[Show abstract][Hide abstract] ABSTRACT: Left circumflex coronary artery (LCX) fistula is rare, and surgical experience is limited. We report our experience with 29 patients with LCX fistula during a 25-year period in terms of clinical features, pathology, surgical procedure, and late outcomes.
Between June 1988 and July 2013, 29 patients (19 males, 10 females; median age, 10 years) with LCX fistula were treated surgically and followed up. Preoperative diagnosis was made echocardiographically in 29 patients and angiographically in 17. The fistula drained into the right atrium in 12, the right ventricle in 8, left atrium and left ventricle, each in 3, main pulmonary artery in 2, and coronary sinus in 1. Surgical procedure included endocardial closure in 17 patients, epicardial closure in 5, endocardial and epicardial closure in 2, suture ligation in 1, and off-pump suture ligation in 4. Postoperative anticoagulation was prescribed for at least 6 months.
There were no operative deaths. Complications included residual shunt in 2 patients, and LCX thrombosis, pneumothorax, hemoglobinuria, and wound infection, each in 1 patient. At the latest follow-up extending to 25 years (mean, 10.1 ± 4.6 years), 17 patients were asymptomatic and in New York Heart Association functional class I, 4 in II and 2 in III. Residual shunt, myocardial infarction, and right atrial thrombosis occurred, each in 1 patient.
Surgical repair of LCX fistula is safe and effective, with low risks and favorable late outcomes. Our experience implies the necessity for postoperative anticoagulation therapy to achieve good long-term outcomes.
The Annals of thoracic surgery 11/2013; 97(2). DOI:10.1016/j.athoracsur.2013.09.015 · 3.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To assess the clinical outcomes of transaortic extended septal myectomy on early and midterm survival of patients with hypertrophic obstructive cardiomyopathy (HOCM).
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.
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.
Surgical procedure for HOCM patients is both safe and efficacious. It provides an excellent relief of LVOT obstruction.
Zhonghua yi xue za zhi 01/2013; 93(2):110-3. DOI:10.3760/cma.j.issn.0376-2491.2013.02.008
[Show abstract][Hide abstract] ABSTRACT: Objectives:
The classification system of Sakakibara and Konno for sinus of Valsalva aneurysm (SVA) is highly complex and seldom utilized in clinical practice. In this study, we propose a new and simple classification system; we suggest a novel approach that utilizes four distinct types of SVAs.
We retrospectively studied 257 cases of SVAs in which surgical repair was performed between October 1996 and December 2009 and divided these cases into four types: I, rupture or protrusion into the right atrium; II, rupture or protrusion into the right atrium or right ventricle near or at the tricuspid annulus; III, rupture or protrusion into the right ventricular outflow tract under pulmonary valve and IV, others. The surgical results of the different approaches in each respective type were compared as follows: cardiopulmonary bypass time, clamp aorta time, mechanical ventilation time, intensive care unit time and postoperative stay time.
In all the patients, there was no early postoperative death; all the patients recovered and were discharged as expected. There were no significant differences in intensive care unit time and postoperative stay time among different approaches in each type (P > 0.05). Two hundred and thirty-eight (92.61%) patients were followed up.
Surgical repair of SVAs exhibited good long-term results. Our classification of SVA could be potentially helpful for surgical practice. For Type I, the right atrium approach is advised; for Type II, the transaortic approach with a right atrium incision is advised; for Type III, the transaortic approach with pulmonary incision is advised while for Type IV, repair according to the respective situation is advisable.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 01/2013; 43(6). DOI:10.1093/ejcts/ezs673 · 3.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Abstract A coronary sinus approach using a Gore-Tex Patch was used to repair an intracardiac left ventricular pseudoaneurysm after a previous bioprosthetic mitral valve replacement. At follow-up six months after surgery, echocardiography and a computed tomographic scan revealed almost complete obliteration of the pseudoaneurysm cavity. (J Card Surg 2012;27:692-695).
Journal of Cardiac Surgery 11/2012; 27(6):692-5. DOI:10.1111/jocs.12029 · 0.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study aims to analyze long-term results after correction of type I and type II truncus arteriosus in older patients operated in one institution over five years.
Between 2006 and 2010, 12 patients, median age 4 years, underwent repair of truncus arteriosus. Repair with reconstruction of the right ventricular to pulmonary artery continuity was performed using a valved conduit in 12 patients.
