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Objective To verify the biomechanical stability of oblique lateral interbody fusion ( OLIF) combinedwith different fixation methods for treating degenerative lumbar scoliosis (DLS) by three-dimensional (3D) finite element analysis. Methods The L1-S1 3D finite element DLS model ( Model 1) was established, and then the OLIF (L2-5) at 3 contiguous levels of fusion and its combination with different internal fixation methods were simulated, namely, stand-alone OLIF model ( Model 2), vertebral screw fixation model ( Model 3), unilateral pedicle screw fixation model (Model 4) and bilateral pedicle screw fixation model (Model 5) were established,respectively. Under upright, flexion, extension, lateral bending and axial rotation states, range of motion (ROM) of fusion segments, as well as cage stress, internal fixation stress, and stress distribution were recorded and analyzed. Results Under six motion states, the overall ROM of fusion segments in Models 2-5 was smaller than that of Model 1. Compared with Model 1, the overall ROM reduction of Model 3 and Model 4 was larger than that of Model 2 and smaller than that of Model 5. Under flexion and extension, the overall ROM reduction of Model 4 and Model 5 was basically equal. Under left and right lateral bending, the overall ROM reduction of Model 3 and Model 5 was basically equal. Under all motion states, the peak stress of Model 3 and Model 4 fusion cage was larger than that of Model 5 and smaller than that of Model 2. The peak stresses of L2-3, L3-4 and L4-5 fusion cages in Model 3 increased by 5. 52% , 10. 96% and 7. 99% respectively compared with Model 5 under left lateral bending, and the peak stresses of L2-3, L3-4 and L4-5 fusion cages in Model 4 increased by 8. 70% , 7. 00% and 6. 99% respectively under flexion. Under all motion states, the peak stress of screw rod in Model 5 was smaller than that of Model 3 and Model 4, and the peak stresses of screw rod in Models 3-5 were the smallest in upright state. Conclusions The OLIF with unilateral pedicle screw fixation or vertebral screw fixation can provide favorable biomechanical stability of the fusion segment. The results provide some references for clinical application of OLIF technology in the treatment of DLS.
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Objective@#To investigate the indication and midterm outcomes of surgical treatment of traumatic tricuspid insufficiency.@*Methods@#Totally 19 patients with traumatic tricuspid insufficiency who underwent surgical treatment at Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University from January 2002 to January 2018 were included in this retrospective study. There were 12 male and 7 female patients, aged (43.1±12.9) years (range: 17-68 years). The main causes of traumatic tricuspid insufficiency included blunt chest trauma following high-speed vehicle accidents (17 patients) and high-fall trauma (2 patients). The preoperative New York Heart Association functional class was class Ⅱ in 5 patients, class Ⅲ in 12 patients, and class Ⅳ in 2 patients. The mechanism of tricuspid insufficiency included anterior chordal rupture in 9 patients, anterior papillary muscle rupture in 3 patients, anterior and posterior chordal or papillary muscle rupture in 4 patients, laceration of leaflet combined with chordal rupture in 2 patients and infection combined with anterior papillary muscle rupture in 1 patient. Anular dilation and enlargement of the right ventricle were observed in all the patients. Paired t test was used to evaluate the echocardiogratic results at preoperation, postoperation and follow-up. Independent sample rank sum test was used to evaluate the intervals between trauma and surgery in tricuspid valve repair group and tricuspid valve replacement group.@*Results@#Tricuspid valve repair was successful in 8 patients, and 11 patients underwent valve replacement. Among the patients who underwent valve replacement, 6 patients received mechanical valve and 5 received bioprosthetic valve. The interval from trauma to surgery of the valve repair group and valve replacement group were 8.5(10.0) months (range: 0.1-13.0 months) and 72.0 (108.0) months (range: 2.0-228.0 months), respectively. Concomitant procedures included debridement in scalp trauma (1 patient), internal fixation of femoral fracture (1 patient). One patient died from liver failure 10 days after operation and the remaining patients survived. Eighteen patients were followed up for (94±50) months, 15 patients were in New York Heart Association functional class Ⅰ and 3 patients in class Ⅱ. One patient received redo-tricuspid valve replacement because of mechanical valve failure at the 11 years of follow-up.@*Conclusions@#The midterm outcomes of surgical treatment of severe traumatic tricuspid insufficiency were satisfactory. Early diagnosis and surgical invention were recommended to achieve successful valve repair.
