Effectiveness of Alcohol Septal Ablation Versus Transaortic Extended Myectomy in Hypertrophic Cardiomyopathy with Midventricular Obstruction.

OBJECTIVES: Investigate the effectiveness of alcohol septal ablation (ASA) and transaortic extended myectomy (TEM) in hypertrophic cardiomyopathy (HCM) with midventricular obstruction (MVO). BACKGROUND: MVO is less common than subaortic obstruction. Data on the effectiveness of ASA and TEM in MVO are lacking. METHODS: The clinical profiles of 22 patients undergoing ASA and 37 patients undergoing TEM were compared. No patient had apical aneurysm, abnormal chordae, mitral valve replacement or repair. RESULTS: Baseline midventricular pressure gradient and symptoms were comparable between the ASA and TEM groups. During follow-up, both groups demonstrated substantial reduction in pressure gradient (the ASA group: 79.7 ± 21.2 mm Hg to 43.7 ± 28.9 mm Hg, P < 0.001; the TEM group: 69.0 ± 23.9 mm Hg to 15.0 ± 16.9 mm Hg, P < 0.001). The reduction in pressure gradient was greater (78.9 ± 18.6% vs. 46.4 ± 33.4%, P < 0.001) and the residual pressure gradient was lower after TEM versus ASA (P < 0.001). Patients with New York Heart Association class III/IV dyspnea decreased from 59.1 to 18.2% (P = 0.022) in the ASA group and from 56.8 to 5.6% (P < 0.001) in the TEM group. Patients with Canadian Cardiovascular Society class III/IV angina decreased from 40.9 to 9.1% (P = 0.016) in the ASA group and from 32.4 to 0% (P < 0.001) in the TEM group. CONCLUSIONS: While ASA and TEM both improve gradients and symptoms, TEM may provide a more reliable reduction in gradients compared to ASA.

[Predictive value of qualitative assessment of general movements for adverse outcomes at 24 months of age in infants with asphyxia].

OJBECTIVE: To investigate the predictive value of the qualitative assessment of general movements (GMs) for adverse outcomes at 24 months of age in full-term infants with asphyxia. METHODS: A total of 114 full-term asphyxiated infants, who were admitted to the neonatal intensive care unit between 2009 and 2012 and took part in follow-ups after discharge were included in the study. All of them received the qualitative assessment of GMs within 3 months after birth. The development quotient was determined with the Bayley Scales of Infant Development at 24 months of age. RESULTS: The results of the qualitative assessment of GMs within 3 months after birth showed that among 114 infants, 20 (17.5%) had poor repertoire movements and 7 (6.1%) had cramped-synchronized movements during the writhing movements period; 8 infants (7.0%) had the absence of fidgety movements during the fidgety movements period. The results of development quotient at 24 months of age showed that 7 infants (6.1%) had adverse developmental outcomes: 6 cases of cerebral palsy and mental retardation and 1 case of mental retardation. There was a poor consistency between poor repertoire movements during the writhing movements period and the developmental outcomes at 24 months of age (Kappa=-0.019; P>0.05). There was a high consistency between cramped-synchronized movements during the writhing movements period and the developmental outcomes at 24 months of age (Kappa=0.848; P<0.05), and the results of predictive values of cramped-synchronized movements were shown as follows: predictive validity 98.2%, sensitivity 85.7%, specificity 99.1%, positive predictive value 85.7%, and negative predictive value 99.1%. There was a high consistency between the absence of fidgety movements during the fidgety movements period and the developmental outcomes at 24 months of age (Kappa=0.786; P<0.05), and its predictive values were expressed as follows: predictive validity 97.4%, sensitivity 85.7%, specificity 98.1%, positive predictive value 75.0%, and negative predictive value 99.1%. CONCLUSIONS: Cramped-synchronized movements and absence of fidgety movements can predict adverse developmental outcomes at 24 months of age in full-term infants with asphyxia.

[Clinical features and management of complete heart block after transaortic extended septal myectomy in patients with hypertrophic obstructive cardiomyopathy].

