Objective To report the experiences of cardiac valve operation in children. Methods Cardiac valve operations were performed in 87 children who were 58 male and 19 female between age of 4 to 14 years (mean 10.2 years). Of the 87 patients, 36 underwent mitral valve replacement, 13 aortic valve replacement, 6 mitral and aortic valve replacement, 13 aortic valvuloplasty, and 19 mitral valvuloplasty. Associated cardiac lesions were simultaneously managed. Results Postoperative complications included low car...
Objective To study the influence of three different ways of myogenic induction on Ca2+ regulation of mesenchymal stem cells (MSCs) derived from umbilical cord blood. Methods From January 2007 to April 2010, three different ways of myogenic induction including the adoptions of 5azacytidine, extraction of myocardium, and myocardial differentiation medium were used to induce MSCs derived from the umbilical cord blood of dogs in Xinhua Hospital of Shanghai Jiaotong University. Confocal laser scanning microscope was used to detect cells induced by the three abovementioned methods, cardiomyocytes and Ca2+ combined with Fluo3/AM inside the MSCs. For each group of cells, 2 to 5 visual fields were chosen, and 30 visual fields were recorded for each kind of cells. The mean fluorescence intensity of ten images shot in one minute was used to reflect the concentration of free intracellular Ca2+. Furthermore, the change of the concentration was continuously monitored by optical density(OD) value. Results After induction, the Ca2+ concentration inside the MSCs was significantly higher than that inside the cardiomyocytes (F=59.400, P=0.000). There was a statistical difference among the intracellular Ca2+ concentration induced respectively by 5azacytidine, extraction of myocardium, and myocardial differentiation medium (F=18.988, P=0.000). No significant difference existed between the intracellular Ca2+ concentration induced by 5-azacytidine and extraction of myocardium (OD value: 1 076.88±44.65 vs. 1 040.90±37.48, P=0.186), while the intracellular Ca2+ concentration induced by 5azacytidine was significantly higher than that induced by myocardial differentiation medium (OD value: 1 076.88±44.65 vs. 973.91±46.49, P=0.001), and the intracellular Ca2+ concentration induced by extraction of myocardium was significantly higher than that induced by myocardial differentiation medium (OD value: 1 040.90±37.48 vs. 973.91±46.49, P=0.001). The concentration of intracellular Ca2+ induced by all the three different methods fluctuated spontaneously, which was quite similar with the cardiomyocytes, but the frequency and the scope of the fluctuation were quite different. Ca2+ was released instantly by KCl stimulation in the two groups of MSCs pretreated by 5-aza and extraction of myocardium. Though MSCs pretreated by myocardial differentiation medium had response to KCl stimulation, Ca2+ could not be released in this group. On the contrary, the duration of Ca2+ release was prolonged. Conclusion Ca2+ regulation system of MSCs derived from umbilical cord blood can be influenced by these myogenic inductions. However, the reason and effect of the differences need to be elucidated by further investigation.
Abstract： Objective To improve therapeutic outcomes for severe leftsided atrioventricular valve regurgitation (LAVVR) after repair of atrioventricular septal defect (AVSD) through discussing pathological changes of the valve and surgical management for these patients, and summarizing the medical experiences of perioperative managements. Methods We retrospectively analyzed the clinical data of 29 patients including 16 males and 13 females with LAVVR after repair of AVSD treated in Xinhua Hospital, Medical College of Shanghai Jiaotong University between January 1995 and December 2009. The age of these patients ranged from 4 to 62 years, averaging at 26.5. According the classification of New York Heart Association (NYHA), there were 10 patients of class Ⅱ, 17 of class Ⅲ and 2 of class Ⅳ before reoperation. Partial repair of AVSD had been carried out for 18 patients, and complete repair had been performed on 11 patients. At reoperation, valve rerepair was performed on 17 patients and mechanical valve replacement (MVR) was necessary in 12 patients. Results In the early period after operation, one patient died of multiple organ failure, one patient had a permanent pacemaker inserted because of complete atrioventricular block, and 1 patient aged 4 years got recovery after 56 hours of circulatory support for severe cardiac failure after reoperation. A mean follow-up of 8.2 years (6 months to 14 years) was done for 25 patients with 3 missing. During the follow-up for 14 patients undergone heart valve repair, there was no obvious acceleration of the forward blood flow of the leftside atrioventricular valve. Ten patients had mild or less LAVVR, 1 had moderate LAVVR and 3 underwent successful left atrioventricular valve replacement at 10 days, 3 years or 6 years after reoperation because of severe LAVVR. Clinical status, as assessed by the NYHA classification, improved after surgery for LAVVR in 25 patients who were followed up with 17 in NYHA class Ⅰ, 6 in class Ⅱ, and 2 in class Ⅲ. Podoid decreased significantly and cardiothoracic ratio was 0.53-0.67 (0.60±0.11) in chest Xray picture. There was no late death. Conclusion With timely surgical treatment, and appropriate surgical method, LAVVR after complete or partial AVSD repair can be managed with excellent shortterm and longterm outcomes.
