We describe aortic arch endarterectomy performed concomitantly with on-pump cardiac surgery in 2 patients with grade V arch atherosclerosis. In both patients, transesophageal echocardiographic findings led to the diagnosis of severe arch atherosclerosis associated with a mobile atheromatous plaque in the aortic arch. The severe arch atherosclerosis was managed with endarterectomy under deep hypothermic circulatory arrest. In patients with severe grade V atherosclerosis in the aortic arch, performing endarterectomy simultaneously with primary cardiac surgery may be justified as a way to reduce the risk of peripheral embolism, including cerebrovascular accidents, with minimal additional surgical risk.
Aorta ; Aorta, Thoracic ; Atherosclerosis ; Circulatory Arrest, Deep Hypothermia Induced ; Diagnosis ; Echocardiography ; Embolism ; Endarterectomy ; Humans ; Plaque, Atherosclerotic ; Stroke ; Thoracic Surgery

BACKGROUNDAntegrade selective cerebral perfusion (ASCP) is regarded to perform cerebral protection during the thoracic aorta surgery as an adjunctive technique to deep hypothermic circulatory arrest (DHCA). However, brain metabolism profile after ASCP has not been systematically investigated by metabolomics technology.

METHODSTo clarify the metabolomics profiling of ASCP, 12 New Zealand white rabbits were randomly assigned into 60 min DHCA with (DHCA+ASCP [DA] group, n = 6) and without ( DHCA [D] group, n = 6) ASCP according to the random number table. ASCP was conducted by cannulation on the right subclavian artery and cross-clamping of the innominate artery. Rabbits were sacrificed 60 min after weaning off cardiopulmonary bypass. The metabolic features of the cerebral cortex were analyzed by a nontargeted metabolic profiling strategy based on gas chromatography-mass spectrometry. Variable importance projection values exceeding 1.0 were selected as potentially changed metabolites, and then Student's t-test was applied to test for statistical significance between the two groups.

RESULTSMetabolic profiling of brain was distinctive significantly between the two groups (Q 2 Y = 0.88 for partial least squares-DA model). In comparing to group D, 62 definable metabolites were varied significantly after ASCP, which were mainly related to amino acid metabolism, carbohydrate metabolism, and lipid metabolism. Kyoto Encyclopedia of Genes and Genomes analysis revealed that metabolic pathways after DHCA with ASCP were mainly involved in the activated glycolytic pathway, subdued anaerobic metabolism, and oxidative stress. In addition, L-kynurenine (P = 0.0019), 5-methoxyindole-3-acetic acid (P = 0.0499), and 5-hydroxyindole-3-acetic acid (P = 0.0495) in tryptophan metabolism pathways were decreased, and citrulline (P = 0.0158) in urea cycle was increased in group DA comparing to group D.

CONCLUSIONSThe present study applied metabolomics analysis to identify the cerebral metabolic profiling in rabbits with ASCP, and the results may shed new lights that cerebral metabolism is better preserved by ASCP compared with DHCA alone.

Animals ; Brain ; metabolism ; Cerebrovascular Circulation ; Circulatory Arrest, Deep Hypothermia Induced ; Humans ; Male ; Metabolomics ; Rabbits

OBJECTIVETo discuss the experience of surgical treatment of total anomalous pulmonary venous connection (TAPVC) in infants.

METHODSThe clinic data of 84 cases with TAPVC under 6 months of age underwent surgical treatment at Department of Cardiac Surgery, Guangzhou Women and Children's Medical Center from January 2012 to October 2015 were analyzed retrospectively. There were 58 male and 26 female patients. The patients were aged 1 days to 6 months with a mean of (2.4±2.2) months at surgery, including 22 newborns. Body weight was 1.8 to 6.8 kg with a mean of (4.3±1.2) kg. There were 24 cases of intracardiac type, 46 cases of supracardiac type, 10 cases of infracardiac type and 4 cases of mixed type. There were 26 cases received emergent operation. There were 14 cases used Sutureless technique in operations and 46 cases used conventional methods in the no-intracardiac type cases, and 2 cases enlarged the anastomsis with autologous pericardium. According to the condition, corrective surgeries of other anomalies were performed in the meantime, including 3 Warden operations (right side), 3 bilateral bidirectional Gleen operation, 2 correction of unroofed coronary sinus syndrome, 1 coarctation of aorta correction with deep hypothermic circulation arrest, and 1 repair of ventricular septal defect.

