Background: There are no previous studies dealing with paroxysmal atrial fibrillation (AF) and hypertension using electrocardiogram and tissue doppler imaging (TDI). The aim of this study was to investigate and identify the predictive indicators for paroxysmal AF in hypertensive patients using P wave dispersion (Pd) and TDI. Methods: Patients with hypertension were enrolled. Patients with paroxysmal AF were classified as the PAF group, and patients without a history of paroxysmal AF were classified as the NAF group. The clinical data, P wave indicators and TDI indicators were collected and compared between the two groups. Results: A total of 120 patients were enrolled into the study with 40 cases in the PAF group and 80 cases in the NAF group. Compared with NAF group, Pd, maximum P wave duration (Pmax), left ventricular end-diastolic dimension (LVEDd) and left atrial dimension (LAD) were significantly longer (P < .05) in the PAF group. PAL, PAI, PAR, LR, LI and IR were significantly longer (P < .05) in the PAF group than in the NAF group. As for ROC analysis, Pd and PAL had the greatest area under the curve. The best diagnostic value of Pd and PAL was 40ms and 78ms, respectively. The combination of Pd >= 40ms with Pmax >= 110ms showed higher specificity and positive predictive value but decreased sensitivity and negative predictive value for paroxysmal AF. Conclusions: The PAF group had significantly longer atrial electromechanical time and higher Pd compared with NAF group. The combination of Pd and TDI may be helpful to predict the onset of paroxysmal AF in patients with hypertension.
Chronic heart failure (CHF) is still the leading cause of morbidity and mortality worldwide, and carries with it large economic and social burdens. Although steady and substantial progress has been made in reducing mortality from heart failure using conventional treatments, novel pharmacologic and surgical interventions have not been effective in extending five year survival rates. Therefore, it is necessary to explore new therapies. Gene therapy was introduced in 1970s with the development of recombinant DNA technology. Due to recent progress in the understanding of myocardial metabolism and application of vector based gene transfer strategies in animal models and initial clinical trials, gene therapy possibly affords an ideal treatment alternative for CHF. In last 2 decades, much research has been done on gene therapy, using various genes, signal transduction passages and delivery methods to treat advanced heart failure. Current research in ischemic heart disease (IHD) mainly focuses on stimulating angiogenesis, modifying the coronary vascular environment, and improving the vascular endothelial function with localized gene coated catheters and stents. Compared with standard ischemic heart disease treatment, the main goal of gene therapy for CHF is to inhibit apoptosis, reduce the undesirable remodeling and increase contractility through the most efficient cardiomyocyte transfection [Katz 2012a]. In this paper, we review various gene transfer technologies in ischemic heart disease and heart failure models, and discuss the advantages and disadvantages of these strategies in vector-mediated cardiac gene delivery, with the main focus on the high efficiency approach of a molecular cardiac surgery delivery system.
Congenital heart disease (CHD) is one of the most common risk factors for infective endocarditis. However, it is rare to find a CHD patient complicated by isolated pulmonary valve endocarditis. Here, we report an adult patient with congenital heart disease complicated by native pulmonary valve endocarditis who underwent a mechanical valve replacement. We also review previous literature to examine key points in the treatment of such patients.
Background: Comparisons between the EuroSCORE and EuroSCORE II in the patient populations for coronary artery bypass grafting are limited. The aim of the study was to compare the use of the EuroSCORE and EuroSCORE II as risk model for predicting in-hospital mortality in Chinese patients undergoing coronary artery bypass grafting (CABG). Methods: Patients (n = 1598) with complete records of baseline and operative data were retrospectively collected from computerized records. The expected mortality rate for logistic EuroSCORE and EuroSCORE II was determined. Performance of the logistic EuroSCORE and EuroSCORE II model was assessed by comparing the observed and expected in-hospital mortality. The area under the receiver operating characteristics curve (AUC) values were calculated for these models to compare predictive power. Results: Observed in-hospital overall mortality rate was 3.19%. The logistic EuroSCORE model (Hosmer-Lemeshow: P < .05, O/E = 0.73) over-predicted mortality (4.39%) and the EuroSCORE II model showed good calibration and discriminative capacity (area 0.762) in predicting in-hospital mortality (Hosmer-Lemeshow: P = .191, O/E = 1.24). Conclusion: EuroSCORE II model reduces the overestimation of the calculated risk by logistic EuroSCORE in this population. EuroSCORE II risk model may be suitable in patients undergoing coronary artery bypass surgery in China.