Objective To summarize our experience on leaflet extension in reoperation after tricuspid valve repair in children at age≤15 years and to explore the application indicators and skills of this technique. Methods We retrospectively analyzed the clinical data of 23 children who underwent reoperation after tricuspid valve repair in Xinhua Hospital between January 2006 and October 2015. There were 15 males and 8 females with a mean age of 8.7 years, ranging from 5 to 15 years. The leaflet was extended by artificial pericardium patch. After surgery, warfarin anticoagulation therapy was done, and international normalized ratio was maintained 2.0 to 3.0. Results The average cardiopulmonary bypass time was 87-132 (98.5±35.7) minutes, and average aortic cross-clamping time was 56-97 (68.40±23.78) minutes. One patient died in hospital. There were 3 patients with complications including respiratory failure in 1 patient, acute renal failure in 1 patient, and right heart insufficiency in 1 patient. All the children cured and were followed up for 5 months to 10 years, with a mean follow-up of 3.5 years. One patient died during the follow-up. Six patients suffered mild to moderate tricuspid regurgitation and tricuspid valve function of the rest patients was good. No other redo-valve surgery or complications correlated to anticoagulation occurred. Conclusion Leaflet extension in reoperation after tricuspid valve repair in children is useful with optimistic middle to long term efficacy and needs intensive care therapy during the perioperative period.
Objective To summarize diagnosis and treatment outcomes of coronary arterial fistulas （CAFs） so as to improve surgical results. Methods Clinical data of 23 patients with CAFs who underwent surgical repair in Xinhua Hospital，School of Medicine，Shanghai Jiaotong University from July 2006 to January 2013 were retrospectively analyzed. There were 15 male and 8 female patients with their age of 35.4±8.7 years. CAFs originated from left anterior descendingartery in 7 patients，right coronary artery in 13 patients，dual coronary arteries in 1 patient，left main coronary artery in 1 patient，and obtuse marginal artery in 1 patient. CAFs drained into pulmonary artery in 16 patients，right ventricle in 5patients，and right atrium in 2 patients. Twelve patients received surgical repair under off-pump condition with beating heart，and the other 11 patients underwent surgery under cardiopulmonary bypass （CPB）. Surgical techniques included extracardiacgasket interrupted suture ligation，intracardiac mattress suture ligation，intracardiac gasket interrupted suture for fistula repair，and a combination of intracardiac suture ligation and extracardiac repair. Results There was no in-hospital death or seriouspostoperative complication in this group. For the 11 patients undergoing surgical repair under CPB，average CPB time was 78.6±7.4 minutes，and average aortic cross-clamping time was 39.0±5.9 minutes. Postoperatively，patients’ heart functionrecovered well，their symptoms disappeared，and there was no myocardial ischemia or residual fistula. Twelve patients werefollowed up at the outpatient department and via telephone for 3 months to 6 years after discharge. During follow-up，theirheart function all recovered well，and echocardiogram detected no abnormality. There was no late death，myocardial ischemiaor residual fistula. Conclusion All CAFs patients need early surgical repair once their diagnosis is clear. Appropriate surgical strategies should be chosen according to the characteristics of pathological anatomy and associated intracardiaclesions. Surgical outcomes are satisfactory.
Objective To summarize the clinical experience of treating adults with pectus excavatum by newly modified orthopedicsteel plate and Nuss procedure. Methods The clinical data of 190 adults with pectus excavatum treated by newly modified Nuss procedure in Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine from January 2011 to June 2016 were collected. There were 151 males and 39 females aged 21.80±3.96 years ranging from 18 to 45 years. The therapeutic efficacy, Haller index and the lung function index were also analyzed. Results All patients recovered well after the operation. Two orthopedic steel plates were implanted in 12 patients. Pneumothorax was found in 7 patients postoperatively and 2 of them was treated by puncture extraction. There were 5 patients with poor healing of incision and all of them were healed after the debridement. Other complications such as steel plate shift was found in 2 patients. Both of them recovered after the reoperation. The duration of operation was 36–65 min. The intraoperative blood loss was 5–20 ml. Postoperative hospital stay was 4–7 days. Haller and lung function index improved after the operation (P<0.001). Conclusion It is effective and safe to treat the pectus excavatum by newly modified orthopedic steel plate and Nuss procedure in adult patients.
Objective To investigate the influence of T helpers 17 (Th17) cells, regulatory T (Treg) cells and their related cytokines on postoperative atrial fibrillation (POAF) after coronary artery bypass graft (CABG). Methods A total of 132 consecutive patients undergoing CABG between May 2013 and July 2016 were recruited. There were 82 males and 50 females with the age ranging from 39-76 years. Venous blood samples were collected within 2 hours after surgery. The expression of Th17 cells, Treg cells and their related cytokines in the peripheral blood was determined. Results POAF occurred in 35 patients (a POAF group) and 97 patients did not develop POAF (a No POAF group). Compared to the No POAF group, the proportion of Th17 cells and Th17/Treg ratio in the peripheral blood significantly increased in the POAF group (P>0.05) while proportion of Treg cells remained no significant change (P>0.05). The expression of Th17-related cytokines (IL-6, IL-8 and IL-17) all obviously increased in the POAF group (P>0.05). However, no significant difference was found in the expression of Treg-related cytokines (IL-10 and TGF-β) between the two groups (P>0.05). Conclusion Th17/Treg is unbanlanced in POAF patients and regulation of this imbalance may decrease the occurrence of POAF.
