OBJECTIVE To compare the effects of cleaning the bloodstain and other organic matter left on the bivalve speculum by 5 different cleaning methods.METHODS The following methods were adopted for 400 bivalve speculums with bloodstain left from gynecological operations:manual cleaning method,ultrasonic cleaning method,fully automatic cleaning method,artificial cleaning plus ultrasonic cleaning method,artificial cleaning plus fully automatic cleaning method,and the effects were detected by visual observation method,magnifier detection method and occult blood test method.RESULTS The positive rate of visual observation on 5 groups of bivalve speculums was 5.00%,3.75%,2.50%,0 and 0,respectively,the positive rate of magnifier detection was 7.50%,5.00%,3.75%,1.25% and 1.25%,respectively,and the positive rate of occult blood test was 15.00%,12.50%,8.75%,4% and 2%,respectively.CONCLUSIONS There are significant differences among 5 cleaning methods(P

Objective Postoperative pulmonary vein stenosis(PPVS) is a severe complication after total anomalous pulmonary venous connection (TAPVC) repair,and represents a significant surgical challenge with a high recurrence rate and poor prognosis.This study was performed to analysis the morphological patterns of pulmonary vein stenosis after TAPVC,and to demonstrate the relationships between the pathological patterns with their clinical manifestations,pathogenesis,surgical options and their prognosis.Methods Between March,2004 to September,2011,11 consecutive patients with PPVS underwent reoperations.Supracardiac type in 5 cases,intracardiac type in 3 cases,mixed type in 1 case,single ventricle associated with supracardiac type in 1 case and infracardiac type in 1 cases.The age was 23 days to 28 months,body weight at the first operation was 5-19 kg,the median weight (10.7 ± 5.1) kg.The age at reoperation was 4 months to 6 years,the interval between the first and second operation was 82 days to 5 years.Morphological patterns of PPVS was classified into 4 types based on the preoperative imaging examinations and surgical findings:(1) anastomic stenosis (type Ⅰ),(2) ostial stenosis of individual pulmonary vein (type Ⅱ),(3) segemental stenosis of individual pulmonary vein (type Ⅲ),(4) complete occulsion of individual pulmonary vein (type Ⅳ).One or more pathological patterns may exit in one patient,and may involved one or more individual pulmonary veins.Fibrous resection in 1 case,patch augmentation in 3 cases,individual pulmonary endarterectomy in 7 cases and sutureless technique in 5 cases.Cardiopulmonary bypass with moderate hypothermia were used in 8 cases,with deep hypothermia and circulatory arrest in 3 cases.Results Type Ⅰ in 2 cases,type Ⅱ in 2 cases,type Ⅰ and type Ⅱ in 1 cases,type Ⅰ,type Ⅱ and type Ⅲ in 1 case,type Ⅱ and Ⅲ in 2 cases,type Ⅱ and Ⅳ in 1 case and type Ⅳ in 2 cases were found in our series.There was no early mortality,I case with residual anastomic obstruction and 2 cases with individual pulmonary vein obstruction.One patient died 17 monthes after reoperation,and the intermediate mortality was 10％.Reoperation was done in 1 case for recurrent pulmonary vein obstruction.Two patients need ViagTa or Bosentan for long time.The others did well during follow-up.Conclusion PPVS is a kind of progressive disease.The morphological patterns of PPVS are related to their clinical presentations and its pathogenesis,and are very important to make surgical decisions and pridict the patient's prognosis.

Cytophagocytosis ; Humans ; Plaque, Atherosclerotic ; physiopathology

OBJECTIVETo study the hormonal and metabolic responses of fetal lamb during cardiopulmonary bypass.

METHODSSix pregnant ewes underwent fetal cardiopulmonary bypasses with artificial oxygenators and roller pumps for 30 minutes, which maintained the blood gas value at the fetal physiological level. The fetal blood pressure, heart rate, pH value and blood lactate levels were monitored. The levels of catecholamine, cortisol and insulin were measured pre-bypass and then again 30 minutes later. The blood glucose and free fatty acid levels were monitored continuously during the bypass. Fetal hepatic PAS staining was also carried out.

RESULTSThere were no changes before and during the bypass in fetal blood pressure, heart rate and blood gas. However, pH values decreased and blood lactate levels increased (P < 0.05). The fetal catecholamine and cortisol levels increased significantly (P < 0.01), while the levels of insulin did not change. The blood glucose and free fatty acid levels increased at the beginning of the bypass (P < 0.01), and then gradually slowed down during the bypass. The fetal hepatic PAS staining showed that hepatic glycogen was consumed in large amounts. After 30 minutes of bypass, the fetal lamb would not survive more than 1 hour.