Aim: To study the expression of Rho kinase (Rho associated coil forming protein kinase-1, ROCK-1) and its substrate myosin phosphatase target subunit 1 (myosin phosphatase target subunit-1, MYPT-1), connexin 40 (Cx40) and connexin 43 (Cx43) in the left atrial appendage of patients with atrial fibrillation, and explore the role of ROCK signaling pathway in patients with atrial fibrillation and its underlying mechanism. Methods: 40 patients undergoing open heart surgery were divided into two groups; atrial fibrillation group (AF group) and sinus rhythm group (SR group). About 100 mg of left atrial appendage tissue was taken during surgery and quickly frozen in liquid nitrogen. Immunohistochemistry and western blot were performed to evaluate the expression and location of ROCK-1, MYPT-1, Cx40 and Cx43 in the left atrial appendage tissue. Results: The results indicated that the expression of ROCK-1, MYPT-1, and Cx40 in the left atrial appendage in patients with atrial fibrillation was significantly upregulated (P < .01), the difference in the two groups was statistically significant, and ROCK-1, Cx40, and MYPT-1 expression in the AF group were higher than those in sinus rhythm group; there was a weakly positive expression of Cx43 protein in the AF group and sinus rhythm group, the difference was not statistically significant, and ROCK-1 and MYPT-1 expression showed a significant positive correlation (r = 0.968, P < .05), MYPT-1 and Cx40 protein expression was also positively correlated (r = 0.983, P < .05). Evidence in the left atrial appendage tissue of patients with atrial fibrillation showed that some proteins in Rho/ROCK pathway were upregulated, and MYPT-1 and Cx40 protein expression in AF group were significantly higher than that of SR group, which was also positively correlated; Cx43 showed a weak positive expression in both the SR group and AF group, which indicates that Rho kinase may induce expression of Cx40 by phosphorylation of MYPT-1; Cx43 may not be involved, suggesting that Rho kinase signaling pathway may activate and play an important role in the pathogenesis of atrial fibrillation lesions.
Partial anomalous pulmonary venous connection (PAPVC) is an uncommon congenital heart disease, which may be difficult to identify and often remains undiagnosed. Accurate diagnosis of major aortopulmonary collaterals and partial anomalous pulmonary venous drainage in patients with congenital heart disease is important but problematic. The goal of this publication is to present the diagnosis and surgical repair of this rare pathology in an eight-year-old boy. Atrial septal defect was found by echocardiography, but no anomalous pulmonary vein was found. However, multi-slice computed tomographic angiography (MSCTA) revealed that the isolated right superior pulmonary vein was replaced by right superior pulmonary vein 1 (RSPV1), right superior pulmonary vein 2 (RSPV2) and right superior pulmonary vein 3 (RSPV3), which connected to the superior vena cava (SVC), the orifice of SVC, and the left atrium, respectively. The patient underwent the repair of PAPVC with division of the SVC and re-implantation on the right atrial appendage to restore normal systemic venous drainage. Postoperative course was uneventful. In conclusion, PAPVC is a rare congenital cardiac pathology. MSCTA could contribute to an accurate anatomic and functional definition of this variant.