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Objective To summarize the short and mid-term outcome of adult patient suffered with aortic stenosis and small aortic root treated by aortic root enlargement with supraannular prostheses replacement or supraannular prostheses replace-ment.Methods From January 2005 to January 2017, 223 patients with aortic stenosis and small aortic root who underwent i-solated aortic valve replacement(AVR) were included in this retrospective study cohort.Patients with aortic insufficiency who underwent isolated AVR or those who underwent combined valve replacement were excluded from the study cohort .Aortic root enlargement with supraannular prostheses replacement was performed in 98 patients(ARE), and supraannular prostheses re-placement was performed in the remaining 125 patients as a control group(SP).The mean age and other baseline characteristics were compared between the two group, except that body surface area(BSA) in ARE were higher than that in SP[(1.62 ± 0.04)m2 vs(1.61 ±0.04)m2, P=0.015].Results Operative mortality occurred in 6 patients(2.7%), the cause of death including low cardiac output syndrome(LCOS, 3 patients), multiple organ failure(MOF, 2 patients) and stroke(1 patient). Reoperation for bleeding occurred in 5 patients and acute renal failure in 9 patients, pneumonia in 5 patients.The other nonfa-tal operative complications included wound complication(8 patients), temporary pacing therapy(24 patients), and new onset of acute mitral regurgitation(1 patient).The operative mortality and nonfatal complication were not statistically different be-tween the two groups.Patients in ARE received more bioprotheses and iEOA was higher than those in SP .Transvalvular pres-sure gradients and incidence of patient-prostheses mismatch were lower in ARE.At the 2 years of follow-up, transvalvular pres-sure gradients and left ventricular mass index were statistically lower in ARE compared with SP .The iEOA of ARE was higher than that in SP(1.22 ±0.13 vs 0.87 ±0.13, P<0.01).However, during the mid-term follow up(mean duration of follow-up was 6.31years), the overall survival rate was not statistically different between the two groups.Conclusion The strategy of aortic root enlargement with supraannular prostheses to treat adult patients with aortic stenosis and small aortic root can provide more optimal hemodynamic effect , effectively avoid PPM and was not associated with increased risk of mortality or adverse event when compared with strategy of supraannular prostheses replacement.However, the mid-term survival rate was not statistically different between the two strategies.
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Objective To study the biological characteristics of, antibiotic resistance in and ger-micidal efficacy at different temperatures against Vibrio parahaemolyticus ( V. parahaemolyticus) strains isola-ted from different sources in order to provide reference for clinical treatment and prevention. Methods Stool samples from patients with diarrhea and small seafood product specimens from markets were collected and an-alyzed with biochemical identification method, serotyping analysis, drug susceptibility test and germicidal ef-ficacy test at different temperatures. Results There were 107 V. parahaemolyticus strains isolated from 1166 stool samples of patients with foodborne diarrhea with a positive rate of 9. 18％ and 42 from 72 seafood product samples with a positive rate of 58. 30％. V. parahaemolyticus strains isolated from the foodborne diar-rhea cases were divided into eight serogroups and among them, O3 and O4 were the predominant serogroups, accounting for 49. 53％ and 34. 58％, respectively. Most of the O antigens in small seafood products be-longed to serogroups of O4, O1 and O3, and four strains of O3 : K6 were isolated. Results of the drug sus-ceptibility test showed that both of the clinical isolates and marine product isolates were highly resistant to ampicillin and the drug resistance rates were 94. 39％ and 88. 10％, respectively. Antibiotic-sensitive strains to monocyclicβ-lactams, aminoglycosides, quinolones, carbapenems, tetracyclines and sulfonamides accounted for over 90. 00％ or even nearly 100. 00％. There were 17 (15. 89％) clinical strains and three (7. 14％) marine product isolates resistant to three or more kinds of antibiotics. At 80℃, the bactericidal rate for marine product isolates was 85. 71％ in 60 s and reached 100. 00％ in 90 s. At 90℃ and 100℃, these isolates could be completely killed in 40 s and 30 s. It took 120 s, 90 s and 50 s to kill clinical isolates at 80℃, 90℃ and 100℃, respectively. Conclusions This study systematically analyzed and compared the drug-resistant phenotypes of and the bactericidal efficacy at different temperatures on V. parahaemolyticus strains isolated from clinical samples and marine products. It would provide reference for preventing and con-trolling the spread of V. parahaemolyticus and hospital infection and for studying treatment strategies.
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Objective This study reviews the 198 consecutive mitral valve operations for elderly patients(＞ 65 y) with ischemic mitral insufficiency performed at Anzhen Hospital between January 2000 and june 2016.The results for mitral valve reconstruction are compared with those for biological mitral valve replacement.Methods From January 2000 to June 2016,198 elderly patients with ischemic mitral insufficiency underwent mitral valve reconstruction (n =150) or biological mitral valve replacement(n =48).All of them coronary artery bypass gafting was performed at the same time.Preoperative clinical characteristics,procedural characteristics,major and minor complications after surgery,preoperative and postoperative left ventricular ejection fraction (LVEF) by echocardiography,and outcome (survivor or death,mitral regurgitation,NYHA degree) were assessed.Results There was no significant difference between the two groups in the rate of mortality during hospitalization and early postoperative cardiac function.The proportion of severe MR in 1,3,and 5 years after MVP were 5.1％ 、6.3％、7.7％ respectively.There was no MVR due to the recurrent moderate-to-severe reflux.There were 2 SBE but no reflux appeared after MVR.There was no significant difference in cardiac function and mortality between the two groups within 5 years.Conclusion There is no significant difference between CABG + MVP and CABG + MVR(BV) in cardiac function and mortality in the treatment of elderly patients with IMR.,There was a possibility of MR recurrence after CABG + MVP.There was no MR after CABG + MVR(BV),but the risk of SBE is higher than MVP.We can select operation mode personalized according to the type of mitral valve disease and cardiac function.
