Anteroapical aneurysm plication improves mechanical intraventricular dyssynchrony in patients with anterior myocardial infarction / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Left ventricular (LV) dyssynchrony has been described to occur in patients with myocardial infarction. Dyssynchrony of left ventricular mechanical contraction produces adverse hemodynamic consequences. This study aimed to test the capacity of geometric rebuilding by aneurysm plication to restore a more synchronous contractile pattern after a mechanical, rather than electrical, intervention.</p><p><b>METHODS</b>A total of sixty patients with anterior myocardial infarction, QRS duration < 120 ms, electively undergoing operation between January 2008 and January 2010 were included for analysis. Real-time 3-dimensional echocardiography was performed to assess LV function, LV systolic and diastolic dyssynchrony by measuring ejection fraction (EF), peak ejection rate (PER), peak filling rate (PFR) and LV dyssynchrony. LV dyssynchrony was defined as the systolic dyssynchrony of the time to reach the minimum systolic volume for 16 LV segments, expressed in percent cardiac cycle, systolic dyssynchrony index (SDI). We compared changes of LV dyssynchrony at different interval times.</p><p><b>RESULTS</b>LV contraction was significantly asynchronous because preoperative SDI was higher, EF, PER and PFR were lowered. Compared with function after operation, LV mechanical intraventricular resynchronization was improved with decreased SDI ((8.7 ± 0.5)% vs. (14.3 ± 1.6)%, P = 0.01); LV function was improved with EF increasing ((43 ± 9)% vs. (37 ± 7)%, P = 0.001), and LV systolic and diastolic dyssynchrony was improved with more rapid PFR (199.4 ± 15.6 vs. 148.4 ± 21.2, P = 0.002) and PER (212.4 ± 14.5 vs. 156.3 ± 26.2, P = 0.001).</p><p><b>CONCLUSIONS</b>Systolic and diastolic dyssynchrony was highly prevalent in patients with aneurysm, irrespective of QRS duration. Aneurysm plication produces a mechanical intraventricular resynchronization.</p>

A novel and feasible way to cultivate and purify endothelial progenitor cells from bone marrow of children with congenital heart diseases / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Endothelial progenitor cells (EPCs) are used in vascular tissue engineering and clinic therapy. Some investigators get EPCs from the peripheral blood for clinic treatment, but the number of EPCs is seldom enough. We have developed the cultivation and purification of EPCs from the bone marrow of children with congenital heart disease, to provide enough seed cells for a small calibre vascular tissue engineering study.</p><p><b>METHODS</b>The 0.5-ml of bone marrow was separated from the sternum bone, and 5-ml of peripheral blood was collected from children with congenital heart diseases who had undergone open thoracic surgery. CD34+ and CD34+/VEGFR+ cells in the bone marrow and peripheral blood were quantified by flow cytometry. CD34+/VEGFR+ cells were defined as EPCs. Mononuclear cells in the bone marrow were isolated by Ficoll(®) density gradient centrifugation and cultured by the EndoCult Liquid Medium Kit(™). Colony forming endothelial cells was detected. Immunohistochemistry staining for Dil-ac-LDL and FITC-UEA-1 confirmed the endothelial lineage of these cells.</p><p><b>RESULTS</b>CD34+ and CD34+/VEGFR+ cells in peripheral blood were (0.07 ± 0.05)% and (0.05 ± 0.02)%, respectively. The number of CD34+ and CD34+/VEGFR+ cells in bone marrow were significantly higher than in blood, (4.41 ± 1.47)% and (0.98 ± 0.65)%, respectively (P < 0.0001). Many colony forming units formed in the culture. These cells also expressed high levels of Dil-ac-LDL and FITC-UEA-1.</p><p><b>CONCLUSION</b>This is a novel and feasible approach that can cultivate and purify EPCs from the bone marrow of children with congenital heart disease, and provide seed cells for small calibre vascular tissue engineering.</p>

