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@#Objective To evaluate the early clinical outcomes of the Renatus® balloon-expandable valve in the treatment of severe aortic stenosis. Methods From November 2021 to April 2022, a total of 38 patients who received Renatus® balloon-expandable valve for severe aortic stenosis in Guangdong Provincial People's Hospital were included. There were 22 males and 16 females, with an average age of 73.7±5.3 years. Mean aortic gradient and peak aortic jet velocity at baseline, post-procedure, and follow-up were compared. Clinical outcomes including all-cause mortality, perivalvular leakage, serious adverse cardiovascular events and the occurrence of permanent pacemaker implantation were assessed. Results All patients completed the procedure successfully without conversion to thoracotomy or perioperative death. The post-implant mean aortic pressure gradient was decreased from 41.5 (27.8, 58.8) mm Hg to 6.0 (3.0, 8.0) mm Hg, and the peak aortic jet velocity was also decreased from 4.1±0.9 m/s to 1.7±0.4 m/s (P<0.001). Pacemakers were required in 2 (5.3%) patients. The median follow-up time was 27.5 (23.0, 87.5) d, with a follow-up rate of 100.0%. The mean aortic gradient was 8.0 (7.0, 10.8) mm Hg and peak aortic jet velocity was 2.0±0.3 m/s, showing significant improvement compared with those in the preoperative period (P<0.001). No severe aortic regurgitation or paravalvular leak was observed. There was no serious cardiovascular adverse event or reoperative event during the study period. Conclusion Transcatheter aortic valve replacement with the domestic Renatus® balloon-expandable valve system is a safe and effective procedure for selected patients with severe aortic stenosis who are at high risk or not candidates for surgical aortic valve replacement.
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@#We reported a 26-year-old male who was diagnosed with apical hypertrophic cardiomyopathy with left ventricular aneurysm. The location of the hypertrophic myocardium and the extent of resection were accurately assessed preoperatively using 3D modeling and printing technology. Myectomy was performed via transapical approach, and the intraoperative exploration was consistent with the description of the preoperative 3D modeling. The patient underwent the surgery successfully without any complications during the hospitalization, and the cardiopulmonary bypass time was 117 min, the aortic cross-clamping time was 57 min, and the hospital stay time was 7 d. The postoperative echocardiography demonstrated left ventricular cavity flow patency. This case provides a reference for the management of patients with apical hypertrophic cardiomyopathy.
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@#Objective To investigate the surgical strategies and clinical efficacy of transmitral septal myectomy in the treatment of recurrent left ventricular outflow tract obstruction (LVOTO) after alcohol septal ablation. Methods The clinical data of patients with recurrent LVOTO after alcohol septal ablation from July 2020 to July 2021 in the Department of Cardiac Surgery, Guangdong Provincial People's Hospital were retrospectively analyzed. Patients were preoperatively evaluated by echocardiography, cardiac magnetic resonance imaging, cardiac computed tomography, 3D modeling and printing technology. A personalized surgical strategy was preoperatively developed according to multimodality imaging assessment, while visual exploration was performed on the digital model and simulated surgical resection was performed on the printed model. Results Two female patients were enrolled, aged 62 years and 64 years, respectively. Totally endoscopic transmitral extended myectomy was successfully performed on both patients with aortic cross-clamping time of 96 min and 85 min, respectively. LVOTO was relieved immediately (subaortic peak pressure gradient decreased from 100 mm Hg to 4 mm Hg and from 84 mm Hg to 6 mm Hg, respectively) and the mitral regurgitation significantly improved after the procedure. No patient had complete atrioventricular block or required permanent pacemaker implantation. The patients were discharged uneventfully without postoperative complications. Conclusion Personalized totally endoscopic transmitral extended myectomy combined with multimodality imaging assessment and 3D modeling and printing has an acceptable clinical effect in patients with recurrent LVOTO after alcohol septal ablation. The procedure can precisely resect the hypertrophic septal myocardium while avoiding serious complications such as septal perforation or complete atrioventricular block.
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@#Objective To analyze the clinical efficacy and survival outcome of totally thoracoscopic redo mitral valve replacement and evaluate its efficiency and safety. Methods The clinical data of patients with totally thoracoscopic redo mitral valve replacement in Guangdong Provincial People’s Hospital between 2013 and 2019 were retrospectively analyzed. Survival analysis was performed using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were used to determine the risk factors for postoperative death. Results There were 48 patients including 29 females and 19 males with a median age of 53 (44, 66) years. All the procedures were performed successfully with no conversion to median sternotomy. A total of 15, 10 and 23 patients received surgeries under non-beating heart, beating heart and ventricular fibrillation, respectively. The in-hospital mortality rate was 6.25% (3/48), and the incidence of early postoperative complications was 18.75% (9/48). Thirty-five (72.92%) patients had their tracheal intubation removed within 24 hours after the operation. The 1- and 6-year survival rates were 89.50% (95%CI 81.30%-98.70%) and 82.90%(95%CI 71.50%-96.20%), respectively. Age>65 years was an independent risk factor for postoperative death (P=0.04). Conclusion Totally thoracoscopic redo mitral valve replacement is safe and reliable, with advantages of rapid recovery, reducing blood transfusion rate, reducing postoperative complications and acceptable long-term survival rate. It is worthy of being widely popularized in the clinic.
