[Show abstract][Hide abstract] ABSTRACT: We retrospectively reported our 26-year experience with operative repair of total anomalous pulmonary venous connection (TAPVC) with biventricular physiology.
Between December 1982 and December 2008, 122 TAPVC patients with biventricular heart underwent surgical repair in our department. Moderate or deep hypothermia was induced at the time of cardiopulmonary bypass (CPB). Follow-up was conducted for 5 postoperative years. Surgical outcomes of early and intermediate deaths after TAPVC repair were retrospectively analyzed.
Six deaths occurred operatively; and three deaths, during follow-up. The 5-year survival rates after TAPVC repair was 92.6 %, without gradient across the anastomosis. The survival rate of the patients who were younger was 78.8 %, significantly lower than those older than 1 year. It was also lower in those who were less than 6 kg in weight. Three patients died during follow-up. Three patients died of ventricular arrhythmia, right heart failure, and pneumonia, respectively, during follow-up. If the left atrium pressure was higher than 15 mm Hg, the snare of the vertical vein was loosened after CPB ceased in the patients with supracardiac connection. It decreased from 21 ± 5 to 13 ± 3 mm Hg. The vertical vein was ligated in 57 cases and left open in 20 cases. A patient with an intact vertical vein had a large shunt and was cured by intervention afterward. Supraventricular arrhythmia occurred in 19 patients with the supercardiac type repaired through a biatrial incision. One patient died of ventricular arrhythmia, and none of the remaining patients had arrhythmias.
Surgical treatment of TAPVC carried a low operative risk and had satisfactory immediate and intermediate results. Age younger than 1 year and weight less than 6 kg were risk factors. It was a good choice to leave the vertical vein open in the patients with a left atrial pressure higher than 15 mm Hg.
Preview · Article · Dec 2015 · Journal of Cardiothoracic Surgery
[Show abstract][Hide abstract] ABSTRACT: Objectives. Low survival rate of mesenchymal stem cells (MSCs) severely limited the therapeutic efficacy of cell therapy in the treatment of myocardial infarction (MI). Bcl-xL genetic modification might enhance MSC survival after transplantation. Methods. Adult rat bone marrow MSCs were modified with human Bcl-xL gene (hBcl-xL-MSCs) or empty vector (vector-MSCs). MSC apoptosis and paracrine secretions were characterized using flow cytometry, TUNEL, and ELISA in vitro. In vivo, randomized adult rats with MI received myocardial injections of one of the three reagents: hBcl-xL-MSCs, vector-MSCs, or culture medium. Histochemistry, TUNEL, and echocardiography were carried out to evaluate cell engraftment, apoptosis, angiogenesis, scar formation, and cardiac functional recovery. Results. In vitro, cell apoptosis decreased 43%, and vascular endothelial growth factor (VEGF), insulin-like growth factor-1 (IGF-1), and plate-derived growth factor (PDGF) increased 1.5-, 0.7-, and 1.2-fold, respectively, in hBcl-xL-MSCs versus wild type and vector-MSCs. In vivo, cell apoptosis decreased 40% and 26% in hBcl-xL-MSC group versus medium and vector-MSC group, respectively. Similar results were observed in cell engraftment, angiogenesis, scar formation, and cardiac functional recovery. Conclusions. Genetic modification of MSCs with hBcl-xL gene could be an intriguing strategy to improve the therapeutic efficacy of cell therapy in the treatment of heart infarction.
Preview · Article · May 2015 · Stem cell International
[Show abstract][Hide abstract] ABSTRACT: Objective To investigate the perioperative features of aged patients undergoing off-pump coronary artery bypass grafting (OPCABG) surgery, and identify the perioperative effect of advanced age on OPCABG. Method A total of 61 aged patients and 585 younger patients from August 2013 to June 2014 were enrolled in this study. The perioperative features were summarized, and the effects of advanced age on intraoperative variables, as well as the postoperative complications were identified using logistic regression analysis. Results The anastomosis time of the target coronary artery and intraoperative dosage of vasoconstrictor drugs was significantly longer or higher in the aged patients. The incidence of the postoperative complications, such as atrial fibrillation, repetitive mechanical ventilation, gastrointestinal dysfunction, and renal insufficiency, were significantly higher in the aged patients. The intubation time and postoperative hospital stay were significantly longer in the aged patients. No significant difference was found between the two groups in cardiocerebrovascular accident and mortality. Multivariate logistic regression analysis revealed advanced age was the independent risk factor for coronary artery anastomosis time, vasoconstrictor dosage, repeated mechanical ventilation, atrial fibrillation, gastrointestinal dysfunction, as well as the intubation time and hospital stay. Conclusion OPCABG in aged patients was safe and effective for avoiding a significant increase for cardiocerebrovascular accident and mortality. Relatively, the tolerance of aged heart to stimulation was poor. Atrial fibrillation, repetitive mechanical ventilation, and gastrointestinal dysfunction were more likely to occur in aged patients. Advanced age made intubation time and hospital stay prolonged significantly.