OBJECTIVE: To analyze the clinical features, precaution and management of complete heart block (CHB) after transaortic extended septal myectomy operation (extended Morrow procedure) in patients with hypertrophic obstructive cardiomyopathy (HOCM). METHODS: From October 1996 to December 2011, 10[6 men; mean age (45.4 ± 15.8) years, range 13-60 years] out of 160 consecutive HOCM patients underwent extended Morrow procedure developed CHB postoperatively. Their clinical data were retrospectively analyzed. Baseline transthoracic echocardiography showed that the left ventricular outflow tract (LVOT) gradients was from 68 to 149 (105.1 ± 25.9) mm Hg (1 mm Hg = 0.133 kPa), ECG showed right bundle branch block in 5 patients and atrial fibrillation, atrial premature beats or ST-T segment changes in other 5 patients. Besides extended Morrow procedure, concomitant surgical procedures included mitral valve replacement (MVR) in 2 (2/10) and MVR plus coronary artery bypass grafting in another 2 (2/10) patients. Follow-up data were obtained by subsequent clinic visits in outpatient department and telephone interviews. RESULTS: The in-hospital mortality was 20% (these two patients died of low cardiac output syndrome and multiple organs failure). Four patients underwent MVR simultaneously survived the operation. Postoperative echocardiography demonstrated a reduced LVOT gradient[(13.6 ± 9.7) mm Hg, P < 0.001]. Permanent pacemakers were implanted in all 8 survived patients at 6 days to 7 months after operation. No other severe complications were observed. During follow-up [from 4 to 72 (19.4 ± 22.1) months], there was no death, 1 patient readmitted to our center at 71 months post operation to change the pacemaker because of low voltage of previously implanted pacemaker. Physical capacity and quality of life improved significantly post operation in these 8 patients. The NYHA functional class remained at I-II post operation and during follow up. CONCLUSIONS: CHB is a severe complication after extended Morrow procedure for patients with HOCM and timely permanent pacemaker implantation is mandatory for patients with post procedure CHB.

[Surgical treatment for hypertrophic obstructive cardiomyopathy: a report of 118 cases].

OBJECTIVE: To assess the clinical outcomes of transaortic extended septal myectomy on early and midterm survival of patients with hypertrophic obstructive cardiomyopathy (HOCM). METHODS: From October 2009 to April 2012, 118 consecutive patients underwent extended Morrow's procedure for HOCM. There were 69 males and 49 females with an average age of (46 ± 13) years. Their clinical data were analyzed retrospectively. Preoperative transthoracic, intraoperative transoesophageal and postoperative transthoracic echocardiography was performed to assess septal thickness, left ventricular outflow tract (LVOT) gradient, mitral valve function and systolic anterior motion (SAM) of anterior mitral valve leaflet, etc. Concomitant surgical procedures were performed if other cardiac diseases required surgical interventions. Follow-up study was carried out during subsequent clinic visits at outpatient department and through telephone interviews with patients and their relatives. RESULTS: The septal thickness was (25 ± 7) mm. SAM was detected in all. The in-hospital mortality was 0.8% (1/118) since one patient died of multiple organs failure one week later. Postoperative echocardiography demonstrated marked reduction in LVOT gradient (92 ± 22 vs 13 ± 10 mm Hg (1 mm Hg = 0.133 kPa), P = 0.000), New York Heart Association (NYHA) class (2.9 ± 0.6 vs 1.2 ± 0.4, P = 0.000) and significant improvement in mitral regurgitation. Concomitant surgical procedures were performed in 45 cases (38.1%, all for preexisting conditions). Complications included complete atrioventricular block (n = 3), first degree atrioventricular block (n = 6), complete left bundle branch block (n = 51), intraventricular conduction delay or left anterior division block (n = 26), transient renal dysfunction (n = 2) and intra-aortic-balloon-pumping (n = 2). No other severe complication was observed. During a follow-up period of 1 - 27 (7 ± 6) months, there was no readmission or death. All patients reported significant increase in physical ability and obvious decrease in limiting symptoms. At the latest follow-up, the NYHA functional class maintained grade I-II in all. And mitral regurgitation remained absent or mild. CONCLUSION: Surgical procedure for HOCM patients is both safe and efficacious. It provides an excellent relief of LVOT obstruction.

[Efficiency and mechanism on reduction of U(VI) by sulfate reducing bacteria].

Under anaerobic conditions, the characteristics of sulfate reducing bacteria (SRB) were applied to reduce U(VI) under different temperature, pH values, U(VI) concentrations and coexisting ions. The results showed that the optimum reduction condition was the temperature 35 degrees C, pH 7.0 and U(VI) concentration 25 mg x L(-1). The maximum reduction capacity of SRB was 179.1 mg x g(-1). Mo(VI) or Ca2+ did not affect SRB on the reduction process of U(VI) under the concentration less than 5 g x L(-1), but they strongly inhibited the process under the concentration more than 20 g x L(-1). The main inhibition of Mo (VI) was physiological inhibition and the inhibition of Ca2+ was competitive inhibition through the stable complex formation, Ca-UO2-CO3. The results also showed that lag phase did not appear on the concentration of Ca2+ less than 5 g x L(-1), but the lag phase of 24 hours appeared on the concentration of Ca2+ more than 20 g x L(-1).

