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find Author "房勤" 13 results
  • Effect of Zerobalanced Ultrafiltration on Postoperative Lung Function in Coronary Artery Bypass Grafting Patients

    Abstract: Objective To investigate the clinical effect of using zerobalanced ultrafiltration on postoperative lung function of coronary artery bypass grafting (CABG) patients under cardiopulmonary bypass (CPB). Methods Forty coronary artery bypass grafting patients in the First Affiliated Hospital of China Medical University from June 2006 to December 2008 were enrolled in this study, and were divided into two groups based on different ultrafiltration procedures. Patients in the experimental group (n=20), 14 males and 6 females, with an age of 65.43±8.31 years, underwent zerobalanced ultrafiltration and conventional ultrafiltration after CPB was carried out. Patients in the control group (n=20), 15 males and 5 females, with an age of 66.51±7.62 years, only underwent conventional ultrafiltration after temperature restoration. Preoperative pulmonary function and arterial blood gas were tested routinely. Airway resistance (Raw), oxygenation index (OI) and alveolar  arterial oxygen difference [P(Aa)O2] were measured at the following points: before CPB, at the end of CPB, 6 hours, and 12 hours after operation. Postoperative mechanical ventilation time was also recorded. Results There was no significantly statistical difference between the two groups of patients in pulmonary function and arterial blood gas indexes before operation, and Raw, OI and P(Aa)O2 before CPB (Pgt;0.05). Nevertheless, at the points of 6 hours and 12 hours after operation, Raw [2.22±0.31 cm H2O/(L·s) vs. 2.94±0.42 cm H2O/(L·s), F=0.061, Plt;0.05; 1.89±0.51 cm H2O/(L·s) vs. 2.52±0.29 cm H2O/(L·s), F=0.096, Plt;0.05] and P(Aa)O2 (86.74±7.63 mm Hg vs. 111.66±7.49 mm Hg, F=0.036, Plt;0.05; 74.82±5.67 mm Hg vs. 95.23±6.78 mm Hg, F=0.059, Plt;0.05) of patients in the experimental group were significantly lower than those of patients in the control group. At the same points, OI of patients in the experimental group was significantly higher than that of patients in the control group (384.33±30.67 vs. 324.63±31.22, F=0.033, Plt;0.05; 342.24±23.43 vs. 293.67±25.44, F=0.047, Plt;005). Ventilator support time of the experimental group was shorter than the control group (15.44±3.93 h vs. 20.68±5.77 h,Plt;0.05). Conclusion Zerobalanced ultrafiltration can improve pulmonary function after coronary artery bypass grafting and shorten postoperative mechanical ventilation time.

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  • 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
  • Echocardiographic evaluation of the relationship between pattern of left ventricular dilation and functional mitral regurgitation

    Objective To evaluate the relationship between pattern of left ventricular dilation and functional mitral regurgitation (FMR) by echocardiography. Methods A single-center retrospective observational study was conducted on 117 patients with age of 31-77 years and left ventricular end diastolic dimension≥60 mm treated in our hospital from January 2013 through May 2016. These patients were divided into four groups by FMR degree: FMR-None/Trace (FMR-N/T group,n=33), FMR-Minor (FMR-Mi group,n=37), FMR-Moderate (FMR-Mo group,n=34) and FMR-Severe (FMR-Se group,n=13). We analyzed their basic information and echocardiographic parameters including left ventricular dimension, volume, systolic function, spherical index, regional wall motion score index, tenting height and area of mitral vavle as well as anterior/posterior angle. Results The incidences of inferior/posterior/lateral myocardial infarction and basal myocardial dyskinesia/aneurysm increased with the increase of FMR degree (FMR-N/T vs. FMR-Mi vs. FMR-Mo vs. FMR-Se: 12.1% vs. 18.9% vs. 44.1% vs. 46.2%,P=0.001 and 12.1% vs. 27.0% vs.47.1% vs. 53.8%,P=0.005, respectively). The tenting height and area of mitral valve, anterior/posterior angle, regional wall score index of the left ventricle where the papillary muscle was attached to had a positive correlation with FMR degree (P<0.05). Conclusion There is a relationship between regional left ventricular dilation and FMR. Evaluating and improving those parameters is very important when we choose the treatment strategy of functional mitral regurgitaion.

