Objective To investigate the influence of CYP2C9 3，VKORC1-1639 G＞A and CYP4F2 rs2108622 genetic polymorphisms on warfarin dosages of patients after heart valve replacement. Methods A total of 133 patients undergoing heart valve replacement in the Department of Cardiovascular Surgery of Fujian Provincial Hospital from November 2011 to August 2012 were included in this study. Polymerase chain reaction（PCR）gene sequencing was performed to detect CYP2C9 3，VKORC1-1639 G＞A and CYP4F2 rs2108622 genetic polymorphism of these 133 patients. Patients were grouped according to their genotypes，and average warfarin dosages were compared between different genotype groups. Results The frequencies of CYP2C9 3 AA，AC and CC were 127 patients，6 patients and 0 patient respectively，and average daily warfarin dosages were 3.75 mg and 2.13 mg respectively which were statistically different between differentCYP2C9 3 genotypes （P＜0.05）. The frequencies of VKORC1-1639 G＞A GG，GA and AA were 3 patients，32 patientsand 98 patients respectively，and average daily warfarin dosages were 6.00 mg，4.50 mg and 3.00 mg respectively which were statistically different between different VKORC1-1639 G＞A genotypes （P＜0.05）. The frequencies of CYP4F2 rs 2108622 CC，CT and TT were 67 patients，59 patients and 7 patients respectively，and average daily warfarin dosages were 3.00 mg，3.75 mg and 4.50 mg respectively which were statistically different between different CYP4F2 rs2108622 genotypes（P＜0.05）. Conclusion CYP2C9 3，VKORC1-1639 G＞A and CYP4F2 rs2108622 genetic polymorphisms are associated with individual difference of warfarin dosages of patients after heart valve replacement.
ObjectiveTo evaluate myocardial segmental motion function in left ventricular of patients with rheumatic mitral stenosis by using the technology of real-time three-dimensional echocardiography (RT-3DE). MethodsWe retrospectively analyzed the clinical data of 14 patients with rheumatic mitral stenosis between October and November 2014 in our hospital as a trial group. There were 4 males and 10 females with a mean age of 50.9±9.0 years ranging from 34 to 64 years. We chose 11 healthy individuals as a control group. There were 7 males and 4 females with a mean age of 49.5±9.7 years ranging from 32 to 67 years. Both the two groups were subjected to myocardial performance evaluation using two-dimensional echocardiography (2DE) and real-time three-dimensional echocardiography (RT-3DE) to examine the left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), longitudinal strain, circumferential strain, area strain, and lateral strain of each left ventricular myocardial segments. Result RT-3DE detected that the trial group had significantly lower values of LVEF, LVEDV and LVESV than those of the control group (P < 0.05). RT-3DE also revealed that the trial group had a significantly weaker longitudinal strain than the control group (P < 0.05). ConclusionRT-3DE is an accurate technology for assessing myocardial motion and function in patients with rheumatic mitral valve disease.
ObjectiveTo summarize clinical experience and early to mid-term results of modified aortoplasty with external wrap for aneurysmal dilatation of the ascending aorta with or without heart valve disease. MethodsClinical data of 27 patients with aneurysmal dilatation of the ascending aorta who underwent modified aortoplasty with external wrap in Department of Cardiovascular Surgery, Fujian Provincial Hospital from January to October 2003 were retrospectively analyzed. There were 19 male and 8 female patients with their age of 35-71 (57±9)years and body weight of 42-90 (59±11)kg.There were 23 patients with aortic valve disease including 3 patients with bicuspid aortic valve. There were 4 patients in New York Heart Association function class Ⅰ, 9 patients in class Ⅱ, 12 patients in class Ⅲ, and 2 patients in class Ⅳ. Preoperative ascending aortic diameter (AAOD)was 40.0-59.1 (46.4±4.8)mm, left ventricular end-diastolic diameter was 42.5-70.7 (56.9±8.3)mm, and left ventricular ejection fraction (LVEF)was 57.7%±8.0%. Patients were followed up with echocardiography to examine changes of AAOD and left ventricle. ResultsCardiopulmonary bypass (CPB)time was 121.2±52.6 minutes, and aortic cross-clamping time was 70.6±29.7 minutes. Two patients received modified aortoplasty without CPB. There was no in-hospital death.Among the 25 patients who received modified aortoplasty under CPB, 1 patient had cerebral infarction and another patient had hypotension and arrhythmia postoperatively.Postoperative AAOD (36.3±3.4 mm)was significantly smaller than preoperative AAOD (46.4±4.8 mm, t=1.675, P < 0.05). Twenty-four patients were followed up from 1.0 to 120.5 months (average, 35.5 months). During follow-up, no cardiac-related death or reoperation was found. Two patients died of pneumonia, and another 2 patients died of cerebral hemorrhage. One patient had upper gastrointestinal bleeding. Aneurysmal dilatation of the ascending aorta recurred in 1 patient 3 years after discharge with AAOD of 49.9 mm. AAOD at 1 year (40.3±4.3 mm)and 3 years (40.3±5.6 mm)after discharge were significantly smaller than preoperative and postoperative AAOD (P < 0.05). ConclusionModified aortoplasty with external wrap is a good surgical procedure for aneurysmal dilatation of the ascending aorta with or without valve disease, and early to mid-term results are satisfactory.
目的总结左心功能低下的冠心病合并瓣膜病变26例患者的外科治疗效果及经验体会。 方法回顾性分析2009年1月至2013年6月福建省立医院左心功能低下（左心室射血分数＜50%）的冠状动脉旁路移植术+瓣膜置换或成形术26例患者的临床资料，其中男15例、女11例，年龄52～72（65.3±8.7）岁。 结果全组均痊愈出院。体外循环时间（156.6±29.4）min，升主动脉阻断时间（76.2±28.8）min，术后呼吸机辅助时间（80.8±22.8）h，住ICU时间（5.6±2.8）d，术后住院时间（18.6±9.3）d，术后血管活性药物应用时间（7.1±1.9）d，全组未使用主动脉内球囊反搏及心脏辅助装置，术后7 d复查心脏彩超，左心室射血分数［45.5%±3.3%（42%～49%）］与术前差异无统计学意义（P＞0.05），左心室舒张期末内径（LVEDD）［（5.1±1.2）］ cm与术前差异有统计学意义（P＜0.05）。 结论左心功能低下的冠心病合并瓣膜病变非手术禁忌，行冠状动脉旁路移植术加瓣膜手术可以取得良好手术疗效。