ObjectiveTo investigate and evaluate the safety and efficacy of Bentall operation in the reoperation of patients with small aortic root or annulus.MethodsBentall procedure was performed in 24 patients with small aortic root or annulus in our hospital from September 2014 to December 2019. There were 18 males and 6 females with a mean age of 31-68 (45.70±15.27) years. All patients had undergone a previous replacement of the aortic valve including 20 patients receiving valve replacement, 2 patients aortic root replacement with a valved conduit and 2 patients bioprothesis replacement.ResultsThere was no early death in hospital and one death during the 30-day postoperative period. Re-thoracotomy due to bleeding was necessary in only 2 patients and no bleeding was related to the proximal anastomosis of the conduit. One patient performed pacemaker implantation for heart block after the procedure. The mean sizes of implanted aortic valve prosthesis were 22.75±1.78 mm. A mean gradient across the aortic valve prostheses in the postoperative echocardiographic examination was 11.17±2.24 mm Hg.ConclusionBentall procedure is safe and allows a larger size of prosthesis implantation in patients with small aortic annulus or root after previous aortic valve or complete root replacement, resulting in good postoperative hemodynamic characteristics and short-term clinical results.
Objective To explore the impact of ischemic postconditioning on ischemia-reperfusion injury in isolatedelderly rat hearts and their relation with P-Akt. Methods A total of 30 healthy elderly SD rats (21-23 months old， male or female) with their body weight of 450-500 g were divided into 3 groups: control group， ischemia-reperfusion group， and postconditioning group， with 10 rats in each group. Coronary artery blood flow，myocardial infarction size， phosphorylatedAkt （p-Akt） expression， and changes in myocardium and mitochondria were detected. Results Coronary artery blood flow of the postconditioning group was significantly higher than that of the ischemia-reperfusion group （6.4±1.2 ml/min vs.3.1±1.2 ml/min， P＜0. 01）， and myocardial infarction size of the postconditioning group was significantly smaller thanthat of the ischemia-reperfusion group （35.0%±2.0% vs. 55.7%±3.6%， Plt;0. 05）. The expression of P-Akt was significantlyhigher， and myocardial fibers and mitochondria were preserved better in the postconditioning group than the ischemia-reperfusion group. Conclusion Ischemic postconditioning can protect isolated elderly rat hearts against ischemia-reperfusion injury， which may be related to P-Akt activation.
Objective To study the clinical results and operative methods of mitral valvoplasty in patients of congenital heart disease with mitral insufficiency. Methods One hundred and twelve patients of congenital heart disease with mitral insufficiency had been treated with valve repair procedure. The surgery was performed under extracorporeal circulation and moderate hypothermia. Most of the patients were diagnosed atrioventricular septal defects (29 cases), ventricular septal defect (25 cases), patent ductus arteriosus (14 cases), and atrial septal defect (14 cases) before operation. The main pathologic characters of mitral valve were mitral valve annular dilatation (58 cases), leaflet lesions (37cases), anterior and posterior leaflet prolapse (36 cases). The surgery consisted of complex methods to repair mitral valves, including rings annuloplasty (22 cases), closure of the commissure (18 cases), double-orifice method (14 cases), chords reimplantation and so on. Results Seventy two patientshad 0 to I class mitral valve regurgitation and 26 patients had Ⅱ class mitral valve regurgitation during the retrial period by echocardiography, only one case needed re-operation. The patients with left ventricular end diastolic diameter (LVEDD) more than 45mm had a reduction of left atrial diameter (from 45.8±10.7mm to 34.4±8.9mm, t=6.53, 7.89,(Plt;)0.001) and left ventricular diameter (from 58.6±10.9 mm to 44.3±8.5 mm, t=7.89, Plt;0.001) after operation. Conclusions Surgical operation on mitral valve regurgitation of congenital heart defect is a benefit and a compound method and transesophageal echocardiography may help the surgeon in estimating the surgical efficacy during operation.
Objective To summarize the clinical features and results of surgical treatment of complex congenital heart disease(CCHD) in infants, investigate the operative indications and improve the operative effect. Methods From November 1999 to June 2008, 323 infants with CCHD were operated in Wuhan Asia Heart Hospital. There were 202(62.5%) male and 121(37.5%) female aged from 4 days to 36 months. The average age was 18.4 months. The range of weight was 4-15 kg, and the average weight was 9.9 kg. There were 218 cases with tetralogy of fallot(TOF), 41 with double outlet right ventricle(DORV), 12 with total anomalous pulmonary venous drainage（TAPVD）, 8 with complete endocardial cushion defect（TECD）, 15 with coarctation of aorta（CoA）, 2 with aortapulmonary window（AP Window） associated with interrupted aortic arch(IAA) and patent ductus arteriosus (PDA), 2 with persistent truncus arteriosus (PTA), 9 with single ventricle（SV）, 2 with Ebstein’s anomaly, 10 with pulmonary atresia（PA）, 3 with transposition of great arteries（TGA）and 1 with corrected transposition of great arteries（cTGA）. Two hundred and ninetyseven patients underwent I stage correction, 26 underwent palliative operation. All the corrective operations were performed under hypothermic cardiopulmonary bypass（CPB）. Results The cardiopulmonary bypass(CPB) time and aortic cross clamping time were 89±34 min and 48±39 min, respectively. All the patients were followed up by telephone or mail. The follow-up time was 1-72 months. Eight patients（2.5%） died after operation, 7 of them died in the early period of operation(within 1 month). Two patients died of long operation time and CPBdependence, 3 died of ventilatordependence, 1 died of cardiac arrest caused by aspiration following multiple organ dysfunction syndrome（MODS）after resuscitation, and 1 died of continuous hypoxia and cardiac arrest after central shunt operation. There was 1 mediumterm death, which was caused by laryngitis complicated with pulmonary infection. There were 315 survivals（97.5%）. Ninetyfive cases had complications(29.4%), all discharged after symptomatic treatment. The [CM(159mm]improved cardiac function was in gradeⅠ-Ⅱ. The respiratory tract infection reduced and the weight increased significantly. Conclusion Early detection, early diagnosis and early surgical treatment are important for CCHD in infants and the surgical results are satisfactory. The surgical procedure should be chosen according to individual abnormality. Surgeons should pay attention not only to the operation indications and satisfactory correction of the abnormality, but also to the staging operation.