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.
Objective To compare the clinic results between offpump left ventricular(LV) aneurysm plication repair and onpump 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 4670 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: Offpump group (n=17), with the size of DA represented 25%-37% of left cavity. Patients in this group underwent offpump LV aneurysm plication repair; Onpump group (n=15), with the size of DA represented 27%-40% of left cavity. Patients in this group underwent onpump 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 offpump 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]endsystolic 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 followup 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 onpump 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 followup time was 1260 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 Offpump 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 longterm prognosis needs further observation.
ObjectivesTo systematically review the efficacy of His-bundle pacing (HBP) and right ventricular pacing (RVP).MethodsPubMed, The Cochrane Library, Web of Science, EMbase, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) and cohort studies on efficacy of HBP and RVP from inception to December, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed using RevMan 5.3 software.ResultsA total of 8 studies involving 1 130 patients were included. The results of meta-analysis showed that: HBP group was superior to RVP group in QRS duration (MD=–43.88, 95%CI –52.53 to –35.22, P<0.000 01), LVEF (MD=4.53, 95%CI 2.67 to 6.38, P<0.000 01), and NYHA (MD=–0.85, 95%CI –1.14 to –0.56, P<0.000 01). However, the operation time (MD=15.21, 95%CI 11.44 to 18.98, P<0.000 01) and fluoroscopy duration (MD=2.98, 95%CI 2.10 to 3.85, P<0.000 01) of HBP group were longer than that of RVP group.ConclusionsCurrent evidence shows that, compared with RVP, HBP is superior in maintaining of QRS duration, LVEF and NYHA; however, the operation time is longer. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusion.
Objective To investigate the risky factors of ventricular arrhythmias following open heart surgery in patients with giant left ventricle, and offer the basis in order to prevent it’s occurrence. Methods The clinical materials of 176 patients who had undergone the open heart surgery were analyzed retrospectively. There were 44 patients who had ventricular arrhythmia (ventricular arrhythmia group), 132 patients who had no ventricular arrhythmia as contrast (control group). The preoperative clinical data, indexes of types of cardiopathy, ultrasonic cardiogram, electrocardiogram and cardiopulmonary bypass (CPB) etc. were choosed, and tested by using χ2 test,t test and logistic regression to analyse the high endangered factors for incidence of ventricular arrhythmia after open heart surgery. Results Age≥55 years (OR=3.469), left ventricular enddiastolic diameter(LVEDD)≥80 mm (OR=3.927), left ventricular ejection fraction（LVEF）≤55% (OR=2.967), CPB time≥120min(OR=5.170) and aortic clamping time≥80min(OR=4.501) were the independent risk factors of ventricular arrhythmia. Conclusion Ventricular arrhythmia is a severe complication for the patients with giant left ventricle after open heart surgery, and influence the prognosis of the patients. Patient’s age, size of the left ventricle, cardiac function, CPB time and clamping time could influence the incidence of ventricular arrhythmias.
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.
Objective To investigate the effect of coronary artery bypass grafting (CABG) on patients with coronary heart disease and giant left ventricular dimension but without aneurysm. Methods The clinic data of 51 consecutive patients with coronary heart disease accompanied by enlarged left ventricle dimension without aneurysm, including 50 males and 1 female, undergoing CABG between January 2004 and December 2006 in Nanjing First Hospital of Nanjing Medical University was retrospectively reviewed. The patients were at the age of 54-61 years with an age of 57.5±3.2 years. All patients received CABG, combined with aortic valve replacement in 7, mitral valve replacement in 16, mitral valvoplasty in 17 and tricuspid valvoplasty in 7. After surgery, perioperative complications and mortality were closely observed and followup for a period of 37 months was carried out. Results The number of distal anastomoses per patient was 2.0-4.0(3.8±1.1). Four patients died perioperatively (7.8%), among whom 2 died from malignant ventricular fibrillation, 1 from acute kidney failure and 1 from stroke caused by severe low cardiac output syndrome. All other patients were discharged from hospital with good recovery. After operation, 5 patients had atrial fibrillation and 11 had ventricular fibrillation, but all of those patients survived after proper treatment. The followup period for 47 patients was 37-49 months (43±11months), with a followup rate of 100%. No death occurred during the follow-up. Ultrasound cardiography in the followup period showed that there was a decreased left ventricular enddiastolic dimension (59±2 mm vs. 68±5 mm; t=7.320, Plt;0.05) and an improved left ventricular ejection fraction (45%±17% vs. 34%±15%; t=4.770, Plt;0.05) compared with those before operation with statistical significance. Conclusion CABG is an effective surgical procedure in the treatment of coronary heart disease with giant left ventricular dimension but without aneurysm.