There was no early mortality. All patients are alive with their original conduit 0.6 to 5 years after correction. No patients required reoperations for conduit dysfunction. Recent clinical examination was undertaken in all patients and they are in good condition.
Though mean age at operation was higher in this study than published results, the operation should be performed if the pulmonary vascular resistance is under 8 units.m(2) before operation.
Journal of Cardiac Surgery 03/2012; 27(2):228-30. DOI:10.1111/j.1540-8191.2012.01423.x · 0.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To explore clinical outcomes of patients undergoing emergent coronary artery bypass grafting (CABG) following failed percutaneous coronary intervention (PCI) in the stent era.
Eleven patients who underwent emergent CABG following failed PCI from January, 2002 to December 2010 were enrolled. The in-hospital follow-up included cardiac deaths, Q-wave myocardial infarction, kidney failure, and cerebrovascular events. The clinical end-point of out-hospital follow-up was the major adverse cardiac events including death, myocardial infarction, and target lesion revascularization.
The patients were (61 ± 5) years old. Coronary angiography showed 5 patients had triple vessel lesions. There were 9 target lesions on left anterior descending artery. There were 3 (27.3%) severe calcified, 4 (36.4%) chronic total occlusion, and 4 (36.4%) diffused long lesions. Reasons for emergent CABG were dissection (n = 5, 45.5%), perforation (n = 3, 27.3%), failure to sufficient predilation (n = 1, 9.1%), acute closure (n = 1, 9.1%) and stent loss (n = 1, 9.1%). The average duration of follow-up was (47 ± 33) months. During in-hospital follow-up, there were 1 (9.1%) cardiac death and 2 (18.2%) Q wave myocardial infarction. During follow-up after hospital discharge, 1 patient (9.1%) died of kidney failure, and there was no rehospitalization due to cardiac events.
Emergent CABG after failed PCI often happened in patients with complex coronary lesions. The long term outcome of patients requiring emergent CABG after failed PCI was favorable in this cohort.
Zhonghua xin xue guan bing za zhi [Chinese journal of cardiovascular diseases] 01/2012; 40(1):30-3. DOI:10.3760/cma.j.issn.0253-3758.2012.01.007
[Show abstract][Hide abstract] ABSTRACT: Sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly, and SVA combined with right ventricular outflow tract stenosis is even rarer. We retrospectively analyzed 222 patients receiving surgical repair of SVA in our center over nine years, and report the incidence of right ventricular outflow tract stenosis in SVAs and the surgical results of 13 cases of SVA with right ventricular outflow tract stenosis.
Between January 2000 and December 2009, 13 patients with SVA combined with right ventricular outflow tract stenosis underwent surgical repair of SVA and correction of right ventricular outflow tract stenosis. There were nine males and four females. The mean age was 29.69 ± 9.98 years (range 13 to 45 years). Associated cardiovascular lesions were ventricular septal defect (n = 12), aortic regurgitation (n = 9), mitral regurgitation (n = 2), and tricuspid regurgitation (n = 1). All 13 patients were followed from 35 to 126 months (mean 80.15 ± 32,14 months).
There was neither early death after operation nor late death. All the patients recovered well uneventfully. The incidence of right ventricular outflow tract stenosis among 222 SVA patients was 5.86%.
Surgical correction of SVA with right ventricular outflow tract stenosis results in good mid-term results. Longer follow-up is needed to determine the efficacy of this procedure as this cohort of patients ages.
Journal of Cardiac Surgery 12/2011; 27(1):99-102. DOI:10.1111/j.1540-8191.2011.01348.x · 0.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We introduce a simple classification of the non-coronary sinus of Valsalva aneurysm, and suggest a different approach for the corresponding type of non-coronary sinus of Valsalva aneurysm.
Between October 1996 and December 2009, 45 patients with non-coronary sinus of Valsalva aneurysm underwent surgical repair. Twenty-three were male and 22 female. The mean age was 32.80±11.77 years (range, 13-67 years). We divided them into two types, type I: rupture or protrusion into right atrium; and type II: rupture or protrusion into right atrium or right ventricle near or at the tricuspid annulus. For type I (n=32), the right atrium approach was chosen, using direct suture with patch repair. For type II (n=13), the transaortic approach with right atrium incision was chosen, with patch repair through an aortic incision and direct suture through a right atrium incision. Surgical results between types I and II were compared as regards cardiopulmonary bypass time, clamp aorta time, mechanical ventilation time, and intensive care unit time, and postoperative stay time.
