ObjectiveTo analyze the significance of application of pulse indicated continuous cardiac output (PICCO) as hemodynamic monitoring for low cardiac output patients after coronary artery bypass grafting (CABG) operation. Method We retrospectively analyzed the clinical data of 110 patients conducted non-extracorporeal circulation CABG operation in Beijing Anzhen Hospital between June 2013 and October 2014. The patient were divided into two groups including a PICCO applied group and a non-PICCO applied group. There were 49 patients including 29 males and 20 females at average age of 60.80±9.34 years in the PICCO group. There were 61 patients with 37 males and 24 females at age of 62.22±10.41 years in the non-PICCO group. We compared the treatment effects between the two groups. ResultsComparing to the non-PICCO group, the PICCO group had shorter average days of postoperative intra-aortic balloon pump (IABP) usage (t=2.155, P=0.039), less usage rate of endotracheal reintubation (χ2=5.098, P=0.039), shorter average postoperative mechanical ventilation time (t=2.087, P=0.044), less occurrence rate of cardiac arrhythmia (χ2=4.011, P=0.045), less occurrence rate of multiple organ dysfunction syndrome (MODS) (χ2=5.075, P=0.035), shorter days in ICU (t=2.141, P=0.040) and in-hospital time (t=2.061 P=0.048). During monitoring, the PICCO group had slower average heart rate, higher average arterial pressure, lower blood lactate, greater oxygenation and greater left ventricular ejection fraction (LVEF) than those in the non-PICCO group. ConclusionThe application of PICCO reduces occurrence of postoperative complications for low cardiac output patients with post coronary artery bypass grafting operation, increases cure rate.
ObjectiveTo summarize our experience of surgical treatment for right pulmonary artery originated from the ascending aorta by using adult diameter artificial vascular and study the operative indication, design, method, and therapeutic efficacy. MethodsWe retrospectively analyzed clinical data of 11 patients with right pulmonary artery originated from ascending aorta in The Second Affiliated Hospital of Harbin Medical University from May 2008 through December 2013, who were treated by using adult diameter artificial vascular. The patients ranged from 4 months to 25 months old, weighted 4-15 kg. Among of them, 4 patients had persistent truncus arteriosus and 7 had aortopulmonary septal defect. All patients were complicated with moderate pulmonary hypertension. All the patients underwent one stage surgical repair under extracorporeal circulation and cardiac arrest. During the surgery, end to side anastomosis was done between the right pulmonary artery and 16-18 mm diameter artificial blood vessels. And artificial blood vessel was connected to the main pulmonary artery or right ventricle outflow tract incision from the aorta above. ResultsThe average operation time was 179-325 (224±68) min. The average cardiopulmonary bypass (CPB) time was 81-208 (117±54) min. The average aortic clamping time was 29-63(42±21) min. The mean residence time in ICU was 71-197 (109±42) hours. The average assisted mechanical ventilator time was 59-191 (91±26) hours. The average length of stay in hospital was 21-39 (28±11) days. Low cardiac output syndromes caused by pulmonary arterial hypertension occurred in 5 patients including 2 deaths and 3 patients with good recovery by reducing the pulmonary arterial pressure and peritoneal dialysis. The result of postoperative cardiac color ultrasound examination of 9 survival patients showed vascular prosthesis, no distortion, no stenosis of the anastomosis, deformity correction satisfaction. Nine patients were followed up for 3-60 months. The results of echocardiography showed no anastomosis and artificial vascular stenosis, and the pulmonary arterial pressure decreased significantly. ConclusionThe right pulmonary artery originated from the ascending aorta in children should be operated as soon as possible. Compared the adult diameter artificial vascular treatment for one stage repair of right pulmonary artery from the ascending aorta with other operation methods, both short-term and long-term effects are good. Postoperative low cardiac output syndrome is a common complication.
