Objective To compare clinical effects between totally video-assisted thoracoscopic surgery and conventional median sternotomy for mitral valve replacement . Methods From March 2012 to October 2013, patients with simple mitral valve disease underwent mitral valve replacement through either right chest port -access totally video-assisted thoracoscopy ( thoracoscopy group, n=110) or conventional median sternotomy (conventional group, n=128).The time of operation, cross-clamp ascending aorta, cardiopulmonary bypass , postoperative mechanical ventilation , intensive care unit stay , postoperative hospital stay , and volume of postoperative chest drainage were compared between the two groups .All the patients were followed after 6 months postoperatively for evaluating the condition of valve regurgitation under echocardiography . Results Between the thoracoscopy group and the conventional group, no significant differences were found in time of operation [(256.2 ±28.5) min vs.(251.2 ±30.0) min, t=1.312, P=0.191], cross-clamp time of the ascending aorta [(40.0 ±2.7) min vs.(39.4 ±2.7) min, t=1.709, P=0.089], and cardiopulmonary bypass time [(74.2 ±4.1) min vs.(73.7 ±4.9) min, t =0.846, P =0.399].As compared to the conventional group, the thoracoscopy group had significantly shorter time of postoperative mechanical ventilation [(716.4 ±79.1) min vs.(811.9 ±58.8) min, t=-10.657, P=0.000], shorter length of intensive care unit stay [(26.2 ±3.6) h vs.(29.3 ±4.7) h, t=-5.640, P=0.000], shorter length of postoperative hospital stay [(9.6 ±1.2) d vs.(10.9 ±2.5) d, t=-4.982, P=0.000], and less volume of postoperative chest drainage [(328.1 ±83.2) ml vs.(561.3 ±143.9) ml, t=-14.978, P=0.000], respectively .No death happened in the two groups . No mitral valve regurgitation was seen during follow-ups at 6 months postoperatively . Conclusion For patients undergoing mitral valve replacement , totally video-assisted thoracoscopic surgery is superior to conventional median sternotomy with respect to surgical trauma .

Objective To probe the feasibility of video-assisted thoracoscopic operation for congenital heart diseases.Methods From October 2004 to August 2008,156 patients with congenital heart disease,including 79 cases of atrial septal defect(ASD),65 cases of ventricular septal defect(VSD),1 case of aortic aneurysm rupture combined with VSD,3 cases of double chamber right ventricles(DCRV) combined with VSD,and 8 cases of partial anomalous pulmonary venous drainage,were treated totally under thoracoscope.Surgical procedures were performed through 3 trocars inserted at the right chest wall,and catheters were placed in the right femoral artery and vein to set up extracorporeal circulation.The ascending aorta was cross-clamped with long tailor-made forceps and the myocardium was protected by coronary perfusion with cold crystalloid cardioplegia. Results All the thoracoscopic operations were completed successfully.The mean extracorporeal circulation and cross-clamping time were(74?28) min and(29?13) min respectively.Postoperative ventilation was withdrawn in(3.2?1.1) h,and the patients were discharged from the hospital in(6.1?1.2) d.Thirteen of the patients had postoperative complications,including 7 cases of right pneumothorax(healed by thoracentesis),and 6 cases of fat liquefaction of the incision at the right axillary(delayed healing).No severe complications occurred in this series.UCG performed 5-7 days after the operation revealed no residual shunt of ASD or VSD;in the patients who had aortic aneurysm rupture combined with VSD,slight aortic valve regurgitation was detected after the neoplasty;and in the 3 patients with DCRV combined with VSD,the right ventricular outflow tract was patent.ECG showed sinus rhythm without AVB in the patients.Follow-up up to 3 months to 3 years were available in 132 cases(over 12 months in 95 cases).During the period,no patient had complaints;and the heart function was confirmed as level Ⅰ.Conclusions Video-assisted thoracoscopic cardiac surgery is feasible,safe,and minimal invasive for patients with VSD or ASD,resulting in quick recovery and good cosmetic outcomes.

