Objective To summarize the treatment experience of supraventricular tachycardia (SVT) after coronary artery bypass graft (CABG). Methods The clinical data of 136 patients who had occurred SVT after CABG between January 2008 and December 2009 were analyzed retrospectively. Results Among 136 patients,no perioperative mortality,atrial fibrillation (AF) occurred in 110 cases (80.88%),paroxysmal supraventricular tachycardia (PSVT) occurred in18 cases ( 13.24% ), atrial flutter occurred in 8 cases (5.88%),112 of 136 cases occurred in 1-3 days after surgery,accounting for 82.35% ,24 cases occurred in 4-7 days after surgery,accounting for 17.65%. Given amiodarone in the treatment of 105 cases,100 cases reverted to sinus rhythm (cardioversion rate of 95.24% ),given esmolol in the treatment of 11 cases, 9 cases reverted to sinus rhythm( cardioversion rate of 81.82% ), synchronous direct current cardioversion in 20 cases, all transferred to sinus rhythm, all patients with improved symptoms. The remaining failed to transfer to sinus rhythm, had got normal ventricular rate, and symptoms improved significantly. Conclusions It is necessary to take effective measures to prevent SVT within 3 days after CABG. Amiodarone, esmolol and synchronous direct current cardioversion can be used effectively and safely to control SVT after CABG.

Objective: To explore the impact of Ischemic preconditioning (IPC) in aged experimental rats after myocardial ischemia-reperfusion (I/R) with its mechanism.
Methods: A total of 32 Wistar rats at the age of (21-23) months were divided into 4 groups, n=8 in each group.①Control group, the rats received cardiac perfusion for 180 min. ②I/R group, the rats received cardiac perfusion for 30 min, followed by ischemia for 30 min, then reperfusion for 120min.③IPC group, the rats received cardiac perfusion for 10 min, followed by ischemia and reperfusion 2 times (5 min in each time), then ischemia 30 min and reperfusion 120 min. ④ Enhanced IPC group, rats received cardiac perfusion for 10 min, followed by ischemia and reperfusion 4 times (5 min in each time), then ischemia 30 min and reperfusion 120 min. The recovery rate of cardiac output (CO), left ventricular developed pressure (LVDP) and the recovery rate of maximum rise and fall of left ventricular pressure (±dp/dtmax) at (30, 60, 90, 120) min after reperfusion were recorded respectively. The creatine kinase (CK-MB), superoxide dismutase (SOD) activity and malondialdehyde (MDA) content were examined before ischemia and 120 min after reperfusion. The apical peroxisome proliferator-activated receptorγco-stimulatory factor 1α(PGC-1α) was examined by immuno-histochemistry.
Results: The MDA content, CK-MB, SOD activities LVDP and (±dp/dtmax) recovery were similar between IPC group and I/R group, P>0.05. While compared with I/R group, the Enhanced IPC group showed decreased CK-MB activity and MDA content, increased SOD activity and CO, LVDP and (±dp/dtmax) recovery rate, all P<0.01. The PGC-1αexpression was similar between IPC group and I/R group, P>0.05. While compared with I/R group, the Enhanced IPC group had increased PGC-1αexpression, P<0.01.
Conclusion: The cardiac IPC was weakened in aged rats which might be because of decreased PGC-1αexpression, the enhanced IPC may up-regulate PGC-1αexpression and therefore, protect the cardiac tissue in aged experimental rats.

Objective To summarize the clinical features and treatment experience of subpulmonic ventricular septal defect (SPVSD). Method The clinical data of 241 cases of SPVSD were analyzed retrospectively. Results Two hundred and fifteen cases were confirmed by echocardiography before operation, while other 26 cases were misdiagnosed (10.79%, 26/241), 42 cases with aortic valve prolapsed,ECG showed left ventricular hypertrophy. All patients underwent surgical repair of VSD. Other procedures had been done in the same stage including aortic valve replacement (AVR) in 8 cases, aortic valvuloplasty (AVP) in 6 cases and other operations. The size of VSD was larger than the value echocardiography measured before operation. There were no perioperative death and no complete atrioventricular block. Two hundred and thirty cases (95.44%, 230/241) were followed up for 3 months to 5 years. The cardiac function (NYHA) in 189 cases were grade Ⅰ and 41 cases were grade Ⅱ. There was no residual shunt of VSD. Among patients who underwent AVP or AVR, 1 case developed mild insufficiency, others developed well. Others underwent another operations all developed well. Conclusion To achieve satisfactory results, it should enhance the overall understanding of SPVSD, improve the diagnostic accuracy of SPVSD, take positive surgical repair of VSD and reasonable treatment with aortic valve disease, and other malformation or disease.

