Background:Minimally invasive techniques for harvesting arterial grafts have emerged to meet the demands for less invasive procedures. With the development of various harvesting methods, ensuring the safety and efficacy of these minimally invasive approaches remains critical. This case report describes minimally invasive direct coronary artery bypass (MIDCAB) surgery involving robotic harvesting of the left internal thoracic artery (LIMA) and laparoscopic-assisted harvesting of the right gastroepiploic artery (GEA). Case summary:A 55-year-old male patient underwent minimally invasive coronary artery bypass grafting, with robotic-assisted harvesting of the left LIMA and laparoscopic-assisted harvesting of the right GEA. The procedural workflow and our experience are described herein. Discussion:This case report emphasizes the importance of multimodality imaging in planning for minimally invasive coronary artery bypass grafting. Robotic harvesting of the IMA and laparoscopic harvesting of the right GEA are safe procedures and can be performed in selected patients.

BackgroundAcute aortic dissection (AD) in pregnancy poses a lethal risk to both mother and fetus. However, well-established therapeutic guidelines are lacking. This study aimed to investigate clinical features, outcomes and optimal management strategies for pregnancy-related AD.MethodsWe conducted a retrospective multicentre cohort study including 67 women with acute AD during pregnancy or within 12 weeks postpartum from three major cardiovascular centres in China between 2003 and 2021. Patient characteristics, management strategies and short-term outcomes were analysed.ResultsMedian age was 31 years, with AD onset at median 32 weeks gestation. Forty-six patients (68.7%) had type A AD, of which 41 underwent immediate surgery. Overall maternal mortality was 10.4% (7/67) and fetal mortality was 26.9% (18/67). Compared with immediate surgery, selective surgery was associated with higher risk of composite maternal and fetal death (adjusted RR: 12.47 (95% CI 3.26 to 47.73); p=0.0002) and fetal death (adjusted RR: 8.77 (95% CI 2.33 to 33.09); p=0.001).ConclusionsImmediate aortic surgery should be considered for type A AD at any stage of pregnancy or postpartum. For pregnant women with AD before fetal viability, surgical treatment with the fetus in utero should be considered. Management strategies should account for dissection type, gestational age, and fetal viability.Trial registration numberNCT05501145.

Background: Sepsis-induced cardiomyopathy (SIC) is a critical complication arising from sepsis characterized by reversible myocardial dysfunction. Despite the increasing attention to SIC in research, the underlying molecular mechanisms remain poorly comprehended. Methods: In this study, we utilized bioinformatics to analyze RNA-sequencing (RNA-seq) and single -cell RNA-sequencing (scRNA-seq) data from the Gene Expression Omnibus (GEO) database to identify key immune cell populations and molecular markers associated with SIC. Our experimental approach combined in vitro and in vivo studies to investigate the roles of integrin alpha M (ITGAM) and intracellular adhesion molecule-1 (ICAM-1) in macrophage recruitment and phenotypic polarization, as well as their impact on cardiac function during SIC. Results: The bioinformatics analysis disclosed significant alterations in gene expression and immune cell composition within the cardiac tissue during SIC, where macrophages emerged as the predominant immune cell type. Notably, ITGAM was identified as a key regulatory molecule that modulates macrophage function, driving the pathogenesis of SIC through its influence on the recruitment and functional reprogramming of these cells. In vitro experiments revealed that lipopolysaccharide (LPS) stimulation triggered an upregulation of ITGAM in macrophages and ICAM-1 in endothelial cells, underscoring their critical roles in immune cell mobilization and intercellular communication. The strategic administration of ITGAMneutralizing antibodies to SIC mice resulted in a marked decrease in macrophage infiltration within the cardiac tissue, which was initially associated with an improvement in cardiac function. However, this intervention paradoxically resulted in an increased mortality rate during the later phases of SIC, underscoring the complex and dualistic function of ITGAM. Conclusion: This study provides new insights into the complex dynamics of immune cells within the cardiac environment during SIC, with a particular emphasis on the modulatory role of ITGAM in shaping macrophage behavior. The findings shed light on the reversible nature of myocardial dysfunction in SIC and emphasize the importance of targeted therapeutic strategies for the effective management of SIC.