RESULTSThe ratio of newborn was higher in Sutureless technique group than in conventional methods group (7/14 vs. 32.6%, χ(2)=4.927, P=0.043), and mean age was less ((1.8±0.4) months vs. (2.4±2.2) months, F=4.257, P=0.042), but there were no difference in body weight, cardiopulmonary bypass time and aorta clamped time between the two groups. Followed up for 1 to 46 months, 10 cases (11.9%) died overall and the mortality of intracardiac (3/10) and mixed (2/4) type were much higher than in intracardiac (4.2%) and supracardiac (13.0%) type. The mortality were no difference between newborn and infants, or whether emergent operation, or Sutureless technique and conventional methods. The maximal pulmonary venous flow velocity was abnormal speed-up >1.8 m/s at 1 week and 1 to 3 months post-operation mostly.

CONCLUSIONSThe mortality of TAPVC was differed by different types. Intrinsic pulmonary vein stenosis maybe the main cause of mortality. The high quality of anastomsis could reduce the operative mortality.

Aortic Coarctation ; Body Weight ; Cardiac Surgical Procedures ; methods ; Circulatory Arrest, Deep Hypothermia Induced ; Female ; Heart Defects, Congenital ; mortality ; surgery ; Heart Septal Defects, Ventricular ; Humans ; Infant ; Infant, Newborn ; Male ; Postoperative Period ; Pulmonary Veins ; pathology ; surgery ; Retrospective Studies

Objective To investigate the diagnosis and surgical treatment strategies of intravenous leiomyomatosis(IVL)extending through inferior vena cava into the right cardiac cavities. Methods Thirty patients of IVL extending through inferior vena cava into the right cardiac cavities were treated in Peking Union Medical College Hospital from November 2002 to January 2015.The following variables were studied: age,cardiopulmonary bypass time,deep hypothermic circulatory arrest time,origins of IVL,blood loss,duration of post-operative hospital stay,hospitalization expenses,edema of lower extremity,blood transfusion,postoperative complication,residual IVL,and re-grow or recurrence. Results Thirteen of 30 patients reported double lower limb edema. The cardiopulmonary bypass was applied in 27 cases,and the average duration of cardiopulmonary bypass was(106.9±53.7)min. Then,21 patients were treated with the deep hypothermic circulatory arrest,and the mean time was(28.2±11.6) min. The tumors originated from the genital veins in 9 cases,the iliac vein in 13 cases,and both veins in 8 cases. The average intra-operative blood loss volume was (2060.5±2012.3)ml,and 21 patients received blood transfusion. The average hospitalization time was(18.9±8.3)days and the average hospitalization expenses was (80 840.4±28 264.2)RMB yuan. While 14 patients had postoperative complications,there was no serious postoperative complication or death.All patients have shown a favorable outcome.Conclusions Tumor embolus extending through inferior vena cava into the right cardiac cavities should be suspected in patients with multiple hysteromyoma. Successful therapy for IVL with right cardiac cavities extension is dependent on reasonable surgical treatment strategies. Surgical removal of the ovaries is vital to avoid IVL re-grow or recurrence.
Cardiopulmonary Bypass ; Circulatory Arrest, Deep Hypothermia Induced ; Female ; Heart Neoplasms ; surgery ; Humans ; Leiomyomatosis ; surgery ; Length of Stay ; Neoplasm Recurrence, Local ; Ovary ; Postoperative Complications ; Vascular Neoplasms ; surgery ; Veins ; pathology ; Vena Cava, Inferior ; pathology

BACKGROUNDLarge animal cardiopulmonary bypass (CPB) models are expensive, and prevent assessment of neurocognitive function, and difficulties with long-term recovery. The purpose of this study was to establish a novel rat model of cardiopulmonary bypass for deep hypothermic circulatory arrest without blood priming.

METHODSTwenty adult male Sprague-Dawley rats weighing 450-560 g were randomized to CPB with deep hypothermic circulatory arrest (DHCA) and control groups, with 10 rats each. The experimental protocols, including blood and crystalloid fluid administration, anesthesia, orotracheal intubation, ventilation, cannulation, and heparinization were identical in both groups. After inducing cardiac arrest, the circuit was turned off and rats were left in a DHCA state for 15 minutes. Rats were rewarmed to 34°C to 35°C over a period of 36 to 42 minutes using CPB-assisted rewarming, a heating blanket, and a heating lamp along with administration of 0.1 mEq of sodium bicarbonate and 0.14 mEq of calcium chloride. The remaining priming volume was reinfused and animals were weaned from CPB.

RESULTSAll CPB with DHCA processes were successfully achieved. Blood gas analysis and hemodynamic parameters were in the normal range. The vital signs of all rats were stable.

