Summary： The effects of L-carnitine, as an ingredient of cardioplegia solution, on cardiac function and cardiomyocyte apoptosis in patients undergoing heart valve replacement operation were investigated. Twenty-three...Summary： The effects of L-carnitine, as an ingredient of cardioplegia solution, on cardiac function and cardiomyocyte apoptosis in patients undergoing heart valve replacement operation were investigated. Twenty-three cases undergoing heart valve replacement with cardiopulmonary bypass （CPB） were randomly allocated into two groups： L-carnitine group （n=12, 12 g/L L-carnitine was put in the ST. Thomas cardioplegia） and control group （n=11, identical to the L-carnitine group except that normal saline was administered instead of L-carnitine）. Serum cardial troponin I （cTnI） levels, the left ventricular ejection fraction （LVEF）, and cardiac index （CI） were measured perioperatively. A bit of myocardial tissue obtained from right atria was taken before CPB and by the end of intracardiac procedure to undergo electron microscopy examination and estimate apoptosis by terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling （TUNEL）. From the end of CPB to 3 days after operation, the serum levels of cTnI in the L-carnitine group was significantly lower than that in the control group （P〈0.05）. Heart color ultrasonogram showed that the CI index and LVEF at 7th day postoperatively in the L-carnitine group were significantly higher than in the control group （P〈0.05）. Compared to the control group, L-carnitine significantly alleviated the morphologic changes of cardiac muscle cells （electron microscopy examination） and decreased the amounts of apoptotic cardiac muscle cells （TUNEL）. Furthermore, the dosage of vasoactive drugs used after operation was significantly less in the L-carnitine group （P〈0.01）. It was concluded that L-carnitine cardioplegia solution could improve cardiac function in patients undergoing heart valve replacement operation and alleviate CPB-mediated apoptosis of cardiac muscle cells.展开更多
Summary: Serum cTnT, CK-MB and LDI were measured in 30 patients with AMI, 76 patients with VMC, 12 patients who had undergone operation without cardioplegia, 16 patients who had received open heart operation, 15 patie...Summary: Serum cTnT, CK-MB and LDI were measured in 30 patients with AMI, 76 patients with VMC, 12 patients who had undergone operation without cardioplegia, 16 patients who had received open heart operation, 15 patients who had undergone thoracotomy for non-heart surgery and 55 healthy people. Concentration of serum cTnT was 0. 057±0. 056 μg/L in healthy people, 0. 069±0. 032 μg/L in patients who underwent thoracotomy for non-heart surgery, 0. 328±0. 472 μg/L in patients with VMC, 0. 388±0. 279 μg/L in patients with DCM, 4. 259± 4. 619 μg/L in patients with AMI, 8. 55±6. 78 μg/L in patients who had undergone operation without cardioplegia and 16. 03±6. 01 μg/L in heart operation patients. In patients with VCM and DCM, serum cTnT was more specific and sensitive than CK-MB and LDI for diagnosing myocardial injury. In patients with AMI and heart operation patients, the increasing multiple of serum cTnT was obviously higher than that of CK-MB and LD1. 72 h after heart operation, cTnT was still higher than normal, while CK-MB had returned to normal level. Serum cTnT had higher specificity and sensitivity and longer diagnostic period in diagnosing myocardial injury. Moreover, cTnT assay could indicate the degree of myocardial injury. So, quantitative analysis of cTnT can be used as a routine examination in the diagnosis of myocardial injury.展开更多
Background： Poor healing wounds or postoperative infection after open-heart surgery are most commonly seen, especially in secondary surgery for heart diseases, with an incidence rate of 2.2% after a valve replacement...Background： Poor healing wounds or postoperative infection after open-heart surgery are most commonly seen, especially in secondary surgery for heart diseases, with an incidence rate of 2.2% after a valve replacement surgery. If not treated in time or the infection progresses, it can lead to sternal infection, even mediastinal and pericardial infection, causing a higher mortality rate. It becomes a really troublesome and complicated case when a poor healing occurs in midsternal incision after the heart valve surgery and a higher medical cost may be needed. Methods From January 2009 to February 2013, 162 patients who underwent heart valve surgery through midsternal incision approach and had a poor healing of wound were observed for prospective randomized controlled trial. The patients were randomly assigned to a vacuum sealing drainage group （n = 81） who received vacuum sealing drainage for healing of the wound or a control group （n = 81） who received traditional