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Objective To study the effect of polymer material on adhesion , proliferation and differentiation of mouse in-duced pluripotent stem cells via co-culturing in vitro, to find a suitable polymeric biomaterials for miPSCs attachment , prolifera-tion and differentiation , forming myocardial patches as a new repair method for myocardial infarction .Methods miPSCs were recovered, passaged and cultured with PHBHHx two-dimension films and PHBHHx three-dimension films together.The mor-phology of miPSCs attached on the films was visualized under scanning electron microscope ( SEM) .The mouse induced pluri-potent stem cells were induced by differentiation medium that containing vitamin C .Control group did not add any inducer.The survival and differentiation of miPSCs were observed through immunofluorescence and flow cytometry .Results MiPSCs can grow, proliferate and differentiate on PHBHHx films both two-dimension and three-dimension.Vitamin C, as a favourable in-ducer, can markedly improve the efficiency of miPSCs differentiation of cardiomyocytes on PHBHHx films .Immunofluorescence results demonstrated positive cTnT expression.Flow cytometry measured cTnT expression: Vitamin C inducer group(47.54 ± 1.46)%>without any inducer group(7.02 ±0.95)%(PPHBHHx two-dimensional films(53.31 ±1.41)%>traditional cell culture(47.54 ±1.46)%(P<0.05).Conclusion iPSCs can ad-here, survive and differentiate on the PHBHHx film.Vitamin C, as a favourable inducer, can markedly improve the efficiency of miPSCs differentiation of cardiomyocytes .Relative to PHBHHx two-dimensional film culture and traditional culture , the three-dimensional PHBHHx film culture has a great advantage in the process of miPSCs differentiating into myocardial cells .
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Objective To evaluate the medium-and long-term efficacy of loading statins after coronary artery bypass grafting surgery by comparing patients undergoing coronary artery bypass grafting surgery(CABG) using a loading dose statins or a regular dose of statins.Methods Cochrane Library, WanFang database etc database web were searched for the efficacy of a loading dose of statins after CABG in randomized controlled trials(RCTs).The quality of included studies was evaluated according to the Newcastle-Ottawa Scale(NOS).The statistical results of treatment were represented by weighted mean difference (WMD) , the odds ratio(OR) and 95％ confidence intervals(CI).Revman 5.2 software was used for data processing and analysis.Results There are eight studies including 8 676 cases, 4 352 cases are in group using a loading dose of statins, 4 324 cases are in group using a regular dose of statins.Meta-analysis showed the level of low-density lipoprotein(LDL-C) in patients who took a loading dose of statins after CABG(WMD =-42.15,95％ CI:-44.45～-39.84, P ＜0.00001);the number of death caused by myocardial infarction (OR =0.74, 95 ％ CI: 0.60～ 0.91, P =0.005);the number of patients occurred myocardial infarction (OR =0.78, 95 ％ CI: 0.66～ 0.92, P =0.004);the number of patients undergoing secondary CABG (OR =0.72, 95％ CI: 0.63～ 0.82, P ＜ 0.00001);the number of patients occurred drug side effects(OR =1.43, 95％ CI: 1.06～ 1.93, P =0.02);the number of patients occurred grafts restenosis by intravascular ultrasound(IVUS) (OR =0.59, 95％ CI: 0.50～0.70, P ＜0.0001).The data above reached statistically significant difference.Conclusion Comparing patients who used a loading dose of statins and those who used a regular dose of statins after CABG.The medium-and long-term efficacy of a loading dose of statins showed significantly reduction of LDL-C;reduction of the occurrence to cardiac events, such as death caused by myocardial infarction, myocardial infarction and secondary CABG;reduction of grafts restenosis.The incidence of drug side effects was a little higher in a loading dose of statin group.But the majority of patients did not show serious drug side effects after using a loading dose of statins.In summary, the medium-and long-term efficacy of a loading dose of statins after CABG is better than that of a regular dose of statins.
