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find Keyword "室壁瘤" 18 results
  • 肥厚性心肌病合并心尖部室壁瘤致单形性室性心动过速一例

    Release date:2016-08-26 02:09 Export PDF Favorites Scan
  • Clinical Outcomes of Plication of Left Ventricular Aneurysm During Off-pump Coronary Artery Bypass Grafting

      Abstract: Objective To evaluate clinical outcomes of plication of left ventricular aneurysm during off-pump coronary artery bypass grafting (OPCAB). Methods A total of 114 patients who underwent coronary artery bypass grafting (CABG) and concomitant surgical treatment for left ventricular aneurysm from January 2007 to January 2011 in Beijing Anzhen Hospital were included in this study. All the patients were divided into 2 groups according to the different surgical procedures they received. In groupⅠ, there were 76 patients including 57 males and 19 females with their average age of (63.4±7.8) years who underwent CABG and left ventricular aneurysmectomy under cardiopulmonary bypass on the  non-beating heart. In groupⅡ, there were 38 patients including 32 males and 6 females with their average age of (60.6±8.9) years who underwent OPCAB and plication of the left ventricular aneurysm on the beating heart. Preoperative data were not statistically different between the 2 groups except that the percentage of the left ventricular aneurysm to the left ventricle  of groupⅠwas significantly larger than that of groupⅡ(42.2%±13.6% vs. 26.5%±12.3%, t=5.499, P=0.000). Postoperative clinical outcomes and morbidities were compared between the 2 groups, and all the patients were followed up for 6 months. Results There was 2 in-hospital death in groupⅠ, one for postoperative refractory ventricular arrhythmia, and the other for severe pneumonia. There was 1 in-hospital death in groupⅡ because of perioperative myocardial infarction. Postoperative thoracic drainage, incidence of reexploration for bleeding, mechanical ventilation time and incidence of  intra-aortic balloon pump (IABP) implantation were not statistically different between the 2 groups (P>0.05). To compare  their echocardiography outcomes at early postoperative stage and 6 months after discharge with preoperative values, left ventricular end-diastolic dimensions (LVEDD) at early postoperative stage and 6 months after discharge were both signific antly decreased than preoperative value in both groups [groupⅠ: (54.0±7.8) mm amp; (56.0±8.1) mm vs. (59.6±6.6) mm,  groupⅡ: (52.0±7.2) mm amp; (53.6±5.3) mm vs. (57.9±5.4) mm], and left ventricular ejection fraction (LVEF) at early  postoperative stage and 6 months after discharge were both significantly higher than preoperative value in both groups  (groupⅠ:43.5%±3.2% amp; 55.7%±3.7% vs. 38.0%±7.4%, groupⅡ:44.7%±2.8% amp; 57.0%±3.5% vs. 41.0%±6.6%), but there was no statistical difference in LVEDD and LVEF between the 2 groups(P>0.05). Conclusion Plication of  left ventricular aneurysm during OPCAB is a safe and effective surgical procedure, and possibly more appropriate for patients  with a smaller left ventricular aneurysm.

    Release date:2016-08-30 05:28 Export PDF Favorites Scan
  • Surgical Treatment for Patients with Coronary Heart Disease and Ventricular Aneurysm

