Objective To investigate the preoperative design and application of the minimum foveolar translocation distance and angle of macular translocation. Methods The fundus fluorescein and indocyanine green an giographies were performed on 53 eyes of 53 patients with classic subfoveal choroidal neovascularization （SCNV）, including 42 with exudative age-related macular degeneration and 11 with high myopic macular degeneration. The actual area of macular SCNV and the minimum foveolar translocation distance and angle were analyzed. Results The actual area of SCNV was 0.39~18.00 mm2 with the mean of (3.08±3.22) mm2. The designed minimum superior translocation distance was 67~2 240μm with the mean of (845.72±425.23) μm；the minimum designed minimum inferior translocation distance was 53~2 430 μm with the mean of (912.17±547.77) μm. The minimum designed superior translocation angle was 1~32°with the mean of (13.23±6.6 8)°；the minimum designed inferior translocation angle was 1~35°with the mean of (14.06±8.46)°. The individual difference of the minimum designed superior and inferior translocation distance was more than 500 μm in 16 eyes （30.19 % ）, and the difference of translocation angle was more than 10°in 11（20.75%）. Conclusion Preoperative design of minimum translocation distance and angle of macular translocation may be helpful to choose the operation program. (Chin J Ocul Fundus Dis，2004，20：75-77)
ObjectiveTo analyze the effects of cardiovascular surgery on Williams syndrome (WS).MethodsThe clinical data of 68 WS patients undergoing cardiovascular surgery in the Department of Cardiac Surgery, Guangdong Provincial People's Hospital from January 2010 to January 2020 were retrospectively analyzed. There were 48 males and 20 females with a median age of 2.8 years ranging from 3 months to 33 years. Except one patient undergoing the coarctation repair, the rest 67 patients underwent surgical interventions to correct supravalvular aortic stenosis (SAVS) and pulmonary artery stenosis with hypothermic cardiopulmonary bypass, concommitant with 3 patients of relief of left ventricular outflow tract obstruction, 2 patients of relief of right ventricular outflow tract obstruction, 2 patients of mitral valvuloplasty, 3 patients of ventricular septal defect repair and 1 patient of arterial catheter ligation.ResultsTwo (2.9%) patients died of sudden cardiac arrest on the next day after surgery. One (1.5%) patient died of cardiac insufficiency due to severe aortic arch stenosis 3 years after surgery. The effect of SAVS was satisfactory. Two (2.9%) patients progressed to moderate aortic valvular regurgitation during postoperative follow-up. A total of 5 (7.4%) patients were re-intervened after operation for arch stenosis or pulmonary stenosis.ConclusionWS patients should be diagnosed early, followed up and assessed for cardiovascular system diseases, and timely surgical treatment has a good clinical effect.
ObjectiveTo evaluate the effectiveness of mitral valve repair for mitral regurgitation.
MethodsWe retrospectively analyzed the clinical data of 47 patients underwent mitral repair in General Hospital of Ningxia Medical University between January 2010 and June 2014 year. There were 36 males and 11 females with age of 10 months to 65 years, mean age of 42.38±15.27 years.
ResultsThere was no operative death within follow-up time of 18±7 months (ranged 14 to 1 586 days). Mitral valve function was normal or traces regurgitation in 33 patients (70.21%). Mild mitral regurgitation occurred in 11 patients (23.40%). Postoperative transesophageal echocardiography showed that 2 patients (4.26%) had moderate regurgitation. They underwent mitral valve repair again and cured. One patient (2.13%) underwent mitral valve replacement because of moderate to severe regurgitation. The dimensions of left atrium and left ventricle obviously decreased and heart function improved significantly compared with preoperative ones.
ConclusionStrict control of surgical indications for different valve disease, the use of mitral valve repair technique, mitral surgery can get a good clinical efficacy. Preoperative diagnosis by transesophageal echocardiography, intraoperative monitoring, and immediate postoperative assessment for mitral valve repair results provide good technical support.
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.
Transcatheter aortic valve replacement (TAVR) techniques have been rapidly developed in recent years. Current guidelines and studies mainly focus on aortic stenosis patients treated by transfemoral approach, but they are not completely appropriate to patients with isolated aortic regurgitation or other patients who need transapical TAVR (TA-TAVR), which affects the standardized treatment of those patients. Therefore, our team pronounced the operational standards for TA-TAVR, based on fully reviewing the literatures worldwide, combined with the opinions of experts from 15 heart centers with rich experience in carrying out TA-TAVR in China. This standard aims to provide clinicians with standardized diagnosis and treatment principles of TA-TAVR and improve the quality of TA-TAVR in China.