Background: The cannabinoid receptor 2 (CB2R), a cannabinoid receptor primarily expressed in immune cells, has been found in the brain, particularly in the hippocampus, where it plays crucial roles in modulating various neural functions, including synaptic plasticity, neuroprotection, neurogenesis, anxiety and stress responses, and neuroinflammation. Despite this growing understanding, the intricate electrophysiological characteristics of hippocampal neurons in CB2R knockout (CB2R KO) mice remain elusive.Aim and Methods: This study aimed to comprehensively assess the electrophysiological traits of hippocampal synaptic and network functions in CB2R KO mice. The focus was on aspects such as synaptic transmission, short- and long-term synaptic plasticity, and neural network synchrony (theta oscillations).Results: Our findings unveiled multiple functional traits in these CB2R KO mice, notably elevated synaptic transmission in hippocampal CA1 neurons, decreased both synaptic short-term plasticity (paired-pulse facilitation) and long-term potentiation (LTP), and impaired neural network synchronization.Conclusion: In essence, this study yields insightful revelations about the influence of CB2Rs on hippocampal neural functions. By illuminating the electrophysiological modifications in CB2R KO mice, our research enriches the comprehension of CB2R involvement in hippocampal function. Such insights could hold implications for advancing our understanding of the neural mechanisms under the influence of CB2Rs within the brain.

Background:Peripheral platelet-white blood cell ratio (PWR) integrating systemic inflammatory and coagulopathic pathways is a key residual inflammatory measurement in the management of acute DeBakey type I aortic dissection (AAD); however, trajectories of PWR in AAD is poorly defined.Methods:Two AAD cohorts were included in two cardiovascular centers (2020-2022) if patients underwent emergency total arch replacement with frozen elephant trunk implantation. PWR data were collected over time at baseline and five consecutive days after surgery. Trajectory patterns of PWR were determined using the latent class mixed modelling (LCMM). Cox regression was used to determine independent risk factors. By adding PWR Trajectory, a user-friendly nomogram was developed for predicting mortality after surgery.Results:Two hundred forty-six patients with AAD were included with a median follow-up of 26 (IRQ 20-37) months. Three trajectories of PWR were identified [cluster alpha 45(18.3%), beta 105 (42.7%), and gamma 96 (39.0%)]. Cluster gamma was associated with higher risk of mortality at follow-up (crude HR, 3.763; 95% CI: 1.126-12.574; P=0.031) than cluster alpha. By the addition of PWR trajectories, an inflammatory nomogram, composed of age, hemoglobin, estimated glomerular filtration rate, and cardiopulmonary time was developed and internally validated, with adequate discrimination [the area under the receiver-operating characteristic curve 0.765, 95% CI: 0.660-0.869)], calibration, and clinical utility.Conclusion:Based on PWR trajectories, three distinct clusters were identified with short-term outcomes, and longitudinal residual inflammatory shed some light to individualize treatment strategies for AAD.