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  • 206例心脏生物瓣膜临床应用分析

    目的总结分析异种生物瓣膜置换术的临床应用结果,评价生物瓣膜在心脏外科中的应用效果和趋势。方法回顾性分析 2004年 7月至 2008年 7月在中国医科大学附属第一医院接受异种生物瓣膜置换术患者 206例的临床资料,男 157例,女 49例;年龄 44~ 79(64.7±13.2)岁。置换生物瓣膜 227枚,联合置换机械瓣膜 11枚;同期行冠状动脉旁路移植术( CABG)51例,房 /室间隔缺损修补术 7例。结果术后早期( 30 d内)死亡 7例。院外随访 6个月~ 5年,平均随访 23个月,随访 134例,随访率 67.3% ( 134/199)。随访患者心功能均得到不同程度的改善,未发现瓣周漏、感染性心内膜炎、血栓和出血等并发症。彩色多普勒超声心动图提示生物瓣膜功能良好,无明显衰败迹象。结论异种生物瓣膜置换疗效确切,并发症少,近期效果较好。

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • 老年危重心瓣膜病的外科治疗与围术期处理

    目的 总结老年危重心瓣膜病患者的手术治疗和围术期处理经验。 方法 回顾性分析 2008年6月至2010年6月中国医科大学附属第一医院37例60岁以上老年危重心瓣膜病患者手术治疗的临床资料,其中男21例,女16例;年龄60~79 (67.3±6.9)岁。二尖瓣病变15例,主动脉瓣病变8例,主动脉瓣+二尖瓣病变14例;合并左心房血栓9例,三尖瓣反流11例。 结果 围术期死亡3例,其中死于术后肺部感染1例,多器官功能衰竭1例,脑梗死1例。术后发生并发症18例,包括呼吸道并发症、室性心律失常、低心排血量综合征和急性肾功能衰竭等,经相应的治疗治愈。随访26例,随访时间6~23个月,心功能分级(NYHA)Ⅰ级13例,Ⅱ级12例,Ⅲ级1例。 结论 完善的术中操作、加强围术期处理,可有效降低老年危重心瓣膜病患者术后并发症的发生和病死率。

    Release date:2016-08-30 05:28 Export PDF Favorites Scan
  • Skeletonized versus Pedicle Left Internal Mammary Artery in Coronary Artery Bypass Grafting: A Randomized Controlled Trial

    ObjectiveTo explore the effect of skeletonized left internal mammary artery (LIMA) in coronary artery bypass grafting (CABG). MethodsA total of 122 patients who underwent pure CABG were recruited in the study in the First Affiliated Hospital of China Medical University between January and April 2013. There were 77 males and 45 females with age of 41-76(62.8±10.5) years. They were randomly assigned to received CABG with skeletonized LIMAs (group A, 60 patients) or pedicle LIMAs (the group B, 62 patients) by random digital table. LIMAs were all anastomosised to the left anterior descending artery. ResultsThere was one patient failure in harvesting LIMA process in the group A and B respectively, and they were changed to saphenous vein grafts and excluded from the criteria. There were 2 and 3 patients of postoperative myocardial infarction in the group A and in the group B respectively, with incidence rate of 3.4% and 4.9% respectively (P > 0.05). One patient died in each group during hospitalization with hospital mortality rates of 1.7% and 1.6% respectively (P > 0.05). Complications such as mediastinal infection occurred zero and one patient in the group A and in the group B respectively (P > 0.05). LIMA harvesting time of the group A was statistically longer than that of the group B (30.7±7.2 min vs. 17.2±5.6 min, P < 0.05). In six months of follow-up after surgery, coronary CT showed patency rate of LIMA in the group A and in the group B was 96.8% and 100.0% respectively (P > 0.05). ConclusionThe recent effect of skeletonized LIMA as graft material in CABG is satisfactory.

