Surgical treatment of aortico-left ventricular tunnel / 中华心血管病杂志

<p><b>OBJECTIVE</b>To review 9 aortico-left ventricular tunnel (ALVT) patients in our hospital, describe the clinical features, diagnosis, treatments and follow-up.</p><p><b>METHODS</b>We identified 9 patients from July 2002 to August 2008. Clinical and surgical details were reviewed. 7 patients were in NYHA class I and 2 in class III, 8 of 9 patients were diagnosed by echocardiography before operation.</p><p><b>RESULTS</b>All patients underwent surgery under standard cardiopulmonary bypass. 2 with direct suture, 5 by patch closure of the aortic end and 1 by patch closure of both aortic end and left ventricular end of the AVLT. 1 underwent aortic valve replacement after incision of the ALVT. One patient died 2 month after operation because of endocarditis and acute heart failure. At follow-up (3 month to 6 years), 3 patients were in NYHA class I, 3 in Class II, 1 in class III and missed 1. No aortic regurgitation or trace in 2, little in 1, little to moderate in 2. The aortic mechanical valve is normal in 1 and paravalvular leakage in 1 patient.</p><p><b>CONCLUSION</b>Aortico-left ventricular tunnel is a rare cardiac malformation with a good post-operative outcome. Surgery is an effective treatment. Long-term follow-up for post-operation is essential.</p>

Clinical analysis of unroofed coronary sinus syndrome with atrioventricular canal defect / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze symptoms, associated anomalies, diagnostic approach, and surgical procedures in patients with unroofed coronary sinus syndrome and atrioventricular canal defect.</p><p><b>METHODS</b>The clinical data of 20 patients with unroofed coronary sinus syndrome from September 1999 to October 2007 were reviewed retrospectively. There were 10 male and 10 female patients. The age ranged from 6 months to 38 years old, with a mean of (11.4 +/- 11.0) years old. The body weight ranged from 6.7 to 73.0 kg, with a mean of (28.4 +/- 21.3) kg. There were 18 cases of partial atrioventricular canal defect, 2 cases of complete atrioventricular canal defect, and 12 cases of common atrium. The initial diagnosis of unroofed coronary sinus syndrome was made by the surgeon at repair of a partial or complete atrioventricular canal defect in 20 patients. Complex unroofed coronary sinus with left superior vena cava (LSVC) directly draining into the left atrium was found in 11 cases, 1 case of LSVC was ligated, 10 cases were reconstructed the intraatrial baffle or the intracardiac tunnel to drain LSVC to right atrium. The other 9 patients with simple unroofed coronary sinus were repaired with other procedures. The associated cardiac lesions were corrected concomitantly.</p><p><b>RESULTS</b>Death occurred in 1 patient with complex congenital cardiac disease due to pulmonary infection. In the 14 early survivors, who had been followed up from 4 months to 3 years, there was no death and severe complications.</p><p><b>CONCLUSIONS</b>When associated with a partial or complete atrioventricular canal defect, LSVC and a common atrium, unroofed coronary sinus syndrome should be considered as a possible additional finding. Repair according to the type of unroofed coronary sinus syndrome is effective.</p>

Extracorporeal membrane oxygenation for treatment of cardiorespiratory function failure in adult patients / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the experience on venoarterial extracorporeal membrane oxygenation (ECMO) in adult patients with cardiac failure.</p><p><b>METHODS</b>From February 2005 to June 2008, 45 patients (male 34, female 11) undergoing cardiogenic shock required temporary ECMO support. Average age was (49.0 +/- 14.1) years. Average body weight was (67.0 +/- 12.8) kg. Coronary heart disease occupied in 21 cases, valve disease occupied in 8 cases, and cardiomyopathy occupied in 7 cases. All the patients could be divided into 3 groups: post-cardiotomy (group 1, n = 31), post-transplantation (group 2, n = 5), decompensate of chronic heart failure (group 3, n = 9). Fourteen patients need cardiac resuscitation before ECMO support. ECMO implantation was performed through the femoral vessels or axillary artery or through the right atrium and ascending aorta.</p><p><b>RESULTS</b>Average support duration of ECMO was (126.7 +/- 104.3) h. Twenty-seven patients could be successfully weaned from support (60.0%), additionally, 5 were bridged to heart transplantation. The in-hospital mortality was 42.2% (19/45). Twenty-six patients (57.8%) could be successfully discharged. The discharge rate was 58.1% in group 1, 4/5 in group 2 and was 4/9 in group 3. Twelve patients were re-operated for hemostasis. Three patients need femoral arterial thrombectomy because of ischemia of lower extremity. Additional intra-aortic balloon pumps were used in 11 patients, with 6 patients successfully discharged. The mortality rate for patients with acute renal failure treated by continuous renal replacement therapy under ECMO support was obviously high (7/9). The dominant mode of death was multisystem organ failure (9/19).</p><p><b>CONCLUSION</b>Early indication, control of complications, and paying attention to the treatment after ECMO support could improve our results with increasing experience.</p>

