0.05). Follow-up of 14 patients was from 1 to 60 months (the mean value is 26. 8 months). There was no late death and re-operation. The average mitral annulus area is (3.00?0.57) cm~2. The transmitral pressure gradient decreased from (8.13?4.49) mmHg to (6.25?3.82) mmHg after operation (P=0.050). There were eight cases with minimal reflux and 6 cases with slight reflux. In all patients, the heart function returned to NYHA I～II grade. Conclusion The “edge-to-edge” technique is a feasible and effective operation for treatment of the mitral regurgitation caused by Barlow's disease.

Objective: To summarize the surgical results of valve replacement in children. Methods: From Jan.1990 to Dec.2002, 45 children ranging from 3 to 14 years (average 10.8 years) underwent cardiac valve replacement. There were 26 males and 19 females. 15 cases were younger than 10 years and 30 cases aged 10 to 14 years. Surgical indications for valve replacement included congenital valve disease (n=32), rheumatic heart disease (n=6), bacterial endocarditis (n=3), mitral insufficiency after atrioventricular canal defect repairing (n=3) and aortic insufficiency after VSD repairing (n=1). Mitral replacement was performed in 23 cases, aortic and tricuspid replacement in 9 cases, and combined mitral and aortic replacement in 4 cases. In forty cases, mechanical valves were used bioprosthetic valves or homograft valves in 5 cases. Results: Operation mortality was 4 4%(2/45 cases). The follow up periods were from 8 months to 12 years (average 4 9 years). Late mortality was 9 3% (4/45 cases). There was no anticoagulation related complications occurring. Conclusion: According to this study, valve replacement with warfarin anticoagulation in children was a safe and feasible technique. A suitable size prosthesis implantation could result in a healthy development.

Objective To sum up the application and the technique of CT-guided percutaneous puncture biopsy of thoracoabdominal masses.Methods 107 cases of thoracoabdominal masses were made percutaneous puncture biopsy,in which chest disease 81 cases,abdominal disease 26 cases.Biopsy was done using 18～20 G Franseen needle and 18 G coaxial automatic cutting needle.Routinely chose vertical plane angle,horizontal plane angle and vertical plane angle on one side of the body outline when needle was been entered.Results The successful rate by first puncture was 100%,and the total verification rate was 92.52%.The rate of thoracic complication was 11.11%.No obvious abdominal complication was found.Conclusion The technique of CT-guided percutaneous puncture biopsy of thoracoabdominal masses is simple,practical,high accuracy and only few complications.It should be emphasized that the needle angle should be having definite reference and the needles should be chosen accurately.

Objective To evaluate a combination therapy for huge tumors in the buttocks.Methods A total of 11 patients from our hospital were collected,among them 5 cases were of hemangioma,4 cases of neurofibroma,2 cases of soft tissue sarcoma.Before definite surgical resection all cases received tumor embolization with silk thread and gelatin-sponge article using Seldinger's technic.Subsequently,all patients underwent a successful tumor resection. Results Superselective embolization for all the cases'feeding arteries resulted in recession of the tumors and relatively well-demarcated margins,and all the lumps became softer.and the local pain was alleviated.Surgical resection could be radical with avoidance of fatal intraoperative hemorrhage.The 5 cases of hemangioma had a average operative bleeding of 450 ml,4 cases of neurofibroma had 420 ml,2 cases of soft tissue sarcoma had 150 ml.No patients needed intraoperative and postoperative blood transfusion.The operation time was about 2-3 hours,the normal tissues were preserved and the contour and function of the diseased limbs were very good.One case had a delayed incision healing,and the others had a healing by the first intention.There was no recurrence and other complications (like deep venous thrombosis)during a follow-up period of 4-8 months. Conclusions Surgical resection combined with interventional embolism for the treatment of huge tumors in the buttocks can reduce the risk of bleeding effectively during operation.It can improve the success rate of operation leading to satisfactory results.