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<p><b>OBJECTIVE</b>To observe the proliferation and differentiation capacities of mouse induced pluripotent stem cells (miPSCs) cultured in 3-hydroxybutyrate-co-3-hydroxyhexanoate(PHBHHx) three-dimensional films three-dimension films for the purpose of finding a suitable polymeric biomaterials for forming myocardial patches.</p><p><b>METHODS</b>miPSCs were recovered, passaged, cultured and identified, then miPSCs divided into the experimental and control groups. MiPSCs in the experimental group were cultured with PHBHHx three-dimension films. MiPSCs in the control group were cultured with traditional culture dish. Stem cell culture medium or differential medium were added to miPSCs to detecte cell vitality by CCK-8 after 72 hours or to measure the cTnT expression of miPSCs through immunofluorescence or the cTnT expression quantity through flow cytometry after 15 days.</p><p><b>RESULTS</b>Cell activity assay showed that the absorbance values were 0.836 ± 0.038 in the experimental group, 0.312 ± 0.004 in the control group (P<0.05). Scanning electron microscope (SEM) observation showed that miPSCs grew well on the PHBHHx dimensional films with normal shape. Immunofluorescence results demonstrated positive cTnT expression in both groups and flow cytometry measured cTnT expression was (60.32 ± 1.76)% in the experimental group and (47.54 ± 1.46)% in the control group (P<0.05).</p><p><b>CONCLUSIONS</b>miPSCs can survive, proliferate and differentiate on PHBHHx dimensional films. miPSCs proliferation and differentiation capacities are significantly higher in PHBHHx three-dimensional films culture compared with the traditional cell culture.</p>
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Animals , Mice , 3-Hydroxybutyric Acid , Biocompatible Materials , Caproates , Cell Culture Techniques , Cell Differentiation , Induced Pluripotent Stem CellsABSTRACT
<p><b>BACKGROUND</b>Misdiagnosis and missed diagnosis of septic pulmonary embolism (SPE), a rare disease, occurs among the patients with right heart infective endocarditis. The purpose of this study was to analyze the characteristics of SPE and improve the early diagnosis and treatment.</p><p><b>METHODS</b>We retrospectively studied 34 patients with septic pulmonary embolism caused by right-sided infective endocarditis who were seen from June 1, 2002 to June 1, 2013. We reviewed the medical records and radiological images of these cases and extracted the following information: age, gender, and symptoms, physical examination, laboratory findings, transthoracic echocardiography (TTE) results, treatment information, comorbid medical conditions, and outcomes. Microbiological samples were collected and processed according to well-established and published guidelines.</p><p><b>RESULTS</b>We identified basic heart disease in 97.1% of the patients. A high proportion of the right-sided infective endocarditis patients had congenital heart defects (82.4%); predominantly, ventricular septal defects. Clinical symptoms were fever (97.1%), cardiac murmurs (94.1%) and fatigue (88.2%). Respiratory symptoms included cough (58.8%), pleuritic chest pain (47.1%) and hyoxemia (52.9%). Positive blood cultures were grown from 35.2% of patients and 50.0% were caused by staphylococcal species. Chest X-rays or CT examinations detected patchy infiltrates and/or nodules in all cases. Transthoracic echocardiography demonstrated infectious foci of the right-side heart in all cases. Parenteral antibiotics were administered for all, and cardiac surgery was carried out for 76.5% of patients with an effective rate of 82.3%.</p><p><b>CONCLUSIONS</b>SPE lacks characteristic clinical manifestation. Congenital heart disease is a common risk of SPE. Most patients with SPE have a good prognosis as long as early diagnosis and proper treatment can be provided.</p>
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Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Middle Aged , Young Adult , Endocarditis , Diagnosis , Therapeutics , Pulmonary Embolism , Retrospective Studies , Sepsis , Diagnosis , TherapeuticsABSTRACT
Objective Comparatively studying the method,efficiency and anti-hypoxia ability of cardiomyocytes which are directionally induced from human embryonic stem cells and mouse embryonic stem cells in vitro so as to provide an experimental basis for further study of inducing the differentiation of embryonic stem cells into cardiomyocytes in vitro.Methods Human embryonic stem cells are induced into cardiomyocytes by suspension method which dosen't using inducersand adherence method which using inducers respectively.Mouse embryonic stem cells are induced into cardiomyocytes by hanging drop method which dosent using inducers and using inducer respectively.Staining the specific marker cTnT of cardiomyocytes by immunofluorescence.Comparing the time,percentage and beating frequency of cardiomyocytes by counting under the microscope.Using apoptosis-hoechst staining kit to detect the apoptosis ratio of beating cardiomyocytes which have been treated by hypoxia with 24 h.Results The group of hESC without inducers results in that the mean time days of appearing beating cardiomyocytes is (13.9 ± 0.9) days,the percentage is 20.8 ％ and the average frequency of beating is (63.8 ± 5.6) times/min.The group of hESC with inducers results in that the mean time days of appearing beating cardiomyocytes is (13.0 ± 1.1) days,the percentage is 66.7％ and the average frequency of beating is (63.0 ± 7.0) times/min.The group of mESC without inducers results in that the mean time days of appearing beating cardiomyocytes is (14.3 ± 1.0) days,the percentage is 12.5％ and the average frequency of beating is (80.2 ± 3.9) times/min.The group of mESC with inducers results in that the mean time days of appearing beating cardiomyocytes is (12.2 ± 1.2) days,the percentage is 81.3％ and the average frequency of beating is (79.9 ±7.7) times/min.Beating cardiomyocytes of each group are positive to cTnT staining.Different apoptosis ratio are detected of beating cardiomyocytes of each group.Conclusion The four methods can all successfully induce the differentiation of embryonic stem cells into myocardiocytes,and the adherent method of hESC induced with activin A + BMP4 is the first successful induction in China.The groups adding inducers improve the differentiation efficiency more significantly than the groups without adding inducers.Inducing mouse embryonic stem cells into cardiomyocytes is more simple and efficient compared with human embryonic stem cells.Without the presence of other protective factor,anti-hypoxia ability of cardiomyocytes induced from human embryonic stem cells is stronger and the beating time are longer in vitro compared with mouse embryonic stem cells.
