Objective To investigate the value of systemic-normothermic/cardiac-hypothermic cardiopulmonary bypass（CPB）on operation of congenital heart disease. Methods Thirty patients of congenital heart disease were randomly divided into two groups, the normothermia group（n=15）and hypothermia group（n=15）. The changes of CPB time, aortic cross-clamp time,operation time and postoperative drainage and the value of blood cell were observed. Results The duration of CPB （37. 5 ±11. 6rain vs. 51. 6± 12. 0 min, P〈0. 05） and operation time （2.2± 0.6h vs. 2. 7±0. 5h, P〈0. 01） in normothermia group were shorter than those of hypothermia group statistically, the differences of postoperative drainage and the value of blood cells between two groups were not statistically significant. Conclusion The use of systemic-normothermic/cardiac-hypothermic CPB on operation of congenital heart disease shows that the time of operation is shorter remarkly , and it could be clinically used safely.
Objective To analyze the effect of myocardial protection between modified Del Nido cardioplegia and St. Thomas Hospital Cardioplegia in adult patients with aortic valve and mitral valve replacement. Methods From January 2014 to June 2016, 140 patients underwent aortic valve and mitral valve replacement in our hospital. According to different cardioplegia, the patients were divided into two groups including a modified Del Nido cardioplegia group (70 patients, 37 males, 33 females at mean age of 53.13±9.52 years) and a St. Thomas cardioplegia group (70 patients, 32 males, 38 females, at age of 50.71±9.29 years). We collected clinical data of the patients before operation (T1), 2 h after aortic unclamping (T2), 24 h after operation (T3) and 48 h after operation (T4). Indexes of muscle enzymes including blood center creatine kinase (CK), creatine kinase isoenzyme (CK-MB) concentration and liver function indexes including urea nitrogen (BUN), creatinine (Cr), alanine aminotransferase (ALT), aspartate aminotransferase (AST) concentrations, and compared the postoperative and follow-up clinical data. Results There was no statistical difference in age, weight, gender, ejection fraction baseline data between the two groups (P>0.05). All patients were successfully completed combined valve replacement under cardiopulmonary bypass. The cardiopulmonary time was no statistical difference between the two groups (P>0.05). However, compared with St. Thomas cardioplegia group, modified Del Nido group was less in perfusion (1.19±0.39vs. 2.99±0.75, P<0.001), shorter in aortic clamping time (P=0.003). No statistical difference was found in defibrillation rate after resuscitation between the two groups (P=0.779). Biochemical indicators were not statistically different at different time points between the two groups (P>0.05). Conclusion Modified Del Nido cardioplegia has the same effect on myocardial protection with St. Thomas cardioplegia in adult patients. It reduces the frequency of reperfusion, and shortens the clamping time. There is no additional injury in the important organs such as liver, kidney. Modified Del Nido cardioplegia myocardial protection ability in adult heart valve surgery is feasible.
Objective To investigate the effects on myocardial perfusion of simultaneous antegrade/retrograde cardiopiegia （SARC） through a single coronary artery and coronary sinus （CS）. Methods SARC was conducted in isolated pig hearts through CS in conjunction with the left anterior descending （LAD）, the left circumflex （LCX）, or the right coronary artery （RCA） respectively. After injecting magnetic resonance （MR） contrast agent （gadolinium diethyienetriamine pentaacetic acid, Gd-DTPA） into arterial or venous route, the distribution of Gd-DTPA with magnetic resonance imaging（MRI） was monitored and the effluent from the venting coronary arteries to assess the efficacy of SARC for myocardial perfusion was measured. Results Injection of Gd-DTPA into a perfusing artery during SARC resulted in increased signal intensity not only in the territory of the perfusing artery but also in the areas normally served by the other two venting coronary arteries （including the right ventrieuiar free wall）. With Gd DTPA given into the CS during SARC, the myocardium in the territories of the two venting coronary arteries was lightened. Signal intensity of the myocardium in the perfusing artery territory and right ventricuiar free wall remained unchanged. Moreover, a significant amount of effluent was collected from the venting coronary arteries during SARC： the LAD 10.5-17.7 ml/min; LCX 9.7-15.2 ml/min, and RCA 4.7-7.8 ml/min. Conclusion SARC through a single coronary artery and CS can provide homogeneous perfusion to the entire heart and is sufficient to prevent ischemic injury in the myocardium normally supported by the venting coronary arteries.
