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Experience of three cases of heart-lung transplantation

Suocheng CHEN ; Guowen DING ; Jun YIN ; Yijun SHI ; Kangrong WANG ; Zhengbing REN ; Guoxiang RONG

Chinese Journal of Thoracic and Cardiovascular Surgery.2013;29(9):517-521. doi:10.3760/cma.j.issn.1001-4497.2013.09.002

Objective To summarize the successful experience of three cases of heart-lung transplantations performed in our institute.Methods From July 2003 to August 2012,three patients,with diagnosis of end-stage heart-lung diseases,received heart-lung transplantation in our institute.One case was diagnosed as congenital atrial septal defect,Eisenmanger syndrome,NYHA class Ⅳ; one was dilated cardiomyopathy with moderate/severe pulmonary arterial hypertension,NYHA class Ⅲ-Ⅳ,one was diagnosed as double outlet left ventricle (DOLV) with ventricle septal defect and stenosis of pulmonary artery and its left and right branches,NYHA class Ⅲ-Ⅳ.Donor hearts were preserved with UW solution,donor lungs were preserved with Euro-Collin solution in case one and with low potassium dextran containing prostaglandin E1 in the others.Extensive disinfection and strict scrutiny were implemented postoperatively.Immunosuppressive therapy included administration of zenapax or basiliximab preoperatively,methylprednisolone during the operation,and cyclosporine a/tacrolimus + prednisone + mycophenolate postoperatively.Surgical hemostasis is of great importance,as the total pleural effusion reaches 14 640 ml within 31 days postoperatively in case two.Strict postoperative disinfection and isolation were implemented,and management of the respiratory tract was intensified.Therapeutic bronchoscopy was performed frequently for sputum suction.In case two,bronchoscopy was used thirteen times within 40 days after transplantation.Broad-spectrum antibiotics and antifungal antibiotics were used for infection control.Results All three patients were discharged after recovery from operation.Case one died of obstructive bronchitis and lung failure caused by chronic rejection four years and ten months postoperatively.Case two died of sudden cerebrovascular accident 68 days after operation.Case three survives more than one year postoperatively so far and is still alive.Conclusion Proper preservation of the donor heart and lung,perfect surgical hemostasis,strict infection control,frequent application of bronchoscopy and appropriate immunosuppressive management are critical to the success of heart-lung transplantation.

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The study of application of the intra-aortic balloon pump in the patients with renal insufficiency during cardiac surgery

Kai WANG ; Xiangrong KONG

Chinese Journal of Thoracic and Cardiovascular Surgery.2013;29(9):522-524. doi:10.3760/cma.j.issn.1001-4497.2013.09.003

Objective To discuss the protective effect of intra-aortic balloon pump(IABP) on renal function in patients with chronic renal insufficiency undergoing cardiac operations.Methods From May 2010 to May 2012,17 patients with moderate renal insufficiency who underwent cardiac surgery using cardiac pulmonary bypass(CPB) were randomized to divide into IABP group and control group.IABP was inserted before the cardiac operation,the support was maintained perioperatively in IABP group.In control group the IABP was never used during the operation.The clinical parameters related to renal function including the output of urine,the serum creatinine levels were documented perioperatively.Results The serum creatinine levels were increased obviously post-operation in both groups.But the degree of increase was significantly smaller in IABP group.Conclusion To patients with moderate renal insufficiency undergoing CPB cardiac operations,perioperative application of IABP is beneficial to protect renal function and may help to improve the outcome.

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Research of reoxygenation injury in cardiopulmonary bypass of cyanotic congenital heart disease

Xiaochen DING ; Peiqing DONG

Chinese Journal of Thoracic and Cardiovascular Surgery.2013;29(9):532-536. doi:10.3760/cma.j.issn.1001-4497.2013.09.006