CONCLUSIONThe fetal lamb has a strong negative reaction to cardiopulmonary bypass.

Animals ; Blood Gas Analysis ; Blood Glucose ; analysis ; Cardiopulmonary Bypass ; adverse effects ; Catecholamines ; blood ; Fatty Acids, Nonesterified ; blood ; Fetus ; physiology ; Hemodynamics ; physiology ; Hydrocortisone ; blood ; Lactates ; blood ; Sheep

Congenital heart disease is the most common congenital defect.With the advancement of surgical techniques, the survival rate of children with congenital heart disease is gradually increasing.However, the neurodevelopmental defects in children with congenital heart disease have gradually increased, which elicits increasing scholars′ attention.Attention deficit hyperactivity disorder(ADHD)is one of the most prominent neurodevelopmental behavior disorders in children.In previous studies, the prevelance of ADHD in cyanotic congenital heart disease was obviously higher than that of the general population, and however, research of congenital heart disease was in its infancy.This paper intends to review the incidence, etiology, pathogenesis, treatment and prognosis of ADHD in congenital heart disease in order to provide references for clinical work.

While the early mortality and complication rate of the congenital heart disease were significantly reduced, the long-term complications, especially the neurological complications, have become more and more concerning. Periopeartive nerve injury was used to be mainly attributed to cardiopulmonary bypass, however, with improvement of surgical and cardiopulmonary bypass technology, this has become significantly lower. For many years efforts to reduce nervous system damage by improving the cardiopulmonary bypass perfusion method has yielded little results. In recent years, it is found that during preoperative period, even as early as fetal period, children with congenital heart disease show slow brain development and damage, which was considered to be more important than extracorporeal circulation in determining long-term nervous system development. Thus recognition of preoperative brain malfunction in children with congenital heart disease has important clinical significance. This paper reviews the recentresearch and progress in this area.

Objective:To study the surgical results of Yasui procedure for interruption of aortic arch and ventricular septal defect(IAA/VSD) associated with aortic stenosis(AS) or aortic atresia(AA).Methods:A retrospective study was performed on all 4 children with IAA/VSD/AS(AA) that underwent a Yasui procedure from Dec 2014 to Dec 2019. Three patients had AS, and 1 patient had AA. The age was from 10 days to 25 months and the weight was from 2.7 kg to 10 kg. The type of IAA was type A in 1 and type B in 3. The diameter and Z value of the aortic annulus were 1.9-4.3 mm and -6.7--3.6. The diameter and Z value of the ascending aorta were 2.6-5.8 mm and -5.4--2.6. The mean Z value of LVEDD and LVEDS was 3.6±2.6 and 3.6±2.9 resparately.Results:All 4 patients survived after the Yasui procedure. Three patients underwent primary repair and 1 patient underwent staged repair. CPB time was 128-283 min and aortic cross-clamping time was 98-171 min. Ventilation time was 93-296 h, and ICU and hospital length of stay was 7-25 days and 18-39 days. Follow-up was complete in all patients from 8 to 92 months, and there was no late death. All the patients were in good biventricular function with NYHA grade Ⅰ in 3 and NYHA grade Ⅱ in 2 patients. No residual left ventricular outflow tract obstruction was detected.Conclusion:The Yasui procedure can be an option for patients with IAA/VSD/AS(AA) and good developed left ventricle and can achieve good early surgical results.

In cardiac surgery such as myocardial infarction, congenital heart disease, and heart transplantation, myocardial ischemia-reperfusion (I/R) damages mitochondria, which in turn causes myocardium energy metabolism disturbance, homeostatic destruction, reactive oxygen species production and DNA damage, and activates myocardium apoptosis and necrosis signals, which eventually lead to myocardial dysfunction or heart failure. Different from the previous I/R treatment targets focusing on a certain pathway or a certain medium, autologous mitochondrial transplantation (AMT) is an emerging method, which transplant viable and respiration-competent mitochondria from healthy organs or tissues to the injured sites which suffer from I/R injury, to replace or repair damaged mitochondria. In recent years, AMT has achieved remarkable results in the prevention and treatment of myocardial I/R. This article reviews the role and mechanism of AMT in I/R myocardial protection.