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@#An 81-year-old male patient was admitted to Guangdong Provincial People's Hospital due to chest distress and shortness of breath after activity for half a year. Examination after admission revealed severe aortic insufficiency, tricuspid aortic valve and extremely horizontal aorta with an aortic root angulation of 99°. The Society of Thoracic Surgeons score was 7%. And taking the strong demand of the patient and his family into consideration, we decided to perform transapical transcatheter aortic valve replacement after multidisciplinary evaluation. The procedure was successfully performed by means of low deployment land zone and traction of pre-exist Prolene suture. Three-month follow-up confirmed the normal function of aortic prosthetic valve without residual regurgitation. This case provides a reference for the interventional treatment in patients with extremely horizontal aorta.
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@#Objective To determine the clinical efficacy of transapical transcatheter mitral valve-in-valve treatment for patients with deteriorated mitral bioprosthesis after aortic-mitral double valve replacement. Methods The clinical data of 9 patients who underwent transapical transcatheter mitral valve-in-valve implantation after aortic-mitral double valve replacement due to mitral bioprosthesis deterioration from May 2020 to January 2021 in our hospital were retrospectively analyzed, including 4 males and 5 females with a mean age of 72.44±7.57 years. Results Surgeries were performed successfully in all patients with no conversion to median sternotomy. The mean procedural time was 101.33±48.49 min, the mechanical ventilation time was 23.11±26.54 h, the ICU stay was 1.89±1.05 d and the postoperative hospital stay was 6.11±2.02 d. Residual mild mitral regurgitation was only observed in 1 patient. Only 1 patient needed postoperative blood transfusion. No major complications were observed in all patients. There was no death in postoperative 90 days. Conclusion For patients with deteriorated mitral bioprosthesis after aortic-mitral double valve replacement, transapical transcatheter mitral valve-in-valve implantation achieves good clinical results and effectively improves the hemodynamics without increasing the risk of postoperative left ventricular outflow tract obstruction. The surgery is feasible and effective.
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Objective To investigate the effects of geraniin on platelet aggregation and platelet-neutrophil interactions.Methods Platelet aggregation,in vitro and ex vivo,was determined by use of Born's method,and the binding of thrombin-stimulated platelets to neutrophils was observed based on the rosette assay.Intracellular calcium concentration of platelets was measured by using Fura-2-AM.Results Geraniin in vitro significantly inhibited arachidonic acid (AA)-,adenosine diphosphate (ADP)-,or platelet activating factor (PAF)-induced platelet aggregation,in a concentration-dependent manner.The medium inhibitory concentrations (IC50) were 2.4,0.4 and 1.1 μmol/L,respectively.Intragastric geraniin at 5 mg/kg markedly suppressed platelet aggregation induced by AA,ADP,or PAF.Geraniin decreased the total rise of [Ca2+]i,Ca2+ release,and Ca2+ influx,in a concentration-dependant manner.The IC50 values were 71.9,84.9,and 62.9 μmol/L,respectively.Geraniin decreased the binding of thrombin-stimulated platelets to neutrophils,and significantly inhibited washed platelet aggregation stimulated by fMLP-activated neutrophils.The IC50 values were 3.2 and 10.2 μmol/L,respectively.Conclusion It is suggested that geraniin inhibited platelet aggregation in vitro and ex vivo,decreased the calcium mobilization of platelets,and suppressed the interactions between platelets and neutrophils.
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Objective To determine the role of adenosine A1 receptor system in the delayed protective effects of ischemic preconditioning(IPC) in brain ischemia.Methods Thirty-five rabbits weighing 2-2.5kg were randomly divided into 7 groups: control (group Ⅰ), 3-min ischemia (group Ⅱ), 10-min ischemia (group Ⅲ), IPC (group Ⅳ), N6-cyclopentyladenosine (CPA)(group V), 8-cyclopentyl-1,3-dipropylxanthine (DPCPX)+ IPC(group Ⅵ), and DPCPX+3-min ischemia (group Ⅶ).Cerebral ischemia was produced by occlusion of both carotid arteries in combination withdrawing blood to maintain MAP at 35-40 mmHg.After 3-min IPC and 3 days of recovery , cerebral ischemia was induced and lasted 10 min (model of delayed protective effects of IPC). Adenosine A1 receptor agonist CPA or antagonist DPCPX was used instead of IPC to evaluate the role of adenosine A1 receptor in the delayed protective effects of IPC.The expression of heat shock protein 70 (HSP70) was analyzed by immunohistochemistry.Neurons density and expression of HSP70 in the hippocampal CA1 region were examined and measured 3 days later.Results (1) CPA could reduce cerebral ischemic injury, but the effects of CPA were not as good as those of IPC (about 70% of IPC).After adenosine A1 receptors being blocked by DPCPX the delayed protective effects of IPC disappeared.(2) 3-min ischemia alone did not cause neuronal injury but induced obvious expression of HSP70.DPCPX not only could make 3-min ischemia cause injury but also reduce the expression of HSP70.Conclusions (1) The delayed protective effects of IPC is related with activation of adenosine A1 receptor system.(2) One of the mechanisms of the blocking effects of DPCPX may be due to the reduction in expression of HSP70 .
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The effect of paracervical block in 30 nulliparas undergoing artificial abortion were com- pared. An electric stimulation was given to the cervix five minutes before anesthesia, three and twenty minutes after anesthesia. The value of stimulant voltages was recorded when patients felt pain. The pain threshold increased from 63.63 ? 18.26 volts of preanesthesia to 110.80? 17.27 volts of 3 minutes after paracervical block (P
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We describe a modification of retrograde guided intubation. With the help of transcricothyroid high-frequence jet ventilation, we used the epidural catheter to pull and guide the tracheal tube down the larynx and trachea, The tests of blood gas of six patients were done at the time of preanaesthesia, intubation and ten minutes after intubation. PaO_2of preanaesthesia, intubation and ten minutes after intubation were 77.72?21.17mmHg; 207.4 ?96.24mmHg ( P