Objective To compare the efficacy between thoracoscopic and open cardiac surgery in the treatment of congenital heart diseases. Methods A total of 62 patients with congenital heart diseases were divided into two groups according to patients’ preference. There were 24 patients in the Thoracoscopic Group. The thoracoscopic operations were performed under extracorporeal circulation, including atrial septal defect repair in 8 patients and ventricular septal defect repair in 16 patients. The Open Group consisted of 38 patients, including atrial septal defect repair in 14 patients and ventricular repair in 24 patients. Results Fatal cases happened in neither of groups. There were no significant differences between the two groups in the bypass time (74?28 min vs 71?24 min; t=0.449, P=0.655), the ascending aorta cross-clamping time (29?13 min vs 28?12 min; t=0.309, P=0.758), and the postoperative mechanical ventilation time (3.2?1.1 h vs 3.3?1.1 h;t=-0.349, P=0.729), respectively. No significant variation in incidence of postoperative complications was observed between the two groups (?~2=2.646,P=0.104). As compared with the Open Group, the Thoracoscopic Group had a significantly less chest drainage volume (32?18 ml vs 66?28 ml;t=-5.290,P=0.000) and a significantly shorter postoperative hospital day (6.1?1.2 d vs 7.6?2.2 d;t=-3.059,P=0.003). Conclusions Thoracoscopic cardiac surgery for congenital heart diseases is a safe and effective technique with little invasion, quick recovery and good cosmetic results.

Objective To summarize the experience of mitral valve replacement (MVR) using video-assisted thoracoscope. Methods 28 cases of MVR were performed through three right anterior ports under thoracoscopy using femorofemoral extracorporeal circulation. The aorta was cross-clamped and the myocardium was protected by coronary perfusion with cold cardioplegic. 33 patients underwent routine open approach MVR as control group. Results There was no death and no morbidity directly related to this approach. Comparing with control group, time of extracorporeal circulation was 82～146 (96?38)min vs. 80～132(92?31)min, cross-clamped 37～76(47?18)min vs. 34～72(45?13)min and ventilation time were 8.6～14.8(10.2?3.1)h vs. 8.3～15.9(11.3?3.4)h . The volume of drainage was 50～230 (72?28)ml in VATS group while 70～460(108?4.2)ml in control group((P

Objective To summarize the experiences of surgical treatment of infective endocarditis. Methods The treatment for 116 patients (53 male and 63 female) with bacterial endocarditis admitted consecutively from June 1996 to July 2002 was analyzed retrospetively. Their age ranged from 5 to 64 years (mean 35.8?10.6 years). Thirty-three patients underwent operations at active phase, as the others were operated after infection was controlled. Eradication of infective vegetations was done in 109 patients, and in 43 of them valvular replacement was also performed. Correction of congenital heart diseases was done in 68. In 3 patients, myxomas were removed. Results Two patients died before the operation, and 3 patients died after surgery. Serious postoperative complications included severe low cardiac output in 5 patients, multiple organ failure in 3, and re-infection in 3 patients. Conclusion Appropriate preoperation preparation, early surgical treatment, and management of complications should be emphasized in the treatment of infective endocarditis.

ObjectiveThis paper reported our experience with thoracoscopic management of isolated atrial fibrillation to define the efficacy and safety of this approach.MethodsThirtytwo patients ( 17 mem,15 women) with isolated atrial fibrillation underwent thoracoscopic surgery.All procedures were finished under 3 port incisions on left posterior chest.Among them 18 cases are paroxysmal and 8 persistent.ResultsThere was no operative death or major perioperative complications.One case was converted to limited thoracotomy because of bleeding.Operation time was 87 - 238 min.Paroxysmal atrial fibrillation occurred in 9 cases in hospital and all the cases were sinus rhythm after discharge.Followup 4 to 20 months,One persistent case was converted paroxysmal.ConclusionPatients with isolated atrial fibrillation can benefited by Videoassisted thoracoscopic left posterior approach with better exposure of left atrial and resection of the left atrial appendage,with decreased operative trauma and better results.

ObjectiveTo summarize the clinical results of totally thoracoscopic cardiac surgery for mitral valve diseases.MethodsFrom May 2004 to October 2011,272 patients underwent totally thoracoscopic cardiac surgery for mitral valve diseases through three ports.Summarize the indication and contraindication are used and for the operation date.Results There was 1 case in-hospital deaths.The time of operations was 2.1 ～ 3.9 (3.0 ± 1.2 ) h.Time of cardiopulmonary bypass and aortic cross-clamp was 76 ～ 158 (98 ± 22) minites and 38 ～ 78 (52 ± 13 ) minites.Time of mechanical ventilation and intensive care unit stay was 5.8 ～ 34.5 ( 11.2 ± 3.6 ) hours and 14 ～ 67 ( 28.2 ± 7.6 ) hours.The volume of drainage was 20 ～ 1200(370 ± 80) ml.The hospital days were 7 ～ 18 ( 10.2 ± 2.1 ) days.The postoperative complications occurred in 14 cases.ConclusionTotally thoracoscopic cardiac surgery for mitral valve diseases is technically feasible and safe with less drainage and shortened hospital stay.