ObjectiveTo evaluate the changes of left ventricular structure and function by echocardiography and its grading of left ventricular diastolic function in patients with mitral valve prolapse treated by minimally invasive mitral valve repair.MethodsBy retrospective analysis, 37 patients including 25 males and 12 females aged 53.49±11.02 years with mitral valve prolapse who underwent minimally invasive mitral valve repair were as an operation group, and 34 healthy persons including 19 males and 15 females aged 54.26±8.33 years matched by age and sex were selected as a control group. Ultrasound parameters of every participant were routinely collected before operation, 1 month, 3 months, 6 months and 1 year after operation, and left ventricular diastolic function was graded. The ultrasound parameters between the two groups were compared.ResultsThe diameters of left ventricular end systolic and diastolic phase, left atrial diameter and left ventricular volume in the operation group were significantly smaller than those before operation. The diameters of left ventricle and left atrium after operation were significantly shorter than those before operation, but they were still larger than those of the control group. The ejection fraction value decreased significantly at one month after the operation and then returned to normal level. The incidence of left ventricular diastolic dysfunction at 6 months and 1 year after operation was significantly lower than that before operation (P<0.05).ConclusionMinimally invasive repair for patients with mitral valve prolapse can significantly improve systolic and diastolic functions of left ventricle while reconstructing left atrial and left ventricular structures.
ObjectiveTo analyze the clinical characteristics of stiff left atrial syndrome (SLAS) after Mei mini maze procedure for atrial fibrillation (AF), and to explore its risk factors and treatments. Methods We retrospectively analyzed the clinical data of the patients who underwent Mei mini maze procedure in Xinhua Hospital between 2010 and 2020. According to whether SLAS occurred in the early postoperative period, patients were divided into a SLAS group and a non-SLAS group. The basic data, perioperative echocardiogram and laboratory test indexes of the two groups were compared. Results A total of 1 056 patients were collected. There were 672 (63.6%) males with an average age of 63.6±9.3 years, including 489 patients with persistent AF and 567 patients with paroxysmal AF. Fourteen (14/1 056, 1.3%) patients developed SLAS, with an average occurrence time of 2.1±1.1 days after the surgery. The average follow-up time of the whole group was 21.4±7.8 months. Two patients in the SLAS group developed SLAS again after discharge, and the occurrence time was 3 weeks and 4 weeks after the operation, respectively; while no SLAS occurred after discharge in the non-SLAS group. Diabetes and small preoperative left atrial diameter were risk factors for SLAS after surgery. Patients with SLAS had a good prognosis after adequate diuretic therapy. Conclusion The incidence of SLAS after Mei mini maze procedure for AF is low, and it mostly occurs in the early postoperative period. After adequate diuretic treatment, the prognosis is good.
ObjectiveTo summarize the efficacy of clips and staplers for left atrial appendage in the thoracoscopic treatment of atrial fibrillation. Methods The clinical data of patients with atrial fibrillation treated in Xinhua Hospital from 2015 to 2016 were retrospectively analyzed. All patients received Mei's minimally invasive surgery for atrial fibrillation. Among them, patients were recruited in a clip group by clipping the left atrial appendage. The other patients were recruited in a stapler group to resect the left atrial appendage by stapler. Follow-up was conducted by outpatient clinic and telephone. Postoperative heart rhythm was recorded by the patient's symptoms, electrocardiogram and 24 h holter. Cranial magnetic resonance, cardiac CT and echocardiography were performed at least once during follow-up. Results There were 30 patients in the clip group, including 20 males and 10 females, with an average age of 65.7±7.1 years. There were 30 patients in the stapler group, including 20 males and 10 females with an average age of 66.8±5.4 years. All patients successfully received the procedure, with no conversion to thoracotomy or perioperative death. Sinus rhythm was maintained at discharge in 56 (93.3%) patients. Till June 2020, 59 patients were followed up for 42-66 (54.1±7.3) months and 1 patient in the clip group was lost. The residual length of the left atrial appendage was 3.9±1.8 mm in the clip group and 3.9±2.8 mm in the stapler group, and there was no statistical difference between the two groups (P=0.910). Kaplan-Meier curve indicated that there was no statistical difference in the maintenance of sinus rhythm between the two groups (P=0.757). During the follow-up period, all patients had no cerebrovascular adverse events such as stroke or embolism. Conclusion Clipping and resection of the left atrial appendage in thoracoscopic atrial fibrillation surgery are both safe and effective methods, which effectively prevent stroke. The atrial appendage clip makes the minimally invasive surgical intervention of the left atrial appendage safer and more convenient.