Objective To investigate the effect and safety of different PaO2 to the reoxygenation injury of cyanotic congenital heart disease through controlling the FiO2 when initiating cardiopulmonary bypass (CPB).Methods Thirty patients with cyanotic congenital heart disease were divided into 3 equal groups according the PaO2 when initiating cardiopulmonary bypass:group 1 (G1,PaO2 ＜ 120 mm Hg) ; group 2 (G2,PaO2 120-180 mm Hg),group 3 (G3,PaO2 180-250 mm Hg),and ten patients with acyanotic congenital heart disease were group 4 (G4,PaO2 ＞ 200 mm Hg).Serum CK-MB,cTnI,IL-6,TNF-α,SOD,8-ISO and S100β were measured before CPB、5 minute after CPB,10 minute after CPB,5 minute after cross clamp releasing,2 hours and 24 hours post operation with intemal jugular vein blood samples.Clinical results were also recorded.Results CK-MB,cTnI,IL-6,TNF-α,8-ISO and S100β3 were all normal without significant differences between them before CPB.After initiation of CPB,their levels in all groups increased,reached the peak before or after the stop of CPB,then gradually declined.At each time point,the levels of these indexes were G3 ＞ G2 ＞ G1 ＞ G4 with significant difference between them (P ＜ 0.05) ; The serum SOD levels of G4 were higher than the other three groups with significant difference(P ＜ 0.05).They all declined after initiation of CPB,reached lowest after cross clamp releasing,then gradually increased.At 5 minute after CPB,10 minute after CPB,5 minute after cross clamp releasing,2 hours post operation,there were significant differences between four groups (P ＜ 0.05),and at 24 hours post operation,the SOD levels of G4 were higher than the other three groups with significant difference (P ＜ 0.05).There were no significant difference between G1,G2 and G3 in SvO2,Lac,positive vasoactive drugs、ventilation time and ICU time.All patients were alive.Conclusion Low reoxygenation concentration can reduce the reoxygenation injury of cyanotic congenital heart disease,though there may be some potential influence to cerebral oxygen metabolism.Further studies about oxygen supplymethodsare necessary in deep hypothermia and long-time CPB.

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Research of left-atrial fibrosis of atrial fibrillation patient and its effect to post-operative rhythm of radiofrequency ablation treatment

Fei LI ; Xu MENG ; Jie HAN ; Ping DONG ; Yong YANG ; Shijie JIA

Chinese Journal of Thoracic and Cardiovascular Surgery.2013;29(9):537-540. doi:10.3760/cma.j.issn.1001-4497.2013.09.007

Objective To research the fibrosis characteristics of Atrial Fibrillation(AF) patients under microscope and its effect to post-operative sinus conversion of Radiofrequency ablation treatment.Methods Based on Lefi Atrial Dimension (LAD).Left atrial appendage tissue samples of 60 AF patients who received bipolar radiofrequency ablation treatment during open heart surgery between July and December 2011,were divided into 4 groups:group a (LAD≤50 mm),group b (50 mm ＜ LAD≤60 mm),group c (60 mm＜ LAD ≤70 mm),group d (LAD ＞ 70 mm),15 patients in each group.The levels of atrial muscle fibrosis and cell size differences are compared for colored slides of samples.Research are done for the difference of sinus rhythm restoration rate among the 4 groups based on ECG records at immediate,leaving hospital,and 3,6,12 months postoperative are collected for all groups.Results Differences of CVF and atrial muscle cell size measured under microscope are statistically meaningful(P ＜ 0.001).Sinus rhythm restoration rate differences at 6 month(P =0.039) and 12 month (P =0.037) post-operative are statistically meaningful.Further,immediate,leaving hospital,and 3,6,12 months postoperative sinus rhythm restoration rates are 93.3％,93.3％,93.3％,100％,100％ for group a,80.0％,73.3％,80.0％,80.0％,80.0％ for group b,66.7％,66.7％,66.7％,73.3％,66.7％ for goup c,and 53.3％,53.3％,53.3％,60.0％,60.0％ for group d respectively.Conclusion For rheumatic heart valve diseases patients who at 6 and 12 month post-operative,the greater the LAD,the higher the atrial fibrosis level,the greater the cell size,the lower the sinus rhythm restoration rate is.

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Diagnosis and surgical treatment of cardiac tumors of the right ventricle

Ben ZHANG ; Tongyi XU ; Yang LIU ; Zhigang LI ; Lin HAN ; Zhiyun XU

Chinese Journal of Thoracic and Cardiovascular Surgery.2013;29(10):585-587. doi:10.3760/cma.j.issn.1001-4497.2013.10.003

Objective To discuss the diagnosis and surgical treatment of the primary right ventricular tumors.Methods The results of surgical treatment of 7 patientss (5 males,2 females; median age,48 years,range,37 to 68 years) with primary right ventricular tumors hospitalized from Jan,1999 to May,2012 were analyzed.By preoperation echocardiography,cardiac myxoma was diagnosed in 2 cases,and cardiac space-occupying lesion was diagnosed in 5 cases.Median sternotomy were performed in all the 7 cases for biopsy or resection of tumor.when resection of tumor,extracorporeal circulation and cardiac arrest were performed.Results The 7 patients accounted for 4.96％ of patients with cardiac tumors surgically treated in the corresponding period.Complete resection of tumor was performed in 5 cases,and only biopsy in 2 cases.The pathological diagnoses included myxoma in 2 cases,lipoma in 1 case,liomyoma in 1 case,undifferentiated sarcoma in 1 case,and mesenchymal sarcoma in 2 cases.There was no in-hospital death.During a follow-up of 1 ～ 51 months (median,38 months),the 3 cases of sarcoma died,and the other patients were good and showed no recurrence.Conclusion The incidence rate of primary right ventricular malignant tumor is relatively high.Echocardiography is the most important diagnosis method.The prognosis of right ventricular malignant tumor is poor.The results of surgical treatment of right ventricular benign tumor are satisfactory.

