Paraplegia is a disastrous complication after operations of descending and thoracoabdominal aortic aneurysm. Re- gional hypothermia protects against spinal cord ischemia although the protective mechanism is not well k...Paraplegia is a disastrous complication after operations of descending and thoracoabdominal aortic aneurysm. Re- gional hypothermia protects against spinal cord ischemia although the protective mechanism is not well know. The objective of this study is to examine whether hypothermia protects the spinal cord by preventing apoptosis of nerve cell and also investigate a possible mechanism involved in hypothermia neuroprotection. Cell apoptosis with necrosis was evident in the spinal cord 24 h after 30 min of ischemia. Moderate hypothermia decreased the incidence of apoptotic nerve cells. Both cell apoptosis and necrosis were attenuated by hypothermia. p53 expression increased and bcl-2 expression declined after ischemia, while hypothermia mitigated these changes. This study suggests that apoptosis contributes to cell death after spinal cord ischemia, and that moderate hypothermia can prevent nerve cell apoptosis by a mechanism associated with bcl-2 and p53 genes.展开更多
To evaluate the clinic outcome of off-pump coronary bypass grafting (OPCABG) of patients with coronary heart disease and chronic obstructive pulmonary disease, we collected and analyzed 1998-2002 data on 28 patients w...To evaluate the clinic outcome of off-pump coronary bypass grafting (OPCABG) of patients with coronary heart disease and chronic obstructive pulmonary disease, we collected and analyzed 1998-2002 data on 28 patients with these two diseases who had received off-pump coronary bypass operation in our hospital, and compared with data on those who also had the same two diseases but received on-pump coronary artery bypass at same time. There were no operation-related death;one died of respiratory failure 14 days after operation while staying in hospital; there were more respiratory complications in the conventional coronary artery bypass grafting group (CCABG) than in the OPCABG group; and the PaO2/FiO2 in the CCABG group was higher than that in the OPCABG group during operation because of CPB, but lower than that in the OPCABG group 6-12 hours after operation. OPCABG seemed more suitable than CCABG for coronary artery disease patients with chronic obstructive pulmonary disease due to less damage to their oxygen-exchange capability and the fewer respiratory complications.展开更多
Objective To evaluate surgical methods and results of extracardiac conduit total cavopulmonary anastomosis (EC-TCPA) without cardiopulmonary bypass (CPB). Methods From May 2000 to April 2003, 11 patients with function...Objective To evaluate surgical methods and results of extracardiac conduit total cavopulmonary anastomosis (EC-TCPA) without cardiopulmonary bypass (CPB). Methods From May 2000 to April 2003, 11 patients with functional univentricle underwent off-pump EC-TCPA (no-CPB group). Their postoperative outcome was retrospectively compared with a 17-patient group who underwent EC-TCPA with cardiopulmonary bypass (CPB group) over a concurrent time period. Results There was 1 operative death in no-CPB group and 2 in CPB group; early postoperative hemodynamics appe-ared to significantly improve in no-CPB group. Blood and platelet transfusions decreased and blood plasma transfusion significantly lowered in no-CPB group compared with CPB group (P = 0.036). Postoperative courses of patients in no-CPB group were smooth and event free, and extubation time was substantially short. Intensive cares unit stay (P = 0.04) and hospital stay (P = 0.02) postoperation were significantly shorter, hospital costs were significantly reduced (P = 0.004) in no-CPB group compared with CPB group. Conclusions EC-TCPA without use of CPB is not a difficult procedure; the procedure results in improvement in postoperative hemodynamics, and decreased use of blood and blood products. It is a more efficient operation with more short recovery time and reduced hospital stay.展开更多
OBJECTIVE To summarize the clinical features and surgical treatment of primary ventricular tumors. METHODS Eight patients with primary ventricular tumor, aged 3 to 52 years, underwent surgical treatment. There were 6 ...OBJECTIVE To summarize the clinical features and surgical treatment of primary ventricular tumors. METHODS Eight patients with primary ventricular tumor, aged 3 to 52 years, underwent surgical treatment. There were 6 males and 2 females. The pathological diagnoses were as follows: multiple left ventricular myxomas in 2 cases; left ventricular rhabclomyoma, fibroma and malignant neurolemmoma in 1 case for each; right ventricular myxoma and malignant neurolemmoma in 1 case for each; intraseptal fibroma in 1 case. The operations were performed through median sternotomy with moderate hypothermic cardiopulmonary bypass