Objective To evaluate the results of right heart bypass (RHB) with 0ff-pump technique operation for treating complex congenital heart disease. Mothods From October 2005 to November 2010, 94 patients with complex congenital heart disease, including tricuspid atresia, single ventricle and 27 cases of ectopia cordis were included. Six-ty-eight cases, underwent bidirectional Glenn shunt and 26 cases underwent total cavopulmonary connection (TCPC). Result Four patients died, and the hospital mortality rate was 4.3%, and one patient had chylothorax. Conclusion RHB is a effective way to treatcomplex congenital heart disease, but the procedure itself is difficult. 1. Step-wise operation is better. The effect of extracardiac conduit operation with windowing operation is better than TCPC. RHB with off-pump technique is a useful procedure in early stage management.

Objective This paper reported the experience of intracardiac surgery through right minithoracotomy incision. Methods 518 cases underwent intracardiac surgery through right minithoracotomy incision under extracorporeal circulation. 256 cases of ventricular septal defect, 229 cases of atrial septal defect, 18 cases of pulmonary stenosis, 7 cases of tetralogy of Follot, aortic valve replacement in 5 casas, mitral valve replacement in 2 cases, left atrial myxoma in 1 case. Results No operative mortality was observed in this study. R re-operation was needed for stopping bleeding in 2 cases after the operation, and pulmonary atelectasis were observed in 3 cases. Conclusion Intracardiac surgery through right minithoracotomy incision causes less bleeding, quick closure of thoracic incision, maintainsthe continuity and the integrity of the bony thorax, and prevents postoperative pigeon breast and good cosmetic results.

Objective To evaluate the operative indications and the perioperative management of congestive heart disease complicated with severe pulmonary hypertension. Methods From January 2008 to December 2011, 83 patients suffered congestive heart disease associated with severe pulmonary hypertension including ASD, VSD, PDA and DORV, were prescribed selective pulmonary vasodilator drugs. Sixteen patients in the control group were treated without these drugs. Operative indications were based on the changes of SpO 2 , echocardiogram and X-ray. Results After the pre-operative preparation, 65(77.1%) operations were performed. one patient died 6 days after the operation; only 5 (31.2%)operations were performed in the control group and no patient died. The follow-up showed that the pulmonary pressure was significantly decreased. Conclusion Satisfactory results can be achieved in the treatment of congestive heart disease with severe pulmonary hypertension by preoperative analysis of surgical indications.

目的 探讨高龄患者的冠脉旁路移植术的适当术式.方法 22例冠心病患者,男16 例,女6 例,年龄(78.6 ± 2.2)(70～87)岁,加拿大心绞痛分级(CCS)2～3 级,NYHA 心功能分级为II～IV级,需性冠脉旁路移植术.根据病情,21例接受非体外循环冠脉搭桥手术(OPCABG),1例因术前合并严重瓣膜关闭不全接受非体外循环冠脉搭桥手术,同期行二尖瓣成形术常规体外循环下冠状动脉搭桥术.结果 22 例手术均顺利完成,共行远端吻合口52 个,平均每人(2.3 ± 0.5)个.早期院内死亡4例,占18%,死亡原因为呼吸衰竭.结论 除非有OPCAB禁忌证或同期需要进行瓣膜手术,对于高龄冠心病患者应尽量采用OPCAB.

目的总结上腔静脉-右肺动脉分流术治疗三尖瓣闭锁(TA)的临床经验。方法2004年10月至2008年4月,采用上腔静脉-右肺动脉分流术治疗TA10例,男8例,女2例;年龄2～13岁,平均年龄5.6岁;体重10.0～33.5kg,平均体重16.4kg。TA合并大动脉错位(右位心)2例,房室间隔缺损3例,永存左上腔静脉1例。均在常温非体外循环下手术,切断上腔静脉,近端缝合,远端与右肺动脉做端侧吻合;1例合并永存左上腔静脉患者行双侧上腔静脉肺动脉吻合术。结果全组无死亡患者,术后末梢血氧饱和度由74%±9%上升至92%±5%。所有患者紫绀明显减轻,顺利出院。随访10例,分别随访6～36个月,血氧饱和度86%±3%,活动能力明显改善。结论上腔静脉-右肺动脉分流术治疗TA效果满意,是比较理想的术式。