There was no early death after operation. There were no significant differences in cardiopulmonary bypass time, mechanical ventilation time, intensive care unit time, and postoperative stay time between two types (p>0.05). There was significant difference in clamp aorta time, with type II being longer than type I (p<0.05). Forty-three patients (93.33%) were followed up; one case of coronary artery disease using medication occurred, and there was no late death.
Approach through the right atrium or right atrium with aortotomy showed the same early surgical results. Our classification of non-coronary SVA is simple and practical for clinical usage.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 03/2011; 40(5):1047-51. DOI:10.1016/j.ejcts.2011.02.012 · 3.30 Impact Factor
[Show abstract][Hide abstract] 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. DOI:10.1016/j.athoracsur.2010.07.081 · 3.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Kawasaki disease (KD) is the leading cause of pediatric ischemic heart disease. The incidence of serious coronary sequelae is low and about 2% - 3% of patients with KD, but once myocardial infarction occurs in children, the mortality is quite high and 22% at the first infarction.This study aimed to evaluate the efficacy of coronary artery bypass grafting (CABG) in patients with KD.
Eight patients with a history of KD underwent CABG between October 1997 and July 2005. The number of bypass grafts placed was 2 to 4 per patient (mean 2.5 +/- 0.8). Various bypass grafts were used in patients, i.e. the left internal mammary artery (LIMA) in 3 patients, bilateral internal mammary artery (IMA) in 2 patients, LIMA plus gastroepiploic artery (GEA) in 1 patient and total saphenous vein grafts (SVGs) in 2 patients. The combined procedures included ventricular aneurysmectomy in 1 patient, mitral valve plasty in 1 and right coronary aneurysmectomy in 1. One patient was not able to wean from cardiopulmonary bypass (CPB), after being supported with intra-aortic balloon pump (IABP), the patient was weaned from CPB successfully.
One patient died of low cardiac output syndrome and acute renal failure 19 days after operation. Other patients recovered and were discharged uneventfully. During the follow-up that ranged from 3 to 57 months (mean 27 months), clincal angina disappeared or improved. Cardiac function was in Class I - II (NYHA).
CABG is a safe and effective procedure for Kawasaki coronary artery disease. However long-term results need to be followed up.
Chinese medical journal 06/2010; 123(12):1533-6. DOI:10.3760/cma.j.issn.0366-6999.2010.12.010 · 1.05 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To compare the predictive value of glomerular filtration rate (GFR) estimated by the Cockcroft-Gault formula or the modification of diet in renal disease (MDRD) equation and serum creatinine for in-hospital and long-term mortality post coronary artery bypass graft surgery (CABG).
Clinical data of 5559 consecutive patients undergoing isolated CABG were retrospectively analyzed. The main outcomes were in-hospital mortality and long-term mortality. Estimated GFR was calculated by the Cockcroft-Gault formula and MDRD equation respectively. Receiver-operating characteristic curves and Cox's analysis were used for the comparison.
Follow-up was complete in 5485 patients (97.6%). Analysis of receiver-operating characteristic curves showed that GFR estimated by the Cockcroft-Gault formula had a maximal accuracy for predicting in-hospital mortality (area under the curve: 0.755, P < 0.01). Multivariate logistic analysis and the Cox's analysis results indicated estimated GFR < 60 mlxmin(-1)x1.73 m(-2) base on the Cockcroft-Gault formula was an independent risk factor for in-hospital and long-term mortality (hazard ratio 4.51 for in-hospital mortality, P < 0.01; hazard ratio 1.54 for long-term mortality, P < 0.01), both Cockcroft-Gault formula and MDRD equation were superior to serum creatinine for predicting in-hospital and long-term mortality post CABG.
GFR estimated by the Cockcroft-Gault formula was superior to GFR estimated by the MDRD equation for predicting in-hospital mortality, and estimated GFR was superior to serum creatinine for predicting in-hospital and long-term mortality.
Zhonghua xin xue guan bing za zhi [Chinese journal of cardiovascular diseases] 02/2010; 38(2):99-102.
[Show abstract][Hide abstract] ABSTRACT: To review the experience of extracorporeal cardiopulmonary resuscitation (E-CPR) for cardiac arrest in adults.
From July 2005 to July 2009, extracorporeal life-support (ECLS) was performed for 10-15 minutes failed in CPR in 11 patients (male 7, female 4, age 24-71 years) with cardiac arrest. In 7 patients after cardiac operation, regular cardiopulmonary bypass was urgently established through re-opening of sternotomy incision, followed by extracorporeal membrane oxygenation (ECMO) for continuous support. In other 4 patients, ECMO implantation was directly performed through the femoral vessels during the CPR.
