In order to salvage the extremity of dog with marked ischemia from extensive damage of the artery, an operation, diversion of saphenous artery and vein with the anterior tibial artery and vein was tried. The results showed that this operative technique was feasible as a method of treatment. Basing on this fact, the diversion of the saphenous vein in situ with the femoral artery, combined with selective extirpation of the valve of thd vein was used to treat 14 cases (15 limb) of high obliteration of artery of the lower extremities with good results.
Abstract： Objective To summarize the methods and results of supra-annular aortic valve replacement（AVR） in patients with severely damaged aortic annulus. Methods Supra-annular AVR was performed in 5 patients between March 2008 and Dec. 2010 in Changhai Hospital, Second Military Medical University. There were 4 males and 1 female with their mean age of 46.3 years (ranging from 38 to 53 years). Non-specific infectious diseases were diagnosed in 4 patients who had severe paravalvular leakage after their first AVR operations (2 patients with Behcet’s disease and 2 patients with arteritis), and one patient had severe infectious endocarditis. All the patients had severely destroyed aortic annulus and could not undergo routine AVR. The prosthetic valves were fixed to the aortic sinus wall between the annulus and coronary arterial ostia, and the sutures passed through from the outside of aortic wall into the inside and prosthetic valve ring. Coronary artery bypass grafting was performed if the coronary ostium was involved. Results All patients recovered from the operations uneventfully, and were followed up from 6 months to 3 years. All patients were in New York Heart Association（NYHA） functional class Ⅰ or Ⅱ during the follow-up period, and paravalvalar leakage, pseudoaneurysm and aortic root aneurysm were not found by the examination of 3D computed tomographic angiography and echocardiography at 6 months（4 cases）, 1 year（2 cases）, and 3 years（1 case）, respectively . Conclusions Supra-annular AVR is an alternative surgical method for patients with severely damaged aortic annulus. The procedure is simple and effective to prevent paravalvular leakage and pseudoaneurysm formation.
Objective To explore clinical application and significance of coronary angiography （CAG） prior to heart valve replacement for patients with rheumatic valvular heart disease （RVHD）. Methods We retrospectively analyzed clinical data of 313 RVHD patients who underwent heart valve replacement in the First Affiliated Hospital of Chongqing Medical University from January 2002 to June 2012. All the patients received screening CAG before surgery. According to CAG results，313 patients were divided into two groups. In the coronary artery lesion （CAL） group，there were 29 patients including 17 male and 12 female patients with their age of 60.0±5.2 years. In the non-coronary artery lesion （non-CAL）group，there were 284 patients including 98 male and 186 female patients with their age of 57.0±5.4 years. Surgicaloutcomes were compared between the two groups. Univariate analysis and multivariate logistic regression were performed to analyze risk factors of CAL for RVHD patients. Results CAG showed 29 patients with CAL，and the overall prevalence of CAL was 9.27%. In CAL group，11 patients underwent concomitant coronary artery bypass grafting with 2.2 grafts for each patient on the average. Postoperatively 1 patient （3.45%） died of low cardiac output syndrome （LCOS）. In non-CAL group，5 patients （1.76%） postoperatively died mainly because of LCOS，ventricular fibrillation，sudden cardiac arrest or respiratory failure. Cardiopulmonary bypass time and aortic cross-clamp time of CAL group were significantly longer than those of non-CAL group （P＜0.05）. There was no statistical difference in postoperative mortality，incidence of LCOS，acute renal failure，respiratory failure，reexploration for bleeding，intraoperative blood loss，mechanical ventilation time or hospital stay between the two groups（P＞0.05）. There was no significant correlation between the types of valvular lesions and CAL. Age≥ 55 years （OR=5.534，P=0.005），male gender （OR=2.335，P=0.038） and diabetes mellitus （OR=4.265，P=0.006） were independent risk factors of CAL for RVHD patients undergoing heart valve replacement. Conclusion For RVHD patients with independent risk factors of CAL （age≥55 years，male gender and diabetes mellitus），CAG must beseriously considered before heart valve replacement. RVHD patients with CAL can obtain similarly satisfactory surgicaloutcomes of heart valve replacement as RVHD patients without CAL by appropriate surgical strategy and strengthened perio-perative management.
