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find Author "孟旭" 15 results
  • Influence of Preoperative Left Atrial Dimension on the Effectiveness of Surgical Radiofrequency Ablation for Treatment  of Atrial Fibrillation

    Abstract: Objective To analyze the influence of preoperative left atrial dimension (LAD) on the effectiveness of surgical radiofrequency ablation for the treatment of atrial fibrillation (AF) through a 5-year postoperative follow-up of AF patients after surgical radiofrequency ablation. Methods Clinical data of 433 patients with persistent or permanent AF who received bipolar radiofrequency ablation procedures during concomitant cardiac surgery in Beijing Anzhen Hospital from 2006 to 2009 were retrospectively analyzed. All the patients were divided into 4 groups according to their preoperative LAD:Group A, 75 patients with their LAD<50 mm, including 22 males and 53 females with their average age of 56.50±10.05 years;Group B, 89 patients with their LAD ranging from 50 to 60 mm, including 32 males and 57 females with their average age of 55.63±10.28 years;Group C, 117 patients with their LAD ranging from 60 to 70 mm, including 41 males and 76 females with their average age of 55.13±10.96 years;and Group D, 152 patients with their LAD>70 mm, including 68 males and 84 females with their average age of 53.22±11.49 years. Postoperative ECG records right after surgery, before discharge, at 6 months and 1,2,3,4 and 5 years during follow-up were collected. The relationship between preoperative LAD and postoperative sinus rhythm restoration rate was analyzed. Results There was statistical difference in sinus rhythm restoration rate right after surgery(P=0. 011), before discharge(P=0. 002), at 6 months(P< 0. 001) and 1 year (P<0. 001), 2 years(P<0. 001), 3 years(P<0. 001), 4 years(P<0. 001) and 5 years(P= 0. 006) during follow-up among the 4 groups. Postoperative sinus rhythm restoration rates right at 6 months and 1,2,3, 4 and 5 years during follow-up was 90.4%, 89.9%, 90.3%, 91.3%, 89.1%, and 90.9% in Group A, 80.2%,79.0%,78.1%, 76.1%,72.5%,70.0% in Group B,74.7%,74.0%,71.2%,72.4%,70.0%, and 64.7% in Group C, and 61.8%,57.6%,56.8%,53.9%,50.7%,and 48.6% in Group D, respectively. Conclusion Patients with a larger preoperative LAD have a lower postoperative sinus rhythm restoration rate after surgical radiofrequency ablation for the treatment of AF.

    Release date:2016-08-30 05:28 Export PDF Favorites Scan
  • The Partial Application of Complete Flexible Artifical Ring in Mitral Valve Repair

    Objective To summarize the experience and results of mitral annuloplasty with modified partial flexible artificial ring. Methods Two hundred and fifteennine patients were underwent partial flexible ring annuloplasty after mitral valve plasty surgery in our hospital from an. 1998 to Aug.2006. The etiology included rheumatic (16 cases), infective endocarditis of mitral (16 cases), ischemic (13 cases), ongenital (40 cases) and degeneration (174 cases). Echocardiogram test were performed in the perioperative periods to monitor the lefe atrium (LA), left ventricular enddiastolic dimension (LVEDD), left ventricular endsystolic dimension (LVESD), left ventricular ejection fraction(LVEF), left ventricular fractional shortening (LVFS) and mitral regurgitation grades. The perioperative mortality, morbidity, reoperation rate were recorded during the followup. Results Aortic cross clamping time was 74±30 min and cardiopulmonary bypass time was 105±37min. The perioperative survival rate was 96.5% (250/259) and free from complications rate was 93.4% (242/259). No left ventricular out flow tract obstruction and coronary artery stenosis were occurred in this group. The 60 months survival rate was 938% (243/259) and 5 years nonreoperation rate was 96.1%(249/259). The perioperative echocardiogram results showed the LVEDD decreased from 62.60±10.19mm to 52.88±8.67mm and the LVEF increased from 57.91% to 61.00%(Plt;0.05). During the followup the mitral regurgitation grades were improved significantly (Plt;0.05),there were 188 cases of trifle mitral regurgitation (72.6%), 62 cases of mild mitral regurgitation (23.9%), 8 cases of moderate mitral regurgitation(3.1%) and 1 case of serious mitral regurgitation(0.4%). Conclusion This simplified mitral annuloplasty technique is an easy handling and effective treatment for the mitral repair.