ObjectiveTo review retrospectively our experience of the diagnosis and surgical treatment in patients with abdominal aortic aneurysm(AAA).MethodsThe diagnosis and surgical treatment in 72 patients 〔62 men, 10 women; mean age (67.5±9.3) years)〕 with AAA from January 1995 to February 2004 were analyzed. Fifty-eight patients with infrarenal AAA and 2 patients with suprarenal AAA underwent elective graft replacement operation; 12 patients with ruptured AAA underwent urgent graft replacement operation. ResultsFiftyeight patients with infrarenal AAA and 2 patients with suprarenal AAA were cured and 2 patients with infrarenal AAA died of multiple organ failure after elective graft replacement operation, the 30day mortality rate in patients with infrarenal AAA after elective operation was 3.45%. Seven patients were cured and 5 patients died of multiple organ failure after urgent graft replacement operation, the 30-day mortality rate was 41.67%. ConclusionThe elective graft replacement operation in patients with AAA is a safe and effective surgical approach under the improvement of surgical technique and management of perioperative period.
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.
ObjectiveTo investigate the prognostic impact of tumor location in gallbladder carcinoma in different sites and evaluate the effect of surgical operation on the median survival time of patients.MethodsFrom 2012 to 2016, 382 patients with gallbladder cancer in the Eastern Hepatobiliary Surgery Hospital were divided into 163 cases of gallbladder duct cancer and 219 cases of gallbladder bottom and body cancer. They were received radical resection, extended radical resection and palliative resection.ResultsThe mean survival time was (19.57+15.63) months in the bottom and body cancer group, (14.62+11.12) months in the cystic duct carcinoma group, and the survival time was significantly different between the two groups (P<0.05). After radical surgery, the mean survival time in the cystic duct carcinoma group and the bottom and body cancer group were (23.82±12.47) months and (30.63±17.81) months, respectively, there was no significant difference between the two groups (P>0.05). The multivariate analysis indicated that tumor location, surgical radical therapy, clinical stage, pathological grade, and pathological classification were all independent risk factors influencing the prognosis of patients (P<0.05). There was no significant difference in median survival time between the two groups (P>0.05).ConclusionsThe prognosis of patients with cystic duct gallbladder carcinoma is worse than that of patients with the bottom and body cancer of the gallbladder, but the prognosis of the two groups after radical resection is similar. The prognosis of patients with extended radical operation according to the condition is similar to that of routine radical operation. There are some differences in clinical stage, pathological grade and pathological classification between the two groups of gallbladder cancer patients. In addition, the great differences exist in the surgical methods, especially in extended radical operation. Therefore, the treatment of gallbladder cancer in these two locations should be treated differently.
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.
Objective
By using a newly developed animal model of limited macular translocation (LMT) in rabbit eyes, to explore the complications,indications and predictability of LMT.
Methods
LMT models were performed in 15 rabbit eyes, and were divided into 4.5 mm group and 3.5 mm group by the length of scleral shortening.The effect of retinal translocation (distance and direction) and its complications were analyzed. In a separated group, postoperative corneal astigmatism was studied after release of scleral shortening suture 1 month after LMT. In order to study the impact of neuroretina-retinal pigment epithelium (RPE) adhesion on LMT, retinas and choroids in 4 pigmented rabbit eyes were pretreated with photocoagulation.
Results
Success rate of LMT was 86.7%. In these cases, retinal translocations were achieved［(distance of 610 to 2690 μm, [AKx-]±s=(1395±636)μm; translocation angle α of 10-38°, [AKx-]±s=(22.7±8.3) °］. The difference in scleral shortening between 4.5 mm and 3.5 mm groups did not significantly influence the final translocation. Major complications of LMT included intraocular bleeding, retinal break, and corneal astigmatism. Release of scleral shortening suture reduced corneal astigmatism and made it more regular, meanwhile, retinal translocation did not regress. The neuroretina-RPE adhesion induced by retinal photocoagulation made neuroretinal hydrodissection difficult, and led to retinal break readily.
Conclusion
Sufficient LMT models in rabbit eye were obtained with few postoperative complications. Direction of retinal translocation is an important factor influencing the effect of LMT, except for distance. Release of scleral shortening suture can effectively reduce corneal astigmatism without causing regression of retinal translocation. For the patients with a history of macular or para-macular photocoagulation, LMT should be performed carefully.
(Chin J Ocul Fundus Dis, 2002, 18: 203-207)