目的:探讨非小细胞肺癌(NSCLC)组织中着丝粒蛋白F(CENPF)、Krüppel样因子4(KLF4)表达与上皮-间质转化(EMT)和预后的关系.方法:选取2017年1月至2019年12月期间于泰州市第四人民医院行手术切除的120例NSCLC患者的癌组织和距癌组织5cm癌旁组织标本,采用免疫组织化学法和免疫印迹法检测癌组织和癌旁组织中CENPF、KLF4及ETM相关标志物[E-钙粘蛋白(E-cadherin)、波形蛋白(Vimentin)]的阳性表达率和表达量.采用Pearson检验分析CENPF、KLF4与EMT相关标志物的相关性,并分析CENPF、KLF4表达与NSCLC患者预后的关系.结果:NSCLC癌组织中CENPF、Vimentin的阳性表达率显著高于癌旁组织(均P＜0.05),而KLF4、E-cadherin的阳性表达率均显著低于癌旁组织(均P＜0.05).NSCLC癌组织中CENPF与E-cadherin 呈负相关,与 Vimentin 呈正相关(P＜0.05);而 KLF4 与 E-cadherin 呈正相关,与 Vimentin 呈负相关(P＜0.05).NSCLC 癌组织中CENPF、KLF4的阳性表达率与TNM分期和淋巴结转移有关(均P＜0.05).入组患者3年无病生存率(DFS)为60.00％.CENPF阳性表达的NSCLC患者3年DFS显著低于CENPF阴性表达患者(56.25％vs 75.00％,P=0.014),KLF4阳性表达的NSCLC患者3年DFS显著高于KLF4阴性表达患者(68.75％vs54.17％,P=0.048).结论:CENPF的高表达及KLF4的低表达可促进NSCLC的EMT发生、进展,并导致患者预后不良,CENPF和KLF4可辅助预测NSCLC患者的预后.

Background: The study was aimed at investigating the mathematical relationship between the aortic valve and aortic root through CTA imaging-based reconstruction. Methods: We selected 121 healthy participants and analyzed the measurements of aortic root dimensions, including the sinotubular junction (SJT), ventriculo-arterial junction (VAJ), maximum sinus diameter (SD), sinus height (SH), effective height (eH) and coaptation height (cH). We also reconstructed 3-D aortic valve cusps using CTA imaging to calculate the aortic cusp surface areas. Data were collected to analyze the ratios and the correlation between aortic valve and aortic root dimensions. Results: Among healthy participants, the STJ was approximately 10% larger than the VAJ, and the SD was 1.375 times larger than the VAJ. The average eH and cH were 8.94 mm and 3.62 mm, respectively. The aortic cusp surface areas were larger in men than women. Regardless of sex, the non-coronary cusp was found to be largest, and was followed by the right coronary cusp and the left coronary cusp. Although the aortic root dimensions were also significantly larger in in men than women, the STJ to VAJ, SD to VAJ, and SH to VAJ ratios did not significantly differ by sex. The mathematical relationship between the aortic cusp surface areas and VAJ orifice area was calculated as aortic cusp surface areas Conclusions: The aortic root has specific geometric ratios. The mathematical relationship between the aortic valve and aortic root might be used to guide aortic valve repair.

目的 探索左心瓣膜置换术后再次胸腔镜下右胸小切口心脏不停跳下行三尖瓣手术的治疗效果.方法 2018年5月～2020年7月我院收治的胸腔镜辅助下右胸小切口行三尖瓣成形或置换的再次手术病人28例,9例病人接受三尖瓣成形术,19例接受三尖瓣置换术.所有病人均使用全麻双腔气管插管,右侧抬高位,右侧锁骨中线至右侧腋前线第4肋间5 cm切口为主操作孔,右侧腋中线第5肋间1 cm切口为观察孔,通过股动静脉插管建立体外循环,所有三尖瓣手术均在心脏不停跳下完成.结果 所有手术均在外周体外循环支持、心脏不停跳下进行,无术中转正中切口,术中无股动静脉插管并发症.体外循环时间(78±15)分钟,术后ICU拔除气管插管时间(20.3±8.6)小时,术后住院时间(8.5±3.0)天.围手术期死亡1例,该病人三尖瓣置换术后出现急性肾功能衰竭合并肺部感染,其余病人术后恢复良好.随访12～30个月,术后均存活,心功能均较术前有明显改善.结论 左心瓣膜置换术后再次胸腔镜下右胸小切口行三尖瓣手术是安全可行的优选手术方式.胸腔镜下右胸小切口可简化手术过程,降低术后死亡率及术后并发症发生率.