With E-CPR support, although the average CPR duration prolonged to (51+/-14) minutes (30-90 minutes), successful resuscitation was achieved in 10 patients with restoration of spontaneous heart beat. Median support duration of ECMO was 126 hours, ranged from 2 to 223 hours. Six patients could be successfully weaned from ECMO. However, the final discharge rate was 36.4% (4/11). Additional intra-aortic balloon pump was used in 2 patients, with 1 patient survived. Continuous renal replacement therapy (CRRT) was necessary in 3 patients because of acute renal failure.
The use of E-CPR can rescue some adult patients who fail to survive with conventional in-hospital CPR. Further studies are warranted to evaluate in order to better define patients who may benefit from E-CPR.
Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue 02/2010; 22(2):82-4.
[Show abstract][Hide abstract] ABSTRACT: To investigate the eGFR as a risk factor for long-term (4-year) outcome in Chinese renal insufficiency patients after isolated coronary artery bypass grafting (CABG) at our institution.
From January 1999 to September 2003, 3371 consecutive patients who underwent isolated CABG were retrospectively reviewed. Of these patients, 549 (16.29%) patients were female, 1979 (58.71%) patients with hypertension, 866 (25.69%) patients with diabetes, 1130 (33.52%) patients with hyperlipidemia, 1011 (29.99%) patients with left main stenosis > 50%, and 1150 (34.11%) patients undergoing off-pump procedures. The mean age was (60 +/- 9) years old. Estimated GFR was calculated using the Cockcroft-Gault formula. The main outcomes were in-hospital mortality, in-hospital morbidity and long-term mortality. COX analysis was used in this study.
There were 649 patients with glomerular filtration rate estimates < 60 ml/(min.1.73 m(2)) and 2722 patients with glomerular filtration rate estimates > 60 ml/(min.1.73 m(2)). The in-hospital mortality and follow-up mortality was higher in the estimated glomerular filtration rate < 60 ml/(min.1.73 m(2)) group (2.77% vs. 0.77%, P < 0.01), (6.81% vs. 2.63%, P < 0.01). The COX analysis result confirmed eGFR < 60 ml/(min.1.73 m(2)), derived using the Cockcroft-Gault formula (HR: 1.948, 95%CI: 1.357 to 2.797, P < 0.01) was an independent risk factor for long-term mortality in patients after coronary artery bypass grafting surgery.
The estimated glomerular filtration rate < 60 ml/(min.1.73 m(2)) derived using the Cockcroft-Gault formula is an independent risk factor for long-term mortality in patients after coronary artery bypass grafting surgery.
Zhonghua wai ke za zhi [Chinese journal of surgery] 01/2010; 48(1):39-41.
[Show abstract][Hide abstract] ABSTRACT: To describe the experience with extracorporeal membrane oxygenation (ECMO) for cardiorespiratory support of 100 patients.
Retrospective analysis of the medical files of 100 patients submitted to the implant of extracorporeal membrane oxygenation system for cardiorespiratory assistance of acute and refractory cardiogenic shock from December 2004 to September 2008. There were 67 males and 33 females, age ranged from 5 d to 76 years with a mean of (28+/-26) years, body mass ranged from 3.8 to 100.0 kg with a mean of (42+/-30) kg. The inter-surface of the ECMO equipment system was completely coated by heparin-coating technique. All patients were applied veno-artery ECMO and activated clotting time was maintained between 120 and 180 s and heparin usage dose was 5 to 20 Uxkg(-1)xh(-1). Mean blood flow was 40 to 220 mlxkg(-1)min(-1) during ECMO assistant period.
The shortest ECMO time was 12 to 504 h with a mean of (119+/-80) h. Sixty-one patients (61.0%) weaned off successfully from ECMO, 55 of them (90.2%) were discharged and 6 died of post-operative complications. Thirty-nine patients could not weaned off from ECMO. Total survival discharge rate was 55.0%. Mean aortic pressure before ECMO in survived patients was significantly higher than that of dead patients (P=0.038). Lactic acid concentration of artery blood before ECMO in survived patients was significantly lower than that of dead patients (P=0.005).
ECMO is an effective mechanical assistant therapy method for cardiac and pulmonary failure after cardiac surgery. Earlier usage of ECMO for heart lung failure patient and avoiding the main organs from un-recovery trauma are key success.