[Clinical experience of surgical treatment on hypertrophic obstructive cardiomyopathy].

OBJECTIVE: To evaluate the surgical outcome of hypertrophic obstructive cardiomyopathy (HOCM). METHODS: From October 1996 to December 2007, 54 HOCM patients underwent surgical treatment. There were 37 males and 17 females ranging from 6 to 68 years old (36 +/- 16) with body weight 27-83 (60 +/- 14) kg. Operation was performed under general anesthesia and cardiopulmonary bypass (CPB) with the moderate systemic temperature and low volume blood flow. The concomitant operations included coronary artery bypass grafting in 5 cases, mitral valve plasty in 5 cases, mitral valve replacement in 9 cases, tricuspid valve plasty in 2 cases, aortic valve replacement in 4 cases and closure of patent ductus arteriosus in 2 cases. Preoperative and postoperative left ventricular (LV), left ventricular outflow tract (LVOT), left atrium (LA), mitral valve function and value of LVEF were evaluated by transesophageal echocardiograph examination. RESULTS: The time of CPB and aortic occlusion were 40 to 290 minutes (107 +/- 52) and 27 to 195 min (70 +/- 36 min) respectively. The endotracheal intubation durations were 5 to 21 hours (14 +/- 15) and ICU duration 11 to 183 hours (45 +/- 34). Comparing with the pre-operative echocardiographic parameters, the size of left atrium (42 +/- 8 vs 35 +/- 7), pressure gradients through LVOT (106 +/- 44 mm Hg vs 24 +/- 19 mm Hg), the thickness of septum (27 +/- 6 mm vs 19 +/- 5 mm) and the value of EF (70 +/- 10 vs 61 +/- 9) obviously decreased postoperatively (P < 0.05). The surviving patients had either no mitral valve regurgitation or only mild mitral valve regurgitation. Four (7.4%) patients died during the perioperative period. The cause of death included severe low cardiac output, heart failure, severe ventricular arrhythmias and severe acute renal failure. There were 4 patients with a complete AV block postoperatively and 3 were implanted permanent pacemakers. The left bundle branch block or left anterior hemiblock were found in 26 cases, intraventricular conduction defect in 6 cases and type I AV block in 4 cases. All surviving patients were in NYHA functional class I/II during the follow-up of 1 month to 10 years. CONCLUSION: Surgical outcome for HOCM patients is satisfactory. Most HOCM patients achieve such a satisfactory relief of LV outflow tract obstruction as to lead a better life.

Surgical outcome and clinical follow-up in patients with symptomatic myocardial bridging.

BACKGROUND: Myocardial bridging with systolic compression of the left anterior descending coronary artery (LAD) may be associated with myocardial ischaemia. The clinical outcome in patients with surgical treatment for symptomatic myocardial bridging remains undetermined. This study assessed the middle- and long-term results of surgical treatment for symptomatic myocardial bridging. METHODS: From 1997 to 2006, 37,463 patients received selective coronary angiography in the Fuwai Cardiovascular Hospital, Beijing, China. Of these, 484 patients had angiographic diagnosis of myocardial bridging. Of the 484 patients, 35 underwent surgery for treatment of myocardial bridging with significant systolic arterial compression. Among the surgical treatment patients, 24 presented with other cardiac disorders, and the remaining 11 symptomatic patients with isolated myocardial bridging were included in the follow-up study. RESULTS: The angiographic prevalence of myocardial bridging was 1.3% in this study. The coronary angiographies of the 11 patients revealed myocardial bridging in the middle segment of LAD causing systolic compression > or = 75% (ranging from 75% to 90%). The mean age of patients was 48.4 years. Surgical myotomy was performed in 3 patients and coronary artery bypass grafting (CABG) in 8 patients. Eight patients were operated on with an off-pump approach and 3 with a cardiopulmonary bypass technique after median sternotomy. Conversion to on-pump CABG surgery was necessary in 1 patient because of perforation of the right ventricle. The left internal mammary artery was used in all patients with CABG. The acute clinical success rate was 100% with respect to the absence of myocardial infarction, death or other major in-hospital complications. All of the patients were followed up clinically. The median follow-up was 35.3 months (range: 6 to 120 months). Nine patients were free from symptoms and one of them continued taking beta blockers. The remaining 2 patients with myotomy had atypical chest pain. One received coronary angiography again and no stenosis was found two years after operation; while exercise testing was performed in the other patient and revealed no evidence of myocardial ischaemia. None of the patients sustained a myocardial infarction or other major adverse cardiac events (death or vessel revascularization) during follow-up. CONCLUSIONS: Myocardial bridging is a relatively common angiographic finding. Surgical myotomy or CABG should be limited to patients who are refractory to oral medication. Surgical relief of myocardial ischaemia due to systolic compression of intramyocardial coronary arteries can be accomplished with low operative risk and excellent middle- and long-term results.

