Biomedical subjects

Li-Zhong Sun

Publications and source records attributed to Li-Zhong Sun.

4 recordsLinked to original sources

PubMed2006

One-stage total or subtotal aortic replacement.

BACKGROUND: The goal of total aortic resection surgery is to correct the extensive or multiple sites of aortic pathology, which involves the entire length of the vessel. This study describes our experience in this operation at Fuwai Cardiovascular Hospital. METHODS: From February 2004 to October 2005, thirteen patients with Marfan syndrome underwent one-stage total or subtotal aortic replacement for aortic dissection or aortic aneurysms. Four patients received subtotal aortic replacement (ascending aorta to the abdominal aorta). Nine patients underwent total aortic replacement (ascending aorta to the aortic bifurcation). Operations were performed under circulatory arrest with profound hypothermia. Patients were opened with a mid-sternotomy and a thoracoabdominal incision. Extracorporeal circulation was instituted with two arterial cannulae and a single venous cannula in the right atrium. During cooling, the ascending aorta or aortic root was replaced. At the nasopharyngeal temperature of 20 degrees C, the aortic arch was replaced with selective antegrade cerebral perfusion. After brain reperfusion, staged aortic occlusions allowed for replacement of descending thoracic and abdominal aorta. Intercostal, visceral, and renal arteries were anastomosed to the graft. RESULTS: There was no operative or early postoperative death. One case of postoperative complication was noted for cerebral infarction secondary to embolism. Spinal neurologic deficits did not occur. At the last follow-up, ranging from 4 to 24 months postoperatively, all 13 patients were alive and had good functional status. CONCLUSIONS: One-stage total or subtotal aortic replacement for treatment of extensive aortic disease is feasible with acceptable surgical risks and satisfactory results. It can eliminate the risk of remnant aortic aneurysm rupture in staged total aortic replacement.

Adult↗

PubMed2006

Minimal access heart surgery via lower ministernotomy: experience in 460 cases.

Minimally invasive cardiac surgery has captured the interest and attention of cardiac surgeons throughout the world. We reviewed our experience of minimal access cardiac operations performed through a lower median ministernotomy. Between January 1997 and August 2003, 100 congenital, 178 valvular, 168 coronary, 12 aneurysmal, and 2 other operations were performed via a 6 to 9 cm lower ministernotomy in 460 consecutive patients. No special instruments were required. Four patients died, and 2 re-operations were necessary. Complications occurred in 28 patients (6.1%). The mean cardiopulmonary bypass time was 88.50 +/- 65.16 min, crossclamp time was 55.81 +/- 31.89 min, time to extubation was 14.71 +/- 29.33 h, and total chest drainage was 7.28 +/- 5.07 mL.kg(-1). Blood transfusions of 951.42 +/- 642.34 mL were needed in 282 patients. Postoperative hospital stay was 11.6 +/- 6.0 days. Our experience shows that many types of cardiac operations can be performed through a lower ministernotomy. This technique results in less trauma, quick recovery, and reduces the risk of infection and blood loss. It is a safe and easy procedure that can bring about favorable early outcomes in a wide range of cardiac operations.

Adolescent↗

PubMed2005

Should the "elephant trunk" be skeletonized? Total arch replacement combined with stented elephant trunk implantation for Stanford type A aortic dissection.

OBJECTIVES: To eliminate the residual false lumen in the descending thoracic aorta and improve long-term outcomes of surgical intervention for Stanford type A aortic dissection, we performed the skeletonized "elephant trunk" procedure in the ascending aorta and aortic arch replacement combined with transaortic stented graft implantation into the descending aorta for both acute and chronic type A aortic dissection, and the short-term results were compared. METHODS: Between April 2003 and November 2004, 60 consecutive patients (mean age, 53 +/- 16.7; approximate range, 28-78 years) with acute (n = 36) or chronic (n = 24) type A aortic dissection underwent this procedure. Right axillary artery cannulation was used for cardiopulmonary bypass and selected cerebral perfusion. The stented graft, a 10-cm-long woven Dacron graft with a self-expandable stent, was implanted through the aortic arch during hypothermic circulatory arrest. Enhanced electric beam computed tomography was performed in each patient before discharge, 3 months after the operation, and once each year thereafter to evaluate the postoperative time course of the residual false lumen. RESULTS: Cardiopulmonary bypass time was 166 +/- 38 minutes, and average selective cerebral perfusion and lower body arrest time was 30 +/- 15 minutes. The in-hospital mortality was 3.3% (2/60). Thrombus obliteration of the residual false lumen in the descending thoracic aorta was observed in 92% and 85% of the acute and chronic aortic dissections, respectively, 3 months postoperatively. There was no late death during follow-up. CONCLUSIONS: The skeletonized elephant trunk procedure is an effective way of closing the residual false lumen of the descending aorta and might contribute to better long-term outcomes for both acute and chronic type A aortic dissection.

Acute Disease↗

PubMed2005

Correction of traumatic tricuspid insufficiency using the double orifice technique.

Traumatic tricuspid insufficiency is an uncommon clinical condition and surgical procedures vary. In this paper we report our experience in treating traumatic tricuspid insufficiency using the double orifice technique. From January 2000 to September 2003, 10 patients with traumatic tricuspid regurgitation were admitted to our hospital, 5 of whom were corrected using the double orifice technique. There were 4 males and 1 female with ages ranging from 31 to 52 years. Preoperative transthoracic echocardiography (TTE) detected severe tricuspid regurgitation in 4 patients and moderate tricuspid regurgitation in 1 patient. At surgery, tear of the tricuspid anterior papillary muscle was found in 2 cases and anterior chordal rupture in 3 cases. The valves were successfully repaired using the double orifice technique in combination with ring annuloplasty. There was no repeat operation, no operative complications or deaths. Before discharge, TTE detected normal tricuspid valve function in 2 cases and tiny regurgitation in 3 cases. After a follow up of 8 to 36 months, TTE demonstrated normal valve function in 1 patient and tiny regurgitation in 4 patients. The double orifice technique appears to be a simple but effective method of repairing traumatic tricuspid incompetence. Satisfactory clinical outcomes can be produced in carefully selected patients.

Adult↗