Off-pump anteroapical aneurysm plication for left ventricular post-infarction aneurysm: long-term results / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The temporal response to off-pump anteroapical aneurysm plication has not been well defined. We have evaluated the long-term clinical and functional results of this technique and compared the efficacy with the patch modeling repair.</p><p><b>METHODS</b>From March 2005 to May 2010, 163 (115 men and 48 women) consecutive patients were operated on for post-infarction left ventricular aneurysm (LVA), 54 patients underwent patch remodeling (group A) and 109 patients underwent off-pump anteroapical aneurysm plication repair (group B). All patients had simultaneous coronary revascularization, other operative procedures included septoplasty in eight and ablation of ventricular tachycardia in six. Follow-up ranged from 1 to 5 years, short-term and mid-term outcomes, including complications, cardiac function, and mortality, were assessed.</p><p><b>RESULTS</b>Early mortality was 1.8% for all patients (group A 1 death vs. group B 2 deaths, not significant (NS)). Peri-operative support included intraaortic balloon pumping in 16 (9.8%), (group A 6 patients vs. group B 10 patients, NS) and inotropic drugs in 84 (51.5%), (group A 34 vs. group B 50, NS). During a mean follow-up of (3.7±0.8) years, eight patients died, with four due to cardiac-related causes. No patient required transplantation, and two required use of an implantable cardioverter-defibrillator for ventricular tachycardia. Survival at 1 and 5 years was 95% and 86%, respectively. It did not differ significantly between group A and group B. Functional class improved from 2.90 ± 0.59 to 1.65 ± 0.54 among the mid-term survivors (P < 0.001), with no significant difference between the two groups. Pre-operative risk factors for mortality or poor function were ejection fraction (EF) < 0.35 (OR = 7.9, 95%CI 1.6 - 40.0); congestive heart failure (CHF) (OR = 4.4, 95%CI 1.0 - 19.0); end-systolic volume index (ESVI) > 80 ml/m(2) (OR = 3.7, 95%CI 1.0 - 14.0); and advanced age > 70 years (OR = 2.4, 95%CI 1.0 - 12.0).</p><p><b>CONCLUSIONS</b>The technique of off-pump anteroapical aneurysm plication associated with coronary grafting can be performed with low operative mortality, providing good symptomatic relief and long-term survival, and similar results can be achieved with patch modeling repair.</p>

The early and middle-long term clinical results of surgical treatment for ventricular septal rupture / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the way of promoting the efficacy of surgical treatment for ventricular septal rupture (VSR) after acute myocardium infarction in terms of perioperative and long term survival.</p><p><b>METHODS</b>The clinic data of 37 VSR cases underwent surgical treatment from October 1994 to October 2007 were analyzed retrospectively. There were 24 male and 13 female, and the age was (63.4 +/- 7.6) years old. The whole group was divided into the VSR repair plus revascularization group (group A, 26 cases) and simple VSR repair group (group B, 11 cases).</p><p><b>RESULTS</b>There were 4 operative deaths in group A (15.4%), 7 deaths in group B (63.6%), P = 0.006. With the follow-up of (34.0 +/- 29.8) months ranged from 2 to 103 months of the 26 operational survivors, there were 5 late deaths, of which 2 deaths in group A and 3 deaths in group B. According to the Kaplan-Meier survival curve, the actuarial survival rate at 6 to 8 year was (64.3 +/- 21.0)% for group A and the actuarial survival rate at 4 year was (25.0 +/- 21.7)% for group B, P = 0.011. Of the 21 mid-long term survivors, 17 cases were in NYHA class I to II and 4 cases in NYHA class III to IV. There were 4 cases suffered from VSR recurrence. According to Logistic regression, the risk factors for the early death were not adoptive of revascularization, cardiogenic shock and emergency surgical procedure, while the risk factors for late death were not adoptive of revascularization and low cardiac output after the procedures.</p><p><b>CONCLUSIONS</b>VSR repair plus revascularization could improve the perioperative and mid-long term survival for the surgical treatment of VSR. The appropriate timing and procedures of the surgical operation are very important to promote perioperative survival and to prevent VSR recurrence.</p>

