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find Author "符竣" 9 results
  • 主动脉不接触技术在梅毒性冠状动脉开口狭窄患者外科治疗中的应用一例

    Release date:2016-08-30 06:09 Export PDF Favorites Scan
  • 室间隔缺损合并动脉导管未闭110例

    Release date:2016-08-30 06:23 Export PDF Favorites Scan
  • 非体外循环冠状动脉旁路移植术中转体外循环的经验与教训

    目的 总结分析非体外循环冠状动脉旁路移植术(OPCAB)中转为体外循环冠状动脉旁路移植术(on pump CABG)的原因及临床资料,以提高OPCAB的成功率。方法 8例患者中转为on pump CABG的原因为:2例术中发现心肌桥,处理时出血难以控制;6例凶术中严重的低血压,其中3例是在搬动心脏时,另外3例在切开靶血管时。中转患者中2例在心脏不停跳下完成,其他均在低温体外循环下完成,体外循环时间为101.8±8.5min。结果8例中转患者中无住院死亡;1例发生轻度的中枢神经系统并发症,其他患者无严重并发症发生;1例中转后术中用主动脉内球囊反搏(IABP)辅助完成手术。OPCAB患者与中转on pump CABG患者比较左心室舒张期末压(13.5±4.5mmHg vs.19.1±6.7mmHg)差别有统计学意义(t=2.180,P=0.04)。结论 左心室舒张期末压增高是OPCAB的高危风险因素,如果〉20mmHg应首选on pump CABG;急诊手术、心肌桥亦是OPCAB的风险因素。

    Release date:2016-08-30 06:26 Export PDF Favorites Scan
  • Comparison of Clinical Outcomes of Two Different Radiofrequency Ablation for the Treatment of Permanent Atrial Fibrillation of Patients with Rheumatic Valvular Heart Disease

    Objective To compare short-term clinical outcomes of bipolar/unipolar radiofrequency (RF) ablation for the treatment of permanent atrial fibrillation(AF) of patients with rheumatic valvular heart disease. Methods Clinicaldata of 124 patients with rheumatic valvular heart disease and permanent AF who underwent heart valve replacement and concomitant bipolar/unipolar RF ablation in Wuhan Asia Heart Hospital from February 2011 to December 2011 were retros- pectively analyzed. According to different RF ablation methods,all the 124 patients were divided into bipolar group and unipolar group. There were 62 patients in the bipolar group including 29 males and 33 females with their age of 44.20±8.61 years,and 62 patients in the unipolar group including 33 males and 29 females with their age of 46.40±9.48 years. Electrocardiogram examinations were performed at the time of intraoperative heart re-beating,the very postoperative day,7 days,1 month,3 months and 6 months postoperatively to detect restoration of sinus rhythm. Results There was no in-hospital death or ablation-related complication in either group. Aortic cross-clamp time(70.05±22.02 min vs. 54.47±20.65 min,P=0.025) and RF ablation time(25.12±3.00 min vs. 15.70±3.02 min,P=0.000)of the bipolar group were significantly longer than those of the unipolar group. At the time of intraoperative heart re-beating,the lst and 7th day after operation, sinus rhythm restoration rates were 88.71%,87.10%,80.65% respectively in the bipolar group,85.48%,77.42%,72.58% respectively in the unipolar group,and there was no statistical difference between the two groups (P>0.05). In the 1st,3rd and 6th postoperative month,sinus rhythm restoration rates of the bipolar group (79.03%,75.81%,72.58% respectively) were significantly higher than those of the unipolar group (59.68%,50.00%,48.38% respectively,P<0.05). Conclusion Clinical outcomes of RF ablation for the treatment of permanent AF of patients with rheumatic valvular heart disease are satisfactory. Unipolar RF ablation has the advantage of being time-saving and easier technique,while short-term sinus rhythm restoration rate of bipolar RF ablation is higher than that of unipolar RF ablation for the treatment of permanent AF.

