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Objective: To explore the efficacy and safety of percutaneous transluminal pulmonary angioplasty (PTPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Methods: This prospective single arm study included 19 CTEPH patients (7 male, age(56.3±12.5)years) admitted to Wuhan Asia Heart Hospital from January 2017 to June 2019 and received PTPA interventional therapy. Baseline data, including age, sex, WHO functional class, 6-minute walk distance (6MWD), NT-proBNP, right heart catheterization values, were collected. Patients received single or repeated PTPA. Number of dilated vessels from each patient was analyzed, patients were followed up for 24 weeks and right heart catheterization was repeated at 24 weeks post initial PTPA. All-cause death, perioperative complications, and reperfusion pulmonary edema were reported. WHO functional class, 6MWD, NT-proBNP, right heart catheterization values were compared between baseline and at 24 weeks follow up. Results: Nineteen CTEPH patients received a total of 56 PTPA treatments. The pulmonary artery pressure (mPAP) decreased from (40.11±7.55) mmHg (1 mmHg=0.133 kPa) to (27.53±4.75) mmHg (P<0.001), and the total pulmonary resistance (TPR) decreased from (13.00±3.56) Wood U to (5.48±1.56) Wood U (P<0.001), cardiac output increased from (3.19±0.63) L/min to (5.23±0.94) L/minutes (P<0.01) at 24 weeks post PTPA. The WHO functional class improved significantly (P<0.001), 6MWD increased from (307.08±129.51) m to (428.00±112.64) m (P=0.002), the NT-proBNP decreased at 24 weeks post PTPA (P=0.002). During the follow-up period, there was no death; hemoptysis occurred in 4 patients during the operation, none of which resulted in serious adverse clinical consequences. One patient developed reperfusion pulmonary edema and recovered after treatment. Conclusion: PTPA treatment is safe and can significantly improve the hemodynamics and WHO functional class of patients with CTEPH.
Subject(s)
Adult , Aged , Humans , Male , Middle Aged , Angioplasty , Angioplasty, Balloon , Chronic Disease , Hypertension, Pulmonary/surgery , Prospective Studies , Pulmonary Artery/surgery , Pulmonary Embolism , Treatment OutcomeABSTRACT
OBJECTIVE@#To study the effect of calorie-enriched formula on postoperative catch-up growth in infants with cyanotic congenital heart disease (CHD).@*METHODS@#A total of 100 infants with cyanotic CHD who underwent surgical operation from January to December, 2017, were randomly divided into a high-calorie group (receiving calorie-enriched formula after surgery) and a conventional group (receiving standard formula after surgery), with 50 infants in each group. All infants were followed up for 6 months. The observation indices included body height, body weight, prealbumin, and N-terminal pro-brain natriuretic peptide before surgery, at the time of ventilator weaning and extubation after surgery, and at 1, 3, and 6 months after surgery. Height-for-age Z-score (HAZ), weight-for-age Z-score (WAZ), and weight-for-height Z-score (WHZ) were also assessed. Adverse reactions were recorded for both groups.@*RESULTS@#There were 25 cases (50%) and 21 cases (42%) of malnutrition in the high-calorie group and the conventional group respectively before surgery (@*CONCLUSIONS@#Compared with the standard formula, calorie-enriched formula can better help with postoperative catch-up growth in infants with cyanotic CHD.
Subject(s)
Humans , Infant , Body Weight , Energy Intake , Heart Defects, Congenital/surgery , Malnutrition , Nutritional Status , Prospective StudiesABSTRACT
With the development of the imaging and interventional techniques, hybrid procedure for patients with congenital heart disease has become a new trend. The hybrid procedure has minimized the surgical complications, and offers more surgical opportunities to those who with complicated congenital heart disease. But there are some problems as the new approach develops fast. The author addresses a couple of opinions based on his clinical practice.
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OBJECTIVE: To compare the predictive value of Ees/Ea in patients with pulmonary arterial hypertension based on right cardiac catheterization and cardiac magnetic resonance examination. METHODS: A total of 50 pulmonary arterial hypertension patients confirmed by right heart catheterization were retrospectively reviewed and followed up 2 years. The relationship between the baseline clinical data and survival prognosis of patients with pulmonary arterial hypertension were analyzed. The predictive value of baseline Ees/Ea for prognosis in patients with pulmonary arterial hypertension were compared. RESULTS: The Ees/Ea calculated by volume method was significantly correlated with the prognosis of patients with pulmonary arterial hypertension(OR =0.082, 95%CI 0.009-0.814, P=0.032). The two-year survival rate of group Ees/Ea>0.67 was significantly higher than that of Ees/Ea≤0.67(86.7% vs. 50%, P=0.003). Conclution Ees/Ea calculated by volume method is an independent influence factor of the survival prognosis of patients with pulmonary arterial hypertension. When Ees/Ea≤0.67, the patients with pulmonary arterial hypertension is more likely to deteriorate.