in 7 cases; via left anterolateral thoracotomy without extracorporeal circulation in 1 case. Tumors were totally removed in 7 cases and subtotally resectecl in 1 case. RESULTS Cardiac arrest after anaesthetization occurred in 1 case with postoperative coma for 10 days. One case died of massive gastro-intestinal hemorrhage postoperatively. Seven cases survived, During a follow-up period of 1 to 21 years, there was no recurrence or metastasis in the 6 cases who received complete tumor resection including 2 cases with malignant tumor. One case of partial tumor removal had a mild heart murmur without tumor progression. All patients were asymptomatic with cardiac functiongrade I. CONCLUSION Primary ventricular tumors showed diversity in their histological characteristics. The mid- and long-term outcomes of surgical treatment for primary ventricular tumors appear to be satisfactory.展开更多
Recently, it has been found that atrial fibrillation (AF) is associated with renin angiotensin aldosterone system (RAAS) activation and that angiotensin converting enzyme inhibition (ACEI) reduces incidence of AF in ...Recently, it has been found that atrial fibrillation (AF) is associated with renin angiotensin aldosterone system (RAAS) activation and that angiotensin converting enzyme inhibition (ACEI) reduces incidence of AF in hypertensive patients. The relationship between ACEI and atrial remodelling in AF has been studied widely, but little is known about the mechanisms linking ACEI to thrombus formation in AF. Studies have shown that ACEI treatment can favourably influence endothelial dysfunction in hypertensive and heart failure patients and potentially modulate the fibrinolytic system in cardiopulmonary bypass patients. These data suggest that ACEI might influence the hypercoagulable state in AF. The objective of this study was to evaluate whether cilazapril, an ACEI, was conducive to hypercoagulated state in AF.展开更多
A 7-year-old girl with an anomalous origin of the left coronary artery from the pulmonary artery restored connection of the left coronary artery to the ascending aorta by aortocoronary bypass graft. Aortocoronary bypa...A 7-year-old girl with an anomalous origin of the left coronary artery from the pulmonary artery restored connection of the left coronary artery to the ascending aorta by aortocoronary bypass graft. Aortocoronary bypass grafting was performed with a vascular prosthesis. Postoperative angiography showed a patent left coronary artery without narrowing or kinking. Clinical improvement was rapid and the left ventricular function recovered completely.展开更多
基金This work was supported in part by National Natural Science Foundation of China(90208011,30300174,30470856 and 30421005)National Basic Research Program(973 Program)(2002CB713802)Shanghai Key Project of Ba-sic Science Research(04DZ14005 and 04DZ05608).
文摘Paraplegia is a disastrous complication after operations of descending and thoracoabdominal aortic aneurysm. Re- gional hypothermia protects against spinal cord ischemia although the protective mechanism is not well know. The objective of this study is to examine whether hypothermia protects the spinal cord by preventing apoptosis of nerve cell and also investigate a possible mechanism involved in hypothermia neuroprotection. Cell apoptosis with necrosis was evident in the spinal cord 24 h after 30 min of ischemia. Moderate hypothermia decreased the incidence of apoptotic nerve cells. Both cell apoptosis and necrosis were attenuated by hypothermia. p53 expression increased and bcl-2 expression declined after ischemia, while hypothermia mitigated these changes. This study suggests that apoptosis contributes to cell death after spinal cord ischemia, and that moderate hypothermia can prevent nerve cell apoptosis by a mechanism associated with bcl-2 and p53 genes.
文摘To evaluate the clinic outcome of off-pump coronary bypass grafting (OPCABG) of patients with coronary heart disease and chronic obstructive pulmonary disease, we collected and analyzed 1998-2002 data on 28 patients with these two diseases who had received off-pump coronary bypass operation in our hospital, and compared with data on those who also had the same two diseases but received on-pump coronary artery bypass at same time. There were no operation-related death;one died of respiratory failure 14 days after operation while staying in hospital; there were more respiratory complications in the conventional coronary artery bypass grafting group (CCABG) than in the OPCABG group; and the PaO2/FiO2 in the CCABG group was higher than that in the OPCABG group during operation because of CPB, but lower than that in the OPCABG group 6-12 hours after operation. OPCABG seemed more suitable than CCABG for coronary artery disease patients with chronic obstructive pulmonary disease due to less damage to their oxygen-exchange capability and the fewer respiratory complications.
