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ABSTRACT: Primary mitral valve (MV) tumor is a rare lesion, and to date, there have been few larger surgical series of MV tumors. We retrospectively analyzed 11 cases of primary MV tumors regarding clinical and pathological features, surgical procedure and long-term outcomes.
From November 1983 to December 2008, we operated on 11 patients (age 36.3 ± 17.7 years, weight 55.4 ± 11.2 kg) with primary MV tumors. Symptoms were cardiac in 8 cases (72.7%) and neurologic in 3 (26.3%). Surgical procedures included en bloc excision and MV repair in 8 cases and tumor resection and MV replacement in 3. No radiotherapy or chemotherapy was given to patients with malignant tumors.
Pathological diagnosis was papillary fibroelastoma in 3 cases, myxoma in 3, lymphangioma in 1, lipoma in 1, hemangioma in 1 and sarcoma in 2. No early deaths or complications occurred. Late death occurred in 2 patients with sarcoma 1 year postoperatively. At the latest follow-up, with a maximum of 25 years (mean 10.6 ± 8.8), the 9 survivors were in New York Heart Association functional class I with normal MV function and no echocardiographic evidence of local recurrence.
The majority of primary MV tumors are benign. They can cause cardiac or neurologic symptoms and should be excised as soon as a diagnosis is made. For benign tumors, valve-sparing resection and valve repair are often possible with excellent long-term outcomes. The prognosis of malignant MV tumors is poor.
Cardiology 09/2011; 119(2):81-7. · 1.71 Impact Factor
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ABSTRACT: Right pulmonary artery to left atrium fistula is a very rare cardiac malformation. We sought to describe our experience with surgical and transcatheter treatment of this defect in three cases.
Between October 2000 and October 2009, three patients with right pulmonary artery to left atrial fistula were treated at our institute. They were all males and aged 23, 7, and 14, respectively. They presented with cyanosis with clubbing of fingers and toes in three cases, and exertional dyspnea in two. Laboratory tests showed elevated hemoglobin and decreased systemic arterial oxygen saturation. Preoperative diagnosis was made by echocardiography and cardioangiography. The fistula was closed surgically in two patients either by simple ligation without cardiopulmonary bypass or by suture of the fistula from inside the right pulmonary artery lumen under cardiopulmonary bypass. In the third patient, the fistula was occluded with an 18-mm Amplatzer septal occluder (AGA Medical, Plymouth, MN, USA).
The systemic oxygen saturation rose up to above 96% immediately after the procedures. No operative or procedural complication and late deaths occurred. All three patients were asymptomatic on follow-up.
Both surgical and transcatheter closure are safe and reliable treatment for patients with right pulmonary artery to left atrial fistula. The treatment should be individualized and performed as soon as the diagnosis is made.
Journal of Cardiac Surgery 02/2011; 26(2):130-4. · 0.87 Impact Factor
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ABSTRACT: Traumatic tricuspid insufficiency (TTI) is uncommon and surgical experience is limited. We report our surgical experience with TTI in 13 patients.
From January 2000 through March 2008, we operated on 13 patients with TTI (10 men 3 women; mean age, 39.8 ± 10.5 years). The intervals from trauma to diagnosis and from trauma to surgery averaged 37.4 and 54.4 months, respectively. At operation, the mechanism of TTI was due to anterior chordal rupture in 8, anterior papillary muscle rupture in 3, rupture of anterior papillary muscle and chordae in 1, and anterior leaflet defect in 1. In 7 patients the annulus was dilated. Valve repair was successful in 13 patients.
No early or late deaths occurred. Severe hemolysis occurred in 1 patient after tricuspid and mitral valve repairs. At follow-up extending to 9.5 years, 9 patients were in New York Heart Association functional class I, and 4 were in class II. Transthoracic echocardiography demonstrated no or trivial residual regurgitation in 7 patients, mild regurgitation in 4, and mild-to-moderate regurgitation in 2. A significant decrease of the right ventricular end-diastolic dimension (37.7 ± 9.7 vs 20.7 ± 4.6 mm; p < 0.001) was observed. The mean transvalvular gradient was 2.5 ± 0.8 mm Hg. Eleven patients were in sinus rhythm.