Georg Thieme Verlag KG Stuttgart · New York.
No preview · Article · Apr 2015 · The Thoracic and Cardiovascular Surgeon
[Show abstract][Hide abstract] ABSTRACT: Background Though maze III procedure is an effective surgical treatment for atrial fibrillation (AF), the complexity and complications prevent its widespread application. Radiofrequency ablation (RA) has become an accepted therapy, but its chronic effects are still unclear. This retrospective clinical study describes our experience of RA and vagal denervation (VD) in surgical treatment of long-standing AF associated with rheumatic heart disease (RHD) during a 5-year follow-up. Methods Between June 2006 and December 2007, a total of 173 consecutive patients with long-standing AF-associated RHD underwent mitral valve replacement and ablation maze procedure. In total, 92 cases had RA alone and 81 had RA + VD. Patients were followed up with clinical examination and electrocardiography, and the data were analyzed by multivariable analysis with Cox hazard model. Results The average follow-up time was 5.0 ± 0.6 years. Multivariable analysis with Cox hazard model revealed that the duration of AF, the size of the left atrium, and tricuspid regurgitation are risk factors for AF recurrence. In addition, long-standing AF ≥ 7 years, left atrium diameter ≥ 58 mm, and severe tricuspid regurgitation may increase the risk of AF recurrence by 2.16-, 2.37-, and 2.67-fold, respectively. Although the freedom from AF during 2 to 5 postoperative years in the RA and RA + VD groups were similar, the percentage of antiarrhythmic drug therapy was higher in the RA group during the early postoperative period (4th month, 54.1 vs. 34.7%, p = 0.017; 5th month, 39.2 vs. 21.3%, p = 0.018; 6th month, 23.0 vs. 10.7%, p = 0.044). Furthermore, the percentage of those free from AF was lower during the 1st year (6th month, 82.2 vs 93.8%, p = 0.023; 1st year, 76.1 vs. 89.9%, p = 0.019). Conclusion RA is effective for the surgical treatment of long-standing AF associated with rheumatic valve disease. Though vagal denervation helped to maintain a stable sinus rhythm at an early stage, there was no additional benefit after the 1st year of follow-up.
Georg Thieme Verlag KG Stuttgart · New York.
No preview · Article · Mar 2015 · The Thoracic and Cardiovascular Surgeon
[Show abstract][Hide abstract] ABSTRACT: Objectives:
This study aimed to investigate the feasibility and effects of intramuscular injections of autologous bone marrow cells (BMC) combined with off-pump coronary artery bypass grafts (OPCAB) on improving cardiac function in chronic myocardial infarction patients.
Ninety patients with chronic myocardial infarction were prospectively enrolled and randomized to an OPCAB with saline or an OPCAB with BMC-treatment group. After finishing CABG, patients received injections of BMC or saline into the marginal area of the infarct. The primary endpoint was incidence of emergent adverse events within 6 months.
There were no differences between the control and BMC-treated groups in baseline ejection fractions (EF) or wall motion score indices (WMSI) in the affected segments. At the 6-month follow-up, the ejection fraction was significantly increased in the BMC-treated group compared to controls (47.58 ± 6.34 vs. 40.11 ± 7.42; p < 0.05), whereas the WMSI were significantly decreased (1.25 ± 0.32 vs. 1.54 ± 0.53; p < 0.05), with no occurrences of life-threatening arrhythmias or death. The addition of BMC injections to OPCAB treatment increased regional perfusion to the marginal infarct area.
These results demonstrate that BMC transplant is beneficial to the cardiac function with no adverse effects, and therefore a safe and feasible adjunct therapy providing beneficial effects in clinical practice.