Prognosis of patients with chronic thromboembolic pulmonary hypertension receiving conservative or operative treatments according to a new clinical classification scheme / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare the efficacy of conservative or pulmonary thromboendarterectomy (PTE) therapy for chronic thromboembolic pulmonary hypertension (CTEPH) patients according to a new clinical classification scheme.</p><p><b>METHODS</b>This retrospective study analyzed 63 cases of CTEPH admitted to our hospital from February 1995 to October 2007 and 45 cases were treated surgically (Group A) and 18 cases received conservative therapy (Group B). Results were analyzed using Fisher exact test and t test according to San Diego medical center quartering classification scheme and Anzhen Hospital modified bifurcate classification scheme.</p><p><b>RESULTS</b>There were 6 operational deaths in Group A and 2 deaths during hospital stay in Group B. During follow-ups (mean 3.6 +/- 2.5 years), there were 4 deaths in Group A and 9 deaths in Group B. the totality survival rate is significantly higher in Group A than that in Group B (P < 0.05). For patients with San Diego Type I CTEPH, survival rate was significantly higher in Group A compared with Group B (P = 0.009) and was similar for patients with type II and III and IV CTEPH between the two groups (P = 0.338, 0.455, 0.800). Survival rate was significantly higher in Group A than that in Group B for patients with Anzhen central type CTEPH (P = 0.009), but was similar between the two groups for patients with Anzhen peripheral type CTEPH (P = 0.125). The Kaplan-Meier survival curve 5 years survival rate in the Group A was (91.7 +/- 8.0)% for Anzhen central type and (76.0 +/- 8.5)% for Anzhen peripheral type (P = 0.04), and the 5 years Kaplan-Meier survival rate in the Group B was (42.9 +/- 18.7)% for Anzhen central type and (56.2 +/- 10.8)% for Anzhen peripheral type (P = 0.851).</p><p><b>CONCLUSION</b>Anzhen Hospital modified bifurcate classification scheme is a simple and effective classification to predict the prognosis and choose treatment method of CTEPH.</p>

Repair of anterior leaflet mitral valve prolapse: the comparison between chordal replacement and chordal shortening / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the relative merits between chordal shortening and artificial chordae to repair the anterior leaflet prolapses (ALP).</p><p><b>METHODS</b>The clinic data of 50 cases underwent repair of ALP from March 1990 to March 2008 were analyzed retrospectively. There were 29 male and 21 female patients with a mean age of (42.6 +/- 11.3) years old. There were 23 patients in chordal shortening group and 27 patients in artificial chordae group.</p><p><b>RESULTS</b>There were 3 operative deaths in chordal shortening group (13.0%), and 1 death in artificial chordae group (3.7%, P = 0.199). With a mean follow-up of (5.8 +/- 4.8) years and a total follow-up of 278 patient-years, there were 3 late deaths respectively in each group. According the Kaplan-Meier survival curve, the actuarial survival rate at 5-8 years was 70.0% +/- 18.2% for chordal shortening group and 86.8% +/- 9.2% for artificial chordae group (chi(2) = 8.17, P = 0.046). There were 5 reoperations, of which 4 in chordal shortening group and 1 in artificial chordae group. According to the Kaplan-Meier freedom from reoperation curve, the freedom from reoperation at 5 years was 83.3% +/- 15.2% for chordal shortening group and 100% for artificial chordae group (chi(2) = 12.06, P = 0.007). The COX proportional hazard regressions revealed that chordal-shortening technique was the independent risk predictor for the late cardiac event after ALP surgical repair.</p><p><b>CONCLUSION</b>Artificial chordae techniques has a relative superiority to chordal shortening for repair of mitral valve ALP.</p>

