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Objective: To investigate the effectiveness and safety of valve surgery in combination with cryoablation in the treatment of atrial fibrillation
Methods: Fifty patients who needed to undergo valve surgery because of heart valve disease and sixtyfive patients who needed to undergo valve surgery in combination with cryoablation were selected as the research subjects. The perioperative technical characteristics, postoperative curative effect and complications were compared between the two different treatment modalities in our hospital between October 2013 and November 2015
Results: No significant differences were observed between the two groups in valve surgery mode, valve type and postoperative length of hospital stay [P>0.05], but the duration of extracorporeal bypass and aorta occlusion of the observation group was longer than that of the control group [P<0.05]. The 3-month, 6-month and one-year atrial fibrillation cardioversion rates of patients in the observation group were superior to those of the control group, and the differences were notable [P<0.05]. The improvement of left atrial diameter of the observation group was also superior to that of the control group [P<0.05]. The incidence of postoperative complications of the two groups had no significant difference [P>0.05]
Conclusion: Valve surgery in combination with cryoablation has favorable short-term clinical effect in the treatment of heart valve disease in combination with atrial fibrillation, which is worth promotion
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Objective To evaluate the efficacy and safety of dexmedetomidine applied in the endovascular stent graft exclusion for aortic dissection . Methods From January 2015 to December 2016, 82 patients with type DeBakey Ⅲ aortic dissection in our hospital were divided into either experimental group or control group according to random number table .In the experimental group, patients were given 15 min infusion of dexmedetomidine at 1 μg/kg, followed by 0.3 μg· kg-1 · h-1 continuous infusion .In the control group , patients were given propofol infusion at 4-6μg· kg-1 · h-1 combined with target controlled infusion of remifentanil at 3-5 μg/L.The two groups were operated under local anesthesia .The Ramsay score, MAP, and SpO2 were observed at baseline time ( T0 ) , anesthesia induction ( T1 ) , skin cut ( T2 ) , and accomplishment of surgery ( T3 ) . Results The Ramsay scores of the experimental group were lower than those of the control group at T 0, T1, T2, and T3[T0:(1.8 ±0.4) points vs.(2.1 ±0.6) points, t=2.664, P=0.009;T1:(2.8 ±0.3) points vs.(5.1 ±0.4) points, t=29.454, P=0.000;T2:(3.0 ±0.5) points vs.(4.8 ± 0.3) points, t=19.766, P=0.000; T3: (2.9 ±0.4) points vs.(3.9 ±0.6) points, t=8.880, P=0.000].The MAP of the experimental group was higher than that of the control group at T 1[(76.2 ±10.1) mm Hg vs.(67.2 ±11.4) mm Hg, t=-3.784, P=0.002],and there was no significant difference at other timepoints between the two groups (P >0.05).The SpO2 of the experimental group at T0, T1, and T2 were higher than those of the control group [T0: (96.0 ±1.0)% vs.(95.0 ±1.5)%, t=-3.552, P=0.000;T1:(95.5 ±1.1)% vs.(90.0 ±1.5)%, t=-18.933, P=0.000; T2: (95.0 ±1.3)% vs.(90.8 ± 1.1)%, t=-15.792, P=0.000].There was no significant difference in SpO 2 at T3 between the two groups(t=0.220,P=0.827).Conclusion Dexmedetomidine can be used safely in aortic dissection stent graft exclusion .