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Peritoneal dialysis in 30 infants and children with acute renal insufficiency after complex congenital heart disease surgery

Lin LU ; Xijie WU ; Liangwan CHEN

Chinese Journal of Thoracic and Cardiovascular Surgery.2013;29(10):588-590. doi:10.3760/cma.j.issn.1001-4497.2013.10.004

Objective To analyse peritoneal dialysis(PD) in 30 infants and children with acute renal insufficiency after complex congenital heart disease surgery,sum up the clinical experience of PD therapy infants and children with acute renal insufficiency after complex congenital heart disease surgery.Methods The clinical records of 30 infants and children during January 2010 to June 2012 were analysed retrospectively,with 23 male and 7 female,aged from 7 days to 18 months[average (8.28 ± 5.17) months],weight 2.5-14 kg[average (5.15 ± 3.89) kg].The reasons for PD:7 cases because of oliguria (urine ＜ 1 ml · h-1 · kg-1,duration ＞ 4 h) and the other 23 cases because of anuria.Results One case with total anomalous pulmonary venous connection(TAPVC) died of left heart failure,1 case with transposition of the great arteries died of multiple organ failure,and the other 28 cases were all cured,cure rate 93.33％.Conclusion PD is easy,safe and low-cost,has definite curative effect in infants and children with acute renal insufficiency after complex congenital heart disease surgery,worth to popularize.

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The evaluation of the left transthoracic approach in simultaneous antireflux surgery at the time of CDH repair in infancy

Wei LIU ; Jianhua LIANG ; Jue TANG ; Fenghua WANG ; Jiahang ZENG

Chinese Journal of Thoracic and Cardiovascular Surgery.2013;29(10):597-599. doi:10.3760/cma.j.issn.1001-4497.2013.10.007

Objective The aim of this study was to evaluate the left transthoracic approach in simultaneous antireflux surgery at the time of CDH repair in Infancy.Methods Between June 2008 and June 2012,18 patients underwent a left transthoracic approach in the treatment of type Ⅲ and Ⅳ hiatal hernia.,including 1 gastric volvulus.Clinical presentation in these patients included vomiting(n =12) 、pulmonary infections (n =9)、symptomatic anemia、failure to thrive (n =18).All the patients were evaluated before and after the surgery on clinical presentation,symptoms and functional assessment.Surgical techniques included extensive mediastinal esophageal dissection,Nissen fundoplication,resection of the hernial sac,crural closure.Results The average of operative time was 90 minutes.The mean blood loss was 5 ml.The average length of stay was 15 days.The hours stayed in PICU were 21.5 h.Mean follow-up was 22 months.There was no hospital mortality and hernia recurrence.Only one patient suffered gastroesophageal reflux disease after operation,and was controlled with antireflux medications.Conclusion Transthoracic is the optimal operative approach for treating the esophageal hiatal hernia,with relatively low postoperative morbidity and recurrence rates.Advantages of the transthoracic approach include the facilitation of Nissen fundoplication、esophageal lengthening procedures,and excellent exposure for the crural suturing.

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Dexmedetomidine on the clinical studies of cerebral injury affect in infant after cardiopulmonary bypass

Yongsheng QIU ; Yingping JIA

Chinese Journal of Thoracic and Cardiovascular Surgery.2013;29(10):617-619. doi:10.3760/cma.j.issn.1001-4497.2013.10.012