Background: Acute kidney injury (AKI) is one of the common complications in infants and children after complex congenital heart surgery. Peritoneal dialysis (PD) is usually applied for renal replacement therapy (RRT), especially in infants. We investigated the efficacy and safety of modified PD for the treatment of acute renal failure and congestive heart failure after cardiac surgery for congenital heart disease in infants. Methods: We retrospectively analyzed five consecutive patients from October 2015 to February 2017. The patients were aged from four days to five years old, and all had acute renal failure and congestive heart failure after cardiac surgery. In the five patients treated with modified PD (five males; average weight: 11.2 +/- 5.5 kg), we used the Seldinger technique percutaneous abdominal puncture 16 G single lumen central venous catheter instead of the Tenckhoff peritoneal dialysis catheter as a PD catheter. Modified PD was intermittent. We recorded and monitored circulation and metabolism index. Results: Five cases (100%) with modified PD were restored to normal renal function. Congestive heart failure was gradually alleviated, and pulmonary and cardiovascular function were improved. Urine volume increased. Neither peritonitis nor catheter leakage occured in any of our cases. Urine volume increased due to PD, from 0.16 + 0.18 mL/kg*h before PD to 2.63 + 1.05 ml/kg*h at the end of PD (P < .05). Serum creatinine, serum urea nitrogen, and serum K+ changed from 85.0 +/- 36.5 mu mol/L, 17.1 +/- 7.5 mmol/L, and 4.57 +/- 0.30 mmol/L before PD, to 76.0 +/- 36.7 mu mol/L, 20.1 +/- 11.0 mmol/L, and 4.42 +/- 0.42 mmol/L at the end of PD, respectively (P > .05). Acidosis, hyperkalemia, hypoxemia and low cardiac output syndrome were improved. All patients were cured and discharged with normal renal function. Conclusions: We conclude that modified single lumen central venous catheter for PD is a safe, feasible, and less invasive therapeutic strategy for AKI in infants undergoing cardiac surgery, and is worthy of being widely applied in clinical practice.
Background: Unprotected left main coronary artery (ULMCA) disease is associated with high mortality and morbidity. The aim of this study is to investigate the efficacy of percutaneous coronary intervention (PCI) on gender-specific patients with ULMCA in the Chinese population and provide a basis for further treatment of PCI in ULMCA disease. Methods: 173 patients (female, N = 52; male, N = 121; mean age = 61.02 +/- 7.95) with ULMCA disease, who underwent PCI between January 2010 and December 2014, were investigated in our study. The mean follow-up time was 23.8 +/- 7.3 months. The baseline clinical characteristics, coronary angiography (CAG) and PCI procedures, and in-hospital and follow-up outcomes of gender-specific patients were evaluated. Results: There were no statistically significant differences in baseline clinical characteristics with the exception of body weight, height, and smoking indexes between women and men. During PCI procedure, femoral artery puncture was more preferred in women than men (P < .05), whereas radial artery puncture was more preferred in men than women (P < .05). The characteristics of CAG and PCI procedures (except puncture path) were showed with no markedly difference between women and men. The incidences of MACCEs in male patients during the in-hospital and follow-up periods were slightly higher than those of the female patients although with no statistical differences. Conclusion: In northern China, the incidence of ULMCA disease in men is likely to be higher than in women, whereas PCI for ULMCA disease shows similarly favorable outcomes in women as well as in men. During the PCI procedure, femoral artery puncture in women and radial artery puncture in men are recommended.
Background: o evaluate the performance of Society of Thoracic Surgeons (STS) 2008 cardiac surgery risk scores for postoperative complications in Chinese patients undergoing single valve surgery at multicenter institutions. Methods: From January 2009 through December 2012, 4493 consecutive patients older than 16 years who underwent single valve surgery at 4 cardiac surgical centers were collected and scored according to the STS 2008 risk scores. The final research population included the following isolated heart valve surgery types: aortic valve replacement, mitral valve replacement, and mitral valve repair. Calibration of the risk scores was assessed by the Hosmer-Lemeshow (H-L) test. Discrimination was tested by calculating the area under the receiver operating characteristic (ROC) curve. Results: The observed incidence rate for cerebrovascular accident (CVA), renal failure (RF), prolonged ventilation (Vent), reoperation (Reop), prolonged postoperative length of stay (PLOS), and short postoperative LOS (SLOS) was 0.90%, 1.32%, 4.18%, 2.43%, 3.64%, and 1.65%, respectively. The predicted incidence rate for CVA, RF, Vent, Reop, PLOS, and SLOS was 0.76%, 1.55%, 4.94%, 6.69%, 3.92%, and 2.54%, respectively. The STS 2008 risk scores give an accurate calibration for individual postoperative risk in CVA, RF, Vent, and PLOS (Hosmer-Lemeshow: P = .052, P = .474, P = .468, and P = .712, respectively). The area under the ROC curve of the STS 2008 risk scores for the above 4 postoperative complications were 0.714, 0.724, 0.727%, and 0.713, respectively. Conclusion: The STS 2008 risk scores were suitable for major postoperative complications in patients undergoing single valve surgery, except for Reop and SLOS.