    Objective To summarize clinical characteristics and treatment results of adult patients with coronary heart disease and ventricular aneurysm,and evaluate surgical outcomes. Methods Clinical data of 86 adult patients with coronary heart disease and ventricular aneurysm who underwent surgical treatment in Fu Wai Hospital from January 2011 to November 2012 were retrospectively analyzed. There were 70 male and 16 female patients with their average age of 57.7±10.6 years and average body weight of 71.7±10.5 kg. Preoperative echocardiography or left ventriculography showed left ventricular thrombus in 22 patients. Coronary angiography showed 47 patients with 3 vessel disease,29 patientswith 2 vessel disease,and 10 patients with single vessel disease. Sixteen patients underwent direct linear suturing of theaneurysm off pump,39 patients underwent simple linear suturing under cardiopulmonary bypass,15 patients received endoventricular purse-string reconstruction,and 16 patients received endoventricular purse-string reconstruction and patch plasty. Three patients underwent reexploration for bleeding. Sixty-four patients received concomitant coronary artery bypass grafting(CABG). Results Postoperatively 2 patients(2.3%) died of refractory ventricular fibrillation and multiple organ dysfunction syndrome respectively. Patients undergoing concomitant CABG received 2.3±1.2 grafts on the average. Seventy-eightpatients (92.9%) were followed up for 2-24 months after discharge. During follow-up,patients’ angina symptoms significantlyresolved,heart function improved in varying degrees,and no new sign of myocardial ischemia was found on electrocardiogram.Left ventricular ejection fraction (LVEF) was significantly higher than preoperative LVEF(51%±7% vs. 41%±9% ,t=6.20,P=0.00),and left ventricular end-diastolic diameter (LVEDD) was significantly smaller than preoperative LVEDD (54.2±6.2 mm vs. 56.0±6.8 mm,t=4.60,P=0.00) . Conclusion Ventricular aneurysm repair and concomitant CABG (or ventricular septal perforation repair,mitral valvuloplasty et al) are positive and effective treatment strategies for postinfarction ventricular aneurysm. Satisfactory clinical outcomes can be achieved by individualized treatment based on appropriate surgical strategies according to the size of ventricular aneurysm.

    Release date:2016-08-30 05:47 Export PDF Favorites Scan
  • Left Ventricular Reconstruction in a Rat Model with Post-infarction Ventricular Aneurysm

    Objective To investigate the experience of left ventricular reconstruction(LVR)in a rat model with post-infarction ventricular aneurysm. Methods A total of 35 male Sprague-Dawley (SD)rats underwent left anterior descending artery (LAD) ligation to create a left ventricular aneurysm (LVA) model following myocardial infarction. Four weeks later, 16 rats with LVA that met the inclusion criteria underwent LVR as the experiment group(LVR group). Another 10 rats with LVA underwent thoracotomy as the control group. Three days, 2 weeks, and 4 weeks after the second operation, all the rats were examined by echocardiography to evaluate the cardiac function. At the end of the study, photography and Masson’s Trichrome staining were used to evaluate the completeness of LVA resection. Results The surgical mortality of LVA and LVR generation was 11.4%(4/35)and 18.8%(3/16)respectively, with the success rate 74.3% (26/35)for LVA model and 81.3%(13/16)for LVR model. Photography and Masson’s Trichrome staining identified complete replacement of ventricular scar by patch. Three days after the second operation, echocardiography illustrated that the left ventricular end-systolic diameter (LVESD)and fractional shortening (FS) of the LVR group were significantly improved compared with the control group (LVESD 5.00±0.87 mm versus 5.90±0.92 mm, P<0.05,FS 34.20%± 6.80% versus 26.60%±6.12%, P< 0.01). The cardiac structure and function of LVR group were also significantly improved 2 weeks and 4 weeks after the second operation compared with the control group(2 weeks:left ventricular end-diastolic diameter (LVEDD)7.60±0.56 mm versus 8.50±1.08 mm,P< 0.01;LVESD 5.10±0.65 mm versus 6.69±0.89 mm,P<0.001;FS 31.90%±6.90% versus 21.10%±6.17%,P<0.001;4 weeks:LVEDD7.70±0.50 mm versus 9.10±0.89 mm,P<0.001;LVESD5.20±0.39 mm versus 7.20±0.95 mm,P<0.001;FS 31.80%±2.40% versus 20.20%±4.17%,P<0.001). Conclusions LVR rat can be used as a stable, reliable and economic screeningmodel in engineered heart tissue(EHT)research.