Objective To formulate an individualized evidence-based treatment for a first-diagnosed patient with coronary artery-pulmonary artery fistula. Methods Aiming at the issue of whether interventional operation was necessary for first-diagnosed coronary artery-pulmonary artery fistula or not, the computer retrieval was conducted in the US National Guideline Clearinghouse, The Cochrane Library, PubMed and MEDLINE from 1990 to 2011, to collect and assess the best evidence of relevant systematic reviews, randomized controlled trials, controlled clinical trials and treatment guidelines, in order to be applied in clinical treatment. Results There were 1 clinical guideline for treating coronary artery fistula and 3 different high-quality evidence studies were retrieved. The results showed percutaneous coronary intervention was the best treatment currently. According to the obtained evidence and patient’s willingness, the relevant examinations were taken, and the preoperative preparation for percutaneous coronary intervention was done actively after the patient was admitted. Three days after hospitalization, the selective coronary angiography showed right coronary artery-pulmonary artery fistula and left coronary circumflexus artery-left atrial multiple fistulae, then the percutaneous coronary intervention spring coil embolization was successfully conducted for right coronary artery-pulmonary artery fistula. After operation, bayasprin enteric-coated tablets 0.1 g/d was taken for anti-platelet aggregation and preventing thrombotic diseases. The observation during operation and postoperative 5-day hospitalization showed no relevant complications. Conclusion Percutaneous coronary intervention is safe and effective for the symptomatic patients with coronary artery-pulmonary artery fistula.
Objective To explore the difference of cardiovascular risk factors and coronary artery lesion between Hui nationality and Han nationality patients with premature coronary heart disease. Methods A total of 316 patients with premature coronary heart disease were divided into two groups, including the Hui group (78 cases) and the Han group (238 cases). Eight risk factors for premature coronary heart disease (including age, gender, body mass index, familial heredity, diabetes, hypertension, dyslipidemia and smoking history) and coronary artery lesion characteristics were compared between the two groups. Results Compared with the Han group, the Hui group had a higher prevalence of smoking history and myocardial infarction, but a lower prevalence of angina (Plt;0.05). Type A disease was the major type in both Hui and Han groups. Compared with the Han group, the rate of type C were higher. Single-vessel lesion was the major lesion in both Hui and Han groups. The incidence of three-vessel lesion in the Han group was significantly lower than that in the Hui group. Gensini score in the Hui group was higher than that in the Han group, with a significant difference (Plt;0.05). Conclusion Hui patients with premature coronary artery disease are more than Han patients with premature coronary artery disease in proportions of smoking, diabetes, and the lesions of the left anterior descending artery, the right coronary artery disease, three-vessel disease rate, and C-type lesions. The coronary artery disease of the Hui group is more serious.
Objective To systematically evaluate impact of perioperative use of clopidogrel on coronary bypass grafting (CABG) patients for anti-platelet treatment, in order to provide evidence for the rational drug use of such patients in the perioperative period. Methods PubMed, EMbase, HighWire, CENTRAL and its affiliated clinical trial registered data center, CBM and CNKI were electronically searched from 2003 to November, 2012. Randomized controlled trials (RCTs) and non-randomized clinical trials on perioperative use of clopidogrel of CABG patients were collected. References of included studies were also retrieved. Two reviewers independently screened studies according to exclusion and inclusion criteria, extracted data, and assessed the methodological quality. Then, meta-analysis was performed using RevMan 5.0 software. Results 18 studies (including 10 RCTs and 8 non-randomized clinical trials) involving 14 592 patients were included. The results of meta-analysis showed that: a) Among 10 included RCTs, preoperative use of clopidogrel for anti-platelet treatment reduced the incidence of myocardial infarction obviously, compared with the blank control group (RR=0.63, 95%CI 0.48 to 0.83, P=0.000 9), but there is no significant difference between the two groups in blood loss amount within 24 hours after operation (MD=130, 95%CI –6.21 to 266.22, P=0.06), the number of reoperation patients because of bleeding (RR=1.42, 95%CI 0.92 to 2.20, P=0.12), and risk of postoperative short-term death (RR=1.19, 95%CI 0.89 to 1.58, P=0.24); b) Among 8 non-randomized clinical trials, there was no significant difference between the two groups in reducing the incidence of myocardial infarction (RR=0.83, 95%CI 0.30 to 2.26, P=0.71), but preoperative use of clopidogrel for anti-platelet treatment significantly increased blood loss amount within 24 hours after operation (MD=82.42, 95%CI 35.18 to 129.66, P=0.000 6), the number of reoperation patients because of bleeding (RR=1.71, 95%CI 1.07 to 2.75, P=0.03), and risk of postoperative short-term death (RR=1.89, 95%CI 1.15 to 3.12, P=0.01). Conclusion Current evidence shows that, perioperative use of clopidogrel can reduce the incidence of myocardial infarction, but doctors should consider cautiously the increased risk of bleeding, re-operation and postoperative short-term death. There is contradiction between the results of RCTs and those of non-randomized clinical trials, which may result from the argument intensity, quantity and sample size bias of the included studies. The above conclusion should be proved by large-scale high-quality RCT results in future.