CONCLUSIONSOur CPB circuit has several novel features, including a small priming volume, active cooling/rewarming processes, vacuum-assisted venous drainage, peripheral cannulation without thoracotomy or sternotomy, and an accurate means of monitoring peripheral tissue oxygenation.

Animals ; Cardiopulmonary Bypass ; methods ; Circulatory Arrest, Deep Hypothermia Induced ; methods ; Male ; Models, Animal ; Rats ; Rats, Sprague-Dawley ; Rats, Wistar

Adult ; Circulatory Arrest, Deep Hypothermia Induced ; adverse effects ; Humans ; Male ; Rhabdomyolysis ; diagnosis ; etiology

BACKGROUND: To determine the predictors of clinical outcomes following surgical descending thoracic aortic (DTA) repair. METHODS: We identified 103 patients (23 females; mean age, 64.1+/-12.3 years) who underwent DTA replacement from 1999 to 2011 using either deep hypothermic circulatory arrest (44%) or partial cardiopulmonary bypass (CPB, 56%). RESULTS: The early mortality rate was 4.9% (n=5). Early major complications occurred in 21 patients (20.3%), which included newly required hemodialysis (9.7%), low cardiac output syndrome (6.8%), pneumonia (7.8%), stroke (6.8%), and multi-organ failure (3.9%). None experienced paraplegia. During a median follow-up of 56.3 months (inter-quartile range, 23.1 to 85.1 months), there were 17 late deaths and one aortic reoperation. Overall survival at 5 and 10 years was 80.9%+/-4.3% and 71.7%+/-5.9%, respectively. Reoperation-free survival at 5 and 10 years was 77.3%+/-4.8% and 70.2%+/-5.8%. Multivariable analysis revealed that age (hazard ratio [HR], 1.10; 95% confidence interval [CI], 1.05 to 1.15; p<0.001) and left ventricle (LV) function (HR, 0.88; 95% CI, 0.82 to 0.96; p<0.003) were significant and independent predictors of long-term mortality. CPB strategy, however, was not significantly related to mortality (p=0.49). CONCLUSION: Surgical DTA repair was practicable in terms of acceptable perioperative mortality/morbidity as well as favorable long-term survival. Age and LV function were risk factors for long-term mortality, irrespective of the CPB strategy.
Aorta ; Aortic Diseases* ; Cardiac Output, Low ; Cardiopulmonary Bypass ; Circulatory Arrest, Deep Hypothermia Induced ; Female ; Follow-Up Studies ; Heart Ventricles ; Humans ; Mortality ; Paraplegia ; Pneumonia ; Renal Dialysis ; Reoperation ; Risk Factors ; Stroke

Adult ; Chorea ; etiology ; Circulatory Arrest, Deep Hypothermia Induced ; Diffusion Magnetic Resonance Imaging ; Endarterectomy ; adverse effects ; methods ; Humans ; Male ; Pulmonary Embolism ; surgery

There has been an improvement in the prognosis of the tumor thrombi invading the inferior vena cava (IVC) and the right atrium (RA) of the renal cell carcinoma with radical nephrectomy and tumor thrombectomy with the aid of a cardiopulmonary bypass. A 26 year old man was diagnosed with the right renal tumor with a tumor invading the right renal vein and the IVC above the right renal vein to the RA and right venticle. He was presented with dyspnea on the exertion, the ascites and the lower extremity edema due to IVC total obstruction. An acute hepatic failure occurred due to an obstruction of the hepatic vein. She received a radical nephrectomy and a removal of the tumor in the IVC and the right cardiac camber under a hypothermic total circulatory arrest using the cardiopulmonary bypass.
Ascites ; Carcinoma, Renal Cell ; Cardiopulmonary Bypass ; Circulatory Arrest, Deep Hypothermia Induced* ; Dyspnea ; Edema ; Heart Atria ; Heart Ventricles* ; Hepatic Veins ; Kidney Neoplasms ; Liver Failure, Acute ; Lower Extremity ; Nephrectomy ; Prognosis ; Renal Veins ; Sarcoma* ; Thrombectomy ; Vena Cava, Inferior*

Advances in anesthetic and surgical management, such as deep hypothermic circulatory arrest and temporary clipping, have improved outcomes for intracranial aneurysm patients. However, these techniques are associated with significant risks. We report on two cases in which adenosine administration was used to induce transient periods of cardiac asystole during intracranial aneurysm surgery. This asystole resulted in profound hypotension and collapse of the aneurysm, which facilitated its safe clipping.
Adenosine ; Aneurysm ; Circulatory Arrest, Deep Hypothermia Induced ; Heart Arrest ; Humans ; Hypotension ; Intracranial Aneurysm