Objective To compare the outcomes of traumatic flail chest with multiple injuries treated by operative fixation versus conservative approach. Methods The clinical data of 60 patients with traumatic flail chest with multiple injuries were retrospectively analysed, and the outcomes between operation group (treated by operative fixation, n=32)and non-operation group (treated by conservative approach, n=28) were compared. Results The mean time of hospital stay, ICU stay and mechanical ventilation was significantly shorter, and the prevalences of chest wall deformity, pulmonary infection, pulmonary atelectasis and respiratory failure were significantly lower in operation group than those in non-operation group (P<0.05). Six months after discharge, the pulmonary function parameters such as inspiratory capacity, forced vital capacity, forced expiratory volume in one second, peak expiratory flow, total lung capacity and maximal midexpiratory flow were significantly higher in operation group than those in non-operation group (P<0.05). Conclusion Traumatic flail chest with multiple injuries treated by operative fixation may lead to less flail chest associated complications. Operative fixation has short- and long-term benefits to flail chest.

Post traumatic epilepsy(PTE)refers to the epileptic seizures after traumatic brain injury. Or-ganic damage can be found by imaging examination, and abnormal electroencephalogram can be detected via electroencephalogram examination which has the similar location of the brain injury. PTE has the characteristics of low incidence, absence of case reports, and easy to exaggerate the state of illness, which add difficulties to the forensic identification. This paper reviews the status of epidemiology, patho-genesis, clinical treatment and forensic identification for PTE.

Objective To summarize the clinical outcome of totally thoracoscopic cardiac surgery for mitral valve replacement.Methods Clinical data of 634 cases undergoing totally thoracoscopic cardiac surgery for mitral valve replacement from May 2004 to February 2016 in Department of Thoracoscopic Cardiacsurgery,Shanghai Yodak Cardiothoracic Hospital was analyzed retrospectively.There were 292 male and 342 female patients,aged from 17 to 68 years with a mean of(45±13)years.All the 634 patients had moderate-severe mitral valve stenosis and(or)incompetence,263 patients had moderate-severe tricuspid valve incompetence,356 patients had atrial fibrillation,46 patients had left atrium thrombosis.Cardiopulmonary bypass was established with right femoral artery and a single 2 stage venus cannula in the right atrium.The ascending aorta was cross-clamped and the myocardium was protected by coronary perfusion with cold crystalloid cardioplegia.Totally thoracoscopic mitral valve replacement were performed.Results Thirteen cases had incision expanded and 8 cases had conversions to sternotomy.Cardiopulmonary bypass and aortic cross-clamp time were(89±18)minutes and(51±12)minutes,respectively.Operation time was(3.1±1.2)hours.Mechanical ventilation time and intensive care unit stay were(17±6)hours and(27±8)hours,respectively.Postoperation drainage quantity was(390±70)ml.The hospital days was(9.2±2.1)days.There were 5 cases in-hospital deaths.Postoperative complications occurred in 42 cases(6.6％),including 18 cases of right hemoneumothorax,12 cases of reoperation for bleeding,3 cases of perivalvular leakage(reoperation was done in 1 patient),3 cases of low cardiac output syndrome,2 cases of acute renal failure,2 cases of inferior vena cava injury,1 case of right femoral artery thrombosis and liver injury,respectively.The mean duration of follow-up was(58±9)months in 608 cases,with a follow-up rate of 96.7％(608/629).Three patients had died during the period of follow-up caused by congestive heart failure(2 patients)and stroke(1 patient).Late complication among 605 survivors were 37 cases,including 32 cases of moderate tricuspid valve insufficiency,3 cases of stroke,1 case of perivalvular leakage and infective endocarditis,respectively.There was no reoperation during the period of follow-up.Conclusion Totally thoracoscopic cardiac surgery for mitral valve replacement is safe and effective,with unique superiority and clinical feasible.