    Release date:2016-08-30 06:08 Export PDF Favorites Scan
  • 二尖瓣置换术后三尖瓣关闭不全的外科治疗

    目的总结二尖瓣置换术后三尖瓣关闭不全患者的外科治疗经验。方法14例心脏瓣膜疾病患者行二尖瓣置换术后发生中度或重度三尖瓣关闭不全,其中相对性关闭不全12例,器质性关闭不全2例。行三尖瓣成形术4例,均使用人工瓣环成形;行三尖瓣置换术10例,其中置换生物瓣6例,双叶机械瓣4例。在心脏不停跳下手术4例,常规心脏停搏手术10例。结果全组无手术死亡,术后发生低心排血量综合征3例,用升压药维持循环,患者均顺利出院。术后复查超声心动图,右心房、室均明显缩小,右心室前后径(22.5±5.6mm)较术前(31.9±5.9mm)明显减小(Plt;0.001)。随访14例,随访时间1.8±1.3年,心功能级2例、级9例,级2例,1例于术后4年因心力衰竭死亡。结论二尖瓣置换术后远期三尖瓣关闭不全的患者经外科矫治后疗效满意,合理掌握手术指征、手术时机和良好的围术期治疗是手术成功的关键。

    Release date:2016-08-30 06:25 Export PDF Favorites Scan
  • 四种人工机械瓣膜的临床对比研究

    目的 评价对比4种人工机械瓣膜的综合性能. 方法 对424例分别置换Sorin Bicarbon瓣,Medtronic-Hall瓣,St.Jude Medical瓣和ATS瓣的患者在围手术期并发症、血流动力学、生存率和早期随访结果方面进行对比研究. 结果 手术死亡率Sorin Bicarbon 瓣,Medtronic-Hall瓣,St.Jude Medical瓣,ATS瓣分别为2.9%,7.8%,6.3%, 1.7%(P=0.11);2年无血栓栓塞发生率分别为100%, 96.6%±3.4%,95.4%±2.0%和98.6%±1.0%(P=0.1439);2年无与抗凝有关的出血发生率分别为100%,100%,100% 和96.7%±1.5%(P=0.1090);3年生存率分别为100%,97.8%±2.2%,96.2%±1.8%和95.4%±2.0% (P=0.7390).4种瓣膜血流动力学方面差别无显著性意义. 结论 目前在我国广泛应用的4种人工机械瓣膜的综合性能均良好,在低强度抗凝治疗条件下,可以取得相似的临床效果.

    Release date:2016-08-30 06:34 Export PDF Favorites Scan
  • Economic Evaluation of Oral Anticoagulation Therapies

    ObjectiveTo assess the health effectiveness, cost and cost effectiveness of different oral anticoagulation (OAT) therapies in China, including warfarin plus international normalized ratio (INR) test in hospital labs (Lab test), warfarin plus patient self-management (PSM) with point of care device, and novel anticoagulant (Dabigatran) alone. MethodsA Markov model containing four states (no complication, hemorrhagic event, thrombotic event and death) was developed to account for long-term cost and outcomes of warfarin/novel anticoagulant users including atrial fibrillation patients and deep venous thrombosis patients. Direct medical cost was taken into consideration, covering expenses of drugs, OAT monitoring and complication management. Both clinical and cost parameters were mainly derived from literatures. ResultsCompared with hospital lab test, the PSM pattern obtained a prolonged 8.48 years and 5.08 QALYs with the larger amount of cost, CNY 47 482. The incremental cost-effectiveness ratio (ICER) of PSM versus hospital lab test came to CNY 19 240 per QALY gained, lower than GDP China per capita in 2014 (CNY 46 628). And the novel anticoagulant pattern was dominated by PSM pattern due to shortened QALYs while increased cost. The sensitivity analysis demonstrated the results were not sensitive to main indicators, including utility in different health status, complication probability, and disease management cost. ConclusionPSM can generate more QALYs by reducing the risk of major thrombotic and bleeding events with acceptable incremental cost, which turns to be the most cost effective way among the 3 patterns and demonstrates promising future in OAT management.