Background: This study evaluated differential inflammatory response to cardiopulmonary bypass reoxygenation in tetralogy of Fallot repair. Methods: We performed a retrospective study at a cardiovascular center from 2012 to 2018, including 500 patients aged 1 week-18 years who received complete repair of tetralogy of Fallot. Patients were grouped according to tertiles of preoperative RVOT gradient on echocardiography into mild, moderate, and severe stenosis. We measured the highest perfusate oxygenation (PpO2) during aortic occlusion as independent variable. Primary outcome was systemic inflammatory response syndrome (SIRS) within 7 days postoperatively or the time of death or discharge. Results: Overall, rate of SIRS was 24.2% without significant differences among three groups (P > 0.05). Older age, male, and smaller indexed left ventricular end-diastolic volume is independent risk factor of SIRS. There were significant interactions between RVOT stenosis and PpO2 on SIRS (P interaction = 0.011): higher PpO2 was associated with a greater SIRS risk among combined moderate and severe stenotic children (OR 1.463 95%CI [1.080, 1.981] per-SD increase, P = 0.014) but not among mild stenotic children (OR 0.900 [0.608, 1.333] per-SD increase; P = 0.600), independent of covariates. Conclusion: The association of PpO2 with SIRS was modified by RVOT obstruction severity in tetralogy of Fallot repair.

Background: Porcine aortic valve (PAV) and bovine aortic valve (BAV) are commonly used in aortic valve replacement (AVR) surgeries. A detailed comparison for their hemodynamic and structural stress/strain performances would help to better understand valve cardiac function and select valve type and size for AVR outcome optimizations. Methods: Eight fluid-structure interaction models were constructed to compare hemodynamic and stress/strain behaviors of PAV and BAV with 4 sizes (19, 21, 23, and 25 mm). Blood flow velocity, systolic cross-valve pressure gradient (SCVPG), geometric orifice area (GOA), flow shear stresses (FSS), and stress/strain were obtained for comparison. Results: Compared with PAV, BAV has better hemodynamic performance, with lower maximum flow velocity (7.17%) and pressure (9.82%), smaller pressure gradient (mean and peak SCVPG: 8.92% and 9.28%), larger GOA (9.56%) and lower FSS (6.61%). The averages of the mean and peak net pressure gradient values from 4 BAV models were 8.10% and 8.35% lower than that from PAV models. Larger valve sizes for both PAV and BAV had improved hemodynamic performance. Maximum flow velocity, pressure, mean SCVPG and maximum FSS from 25 mm BAV were 36.80%, 15.81%, 39.05% and 38.83% lower than those from 19 mm BAV. The GOA of PAV and BAV 25 mm Valve were 43.75% and 33.07% larger than 19 mm valves, respectively. BAV has lower stress on the leaflets than PAV. Conclusions: BAV had better hemodynamic performance and lower leaflets stress than PAV. More patient studies are needed to validate our findings. (c) 2021 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).

Aortic valve replacement (AVR) remains a major treatment option for patients with severe aortic valve disease. Clinical outcome of AVR is strongly dependent on implanted prosthetic valve size. Fluid-structure interaction (FSI) aortic root models were constructed to investigate the effect of valve size on hemodynamics of the implanted bioprosthetic valve and optimize the outcome of AVR surgery. FSI models with 4 sizes of bioprosthetic valves (19 (No. 19), 21 (No. 21), 23 (No. 23) and 25 mm (No. 25)) were constructed. Left ventricle outflow track flow data from one patient was collected and used as model flow conditions. Anisotropic Mooney-Rivlin models were used to describe mechanical properties of aortic valve leaflets. Blood flow pressure, velocity, systolic valve orifice pressure gradient (SVOPG), systolic cross-valve pressure difference (SCVPD), geometric orifice area, and flow shear stresses from the four valve models were compared. Our results indicated that larger valves led to lower transvalvular pressure gradient, which is linked to better post AVR outcome. Peak SVOPG, mean SCVPD and maximumvelocity forValveNo. 25 were 48.17%, 49.3%, and 44.60% lower than that fromValveNo. 19, respectively. Geometric orifice area from Valve No. 25 was 52.03% higher than that from Valve No. 19 (1.87 cm(2) vs. 1.23 cm(2)). Implantation of larger valves can significantly reduce mean flow shear stress on valve leaflets. Our initial results suggested that larger valve size may lead to improved hemodynamic performance and valve cardiac function post AVR. More patient studies are needed to validate our findings.

