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Objective To analyze the therapeutic effect of emergency surgery in the treatment of severe valvular heart disease and its influence on heart function.Methods 87 cases with severe valvular heart disease were selected,and they were given emergency surgical treatment.Before and after treatment,the cardiac function index[end -diastolic volume (EDV),end-systolic volume (ESV),left ventricular end systolic volume index (LVESVI),left ventricular end-diastolic volume index (LVEDVI),left ventricular ejection fraction (LVEF)],postoperative complications and survival rate were compared.Results After treatment,the EDV [(125.78 ± 31.67) mL],ESV [(71.30 ± 16.58) mL] and LVESVI [(50.39 ± 13.30) mL/m2],LVEDVI [(88.74 ± 13.51) mL/m2],LVEF [(51.48 ± 12.73) ％] were better than those before treatment [(116.48 ± 28.94) mL,(63.26 ± 15.47) mL,(33.27 ± 8.54) mL/m2,(64.47 ± 12.69)mL/m2,(47.53 ± 11.20)％],the differences were statistically significant (t =2.022,2.022,3.307,12.213,2.173,all P ＜ 0.05).The incidence rate of complications was 24.14％ (21/87),included arrhythmia in 4 cases,low cardiac output syndrome in 8 cases,acute renal failure in 9 cases.Postoperative 1 year,2 years,the survival rates were 91.95％ (80/87),85.06％ (74/87),respectively.Conclusion Emergency surgical treatment for severe valvular heart disease can effectively improve cardiac function index,improve the survival rate.
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Objective:To investigate the expression of fibrillin-1 (FBN-1) in the atrium tissue of the patients with rheumatic heart valve disease complicated with atrial fibrillation(AF), and to explore its relationship with atrial fibrosis in the patients with valvular atrial fibrillation.Methods:Eighty-four consecutive patients with rheumatic heart valve disease underwent cardiac surgery were enrolled in this study.The patients were divided into AF group(n=39) and sinus rhythm group(SR group, n=45).The clinical data of patients were collected before operation.The right atrium tissue (0.3-0.5 mm3) was disserted during operation.The degrees of right atrial fibrosis of the patients in two groups were observed by Masson staining.Western blotting method was used to measure the protein expressions of FBN-1 in atrium tissue of the patients in two groups.Results:There were no significant differences in the gender ratio, age, blood pressure, blood biochemical indicators and other aspects of medical history between two groups(P>0.05);the diameters of left and right atrium of the patients in AF group were significantly larger than those in SR group(P<0.05).The Masson staining results showed that there was obvious fibrosis in AF group, and the collagen volume fraction and collagen level in AF group were significantly higher than those in SR group (P<0.05).The expression level of FBN-1 in right atrium tissue in AF group was obviously higher than that in SR group(P<0.05).The expression level of FBN-1 protein in right atrium tissue of the patients with valvular atrial fibrillation was positively correlated with the collagen level(r=0.544,P=0.021).Conclusion:There is obvious atrium fibrosis in the patients with valvular atrial fibrillation;it is closely related to the up-regulation of the expression of FBN-1 gene.
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Objective To investigate the expression of α-smooth muscle actin (α-SMA)in patients with valvular atrial fibrillation and study the relationship betweenα-SMA and atrial fibrosis in patients with valvular atrial fibrillation (AF).Methods For this study we enrolled 84 consecutive patients with rheumatic heart disease who were to receive cardiac surgery.The patients were divided into AF group (AF,n=39)and sinus rhythm group (SR, n=45).Their clinical data including baseline demographics,routine laboratory test and echocardiographics were collected before surgery.The right atrial tissue (0 .3-0 .5 cm3 )was disserted during the surgery.Right atrial fibrosis was observed by Masson staining.The mRNA expression ofα-SMA in atrial tissue were determined by Real-time quantitative PCR.Western blot was used to measure the protein expression ofα-SMA in atrial tissue.Results The two groups did not significantly differ in sex ratio,age,blood pressure,blood biochemical indicators or other aspects of medical history (P>0.05).However,left and right atrium diameters in AF group were significantly larger than those in SR group (P<0 .05 ).Masson staining suggested that collagen volume fraction and collagen content were significantly higher in AF group than in SR group (P<0 .05 ).The mRNA and protein expressions ofα-SMA in right atrial tissue were obviously higher in AF group than in SR group (coefficients P<0 .05 ).The mRNA and protein expressions ofα-SMA from right atrial tissue in the 84 patients were positively correlated with collagen content (coefficients of 0.587 and 0.607;P=0.029,0.014,respectively).Conclusion There is significant atrial fibrosis in patients with valvular atrial fibrillation,which is closely related to up-regulated expression ofα-SMA gene.