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  • Short and Mid-term Outcome of Surgical Intervention for Low-gradient Aortic Stenosis Patients with Impaired Left Ventricular Function

    ObjectivesTo investigate simple assess method of the degree of low transvalvular gradient aortic stenosis patients with impaired left ventricular function and to investigate aortic valve replacement indications, short and mid-term outcome of this kind of patients. MethodsWe retrospectively analyzed the clinical data of 21 low-gradient patients with impaired left ventricular function in our hospital from January 2011 through May 2014. There were 15 males and 6 females aged 41-66 (54.6± 10.7) years with mean aortic transvalvular gradient less than 40 mm Hg and left ventricular ejection fraction (LVEF) less than 50%. ResultsIn response to dobutamine echocardiography stress test, 20 patients underwent aortic valve replacement. The result of intraoperative pathology showed 11 patients were with bicuspid aortic valve malformation, 4 patients with degenerative changes, 4 patients with rheumatic disease. During the same period, 3 patients underwent atrial fibrillation ablation, 1 patient with ascending aorta replacement, 2 patients with coronary artery bypass grafting, 1 patient with mitral valvuloplasty. One patient died of multiple organ failure on the fourth day after operation. The remaining patients recovered. The patients were followed up for 3 to 37 months after operation. Heart function of majority improved to gradeⅠorⅡin 3 months after surgery. The result of echocardiogram showed prosthetic valve function was good and LVEF increased (preoperative 35.7%± 8.2% vs. postoperative 49.4%± 7.2%). One patient suffered sudden death of unknown cause in the 11th months after operation. ConclusionsFor patients whose dobutamine echocardiography stress test displayed with true severe aortic stenosis and left ventricular contractile reserve capacity, after aortic valve replacement and relief of the obstruction, the left ventricular afterload decreases significantly, the left ventricular function also improves, LVEF and the quality of life improve significantly after operation.

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  • 左心室射血分数低下患者行冠状动脉旁路移植术

    目的 分析左心室射血分数(LVEF)<45%患者行冠状动脉旁路移植术(CABG)的临床效果。 方法 回顾性分析中国医科大学附属第一医院2007年6月至2010年6月423例连续行单纯CABG患者的临床资料,据LVEF值不同将患者分为两组:A组,376例,男279例,女97例;年龄(58.6±11.4)岁,LVEF均≥45%;B组,47例,男36例,女11例;年龄(60.7±12.1)岁,LVEF均<45%,比较两组患者行CABG的临床效果。 结果 A组术后低心排血量发生率 [3.7% (14/376) vs. 17.0% (8/47), P<0.05] 和院内病死率[1.6% (6/376) vs. 6.4% (3/47),P<0.05]均低于B组,且差异有统计学意义。术后门诊或电话随访6~38个月,A组随访335例,B组随访41例,随访率共为88.9% (376/423)。A组死亡1例,死于术后17个月突发急性心肌梗死,其余患者心绞痛症状完全消失或减轻。B组死亡2例,1例术后9个月死于心力衰竭,另1例术后31个月死于消化道恶性肿瘤;术后6个月LVEF较术前明显提高(51.7%±12.5% vs. 38.7%±4.6%,P<0.05),大多数患者活动耐受力及心功能明显改善。 结论 CABG对于LVEF低下的冠心病患者是一种安全有效的治疗方法,加强围术期处理,有助于提高手术效果。

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • Minimally Invasive and Routine Mitral Valve Repair or Replacement for Patients with Single Mitral Valve Disease:A Case Control Study

    Objective To compare the clinical outcomes and safety of minimally invasive and routine mitral valve repair or replacement for patients with single mitral valve disease. Methods We retrospectively analyzed the clinical data of 67 patients with single mitral valve disease (without aortic valve and tricuspid valve lesion or other heart diseases including atrial septal defect) who underwent mitral valve repair or replacement in the First Affiliated Hospital of China Medical University between January and July 2011. The patients were divided into two groups according to different surgical approaches:the minimally invasive surgery group (n=29,8 males and 21 females,age 51.4±9.4 years) underwent minimally invasive mitral valve repair or replacement via right mini-thoractomy;and the routine surgery group (n=38,11 males and 27 females,age 53.6±11.9 years) underwent mitral valve repair or replacement via middle sternotomy. In the minimally invasive surgery group,9 patients underwent mitral valve repair while the other 20 patients underwent mitral valve replacement. And no patient underwent transition to routine operation. In the routine surgery group,15 patients underwent mitral valve repair and 23 patients underwent mitral valve replacement. Clinical outcomes and safety of the operations were compared between the two groups. Results There was no statistical difference in operation time between the two groups (207.9±18.1 min versus 198.4±27.5 min,P=0.076). The amount of postoperative drainage (126.7±34.5 ml versus 435.6±87.2 ml,P=0.000) and blood transfusion (red blood cell 1.4±0.8 U versus 2.3±1.1 U,P=0.000;blood plasma 164.3±50.4 ml versus 405.6±68.9 ml,P=0.000) of the minimally invasive surgery group were significantly lower than those of the routine surgery group. The cardiopulmonary bypass time (81.7±23.9 min versus 58.7±13.6 min,P=0.000) and aortic-clamping time (51.6±12.7 min versus 38.4±11.7 min,P=0.000) of the minimally invasive surgery group were significantly longer than those of the routine surgery group. The length of ICU stay (22.5±3.6 h versus 31.7±8.5 h,P=0.000),mechanical ventilation (7.4±3.2 h versus 11.2±5.1 h,P=0.000) and postoperative hospitalization (7.1±1.6 d versus 13.5±2.4 d,P=0.000) of the minimally invasive surgery group were significantly shorter than those of the routine surgery group. There was no statistical difference in postoperative complications between the two groups. Minimally invasive surgery group patients were followed up for 5.3±2.4 months with a follow-up rate of 72.4%(21/29). Routine surgery group patients were followed up for 5.5±3.8 months with a follow-up rate of 71.0%(27/38). There was no significant complication during follow-up in both two groups. Conclusion Minimally invasive mitral valve operation via right mini-thoracotomy is effective and safe with a good cosmetic result. Compared with routine operation,patients undergoing minimally invasive operation recover better and faster.