Objective To observe the effect of application of dexmedetomidine on cerebral injury in infants after cardiopulmonary bypass.Methods 60 cases of congenital heart disease were divided into 3 groups,each group 20 infants,namely D1,D2 and N group.Group D1 dexmedetomidine 1.0μg/kg,in 0.2μg · kg-1 · h-1 intravenous infusion,until the end of operation; group D2 with dexmedetomidine 0.5 μg/kg,in 0.1 μg · kg-1 · h-1,drug concentration and injection speed was the same as the group D1.Group N intravenous normal saline in the whole operation process,infusion speed was the same as the experimental group,anesthesia and experimental group agreement.Take blood samples sent to laboratory before the operation (T1),at the end of CPB (T2),after CPB 2 h (T3),6 h (T4),24 h (T5) respectively,colleced records of perioperative data.Results There were no significant in 3 groups,for infant's age,weight,operation time,CPB time difference (P ＞0.05).In T1,there was no statistical difference between the 3 groups in S-100β protein and NSE (P ＞ 0.05).In group N,S-100β protein and NSE in T2,T3,T4,T5 were increased significantly than the level in T1 (P ＜ 0.05).In T2,compared with group D2,S-100β and NSE increased significantly in group N and D1 (P ＜ 0.01),and there were more in D2 than D1 group.Differences in heart rate,blood pressure and hemodynamics were observed in infant during perioperative period was not significant (P ＞ 0.05).Conclusion Dexmedetomidine can reduce the ascensional range of S-100β and NSE in infant after cardiopulmonary bypass,and relieve the cerebral injury.

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Evaluation of viable myocardium in patients with chronic total coronary occlusion by real-time myocardial contrast echocardiography

Lei XU ; Chang LIU ; Chunhong XIU ; Zonghong LIU ; Xigang XIAO ; Jingxia SHEN ; Hongyu LIU

Chinese Journal of Thoracic and Cardiovascular Surgery.2013;29(10):600-603. doi:10.3760/cma.j.issn.1001-4497.2013.10.008

Objective Analysis of myocardial microvascular perfusion in patients with chronic total coronary occlusion (CTO) who underwent a coronary artery bypass graft (CABG) use real-time myocardial contrast echocardiography (RTMCE),to provide an effective method of detecting viable myocardium and a reference for the choice of CABG indications.Methods Twenty-seven patients with CTO underwent RTMCE 1 week before CABG,they underwent follow-up echocardiography and coronary artery 256-slice multislice computed tomography aagiography 1 year after CABG.Myocardial viability was defined as a postoperative ultrasound wall motion significantly improved ≥ 1 point.Semi-quantitative analysis of contrast images,myocardial viability was defined as myocardial perfusion score ≤ 2 points.Viable myocardium by quantitative assessment of myocardial blood flow (MBF) was determined by analyses of receiver-operating characteristic (ROC) curves.Results Patients with LVEF increased significantly after CABG (P ＜ 0.01),Of 259 segments with wall motion abnormality,149 (58％) showed wall motion significantly improved ≥ 1 point after CABG,considered viable myocardium,110 (42％) were not observed in wall motion improved,considered to be non-viable.The viable myocardial segments were significantly greater than non-viable myocardial segments in A,β,A × β value (P ＜ 0.01).Compared with the semi-quantitative analysis,quantitative analysis of MBF increased the sensitivity and accuracy of RTMCE for detecting viable myocardium (P ＜ 0.05).Conclusion RTMCE could accurately assess myocardial viability and provide a strong reference for clinical decision making and judging prognosis.

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Combined laparoscopic and thoracoscopic esophagectomy for esophageal carcinoma and gastro-esophageal anastomosis in right thoracic cavity: analysis of 38 cases

Anguo CHEN ; Renquan ZHANG ; Wanli XIA ; Ningning KANG ; Wei GE ; Kechao ZHU ; Zaicheng YU

Chinese Journal of Thoracic and Cardiovascular Surgery.2013;29(9):525-527. doi:10.3760/cma.j.issn.1001-4497.2013.09.004

Objective To investigate the feasibility of combined laparoscopic and thoracoscopic esophagectomy for esophageal carcinoma and gastro-esophageal anastomosis in right thoracic cavity.Methods We retrospectively analyzed the clinical data of 38 patients who underwent esophagectomy for esophageal carcinoma and gastro-esophageal anastomosis in right thoracic cavity from October 2011 to August 2012.To remove the stomach in laparoscopic and the esophagus in thoracoscopy.The main portion of a gastric conduit is created using three to four firings of a linear stapler(Ethicon Endo-surgery,Cincinati,OH) and jejunum stoma.Gastric conduit was pulled into the chest cavity and anastomosed to the esophagus.Results The average operative time was 280 minutes,the mean operative blood loss was 120 ml.No patient required laparotomy.No pulmonary complications or anastomotic leaks occurred.One had gastric retention,another one had chylous hydrothorax.All patients were cured,no one dead in hospital.Conclusion Combined laparoscopic and thoracoscopic esophagectomy for esophageal carcinoma and gastro-esophageal anastomosis in right thoracic cavity is technically feasible and safe,minimized trauma,less operative blood loss and quick recovery.

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