[Show abstract][Hide abstract] ABSTRACT: This study aimed to investigate the impact of different doses of atorvastatin on contrast-induced acute kidney injury (CI-AKI) in patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI) requiring contrast media by performing a meta-analysis. We searched the Pubmed, EMBASE, Cochrane Library, Wanfang database, China National Knowledge Infrastructure, and VIP database through April 2014. Only randomized controlled trials (RCTs) comparing short-term high-dose atorvastatin with low-dose atorvastatin on contrast-induced acute kidney injury were selected. The main outcomes were the change of acute kidney injury markers and the incidence of contrast-induced nephropathy (CIN). We combined 14 RCTs consisting of 1689 patients. Compared with the low-dose atorvastatin, high-dose atorvastatin treatment was associated with a reduction in serum creatinine levels (weighted mean differences [WMD]-0.1mg/dL; 95% CI -0.14– -0.05). In addition, high-dose atorvastatin treatment was also associated with a lower incidence of CIN (risk ratios 0.41; 95% CI 0.29–0.56). This meta-analysis suggests that short-term high-dose atorvastatin therapy appears to be superior to the low-dose atorvastatin in preventing CI-AKI among patients undergoing CAG/PCI requiring contrast media.
No preview · Article · Oct 2014 · The Journal of Clinical Pharmacology
[Show abstract][Hide abstract] ABSTRACT: Background
Genetic modifications can improve the therapeutic efficacy of mesenchymal stem cell (MSC) transplantation in myocardial infarction. However, so far, the efficiency of MSC modification is very low. Seeking for a more efficient way of MSC modification, we investigated the possibility of employing the intercellular trafficking capacity of the herpes simplex virus type-1 tegument protein VP22 on the enhancement of MSC modification.
Plasmids pVP22-myc, pVP22-EGFP, pEGFP-VP22, pVP22-hBcl-xL and phBcl-xL-VP22 were constructed for the expressions of the myc-tagged VP22 and the fusion proteins VP22-EGFP, EGFP-VP22, VP22-hBcl-xL and hBcl-xL-VP22. MSCs were isolated from rat bone marrow and the surface markers were identified by Flowcytometry. COS-1 cells were transfected with the above plasmids and co-cultured with untransfected MSCs, the intercellular transportations of the constructed proteins were studied by immunofluorescence. The solubility of VP22-hBcl-xL and hBcl-xL-VP22 was analyzed by Western blot.
VP22-myc could be expressed in and spread between COS-1 cells, which indicates the validity of our VP22 expression construct. Flowcytometry analysis revealed that the isolated MSCs were CD29, CD44, and CD90 positive and were negative for the hematopoietic markers, CD34 and CD45. The co-culturing and immunofluorescence assay showed that VP22-myc, VP22-EGFP and EGFP-VP22 could traffic between COS-1 cells and MSCs, while the evidence of intercellular transportation of VP22-hBcl-xL and hBcl-xL-VP22 was not detected. Western blot analysis showed that VP22-hBcl-xL and hBcl-xL-VP22 were both insoluble in the cell lysate suggesting interactions of the fusion proteins with other cellular components.
The intercellular trafficking of VP22-myc, VP22-EGFP and EGFP-VP22 between COS-1 cells and MSCs presents an intriguing prospect in the therapeutic application of VP22 as a delivery vehicle which enhances genetic modifications of MSCs. However, VP22-hBcl-xL and hBcl-xL-VP22 failed to spread between cells, which are due to the insolubility of the fusion protein incurred by interactions with other cellular components.
[Show abstract][Hide abstract] ABSTRACT: Objective
Early death following coronary artery bypass graft (CABG) surgery tends to occur in coronary heart disease (CHD) patients with significantly decreased left ventricular function.Methods
The clinical data of 231 patients with preoperative left ventricular ejection fraction (LVEF) ≤35% who underwent CABG were retrospectively analyzed from June 2007 to October 2012. The patients were divided into 2 groups: group A contained 39 patients who suffered early postoperative death and group B contained 192 patients who had a successful CABG outcome.ResultsMultivariate analysis demonstrated that only significantly decreased preoperative right ventricular (RV) diastolic function (increase in Et/Et′) and lack of suitable target bypass vessels were independent risk factors for early death after CABG surgery in patients with severely impaired left ventricular function (P = 0.003 and 0.002, respectively). Other factors, including age, intra-aortic balloon pump (IABP) implantation, ischemic mitral regurgitation (IMR) treatment, left atrial internal diameter, and end-diastolic left ventricular internal diameter, were not associated with early death following CABG. Preoperative Et/Et′ ≥10 was significantly associated with early death after CABG in patients with severely impaired left ventricular function (χ2 = 11.55, P < 0.001, odds ratio [OR] = 17.54, 95% confidence interval [CI]: 2.12–383.16).Conclusion
Decreased preoperative RV diastolic function and lack of suitable target bypass vessels are independent risk factors for early death following CABG in patients with severely impaired left ventricular function. Therefore, assessment of preoperative RV diastolic function will be helpful in predicting early death after CABG in these patients. Additionally, Et/Et′ ≥10 is significantly associated with early death after CABG.