ObjectiveTo summarize the age distribution of different pathological types of primary left ventricular tumor and its influence on preoperative diagnosis, surgical methods and therapeutic effect.Methods The clinical data of 35 patients with primary left ventricular tumor admitted to Fuwai Hospital of Chinese Academy of Medical Sciences from January 2008 to March 2019 were retrospectively analyzed. There were 19 males and 16 females with an average age of 33.81±17.56 years. According to the age, the patients were divided into an infant group (less than 7 years), an adolescent group (7-17 years), a young group (18-44 years), a middle-aged group (45-59 years) and an elderly group (over 60 years). The age distribution characteristics of different pathological types of tumor patients were analyzed, and the influence on surgical methods, short-term and long-term curative effect of surgery in different age groups was analyzed. Within 6 months after the operation, the patients returned to the hospital to review the echocardiography, and then were followed up by telephone.Results Of the 35 patients with primary left ventricular tumor, only 1 patient in the middle-aged group had low malignancy carcinoid tumor, and the others were benign tumors. Fibroma and rhabdomyoma accounted for the majority of the infant group and adolescent group. Myxoma was the common tumor in the young group, middle-aged group and elderly group, followed by lipoma. Thirty-three patients were operated under general anesthesia, hypothermia and cardiopulmonary bypass (CPB). Two patients with epicardial lipoma underwent normothermic surgery without CPB. Nine patients underwent partial resection of left ventricular tumors, and 26 patients received complete resection of left ventricular tumor. There was no hospital death, opening stanching, secondary thoracotomy, low cardiac output, embolism or other complications. The postoperative hospital stay was 7.97±2.56 days, and the postoperative reexamination was normal. Subsequently, 35 patients were followed up by telephone or outpatient service. The average follow-up time was 59.87±37.62 months. In the young group, 2 patients with partial resection recurred.Conclusion Surgical resection is the first choice for the treatment of left ventricular benign tumor, and it is safe. The principle of left ventricular tumor surgery is to protect the function of ventricle and valve, prevent damage to the conduction system, and remove the tumor as completely as possible.
To evaluate the value of left ventricular diastolic function in type 2 diabetes mellitus (DM) using dual-gate Doppler and relative factors, we included 50 non-obesity and hypertension-free DM patients into the controlled group in the study along with 48 age-and-gender-matched healthy volunteer subjects. The peak early diastolic velocity (E), peak later diastolic velocity (A), deceleration time (DT), anterior mitral annulus diastolic peak velocity (e'), isovolumic relaxation time (IVRT), E/A, E/e', Tei index and TE-e' were measured with dual-gate Doppler. 20 subjects were randomly selected for repetitive analysis. Study showed statistical difference in E/A, DT, e', E/e', IVRT, Tei index and TE-e' between the two groups (P < 0.05). Linear regression analysis showed positive correlation between TE-e' and IVRT, course of DM patients and TE-e'(Beta=0.295, P=0.020), and HbA1C control level and TE-e'(Beta=0.399, P=0.010). Repeated analysis showed good reproducibility for both within and between groups. Dual-gate Doppler has clinical value in evaluating left ventricular diastolic function in type 2 diabetes mellitus patients. The course of type 2 diabetes mellitus patients and HbA1C control level were both closely related with left ventricular diastolic function.