Background Little is known regarding the effect of cardiopulmonary bypass (CPB) reoxygenation on cardiac function following tetralogy of Fallot repair. We hypothesized that hyperoxic reoxygenation would be more strongly associated with myocardial dysfunction in children with tetralogy of Fallot. Methods We investigated the association of perfusate oxygenation (PpO2) associated with myocardial dysfunction among children aged 6–72 months who underwent complete repair of tetralogy of Fallot in 2012–2018. Patients were divided into two groups: lower PpO2 group (≤ 250 mmHg) and higher PpO2 (> 250 mmHg) group based on the highest value of PpO2 during aortic occlusion. The odd ratio (ORs) and 95% confidence intervals (CIs) were estimated by logistic regression models. Results This study included 163 patients perfused with lower PpO2 and 213 with higher PpO2, with median age at surgery 23.3 (interquartile range [IQR] 12.5–39.4) months, 164 female (43.6%), and median body mass index 15.59 (IQR 14.3–16.9) kg/m 2 . After adjustment for baseline, clinical and procedural variables, patients with higher PpO2 were associated with higher risk of myocardial dysfunction than those with lower PpO2 (OR 1.770; 95% CI 1.040–3.012, P = 0.035). Higher PpO2, lower SpO2, lower pulmonary annular Z-score, and longer CPB time were independent risk factors for myocardial dysfunction. Conclusions Association exists between higher PpO2 and myocardial dysfunction risk in patients with tetralogy of Fallot, highlighting the modulation of reoxygenation during aortic occlusion to reduce cardiovascular damage following tetralogy of Fallot repair. Trial registration Clinical Trials. gov number NCT03568357. June 26, 2018

目的:探讨左心瓣膜术后再发三尖瓣重度关闭不全行全胸腔镜下三尖瓣置换的近期临床疗效,与经右胸小切口技术的临床结果进行比较.方法:2018年1月-2020年12月回顾性分析南京医科大学第一附属医院50例左心瓣膜术后出现三尖瓣重度关闭不全患者的临床资料.采用心脏不停跳技术,并根据手术方式的不同分为行全胸腔镜组(24例)及经右胸小切口组(26例).对比两组术中体外循环(cardiopulmonary bypass,CPB)时间,手术时间、24h引流量、呼吸机使用时间、术后住院时间,以及术后并发症.结果:全腔镜组和小切口组各1例住院30 d死亡,两组差异无统计学意义.全胸腔镜组CPB时间较小切口组稍长,但两组差异无统计学意义(P＞0.05).全胸腔镜组在手术时间、术后住院时间,均显著小于小切口组.术后随访1～36个月,全胸腔镜组术后三尖瓣无瓣周漏及传导阻滞,小切口组1例瓣周漏,术后心功能恢复两组无明显差异.结论:全胸腔镜下心脏不停跳再次三尖瓣置换近期疗效满意,和小切口三尖瓣置换相比较,具有创伤小、恢复快的特点,是左心瓣膜术后再次三尖瓣置换的重要治疗方式.