Satisfactory early and midterm outcomes can be achieved for TTI by tricuspid valve repair. Early surgical intervention should be emphasized to achieve good functional results and preserve the right ventricular function.
The Annals of thoracic surgery 12/2010; 90(6):1934-8. · 3.74 Impact Factor
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ABSTRACT: A fully implantable, axial flow blood pump has been developed in Fu Wai Hospital aiming for clinical use. This ventricular assist device (VAD), which was developed after numerous CFD analyses for the flow characteristics of the pump, is 58.5-mm long, 30-mm wide (including DC motor), and weighs 240 g. The pump can deliver 5 L/min for pressures of 100 mm Hg over 8,000 rpm. In this study, short-term hemocompatibility effects of the axial left ventricular assist device (LVAD) (FW blood pump) were evaluated in four healthy sheep. The device was implanted into the left ventricular apex of beating hearts. The outflow graft of each device was anastomosed to the descending aorta. The hemolysis, which was evaluated in vivo by free hemoglobin value, was below 30 mg/dL. Evaluation of serum biochemical data showed that implantation of the FW blood pump in sheep with normal hearts did not impair end organ function. Gross and microscopic sections of kidney, liver, and lung revealed no evidence of microemboli. Performance of the pump in vivo was considered sufficient for a LVAD, although further design improvement is necessary in terms of hemolysis and antithrombosis to improve biocompatibility of the pump.
ASAIO journal (American Society for Artificial Internal Organs: 1992) 01/2009; 55(1):28-32. · 1.39 Impact Factor
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ABSTRACT: Due to the smaller size, smaller artificial surface, and higher efficiency, axial blood pumps have been widely applied in clinic in recent years. However, because of its high rotor speed, axial flow pump always has a high risk for hemolysis, which the red blood cells devastated by the shearing of tip clearance flow. We reported a novel design with the integrated blade-shroud structure that was expected to solve this problem by abolishing the radial clearance between blade and casing designed with the techniques of computational fluid dynamics (CFD). However, the numerical simulation result of the newly designed structure showed an unexpected backflow (where flow velocity is reverse of the main flow direction) at the blade tip. In order to eliminate this backflow, four flow passes were attempted, and the expansion angles (which reflect the radial amplification of the flow pass, on the meridional section, and should be defined as the angle between the center line of the flow pass and the axial direction) of the blades of the integrated rotor are 0 degrees, 8 degrees, 15 degrees, and 20 degrees, respectively. In the CFD result, it could be easily found as the expansion angles increased, the backflow was restrained gradually, and was eliminated at last. After numerous "cut and try" circles, the pump model was finally optimized. The numerical simulation of this model also showed a stable hydraulic characteristic.
Artificial Organs 08/2007; 31(7):580-5. · 2.00 Impact Factor
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Lu-Jia Gong,
Elke Lehmkuhl,
Sheng-shou Hu,
Friederike Kendel,
Stein Kandle,
Yong Du,
Yan Zhang,
Ming Du,
Qing-yu Wu,
Jian-ping Xu,
Li-zhong Sun, Xiao-dong Zhu,
Vera Regitz-Zagrosek
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ABSTRACT: The purpose of this study was to explore the association of gender and age on in-hospital mortality after coronary artery bypass graft (CABG) among the Chinese population.
A total of 2682 patients (male: 2316, female: 366) who underwent CABG surgery were retrospectively investigated between January 1st, 1997 and December 31st, 2001 for perioperative risk factors and in-hospital mortality rate after CABG.
Preoperative comorbidity rate and postoperative complication rate were higher in women than that in men, although left ventricular ejection fraction was higher and the number of diseased vessels fewer in women than in men. The in-hospital mortality rate was three times higher in women than that in men (3.01% vs. 1.12%, P = 0.001), especially in the younger age group (2.6% vs. 0.5%, P = 0.001, risk-adjusted odds ratio 4.844, 95% CI: 1.549 - 15.142). In older patients, there was no notable difference in in-hospital mortality between the genders (3.7% for women vs. 2.4% for men, P = 0.383).