    Release date:2016-08-30 05:46 Export PDF Favorites Scan
  • 心脏直视手术后早期心肌顿抑的诊断与治疗

    目的探讨心脏瓣膜置换术后早期心肌顿抑的诊断及治疗以及其所引起的低心排血量综合征(LCOS)的诊疗。 方法回顾性分析我院 2011 年 1 月至 2018 年 3 月期间 42 例心脏瓣膜置换术后早期出现心肌顿抑导致 LCOS 患者的临床资料,其中男 19 例、女 23 例,年龄 38~55(47.91±5.51)岁。术前左心室舒张末期内径(LVEDD)3.8~6.5(5.3±0.9)cm,左心室射血分数(EF)45%~60%(51.2%±5.3%);冠状动脉粥样硬化性心脏病筛查均为阴性;其中单纯主动脉瓣置换 12 例,二尖瓣置换合并三尖瓣成形 15 例,二尖瓣和主动脉瓣置换 15 例。 结果42 例患者均在术后早期[10~24(18.83±4.24)h]出现无明确原因的 LCOS,大剂量肾上腺素[0.06~0.10 μg/(kg·min)]和去甲肾上腺素[0.1~0.5 μg/(kg·min)]治疗无效而加用主动脉内球囊反搏(IABP)治疗,其中 25 例患者行肾脏替代治疗(CRRT)。IABP 辅助时间 3~10(5.16±1.95)d,CRRT 治疗时间 22~61(42.17±10.75)h。40 例患者痊愈出院,2 例患者院内死亡,1 例死于脓毒血症,1 例患者死于恶性心律失常。 结论心脏瓣膜置换术后早期出现心肌顿抑引起病情突变恶化,如能早期诊断、早期治疗,将取得好的临床结果。IABP 可以减轻心脏负荷,增加冠状动脉灌注,改善循环,有助于患者渡过心肌顿抑期;CRRT 可以改善 LCOS 患者内环境,减轻肾脏负担。两者是成功救治此类患者的重要手段。

    Release date:2019-03-01 05:23 Export PDF Favorites Scan
  • Efficacy of restrictive bare stent in the treatment of acute Stanford type A aortic dissection

    ObjectiveTo observe the efficacy of restrictive bare stent released on the distal end of the trunk of Stanford type A aortic dissection. Methods The clinical data of 22 patients with Stanford type A aortic dissection requiring aortic arch replacement and trunk surgery and selected for restrictive bare stent placement from November 2016 to February 2018 in our hospital were retrospectively analyzed. Among them, there were 19 males and 3 females, aged 34-68 (49.72±8.05) years. The bare stent was released in the descending thoracic aorta, and the stented elephant trunk was placed in the bare stent. The aortic computerized tomography angiography was reviewed before discharge and the stent position and complications were observed. ResultsOne patient failed to be implanted with bare stents due to a greater resistance and prolapse during implantation. Bare stents were successfully implanted in the remaining 21 patients. One patient died of large-area cerebral infarction after surgery and one patient suffered paraplegia. Twenty patients who survived and successfully implanted bare stents were followed up at regular intervals for 4-21 (13.00±6.14) months. No stroke or death occurred during the follow-up. The computerized tomography angiography showed good stent morphology and position, and no displacement or type Ⅲ endoleak. No stent graft-induced new entry was found. ConclusionAs an adjunct to stented elephant trunk, the use of restrictive bare stents can reduce the possibility of recurrence of a distal stent fracture, significantly expand the narrowest segment and true lumen caliber near the endoluminal graft. Aortic remodeling works well.

    Release date:2019-07-17 04:28 Export PDF Favorites Scan
  • Totally arterialized minimally invasive coronary artery bypass grafting under the guidance of coronary artery function: A case report

    We reported a 59-year-old male with exertional angina pectoris, and the coronary angiography showed multiple vessel lesions. The initial strategy was coronary artery bypass grafting (CABG). The measurement of quantitative flow ration (QFR) before operation indicated that the posterior descending branch (PD) did not need to be treated. The left circumflex branch (LCX) was small, and the QFR of the left anterior descending branch (LAD) and the first diagonal branch (D1) was<0.8. Therefore, the LAD and D1 were re-vascularized. The operation strategy was changed to on-pump CABG through a small incision, and the final strategy was LIMA-D1-LAD (sequential), fractional flow reserve (FFR) of distal LAD and D1 after CABG were>0.8 by computed tomography FFR. SYNTAX scores after CABG were 20 and the functional SYNTAX scores after CABG were 3, indicating a good prognosis.