Objective To investigate the experience in surgical treatment of ascending aortic root aneurysms.Methods Twenty-three cases(age from 22 to 55 years,mean31.8years)with ascending aortic root aneurysms were diagnosed as having Marfan syndrome(12 cases),dissection aneurysms of type Stanford A(8 cases),and aortic valve stenosis combined with ascending aortic ectasia(3 cases).Our operations consist of 16 Bentall procedures,3 Wheat procedures,1 David procedure,and 1 total arch replacement and elephant trunk procedure.Results There was one case of operative death in the series.Follow-up was completed in 12 cases.During the follow-up(average of 41 months),there was no complicated diseases.Conclusion Bentall procedure is main treatment method of choice for ascending aortic root aneurysms.David operation may decreased incidents of blooding and thrombus after valve replacement.

<正>升主动脉根部瘤是常见的胸主动脉瘤,可伴有主动脉瓣窦部和环扩张及关闭不全,有的瘤体可以发展至弓部和主动脉夹层(Stanford A型),病情急且凶险,死亡率高,外科手术是唯一的治疗手段。我院自2002年4月-2008年10月,共行升主动脉瘤手术21例,取得了较好的临床效果。

Objective To share the experience of heart thransplantation. Methods 3 recipients with terminal myocardiosis were reviewed. The transplantation was performed with inferior and superior vena anastomofic technique. During perioperative period, we selected and maintained the recipients, protected donor-isolated heart, supported circulation,decreased immune reaction and controlled infections. Results All the 3 patients survived. Heart function improved from NYHA class 1V before heart transplant to NYHA class Ⅰ, Ⅱ. The follow-up time was 19 months ,28 months and 49 months respectively. Rejection occurred in two cases due to non-compliance to medication. Conclusions Suitable recipient, proper donor heart procurement and preservation, suitable maintenance of circulation, proper managements of anti-immunitive reaction, prevention of infections are critical for successfal heart transplantation. Medicine-take required may avoid or reduce rejection.

Objective:Heart transplantation has become an effective therapy for patients with end stage heart failure. The preservation of the donor heart is an important factor that affects the results of the operation. We performed 3 cases of orthotopic heart transplantation and obtained some experience in the preservation of the donor heart. Methods: Three male patients with end stage heart failure received the operation in our department successfully. Doppler echocardiography showed left ventricular end diameter （LVED） of the patients were 91, 87, and 83 mm, and ejection fraction （EF） were 24%, 20%, 12.9%, respectively. Once the declaration of brain death had been made, the median sternotomy was performed with a sternal saw. Haparin at a dose of 300 U/kg of body weight was administered. After at least 2-min heparin circulation, the procurement proceeded. The superior vena cava and the inferior vena cava were nearly completely divided. When the heart was empty, the ascending aorta was cross-clamped and the St. Thomas solution was infused by gravity. The heart was excised by transection of the inferior vena cava, the superior vena cava and all pulmonary veins. After donor heart was removed, it was infused with University of Wisconsin （UW） solution by gravity at a temperature of 4-6 ℃, then placed in UW solution for storage during transportation. The temperature of solution was maintained at about 4-6 ℃. The ischemic times of donor heart were 9, 8 and 6 h, respectively. The bicaval anastomotic heart transplantation was adopted. The left atrial anastomoses were constructed using 3.0 polypropylene. The inferior vene cava anastomosis was constructed, the donor and native aorta were cut to an appropriate length. Then the aorta and main pulmonary artery anastomosis were performed respectively. The superior vene cava anastomosis was usually constructed during the rewarming phase. The intraoperative course with a cardiopulmonary bypass of the 3 patients was 96, 44 and 49 min, respectively. Standard triple immunosuppression therapy was commenced in the immediate post-operative period. Results: The operation procedure was smooth and no perioperative death occurred. The follow-up was carried out carefully. The patient’s condition was fine in 25, 30 and 32 months after operation. The blood pressure was 130/90, 140/95 and 120/80 mmHg, respectively, and LVED was 51, 49 and 53 mm; EF was 50%, 54% and 60%, respectively. Cardiothoracic ratio was 0.63, 0.55, and 0.64, respectively. Conclusion: Preservation time of donor heart with St. Thomas solution infusion and UW solution storage at 0-4 ℃ may exceed 6 h, and receive comparable middle-term outcomes.