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Objective To review the outcome of coronary artery bypass grafting (CABG) using left internal thoracic artery (LITA) grafts in these patients aged more than 70 years old.Methods 1471 patients aged more than 70 years old[mean (73.3 ± 3.9) years] from July 2010 through August 2012,who underwent CABG in Anzhen hospital,form the cohort of this study.Among them,1395 cases underwent off-pump CABG,while 76 cases underwent on-pump CABG which includes onpump beating heart CABG in 12 cases.The average number of the grafts is 3.12 ±0.68.All of the patients were divided into two groups on base of the graft:Group A:only saphenous vein graft was used in 564 cases; Group B:The left internal thoracic artery to the left anterior descending artery was used in 907 cases,which also include total arterial grafting,facilitated by the use of the radial artery,right gastroepiploic artery was operated in 42 cases,beside these artery grafts,saphenous vein graft was used to anastomosis with other vessels.Results Operative mortality was 2.12％ in group A and 2.09％ in group B.There was no significance between the 2 groups.The volume of blood drainage was larger in group B than that in group A.At the same time,there was no significance in the incidence rate of second thoractomy,malignant arrhythmia,stroke,poor wound healing,and usage of IABP between the 2 groups.Conclusion It did not increase the mortality and morbidity of serious complications using the left internal thoracic artery to the left anterior descending artery in those elderly patients aged more than 70 years old during the CABG operation.With consideration of the obvious advantages in the long term patency,LITA was proposed to be used in CABG even in those age ＞ 70 patients.
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Objective To investigate the diagnosis and surgical treatment for the intracardiac leiomyomatosis (ICL).Methods Retrospectively reviews the data of 18 cases of ICL from February 1995 to June 2011 in Anzhen Hospital.Preoperative diagnosis of right atrial myxoma in 2 cases,right atrium/ventricular thrombus in 2 cases,pulmonary embolism in 2 cases,the inferior vena cava and right atrial tumor in 3 cases,the inferior vena cava lesions in 9 cases.18 cases of ICL were diagnosed by echocardiography,magnetic resonance imaging ( MRI ),computer tomography (CT) and angiography.ICL were recected under anesthesia,cardiopulmonaray bypass surgery,he incisions were respectively through the chest,thoraco-abdominal or abdominal incision,cardiopulmonary bypass method were respectively at room temperature,mid-low temperature with cardiac arrest,lowflow,deep hypothermic circulatory arrest.Results There was no operative death.Right atrium,inferior vena cava,bilateral renal vein,bilater alIliac vein vascular were not found leiomyoma by vascular ultrasound.Follow-up time was 5 ～ 106 (49 ± 42 )months,1 patient died of the leiomyoma recurrence after 5 months after the primary operation,the remaining 17 patients were followed up asymptomatically.10 were in NYHA functional class Ⅰ,and 7 in class Ⅱ.The 5yrs survival rate calculated by the Kaplan-Meier survival curve was (93 ±5 )％.Conclusion The ICL preoperative diagnosis is difficult,surgical treatment of ICL can get a good mid-long term survival rate and living quality.
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Objective The rate of post -operative complications has been increased with the changes in patients' age,prolonged duration, more severe and diffused lesions, and more patients with complications in recent years. We try to identify the risk factors associated with prolonged stay in the intensive care unit ( ICU ) after coronary artery bypass graft surgery (CABG). Methods 1623 patients who received CABG surgery in Beijing Anzhen Hospital Between June 1, 2006 and December 31,2007 were divided into two groups based on their stay duration in the ICU. Prolonged stay in ICU was defined as 5days or more. Univariate and multivariate analysis ( logistic regression) were used to identify the risk factors. The discrimination and calibration of the result were tested after the risk factors were determined. Results Fifty one patients had prolonged ICU stay, accounting for 3.14% of total cases. Multivariate logistic analysis showed that the age of patients, peripheral vascular diseases, critical status before operation, LVEF, operative status, mitral regurgitation, postoperative respiratory failure,postoperative renal failure, secondary thoracotomy for postoperative bleeding were associated risk factors. Conclusion Prolonged ICU stay after CABG surgery can be predicted based on the above factors. For patients with these risk factors, more pre-and postoperative care strategies are needed.