Objective:To explore and summarize the surgical strategies of biventricular conversion from single-ventricle palliation for the complex congenital heart defects in this study.Methods:From April 2017 to December 2019, a total of 14 cases with complex complex congenital heart defects who had planned to undergo single-ventricle palliation were finally accepted biventricular conversion. According to the development and anatomical characteristics of the ventricles, they were divided into two groups: ventricular well development group(9 cases), all of which showed complex intracardiac defects, and the ventricles well developed, including 4 cases of double outlet right ventricle with remote ventricular septal defect, 2 cases of transposition of great arteries combined with ventricular septal defect and left ventricular outflow tract obstruction, one case of congenitally corrected transposition of the great arteries combined with double outlet right ventricle and interrupted aortic arch, one case of double outlet right ventricle with subpulmonary ventricular septal defect and atrioventricular connection inconsistency, one case of pulmonary atresia with ventricular septal defect. Ventricular unbalanced development group(5 cases), all of which were functional single ventricle, including 3 cases of heterotaxy and 2 cases of unbalanced complete atrioventricular septal defect. The operation time, postoperative complications, death, cardiac function and reoperation of the two groups were compared.Results:There was one early death, with a mortality rate of 7.1%. In the ventricular well development group, the average waiting time for biventricular conversion was(56.4 ± 38.9) months. One case died after the operation. The early complications included 2 case of arrhythmias, 3 cases of pleural effusions and 2 cases of pulmonary infections. In the ventricular unbalanced development group, the average waiting time for biventricular conversion was(20.4 ± 15.8) months, and the average of left ventricular end-diastolic volume was(33.6 ± 2.1) ml/m 2. The early complications included 2 cases of low cardiac outputs, one case of arrhythmia and one case of renal failure. There was no significant difference in operation time, intubation time and ICU time between the two groups. The patients were followed up for 4 months to 3 years, and there was no death. In the ventricular well development group, one case was reoperated due to the obstruction of the anastomosis between the superior vena cava and the right atrial appendage. In the ventricular unbalanced development group, one case was implanted with a permanent pacemaker due to the degree Ⅲ atrioventricular block. The NYHA grade of the whole group was Ⅰ-Ⅱ. Conclusion:Whether the complex congenital heart defects with the ventricles well developed or unbalanced, the comprehensive evaluation before the planned single-ventricle palliation will be helpful to find the appropriate cases for biventricular conversion. According to its anatomical characteristics performed the corresponding biventricular conversion can obtain a satisfied clinical outcomes, although the long-term results still need further follow-up.

Objective The purpose of this report is to summarize and evaluate the clinical effect and experience of re-intervention for children with pulmonary venous restenosis.Methods The clinical data of 53 patients with pulmonary venous restenosis who received reintervention at SCMC from September 2009 to January 2018 were retrospectively analysed, including 34 males and 19 females with mean age of(15.1 ±13.2)months(2-77 months) and mean weight of(7.9 ±3.3)kg(3.7 -17.3 kg).The mean preoperative pulmonary venous velocity was(2.28 ±0.40)m/s(1.89 -3.07 m/s).Primary disease in-cluded 43 cases of total anomalous of pulmonary venous drainage(14 supracardiac type, 20 infracardiac type, 2 intracardiac type and 7 mix type), 8 cases of partial anomalous of pulmonary venous drainage and 2 cases of primary pulmonary venous ste-nosis.The distribution of reintervention methods were shown as follow:34 cases of sutureless technique(21 cases with pedicle pericardium and 13 cases with left auricle tissue), 10 cases of bovine pericardium enlargement, 5 cases of blunt enlargement, 3 cases of balloon dilatation and 1 case of stent implantation.Results The early postoperative pulmonary venous velocity was (1.12 ±0.23) m/s.There were 4 in-hospital deaths with a mortality of 7.5％.49 survivors were under a follow-up of 3-98 months.The echocardiography showed pulmonary venous anastomosis and diameter have grown after reintervetion with a mean growth speed of(0.022 ±0.014)cm/month(P<0.05) and a mean velocity of(1.25 ±0.28)m/s;4 patients occured varying degrees of pulmonary venous obstruction( >1.6 m/s) but no one need reoperation at present.More than 90％ patients exhibi-ted an improvement of NYHA functional class from Ⅲ or Ⅳ preoperatively to Ⅰ or Ⅱ at follow-up.Conclusion Pulmonary venous restenosis is a common complication after primary pulmonary malformations operation .The reintervetion should be per-formed in early period of pulmonary venous obstruction .Pulmonary venous anastomoses after sutureless technique , bovine peri-cardium enlargement and blunt enlargement have grown obviously; although balloon dilatation has a good effect at early period of postoperation, it also has a high restenosis rate and needs a strict mid-and long-term follow-up.