对多发性心脏血栓合并肺动脉栓塞1例分析如下. 1 病历摘要 女,18岁.因咳嗽、胸闷2周入院.2007-07-03无明显诱因出现咳嗽,胸闷,2 d后突发胸闷、黑朦,持续数分钟缓解.检查结果示:右室腔内占位性病变,黏液瘤可能性大,继发肺动脉瘤栓栓塞,不除外右室恶性肿瘤并肺动脉种植性转移可能.

1 临床资料 1.1 一般资料2006年1月,我科对一名马凡综合征患者施行David手术.男性,22岁,因反复胸闷、呼吸困难、乏力、头晕1年半入院.

OBJECTIVE To evaluate the result of right heart bypass operation(RHB) for treating complex congenital heart disease.METHODS From October 2004 to January 2008,24 patients with complex congenital heart disease underwent RHB.The dignoses of patients included tricuspid atresia,single ventricle,and so on.Among them,8 cases were found ectopia cordis.Opreation precedure included bidrectional Glenn shunt(19 cases) and total caval pulmonary connection(TCPC,5 cases).In the 24 cases,16 patient underwent off-pump operation.RESULTS Total hospital mottality was 4.2%.Postoperative complications included chylothorax(1 case) and hypoxemia(1 case).CONCLUSION 1.RHB with staging operation has good effect for complex congenital heart disease with increased operation difficulty;2.The effect of extracardiac conduit operation with windowing operation is better in TCPC;3.RHB with off-pump technique is a useful procedure in the early management.It is easy to perform.

目的总结右心旁路手术治疗三尖瓣闭锁体会。方法2004年10月~2008年5月,采用右心旁路手术治疗三尖瓣闭锁合并其他畸形11例,其中10例采用双向Glenn术。10例在常温非体外循环下手术,1例在体外循环下手术。结果无死亡病例,术后平均末梢饱和度由0.73±0.15上升至0.91±0.23,所有患者发绀明显减轻,顺利出院。结论右心旁路手术治疗三尖瓣闭锁畸形效果满意,是比较理想的术式。

我院在15年中为一个家庭进行了四例心脏粘液瘤切除手术,十分罕见.

目的 评价经胸小切口应用Amplatzer封堵器治疗房间隔缺损的疗效和安全性.方法 14例继发孔型房间隔缺损患者,缺损长径12～36 mm,全麻下经右胸骨旁第4肋间小切口入胸,在经食管超声心电图监测下,经右房放置封堵推送器,于房间隔缺损两侧释放封堵器将其封闭.结果 14例全部封堵成功,无残余分流,封堵操作时间为25～45 min,术后随访患者无并发症出现;合并肺动脉高压6例中,4例缺损大于30 mm、3例年龄大于50岁封堵后肺动脉压下降,心功能明显提高.结论 经胸小切口封堵术是治疗房间隔缺损的有效方法,尤其对大缺损合并肺动脉高压者操控性好、安全可靠.

