Objective To investigate the clinical characteristics of primary malignant tumors of the left atrium and the late results of surgical treatment. Methods The clinical experience with surgical treatment of 13 primary malignant tumors of left atrium was analyzed retrospectively. Complete resection of malignant tumor was achieved in 7 cases(53.8％ )，and subtotal resection was achieved in 3 cases(23.0％), only biopsy was performed in 2 patients(15.4％ )because of extensive metastasis of tumor. Heart transplantation was performed in 1 case(7.7％). Results There was no hospital death. The pathological diagnosis was undifferentiated sarcoma in 5 cases, leiomyosarcoma in 2 cases, malignant transformation of myxoma in 2 cases, angiosarcoma in 1 case, fibrosarcoma in 1 case, malignant fibrous histocytoma in 1 case and malignant hemangiopericytoma in 1 case. There were 11 patients followedup for 3 months to 65 months and showed 9 late death due to recurrence or metastasis. There was 2 patients lost of follow-up. Conclusion Primary malignant tumors of the left atrium should be resected to relieve symptoms caused by local tumor growth. Surgery provides control of primary tumor and allows the potential for cure or longterm survival with effective adjuvant therapy. The prognosis of these patients is still poor.
ObjectiveTo define the patient characteristics and perioperative management, and to define the mortality and its risk factors after arterial switch operation (ASO).MethodsWe conducted a bidirectional cohort study with 571 consecutive patients undergoing ASO from 1997 to 2016 in our hospital. We enrolled patients who underwent ASO before 2012 retrospectively and after 2012 prospectively and followed up all the patients prospectively. Demographic characteristics, clinical information and mortality of these patients were summarized. Joinpoint regression analysis was used to identify the time trend of the overall mortality. Kaplan-Meier survival analysis was used to evaluate the mid- and long-term survival rate after ASO. Cox proportional hazards regression models were used to explore the potential factors associated with mortality. The cumulative incidence of complications after ASO was predicted using competing risk models.ResultsSeveral aspects of patients’ characteristics and perioperative management in our center differed from those in the developed countries. The overall mortality and in-hospital mortality after ASO was 16.3% and 15.1%, respectively. The overall cumulative survival rate at 5, 10 and 15 years after ASO was 83.3%, 82.8% and 82.8%, respectively. A significant decrease of overall mortality from 1997 to 2016 was observed. Independent risk factors of mortality included earlier ASO (1997-2006), single or intramural coronary anatomy and longer cardiopulmonary bypass time. Ten years after ASO, re-intervention, arrhythmia, pulmonary and anastomotic stenosis were the most common complications with a cumulative incidence over 10%.ConclusionSignificant improvements in the results of the ASO were observed and the postoperative mortality rate is close to reports from developed countries. Nonetheless, we have identified the need for further improvement in the early and late postoperative periods after ASO. Pulmonary stenosis, anastomotic stenosis and arrhythmia should be paid attention to during the long-term follow-up after ASO.
Abstract： Objective To study the molecular mechanism of pathologic states related to cardiopulmonary bypass (CPB) and screen the differential proteins from the serum before and after CPB in the open heart surgery patients. Methods By the twodimensional gel electrophoresis (2DE), we took the blood samples from each of the sixteen open heart surgery patients 30 minutes before CPB, 1 hour after CPB, and 24 hours after CPB. The protein spots were analyzed by the PDQuest image analysis software and the differential protein spots were identified by matrixassisted laser desorption/ionizationtime of flightmass spectrometry (MALDITOF-MS). Then, enzymelinked immunosorbent assay (ELISA) was used to determine the expression level of serum amyloid A protein (SAA) in the serum of healthy people and the enrolled patients before and after CPB. Results Through 2DE in combination with massspectrometry, 7 proteins altered in expression were identified, including SAA, haptoglobin (HPT), leucinerich alpha2-glycoprotein (A2GL), hemoglobin subunit beta (HBB), serine/threonineprotein phosphatase 2A -regulatory subunit B″ subunit gamma (P2R3C), transthyretin (TTHY), and T-complex protein 11-like protein2 (T11L2). ELISA analysis showed that SAA levels in healthy people and the open heart surgery patients 30 minutes before CPB were not statistically different (t=-1.955, P=0.056), while the SAA level rose from 54.47±48.32 μg/ml 30 min before CPB to 1 017.78±189.92 μg/ml 24 hours after CPB in the serum of open heart surgery patients． Conclusion The results of this pilot study illustrate that SAA, HPT, A2GL, HBB, P2R3C, TTHY and T11L2 may be the molecule markers of pathologic state related to CPB. Acute phase reaction happens intensively after CPB in human body.