Chinese woman, especially in younger age, had a higher in-hospital mortality rate post CABG than that in men, suggesting that younger female gender is an independent risk factor for in-hospital mortality after CABG. Future studies are warranted to clarify the underlying mechanisms.
Zhonghua xin xue guan bing za zhi [Chinese journal of cardiovascular diseases] 06/2006; 34(5):415-21.
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ABSTRACT: Minimally invasive cardiac surgery has captured the interest and attention of cardiac surgeons throughout the world. We reviewed our experience of minimal access cardiac operations performed through a lower median ministernotomy. Between January 1997 and August 2003, 100 congenital, 178 valvular, 168 coronary, 12 aneurysmal, and 2 other operations were performed via a 6 to 9 cm lower ministernotomy in 460 consecutive patients. No special instruments were required. Four patients died, and 2 re-operations were necessary. Complications occurred in 28 patients (6.1%). The mean cardiopulmonary bypass time was 88.50 +/- 65.16 min, crossclamp time was 55.81 +/- 31.89 min, time to extubation was 14.71 +/- 29.33 h, and total chest drainage was 7.28 +/- 5.07 mL.kg(-1). Blood transfusions of 951.42 +/- 642.34 mL were needed in 282 patients. Postoperative hospital stay was 11.6 +/- 6.0 days. Our experience shows that many types of cardiac operations can be performed through a lower ministernotomy. This technique results in less trauma, quick recovery, and reduces the risk of infection and blood loss. It is a safe and easy procedure that can bring about favorable early outcomes in a wide range of cardiac operations.
Asian cardiovascular & thoracic annals 05/2006; 14(2):109-13.
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ABSTRACT: Left ventricular rupture after mitral valve replacement is a rare but lethal complication. Between 1995 and 2003, left ventricular rupture occurred in 13 of 5,449 patients who underwent mitral valve replacement, with an incidence of 0.24%. There were 4 immediate ruptures and 9 delayed ruptures. Urgent repair of the rupture was performed under cardiopulmonary bypass in 11 cases. All mitral prostheses were explanted. External repair alone was performed in one patient. External repair combined with internal repair was performed in 10 patients. Two patients died of cardiac tamponade and failure of cardiac resuscitation. Of the 11 patients who had a re-operation, 6 died in hospital and 5 survived. The mortality was 61.5% (8/13). At a mean follow-up of 4 years, 2 patients were in New York Heart Association functional class II and 3 were in class III. Proper diseased valve removal, decalcification, and prosthesis selection could minimize the incidence of left ventricular rupture. Immediate diagnosis and urgent surgical intervention are crucial for successful repair.
Asian cardiovascular & thoracic annals 03/2006; 14(1):26-9.
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ABSTRACT: To create a new method of pulmonary artery cannulation during operation for right ventricular assistance, for which minimally invasive decannulation can be done after operation.
A specially-made disassemblable composite graft consisting of a woven dacron tube and a bovine pericardial tube (composite graft) was anastomosed to the pulmonary artery as a pathway in seven dogs by median sternotomy. The end of the woven dacron tube and a link-thread for connecting the two tubes in the composite graft were drawn outside the body through an intercostal tunnel. A predisposed drawing-tieing thread in the composite graft was drawn outside through another intercostal tunnel and then tightened. An inflow cannula was placed into the left femoral vein or jugular vein via an incision of skin so as to establish a right ventricular assist system. By means of the centrifugal pump, the right ventricular bypass was established. After stopping the pumping, the 2 sets of predisposed prolene thread in the composite graft were tied by catheter and knotting tool via the small skin incision, 8 knots for each set, to close the bovine pericardial tube, and then the drawing-tieing thread, link-thread, and the dacron tube in the composite graft were removed. Median sternotomy was performed again to observe the anastomotic stoma, the closure of the stump of bovine pericardial tube, and whether hemorrhage occurred.