    Release date:2016-10-02 04:56 Export PDF Favorites Scan
  • Protection of spinal cord ischemia-reperfusion injury mediated by N-methyl-D-aspartate receptors

    ObjectiveTo analyze the protective mechanism of spinal cord ischemia-reperfusion injury mediated by N-methyl-D-aspartate (NMDA) receptor.MethodsA total of 42 SD rats were randomly assigned to 4 groups: a non-blocking group (n=6), a saline group (n=12), a NMDA receptor blocker K-1024 (25 mg/kg) group (n=12) and a voltage-gated Ca2+ channel blocker nimodipine (0.5 mg/kg) group (n=12). The medications were injected intraperitoneally 30 min before ischemia. The neural function was evaluated. The neuronal histologic change of spinal cord lumbar region, the release of neurotransmitter amino acids and expression of spinal cord neuronal nitric oxide synthase (nNOS) were compared.ResultsAt 8 h after reperfusion, the behavioral score of the K-1024 group was 2.00±0.00 points, which was statistically different from those of the saline group (5.83±0.41 points) and the nimodipine group (5.00±1.00 points, P<0.05). Compared with the saline group and nimodipine group, K-1024 group had more normal motor neurons (P<0.05). There was no significant difference in glutamic acid concentration in each group at 10 min after ischemia (P=0.731). The nNOS protein expression in the K-1024 group was significantly down-regulated compared with the saline group (P<0.01). After 8 h of reperfusion, the expression of nNOS protein in the K-1024 group was significantly up-regulated compared with the saline group (P<0.05).ConclusionK-1024 plays a protective role in spinal cord ischemia by inhibiting NMDA receptor and down-regulating nNOS protein expression; during the reperfusion, K-1024 has a satisfactory protective effect on spinal cord function, structure and biological activity of nerve cells.

    Release date:2020-12-31 03:27 Export PDF Favorites Scan
  • 心脏瓣膜手术的百年坚持与探索—2023亚洲心脏瓣膜中国论坛纪要

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  • Preliminary Experimental Study of a Novel Device for Left Atrial Appendage Closure

    ObjectiveTo evaluate the performance and safety of a novel device for left atrial appengdage (LAA) closure in dogs. MethodsThrough the fourth left intercostal, the LAA clips were implanted at the base of LAA in six dogs. Macroscopic pathology, histopathology and biological detection were performed at 7 d, 60 d, 90 d, 180 d after implan-tation respectively. ResultsThe devices were all successfully implanted at the base of LAA. There is no transposition of the LAA clips. Complete fibrosis and atrophy of LAA occurred at 60 d after implantation. LAA closure was completed with a new endothelial tissue layer developed on the occluded orifice of the left atrium after 60 d after implantation. The level of atrial natriuretic peptide did not decrease significantly after the device implantation (275.64±60.00 pg/ml vs. 248.34±56.10 pg/ml, P=0.529). ConclusionThe novel device for LAA closure achieved easy, reliable and safe closure of the LAA in canine model.

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  • 右冠开口异常合并联合瓣膜病及左房巨大血栓一例

    Release date:2016-12-06 05:27 Export PDF Favorites Scan
  • Risk factors and management experiences of stent valves detachment in transcatheter aortic valve implantation (TAVI)

    ObjectiveTo summarize and analyze the risk factors and management of artificial valve slippage in transcatheter aortic valve implantation (TAVI).MethodsWe retrospectively analyzed the clinical data of 131 patients undergoing TAVI surgery in our center from September 2017 to May 2019, including 62 patients through transapical approach and 69 patients through transfemoral artery approach.ResultsA total of 131 patients received TAVI surgery, among whom 4 patients had slipped during the operation, 2 patients via transfemoral artery approach, and another 2 patients via transapical. The average age was 77±9 years with one female (25%). Preoperative evaluation, higher position and poor coaxial were main risk factors for valve slip in TAVI.ConclusionValve slippage is also a serious complication in TAVI surgery. Reasonable and effective treatment can avoid thoracotomy.

    Release date:2020-07-30 02:16 Export PDF Favorites Scan
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