Objective To systematically review the effectiveness and safety of coronary artery bypass grafting (CABG) versus percutaneous coronary stent implantation (PCI) in the treatment of patients with unprotected left main coronary artery disease (ULMCA). Methods Databases including The Cochrane Library (Issue 2, 2012), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were electronically searched from inception to September 2012 for randomized controlled trials on the effectiveness and safety of coronary artery bypass grafting (CABG) versus percutaneous coronary stent implantation (PCI) for ULMCA; References of the included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then, meta-analysis was performed using RevMan 5.0. Results Four studies were included involving 1 611 cases, of which, 802 cases are in the CABG group, while 809 cases were in the PCI group. The results of meta-analysis showed that: comparing with PCI, CABG significantly reduced the postoperative repeat revascularization rate (OR=0.45, 95%CI 0.31 to 0.66, Plt;0.000 1), but there was no significant difference between the two groups in reducing the myocardial infarction incidence (OR=1.28, 95%CI 0.47 to 3.48, P=0.63), mortality rate (OR=1.36, 95%CI 0.80 to 2.34, P=0.26), and the incidence of major adverse cardio-cerebral vascular events (OR=0.92, 95%CI 0.66 to 1.28, P=0.61). Conclusion This study indicates that CABG is superior to PCI in reducing postoperative rate of target vessel revascularization. But CABG and PCI are alike in reducing myocardial infarction incidence, mortality rate, and the incidence of major adverse cardio-cerebral vascular events. Due to the limited quantity and quality of the included studies, the above conclusion needs to be verified by more high quality RCTs.
Objective To investigate the correlation between glycosylated hemoglobin A1c (HbA1c) and severity of coronary artery lesions in young men with acute myocardial infarction (AMI). Methods Total 278 young men with AMI less than 45 years old were retrospectively studied, and all of them were admitted to hospital from January 2009 to December 2011, and had undergone coronary angiography. According to the results of coronary angiography, the patients were divided into three groups based on the number of artery lesions: the single group (156 cases), the double group (64 cases) and the triple group (58 cases). The relationship between the severity of coronary artery lesions and the following factors were observed: HbA1c, systolic blood pressure (SBP), diastolic blood pressure (DBP), hemoglobin (Hb), serum uric acid (UA), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), body mass index (BMI), smoking history, drinking history and family history of early coronary artery disease. Results a) HbA1c levels were gradually raised in all the three groups, but the single group (6.39±1.67%) was significantly lower than the double group (6.91±1.63%) and the triple group (7.41±2.12%), with significant differences (Plt;0.05); the HbA1c level of the single group was significantly lower than the triple group in both the ST-segment elevation AMI (6.42±1.68% vs. 7.17±1.86%, Plt;0.05) and the non-ST-segment AMI (5.57±0.37% vs. 8.56±2.83%, Plt;0.05); the HbA1c level of the single group was significantly lower than the triple group in patients with diabetes millitus (8.31±1.83% vs. 8.59±2.02%, Plt;0.05) and in patients without diabetes millitus (5.56±0.33% vs. 5.74±0.37%, Plt;0.05); b) There were significant differences in SBP, TC, HDL-C, LDL-C and drinking history between the single group and the other two groups (all Plt;0.05), and there were significant differences in DBP and TG between the single group and the double group (all Plt;0.05); and c) The results of logistic regression analysis showed that, LDL-C (OR=1.790), HbA1c (OR=1.287) and SBP (OR=1.042) were the independent risk factors (all Plt;0.05) for multiple lesions in coronary arteries of young men with AMI. Conclusion Glycosylated hemoglobin A1c is an independent risk factor for multiple lesions in coronary arteries of young men with AMI.