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • Realtime Threedimensional Echocardiography Evaluation in Changes of Left Ventricular Regional Systolic Function after Surgical Treatment of Left Ventricular Aneurysm

    Abstract: Objective To investigate changes of left ventricularregional systolic function after surgical treatment of left ventricular aneurysm (LVA) by realtime threedimensional echocardiography (RT-3DE). Methods From February 2009 to February 2010, 14 consecutive patients who were diagnosed to have coronary artery diseases with LVA underwent surgical repair and coronary artery bypass grafting (LVA group) in our hospital. All patients of the LVA group were followed up for a mean period of 4 months. Twodimensional echocardiography (2DE) and RT-3DE were performed before operation and during the follow-up. Left ventricular regional ejection fraction (EF) was acquired by Qlab software analysis. At the same time, 12 healthy persons were included as controls (control group). Statistical analyses were carried out to compare left ventricular regional EF between the LVA group (before operation and 4 months after operation) and the control group. Results Contrary to the control group, preoperative regional EF of the LVA group increased from apex to base. In addition to the inferior basal segment, lateralinferior basal segment and anteriorinferior basal segment, regional EF in the remaining 14 segments were significantly lower than that of the control group (P<0.05). At postoperative followup, regional EF recovered the increase from base to apex, and there was no significant difference between anteriorinferior segment and lateral segment regional EF of the LVA group and those of the control group (P>0.05), while regional EF of other segments in the LVA group was lower than that in the control group (P<0.05). Conclusion RT-3DE is an effective method to assess left ventricular regional systolic function in patients with LVA. After LVA repair and coronary artery bypass grafting, regional systolic function will restore to the normal direction of progressive increase, and some nonaneurysm segments systolic function will go back to normal.

    Release date:2016-08-30 05:57 Export PDF Favorites Scan
  • 冠心病合并室壁瘤及二尖瓣关闭不全的外科治疗

    摘要: 目的 总结冠心病合并室壁瘤和二尖瓣关闭不全的外科治疗经验及效果。 方法 回顾性分析78例冠心病合并室壁瘤和二尖瓣关闭不全患者的临床资料,其中男45例,女33例;年龄42~70岁,平均年龄55岁。室壁瘤位于心尖部44例,外侧壁14例,下壁20例; 二尖瓣中度关闭不全48例,重度关闭不全30例。手术在低温体外循环下施行,室壁瘤线性缝合术24例,心内膜环缩、三明治缝合术36例,心内膜环缩、左心室补片成形术18例,同期血栓清除术13例;二尖瓣成形术42例,二尖瓣置换术36例;移植旁路血管1~6支(2.5±1.5支)。 结果 围术期死亡5例,死于败血症1例,多器官功能衰竭2例,心力衰竭2例。术中停机困难5例。术后主要并发症:低心排血量综合征、恶性心律失常和多器官功能衰竭。左心室舒张期末内径(55.6±1.2 mm vs. 68.2±4.0 mm),射血分数(45%±23% vs.34%±14%),心功能分级(NYHA,1.82±0.26级 vs. 3.36±0.56级)与术前比较差异均有统计学意义(Plt;0.05)。随访69例,随访率94.52%,随访时间25±8个月。随访期间无远期死亡,无症状复发。心功能Ⅰ~Ⅱ级58例,Ⅲ级9例,Ⅳ级2例, 较术前明显改善(Plt;0.05)。 结论 根据病理生理特点选择对心腔、血管和瓣膜全面处理的手术方式,加强围术期管理,手术治疗冠心病合并室壁瘤及二尖瓣关闭不全的近、远期疗效满意。

    Release date:2016-08-30 06:01 Export PDF Favorites Scan
  • Comparison of Clinic Results of Left Ventricular Dyskinetic Aneurysmectomy between Offpump and Onpump.

