Beginning from the epidemiology of coronary heart disease, the authors firstly analyze the pathology and pathophysiology of the infarcted heart. Back to the basic anatomy of heart muscles, the authors then review the development history of basic anatomy theory of heart muscle fibers, focusing mainly on the helical myocardial band theory. This part covers theories of evolutionary biology, developmental biology, and modern imaging evidence on cardiac structures, as well as the intrinsic link between structures and functions of the heart. The relation between cardiac geometry and function is analyzed with helical myocardial band theory. Then returning to clinical problems, the authors introduce the development of left ventricular reconstruction (LVR), the impact of helical myocardial band theory on LVR, current status and disputes of LVR, and future prospect of LVR.
Coronary artery bypass grafting (CABG) is an effective method for the treatment of coronary heart disease at present. However, there is still a high rate of vein graft occlusion after CABG, which has a serious impact on the short and long-term clinical results. Venous access technique has been considered as an important factor on affecting the long-term patency rate. Compared with harvesting technology of the open saphenous vein harvesting, no-touch technology retained the surrounding tissue and vascular adventitia of great saphenous vein, and it avoided the high pressure of expansion vein. After CABG was performed by using the no-touch technique, the vein grafts obtained a better short and long-term patency rate, but the effect still needs further clinical verification.
ObjectiveTo investigate dyssynchrony of non-infarction areas before and after surgical ventricular reconstruction after acute myocardial infarction. MethodsTwelve patients with postinfarction ventricular aneurysm and heart failure who underwent left ventricular reconstruction surgery in Fu wai Hospital from June 1,2010 to June 31,2011 were enrolled in this study. There were 9 male and 3 female patients with their age of 53.9±7.0 years. Another 12 healthy volunteers were chosen as the control group including 10 males and 2 females with their age of 30.6±3.8 years. Magnetic resonance imaging (MRI) was examined preoperatively and within 3 months after discharge with same sequences. Tagging images were analysis by using Harmonic Phase (HARP) software to extract the data and the data were put into another software to calculate dyssynchrony index. ResultsAfter operation,left ventricular ejection fraction (LVEF) improved from 30.3%±7.7% to 43.4%±6.3% (P<0.05) and left ventricular end-systolic volume index decreased from 68.6±10.8 ml/m2 to 32.7±9.0 ml/m2 (P<0.05). However,left ventricular dyssynchrony index of non-infarction areas remained stable from 0.82±0.13 to 0.83±0.17 (P>0.05). ConclusionSurgical ventricular reconstruction can significantly improve LVEF and reduce left ventricular volume,but left ventricular synchrony index of non-infarction areas is not changed.
ObjectiveTo assess early and mid-term outcomes and our clinical experience of reduction ascending aortoplasty (RAA) for patients with aortic valve disease and ascending aortic dilatation, and improve treatment effects. MethodsClinical data of 36 patients with aortic valve disease and ascending aortic dilatation who underwent aortic valve replacement and RAA in Fu Wai Hospital between January 2002 and August 2010 were retrospectively analyzed. There were 26 male and 10 female patients with their age of 7-72 (51±16) years. Ascending aorta diameter (AAD) was measured by echocardiography preoperatively, postoperatively, during follow-up and compared. ResultsThere was no perioperative death. Cardiopulmonary bypass time was 96.2±28.3 minutes, and aortic cross-clamp time was 69.2±22.1 minutes. Posto-perative hospital stay was 11.0±7.8 days. All the 36 patients were followed up after discharge for 1.1-9.0 (4.0±2.3) years. During follow-up, there was 1 death, but none of the patients needed reoperation. Echocardiography showed normal aortic valve function. Postoperative AAD was significantly smaller than preoperative AAD (36.4±6.1 mm vs. 46.8±4.6 mm, t=13.12, P=0.00). AAD during follow-up was significantly larger than postoperative AAD (40.8±6.8 mm vs. 36.4±6.1 mm, t=-2.64, P=0.01) but significantly smaller than preoperative AAD (40.8±6.8 mm vs. 46.8±4.6 mm, t=3.48, P=0.00). ConclusionEarly and mid-term outcomes of RAA are satisfactory for patients with aortic valve disease and ascending aortic dilatation, but long-term results need further observation.
ObjectiveTo examine changes of in-hospitalization mortality for arterial switch operation (ASO) for the patients with D-transposition of the great arteries (TGA) in our hospital. MethodsWe retrospectively analyzed the clinical data of 473 consecutive TGA patients undergoing ASO to assess temporal trends of in-hospital mortality between 2001 and 2012 year. The patients in every 2 years were brought together into a group. By this way, all the patients were divided into 6 groups. In risk-adjusted analyses, mortality of each group between 2001 and 2012 year were compared within the 6 groups. ResultsAmong all the patients, 29 in-hospital deaths occurred. Between 2001 and 2012 year, the prevalence of preoperative factors-including age (P=0.13), gender (P=0.94), height (P=0.29), weight (P=0.21), combined with pulmonary hypertension (P=0.59), training for left ventricle (P=0.14), and anatomy of coronary arteries (P=0.27) did not significantly change. Crude mortality significantly decreased during that period (17.4% in the first group vs. 4.1% in the sixth group, P<0.001). Adjusted mortality also significantly became better in the ten years (the sixth group vs. the first group, odds ratio 0.098, 95% confidence interval, 0.018-0.550，P=0.01). ConclusionBetween 2001 and 2012 year, the prevalence of risk factors among TGA patients undergoing ASO remains unchanged, but the in-hospital mortality substantial decreases.
Objective To evaluate the efficacy of 3-dimensional printing model (3DPM) aiding decision making and surgery rehearsal for the treatment of double outlet right ventricle (DORV) with non-committed ventricular septal defect (NC-VSD). Methods From January 1st, 2012 through December 30th, 2014, 12 patients with DORV and NC-VSD were operated with the aid of “3DPM guidance” to do decision making and surgical technique rehearsal preoperatively. There were 9 males and 3 females at age of 2.9±2.2 years. The “3DPM guidance” consisted of step by step procedures: computerized tomography (CT) scan for the patients, CT based 3DPM rendering, 3DPM exploration, decision making, and surgery rehearsal. During surgery rehearsal, surgeons did patch designing, VSD enlargement planning, muscle bundle resection etc. Eight out of the twelve patients underwent biventricular repair, 4 patients underwent single ventricle repair. Six of the eight biventricular repair patients had intra-ventricular baffle repair, 1 patient had intra-ventricular baffle repair and arterial switch procedure, 1 had modified Nikaidoh procedure. VSD enlargement was performed in all the patients in biventricular repair group. The reasons not to do a biventricular repair included very restrictive VSD, tricuspid attachments across the sub-aortic passway. Results The operation findings correlated well with the 3DPM in all the cases. There was no hospital death, no major complication. One patient had a mild sub-aortic stenosis and he was under close follow-up. There was no late death and reoperation. Surgeons involved were satisfied with the “3DPM guidance”. Conclusions 3-D printing model is an excellent way to help decision making for DORV with NC-VSD and can provide surgery simulation which decrease complication rate and help achieve good outcomes.