Clinical application of BVS5000 left ventricular assist device in heart failure patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Mechanical ventricular assistance is an important therapeutic method for severe heart failure patients. A variety of ventricular assist devices have been designed for use. The purpose of this report was to describe the experience of using Abiomed BVS5000 as a means of left ventricular support as a clinical treatment for heart failure patients.</p><p><b>METHODS</b>From February 2004 to April 2006, 12 male patients were supported with Abiomed BVS5000 left ventricular assist device (LVAD) at Fu Wai Hospital. The average age was (55.2 +/- 9.6) years (range 39 to 68 years). The mean body surface area was (1.76 +/- 0.1) m(2) (range 1.6 to 1.9 m(2)). Devices were inserted for post-cardiotomy shock after coronary artery bypass graft in 11 patients (92%) and in 1 dilated cardiomyopathy patient for acute cardiogenic shock. Modified cannulation methods by inserting the arterial cannulae in femoral artery and inserting the venous cannula in left atrium through a segment of bovine jugular vein were used in 7 patients. In this way, the device could be taken off without re-sternotomy when support was finished. A comparison was made between the modified method and routine left atrium-to-ascending aorta cannulating method.</p><p><b>RESULTS</b>The median duration of support was 5 (3 - 43) days, with support flow rate of 3.8 - 4.5 L/min. There were 9 (75%) patients weaned from support and 8 (67%) patients discharged from the hospital. Four (33%) patients were dead. The most common morbidity was adverse neurological events. There is no statistical difference between modified and routine method on average in BVS5000 support duration, in assisted flow rate, in mechanical ventilation duration, in the intensive care unit stay and thoracic drainage.</p><p><b>CONCLUSIONS</b>The Abiomed BVS5000 is valuable to support patients with acute cardiogenic shock for short-term use. By the modified cannulating method, the weaning procedure can be effectively simplified. Optimization of inserting indication remains challenging and attributes to a successful assist program.</p>

Mechanical circulation support as emergency bridging for heart transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the experience of patients in acute cardiogenic shock required insertion of mechanical circulation support devices (MCS) before undergoing standard pretransplant evaluations.</p><p><b>METHODS</b>From February 2005 to August 2007, 10 patients including 7 male and 3 female required emergency bridging placement of MCS. Average age was (40 +/- 16.2) years old. Mean body weight was (70.8 +/- 18.1) kg. There were 5 patients of dilated cardiomyopathy, 2 patients of arrhythmic right ventricular cardiomyopathy, 2 patients of ischemic cardiomyopathy and 1 patient of end-stage valvular heart disease. All patients were accompanied with acute decompensation of congestive heart failure. Before implantation of MCS, all patients received treatment of three or more inotropic drugs at maximal dosages, 6 patients suffered from ventricular tachycardia, 4 patients required cardio-pulmonary resuscitation treatment and 3 patients suffered from definite function defect of liver and kidney. MCS included ECMO for 8 patients, BVS5000 and MEDOS for 1 patient respectively.</p><p><b>RESULTS</b>The duration of MCS supporting was 3 to 44 d with a mean of (11.5 +/- 13.9) d. Four patients were successfully supported for getting heart transplantation, 1 patient received kidney transplantation simultaneously. Two patients recovered from acute heart failure, discharged and remained on regular heart transplantation list. One patient died from cerebral embolism after 44 days' support and 1 died from multiple organ failure after 3 days' support. Because of severe infection, MCS treatment of 2 patients was terminated ahead of schedule by their family and the patients were lost finally.</p><p><b>CONCLUSIONS</b>The use of MCS devices for acute catastrophic situation appears warranted despite the abbreviated transplant evaluations. It is important for improving the outcomes with beginning MCS support before multiple organ system failure occurs, and accurately identifying individuals who can benefit from MCS.</p>