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Objective We aimed to recent experience at our hospital in the diagnosis and treatment of pericardial effusion after cardiac surgery and to identify risk factors for its development.Methods We searched our hospital for patient who had cardiac surgery with cardiopulmonary bypass from January 2002 through December 2010.For patient with pericardial effusion,medical records were reviewed to evaluate its manifestations and management.To identify risk factors for effusion,patients with effusions were compared with patients without effusions.All patients had routine postoperative echocardiographic examination.Results Of 22462 patients identified,509 (2.3％) had pericardial effusion.Compared with patients without pericardial effusion,ages,sex,cardiac function and so on were no significant( P ＞ 0.05 ).Body,valve cardiac diseases,and cardiopulmonary bypass time and so on were significant ( P ＜ 0.05 ).Among 509 patients with pericardial effusion,262 patients (51.4％) of whom had specific symptoms.Clinical features of tamponade were documented in 51 patients( 10.1％ ).Pericardial effusions were evacuated by echocardilgraphy-guided pericardiocentesis ( n =27,10.3％ ) or surgical drainage ( n =15,5.7％ ).Pericardial effusion resolved after left thoracocentesis for pleural effusion in 5 patients ( 1.9％ ) ; The Other patients with pericardial effusion were treated conservatively.Indeperdent risk factors for pericardial effusion were large body,valve cardiac operations,and prolonged cardiopulmonsry bypass.Conclusion In our study,pericardial effusion occurred in 2.3％ of patients,and symptoms were nonspecific.Several factors,mainly related to preoperative characteristics and type of operation,predispose patients to effusion,echocardiography-guided pericardiocentesis is effective and safe in these patients with pericardial effusion.
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Objective To compare the results of Danielson procedure with and without prosthetic valve ring in treating Ebstein anomaly and to define the effect of prosthetic valve ring on the procedure.Methods From January 2006 to December 2009,31 cases of Ebstein anomaly over 10 years old were classified as type A or type B according the Carpentier＇s classification scheme.Patients were treated by Danielson procedure or Danielson procedure plus prosthetic valve ring at Anzhen hospital.They were retrospectively classified as Danielson procedure group (group A,n =19) and Danielson procedure plus prosthetic valve ring group (group B,n =12 ).Results There was 1 early in-hospital death due to lung infection and hypoxemia in group A,and no early death in group B ( Fisher exact test,P =0.51 ).The mean follow-up time was ( 23.0 ± 18.5 ) months (5 -41 months).The cumulative follow-up time was 59.42 patient-years.There was one late death in group A due to the redo tricuspid valve plastic procedure because of severe tricuspid regurgitation,and no late death in group B.With echocardiography inspection,11 patients had mild and 7 had moderate to severe tricuspid regurgitation in group A,and only 2 mild tricuspid regurgitation in group B.The tricuspid valve competence after surgery in group B was better than in group A ( Fisher exact test,P=0.024).The 6-minute walk distance test (6MWD) in group B was significantly better than in group A(415 ±41 )m vs ( 382 ± 46 ) m( t test,P =0.047 ).The New York heart functional class in group B was statistically better than in Group A ( P =0.024).Conclusion Although there was no significant difference in the early and late mortality rate between the two groups after surgery,Danielson procedure plus prosthetic valve ring was better than pure Danielson procedure in prevention of late tricuspid regurgitation recurrence,heart function and 6MWD test during follow-up.