目的 比较Del Nido心脏停搏液与冷含血停搏液在复杂心脏手术中的心肌保护效果.方法 回顾性分析2018年1月至2019年10月体外循环(CPB)下行复杂心脏手术(主动脉阻断时间＞120 min)75例患者的病例资料,按照使用的心肌保护液不同将其分为Del Nido停搏液组37例和冷含血停搏液组38例.收集两组患者身体质量指数(BMI)、术前及术后射血分数(EF)、体外循环时间、主动脉阻断时间、后并行时间、停搏液灌注次数及总量、两组心脏的自动复跳率、除颤率、术后24h和术后48 h血清肌钙蛋白(cTnT)和肌酸磷酸激酶同工酶(CKMB)浓度,术后机械通气时间、ICU滞留时间、术后住院时间、术后正性肌力药物使用天数、术后肝肾功能等临床资料.结果 两组患者均顺利完成手术.A组的后并行时间、停搏液灌注次数、除颤率明显低于B组,差异有统计学意义(P＜0.05,P＜0.01).A组术后24 h、48 h CKMB、cTnT水平较B组明显降低,差异有统计学意义(P ＜0.05,P＜0.01).结论 Del Nido心脏停搏液与冷含血停搏液相比,在复杂心脏手术中,前者灌注次数更少,除颤率更低,后并行时间更短,术后24 h、48 h CKMB、cTnT水平明显降低,心肌保护效果要优于冷含血停跳液.Del Nido心脏停搏液在复杂心脏手术中的临床应用是安全可行的.

BACKGROUND:The Swan-Ganz catheter plays an important role in gaining understanding of cardiac pathophysiology and in the hemodynamic monitoring of critically ill patients. Difficult removal of the Swan-Ganz catheter is a rare but serious complication.CASE PRESENTATION:This case presents the difficult removal of a Swan-Ganz catheter in a 28-year-old female patient after cardiac surgery. Fluoroscopy and chest X-ray revealed that a portion of the Swan-Ganz catheter was coiled on the central venous catheter at the level of the superior vena cava. Under X-ray guidance, the central venous catheter was first removed, and then the Swan-Ganz catheter was successfully withdrawn through the percutaneous introducer sheath.CONCLUSIONS:This case report provides an unreported reason for difficult removal and describes a successful solution. This report suggests that X-ray examinations may be necessary before removing the Swan-Ganz catheter.

OBJECTIVES:Our goal was to investigate the safety and feasibility of triport periareolar thoracoscopic surgery (TPTS) and its advantages in repairing adult atrial septal defect.METHODS:Between January 2017 and January 2020, a total of 121 consecutive adult patients underwent atrial septal defect closure in our institution. Of these, 30 patients had TPTS and 31 patients had a right minithoracotomy (RMT). Operational data and clinical outcomes were compared between the 2 groups.RESULTS:The total operation time, cardiopulmonary bypass time and aortic cross-clamp time in the TPTS group were slightly longer than those in the RMT group, but there were no differences between the 2 groups. Compared with the RMT group, the TPTS group showed a decrease in the volume of chest drainage in 24 h (98.6 ± 191.2 vs 222.6 ± 217.2 ml; P = 0.032) and a shorter postoperative hospital stay (6.5 ± 1.5 vs 8.0 ± 3.7 days; P = 0.042). The numeric rating scale on postoperative day 7 was significantly less in the TPTS group than in the RMT group (2.82 ± 1.14 vs 3.56 ± 1.42; P = 0.034). The patient satisfaction scale for the cosmetic results in the TPTS group was significantly higher than in the RMT group (4.68 ± 0.55 vs 4.22 ± 0.76; P = 0.012). No differences were found in postoperative complications. No in-hospital death or major adverse events occurred in the 2 groups.CONCLUSIONS:TPTS is safe and feasible for the closure of adult atrial septal defect. Compared with RMT, it has been associated with less pain and better cosmetic outcomes.

目的:探究凝血功能对胸腔镜手术治疗非小细胞肺癌的疗效评估及预后预测的临床应用价值.方法:选择在我院行胸腔镜手术治疗的50例非小细胞肺癌患者为研究对象,分析凝血功能指标与患者临床病理特征的关系,比较患者治疗前后凝血功能指标水平的变化,并对患者的顸后进行预测.结果:不同性别、病理类型、病理期及淋巴结转移状态患者的凝血功能指标比较差异具有统计学意义(P＜0.05);患者行胸腔镜手术治疗后凝血功能指标水平变化显著(P＜0.05);Log-Rank单因素生存分析显示凝血功能指标中纤维蛋白原(Fib)和D-二聚体(D-D)水平高于平均值的非小细胞肺癌患者生存率显著降低(P＜0.05);Logistic多因素回归分析显示Fib和D-D升高为影响非小细胞肺癌患者生存期和顸后的独立危险因素(P＜0.05).结论:凝血功能指标与胸腔镜手术治疗的非小细胞肺癌患者疗效及预后有一定的相关性,Fib和D-D是患者预后的独立危险因素.