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  • Comparison between Minimally Invasive Mitral Valve Replacement via Right Minithoracotomy and Traditional Mitral Valve Replacement

    Objective To compare clinical outcomes and safety between minimally invasive mitral valve replacement via right minithoracotomy (mini-MVR) and traditional mitral valve replacement (MVR). Methods Clinical data of 68 patients with valvular heart diseases who underwent mini-MVR from February 2009 to December 2011 in Wuhan Asia Heart Hospital were retrospectively analyzed. There were 36 males and 32 females in this mini-MVR group with their mean age of 34.2±11.2 years. Preoperatively, there were 21 patients with mitral stenosis (MS), 17 patients with mitral insufficiency (MI), 30 patients with MS and MI, and 19 patients with tricuspid insufficiency (TI). Another 200 patients with valvular heart diseases who underwent traditional MVR during the same period were included as the control group. There were 86 males and 114 females in the control group with their mean age of 49.4±13.2 years. Preoperatively, there were 85 patients with MS, 66 patients with MI, 49 patients with MS and MI, and 76 patients with TI. Hospital mortality, aortic crossclamp time, length of intensive care unit (ICU) stay, postoperative chest tube drainage, reexploration for bleeding and postoperative morbidities were compared between the two groups. Results There was no in-hospital death in the mini-MVR group. There was no statistical difference in hospital mortality, cardiopulmonary bypass time, incidence of reexploration for bleeding, postoperative arrhythmias, dialysis-requiring acute renal failure and wound infection between the two group (P>0.05). Aortic crossclamp time of the mini-MVR group was significantly longer than that of the control group. But postoperative mechanical ventilation time (10.2±3.1 h vs. 15.2±7.1 h, P=0.008), chest tube drainage(92.0±28.0 ml vs. 205.0±78.0 ml, P=0.000), blood transfusion (0.8±1.6 U vs. 1.9±2.1 U, P=0.006), length of ICU stay (14.0±8.0 h vs. 26.0±12.0 h, P=0.003) and length of hospital stay (14.8±4.6 d vs. 19.7±3.2 d, P=0.006)of the mini-MVR group were significantly shorter or less than those of the control group. Conclusion The safety of mini-MVR is comparable to that of traditional MVR without causing higher postoperative morbidities, while the postoperative recovery after mini-MVR is better than traditional MVR.

    Release date:2016-08-30 05:45 Export PDF Favorites Scan
  • Surgical Outcomes of Patients with Marfan Syndrome Complicated by Type A Aortic Dissection

    Abstract: Objective To evaluate surgical outcomes of patients with Marfan syndrome (MFS) complicated by type A aortic dissection (AAD) during follow-up. Methods We retrospectively reviewed clinical data of 44 patients with MFS complicated by AAD who were admitted to Wuhan Asia Heart Hospital from January 2006 to January 2012. There were 31 male patients and 13 female patients with their age of 12-54 (33.0±9.8) years. Twenty-three patients underwent Bentall procedure at different time after the onset of AAD, while the other 21 patients received conservative treatment in stead of surgery because of economical or other reasons. COX regression with time-varying covariates was performed to analyze related factors, using primary end point, primary end point+secondary end point as the outcome variables respectively, to compare postoperative outcomes and quality of life between the surgical treatment patients and conservative treatment patients. Results Postoperatively 1 patient died of multiple organ failure, and the other 22 patients survived the surgery. All the 43 patients were followed up from 1 to 75 months. The 3-year survival rate of the 22 surgical treatment patients was 95.7%, and they all had a good quality of life during follow-up. The survival condition and quality of life of the 21 conservative treatment patients was poor, and 13 patients (61.9%) died with the 3-year survival rate of only 31.7%. The main causes of their death included acute cardiac tamponade, aortic dissection rupture, acute myocardial infarction andcardiogenic shock. COX regression with time-varying covariates showed that the treatment outcomes of the surgical treatment patients were statistically different from those of the conservative treatment patients after modifying the influence caused by different operating time (OR of T_COV_ =0.088, P=0.028) . The risk of death of surgical treatment was only 8.8% of that of conservative treatment. Conclusion The prognosis of patients with MFS complicated by AAD is very poor. Therefore, all these patient, both in acute stage and chronic stage, should undergo surgical treatment as early as possible. The short-term and follow-up outcomes of surgical treatment are satisfactory.

    Release date:2016-08-30 05:28 Export PDF Favorites Scan
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