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Objective Metabolic syndrome ( MS), a disorder involving multiple metabolic abnormalities such obesity,hypertension, diabetes or abnormal glucose tolerance and dyslipidemia, has been observed in many patients receiving coronary artery bypass procedures. In this study we try to examine the perioperative effects of metabolic syndrome on the off-pump coronary artery bypass (OPCABG). Methods A prospective study was conducted in 1060 consecutive OPCABG patients who were admited to Beijing Anzhen Hospital from July 2009 to March 2010. The patients were grouped as MS group and non-MS group according to the diagnostic criteria for Chinese metabolic syndrome. The outcomes such as mortality, atrial fibrillation,stroke, staying in ICU for more than three days, use of IABP, ECMO, dialysis, multiple organ dysfunction score ( MOOS) ,postoperative score for cardiac surgery (PSCS), PaO2/FiO2 , heart rate x central venous pressure/mean artery pressure(pressure-adjusted heart rate, PAHR) ,renal and liver function, platelets, and the dosage of vasoactive agents were analyzed and compared between the two groups by x2 test or t test. Results Three hundred and eighty-nine cases were diagnosed with MS among 1060 cases with OPCABG. In the MS group, 17 cases stayed in ICU for more than 3 days, 2 cases died, 76 had atrial fibrillation, 3 had stroke, 18 cases were treated with intra-aortic balloon counterpulsation (IABP). In the non-MS group, 47 cases stayed in ICU for more than 3 days, 12 cases died, 148 had atrial fibrillation, 3 had stroke, 48 cases were treated withIABP, 3 cases received ECMO and 4 cases received dialysis. No significant difference between MS group and non-MS group was identified in the aspects of mortality, atrial fibrillation, stroke, duration of more than three days in ICU, the use of IABP,ECMO, dialysis after OPACBG based on the x2 test(P＞0.05). However, on the operative days, the MODS and PSCS in MS group were significantly higher than that in non-MS group (P ＜ 0.05). MODS 2. 57 ± 1. 62 in MS group vs. 2. 15 ± 1.65 in non-MS group, PSCS 4.27 ±2.15 in MS group vs. 3.92 ±2.29 in non-MS group. PaO2/FiO2 in MS group was significantly lower than that in non-MS group (249.23 ± 110.99 vs. 283. 33 ± 114. 35), P ＜ 0. 01. PAHR in MS group was significantly higher than that in non-MS group (9.98 ±3.54 vs. 9.23 ±3. 88), P ＜0.05. On the first postoperative days, the MODS in MS group was also significantly higher than that in non-MS group (3.05 ±1.64 vs. 2.82 ± 1.72), P＜0.05. PaO2/FiO2 in MS group was significantly lower than that in non-MS group (277.11 ±122.99 vs.318.47 ±143.84), P＜0.05. Conclusion MS was not a predictor for death, atrial fibrillation, stroke, duration of more than three days in 1CU, the use of IABP, ECMO, dialysis after OPACBG. However, MS had a temporary adverse effect on the respiratory and circulatory systems on the operative day and the first postoperative day after OPCABG.
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Objective Evaluate the clinical outcomes of redo coronary revascularization performed with CABG techniques. Methods During the past 10 years, 51 patients (2.5% in the patients who underwent CABG and OPCABG) received redo coronary revascularization in our hospital. The period between the first and the redo surgeries was ( 15.1±5.8)years. Two different procedures were performed with or without cardiopulmonary bypass for the redo CABG: off-pump procedure (OPCABG) in 10 patients and on-pump procedure (CABG) in 41 patients. Two types of surgical approaches were used: me-dian sternotomy in 43 patients and left thoracotomy in 8 patients. Results Respiratory failure requiring mechanical ventilation occurred in 3 of the 51 patients after the operation, as compared with none in the patients who underwent OPCABG. The mean duration treated in the ICU was (2.2±0.7 ) days and that of hospital admission was( 9.2±2.4) days. Two patients (3.9%)died in hospital, one ease was in the off-pump group and the other was in the on-pump group. The causes of death were thought to be acute myocardial infarction with low output syndrome in 1 case and severe respiratory failure in the other. Complications occurred in 11 patients, including re-thoracotomy for hemostasis in 1 patient, respiratory failure in 3 patients and other complications 7. Postoperative EF was 0.60±0. 06. Complete revascularization was achieved in 44 patients, 6 patients in the offpump group and 38 patients in the on-pump group. Partial revascularization was observed in the additional 7 patients. Conclusion Redo CABG performed with or without cardiopuimonary bypass may provide favorable effects with acceptable safety profile and complete revascularization is achievable.