No preview · Article · Jun 2014 · Echocardiography
[Show abstract][Hide abstract] ABSTRACT: Objectives:
Mesenchymal stem cells (MSCs) have limited clinical therapeutic effects in older myocardial infarction (MI) patients. Thus, whether younger MSCs might confer greater protection is worth investigating.
Human MSCs (hMSCs) were isolated before coronary artery bypass graft surgery and growth characteristics of hMSCs at passage 3 were observed. Vascular endothelial growth factor (VEGF) and Bcl-2 mRNA and protein expression from hMSCs were measured. In vivo, 45 adult male rats with MI were randomized to receive one of three treatments: old hMSCs, young hMSCs or culture medium (control) transplanted into infarcted myocardium. Echocardiography, TUNEL, immunohistochemistry and Western blot were used to assess results.
hMSC proliferation in the old group was significantly lower than the young group. VEGF decreased 35% and Bcl-2 decreased more than 60% at the mRNA level; VEGF and Bcl-2 protein were decreased in the old versus the young group. hMSC transplantation may improve cardiac function, but MSC source may affect therapeutic efficacy. Similar data were obtained from TUNEL, immunohistochemistry and Western blot.
Transplantation of hMSCs improves heart function, but proliferative ability and myocardial protection decrease with older MSCs, likely due to differences between VEGF and Bcl-2 expression and reduced anti-apoptosis.
[Show abstract][Hide abstract] ABSTRACT: AimTo evaluate the development of pulmonary arteries (PAs) in patients with pulmonary atresia, ventricular septal defect, and diminutive PAs by using a central end-to-side shunt. MethodsA total of 103 consecutive patients (71 male and 32 female) with pulmonary atresia, ventricular septal defect, and diminutive PAs received a central end-to-side shunt between PA and aorta from May 2004 to December 2010. The age and weight ranged between 2 to 86 months and 2.5 to 21.5 kg, respectively. Overall 79 patients with main PA diameters less than 4mm received a central end-to-side shunt between PA and aorta, and 24 patients with main PAs absence received a modified central shunt between PA branches and aorta. ResultsThere were no deaths during operation and follow-up. Compared with preoperative measures, total PA index increased from mean value 68.811.4 mm(2)/m(2) to 129.1 +/- 24.9 mm(2)/m(2) (p<0.001). The increased PA index change at the time of 6 months or final repair after shunt completion was 87.7 +/- 27.4% (27-150%). By multivariate regression analysis, age at shunt, shunt procedure, and number of major aortopulmonary collateral arteries were correlated with increasing PA index change. Conclusion
The central end-to-side shunt promoted sufficient growth of the diminutive central PAs, especially in infant patients. Due to the risk of a distortion of pulmonary branches, the authors interposed a modified procedure for patients with main PAs absence by anastomosis of left PA and right PA directly in an end-to-side fashion to the both lateral wall of ascending aorta. It is technically easy to perform, warrants low risk of shunt thrombosis, and flow restriction in the early postoperative period.
No preview · Article · Sep 2013 · The Thoracic and Cardiovascular Surgeon
[Show abstract][Hide abstract] ABSTRACT: Common atrium (CA) is a rare congenital heart defect. We reviewed our experience of surgical treatment of CA and summarize the clinical features of CA and the key techniques for surgical correction.
Between August 1984 and August 2010, 37 consecutive cases of CA underwent corrective surgery. There were no clinical findings of Down, asplenia-polysplenia or Ellis-van Creveld syndromes in all cases. Mitral valvuloplasty was performed in 34 cases, and tricuspid valvuloplasty in 20 cases. Complete closure of a mitral cleft was required in 32 cases. All new atrial septa were reconstructed using patches. Follow-up period ranged from 1 to 20 years.
