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Objective To analyze the influence of left atrial dimension (LAD) on the effectiveness of heart valve replacement combined with dipolar radiofrequency ablation in atrial fibrillation (AF). Methods Eighty-one patients with permanent AF and heart valve diseases having undergone surgical treatment were selected. The patients were divided into two groups according to the size of LAD:groupⅠ (45 patients with LAD<60 mm) and group Ⅱ (36 patients with LAD ≥60 mm). All the patients underwent heart valve replacement and douching dipolar radiofrequency ablation, and were given amiodarone therapy after operation. The ultrasonic cardiogram and electrocardiogram after operation were inspected periodically. The changes of cardiac function and electrophysiology activity were observed. The patients were followed up for 12 months. Results The early-stage mortality after operation was 3.7% (3/81), and all of death was caused by postoperative low cardiac output syndrome. Two cases appeared third-degree atrioventricular block after surgery, and they were installed permanent pacemaker. During the follow-up, 1 case died because of sudden cerebrovascular accident. Two cases were loss to follow-up. There was no statistical difference in rate of maintaining sinus rhythm at discharge from hospital between group Ⅰ and group Ⅱ: 75.0% (33/44) vs. 73.5% (25/34), P=0.88. But the rates of maintaining sinus rhythm at 3 and 12 months after operation in groupⅠwere significantly higher than those in groupⅡ:81.4% (35/43) vs. 58.8% (20/34) and 88.1% 37/42) vs. 60.6% (20/33), and there were statistical differences ( P=0.029 and 0.006). Conclusions For the patients in permanent AF and heart valves diseases with LAD <60 mm, the dipolar radiofrequency ablation during heart valve replacement has considerably beneficial effects on rate of maintaining sinus rhythm. But for the patients with LAD≥60 mm, the result is not optimistic and has a lower postoperative sinus rhythm restoration rate.
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Objective To observe the mid-term changes of pulmonary function and quality of life in the patients with emphysema who have undergone lung volume reduction surgery.Methods 44 subjects with severe emphysema underwent single or double lung volume reduction surgery through thoracoscope.There were 33 male and 11 female in the population analyzed with an age range of 46 to 70 years old.The mean age of the patients was (65.2-± 6.0) years.The pulmonary function and quality of life evaluation were determined over 3 time periods:prior to surgery,12 months postsurgery,and 24 months postsurgery Pulmonary function measurement project including the forced expiratory volume in 1 second (FEV 1),FEV 1％ of predicted value,residual volume (RV),RV ％ of predicted value,partial pressure of oxygen(PO2),partial pressure of carbon dioxide (PCO2),life quality evaluation performed in the form of questionnaire,including whether under anhelation,satisfactory sleep,living by self-care,participating in household duties,taking part in social work,whether to have a good mental state and have a hobby.Results There was 1 death of 44 patients from respiratory failure.43 patients recovered smoothly.4 cases were lost to follow-up.In 39.patients with follow-up,1 patient succumbed to cerebrovascular at 13 months after surgery.The other 38 cases compared with the preoperative at 12 and 24 months postsurgery,postoperative forced expiratory volume in 1 second (FEV1) increased,P ＜ 0.05,residual gas volume (RV) decreased,P ＜ 0.05,partial pressure of oxygen (PO2) increased,P ＜ 0.05,partial pressure of carbon dioxide (PCO2) decreased,P ＜ 0.05,meanwhile,the quality of life has improved significantly.Conclusion Lung volume reduction surgery in patients with severe obstructive emphysema can improve pulmonary function and quality of life.And its effect would not disappeared in the short term.
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Objective To analyze the clinical characteristics,diagnosis and the surgical treatment experience of the pulmonary sequestration.Methods The clinical data from 26 patients with pulmonary sequestration undergoing surgical operation were reviewed and analyzed retrospectively.Results Pulmonary sequestration was diagnosed in 16 out of 26 patients before the operation with the diagnosis rate of 61.5%(16/26).Pre-operation chest X-ray and plain CT-scan were performed in 26 cases.Enhancement CT scanning and CTA imaging were performed in 8 cases, magnetic resonance imaging were performed in 5 cases.21 patients with intralobar sequestration underwent lobectomy and 8 patients with extralobar sequestration underwent local lesion resection.Abnormal supply arteries were intraoprat-ibely found in 21 cases originating from the thoracic main artery,3 cases from the celiac artery,2 cases from the dia-phragm artery.Smooth recovery was achieved in all patients.No peri-operative death occurred.Symptoms disappeared were followed-up for 6 months.Conclusion Enhancement CT scanning,CTA imaging and magnetic resonance ima-ging ( MRI) may improve the diagnosis of pulmonary sequestration.Operation is a safe and effective method for the treatment of pulmonary sequestration.But intraoperative abnormal blood supply arteries should be paid attention to the treatment and prevention of intraoperative and postoperative bleeding.