Objective\ In order to assess and evaluate the clinical results of cold blood cardioplegia and intermittent cross clamping as myocardial preservation in coronary artery bypass grafting(CABG).\ Methods\ According to the management methods, 2 013 cases for elective, isolated CABG were divided into two groups at St.George’s Hospital, London.Cold blood cardioplegia group: 596 patients treated with cold blood cardioplegia, and hypothermic ventricular fibrillation group: 1 417 patients treated with intermitt...
Objective To investigate the protective effects of metallothionein （MT） for immature myocardium and myocardial interstitium.Methods Twenty-four rabbits （aged 14-21 days） were divided into 4 groups with random number table, 6 each group. Distilled water was injected intraperitoneally in control group and 3.6% ZnSO4 （1.5 ml/kg） was injected intraperitoneally in group 1, group 2 and group 3. Control group, group 1, group 2 and group 3 isolated working rabbit heart model were used in 24h, 12h, 24h and 48h after intraperitoneally respectively. The MT content, recovery of hemodynamics, biochemistry and myocardial ultrastructure were tested. Results The MT content, hemodynamics recovery, adenosine triphosphate （ATP） content, superoxide dismutase activity, Ca2＋-ATPase activity, synthesizing ATP activity of mitochondria, hydroxyproline in group 2 and group 3 were higher than those in control group and group 1 （P 〈 0. 01）. The myocardial watery content, creatine kinase and dehydrogenase leakage, malondialdehyde content, endothelin, mitochondrial Ca2＋ content in group 2 and group 3 were lower than those in control group and group 1（P〈0.01）. The myocardial ultrastructure injuries were less in group 2 and group 3 than that in control group and group l. Conclusion This study demonstrates that myocardial MT prolonged expression can be induced by ZnSO4 and the ischemia-reperfusion injury of immature myocardium and myocardial interstitium could be reduced by MT.
Abstract： Objective To observe myocardial protective effect of sevoflurane used in the whole process of cardiopulmonary bypass（CPB）. Methods A total of 150 patients older than 18 years who underwent cardiac surgery under CPB in Fu wai Hospital from January 2010 to November 2011 were enrolled in this double-blind and randomized controlled study. All the patients were randomly divided into three groups：Sevoflurane pretreatment group （Group A，n=50），whole-process Sevoflurane group （Group B，n=50），and whole-process intravenous anesthesia group （Group C，n=50）. Radial artery pressure and other hemodynamic parameters were continuously measured for all the patients. At following time points: CPB beginning （T1），aortic declamping （T2），3 hours after aortic declamping （T3），and 24 hours after aortic declamping （T4），serum concentrations of cardiac troponin I （cTnI） and other parameters were measured by enzyme-linked immunosorbent assay （ELISA）. Results There were 31 males and 19 females at age of 60.43±3.24 years in group A，28 males and 22 females at age of 59.88±4.12 years in group B，31 males and 19 females at age of 58.76±3.87 years. There was no statistical difference in mean arterial pressure （MAP），central venous pressure （CVP），pulmonary artery wedge pressure （PAWP） and heart rate （HR） at respective time points among the 3 groups （P＞0.05）. At T1 and T2，there was no statistical difference in cardiac index （CI） among the 3 groups （P＞0.05）. At T3，there was no statistical difference in CI between Group A and Group C（F=3.382，P=0.845），but CI of Group B was significantly higher than that of Group A and C（F=3.382，3.382； P=0.033，0.020）. At T4，CI of Group B was significantly higher than that of Group A and C （F=13.324，13.324； P=0.005，P=0.000），and CI of Group A was significantly higher than that of Group C （F=13.324，P=0.024）. At T1 and T2，there was no statistical difference in serum concentrations of creatinine kinase MB （CK-MB），cTnI，interleukin-6 （IL-6） and tumor necrosis factor alpha （TNF-α） among the 3 groups （P＞0.05）. At T3 and T4，serum concentrations of CK-MB，TNF-α，IL-6 and cTnI of Group C were significantly higher than those of Group A，and serum concentrations of CK-MB，TNF-α，IL-6 and cTnI of Group A were significantly higher than those of Group B （F=531.616，5.410，3.5813，3.160，1.126，4.702，7.819，5.424，all P=0.000）. Conclusion Sevoflurane used in the whole process of CPB has definite myocardial protective effect which is ber than that of Sevoflurane pretreatment.