Clinical experience of BVS5000 left ventricular assist devices in heart failure patients / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the experience of Abiomed BVS5000 as a mean of left ventricular support on clinical treatment for severe heart failure patients.</p><p><b>METHODS</b>From February 2004 to April 2006, 12 male patients were supported with Abiomed BVS5000 as a left ventricular assist device. The average age was (55.2 +/- 9.6) years old (range from 39 to 68 years old). Mean body surface area was (1.76 +/- 0.1) m2 (range from 1.6 to 1.9 m2). Devices were inserted for post-cardiotomy shock after coronary artery bypass grafting in 11 patients (92%) and in 1 dilated cardiomyopathy patient for acute cardiogenic shock. Modified cannulation methods by inserting the arterial cannulae in femoral artery and inserting the venous cannula in left atrial through bovine jugular vein were used in 7 patients. In this way, the device could be taken off without resternotomy when support was finished. A comparison was made between the modified method and routine left atrium-to-ascending aorta cannulating method.</p><p><b>RESULTS</b>The average duration of support was (8.8 +/- 11.2) d (range from 3 to 43 d), with support flow rate of 3.8 to 4.5 L/min. There were 9 patients (75%) weaned from support and 8 patients (67%) discharged from the hospital Four patients (33%) were dead. The most common morbidity was adverse neurologic events. There was no statistic difference between modified and routine method on average BVS5000 support duration, assisted flow rate, mechanical ventilation duration, stay of intensive care unit and thoracic drainage.</p><p><b>CONCLUSIONS</b>The Abiomed BVS5000 is valuable to support patients with acute cardiogenic shock for short-term use. With using modified cannulating method, the weaning procedure can be effectively simplified.</p>

Pathological changes of radial artery used for coronary artery bypass grafting and its related risk factors for intimal hyperplasia / 中华外科杂志

<p><b>OBJECTIVE</b>To examine the degree of intimal hyperplasia and the prevalence of atherosclerosis in radial arteries taken from the patients undergoing coronary artery bypass grafting (CABG), and to analyze the risk factors to obtain some helpful information for choosing arterial conduits.</p><p><b>METHODS</b>Forty-one radial arteries and 11 internal mammary arteries samples were collected. The average age of patients was 48.5 years, and they all were male. Intimal hyperplasia, atherosclerosis, medial calcification were evaluated by routine histological methods, and the severity of diseases was measured on the percentage of luminal narrowing and the intima-to-media ratio (the intima area/media area). The risk factors for coronary heart disease were also analyzed.</p><p><b>RESULTS</b>Ninety-three percent (38 of 41) of radial arteries showed mild intimal hyperplasia, which was not regarded to influence blood flowing after CABG. As a part of them, 54% (22/41) of radial arteries had a lower than 25% of luminal narrowing, meanwhile 39% (16/41) of radial arteries had the percentage of luminal narrowing between 25% and 50%. Only 7% (3 of 41) of radial arteries were found to have occlusive lesions, which made arterial lumen decreased more than 75%. The 3 patients including 2 with severe atherosclerosis and another 1 aged 17 years was involved by fibromuscular dysplasia. The later vessel was discarded after harvesting. The percentage of luminal narrowing and the intima-to-media ratio were higher in radial artery than that in internal mammary artery (t = 3.00, 2.49, P < 0.05). The two parameters were positively correlated with age (r = 0.398, 0.310, P < 0.05), but this study failed to show any relationship between intimal hyperplasia of radial artery and coronary lesions and other risk factors. Medial calcification was not found by routine histological method in all cases.</p><p><b>CONCLUSION</b>Only mild intimal hyperplasia and no medial calcification are found in radial arteries used for CABG in the patients. Because the risk factors could not yet predict the severity of radial arterial lesions, this study strongly suggests that the Doppler ultrasonography and pre-operation clinical consideration should be emphasized to screen out some arteries with occlusive lesions.</p>