ObjectiveTo analyze whether association of edge to edge valve repair to artificial ring annuloplasty would result in better results in patients with severe tricuspid regurgitation (TR).MethodsFrom April,2001 to May,2010,41 patients underwent tricuspid valve repair to treat severe TR were studied.Twenty-one patients were done artificial ring annuloplasty alone (group R) and twenty patients were done artificial ring annuloplasty associated with edge to edge valve repair ( group E).All the patients received echocardiography before surgery,before discharge and in mid and long-term follow-up.The ratio between TR jet area (TRA) and right atrial area (RAA) was used to quantitatively evaluate the seriousness of TR.Movement of tricuspid valve leaflets,tricuspid valve orifice area,pulmonary artery pressure ( PAP),left ventricular ejection fraction ( LVEF) were obserbed to evaluate heart function.ResultsAt discharge in group R,no or trivial TR was presented in 7 patients,mild TR in 12 patients and moderate TR in 2 patient.Bad apposition of the free edges of anterior and septal leaflets was observed in paients with mild and moderate TR.While in group E,no or trivial TR was presented in 13 patients and mild TR in 7 patients.The follow-up ranged from 6 months to 100 months[average (54.8 ±26.7) months].In group R,no or trivial TR was present in 5 patients,mild TR in 11 patients,moderate TR in 4 patients and severe in 1 patient.Bad apposition of the free edges of anterior and septal leaflets was observed in paients with mild to severe TR.Redo tricuspid valve repair was done in one patient in group R for recurrent severe TR and the edge-to-edge valve repair was utilized.In group E,no tricuspid stenosis was found.No or trivial TR was presented in 10 patients,mild TR in 9 patients and moderate TR in 1 patient.The ratio of TRA/RAA of group R was significantly higher than that of group E (0.25 ±0.16 vs.0.13±0.10,P < 0.01).ConclusionAssociation of edge-to-edge valve technique to artificial ring annuloplasty was safe and effective for treatment of severe tricuspid regurgitation due to bad apposition of free edges of tricuspid leaflets and dilatation of tricuspid annulus,.It could decrease the incidence of residual tricuspid regurgitation and prevent the recurrence of severe tricuspid regurgitation.

Objective To investigate the association between CYP11 B2 gene polymo-rphism and left ventricle hypertrophy with meta analysis.Methods Literatures about the association of CYP11 B2 gene polymorphism and left ventricle hypertrophy from January 1992 to December 2011 were searched.The electronic databases retrieved from Pubmed,Embase,China national knowledge intemet,Chinese biological medicine disk,VIP fulltext database and Wanfang fulltext database.Odds ratio of CYP11 B2 genotype distributions in left ventricle hypertrophy patients comparing with healthy control were analyzed.RevMan5.1 software was applied for investigating hereogeneity among individual studies and summarizing effects with proper statistical methods.Six case control studies were enrolled.Results A total of 541 cases and 553 controls were enrolled for the study.The pooled OR of CC vs TT + TC genotype was 1.15 (95％ CI:0.74 ～ 1.80) (Z =0.63,P =0.53) in the subgroup of hypertension,and the pooled OR of CC vs TT + TC genotype was 1.15 (95 ％ CI:0.74 ～ 1.80) (Z =0.63,P =0.53) in the subgroup of race.The pooled OR of C vs T allele was 1.15 (95％ CI:0.76 ～ 1.74) vs 0.87 (95％ CI:0.58 ～ 1.31) (Z =0.67,P =O.50).Conclusion Whether the hypertension or the race,the genotype of CYP11 B2 polymorphism has no association with an increased risk of left ventricle hypertrophy.

Objective Tricuspid regurgitation is often associated in patients with congenital heart disease. Significant morbidity and mortality are related to tricuspid valve replacement. Tricuspid valve plasty is still a preferred choice. This report deals with our surgical experience in using edge-to-edge valve plasty technique to correct severe tricuspid regurgitation in patients with congenital heart disease. Methods From April 2001 to Mar. 2010, severe tricuspid regurgitation was corrected with a flexible band anuloplasty and edge-to-edge valve plasty technique in 14 patients with congenital heart disease. The age ranged from 7 years to 62 years [average (31.2 ± 16.1 ) years]. Congenital cardiac anomalies include: atrioventricular canal in 5 cases, secundum atrial septal defect in 6 cases, secundum atrial septal defect with mitral valve regurgitation in 2 cases and cor triatriatum in 1 case. Results No hospital death or postoperative morbidity occurred. No or trivial tricuspid regurgitation was present in 11 cases and mild tricuspid regurgitation in 3 cases at discharge. The follow-up ranged from 3 month to 97 months [average (51.6 ± 26.8 ) months]. No tricuspid stenosis was found. No or trivial tricuspid regurgitation was present in 5 cases. Mild tricuspid regurgitation was present in 8 cases, and moderate tricuspid regurgitation in 1 case at the latest followup. Conclusion Edge-to-edge valve plasty is an easy, effective and important procedure to correct severe tricuspid regurgitation in patients with congenital heart disease.