Objective To provide evidence for timely diagnosis and treatment of Kawasaki disease through assessing the relationship between the duration of fever and the incidence of coronary artery lesion in patients with Kawasaki disease. Methods To retrospectively analyze the clinical information of 352 inpatients with Kawasaki disease (including typical Kawasaki disease, incomplete Kawasaki disease, and non-responsive to intravenous immunoglobulin treatment Kawasaki disease ) from January 1997 to December 2007. The relationship between the duration of fever and the incidence of coronary artery lesion was presented by a linear trend plot, using Cochran-Armitage trend test. A value of P lt; 0.05 was considered statistically significant. Results Among 352 patients with Kawasaki disease, 88 had coronary artery lesions. Sixty-eight out of 294 patients with typical Kawasaki disease, 20 out of 58 patients with incomplete Kawasaki disease, and 18 out of 44 patients with non-responsive Kawasaki disease had coronary artery lesions. Linear trend analysis showed that the duration of fever in all 352 patients with Kawasaki disease and 294 cases with typical Kawasaki disease was positively correlated with the incidence of coronary artery lesion (Plt;0.05). However, in patients with incomplete Kawasaki disease and non-responsive Kawasaki disease, the relationship between the duration of fever and the incidence of coronary artery lesion was not significant (Pgt; 0.05). Conclusion The longer the duration of fever was in patients with Kawasaki disease, higher the risk of coronary artery lesion.
ObjectiveTo explore the pathogenesis, diagnosis and treatment of superior mesenteric artery syndrome (SMAS) complicated with Wernicke encephalopathy (WE). MethodsThe clinical data of 11 cases of SMAS patients complicated with WE were retrospectively analyzed. ResultsOf 9 SMAS patients complicated with WE, 8 patients were gradually awake and the time of consciousness recovery was from 7 d to 9 weeks (mean 5.2 weeks). Another 1 patient died of multiple organ failure attributed to severe condition. The symptoms of ophthalmopegia and ataxia in the rest 2 patients improved. All of symptoms such as ataxia, nystagmus, tinnitus, nausea, and sweating gradually disappeared. The nystagmus disappeared from 3 h to 4 d (mean 2.3 d) in five patients and the ataxia disappeared from 3 d to 12 weeks (mean 7.0 weeks) in 4 patients. The tinnitus, nausea, and sweating in 6 patients disappeared within 1 week. ConclusionImproving the understanding of SMAS complicated with WE is important during clinical practice and early diagnosis and intervention is the key point for a good prognosis.
Objective To find out the follow-up results of early in-stent restenosis (ISRS) and develop effective way to improve clinical treatment and precaution of restenosis. Methods The data from a registry of 51 consecutive patients who underwent elective carotid artery angioplasty and stenting （CAS） at our institution between Jan. 2003 and Sept. 2005 were retrospectively reviewed. Complete data for 37 of these patients were available. All patients underwent duplex ultrasound scanning in follow-up period, which was used to determine the degree of restenosis. Results CAS was performed in 37 patients， 8.1% (3/37) were women. Mean age was (70.5±5.9) years. Mean time of follow-up was (12.2±7.7) months. Sixteen (43.2%) caces of ISRS （gt;30%） were found by color duplex ultrasound scanning， but only 1 (2.7%) ISRS was found gt;50%; 3 female patients had minor ISRS. Among all factors, female patients had higher incidence of ISRS than male (P=0.038); balloon-expanding after stenting and accompanying with other artherosclerosis of periphery vessel had correlation about ISRS （P=0.037, P=0.016）. Conclusion The severe restenosis rate is acceptable. Female patients were more likely to have ISRS. Balloon-expanding maybe have effect on reducing incidence of ISRS and controlling artherosclerosis was helpful.