目的 比较Del Nido停搏液、HTK停搏液与改良St.Thomas停搏液三种不同心肌保护液在心脏瓣膜置换术中的心肌保护效果.方法 回顾性分析2016年1月至2018年12月行体外循环(CPB)下瓣膜置换术的120例患者的临床资料,按照使用心肌保护液的不同分为三组:Del Nido停搏液组40例患者,HTK停搏液组40例患者,改良St.Thomas停搏液组40例患者.收集CPB时间、主动脉阻断时间、停搏液灌注次数、自动复跳率、除颤率、术后24h和术后72 h外周血肌钙蛋白Ⅰ(cTnⅠ)和肌酸磷酸激酶同工酶(CK-MB)浓度、术后正性肌力药使用天数、气管插管时间、人住重症监护室时间、术后住院天数、停跳液治疗费用、术后射血分数(EF)等临床资料.结果 三组患者性别、年龄、体重、术前射血分数等基本资料差异无统计学意义(P＞0.05);三组患者均顺利完成瓣膜置换手术.三组体外循环时间、自动复跳率、血液指标、气管插管时间、入住重症监护室时间、术后住院天数差异无统计学意义.与改良St.Thomas停搏液组相比,Del Nido停搏液组、HTK停搏液组灌注次数均明显减少,主动脉阻断时间缩短,除颤率降低,差异具有统计学意义.与HTK停搏液组相比,Del Nido停搏液组治疗费用明显降低.结论 DelNido停搏液具有与HTK停搏液同样的心肌保护效果,且治疗费用更低,易于配制,与改良St.Thomas停搏液相比,前两者阻断时间缩短,灌注次数减少,除颤率明显降低;Del Nido停搏液在成人心脏瓣膜手术中的临床应用是安全可行的.

目的:本文主要为评价超声引导在心脏外科ICU规培医生深静脉穿刺临床教学中的效果.方法:选取心脏外科ICU规培医生40名,采用随机数字法分为实验组和对照组,每组20人,实验组采用超声引导、对照组采用解剖盲探法进行深静脉穿刺置管的示教,然后分别采用以上两种方法对两组规培医师进行考核.结果:实验组与对照组相比较,平均穿刺置管时间明显缩短(12.2±2.5min vs 26.4±3.2 min),首次穿刺成功率明显提高(71.3％vs 43.5％),穿刺并发症明显减少(2.5％vs 8.6％),且均有明显统计学差异(P<0.05).结论:超声引导在心脏外科ICU深静脉穿刺临床教学中效果明显.

ObjectiveWe performed closure of the patent ductus arteriosus (PDA) using a hybrid approach with an Amplatzer Duct Occluder. MethodsSix patients (two males and four females) underwent PDA closure at a mean age of 7.8 months (range 2-24 months) and a mean weight of 6.6kg (range 4.5-13kg). The main pulmonary artery (MPA) was exposed via a minimally invasive left parasternal second intercostal space incision. Under transesophageal echocardiography guidance, the PDA occluder was implanted via direct puncture of the MPA. ResultsThe procedure was successful in all patients with no residual shunt. There were no hospital deaths, and the postoperative course was uneventful. All patients were discharged on the 3rd to 4th day. There was no residual shunt in any patient on midterm follow-up. ConclusionsThe novel hybrid approach is a safe, minimal invasive procedure. Further experience and longer follow-up of these patients is necessary to conclude whether this technique is applicable to all the patients with a PDA.