There were no hospital deaths or conduction system block. After surgery, mild mitral insufficiency was observed in only one case. Two cases had moderate-severe mitral insufficiency at postoperative years 1 and 3, respectively, that required mitral valve replacements. One patient died of low cardiac output syndrome after reoperation.
Long-term survival after surgical correction of CA is good. Routine closure of a cleft in the mitral valve is very important for successful surgery. doi: 10.1111/jocs.12202 (J Card Surg 2013;28:580-586).
No preview · Article · Sep 2013 · Journal of Cardiac Surgery
[Show abstract][Hide abstract] ABSTRACT: Bronchogenic cyst is considered as an uncommon congenital anomaly. It can be mostly found in mediastinum or lung. Intracardiac bronchogenic cyst is very rare. We found 2 cases in more than 20000 cardiac surgical cases in our department. The 2 cases bronchogenic cyst arose from interatrial septum (IAS), the preoperative diagnosis were myxoma, but the histological diagnosis were bronchogenic cyst in both cases. Although it is very rare, it should be considered while intracardiac tumor is diagnosed. It is recommended to complete resection of any bronchogenic cyst for primarily diagnostic and potentially therapeutic reasons, and every effort should be made to prevent complications due to injury to nearby tissues.
Preview · Article · Jul 2013 · Journal of Cardiothoracic Surgery
[Show abstract][Hide abstract] ABSTRACT: Alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) are the major enzymes responsible for alcohol metabolism in humans. Emerging evidences have shown that functional polymorphisms in ADH and ALDH genes might play a critical role in increasing coronary artery disease (CAD) and myocardial infarction (MI) risks; however, individually published studies showed inconclusive results. The aim of this meta-analysis is to evaluate the associations between the genetic polymorphisms of ADH and ALDH genes with susceptibility to CAD and MI. A literature search was conducted on PubMed, Embase, Web of Science and Chinese BioMedical databases from inception through December 1st, 2012. Crude relative risks (RRs) with 95% confidence intervals (CIs) were calculated. Twelve case-control studies were included with a total of 9,616 subjects, including 2,053 CAD patients, 1,436 MI patients, and 6,127 healthy controls. Meta-analysis showed that mutant genotypes (GA+AA) of the rs671 polymorphism in the ALDH2 gene were associated with increased risk of both CAD and MI (CAD: RR=1.20, 95%CI: 1.03-1.40, P=0.021; MI: RR=1.32, 95%CI: 1.11-1.57, P=0.002). However, there were no significant associations of ADH genetic polymorphisms to CAD and MI risks (CAD: RR=0.92, 95%CI: 0.73-1.15, P=0.445; MI: RR=0.93, 95%CI: 0.84-1.03, P=0.148). In conclusion, this meta-analysis provides strong evidence that ALDH2 rs671 polymorphism may be associated with increased risks of CAD and MI. However, further studies are still needed to accurately determine whether ADH genetic polymorphisms are associated with susceptibility to CAD and MI.
[Show abstract][Hide abstract] ABSTRACT: Background
Diabetes mellitus (DM) exacerbates coronary artery disease (CAD) morbidity and mortality. Mesenchymal stem cells (MSCs) play an important therapeutic role in myocardial ischemic injury. However, little is known about changes in the cardioprotective characteristics of MSCs from patients with DM.
Sternal bone marrow aspirates were taken at the time of coronary artery bypass graft surgery. The morphology and growth characteristics of hMSCs were observed in passage 3. Differences in gene expression profiling were measured by Affymetrix GeneChipHuman Genome U133 Plus 2.0 Arrays. Forty two adult male rats with experimentally CAD were randomized into three groups. MSCs from patients with CAD+DM or CAD were injected into the infarcted myocardium. Control animals received culture medium. Echocardiography, TUNEL, immunohistochemistry and Western-blot analysis were performed 4 weeks after transplantation.
Growth curves showed that proliferation of hMSCs in the CAD+DM group was significantly lower than in the CAD group. Nine transcripts of genes related to apoptosis containing Bcl-2 were found to differentiate the two groups. Transplantation of hMSCs in the infarcted border zone improved cardiac function, but DM partly impaired this effect. Similar results were observed from TUNEL, immunohistochemistry and Western-blot analysis.
hMSCs from patients with CAD+DM and CAD alone both have proliferative properties. Transplantation of hMSCs ameliorate heart function, but proliferative ability and myocardial protection decrease significantly in MSCs obtained from patients with CAD+DM compared with cultures from patients with CAD alone, possibly as a result of differences in Bcl-2 protein expression and reduced anti-apoptosis.
