A novel "box lesion" minimally invasive totally thoracoscopic surgical ablation for atrial fibrillation

<p><b>INTRODUCTION</b>Minimally invasive surgical ablation is an emerging alternative method to catheter ablation and the full surgical maze procedure for nonpharmacologic treatment of atrial fibrillation (AF). We present a totally thoracoscopic "box lesion" radiofrequency ablation procedure in patients with paroxysmal or persistent AF.</p><p><b>MATERIALS AND METHODS</b>From June 2011 to October 2012, 14 patients with lone paroxysmal (n = 7) or persistent AF (n = 7) were enrolled in this study. Procedures were performed through 3 5-12 mm holes on each side of the chest wall. A bipolar ablation device was used to create a box lesion in the posterior wall of the left atrium that encircled the 4 pulmonary veins (achieving bilateral pulmonary vein/posterior left atrial wall isolation). Perioperative complications were recorded for all patients. Freedom from AF was assessed by 24-hour Holter monitoring every 3 months or during symptoms of arrhythmia.</p><p><b>RESULTS</b>The ablation was successfully performed in all patients, with median operation time of 128 minutes (range, 45 to 180 minutes). No operative mortality or morbidity were noted during the study period. Freedom from AF was achieved in 12 patients (85.7%) during follow-up (median follow-up 9 months). One patient with persistent AF was shifted to paroxysmal AF. No atrial flutter or atrial tachycardia was noted during the follow-up.</p><p><b>CONCLUSION</b>These early results show that totally thoracoscopic surgical ablation using a unique "box lesion" procedure for persistent or paroxysmal AF is a feasible and effective method with good short-term results. Further study is necessary to validate this result.</p>

Effects of myocardial platelet rich plasma injection on rats with acute myocardial infarction:(99)Tc(m)-MIBI gated SPECT imaging evaluation results / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the effect of direct myocardial injection of platelet rich plasma (PRP) on cardiac function, ventricular remodeling and myocardial perfusion.</p><p><b>METHODS</b>Myocardial infarction was induced in 30 Fisher rats by left anterior descending coronary artery (LAD) ligation. One week after LAD ligation, rats in control group (n = 15) received 0.5 ml saline myocardial injection and rats in PRP group (n = 11) received 0.5 ml PRP myocardial injection.(99)Tc(m)-methoxyisobutylisonitrile (MIBI) gated single photon-emission computed tomography (SPECT) imaging was applied at 1 week post LAD ligation and prior myocardial saline/PRP injection and repeated at 4 week post LAD ligation to assess myocardial perfusion and ejection fraction (EF), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and the number of infarct segments.</p><p><b>RESULTS</b>EF remained unchanged between 1 and 4 weeks post LAD ligation in control group and was significantly higher at 4 weeks post LAD ligation than at 1 week post LAD ligation in PRP group (P < 0.05). LVESV was significantly increased in the control group (P < 0.05) while remained unchanged in the PAP group (P < 0.05) at 4 weeks post LAD ligation compared that at 1 week post LAD ligation. LVEDV remained unchanged in the control group (P > 0.05) and significantly increased in the PRP group (P < 0.05) from 1 week to 4 weeks post LAD ligation. Myocardial perfusion remained unchanged in the control group and significantly improved in the PRP group at 4 week post LAD ligations. Histological examination also confirmed that PRP treatment can decrease infarct size [from (47 ± 19)% to (36 ± 11)%], increase ventricular wall thickness [from (3.1 ± 0.9) mm to(4.6 ± 1.8) mm] (P < 0.05).</p><p><b>CONCLUSION</b>Myocardial PRP injection could improve cardiac function and reperfusion in this rat model of acute myocardial infarction.</p>

Challenges for rear hospital care of Wenchuan earthquake casualties: experience from West China Hospital / 中华创伤杂志(英文版)

