博士
國立臺灣大學
生理學研究所
93
Ischemic preconditioning (IPC) has been widely explored in various experimental models for more than 10 years and it has been also observed in several organs other than the heart. ...The concept of intraorgan “remote preconditioning” (RPC) has been previously advocated in heart to reduce the infarct size. The concept of intraorgan RPC had beem extended to the interorgan RPC. Skeletal RPC seemed to be a good way for myocardial protection, but some controversial data still exists and no further mechanism was investigated. The aim of this thesis was to investigate the effect of skeletal ischemia/reperfusion on myocardial infarction and the role of free radicals.
First, skeletal RPC was designed in rats by repeated 4-cycle 10-min ischemia-reperfusion of femoral artery. Four experimental groups were included: I, sham group; II, RPC only; III, infarction only; IV, incorporating both RPC and infarction. Chemiluminescence study showed significant elevation of free radical in groups II and IV, and pre
Acute traumatic aortic transection is a critical condition in victims of major trauma. How to avoid the complications of surgical repair is still a challenge to trauma and cardiovascular surgeons. A ...74-year-old woman was referred to our hospital with multiple fractures and hypotension after a motor vehicle accident. Computed tomography revealed acute traumatic aortic transection at the upper thoracic aorta with periaortic hematoma. She underwent repair of the aortic injury after primary survey. The patient received urgent aortic grafting under heparin-free extracorporeal membrane oxygenation support for lower body perfusion. The postoperative course was smooth. No neurologic or hemorrhagic complication was noted. The results of this case indicate that extracorporeal membrane oxygenation could be used as a heparin-free partial bypass system during surgery for traumatic aortic transection. The risk of spinal cord ischemia during aortic clamp or bleeding due to heparinization during conventional cardiopulmonary bypass could be minimized.
Persistent truncus arteriosus (PTA) is a rare congenital heart disease. The disease spectrum and outcome in the Oriental are still unclear.
A total of 35 patients with PTA were identified from the ...Pediatric Cardiology Database of this institution, giving an incidence of 0.47%. According to the Van Praagh classification, we found type A1 in 16, A2 in 10, A3 in 4 and A4 in 5 patients. The most common truncal valves were still tricuspid (57.1%) and quadricuspid (28.5%), with the latter being associated with moderate to severe truncal regurgutation. Eleven patients had not received surgery and all died. We classified the era of operation as early (between 1980 and 1995) or late (1996-2001), and further classified the type of PTA as simple (type A1 or A2) or complex (interrupted aortic arch-A4, absent orifice of one PA from truncal root-A3 or moderate truncal valve insufficiency). The overall surgical mortality was 67%. Statistical analysis revealed that age at operation (older than 6 months), early operation era and complex PTA were risk factors for survival.
PTA is a rare form of congenital heart disease in Taiwan and probably also in the Oriental. The surgical reparation seems to improve with experience. Early operation may prevent pulmonary vasculopathy. However, the results in complex PTA remain poor.
Arterial switch operation (ASO) is considered the procedure of choice for transposition of great arteries (TGA). The results and long-term prognosis improved with recent advances in perioperative ...management. We herein analyze the clinical outcome of patients undergoing ASO at our institution during the past 3 years. From 2000 to 2002, 44 patients (30 male and 14 female) of TGA received ASO. Age at operation varied from 4 days to 6.6 years (median 14 days) with body weight ranged from 2.25 kg to 18.1 kg (median 3.3 kg). Palliative procedure prior to ASO was performed in 8 patients (18.8%). Normal coronary artery pattern was found in 28 patients (63.6%). The early mortality was 11% (5/44). Only associated ventricular septal defect (VSD) was a significant predictor for operative mortality (p=0.012). With a follow-up ranged from 11 to 44 months, the gradient of neo-pulmonary artery stenosis was 16.5 +/- 18.2 mmHg. Four patients (10%) received balloon dilatation and the other three (7.7%) underwent reoperation. The gradient of neo-aortic stenosis was 16.5 +/- 18.2 mmHg that needed to be dilated in three patients (7.7%). The probability free from reintervention was 73% at the 3rd postoperative year. One patient had moderate degree of pulmonary valve regurgitation and six had moderate neo-aortic valve regurgitation. In conclusion, the ASO can be performed in infants with satisfactory results, even in those with a body weight less than 2.5 kg. Only associated VSD was shown to be a risk factor.
Off-pump coronary artery bypass grafting (CABG) OPCAB is preferred to conventional CABG with cardiopulmonary bypass (CPB) for many specific subgroups, such as elderly patients and high-risk patients. ...Whether OPCAB should be the first choice of surgical procedure for a wider range of coronary artery disease patient subgroups remains controversial. The purpose of this study was to compare the clinical results of OPCAB and CPB in our hospital.
We retrospectively analyzed the results for 404 patients who received OPCAB or CPB between March 2000 and December 2001. Surgical methods adopted were at the discretion of the attending surgeon. In addition, subgroups of patients were analyzed to assess whether or not OPCAB was more successful in patients with specific characteristics.
There were no significant differences in the demographic data between the 2 groups. The perioperative mortality rate was similar for the CPB and OPCAB groups (2.5% and 2.0%, respectively; p = 1.00.) OPCAB was superior with respect to inotropic use, postoperative bleeding amount, transfusion amount, and length of intensive care unit and hospital stay (p < 0.05 for all), and also had a lower incidence of re-entry due to bleeding (6.7% vs 13.6%, p = 0.04) and prolonged hospitalization > 30 days (1.5% vs 10.8%, p < 0.01). At 12 months' follow-up, the OPCAB group had a lower rate of mortality (1.5% vs 5.6%, p = 0.03) and a comparable rate of readmission for cardiac reasons (6.6% vs 9.6%, p = 0.28). The rate of poor in-hospital outcome was lower in the OPCAB than in the CPB group (3.0% vs 13.3%, p </= 0.01), while the percentage with poor results on follow-up was comparable between the 2 groups (7.1% vs 12.1%, p = 0.09). In addition, subgroups defined as: female, age > 65 years, age < 65 years, diabetes, peripheral arterial occlusive disease, end-stage renal disease, left ventricular ejection fraction < 50%, preoperative intra-aortic balloon pump use, and left-main disease had better in-hospital outcome in the OPCAB group compared with the CPB group, while no subgroups had worse in-hospital outcomes with OPCAB. The 12-month follow-up outcome was similar with the 2 techniques.
Use of OPCAB in CABG operation was associated with improved in-hospital outcome and similar follow-up outcome compared to CPB. No subgroup had a worse outcome with OPCAB.