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Objective To observe the protective effect of dexamethasone, the inhibitor of nuclear factor-Kappa B, on the ischemia-perfusion injury of rat lung during the period of lung preservation. Methods Twenty-four rats were randomly divided into two groups: the control group and the trial group. The harvested lung blocks were flushed with and stored in the low-potassium-dextran (LPD) solution in control group, but in the trail group LPD containing dexamethasone solution was used. The lungs were stored at 4 ℃ for 16 h in both groups. The isolated rat lung reperfusion models were established and the donor lungs were perfused for 1 h. PaO_2 and PawP were measured at every 15 min intervals during reperfusion. After reperfusion, the lung tissue wet-to-dry (W/D) ratio and myeloperoxidase (MPO) activity were obtained. The protein and mRNA expression of intercellular adhesion molecule-1 (ICAM-1), nuclear factor-Kappa B (NF-?B) was also detected by using immunohistochemistry and semi-quantitative RT-PCR at the end of reperfusion. Results The levels of decreased PaO_2 and increased PawP in trail group were lower than in control group at the every interval time in the samples obtained 15 min after reperfusion (P
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Objective To evaluate the protective effect by inhibiting nuclear factor-kappa B (NF-?B) by N-acetyl-L-cysteine(NAC) on donor rat lung. Methods 24 SD rats were randomly divided into two groups, the control group and the experiment group. The harvested lung blocks were flushed with and stored in the low-potassium-dextran (LPD) solution in control group, but in the experiment group, LPD solution containing NAC was used. The lungs were preserved at 4℃ for 16 hours in both groups. Isolated rat lung reperfusion models were established and the donor lungs were perfused for 1 hour. PaO_2 and PAwP were measured at every 15 min intervals during reperfusion. After reperfusion, the lung tissue wet-to-dry (W/D) ratio and myeloperoxidase(MPO) activity were obtained. The protein and mRNA expressions of intercellular adhesion molecule-1(ICAM-1) and nuclear factor-kappa B(NF-?B) were also observed by using immunohistochemistry and semi-quantitative RT-PCR at the end of reperfusion. Results After reperfusion for 60 minutes, in experiment group, PaO_2 drop in and increase PAwP lower than in control group (P
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Objective To summarize the experiences of reoperations on Ebstein's anomaly. Methods Clinical data of 17 cases of Ebstein's anomaly (6 males and 11 females, aged from 3 to 54 years old, averaged 23) were analyzed retrospectively. All the patients felt short breath and palpitation after exertion, and cyanosis was found in two patients. In the first operation, downwards displaced tricuspid valve leaflet was suspended and atrialized right ventricle was replicated in 14 cases, tricuspid anuloplasty and atrial septal defect were repaired in 2 cases, and tricuspid valve was replaced in 1 case. The interval time between two operations was 1-20 years in an average of 8 years. Before second operation, the cardiac function was NYHA Ⅱ in 6 cases, NYHA Ⅲ in 11 cases. Eight cases received Ebstein's anomaly anatomic correction, including transplanting downward displaced tricuspid valve and excising atrialized right ventricle. Seven cases received tricuspid valve replacement. Two cases received tricuspid valveplasty. All of operations were performed on arrested heart with moderate hypothermic cardiopulmonary bypass. The time of cardiopulmonary bypass was 70-287 (89.3?11.1)min, the time of aorta clamping was 70-287 (64.0?8.6)min. The transesophageal echocardiography was routinely performed before the operations and after the hearts rebeating. Results No case died in hospital, and all the patients were followed up for 1-3 years. Transesophageal echocardiography showed the tricuspid valve was closed well (non-reflow in 9 cases, mild reflow in 1 case) in 10 cases which received Ebstein's anatomic correction and tricuspid valveplasty. The cardiac function states of patients were significantly improved (NYHA Ⅰ-Ⅱ). Conclusion Most of patients with reoperations on Ebstein's anomaly can received anatomic correction. Tricuspid valve replacement is available if the pathology of tricuspid valve is severe.
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Objective To summarize the experience of perioperative management of coronary artery bypass graft(CABG) in high-risk patients with coronary heart disease.Methods The clinical data of 164 patients underwent CABG from March 2004 to November 2005 were analyzed.Of 164 patients,151(92.05%) cases had severe coronary heart disease.Results Totally 144 artery-vessels and 353 venous-vessels were transplanted to patients.Combined operative procedures included 11 cases of ventricular aneurysm resect,5 cases of valve replacement,5 cases of valve repair,and 1 case of surgical repair of perforation of ventricular septum.Post-operative complications included 2 cases of low cardiac output,1 case of respiratory failure,1 case of renal failure,and 1 case of cerbral infarction.Two patients died and the operative mortality was 1.22%.Conclusion CABG procedure is safe in the treatment of high-risk patients with coronary heart disease.Proper preoperative and perioperative treatment can improve the curative effects significantly.
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112.33mmHg).PaO2 of group B was significantly higher than those of group A after 30 minutes of reperfusion(54.42-118.87mmHg vs 112.33-183.73mmHg,P