Objective    To summarize the experience of totally thoracoscopic cardiac surgery for ventricular septal defect. Methods    Clinical data of 449 patients undergoing totally thoracoscopic cardiac surgery for ventricular septal defect from May 2008 to December 2018 in Shanghai Yodak Cardiothoracic Hospital were analyzed retrospectively. There were 232 male and 217 female patients, aged from 3 to 55 years with a mean age of 17.3±11.2 years. Results    All the operations were completed successfully. Mean operative time was 2.4±0.3 h. The mean extracorporeal circulation time and aortic cross-clamp time was 64.2±11.6 min and 28.4±10.7 min, respectively. Mechanical ventilation time and intensive care unit stay was 6.9±3.8 h and 20.5±5.6 h, respectively. Postoperation drainage quantity was 213.1±117.2 mL. The hospital stay was 6.9±1.3 d. Intraoperative and postoperative complications occurred in 11 patients (2.4%), including 1 patient of intraoperative reoperation, 3 patients of reoperation for bleeding, 3 patients of the incision infection, 2 patients of small residual shunt, 1 patient of right femoral artery incision stenosis complicated by thromboembolism and 1 patient of right pleural cavity pneumothorax. The mean follow-up time was 72.2±33.9 months. During the period, there was no reoperation, but 2 patients of ventricular septal defect small residual shunt, 1 patient of mild-moderate mitral valve and 1 patient of mild-moderate aortic valve incompetence, respectively. During the period, heart function of the patients was NYHAⅠ-Ⅱ. Conclusion    Totally thoracoscopic cardiac surgery for ventricular septal defect is a safe and effective treatment, with few serious complications, fast recovery for patients and good short to medium-term outcomes.

Objective    To summarize the experience of totally thoracoscopic cardiac surgery (TTCS) for atrial septal defect. Methods    Clinical data of 442 patients undergoing TTCS for atrial septal defect from May 2008 to December 2018 in Shanghai Yodak Cardiothoracic Hospital was analyzed retrospectively. There were 149 male and 293 female patients, aged 3-74 (29.1±14.3) years. Surgical procedures were performed through 3 ports at the right chest wall. Results    All the operations were completed successfully. Mean operative time was 1.5-4.6 (2.2±0.3) h. The mean extracorporeal circulation and aortic cross-clamp time was 28-118 (55.9±13.3) min and 8-78 (21.5±10.2) min, respectively. Mechanical ventilation and intensive care unit stay time was 3.5-122.0 (8.1±7.4) h and 13-141 (20.7±10.2) h, respectively. Postoperation drainage volume was 70-1 280 (251.8±131.5) mL. The hospital stay was 4-16 (7.1±1.4) d. Intraoperative and postoperative complications occurred in 15 patients (3.3%). The mean follow-up time was 1-128 (67.6±33.3) months, and during the period, there were 25 patients of atrial fibrillation, 25 patients of mild-moderate tricuspid valve incompetence, 1 patient of moderate tricuspid valve incompetence. There was no reoperation or residual shunt during the period of follow-up. And the heart function was improved. Conclusion    TTCS is a feasible, safe and minimal invasive approach for patients with atrial septal defect and has good short to medium-term outcomes.

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.

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.

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 .

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.

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.