Objective To investigate the correlation between glycosylated hemoglobin A1c (HbA1c) and severity of coronary artery lesions in young men with acute myocardial infarction (AMI). Methods Total 278 young men with AMI less than 45 years old were retrospectively studied, and all of them were admitted to hospital from January 2009 to December 2011, and had undergone coronary angiography. According to the results of coronary angiography, the patients were divided into three groups based on the number of artery lesions: the single group (156 cases), the double group (64 cases) and the triple group (58 cases). The relationship between the severity of coronary artery lesions and the following factors were observed: HbA1c, systolic blood pressure (SBP), diastolic blood pressure (DBP), hemoglobin (Hb), serum uric acid (UA), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), body mass index (BMI), smoking history, drinking history and family history of early coronary artery disease. Results a) HbA1c levels were gradually raised in all the three groups, but the single group (6.39±1.67%) was significantly lower than the double group (6.91±1.63%) and the triple group (7.41±2.12%), with significant differences (Plt;0.05); the HbA1c level of the single group was significantly lower than the triple group in both the ST-segment elevation AMI (6.42±1.68% vs. 7.17±1.86%, Plt;0.05) and the non-ST-segment AMI (5.57±0.37% vs. 8.56±2.83%, Plt;0.05); the HbA1c level of the single group was significantly lower than the triple group in patients with diabetes millitus (8.31±1.83% vs. 8.59±2.02%, Plt;0.05) and in patients without diabetes millitus (5.56±0.33% vs. 5.74±0.37%, Plt;0.05); b) There were significant differences in SBP, TC, HDL-C, LDL-C and drinking history between the single group and the other two groups (all Plt;0.05), and there were significant differences in DBP and TG between the single group and the double group (all Plt;0.05); and c) The results of logistic regression analysis showed that, LDL-C (OR=1.790), HbA1c (OR=1.287) and SBP (OR=1.042) were the independent risk factors (all Plt;0.05) for multiple lesions in coronary arteries of young men with AMI. Conclusion Glycosylated hemoglobin A1c is an independent risk factor for multiple lesions in coronary arteries of young men with AMI.
【摘要】 目的 评估经桡静脉途径介入治疗冠状动脉病变的临床效果及安全性。 方法 将2003年7月-2009年7月接受治疗的174例冠状动脉病变患者随机分为对照组及观察组，对照组采用经典股动脉途径行冠脉介入治疗，观察组采用桡动脉途径介入治疗。观察两组患者穿刺时间、手术时间、穿刺成功率、手术成功率、并发症发生率。 结果 两组穿刺时间、手术时间、手术成功率差异无统计学意义，观察组并发症发生率少于对照组，穿刺成功率低于对照组。 结论 经桡动脉途径介入治疗冠状动脉病变能够减少手术后并发症的发生，临床疗效确切。【Abstract】 Objective To explore the clinical effect of intervention treatment through radial arteries on coranaria disease and its safety. Methods A total of 174 patients with coranaria disease from July 2003 to July 2009 were randomly divided into a control group and an observed group. The patients underwent the intervention treatment through femoral arteries in control group and through radial arteries in observed group. The duration and achievement rate of paracentesis and operation, and the incidence rate of complications were observed and the results in the two groups were compared. Results There were no differences in the duration and achievement rate of paracentesis and operation, and the achievement rate of operation between the control and observed groups. Compared with the control group, the incidence rate of complications and achievement rate of paracentesis were lower in observed group. Conclusion Intervention treatment through radial arteries on coranaria disease could reduce the post-operative complications with reliable therapeutic effect.