Full-text · Article · Mar 2013 · Cardiovascular Diabetology
[Show abstract][Hide abstract] ABSTRACT: This study was conducted to address whether staged surgical intervention or primary repair would be preferred for treating patients with tetralogy of Fallot and small left ventricle.Methods: We retrospectively assessed 28 patients with tetralogy of Fallot and small left ventricle at the Chinese PLA 208th Hospital, Changchun, between January 2005 and December 2008. Of this cohort, 11 patients had undergone a systemic-to-pulmonary arterial shunt with a polytetrafluoroethylene interposition graft (off pump), followed by ancillary repair procedures as a surgically staged group; the remaining 17 patients underwent primary intracardiac repair via cardiopulmonary bypass. The oxygen level as measured by pulse oximetry (SpO2), the McGoon ratio, and the left ventricular end-diastolic volume index (LVEDVI) were measured before shunt procedures and at 6 to 18 months afterwards. All data were analyzed statistically with the paired Student t test. The 2 groups were compared with respect to LVEDVI values and McGoon indices at baseline by the independent t test.Results: None of the patients died as a direct result of the surgery, but 1 fatality due to pneumonia occurred 4 months after shunting. Mean postshunt values for SpO2, the McGoon ratio, and the LVEDVI increased significantly from 76.8% � 9.0% to 87.5% � 2.4% (P < .01), from 1.42 � 0.27 to 1.62 � 0.32 (P < .05), and from 20.1 � 7.0 mL/m2 to 34.3 � 7.4 mL/m2 (P < .01), respectively. Nine patients were fully repaired within the 6- to 18-month time frame after shunting, while 1 patient awaited definitive surgery for pulmonary hypoplasia. In the primary-repair group, in which the increases the LVEDVI and McGoon ratio were comparatively higher, 1 patient died of hypoxemia.Conclusion: A LVEDVI 20 mL/m2 may be an indication for primary repair in patients with tetralogy of Fallot. With values
No preview · Article · Feb 2012 · Heart Surgery Forum
[Show abstract][Hide abstract] ABSTRACT: Right-side heart function is essentially externalized during extracardiac total cavopulmonary connection. The Fontan procedure has a certain impact on pulmonary hemoperfusion and may explain various postsurgical complications. In this study, alterations of pulmonary perfusion in patients undergoing the Fontan procedure were analyzed at the 5-year postoperative mark by radionuclide imaging and angiocardiography, and results of both methods were compared.
For 43 post-Fontan patients, perfusion ratios of each lung segment were calculated based on radionuclide imaging data. The pulmonary vascular resistance and pulmonary artery index of each patient were also calculated from right angiocardiographic measurements.
The radionuclide count and advantage perfusion ratio of right lung at follow-up did not differ significantly from early postoperative values (t=0.38, p>0.05; t=1.12, p>0.05), and superior/inferior vena cava perfusion ratios were stable (t=0.88, p>0.05; t=0.74, p>0.05). The superior/inferior segment perfusion ratio of the whole lung declined significantly (t=2.54, p<0.05), while that of the dorsal lung segment rose significantly (t=2.16, p<0.05). Compared with early postoperative status, the pulmonary arterial index of patients at follow-up were significantly increased (t=2.41, p<0.05), while small pulmonary vascular resistances declined significantly (t=2.08, p<0.05; t=2.69, p<0.05), and arterial oxygen saturation levels were unaltered (t=1.12, p>0.05). The early angiographic and radionuclide perfusion studies of 5 patients did not match.
After the Fontan procedure, hypostatic redistribution of pulmonary blood flow is characteristic. The weak pulse of blood, in the absence of ventricular ejection, can promote pulmonary vascular changes, but at later (intermediate) follow-up, the decline in vascular resistance that results carries no benefit in terms of blood perfusion or oxygenation. Microcirculatory arteriovenous shunting is the likely cause. In this study of functional pulmonary hemoperfusion, radionuclide imaging was deemed superior to angiocardiography.
No preview · Article · Feb 2012 · The Annals of thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: To explore the changes of pulmonary perfusion over 5 years in patients who underwent extracardiac total cavopulmonary connection.