[Surgical treatment of Williams syndrome combined with cardiovascular disease].

OBJECTIVE: To introduce the experience of diagnosis and surgical treatment of Williams syndrome combined with cardiovascular disease. METHODS: Between October 1996 and June 2003, 8 patients of Williams syndrome with cardiovascular disease were admitted in Fuwai hospital. Seven patients underwent surgical correction. One didn't undergo surgical procedure. There were 6 male and 2 female ranging from 1.5 to 12.0 years old (medium age 6.4). Three had localized type supravalvular aortic stenosis and 5 diffused type supravalvular aortic stenosis. In them, 2 patients were combined with peripheral pulmonary stenosis. Single patch aortoplasty were performed in 6 cases, and inverted bifurcated patch aortoplasty in one patient. RESULTS: One patient died and one patient suffered renal insufficiency. In the early postoperative period, the mean speed of flow was reduced to 1.7 m/s from 4.6 m/s, and the mean systolic pressure gradient was reduced from 91 mm Hg to 18 mm Hg. Six patients were followed up 16 to 91 months. There were 5 cases in NYHA function class I, and one in class II. CONCLUSION: Satisfied result can be achieved in surgical treatment of Williams syndrome with supravalvular aortic stenosis, but it is not in combined with peripheral pulmonary stenosis.

[Surgical treatment of active infective endocarditis].

OBJECTIVE: To summarize the recent experience of surgical management of the active infective endocarditis (IE) disease in Fuwai Hospital. METHODS: From October 1, 1996 to December 31, 2003, 54 patients with active IE underwent heart operation in Fuwai Hospital. There were 41 males, 13 females, with an average age of 35 years old and an average weight 58 kg. Of the cases, 23 had congenital anomalies of the heart, and 1 had rheumatic valvulitis. Streptococci were found in 20 patients, staphylococci in 3, enterococci in 1, enterococcus in 2 and G(+) cocci in 1. Pre-operative cardiac classification (NYHA): class I was in 6 cases, class II in 12 cases, class III in 7 cases and class IV in 29 cases. Systemic embolization occurred in 23 cases and pulmonary infarction in 2 cases. Emergent operations were performed in 27 cases because of heart failure (8 cases), embolism (4 cases), aggressive infection (3 cases), heart failure plus embolism (2 cases), heart failure with aggressive infection (4 cases), aggressive infection with embolism (2 cases) and all the three factors (4 cases). The operations included aortic valve replacement (25 cases), aortic and mitral valves replacement (15 cases), mitral valve replacement (6 cases), mitral valve repair (3 cases), pulmonic valve replacement (1 case) and intracardiac shunt repair (4 cases). RESULTS: The operative mortality was 17% (5 operative death and 4 lost in following-up after being discharged). All of operative deaths were due to infection. Fourteen patients had operative complications. The morbidity included peri-prosthetic leakage (8 cases), prosthetic IE (5 cases), residual intracardiac shunt (2 cases), complete heart block (2 cases), myocardial infarction, ventricular fibrillation, pulmonary trunk stenosis, and mitral regurgitation (1 case in each). Post-operative cardiac classification (NYHA): class I was in 41 cases, class II in 3 cases, class III in 1 case. Two patients were re-operated because of peri-prosthetic leakage, and then they were cured. Re-operation was also performed in other 3 patients. Unrelated late sudden death occurred in 1 patient and hemiplegia caused by anticoagulant intracranial hemorrhage in another patient. CONCLUSION: Acceptable results can be achieved with active surgical intervention in active patients with IE.

[Fluorescence quantification of intracellular calcium of rat smooth muscle cells].

OBJECTIVE: To explore the kinetic changes of calcium in rat smooth muscle cells and establish a method for quantification of intracellular calcium. METHODS: Rat mesenteric arteriolar smooth muscle cells (ASMCs) were isolated and the kinetic changes of calcium were measured using highly sensitive Ca2+ fluorescent probe indo-1 with laser scanning confocal microscopy (LSCM). The dissociation constant values (Kd) of the fluorescent probe indo-1 was measured at 37 degrees Celsius, and according to the conversion formula from fluorescence intensity to concentration, the concentration of Ca2+ was calculated. RESULTS: Analysis of the fluorescent images using LSCM showed that [Ca2+]i in the ASMCs were significantly elevated in response to stimulation with dexamethasone, and spontaneous calcium waves as well as intracellular calcium overloading were observed occasionally. CONCLUSION: Fluorescence quantification with LSCM is applicable for detecting the kinetic changes of intracellular [Ca2+]i.