Objective:To evaluate the effects of improved distension on endothelial cell of vein graft.Method:72 rabbits were divided into 3 groups randomly(group A,B,C)to observe different distension solution(control、Papaverine、Papaverine+Verapamil).In each group,the rabbits were separated into 4 sub-groups undergoing different distension pressures(30,40,50,100 mmHg).All harvested external jugular veins were distended by different pressure and different distension solution respectively.The number of dead vascular endothelial cell and endothelial cell function were measured by confocal.Result:At same pressure,in group C,the number of dead vascular endothelial cell was less than other two groups(P0.01),and endothelial cell function was much better too;In group A and B,the best distension pressurewas 50 mmHg,while in group C,it was 40 mmHg.Conclusion:Improved distension can improve the protective effect on endothelial cell of vein graft.

Objective To investigate the effects of mitochondrial adenosine triphosphate (ATP)-sensitive potassium channel opener diazoxide(DZ) on myocardium apoptosis during ischemia and reperfusion (I/R) in rats. Methods Fifty rats were divided into 5 groups randomly, 10 rats each group. Langendorff model were established. Control group: the normal heart muscle was harvested immediately after thoracotomy; group A: the heart of rats underwent 30min ischemia and 60min reperfusion with normal saline; group B: the heart of rats were treated with St.ThomasⅡ cardioplegia before ischemia; group C: the heart of rats were treated with DZ (20mg/kg) and St.ThomasⅡ cardioplegia before ischemia; group D: the heart of rats were treated with glibenclamide(3mg/kg), 10min before DZ and St.ThomasⅡcardioplegia. At the end, the content of [Ca2+]m, malondialdehyde (MDA), and cytochrome C (Cyt C) protein was measured respectively; the activity of Caspase-3 and the expression of Caspase-3 messenger ribonucleic acid (mRNA) was evaluated by reverse transcription poiymereise chain reaction. Myocardium apoptosis was sighted by Terminal deoxynucleltidyl transferase mediated dUTP nick and Label Ling as say (TUNEL) procedure. Results Compared with control group, the levels of [Ca2+]m, MDA, Cyt C protein, Caspase-3 protein and its mRNA in group A, group B, group C and group D were significantly increased, and the index of myocardium apoptosis was significantly increased, the levels of [Ca2+]m, MDA, CytC protein, Caspase-3 protein and its mRNA in group C were significantly decreased than those in group A, group B, and group D. Conclusion These results suggest that DZ has a cardioprotective effect on myocardium apoptosis during I/R in rats.

OBJECTIVE To summarize the clinical experience of extracorporeal circulation in 3 cases of heart transplantation with long-time preserved heart(6h and 7m-9h 2m,mean 7h45m).METHODS One case was performed the second operation with cannulation of fermoral artery,fermoral vein and superior vena eava.The other two cases were performed with fermoral artery,ascending aorta and two-stage cannulation.All 3cases were given moderate hypothermic(from 28.1℃ to 29℃),light-moderate blood dilution(Hb from 82 to 119g/L),and perfusion flow from 50 to 83ml/(kg·min).Heart preservation: The donor heart was arrested with aorta perfusion the cold cardioplegic solution,after being harvested,the donor heart was perfused with UW solution in 4℃ and preserved in UW solution.RESULTS All the cases recovered successfully.CONCLUSION Proper extracorporeal circulation management,good donor heart protection are the key to success in heart transpalntation.

Objective To analyse the experience of 115 cases with heart diseases treated through small thoractomy. Methods Right thoracic incision was used in 108 cases, robot-assisted operation in 5 cases and occlusion of ASD with occluder through right mini-thoractomy in 2 cases in this hospital from September 2001 to October 2004. Results There was no operation-related death. Re-operation for stopping bleding were performed in 1/115 cases(0.9%), pulmonary complication occurred in 3/115 cases(2.6%)and cerebral complication in 2/115 cases(1.7%). Conclusion Right small thoractomy has the characters of minimal injury, less bleeding and quick closure of thoracic incision and is suitable for cardiac deformities.