Objective To study the radiofrequency ablation (RA) and vagal denervafion (VD) in surgical treatment of long-standing atrial fibrillation (AF) associated with rheumatic heart disease (RHD).Methods Retrospective analysis the cardiac rhythm by 24-hour Holter monitoring during 5-year follow-up after total Maze procedure accompanied rheumatic mitral valve replacement.Between June 2006 and December 2007,a total of 173 consecutive patients with long-standing AF-associated RHD underwent mitral valve replacement and ablation maze procedure,92 cases had RA alone and 81 had RA + VD.Results Although Kaplan-Meier curve shows that the freedom from AF at 5 years follow-up time were similar(P =0.718),the percentage of antiarrhythmic drug therapy was significant higher in the RA group during early postoperative period(4th month,54.1％ vs.34.7％,P=0.017;5th month,39.2％ vs.21.3％,P=0.018;6th month,23.0％ vs.10.7％,P =0.044),and the percentage of those free by AF was significant lower(6th month,82.2％ vs.93.8％,P =0.023;1st year,76.1％ vs.89.9％,P=0.019).Conclusion Total maze procedure with bipolar radiofrequency ablation is effective to treat longstanding AF associated with rheumatic valve disease.Vagal denervation helped to maintain stable sinus rhythm and lower antiarrhythmic drug therapy at the early stage,but there was no additional benefit after the 1 st year of follow-up,it may be caused from the reactivation of vagal plexus electrical activity.

Objective To probe the effective measures for decreasing the early mortality after unsuccessful interventional treatment for atrial septal defect(ASD)and ventricular septal defect(VSD).Methods A total of 16 patients who underwent surgical treatment of unsuccessful interventional treatment for ASD and VSD from January 2000 to December 2007 were included in this retrospective analysis.Surgical indication was the occluder abscission(7 cases),cardiac perforation(3 eases),the third degree atrioventricular conduction block(3 cases),valvular regurgitation(2 cases,1 case accompanied with the third degreeatrioventricular conduction block),residual shunt(1 case),unsuecesflful interventional treatment(1 case).An of 16 cases underwent surgical treatment including removal of the displaced occluder and/or the congenital heart disease repaired on cardiopulmonary bypass.After surgical treatment.all patients were transferred into ICU for further supervision and treatment.Results There Was no hospital mortality.Twelve ASD cases were performed after the interventional treatment,which included 5 cases with central ASD and 7 CaseS with inferior sinus venous ASD.Coincidental rate between operating exploration and preoperative diagnosis was 41.7%(5/12).Misdiagnostic rate between them was 58.3%(7/12).The diameter of ASD (31.0 ±1.0)mm by operating exploration after interventional therapy of ASD obviously increased compared with that(26.0±2.3)mm before preoperative diagnosis(P<0.05).The diameter of VSD(5.0±0.8)mm by operating exploration after intervenfional therapy of VSD obviously increased compared with that(4.0±0.3)mm before operative diagnosis(P>0.05).,The third degree atrioventricular conduction block(3 cases)restored sinus rhythm after operation.Procedure was successful in all patients.Conclusion It is necessary to monitor severe complications of unsuccessful interventional treatment for ASD and VSD to assure the successes of the operations.

Objective To study the aortic valve replacement with Hancock Ⅱ Ultra valve and its early hemodynamic results.Methods The 30 patients who received Hancock Ⅱ Ultra aortic valve replacement at our hospital were matched 1 ∶1 with 30 patients who received Hancock Ⅱ on variables known to affect hemodynamic measurements:size of valve,age,sex,and body surface area.Early postoperative transthoracic echocardiography was performed in all patients.Results 3 months postoperatively,Hancock Ⅱ Ultra valves had significantly lower transvalular gradients,velocity,left ventricle mass index and larger effective orifice area.Compared with Hancock Ⅱ valves,in ≤22 mm group,Hancock Ⅱ Ultra valves had significantly lower transvalular velocity[ (2.26 ± 0.05 ) vs ( 2.57 ± 0.06 ),t =2.07,P ＜ 0.05 ],lower transvalular mean gradients [(11.4 ±1.3) vs (13.1 ±1.5),t =2.09,P＜0.05],higher effective orifice area[ (0.79 ±0.13)vs(0.71 ±0.02),t =2.06,P＜0.05],lower left ventricle mass index[ (119.1 ± 11.1)vs(133.2 ±16.4),t =2.67,P ＜0.05] and bigger left ventricle outflow tract (20.4 ±0.3 vs 18.9 ±0.2,t =2.23,P＜0.05).Conclusion The Hancock Ⅱ Ultra valve has more favorable early postoperative hemodynamics than the Hancock Ⅱ,especially for the small aortic ring patients.