Forty-three patients who had undergone extracardiac total cavopulmonary connection were examined with pulmonary perfusion 1 month and 5 years following the operation. 99mTc-MAA was used for perfusion imaging; pulmonary perfusion value and blood distribution were measured and calculated. Vena cava pressure and arterial oxygenation were measured using the right cardiac catheter, and the pulmonary arteriole resistance was calculated. The status of the conduit connection was assessed by computed tomography three-dimensional reconstruction.
Radionuclide counts of the follow-up group were similar to those of the early postoperative group, and the ratios of right to left pulmonary perfusion and inferior vena cava perfusion were not changed. However, the ratio of the whole pulmonary superior to inferior segment was remarkably reduced (t=2.54, P<0.05), with a significantly higher perfusion rate in the posterior segment of the lower lobe (t=2.16, P<0.05). The pulmonary arteriole resistance of the follow-up group was reduced significantly (t=2.08, P<0.05). The vena cava pressure was also reduced (t=2.69, P<0.05), but oxygenation was not significantly changed. Five patients showed a mismatch between pulmonary angiography and radionuclide scintigraphy soon after the operation. The pulmonary angiography showed that the anastomosis was patent, and both lungs were demonstrated. However, the radionuclide scintigraphy only demonstrated the unilateral lung soon after the operation, and both lungs were demonstrated during follow-up.
Radionuclide scintigraphy is superior to the pulmonary angiography in the study of functional pulmonary perfusion. Fontan circulation may lead to gravity-dependent blood redistribution, and its weak pulsation can promote pulmonary vascular development. However, the reduced pulmonary arterial resistance at mid-term follow-up may not lead to an increased amount of pulmonary perfusion or oxygen supply, which is probably because of the massive opening of the arteriovenous shunt and increased futile circulation.
No preview · Article · Nov 2011 · Nuclear Medicine Communications
[Show abstract][Hide abstract] ABSTRACT: We aimed to investigate the initial experience of endoscopic vein harvesting (EVH) for coronary artery bypass grafting (CABG) in Chinese patients.
Forty patients scheduled for isolated CABG were prospectively randomized into an EVH group (n = 20) and an open vein harvesting (OVH) group (n = 20). Clinical data were collected, and all of the vein grafts were assessed by macroscopic appearance, histologic quality (endothelial integrity), and functional characteristics of endothelial nitric oxide synthase.
The 2 groups were similar with respect to hospital mortality (EVH group, 0; OVH group, 1; P = 1). There were no postoperative myocardial infarctions in either group and no deaths or reinterventions in either group during the follow-up period. Harvesting times in the 2 groups were similar (EVH, 12.15 ± 2.32 min; OVH, 12.55 ± 2.11 min; P = .571). Three patients in the EVH group were converted to a partly open or skin-bridge technique. Electrocautery at least 2 mm distal to the origin of the side branch was the safety margin.
The use of EVH in Chinese patients was not related to adverse events and may be safely used for CABG procedures. Preoperative duplex mapping, systemic heparinization before harvesting, minimal surgical manipulation, and sectioning of side branches at least 2 mm distal to the origin may help improve the quality of vein grafts harvested with EVH and maximize the benefit of this less-invasive technique.
No preview · Article · Oct 2011 · Heart Surgery Forum
[Show abstract][Hide abstract] ABSTRACT: Reducing lung injury during cardiopulmonary bypass (CPB) is important for patients' recovery. The present study was designed to research convenient and effective pulmonary artery perfusion mode during CPB in an animal model.
Twelve healthy mongrel dogs were randomly divided into 2 groups: a control group and a perfusion group designed to simulate clinical CPB-induced lung injury. During CPB, pulmonary artery perfusion with modified low-potassium dextran (LPD) solution was performed immediately after the initiation of ischemia and before reperfusion for 3 to 4 minutes each time, with pressure maintained at 15 to 20 mmHg; animals in the control group were not perfused. After pulmonary reperfusion, the changes in pulmonary function and tissue biochemical data were determined.
Compared with the control group, lung compliance, oxygenation, and vascular resistance after reperfusion were significantly improved in the perfusion group. The malonaldehyde concentration, neutrophil sequestration ratio, and tissue water content also decreased significantly in the perfusion group.
The pulmonary artery perfusion mode used in this experiment could relieve CPB-induced lung injury effectively. Improving cellular tolerance to hypoxia and decreasing inflammatory reaction may be the important mechanisms. Moreover, this mode is convenient and does not interfere with the intended operations, which is promising for clinical use.
No preview · Article · Feb 2011 · Heart Surgery Forum