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Objective: To explore the occurrence rate of permanent pacemaker implantation (PPI) with relevant risk factors in patients after mechanical aortic valve replacement. Methods: A total of 1986 consecutive patients with mechanical aortic valve replacement were enrolled in this study. According to PPI conduction caused by severe arrhythmia , the patients were divided into 2 groups: PPI group,n=61 including 27 male with the average age of (53.6 ± 9.03) years and Non-PPI group,n=1925. The median follow-up time was (4.47 ± 4.36) years after valve replacement. Results: The patients in PPI group were with the elder age and higher ratio of pre-existing atrial ifbrillation (AF) than those in Non-PPI group,P1 year) was 2.22%. For PPI indications, there were 70.5% patients with high degree A-V block including 30 of AF combining long intervals, 12 of high degree A-V block, 1 of complete left bundle branch block (LBBB) and 14.8% patients with sick sinus syndrome/sinus arrest/ sinus bradycardia. Conclusion: PPI incidence was at a relative low level, the long term occurrence rate was higher than both short term and midterm; elder age, pre-existing AF could be the high risk factors for PPI requirement, and the major PPI indication was high degree AV block in clinical practice.
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Objective To evaluate the correlating clinical factors of coronary artery calcification score(CACS).Methods 141 patients suspected of coronary artery disease were included.They underwent multi-slice row computed tomography,pulse wave velocity ( PWV ),UCG and blood biochemistry within a period of 3 months.The subjects were divided into three groups according to CAC score:A(CACS =0-10),B ( CACS = 11-400),C ( CACS > 400).Results CACS was significantly associated with age,history of hypertension and diabetes mellitus.It was also associated with the presence of mitral annular calcification and aortic valve calcification,low ankel brachial pressure index(ABI) and high mean artery pressure(MAP) as well as high values of brachial ankel PWV (baPWV) and Upstroke time (UT).Muhifactorial logistic regression analysis showed that the presence of aortic valve calcification and mitral annular calcification,the history of diabetes mellitus and high value of UT were independently correlated with severe coronary artery calcification.Conclusions Aortic valve calcification,mitral annular calcification,history of diabetes mellitus,high value of UT were independently correlated with severe coronary artery calcification.Measurement of PWV and UCG should be performed before muhi-slicerow computed tomography,because the assessment of coronary artery lumen narrowing with multi-slice row computed tomography can not be carried out accurately in the presence of severe coronary artery calcification.
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Objective To evaluate the characteristics of echocardiogram in senile degenerative heart valvular disease. Methods The cardiac structure and functional changes of the 166 cases of senile degenerative heart valvular diseases were studed with HP5500(USA) and En Visor color doppler(Philips). Results Simple aortic valve calcification was found in 93 cases(56.0%); simple mitral calcification, 18 cases(10.8%);aortic valve calcification combining mitral calcification, 55 cases,(33.1%);enlarged left atrium 116 cases(69.9%);left ventricular diastolic dysfunction 142 cases(85.5%).Within 136 cases of cardiac valve dysfunction, there was aortic valvular regurgitation in 70 cases(42.2%),stenosis of aortic valve in 23 cases(13.9%),mitral regurgitation in 20 cases(12.2%),mitral stenosis in 8 cases(4.8%),aortic valvular regurgitation combining stenosis in 10 cases(6.0%),mitral regurgitation combining stenosis in 5 cases(3.0%). The highest morbidity in valvular dysfunction was aortic valvular regurgitation(42.2%),the second was aortic valve stenosis(13.9%),the lowest morbidity was mitral stenosis combining insufficiency(3.0%). Enlarged left atrium was in 116 cases(69.9%). Conclusions The senile degenerative heart valvular disease have no specific clinical manifestation. With increasing age,the proportion of complex valve calcification is increased, and the highest is the aortic insufficiency in valvular dysfunction. The proportion of enlarged left atrium is also increased.