    Objective To compare the clinic results between offpump left ventricular(LV) aneurysm plication repair and onpump LV linear aneurysmectomy for LV dyskinetic aneurysm (DA), and to improve the curative effect of aneurysm. [WTHZ]Methods From September 2003 to September 2007, 32 patients with DA located in the anterior wall or apex of LV were operated. There were 23 male and 9 female aged 4670 years with a mean age of 63 years. According to the procedure with or without cardiopulmonary bypass(CPB), 32 patients were divided into two groups: Offpump group (n=17), with the size of DA represented 25%-37% of left cavity. Patients in this group underwent offpump LV aneurysm plication repair; Onpump group (n=15), with the size of DA represented 27%-40% of left cavity. Patients in this group underwent onpump LV linear aneurysmectomy. Coronary artery bypass grafting was the concomitant procedure in both groups. The clinic results were compared and evaluated via indexes such as left ventricular volume, systolic function etc which were determined by echocardiography. [WTHZ]Results No operation death was found in both groups. In offpump group, there was no perioperative complication. Postoperative cardiac function classification (NYHA) improved significantly (1.0±0.8 grade vs. 2.9±0.3 grade,P=0.001), left ventricular ejection fraction(LVEF) improved significantly (41.0%±4.5% vs. 36.4%±4.8%,P=0.035), and left ventricular [CM(159mm]endsystolic volume index (LVESVI) reduced significantly (52.6±27.7 ml/m2 vs. 79.7±21.4 ml/m2, P=0.003) compared with that before operation. Seventeen cases were followed up, and the followup time was 12-53 months with a mean time of 29 months. No death was found during following up. One case was reoperated 1 year after operation because of severe mitral valve regurgitation. One case had congestive heart failure 3 years after operation with a LVEF of 31% and still in observation. The other cases were fine. In onpump group, there were 3 cases had perioperative complications (Two with neurological complications and one with respiratory failure). Postoperative cardiac function classification (NYHA) improved significantly (1.0±0.6 grade vs. 3.1±0.9 grade,P=0.001). LVEF improved significantly (42.3%±3.2% vs. 35.6%±6.5%, P=0.023). LVESVI reduced obviously (49.3±22.6 ml/m2 vs. 81.3±25.0 ml/m2, P=0.003) compared with that before operation. Fifteen cases were followed up and the followup time was 1260 months with a mean time of 35 months. No death was found during following up and the clinic results were good. No significant difference was observed between the two groups (Pgt;0.05). [WTHZ]Conclusion Offpump LV aneurysm plication repair for LV dyskinetic aneurysm can effectively reduce the volume of LV, improve LVEF and cause less perioperative complications. It is a safe and effective procedure. Its longterm prognosis needs further observation.

    Release date:2016-08-30 06:06 Export PDF Favorites Scan
  • The Diagnosis and Surgical Treatment of Postinfarction Left Ventricular PseudoAneurysm

    Abstract: Objective To evaluate the treatment efficacy of post-infarction left ventricular pseudo-aneurysm (LVPA) through surgical procedure, and explore the diagnosis and differential diagnosis details of LVPA. Methods Between May 1993 and July 2007, 7 cases were diagnosed through echocardiography aided with left ventriculography or multi-sliced computer tomography (MSCT) or magnetic resonance imaging (MRI); 6 cases with LVPA were surgically treated through different procedure that included direct closure, cut and patching or cut and sandwiching procedure choose according to its location, anatomical morphology, and comorbidity; accompanied diseases were treated by coronary artery bypass grafting(CABG) procedure. Results Six cases were diagnosed before surgery, and 1 case was diagnosed during the surgical procedure. One died from the cardiac tamponade due to rupture of LVPA before the surgical procedure, so the inhospital mortality was 14.3%(1/7). There was no operative death. With the follow-up from 2 months to 13 years of the 6 operational survivors, 1 case died from cardiac rupture and pericardial tamponade 4 years after the repair procedure. Of the 5 surviving LVPA, the left ventricular ejection fraction(LVEF) values were from 43% to 52%, and 3 cases were in New York Heart Association (NYHA) class Ⅰ, and 2 cases were in NYHA class Ⅱ. Conclusion Echocardiography, aided with left ventriculography or MSCT or MRI, is an effective measure for diagnosis of LVPA. Surgical procedure is an effective measure to treat LVPA,but different surgical procedures, accompanied with homeochronous CABG procedure,should be adopted to deal with LVPA according its location, anatomical morphology, and accompanied deformity. The perioperative and mid-long term efficacy were good for the surgical treatment of LVPA, but it is imperative to pay attention to prevention of the recurrence and the late rupture of repaired LVPA. 