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Objective To explore the value of video-assisted thoracoscopic thymectomy in the treatment of thymoma accompanied by myasthenia gravis.Methods In this study,forty-two patients who were preoperatively con-firmed to be thymoma accompanied by myasthenia gravis from 2008.1 to 2012.12 were treated using VATS,including typeⅠin 23 cases,typeⅡa in 11 cases,typeⅡb in 7 cases,and type Ⅲ in 1 case.Thymectomy and dissection of all fatty tissue anterior to the pericardium were performed in all cases.The operation time,blood loss,chest drainage time,hospital stay and outcomes were recorded and compared.Results In this group,one patient showed myasthenic crisis after surgery and recovery well after treated by ventilatory support.the patients had fewer blood loss(<35mL) , shorter operation and postoperative drainage time, and shorter postoperative hospital stay.Conclusion Extended thymectomy by VATS is safe and feasible with the advantage of less invasion,less surgical trauma and pain,lower rate of complication,and good curative effect.
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ObjectiveTo explore the surgical treatment of congenital heart disease combined with severe pulmonary hypertension.MethodsThirty-two patients of congenital heart disease combined with severe pulmonary hypertension were included in the study.The saturation of arterial oxygen ranged from 0.84 to 0.94 and echocardiography showed left to right slow velocity shunt in 20 eases,double direction shunt in 10 cases and no shunt in 2 cases.The pulmonary arterial pressure was 65-120 (82 ± 14) mm Hg ( 1 mm Hg =0.133 kPa).All patients received surgical repairs under cardiopulmonary bypass and were treated preoperatively with oxygen inhalation therapy,oral intake of beraprost sodium or silaenafil respectively according to the degree of pulmonary hypertension.During cardiopulmonary bypass,pulmonary artery perfusion was performed with protective solution containing ulinastatin for lung protection.Vasoactive drugs were routinely administrated postoperatively.Results Thirty-two cases underwent the surgical treatment successfully with their postoperative pulmonary arterial pressure decreased 20 -40 mm Hg and 2 cases died of severe low cardiac output syndrome and fatal arrhythmia.The mortality was 6.25％(2/32).ConclusionComprehensive perioperative management followed by radical operation can achieve a good clinical result on congenital heart disease combined with pulmonary hypertension.
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Objective To summarize the results of valve re-operative cases after cardiac valve replacement, to find the better re-operative time, and to estimate the re-operative methods and influencing factors of the operation. Methods Thirteen valve re-operative cases after cardiac valve replacement from October 2008 to February 2010 were retrospectively studied. According to NYHA classification, 9 cases belonged to class Ⅳ, and only 4 cases belonged to class Ⅲ preoperatively. Mitral valve replacement (MVR)was performed in 7 cases, aortic valve replacement (AVR) in 3 cases, MVR + AVR in 3 cases. Results The early-stage postoperative mortality was 7.7%( 1/13),and the reason was low cardiac output syndrome. Two cases who underwent re-operation and re-intubation respectively after operation for hemorrhage were improved after treatment. Twelve cases were discharged in 3-6 weeks after heart valve surgery and all were followed up for 6-15 months. The cardiac function of all the discharged patients recovered well and no death occurred during follow-up. Conclusion The key factors to reduce the death of re-operation are improving preoperative heart function,setting up extracorporeal circulation as soon as possible,consummating myocardial preservation,perfecting operating skills,correcting low cardiac output syndrome in time and preventing complications.