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Objective Patients in the intensive care unit (ICU) are at high risk for multi-organ failure and death. Few well-established scoring systems have been used in the cardiac surgery. We try to identify a feasible score system for the risk assessment after CABG. Methods 1028 consecutive patients who had received CABG and staying in a single cardiac postoperative intensive care unit of Anzhen hospital were enrolled in the prospective study between October of 2007 and May of 2008 and assessed daily with three score systems, the multiple organ dysfunction score (MODS), the sequential organ failure assessment (SOFA) and our postoperative score for cardiac surgery (PSCS). Four new variances were added to PSCS system, which were Euroscore, IABP, ECMO and dialysis. Euroscore was considered as a preoperative factor which provided the preoperative information of the patient. IABP and ECMO were considered as assistant factors to support circulatory system. The dialysis was also considered as an assistant factor to support renal system. The differences with the respects of sensitivity and specificity among the three systems were compared with Hosmer-Lemeshow goodness-of-fit and receiver operating characteristic (ROC)curve. Results The new variances added to PSCS system were shown to be associated with mortality in a multivariate logistic regression analysis. The EXP(B) value for Euroscore was 3. 803, the EXP(B) value for IABP was 1. 645, the EXP(B) value for ECMO was 3.803, and the EXP(B) value for dialysis was 1.605. In discrimination analysis, ROC values of the operative day score were 0.602 for MODS, 0.571 for SOFA, and 0. 821 for PSCS; ROC values of the maximum score were 0.847 for MODS, 0.830 for SOFA, and 0.929 for PSCS; ROC values of the maximum score during the first 3 days were 0.838 for MODS, 0.814 for SOFA, and 0.919 for PSCS; score changes of ROC value between the third day and the first day were 0.767 for MODS, 0.779 for SOFA, and 0. 780 for PSCS. In calibration analysis, we compared the x2 values, P values and overall corrected percentage of the three different systems. x2 values of the three systems were 6. 763 for MODS, 4. 101 for SOFA, and 1.687 for PSCS; P values of the three systems were 0.454 for MODS, 0. 848 for SOFA, and 0. 975 for PSCS; overall corrected percentages of the three systems were 98.1%, 98%, and 98.3% respectively. Conclusion The sensitivity and specificity of PSCS were superior to MODS and SOFA in predicting death risk after CABG.
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Objective To summarize the clinical experience for treating anterior mitral leaflet prolapse with an artificial chordal loop. Methods From January 2008 to August 2009, pre-measured ePTFE loops were used to treat anterior leaflet prolapse in 8 patients, 5 males and 3 females, aged from 28 to 68 ( average 56.0 ± 8.9 ) years. The heart function (NYHA) was class Ⅱ in 2 patients and class Ⅲ in 6. Echocardiography showed chordal rupture in 7 patients, 2 with chordal rupture and elongation and pure chordal elongation in 1. There were 3 patients with A1 segment prolapse of anterior mitral leaflet, 2 with A2 segment prolapse, 3 with both A2 and A3 segments prolepses by Carpentier standardization. There were 2 patients with posterior leaflet chordal rupture in P2 and P3 segment, 1 with cor triatrium. Left ventricular end diastolic diameter (LVEDD) was 53 - 62 mm [average ( 57.2±3.8 ) mm]. Ejection fraction (EF) was 0.60 - 0. 68 ( average 0.63 ± 0.02). Heart-thoracic ratio was 0. 52 ± 0. 17. We measured the normal chordal using both a caliber and by echocardiography ( for comparison after operation). The artificial chordal loops was constructed on the caliber using ePTFE suture, and then fixed the loop to the papillary muscle and the free edge of the anterior leaflet. Results There was no operation death. Hemolysis after 2 days of operation in 1 patient was amended by alkalinization, diuresis and hormone treatment. Pre-discharge transthoracic echocardiography showed mild regurgitation in 1patient, trivial regurgitation in 7. LVEDD were 42 -51mm [average (47. 1 ±2.2) mm] significantly decreased than that of pre-operation. Following parameters were measured and compared with pre-operation: EF 0. 58 ± 0. 03 vs. 0. 63 ± 0. 02, beart function ( NYHA ) class 1.25 ± 0. 42 vs. 2.75 ± 0. 58. Normal chordal length measured by caliber was ( 21.20 ± 1.55 ) mm vs. ( 22. 10 ± 2.68 ) mm by echocardiography. Anticoagulate therapy with warfarin was for 3 months after discharge and followed-up all the patients [1 - 19 months, average (8.2 ± 4.3 ) months]. Post operative echocardiography showed mild regurgitation in 1 patient, no or trivial regurgitation in 7 patients. The heart function class was evident improved compared with pre-operation :6 patients in class Ⅰ , 2 patients in class Ⅱ. Conclusion The pre-measured ePTFE loop is reliable and reproducible confirmed by short term follow-up for treating anterior leaflet prolapse.
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Objective To summarize the clinical experience of surgical treatment for the congenital coronary artery anomaly.Methods 15 patients with coronary artery anomaly,congenital coronary artery fis-tulas were 11 patients,including 1 patient associated with Fallot,5 patients underwent ligation of isolated fistula and 1 patient's fistula was performed tangent suture though off-pump cardiopulmonary bypass,4 pa-tients'fistulas were repaired by endocardiac way and 1 patient was mended through dissection of fistula under Oil-pump cardiopulmonary bypass.Anomalous origin of the left coronary artery from pulmonary artery were 4 patients and 1 patient associated with rheumatoid valve disease.Operative methods included ligation of left circumflex (1 case),anastomosis of left subclavian artery-left artery-left main (1 case) and transplantation of left main(2 cases).Results There was 1 death becaused severe low cardiac output syndrome,and the there was good prognosis and no clinical symptoms found in 14 patients during follow-up.Conclusion The feasible operation for the coronary artery anomaly should be performed as early as possible once diagnosed correctly.