Effect of pulmonary autograft transplantation in the surgical treatment of aortic valve disease / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Aortic root replacement with pulmonary autograft (Ross procedure) has the advantages of good haemodynamics and growth potential without the need for anticoagulation. In this study, we reviewed our experience of the Ross procedure for patients with aortic valve disease.</p><p><b>METHODS</b>From October 1994 to January 2005, 42 Ross procedures were performed in our centre. There were 30 males and 12 females. The mean age was 28 +/- 15 years (range, 5-56 years). Congenital heart disease (CHD) with aortic valve stenosis (AS) and/or aortic valve insufficiency (AI) in 40 cases including one associated with ventricular septal defect (VSD), degenerated aortic valve disease with AS in 1 and subacutive bacterial endocarditis (SBE) with AI in 1 were studied. The diagnosis was made by ultracardiography (UCG) in all patients. The mean aortic valve annulus diameter (AVD) was (2.45 +/- 0.31) cm and pulmonary valve annulus diameter (MPVD) was (2.34 +/- 0.21) cm. All patients had normal pulmonary valves. The New York Heart Association (NYHA) function class was II in 36 cases and III in 6 cases. The operation was performed under moderate hypothermic cardiopulmonary bypass (CPB) with aortic root replacement using pulmonary autograft and pulmonary valve replacement with a homograft.</p><p><b>RESULTS</b>There was no early hospital mortality. Postoperative UCG showed normal aortic valve function in all our patients. The mean gradient across the aortic valve was (6.11 +/- 0.12) mmHg. The left ventricular diastole diameter (LVDD) decreased significantly from (62 +/- 5) mm to (56 +/- 3) mm (P < 0.001). The mean postoperative left ventricular ejective fraction (LVEF) was 0.49 +/- 0.23. All patients were in NYHA class I-II. Follow-up was completed in 38 cases for a mean period of 3.2 years (range 1-10 years). All survivors were in NYHA class I with normal neo-aortic and pulmonary valve function. One patient died after secondary operation due to homograft fungal endocarditis 1 year after the Ross procedure. The cause of death was uncontrolled bleeding. Another patient suffered from cardiogenic shock and was on extracorporeal membrane oxygenation (ECMO) for 10 days postoperatively. This patient was subsequently self-discharged from hospital due to financial issues and he was excluded from follow-up.</p><p><b>CONCLUSION</b>The Ross procedure is an excellent technique to treat aortic valve disease. Our data show that it can be performed safely with good early and mid-term clinical outcomes.</p>

The clinical analysis of 54 cases for the surgical treatment of pulmonary embolism / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the results of surgical procedures for pulmonary embolism.</p><p><b>METHODS</b>Fifty-four patients of pulmonary embolism received surgical treatment from October 1994 to June 2007, of which 9 were acute pulmonary embolism underwent pulmonary embolectomy and 45 patients were chronic thromboembolic pulmonary hypertension (CTEPH) underwent pulmonary thromboendarterectomy.</p><p><b>RESULTS</b>The mortality rate was 44.4% in acute pulmonary embolism group and 13.3% in CTEPH group (P < 0. 05). Thirteen patients had residual pulmonary hypertension and 23 patients had severe pulmonary reperfusion injury postoperatively. The pulmonary artery systolic pressure changed from (89.4 +/- 36.3) mm Hg (1 mm Hg =0.133 kPa) preoperative to (55.6 +/- 22.4) mm Hg postoperative. The pulmonary vascular resistance changed from (89. 7 +/- 56.7) kPa L(-1) S(-1) preoperative to (38.9 +/- 31.1) kPa L(-1) S(-1) postoperative. The arterial partial pressure of oxygen changed from (52. 3 +/- 6.7 ) mm Hg preoperative to (87.6 +/- 6.5) mm Hg postoperative. The arterial oxygen saturation changed from (88.9 +/- 4.5)% preoperative to (95.3 +/- 2.8 )% postoperative (P < 0.05). With the follow-up of (41.8 +/- 36.4) months, there were 4 patients died. According to NYHA, there were 28 patients for class I , 10 patients for class II and 2 patients for class III. According to Kaplan-Meier survival curve, the 3-year, 4-year, 5-year and 8-year survival rate were (97.1 +/- 2.8 )%, (94.0 +/- 4.1)%, (90.8 +/- 5.2)% and (85.0 +/- 7.3)% respectively. Linear rate of bleeding and thromboembolic related to anticoagulation were 0. 63% patient-years and 0. 62% patient-years respectively.</p><p><b>CONCLUSIONS</b>The operational mortality of acute pulmonary embolism is significantly higher than CTEPH, and the mid-long term survival rate is agreeable and the complication rate related to anticoagulation is relatively low.</p>