The mean maximum output of right ventricular assist system from left femoral or jugular vein to pulmonary artery was (64.4 +/- 12.3) ml.min(-1).kg(-1). The second sternotomy showed satisfactory knotting on the bovine pericardial tube except in one case, whose second set of drawing-tieing thread was tied in the seventh knot and failed to be drawn out, thus partially remained in the body. No bleeding was found in all cases.
The new cannulating methods with minimally invasive decannulation after operation created in this study is simple, easy and effective.
Zhonghua yi xue za zhi 05/2004; 84(7):596-8.
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ABSTRACT: To study the efficiency of surgical treatment on coarctation of the aorta and associated with heart defect.
From 1994 to 2001, 45 patients with aortic coarctation and associated with heart defect underwent surgical repair. They were divided into two groups: single-stage repair group (26 cases) and two-stage repair group (19 cases). There was mild or severe pulmonary hypertension in 23 cases (with mean pulmonary artery pressure being 56 mm Hg). There were two incisions used in first-stage group (single midline incision in 21 cases and left-side combined midline incision in 5 cases). The mean course for the second operation was 105 days in second-stage group.
Two patients died in each group. Twenty-four patients had not blood pressure difference between arm and leg after operation. The mean systolic blood pressure difference was less than 10 mmHg in 10 patients. Mean period of follow-up was 28.6 months. No patients died and had re-coarctation.
The operative results showed no difference between single-stage and two-stage repair in surgical correction of aortic coarctation associated intracardiac defect. The left-side combined midline incision in single-stage operation was an effective and safe technique.
Zhonghua wai ke za zhi [Chinese journal of surgery] 02/2004; 42(1):52-4.
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ABSTRACT: Based on the assumption that only the pump function of the diseased heart should be assisted or replaced by device while resecting the native heart is unnecessary, the concept of a "functionally total artificial heart (FTAH)" was explored. An artery pump (AP) was designed for the FTAH. The fabricated pattern of the AP, having an outer diameter of 28 mm and a length of 42 mm, was implanted in the position of ascending aorta or pulmonary trunk, joining in series to the chambers of the left ventricle or the right ventricle. The total weight of the AP pattern is 74 g, and it displaces 29 mL of volume and can achieve 5 L/min against 100 mm Hg pressure with a speed lower than 10,000 rpm. In mock circulation, two APs were connected in series with each other, and their flow rates could automatically balance each other. Simulative cardiac output and atria pressures can be maintained within a suitable range by properly adjusting the rotational speeds of each pump. Because the response of the APs to the pressure alterations at their inlets and outlets are similar to that of native heart, no intricate regulating mechanism would be necessary. This preliminary study shows that the concept of the FTAH is feasible if two APs are simultaneously implanted to replace native heart function.
ASAIO journal (American Society for Artificial Internal Organs: 1992) 53(3):288-91. · 1.39 Impact Factor
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Yan Zhang,
Zhao Zhan,
Xing-Min Gui,
Han-Song Sun,
Hao Zhang,
Zhe Zheng,
Jian-Ye Zhou, Xiao-Dong Zhu,
Guo-Rong Li,
Sheng-Shou Hu,
Dong-Hai Jin
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ABSTRACT: A fully implantable, axial flow blood pump has been developed in our hospital. Both in vitro and in vivo tests showed that the hemolysis and thrombus characteristics of the pump were in an acceptable but not in an ideal range. Computational fluid dynamics (CFD) and in vitro test results showed that the pump worked at off-design point with a low hydraulic efficiency; CFD analysis also showed regions of reverse flow in the diffuser, which not only decreases the pump's hydrodynamic efficiency, but also increases its overall potential for blood trauma and thrombosis. To make a blood pump atraumatic and nonthrombogenic, several methods were taken to reach a final model of the optimized blood pump using CFD, which decreased the rotational speed from 9,000 to 8,000 rpm, and the design flow rate from 11 to 6 L/min. More significantly, the flow separation and recirculation in the diffuser region were eliminated, which mitigated the traumatic and thrombus effect on blood. The acceptable results of the numerical simulations encourage additional in vitro and in vivo studies.
ASAIO journal (American Society for Artificial Internal Organs: 1992) 54(2):150-5. · 1.39 Impact Factor