Zhonghua wai ke za zhi [Chinese journal of surgery] 12/2009; 47(23):1798-800.
[Show abstract][Hide abstract] ABSTRACT: To explore the experience on venoarterial extracorporeal membrane oxygenation (ECMO) in adult patients with cardiac failure.
From February 2005 to June 2008, 45 patients (male 34, female 11) undergoing cardiogenic shock required temporary ECMO support. Average age was (49.0 +/- 14.1) years. Average body weight was (67.0 +/- 12.8) kg. Coronary heart disease occupied in 21 cases, valve disease occupied in 8 cases, and cardiomyopathy occupied in 7 cases. All the patients could be divided into 3 groups: post-cardiotomy (group 1, n = 31), post-transplantation (group 2, n = 5), decompensate of chronic heart failure (group 3, n = 9). Fourteen patients need cardiac resuscitation before ECMO support. ECMO implantation was performed through the femoral vessels or axillary artery or through the right atrium and ascending aorta.
Average support duration of ECMO was (126.7 +/- 104.3) h. Twenty-seven patients could be successfully weaned from support (60.0%), additionally, 5 were bridged to heart transplantation. The in-hospital mortality was 42.2% (19/45). Twenty-six patients (57.8%) could be successfully discharged. The discharge rate was 58.1% in group 1, 4/5 in group 2 and was 4/9 in group 3. Twelve patients were re-operated for hemostasis. Three patients need femoral arterial thrombectomy because of ischemia of lower extremity. Additional intra-aortic balloon pumps were used in 11 patients, with 6 patients successfully discharged. The mortality rate for patients with acute renal failure treated by continuous renal replacement therapy under ECMO support was obviously high (7/9). The dominant mode of death was multisystem organ failure (9/19).
Early indication, control of complications, and paying attention to the treatment after ECMO support could improve our results with increasing experience.
Zhonghua wai ke za zhi [Chinese journal of surgery] 10/2009; 47(20):1563-5.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the surgical outcome of hypertrophic obstructive cardiomyopathy (HOCM).
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.
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.
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.
[Show abstract][Hide abstract] ABSTRACT: To analyze symptoms, associated anomalies, diagnostic approach, and surgical procedures in patients with unroofed coronary sinus syndrome and atrioventricular canal defect.
The clinical data of 20 patients with unroofed coronary sinus syndrome from September 1999 to October 2007 were reviewed retrospectively. There were 10 male and 10 female patients. The age ranged from 6 months to 38 years old, with a mean of (11.4 +/- 11.0) years old. The body weight ranged from 6.7 to 73.0 kg, with a mean of (28.4 +/- 21.3) kg. There were 18 cases of partial atrioventricular canal defect, 2 cases of complete atrioventricular canal defect, and 12 cases of common atrium. The initial diagnosis of unroofed coronary sinus syndrome was made by the surgeon at repair of a partial or complete atrioventricular canal defect in 20 patients. Complex unroofed coronary sinus with left superior vena cava (LSVC) directly draining into the left atrium was found in 11 cases, 1 case of LSVC was ligated, 10 cases were reconstructed the intraatrial baffle or the intracardiac tunnel to drain LSVC to right atrium. The other 9 patients with simple unroofed coronary sinus were repaired with other procedures. The associated cardiac lesions were corrected concomitantly.
Death occurred in 1 patient with complex congenital cardiac disease due to pulmonary infection. In the 14 early survivors, who had been followed up from 4 months to 3 years, there was no death and severe complications.
When associated with a partial or complete atrioventricular canal defect, LSVC and a common atrium, unroofed coronary sinus syndrome should be considered as a possible additional finding. Repair according to the type of unroofed coronary sinus syndrome is effective.
Zhonghua wai ke za zhi [Chinese journal of surgery] 06/2009; 47(11):845-8.
[Show abstract][Hide abstract] ABSTRACT: This report reviews our experience in venoarterial extracorporeal membrane oxygenation (ECMO) support treatment in adult patients with cardiac failure, as well as analysis of the risk factors of early mortality. From February 2005 to June 2008, 45 patients undergoing cardiogenic shock required temporary ECMO support. They were divided into three groups: post-cardiotomy (n=31) and post-transplantation (n=5) heart failure, decompensated heart failure (n=9). ECMO implantation was performed through the femoral vessels, or axillary artery, or through the right atrium and ascending aorta. Average support duration was 126.7+/-104.3 h. Twenty-seven patients could be successfully weaned from support (60%); additionally, five were bridged to heart transplantation. The in-hospital mortality was 42% (19/45). Twenty-six patients (58%) could be successfully discharged. Additional intra-aortic balloon pumps were used in 11 patients, and six of them were successfully discharged. The mortality rate was obviously high for patients with acute renal failure treated by continuous renal replacement therapy (CRRT) under ECMO support (7/9 patients). The dominant mode of death was multisystem organ failure (9/19). ECMO offers effective cardiopulmonary support in adults. The better outcome requires a multidisciplinary approach to prevent complications unique to itself and limit organ injury before and during this support.