    Release date:2016-08-30 06:08 Export PDF Favorites Scan
  • Surgical Treatments of Post Infarction Ventricular Aneurysm and Mitral Regurgitation

    Objective To summarize the experiences of surgical treatment for post infarction ventricular aneurysm and mi tral regurgitation, thus to improve surgical curative effect and survival rates . Clinical data of 37 patients with myocardial infarction complicated with ven tricular aneurysm and severer than moderate mitral regurgitation were retrospectively an alyzed between December 2000 and June 2007, all 37 patients underwent coron ary artery bypass grafting and reconstruction of left ventricular after aneurysm resection, mitral valve repair or replacement. Results Three patients died during hospital stay after surgery,mortality rate was 81%, of th em two died in renal failure, one died in brain complications.Thirty patients we re followed up, followup rate was 88.2%(30/34), with 4 patients missed. Follow up time ranged from 1 month to 6 years after surgery, 2 patients died in foll o wup period, of them one died in anticoagulant treatment failure complicated w ith the large cerebral infarction, one died of lung infection and heart failure. The inner diameter of le ft atrium and enddiastolic left ventricle reduced obviously than those before operation (30.1±3.5mm vs.39.3±3.7mm, P=0.004;48.4±4.3mm vs.61.2±5.1mm, P=0.003)by color doppler echocardiography examination at 6th month a fter su rgery.There was no obvious change in size of untouched ventricular aneurysm(diam eterlt;5cm). No regurgitation or slight regurgitation were observed in 12 patient s, mild regurgitation was observed in 2 patients and moderate in 1 patients. Conclusion According to different types of post infarctio n ventricular aneurysm and mitral regurgitation, constitution o f different surgical treatment programs, can result in favorable early and long-term curative effect. There’s marked improvement in most patients’cardiac f unction and survival rate.

    Release date:2016-08-30 06:09 Export PDF Favorites Scan
  • Giant Left Ventricular Aneurysms: Early and Long-term Results of Two Types of Repair

    Abstract: Objective To evaluate the early and long-term results for the management of giant left ventricular aneurysm with comparison of different surgical ventricular restructive approaches. Methods Between January 1992 and December 2004, 148 consecutive patients underwent repair of giant left ventricular aneurysms and were divided into two groups, conventional group: 89 patients were submitted to linear repair; modified group: 59 patients were submitted to endocardium encircle suturing remodeling(EESR). There were no significant difference in New York Heart Association (NYHA) class Ⅲ /Ⅳ , left ventricular dysfunction before operation, aortic clamp time and number of coronary bypass grafts in two groups. Results Five patients died after operation (3. 4%), 4 cases in conventional group and 1 case in modified group, the hospital mortality rate was 4.5% vs. 1.7% (P=0. 320). The major morbidity were low cardiac output syndrome and ventricular fibrillation. One hundred and thirty-four patients (93.7 % ) were followed up, during a mean follow-up of 51.4± 27.0 months (range 1-120 months), 21 patients had died. The NYHA class more than m in the early stage after operation was the independent risk factor for late death (P= 0. 000). Actuarial survival rates were 91.6% of modified group vs. 76.3% of conventional group at 5 years (P=0.040), and 91.6% vs. 61.4% at 8 years(P=0.000). At late follow-up the meanNYHAclass, left ventricular end-diastolic dimension (LVEDD) and left ventricular ejection fraction (LVEF) were significant improved (P = 0. 000)in both groups. The rate of re-dilatation of LVEDD was higher in conventional group than that in modified group ( 38.8% vs. 16.7%, P= 0. 030). Conclusion The technique of repair of postinfarction dyskinetic giant left ventricular aneurysms should be adapted in each patient to the cavity size and shape, and the dimension of the scar. The EESR achieves better results with respect to perioperative mortality, late functional status and survival than linear repair.

    Release date:2016-08-30 06:23 Export PDF Favorites Scan
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