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Objective To compare the clinical effect of video-assisted thoracoscopic surgery and traditional surgery on patients with thymoma. Methods 52 patients with thymoma were randomly divided intoexperimental group and control group each with 26 cases. The control group received the traditional surgical method. The experimental group was treated by video-assisted thoracoscopic surgery. To compare the two groups of patients with intraoperative blood loss, surgical incision, operation time, analgesic drug use, hospital stay and complications and other indicators. Results The intraoperative blood loss, incision size and the amount of analgesic drug application of the experimental group were significantly smaller than those of the control group(P<0.05). The operation time and hospitalization time were significantly shorter than those of the control group. The complication was significantly lower than the control group, the difference was statistically significant(P<0.05). Conclusion Video - assisted thoracoscopic surgery is safe and reliable in the treatment of thymoma. It has the characteristics of less trauma, quick recovery, less pain and less complication. It should be widely used in clinical practice.
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Objective To compare the clinical effect of video-assisted thoracoscopic surgery and traditional surgery on patients with thymoma. Methods 52 patients with thymoma were randomly divided intoexperimental group and control group each with 26 cases. The control group received the traditional surgical method. The experimental group was treated by video-assisted thoracoscopic surgery. To compare the two groups of patients with intraoperative blood loss, surgical incision, operation time, analgesic drug use, hospital stay and complications and other indicators. Results The intraoperative blood loss, incision size and the amount of analgesic drug application of the experimental group were significantly smaller than those of the control group(P<0.05). The operation time and hospitalization time were significantly shorter than those of the control group. The complication was significantly lower than the control group, the difference was statistically significant(P<0.05). Conclusion Video - assisted thoracoscopic surgery is safe and reliable in the treatment of thymoma. It has the characteristics of less trauma, quick recovery, less pain and less complication. It should be widely used in clinical practice.
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<p><b>OBJECTIVE</b>To investigate the long-term effect of bosentan on outcome in patients after Fontan operation.</p><p><b>METHODS</b>Patients after Fontan surgery were randomly divided into bosentan group (B, n = 16) and control group (C, n = 23). Bosentan was applied within 7 days after Fontan surgery as follows: at the first month, 7.8125 mg Bid for patients with body weight ≤ 10 kg; 15.625 mg Bid for patients with body weight between 10-20 kg; 31.25 mg Bid for patients with body weight 20-30 kg and 62.5 mg Bid for patients with body weight > 30 kg. At the second month, the bosentan dose was doubled and Bosentan therapy was continued for more than 1 year. Group C didn't take drugs affecting pulmonary artery pressure. All patients were followed up for 2 years and incidence of mortality, protein losing enteropathy, pulmonary arteriovenous fistulae, 6-minute walk test, heart function were compared between the two groups.</p><p><b>RESULTS</b>After 2 years, mortality tended to be lower in group B compared to group C [6.25% (1/16) vs. 21.8% (5/23), P > 0.05]. Incidence of pulmonary arteriovenous fistulae and protein losing enteropathy were significantly lower in group B than in group C (6.25% vs. 34.78%, P = 0.01;6.25% vs. 39.13%, P = 0.02, respectively) . The results of 6-minute walk test[ (485 ± 44) m vs. (302 ± 183) m] and heart function in group B (3 NYHA III/IV patients in group B vs. 14 NYHA III/IV patients in group C, all P < 0.05) were all better than group C. The concentrations of vasoactive factors such as brain natriuretic peptide (BNP, 279.07 ± 128.17 vs. 457.67 ± 221.30), endothelin (ET, 3.30 ± 0.61 vs. 4.98 ± 1.24) and thromboxane (TXA2, 97.2 ± 24.0 vs. 163.22 ± 24.4) were also significantly lower in group B than in group C (all P < 0.05). Prostacyclin (PGI2) level and incidence of arrhythmias were similar between the two groups. There was no thrombotic event in both groups during follow up.</p><p><b>CONCLUSION</b>Bosentan trerapy in patients post Fontan operation could reduce the incidence of pulmonary arteriovenous fistulae and protein losing enteropathy and improve heart function.</p>