文摘Objective To evaluate surgical methods and results of extracardiac conduit total cavopulmonary anastomosis (EC-TCPA) without cardiopulmonary bypass (CPB). Methods From May 2000 to April 2003, 11 patients with functional univentricle underwent off-pump EC-TCPA (no-CPB group). Their postoperative outcome was retrospectively compared with a 17-patient group who underwent EC-TCPA with cardiopulmonary bypass (CPB group) over a concurrent time period. Results There was 1 operative death in no-CPB group and 2 in CPB group; early postoperative hemodynamics appe-ared to significantly improve in no-CPB group. Blood and platelet transfusions decreased and blood plasma transfusion significantly lowered in no-CPB group compared with CPB group (P = 0.036). Postoperative courses of patients in no-CPB group were smooth and event free, and extubation time was substantially short. Intensive cares unit stay (P = 0.04) and hospital stay (P = 0.02) postoperation were significantly shorter, hospital costs were significantly reduced (P = 0.004) in no-CPB group compared with CPB group. Conclusions EC-TCPA without use of CPB is not a difficult procedure; the procedure results in improvement in postoperative hemodynamics, and decreased use of blood and blood products. It is a more efficient operation with more short recovery time and reduced hospital stay.
文摘OBJECTIVE To summarize the clinical features and surgical treatment of primary ventricular tumors. METHODS Eight patients with primary ventricular tumor, aged 3 to 52 years, underwent surgical treatment. There were 6 males and 2 females. The pathological diagnoses were as follows: multiple left ventricular myxomas in 2 cases; left ventricular rhabclomyoma, fibroma and malignant neurolemmoma in 1 case for each; right ventricular myxoma and malignant neurolemmoma in 1 case for each; intraseptal fibroma in 1 case. The operations were performed through median sternotomy with moderate hypothermic cardiopulmonary bypass in 7 cases; via left anterolateral thoracotomy without extracorporeal circulation in 1 case. Tumors were totally removed in 7 cases and subtotally resectecl in 1 case. RESULTS Cardiac arrest after anaesthetization occurred in 1 case with postoperative coma for 10 days. One case died of massive gastro-intestinal hemorrhage postoperatively. Seven cases survived, During a follow-up period of 1 to 21 years, there was no recurrence or metastasis in the 6 cases who received complete tumor resection including 2 cases with malignant tumor. One case of partial tumor removal had a mild heart murmur without tumor progression. All patients were asymptomatic with cardiac functiongrade I. CONCLUSION Primary ventricular tumors showed diversity in their histological characteristics. The mid- and long-term outcomes of surgical treatment for primary ventricular tumors appear to be satisfactory.
文摘Recently, it has been found that atrial fibrillation (AF) is associated with renin angiotensin aldosterone system (RAAS) activation and that angiotensin converting enzyme inhibition (ACEI) reduces incidence of AF in hypertensive patients. The relationship between ACEI and atrial remodelling in AF has been studied widely, but little is known about the mechanisms linking ACEI to thrombus formation in AF. Studies have shown that ACEI treatment can favourably influence endothelial dysfunction in hypertensive and heart failure patients and potentially modulate the fibrinolytic system in cardiopulmonary bypass patients. These data suggest that ACEI might influence the hypercoagulable state in AF. The objective of this study was to evaluate whether cilazapril, an ACEI, was conducive to hypercoagulated state in AF.
文摘A 7-year-old girl with an anomalous origin of the left coronary artery from the pulmonary artery restored connection of the left coronary artery to the ascending aorta by aortocoronary bypass graft. Aortocoronary bypass grafting was performed with a vascular prosthesis. Postoperative angiography showed a patent left coronary artery without narrowing or kinking. Clinical improvement was rapid and the left ventricular function recovered completely.