Background: The purpose of this study was to assess the short- and mid-term follow-up results of transthoracic device closure of perimembranous ventricular septal defect (pm VSD) in adults. Methods: Sixty-one adults underwent transthoracic device closure of pmVSD at our institution from Jan. 2012 to Jan. 2016. All relevant clinical data were recorded and analyzed. All patients were invited to undergo contrast transthoracic echocardiography (TTE) for 12 months to 60 months after VSD closure. Phone interviews were conducted to further evaluate the cardiac function status. Results: All patients were successfully occluded using this procedure. The most frequent complication was transient cardiac arrhythmia, which was easily treated during the perioperative period. During the follow-up period, we found no recurrence, malignant arrhythmia, thrombosis, device embolization, valve damage, device failure, or cases of death. The total occlusion rate was 100 percent in the 12 months of follow-up, and most of patients showed significant improvement in their clinical status. From the TTE data, the intracardiac structure and cardiac function were improved in the follow-up. Conclusion: Transthoracic device closure of perimembranous ventricular septal defect in adults is a safe and feasible technique. The short- and mid-term follow-up results were satisfactory, but long-term follow-up is required to better assess the safety and feasibility of this method in adults.
Background: The incidence, risk factors, and long-term prognosis of new-onset ventricular tachycardia (VT) and ventricular fibrillation (VF) after coronary artery bypass graft surgery (CABG) in patients with impaired left ventricular function have not been thoroughly examined. Methods: This study enrolled 612 consecutive patients with impaired left ventricular function (ejection fraction <50%) undergoing CABG at a single institution between March, 1996, and September, 2015. Outcomes were analyzed and compared, including in-hospital mortality and long-term survival. After a propensity-score, matching was performed to adjust for differences between the two cohorts. Factors significantly associated with VT/VF were also investigated using multivariate logistic regression. Results: Of the 600 patients included in the analyses, 92 (15.3%; 95% confidence interval [CI] 12.5-18.3%) had new-onset VT/VF postoperatively. Before propensity matching, patients with postoperative VT/VF were more likely to have renal failure, intra-aortic balloon pump support, lower preoperative ejection fraction (EF), and a larger left ventricle than those without VT/VF. Multivariate regression identified three preoperative risk factors and one protective factor that were independently associated with new-onset VT/VF: previous renal failure (odds ratio [OR] 4.42, P = .02), left ventricular end-diastolic dimension enlargement (OR 1.83, P = .03), ejection fraction (OR 1.88, P = .02 for EF >= 30 and <40% versus >= 40% and <50%; OR 5.46, P = .00 for EF <30% versus >= 40% and <50%), and preoperative beta-blockers (OR 0.58, P = .03). The median follow-up time was 46.6 months. In the propensity-matched cohorts, survival for patients who had in-hospital VT/VF was lower than that of the non-VT/VF group (89.9% versus 97.6%; P < .05). Conclusion: This study shows a high incidence of new-onset VT/VF after CABG in patients with impaired left ventricular function. The early and long-term survival rates were significantly lower in the VT/VF group. Preoperative renal failure, left ventricular end-systolic dimension enlargement, and the severity of left ventricular function were independently associated with the development of new-onset VT/VF after CABG surgery. Preoperative use of beta-blocker was proved to be protective in reducing both VT/VF incidence and in-hospital mortality in CABG patients with impaired left ventricular function following CABG. When considering these data, a prescription of beta-blockers is prognostically indicated to CABG patients, especially those with new-onset VT/VF postoperatively.