    Release date:2016-08-30 05:46 Export PDF Favorites Scan
  • Minimally invasive multi-vessel coronary artery bypass grafting through a small incision in left chest

    Objective To study the technical characteristics, clinical outcomes and short- and long-term results of minimally invasive multi-vessel coronary artery bypass grafting and to evaluate the feasibility and efficacy. Methods From April 2012 to December 2014, minimally invasive cardiac surgery for coronary artery bypass grafting (MICS CABG) in 11 patients was performed in the First Hospital of China Medical University. All patients were males and the average age was 62.7 (47.0-73.0) years. Eight patients with 3-vessel lesions and 3 patients with 2-vessel lesions. General anesthesia was performed with double lumen endotracheal intubation and single lung ventilation. The patient was positioned 15 degrees to 30 degrees in right lateral position. The left anterior and lateral incision was made at the fourth/fifth intercostal space with the length of 5-7 cm and 2/3 part of the incision located in the medial side of anterior axillary line. Left internal thoracic artery (LIMA) was harvested from the third intercostal space up to the subclavian vein and down to more than fifth intercostal space through the surgical window. Through the xiphoid and sixth intercostal space incision with the length of 1 cm, the Starfish and Octopus system were placed to fix apex and ascending aorta and target vessels were exposed. The proximal and distal anastomosis was done under the direct vision. The sequence of distal anastomosis was from posterior descending branch to obtuse/diagonal branch and left anterior descending branch. The chest and pericardial draining tubes were placed through the xiphoid and sixth intercostal space incision. Results The mean operation time was 4.1 (3.2–5.8) h. Five patients underwent the operation with the assist of cardiopulmonary bypass and the mean assisting time was 21.0 (17.0-38.0 ) min. The mean number of distal anastomosis was 2.8 (2.0-3.0) and LIMA was harvested and grafted in all 11 patients. The mean drainage was 425.0 (180.0-750.0) ml, mean ventilation time 7.8 (4.3-11.2) h, ICU stay 15.9 (11.0-38.0) h, and hospital time 7.7 (5.0-14.0) d. There was no operative death and re-exploration for bleeding. One patient was complicated by paroxysmal atrial fibrillation and one patient myocardial infarction. The average follow-up was 19.4 (12.0-36.0) months, and no chest pain, re-admission or re-intervention happened. Coronary artery CT angiographies demonstrated that all LIMAs were patent and 4 vein grafts were occluded and venous graft patency rate was 80.0% one year after surgery. Conclusion MICS CABG has the advantage of quick recovery, good cosmetic effect and low incision infection rate compared to the conventional CABG. Compared with robotic surgery, the cost of MICS CABG is low and the same as that of the conventional CABG. It is a new kind of CABG and could be performed following the learning curve under strict training of doctors and careful patient selection. With the good short- and middle-term results, MICS CABG needs to be evaluated for long-term graft patency rate, re-revascularization rate, and clinical evidence.

    Release date:2017-07-03 03:58 Export PDF Favorites Scan
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