To review the challenges and countermeasures in the hospital care for Wenchuan earthquake casualties and draw lessons for the protective response in the future. Medical records and laboratory findings of the victims admitted in West China Hospital (WCH) were retrospectively analyzed. Related data were compared between beforemath and aftermath of the earthquake and between WCH and frontier county hospitals. One thousand and thirty-one earthquake survivors were hospitalized, 1 358 victims underwent surgery and 142 victims were transferred to intensive care unit. The incidence of infection, crush syndrome and multiple organ dysfunction syndrome (MODS) was 39.6%, 20.7% and 2.3% respectively. Wound classification showed that the incidence of extremity damage was 72%, while the incidence of chest trauma, abdominal trauma and brain trauma was less than 10% respectively. Isolating rates of environmental pathogens were increased in the aftermath of earthquake, and the spectrum of the pathogens and related antibiotic sensitivities were quite different from those in the beforemath of earthquake. The social economic and population conditions in the earthquake-stricken areas affected the composition of the victims and the geographic features restricted the efficiency of rescue. Trauma-induced MODS, crush syndrome and severe infections all constituted the dilemma for the hospital care, to resolve whether the multidiscipline team work was proved to be an optimizing choice. For a more effective disaster protective response in the future, the study on rescue plan and the ladder therapies for massive casualties should be potentiated.

Tricuspid valve replacement and anticoagulation therapy: a report of 70 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the operative indication, the choice of valve prostheses, and the method of anticoagulation therapy of tricuspid valve replacement (TVR).</p><p><b>METHODS</b>From May 1998 to January 2008, 70 patients underwent TVR. There were 59 cases of rheumatic heart diseases. The operations included mitral and tricuspid valve replacement for 37 cases, triple valve replacement for 18 cases, isolated TVR for 13 cases, and tricuspid and aortic valve replacement for 2 cases. All the patients received oral anticoagulant therapy (warfarin) 2 d after the operations.</p><p><b>RESULTS</b>There were 3 in-hospital deaths (4.3%) and 1 late death (0.4%). The follow-up rate was 88.1%, and the cumulative follow-up was 243.5 patient-years (pty). The anticoagulation-related event rate was 2.9% pty, and the mean INR value of 643 out-patient samples was 1.87 +/- 0.68. Post-operative heart function NYHA classification: 52 cases in class I to II, and 7 cases in class III.</p><p><b>CONCLUSIONS</b>TVR should be indicated for severely damaged and deformed tricuspid valve of rheumatic heart diseases. Bileaflet mechanical valve is a suitable prosthesis for TVR. The optimal anticoagulation therapy intensity of TVR needs to be investigated.</p>

Low intensity anticoagulation therapy after mechanical heart valve replacement / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the proper anticoagulation intensity in patients after mechanical heart valve replacement in china.</p><p><b>METHODS</b>The anticoagulation therapy intensity and the complications in 480 patients after mechanical heart valve replacement were studied.</p><p><b>RESULTS</b>The follow-up rate was 89.17%, the total patient-years (Pty) was 2,110.04 years, the mean oral import warfarin dosage was (2.81 +/- 0.95) mg/day, and native warfarin dosage (2.38 +/- 0.46) mg/day. The mean PTR value of 2 116 samples was 1.43 +/- 0.26, and the INR value of 1 195 samples was 1.63 +/- 0.49. The total hemorrhage rate was 4.60% Pty, and the hemorrhage death rate was 0.38% Pty. The PTR and INR values were higher in the hemorrhage group than in the no-hemorrhage group. (t = 1.816, P < 0.05; t = 2.407, P < 0.01). The thromboembolism rate was 0.66% Pty, and the thromboembolism death rate was 0.05% Pty. There were 15 pregnancies in 14 women patients and no malformed newborns were found.</p><p><b>CONCLUSIONS</b>The most important complication of anticoagulation therapy after mechanical heart valve replacement is hemorrhage in china; The proper anticoagulation intensities of this group are INR 1.5-2.0 and PTR 1.3-1.5. It is beneficial to adopt the low intensity anticoagulation therapy for decreasing the death rate from hemorrhage, protecting pregnant women and newborns from hemorrhage and malformation, and improving the life qualities of the patients.</p>