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Objective To observe the clinical effects of intensive insulin therapy on postoperative infection, inflammatory response and prognosis in the non-diabetic patients of different ages undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). Methods 60 cases of non-diabetic patients (>60) undergoing coronary artery bypass grafting with cardiopulmonary bypass between June 2005～June 2010 were selected and analyzed retrospectively. 60 patients were divided into 2 groups, the previous 24 cases were included in a routine treatment group and later 36 cases were included in the intensive therapy group. The blood sugar of intensive therapy group was strictly controlled starting from the anesthesia. The routine treatment group was controlled starting from backing to ICU according to blood glucose results. Patients were assigned to the routine therapy group with the blood glucose maintained at 10.0～11.1 mmol/L and the intensive therapy group received tight glycemic control with the target blood glucose maintained at 4.4～6.1 mmol/L. Postoperative infection, mechanical ventilation time, hospital stay and mortality indicators were compared between the 2 groups. Results There were no significant difference (P＞0.05) in gender, body weight, disease diagnosis and combined surgical methods and surgical materials such as cardiopulmonary bypass time between the 2 groups. Neutrophil count［(12.6±2.8)×109/L vs (18.8±3.1)×109/L］, blood infections, respiratory tract infection(6/36 vs 10/24) and wound infectionrates(2/36 vs 6/24) and other indicators of intensive of insulin therapy group were lower than the regular therapy group (P＜0.05). The postoperative hospital stay of intensive therapy group［(12.2±3.7)d vs (15.6±5.4)d)］ was statistically significant shorter compared with the conventional treatment group (P＜0.05). There was no significant difference in postoperative mortality between the 2 groups (P＞0.05). Conclusions Intensive insulin therapy may significantly reduce postoperative infection rate in the old age patients, thus leading to an improved prognosis in the non-diabetic patients undergoing coronary artery bypass grafting with cardiopulmonary bypass.
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Objective To analyze the medium and long-term results of tricuspid valve replacement (TVR)and summarize the operative experience for tricuspid valve disease.Methods Clinical data of 27 patients with severe tricuspid valve disease from September 2005 to May 2010 were retrospectively reviewed.Biological valve prosthesis was replaced in 23 patients,while mechanical valve prosthesis was replaced in 4 patients.Accompanying procedures included mitral valve replacement in 8 cases,mitral valve replacement and aortic valve replacement in 4 cases,and repair of atrial septal defect in 4 cases.Results The operative mortality was 11.1％(3/27),among these patients,2 cases died of serious low cardiac output syndrome,1case died of muhiorgan failure on the 7th day after operation,1 case who underwent reoperation for hemorrhage postoperative was improved after treatment.During follow-up,1 patient died of biological valve prosthesis dysfuncion 3 years after operation,1 patient died of cerebral embolism 19 months after operation.Six cases were in New York Heart Association(NYHA)class Ⅰ,and 14 cases in NYHA class Ⅱ during the period of follow-up.Conclusions Because operative and follow-up mortality is high,TVR is the last selection for the treatment of tricuspid valve disease.Appropriate operative technique and perioperative therapy are the key for clinical success.For those older than 50 years,follow-up inconvenience and reproductive-age female patients,biological valve prosthesis should be recommended as a preferential choice.
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ObjectiveTo investigate the myocardial protection on cardiac valve replacement surgery with creatine phosphate of myocardial GIK (GIK) in order to reduce the surgical risk and improving the efficacy.Methods126 cases were unergone surgical treatment of heart valve disease,whose cardiac function on admission wereⅢor Ⅳ. 126 patients were randomly divided into two groups. Cardiopulmonary bypass time, aortic cross clamp time, postoperative myocardial injury markers ( CK-MB, cTNI) changes, arrhythmias, heart function recovery, length of stay and mortality rate and other indicators were compared between the two groups. ResultsThe age, gender, body mass,heart disease and surgery combined data were not statistically significant between the two groups( all P ＞0. 05). The cardiopulmonary bypass time, aortic cross clamp time and mortality had no significant differences between the two groups( all P ＞ 0.05 ). The CK-MB( 21.36± 9.21 ) U/L and cTNI(0.83 ± 0. 35 ) ng/ml of creatine phosphate group were significantly lower than those of the control group. The incidence of arrhythmia in phosphocreatine group (37. 1％ ) was significantly lower than ordinary group (57.8 ％ ) ( X2 ＝ 5. 418, P ＜ 0. 05 ). ConclusionThe application of creatine phosphate GIK before valve replacement surgery could effectively reduce reperfusion injury after myocardial ischemia,myocardial protection,and significantly reduce the incidence of arrhythmia and improve heart function in patients.