Objective To explore the feasibility and option of different surgeries for neonates with pulmonary atresia and ventricular septal defect (PA/VSD) through assessing the effect of common surgeries. Methods Fourteen neonates who underwent their first surgery in our center from July 2004 to October 2014 were included. Their basic characteristics, operation and pre- and postoperative clinical information were extracted. Follow up was conducted and the last visit was on October 10, 2016. Short- and midterm survival and total correction rate were compared among different surgeries. Results Among the 14 patients, there were 4 (28.6%) patients, 6 (42.9%) and 4 (28.6%) who underwent one-stage repair, right ventricular outflow tract (RVOT) reconstruction, and systemic to PA shunt operation respectively. The overall in-hospital mortality after the first operation was 28.6% (4/14). At last visit, no death occurred resulting the 5-year survival rate of 71.4% (10/14). The overall total correction rate for all neonates was 64.3% (9/14). Although no statistical difference was found in the mortality among the one-stage repair , RVOT reconstruction and systemic to PA shunt group(50.0% vs. 33.3% vs. 0.0%, P=0.280), the survival and hazard analysis implied better outcomes of the systemic to PA shunt palliation operation. There was no statistical difference in the total correction rate and months from the first palliative operation to correction between those who underwent RVOT reconstruction and systemic to PA shunt (75.0% vs. 50.0%, P=0.470; 32.0 months vs. 18.0 months, P=0.400). Conclusion Performing surgeries for neonates with PA/VSD is still a great challenge. However, the midterm survival rate was optimistic for the early survivors. Systematic to PA shunt seemed to be a better choice with lower mortality for the neonates with PA/VSD who need the surgery to survive.
Objective To investigate the effect of applying intraoperative epicardial echocardiography (IEE) on preoperative monitoring and evaluating the clinical result of cardiac surgery. Methods We retrospectively analyzed the clinical data of 248 patients treated in the Affiliated 105 Hospital of People’s Liberation Army and the First Affiliated Hospital of Anhui Medical University from June 2008 to May 2015. There were 108 males and 140 females. The age ranged from 7 months to 71 years. There were 113 patients diagnosed with the congenital heart disease (CHD) at the mean age of 11.89±14.74 years. There were 135 patients diagnosed with valvular heart disease at the mean age of 47.20±14.57 years. All patients underwent IEE during operation. Results In 113 patients with CHD, we found new deformities and corrected preoperative diagnosis before cardiopulmonary bypass (CPB) and we identified surgical complications after CPB by IEE. Other deformities and left atrial thrombus were found in 135 patients with valvular heart disease by IEE before CPB. After CPB, paravalvular leak and mitral regurgitation were found, therefore we took action immediately. Conclusions IEE can improve the preoperative diagnosis and reduce perioperative complications, which has value of application during cardiac surgery.
ObjectiveTo summarize surgical experience and explore the best treatment strategy for the management of complicated mediastinitis after cardiac surgery. MethodsClinical data of 18 patients who received vascularized muscle flap transposition combined with negative pressure wound therapy (NPWT)for the treatment of complicated mediastinitis after cardiac surgery in one stage in the Department of Cardiac Surgery of Beijing Anzhen Hospital, Capital Medical University between June 2006 and December 2012 were retrospective analyzed. There were 12 male and 6 female patients with their average age of 65.5±8.2 years. The average interval between cardiac surgery and vascularized muscle flap reconstruction was 12.5±5.8 days. ResultsPostoperatively, 1 patient died of recurrent mediastinitis, sepsis and multiple organ dysfunction syndrome. Seventeen patients had an uneventful postoperative recovery and one-stage wound healing. Postoperative hospital stay was 18.6±7.2 days and wound healing time was 4.5±2.4 weeks. All the 17 patients were followed up for over 6 months, no recurrent mediastinitis was observed, and they had a good quality of life. ConclusionVascularized muscle flap transposition combined with NPWT is a simple and effective surgical strategy for the treatment of complicated mediastinitis after cardiac surgery in one-stage.