ObjectiveTo compare the effects of preventative intra-aortic balloon pump (IABP) insertion with intra-or post-operative IABP insertion in high-risk patients undergoing coronary artery bypass grafting (CABG).MethodsFrom Jan 2008 to May 2011,one hundred and four patients received CABG or off-pump CABG (OPCABG) and IABP therapy in our hospital.The enrolled criteria of IABP insertion included left ventricular ejection fraction (EF) less than 0.40,unstable angina,AMI,left main stenosis,emergency CABG,refractory ventricular arrhythmia.Group1 included thirty eight patients with preoperative IABP insertion,thirty one for intra-operative IABP insertion ( group 2 ) and thirty four for postoperative IABP insertion ( group 3 ).The indications for IABP insertion for group 2 and 3 were unstable hemodynamics,failure to wean off cardiopulmonary bypass and low output syndrome during or after operation.Clinical data including operative mortality,ventricular fibrillation,chest drainage,hospital stay,ICU stay,ventilator supporting time,IABP supporting time,EF improvement rate,mechanical assist device and Inotropic drugs utilizations were analyzed among three groups.ResultsGroup 1 demonstrated good therapeutic results.There were significant statistic differences in operative mortality ( group 1 2.6％,group 2 12.9％,Group 3 47.1％),hospital stay[group 1 (23.6 ± 9.8) days,group 2 (21.5 ±9.7) days,group 3 (28.9 ±13.3) days],ICU stay[group 1 (2.3 ± 1.1 ) days,group 2 (3.5 ± 1.5 ) days,group 3 (5.2 ± 3.4) days],ventilator supporting time [group 1 (29.5 ± 23.0) hours,group 2 (38.7 ± 20.6) hours,group 3 (84.1 ± 48.0) hours],IABP supporting time [group 1 (77.0 ± 43.7 ) hours,group 2 ( 93.8 ± 44.8 ) hours,group 3 ( 121.5 ± 71.7 ) hours],EF improvement rate [group 1 (7.5 ± 7.2),group 2 ( 8.5 ± 7.5 ),group 3 (2.0 ± 6.7)],inotropic drugs utilization[group 1 ( 3.7 ± 4.9) days,group2 (6.2±4.6) days,group3 (10.8±5.4) days](P＜0.05).ConclusionComparing with intra- or post-operative IABP insertion,high-risk patients undergoing CABG could significantly benefit from preventative IABP insertion.Early IABP insertion was recommended for high-risk patients undergoing coronary artery bypass grafting.

Objective To analysis of risk factors for left atrial thrombosis in patients with rheumatic mitral stenosis.Methods From January 2001 to December 2008, 2277 patients with rheumatic mitral stenosis underwent operations in our hospital. There were 737 males and 1540 female, the age ranged from 19 to 84 years [average (50.9 ±10.2) years]. Left atrial thrombosis group (554 cases) and no thrombosis group (1723 cases) were divided, retrospectively collected data were analyzed with univariate and multivariate Logistic regression. Results 12 bvariables, including age, mitral valve orifice area, left atrial diameter, left ventricular diastole diameter, CRP, gender , degree of mitral stenosis, or regurgitation, degree of bicuspid regurgitation, degree of pulmonary hypertension, atrial fibrillation and heart function had statistic difference between two groups. With multivariate Logistic regression for these 12 factors, age, mitral valve orifice area, left atrial diameter, degree of mitral regurgitation and atrial fibrillation were found to be the affecting factors for left atrial thrombosis in patients with rheumatic mitral stenosis. Conclusion For patients with rheumatic mitral stenosis, age, mitral valve orifice area, left atrial diameter and atrial fibrillation are the risk factors for left atrial thrombosis. Mitral regurgitation is a protective factor for left atrial thrombosis.

Objective This study aims to evaluate the initial results of a hybrid procedure for treating descending thoracic aortic disease that involves distal aortic arch.It also intends to report our initial experience in performing this procedure.Methods A total of 45 patients(35 males and 10 females) with descending thoracic aortic disease underwent a hybrid procedure,namely,thoracic endovascular aortic repair(TEVAR) combined with supra-arch branch vessel bypass,in our center from April 2009 to August 2014.Right axillary artery to left axillary artery bypass(n =20) or right axillary artery to left common carotid artery and left axillary artery bypass(n =25) were performed.The conditions of all patients were followed up from the 14th month to the 77th month postoperative[mean(38.0 ± 17.1) months].Mortality within 30 days,complications such as endoleak after the hybrid procedure,and stenosis or blockage of the bypass graft during the follow-up period were assessed.Results One case of death and one case of cerebral infarction were reported within 30 days.Two patients underwent open surgery beacuse of endoleak.And a newly formed intimal tear was observed in one patient and the patient underwent a second TEVAR during the follow-up period.Condusion Initial results suggest that the one-stage hybrid procedure is a suitable therapeutic option for thoracic aortic pathologies that involve distal aortic arch.However,this procedure is not recommended for type-B aortic dissection,in which a tear is located in the greater curvature or near the left subclavian artery,because of the high possibility of endoleak occurrence.