Interactive Cardiovascular and Thoracic Surgery 05/2009; 9(2):296-300. DOI:10.1510/icvts.2008.197681 · 1.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate the experience of patients in acute cardiogenic shock required insertion of mechanical circulation support devices (MCS) before undergoing standard pretransplant evaluations.
From February 2005 to August 2007, 10 patients including 7 male and 3 female required emergency bridging placement of MCS. Average age was (40 +/- 16.2) years old. Mean body weight was (70.8 +/- 18.1) kg. There were 5 patients of dilated cardiomyopathy, 2 patients of arrhythmic right ventricular cardiomyopathy, 2 patients of ischemic cardiomyopathy and 1 patient of end-stage valvular heart disease. All patients were accompanied with acute decompensation of congestive heart failure. Before implantation of MCS, all patients received treatment of three or more inotropic drugs at maximal dosages, 6 patients suffered from ventricular tachycardia, 4 patients required cardio-pulmonary resuscitation treatment and 3 patients suffered from definite function defect of liver and kidney. MCS included ECMO for 8 patients, BVS5000 and MEDOS for 1 patient respectively.
The duration of MCS supporting was 3 to 44 d with a mean of (11.5 +/- 13.9) d. Four patients were successfully supported for getting heart transplantation, 1 patient received kidney transplantation simultaneously. Two patients recovered from acute heart failure, discharged and remained on regular heart transplantation list. One patient died from cerebral embolism after 44 days' support and 1 died from multiple organ failure after 3 days' support. Because of severe infection, MCS treatment of 2 patients was terminated ahead of schedule by their family and the patients were lost finally.
The use of MCS devices for acute catastrophic situation appears warranted despite the abbreviated transplant evaluations. It is important for improving the outcomes with beginning MCS support before multiple organ system failure occurs, and accurately identifying individuals who can benefit from MCS.
Zhonghua wai ke za zhi [Chinese journal of surgery] 08/2008; 46(14):1073-5.
[Show abstract][Hide abstract] ABSTRACT: Mechanical ventricular assistance is an important therapeutic method for severe heart failure patients. A variety of ventricular assist devices have been designed for use. The purpose of this report was to describe the experience of using Abiomed BVS5000 as a means of left ventricular support as a clinical treatment for heart failure patients.
From February 2004 to April 2006, 12 male patients were supported with Abiomed BVS5000 left ventricular assist device (LVAD) at Fu Wai Hospital. The average age was (55.2 +/- 9.6) years (range 39 to 68 years). The mean body surface area was (1.76 +/- 0.1) m(2) (range 1.6 to 1.9 m(2)). Devices were inserted for post-cardiotomy shock after coronary artery bypass graft in 11 patients (92%) and in 1 dilated cardiomyopathy patient for acute cardiogenic shock. Modified cannulation methods by inserting the arterial cannulae in femoral artery and inserting the venous cannula in left atrium through a segment of bovine jugular vein were used in 7 patients. In this way, the device could be taken off without re-sternotomy when support was finished. A comparison was made between the modified method and routine left atrium-to-ascending aorta cannulating method.
The median duration of support was 5 (3 - 43) days, with support flow rate of 3.8 - 4.5 L/min. There were 9 (75%) patients weaned from support and 8 (67%) patients discharged from the hospital. Four (33%) patients were dead. The most common morbidity was adverse neurological events. There is no statistical difference between modified and routine method on average in BVS5000 support duration, in assisted flow rate, in mechanical ventilation duration, in the intensive care unit stay and thoracic drainage.
The Abiomed BVS5000 is valuable to support patients with acute cardiogenic shock for short-term use. By the modified cannulating method, the weaning procedure can be effectively simplified. Optimization of inserting indication remains challenging and attributes to a successful assist program.
Chinese medical journal 06/2008; 121(10):877-80. · 1.05 Impact Factor