioperative myocardial infarction: 7(2.5%) vs 3(2.7%),?2=0.000,P=1.000;renal inefficiency: 9(3.2%) vs 4(3.5%),?2=0.000,P=1.000;pulmonary complications: 15(5.4%) vs 6(5.3%),?2=0.000,P=1.000].The early postoperative mortality of Group OPCAB was significantly lower than that in Group CCABG[2(0.7%) vs 5(4.4%),?2=4.368,P=0.037].The time of intubation[20(8-48) h vs 51(14-130) h,Z=-2.823,P= 0.005],ICU-stay [51(38-141) h vs 92(42-352) h,Z=-2.618,P=0.009],volume of transfusion [500(200-1200) ml vs 800(400-2100) ml,Z=-2.411,P= 0.016],re-open [5(1.8%) vs 10(8.8%),?2=9.052,P=0.003] and complication of CNS [3(1.1%) vs 9(8.0%),?2=10.647,P=0.001] of Group OPCAB were significantly less than that of Group CCABG.Conclusions It is feasible,safe and effective to perform OPCAB in patients with left main coronary lesions.

Objective The preservation of all subvalvular apparatus for chronic mitral regurgitation has been reported in many studies. In this paper we analyzed the effects of complete chordal preservation for mitral stenosis versus mitral regurgitation on postoperative recovery.Methods Thirty-nine patients undergoing mitral valve replacement(MVR) with preservation of all subvalvular apparatus were divided into two groups, mitral stenosis (MS) group(n=23) and mitral incompetence (MI) group(n=16), according to the preoperative diagnosis. Echocardiography was performed preoperatively and at the time of discharge to determined left ventricular end diastole dimension (LVEDD),ejection fraction(EF) and the hemodynamics of the prosthesis.Results The LVEDD and EF did not change in MS group, declined in MI group postoperatively. No hemodynamic disorder of the prosthesis was detected in either group.Conclusions The valve replacement with preservation of all subvalvular apparatus could be used in both the mitral stenosis and mitral regurgitation.The early-term effects of two groups are similar,and the long-term effects are still to be observed.

55 mm or course of AF over 2 years [54.5%(24/44) and 68.7%(46/67),?2=29.265,P=0.000 and ?2=13.814,P=0.000].Conclusion RFA Maze Ⅲ procedure during open-heart surgery is safe and effective for patients with AF.

Objective To summarize the clinical result of patients undergoing endoscopic vein harvest (EVH) technology to collect greater saphenous vein (GSV) in coronary artery bypass graft (CABG) operation, and to assess the operation outcome of EVH. Methods A total of 862 patients underwent primary CABG, among whom saphenous vein of 482 patients were taken using EVH, and the others by open vein harvesting (OVH) based on patients' willingness. The operation risk factors and complication were compared between the two groups. The 64 multi-slice computed tomography (64-MSCTA) was used to evaluate the vein grafts patency after surgery for 1 year. The vein patency between the two groups was compared. Results There was no significant difference in risk factors of incision complication between two groups ( P>0.05). But the incidence of various incision complication was significantly lower in EVH group (10.2%,49/482) compared with that in OVH group (35.0%,133/380) ( P<0.05). The time of harvesting and the length of conduits was similar between two groups (P>0.05). After 1 year's follow-up, the vein graft patency were 86.0%(404/470) and 87.1%(324/372) in EVH group and OVH group, and there was no significant difference ( P>0.05). Conclusions The decrease in incision complication of EVH is unquestionably superior to those of OVH, especially for those patients with risk factors of incision complication. The EVH vein graft has good patency in short time.

Objective To evaluate arch replacement in islet fashion combined with intraluminal-including technique.Methods From Aug.2011 to Mar.2012,19 patients with type A aortic dissection needed arch replacement were selected,whose cephalo-brachial artery and left common carotid artery were intact or left subclavicular artery alone was involved,Sixteen patients were male.Mean age was (49.6 ± 5.7) years.Urgent surgery and red surgery were completed in 13 cases,6 cases and 1 case,respectively.The arch replacement was performed in a modified islet fashion,remaining the adventitia and trimming intima,constituting a common opening with the proximate end of stented elephant trunk in side-to-side manner by using intraluminal anastomosis technique.This common opening was anastomosed with the distal end of the ascending aortic Dacron graft,completed the procedure of arch replacement.If left subclavicular artery was involved by dissection or it was displaced pathologically as to expose difficultly,it should be covered by the stented elephant trunk,and be transplanted to left common carotid artery in end-to-side manner.Finally,the entire Dacron graft was wrapped by remained adventitial coat using including technique,with a shunt connecting to right atrium.Results Mean duration of cardiac pulmonary bypass,aortic cross clamp and selective cerebral perfusion was (215 ±54),(93 ± 18) and (30 ±6) minutes,respectively.In one case with delayed sternum closure due to extensive bleeding,the mean chest tube output in first 24 hours was (926 ±322) mL,the mean duration of postoperative ICU was (78 ±21) hours; none of the patients was reopened for bleeding.Postoperative hypoxemia,transient neurologic dysfunction,and hematosepsis occurred in 3 cases,1 case and 1 case,respectively.One patient needed re-intubation attributing to pulmonary infection.There was no complication of permanent neurologic deficit or postoperative visceral mal-perfusion.All patients survived and were discharged from hospital.Severe complication was not observed at follow-up of 1 to 5 months.Conclusions The modified aortic arch replacement procedure,which adopt islet fashion combined with intraluminal inclusion technique,characterized by its feasibility,safety,reproduction and easy to control bleeding,may be considered as an alternative approach for managing arch disease.Its short-term outcomes were competitive and prospective was promising.

Objective To evaluate the clinical characteristics,diagnosis and surgical repair methods of double aortic arch (DAA) associated with complex cardiac anomalies.Methods Retrospectively analyzed the clinical data of the 5 DAA associated with complex cardiac anomalies patients,4 males and 1 female,age from 41 days to 19 years old,weight 4.3-56.0 kg.Accompanied cardiac malformites including 2 cases with TOF,2 cases with DORV,and 1 case with d-TGA.4 cases were diagnosed DAA via MSCT and were surgical treated combined with cardiac malformations at same stage.1 case of DAA associated with d-TGA experienced stubborn pulmonary infection with increased airway resistance and could not tolerate ventilator weaning after aterial switch operation.Then he was diagnosed DAA with left arch atresia through MSCT.So,the patient underwent another surgery to excise the left aortic arch.Results One case worsened postoperatively by the cause of vomiting and aspiration and then died.The other four were survival and discharged with no DAA repair relating complication.Conclusion Double aortic arch can be cured by surgical repair and DAA with cardiac defects can be operated in one stage via median sternotomy.Congenital vascular ring should be considered in patients with stubborn and unexplained respiratory symptoms,who should receive timely imaging examinations for accurate diagnosis and surgical treatment at the early stage.