ObjectiveTo explore the reoperation on aortic diseases in patients with previous aortic valve surgery due to rheumatic aortic valve disease, improve the understanding of aortic valve disease secondary to surgery of aortic valve. MethodsWe retrospectively analyzed the data of twenty-seven patients with previous aortic valve replacement due to rheumatic aortic valve disease underwent aortic root or other aortic operation in Fu Wai Cardiovascular Hospital because of new aortic root or aortic diseases between August 2003 and May 2012. All the patients with new aortic diseases were diagnosed by cardiac ultrasound and aortic computed tomography. The new diseases included type A aortic dissection in 13 patients, ascending aortic aneurysm in 6 patients, and aortic root aneurysm in 8 patients. There were 20 males and 7 females with mean age of 50±10 years (ranged 28-69 years). Seven patients underwent aortic root replacement, 6 patients received ascending aorta and total aortic arch replacement combined with stented graft implantation into the descending aorta, 6 patients received aortic root and total aortic arch replacement combined with stented graft, and 8 patients received the ascending aorta replacement. All patients were followed by clinic interview or telephone. ResultsThe interval time for reoperation was 6-110 (57±32) months. No patient died within 30 days after operation. Cardiopulmonary bypass time was 50-274 (143±65) minutes; hospital stay was 13-27 (19±11) days. Four patients had renal insufficiency after operation and all were cured by hemofiltration before departure. Three patients had neurological complications of transient brain dysfunction, and there was no postoperative spinal cord deficits occurred. Four patients had pulmonary complication. The mean follow up time were 4-118 (43.5±32.2) months. Five patients were missed and 4 cases died during the follow-up. The follow-up rate was 81.5%. Three-year survival rate was 85.1%. There was no case received third operation due to aortic disease during the follow-up. ConclusionWe should pay more attention to patients with previous surgery due to rheumatic aortic valve disease, especially to patients combined with enlarged ascending aorta, so that aortic adverse events following to aortic valve operation can be reduced or be avoided in long term.
ObjectiveTo investigate the perioperative results and safety of minimally invasive direct coronary artery bypass grafting (MIDCAB) treatment of anterior descending artery disease through a small left thoracic incision assisted by thoracoscopy. MethodsThe clinical data of 92 patients who received MIDCAB in our hospital from May 2014 to October 2018 were retrospectively analyzed, including 72 (78.26%) males aged 42-78 (61.2±7.48) years, and 20 (21.74%) females aged 30-80 (61.30±12.26) years. The perioperative complications, blood product use, left heart function changes, ventilator use time, ICU stay, hospital stay and other indicators were analyzed. ResultsTwo (2.17%) patients were transferred to thoracotomy, 5 (5.43%) patients received blood products during the operation, 2 (2.17%) were subjected to secondary thoracotomy to stop bleeding, 4 (4.34%) had postoperative hypoxemia and 1 (1.08%) was reintubated. The ventilator use time was 3-227 (22.35±35.39) hours, the ICU stay was 16-777 (78.85±108.62) hours, and the postoperative hospital stay was 2-36 (8.86±6.05) days. One (1.08%) patient died in hospital. ConclusionMIDCAB for anterior descending artery disease has good perioperative results, especially for solitary anterior descending artery disease, which can reduce the use of blood products, and shorten the time of ventilator use after operation, ICU stay and hospital stay.
Objective To investigate the role of red cell distribution width ( RDW) in coronary artery diseases patients complicated with obstructive sleep apnea-hypopnea syndrome ( OSAHS) . Methods 134 coronary artery diseases patients who had at least one-vessel disease confirmed by coronary angiography were investigated by polysomnography for OSAHS. The patients were classified according to theapneahypopnea index(AHI) . The level of RDW, triglyceride, cholesterol, high density lipoprotein, low density lipoprotein, hemoglobin, white blood cells and hematocritwere measured. The receiver operating characteristic curve was drawn to predict the moderate-severe OSAHS in coronary artery diseases patients according to RDW value. Results When 134 coronary artery diseases patients were classified into a control group and an OSAHS group according to the AHI, the level of RDW in two groups was not significantly different [ ( 13.44 ±1.30) % vs. ( 13.12 ±0.92) % , P gt; 0.05] . When 134 coronary artery diseases patients were classified into a control and mild OSAHS group and a moderate-severe OSAHS group according to the AHI, the level of RDW in two groups was significantly different [ ( 13.07 ±0.94) vs. ( 14.02 ±1.41) % , P lt; 0.05] . And no difference was found in hemoglobin, triglyceride, cholesterol, high density lipoprotein, low density lipoprotein, platelet, and hematocrit between two groups. The ROC curve analysis revealed that the area under ROC curve was 0.748 ( 0.523-0.972) , and the best cut-off for moderate-severe OSAHS was 13.95% with sensitivity of 71.43% and specificity of 82.98% . Conclusion RDW may be a useful and simple tool to predict moderate-severe OSAHS in coronary artery diseases patients.