Hemolysis combined with renal injury is a rare but serious complication after mitral valve repair. Here, we report two representative cases of hemolysis combined with renal injury. Although timely reoperation was not possible for several reasons, different clinical outcomes were observed that could aid in future decisions.
Descending aorta interruption is an extremely rare congenital defect. Conventional repair with end-to-end anastomoses is often a surgical challenge in view of the extensive collateral vessels that develop on the chest wall and inside the chest cavity. Extra-anatomic bypass is the preferred technique for the surgical repair of this entity, which avoids the network of collateral vessels, enables simultaneous treatment of associated lesions, and in all likelihood reduces morbidity and mortality. Here we describe an extra-anatomic bypass from the ascending aorta to the bilateral iliac arteries in a 24-year-old woman using vascular grafts (MAQUET Holding B.V. & Co. KG, Rastatt, Germany) without cardiopulmonary bypass.
Background: This study was conducted to explore the impact of renal dysfunction on short-term and mid-term out-comes in elderly patients. Methods: Patients over 65 years of age receiving surgical ventricular restoration (SVR) were included in the study. They were stratified through estimated glomerular filtration rate (eGFR), with a cutoff point of 60 mL/min/1.73m(2). Risk-adjusted analysis, including propensity score matching, was carried out to compare short-term and mid-term outcomes between the two groups of patients. Results: From January 1999 to December 2015, a total of 280 elderly patients underwent SVR. Of the patients, 79 had eGFR lower than 60 mL/min/1.73m(2) and were considered to have renal dysfunction. Mortality was higher in the renal dysfunction group than the normal renal function group, with marginal significance (adjusted P value =.06). The need for mechanical supports (adjusted P value =.04) was higher in the renal dysfunction group. Hemofiltration (adjusted P value <.01) and requirements for transfusion (adjusted P value =.03) were significantly higher in the renal dysfunction group than in the group with normal renal function. The presence of renal dysfunction was associated with higher risk of major adverse cerebro-cardiovascular events (MACCE) than normal renal function (HR = 2.34, 95% CI = 1.34-4.08, P =.003). Conclusion: Compared to patients with normal renal function, elderly SVR patients with renal failure have a higher incidence of short-term mechanical support, mid-term mortality, and MACCE events.
Background: The study was to analyze the therapeutic effect and risk factors of in-hospital mortality in patients with acute Stanford type A aortic dissection operated by Sun's procedure. Methods: From Jan. 2010 to March 2016, 72 patients whose data was fully accessible underwent Sun's procedure in our hospital due to acute Stanford type A aortic dissection. Patients were divided into the survival group and the death group, and the risk factors for in-hospital mortality were collected and analyzed. Results: All 72 patients were diagnosed as acute Stanford type A aortic dissection by CT angiography in which the ascending aorta, aortic arch and descending aorta were involved; these patients were operated by Sun's procedure. The operation of proximal aorta included 39 Bentall procedure, one David surgery, and 32 ascending aorta replacement. The in-hospital mortality rate was 19.4% (14 patients). Studies showed the risk factors for the in-hospital mortality included the body mass index, cardiopulmonary bypass time, operation time, intraoperative transfusion of red blood cells and plasma volume, and the total perioperative transfusion of red blood cells, plasma and cryoprecipitate volume. Independent risk factors included the body mass index and cardiopulmonary bypass time. Conclusion: Acute Stanford type A aortic dissection is a severe, complex disease with high in-hospital mortality, though the Sun's procedure is an effective surgical approach in treating this kind of disease in some center. Body mass index and cardiopulmonary bypass time are independent risk factors for in-hospital mortality.