BACKGROUND:For patients with degenerative mitral annulus dilatation complicated by atrial fibrilation, atrial fibrilation is needed to be treated concomitant with artificial valve ring implantation. Although Cox maze III procedure is the gold standard for treatment of atrial fibrilation, its safety has been questioned. OBJECTIVE:To evaluate the safety of artificial valve rings implantation and Cox Maze III procedure for treatment of degenerative mitral annulus dilatation complicated by atrial fibrilation. METHODS: A total of 43 patients with degenerative mitral annulus dilatation and atrial fibrilation were enroled and were randomly divided into test group (n=21) and control group (n=22). Patients in the test group were treated with mitral valvuloplasty and Cox Maze III procedure. Patients in the control group were only treated with mitral valvuloplasty. RESULTS AND CONCLUSION: (1) Intraoperative safety indexes: the durations of cardiopulmonary bypass and aortic clamping. and the incidence of hemoglobinuria in the test group were higher than those in the control group (P < 0.001). There was no significant difference in the urine output between these two groups. (2) Postoperative safety indexes: the incidence of atrial dysrhythmia (i.e., any atrial dysrhythmia other than atrial fibrilation), proportion of patients requiring a temporary pacemaker and hospital stays in the test group were higher than those in the control group (P < 0.05). There were no significant differences in the secondary-thoracotomy bleeding rate and incidence of stroke between these two groups. (3) Postoperative outcomes: the rates of cardioversion to achieve sinus rhythm at the day of surgery and at discharge in the test group were significantly higher than those in the control group (P < 0.001). At discharge, patients in both groups were al at NYHA functional class Ior II. Echocardiography showed trace to mild mitral regurgitation and complete closure of the tricuspid valve. There were no significant differences in the left atrial diameter, left ventricular diameter, left ventricular volume, and ejection fraction between these two groups. However, the proportions of mitral and tricuspid valve peak A-waves were significantly higher than those in the control group (P < 0.001). These results show that artificial valve ring implantation and Cox Maze III procedure is a safe and effective method for treating degenerative mitral annulus dilatation complicated by atrial fibrilation during operation.

Objeetive We sought to compare the safety and efficacy of cut-and-sew Cox-maze Ⅲ procedure for atrial fi brillation associated with degenerative mitral regurgitation,by comparing with patients without atrial fibrillation.Methods From May 2013 to November 2015,217 patients underwent mitral valve repair were enrolled,including 145 without atrial fibrillation(control group) and 28 received concomitant cut-and-sew Cox-maze Ⅲ procedure (treatment group).Propensity scores were calculated on the basis of 16 known preoperative factors and yielded the best matched patients.Safety and outcomes were compared between the two matched groups.Results 28 pairs of patients were matched successfully.No hospital deaths occurred and the major complications showed no statistical differences (P ＞ 0.05).Cardiopulmonary bypass time and crossclamp time,proportion of amiodarone use and temporary pacemaker use,and postoperative hospital stay in the treatment group were higher than those in the control group(P ＜0.001).Patients were followed up from 6 months to 3 years,and no patients occurred deaths and strokes.After 6 months,there were no significant differences in the rates of sinus rhythm and drug free between the two groups (P ＞ 0.05).In both groups,left atrial diameter and left ventricular diameter decreased,and ejection fraction increased compared with those before operation.Atrial function in the treatment group recovered 3 years after operation.At the latest follow-up,patients in both groups were all at NYHA functional class Ⅰ.Conclusion The additional cut-and-sew Cox-maze Ⅲ procedure for treatment of degenerative mitral disease complicated by atrial fibrillation does not increase the operative risks of mitral valve repair,and had early and mid-term outcomes similar to that of patients without atrial fibrillation.

Osteoarthropathy is a common chronic disease among middle-aged and elderly populations, characterized by joint pain, limited mobility, and even disability in severe cases. Treatment methods include weight control, functional exercise, local or systemic medication use, and ultimately joint replacement surgery. However, patients often experience ineffective drug treatment or inability to tolerate adverse drug reactions, as well as inability to tolerate joint replacement surgery. Multiple studies have shown that low-dose radiotherapy can alleviate joint pain and limited mobility by regulating multiple stages of the inflammatory process. In addition, the risk of secondary malignant tumors is extremely low, with rare acute and chronic adverse reactions. However, there is still some controversy regarding the optimal segmentation method for radiotherapy in clinical applications, which remains to be elucidated by more prospective studies. Low-dose radiotherapy for osteoarthropathy has been rarely studied in China. This non-invasive, safe, and effective treatment is expected to provide more treatment options for Chinese patients with osteoarthritis.