Outcome of surgical treatment of post-traumatic tricuspid insufficiency / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the optimal time and procedure of surgical treatment of traumatic tricuspid insufficiency.</p><p><b>METHODS</b>From May 1984 to September 2004, eight patients underwent operation for traumatic tricuspid valve insufficiency. All patients, male, aged from 7 to 67 years median: 38 years, mean: (38.5 +/- 18.1) years. The intervals between trauma and operation ranged from 1 month to 20 years median: 19 months, mean: (52.5 +/- 80.3) months). In seven patients, tricuspid insufficiency was attributed to blunt chest trauma including vehicle accident in three patients and the other patient is a stab wound. Diagnosis was confirmed by echocardiography. Pre-operative cardiac functions in patients were classified as New York Heart Association (NYHA) classes II-IV. During operation, the anterior leaflet of the tricuspid valve was completely or partially flailed as a result of chordal rupture in all patients. Chordal rupture of septal leaflet was found in one patient. Anterior leaflet was perforated in two patients. Septal leaflet was retracted and adherent to ventricular septum in two patients. Valve repair was intended for all patients. Finally, valve repair was performed successfully in 3 patients and tricuspid replacement was performed in 5 patients.</p><p><b>RESULTS</b>No early or late death occurred. With a follow-up through clinical manifestation and echocardiography for 7-129 months median: 39 months, mean: (53.4 +/- 42.8) months, all patients were classified as NYHA class I, without any changes.</p><p><b>CONCLUSIONS</b>The satisfactory treatment of traumatic tricuspid insufficiency can be obtained by surgical treatment. Earlier surgery may increase the feasibility of tricuspid valve repair and prevent the deterioration of right ventricular function.</p>

Acute hemodynamic effects of intravenous diltiazem in patients with congenital heart defects and pulmonary hypertension post cardiac surgery / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the acute hemodynamic effects of intravenous diltiazem in patients with congenital heart defect (CHD) and severe pulmonary hypertension (HP) post cardiac surgery.</p><p><b>METHODS</b>From November 2003 to September 2005, 12 patients with CHD and severe HP (4 male, mean age 17.8 +/- 9.8 years) after cardiac surgery received intravenous diltiazem (3 - 5 microg x kg(-1) x min(-1)) in the Intensive Care Unit. Mean pulmonary artery pressure (mPAP), mean arterial pressure (MAP), heart rate (HR), stroke volume (SV), systemic vascular resistance (SVR), pulmonary vascular resistance (PVR) were monitored with Swan-Ganz catheter before (T1) and 6 hours (T2) after diltiazem injection, before weaning patients off of ventilator (T3), 1 hour (T4) and 24 hour (T5) after extubation.</p><p><b>RESULTS</b>All patients survived during the observation period and no patient developed pulmonary hypertension crisis. The average ventilation time was (88.7 +/- 50.1) hours. Mean ICU stay time was (5.8 +/- 3.1) days. Compared to T1, mPAP was significantly decreased at T3 and T5, MAP significantly increased at T4 and T5, HR significantly reduced at T2 and thereafter, SV significantly increased at T3, T4 and T5 and PVR significantly increased at T3 and T5 while SVR remained unchanged after diltiazem therapy.</p><p><b>CONCLUSION</b>Intravenous use of diltiazem is safe and effective for patients with CHD with severe HP post cardiac surgery.</p>