treating for the infected wound. Their therapeutic effects, healing time and treatment costs, etc were compared. Results Two patients from the vacuum sealing drainage group came back to hospital for repair due to dehiscence of the incision after discharge, and no patient died. Six patients from the control group came back to hospital for repair due to dehiscence of the incision after discharge, two came back to hospital for surgery due to chronic osteomyelitis, and one patient died two weeks later after surgery due to severe chest infection. Wound healing time for vacuum sealing drainage group was 14.6 ± 3.6 days, which was significantly shorter than that of the control group （21.2 ± 7.8 days, P 〈 0.05）, while the medical costs showed no significant difference between the two groups （P 〉 0.05）. Seventy-eight patients （96.29%） in the vacuum sealing drainage group showed a good healing of the wound and sternum after a six-month follow-up. Conclusion The use of vacuum sealing drainage technique in poor-healing wounds after heart valve surgery through midsternal incision approach could achieve good therapeutic efficacy, with shorter wound healing time and similar costs as traditional treatment.展开更多
The management of patients with coexisting diseases who undergo cardiac surgery is a subject to controversial discussions as the operative mortality is thought to be increased by simultaneous procedures. Traditionally...The management of patients with coexisting diseases who undergo cardiac surgery is a subject to controversial discussions as the operative mortality is thought to be increased by simultaneous procedures. Traditionally, the surgical procedures have been staged with the cardiac surgery performed first followed by the visceral operation at a later date. However, especially in cases of malignant disease (e. g. pulmonary or abdominal) the curative treatment is delayed and the additional costs of two settings have to be considered. 1 Although encouraging results have been reported concerning simultaneous pulmonary tumor resection, carotid endarterectomy or abdominal aneurysm repair, 2-5 detailed knowledge concerning further coexisting non-cardiac diseases requiring surgical therapy is still lacking. In some extremely rare cases patients suffer from more than just one coexisting disease of different origins: the current report focuses on a 61-year-old female patient suffering from ischemic heart disease, occlusion of the innominate artery and a retrosternal goiter as an incidental finding. She was treated in a simultaneous procedure with three operations in only one setting. The perioperative features of this special case are reflected in the following course.展开更多
文摘Summary： The effects of L-carnitine, as an ingredient of cardioplegia solution, on cardiac function and cardiomyocyte apoptosis in patients undergoing heart valve replacement operation were investigated. Twenty-three cases undergoing heart valve replacement with cardiopulmonary bypass （CPB） were randomly allocated into two groups： L-carnitine group （n=12, 12 g/L L-carnitine was put in the ST. Thomas cardioplegia） and control group （n=11, identical to the L-carnitine group except that normal saline was administered instead of L-carnitine）. Serum cardial troponin I （cTnI） levels, the left ventricular ejection fraction （LVEF）, and cardiac index （CI） were measured perioperatively. A bit of myocardial tissue obtained from right atria was taken before CPB and by the end of intracardiac procedure to undergo electron microscopy examination and estimate apoptosis by terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling （TUNEL）. From the end of CPB to 3 days after operation, the serum levels of cTnI in the L-carnitine group was significantly lower than that in the control group （P〈0.05）. Heart color ultrasonogram showed that the CI index and LVEF at 7th day postoperatively in the L-carnitine group were significantly higher than in the control group （P〈0.05）. Compared to the control group, L-carnitine significantly alleviated the morphologic changes of cardiac muscle cells （electron microscopy examination） and decreased the amounts of apoptotic cardiac muscle cells （TUNEL）. Furthermore, the dosage of vasoactive drugs used after operation was significantly less in the L-carnitine group （P〈0.01）. It was concluded that L-carnitine cardioplegia solution could improve cardiac function in patients undergoing heart valve replacement operation and alleviate CPB-mediated apoptosis of cardiac muscle cells.
文摘Summary: Serum cTnT, CK-MB and LDI were measured in 30 patients with AMI, 76 patients with VMC, 12 patients who had undergone operation without cardioplegia, 16 patients who had received open heart operation, 15 patients who had undergone thoracotomy for non-heart surgery and 55 healthy people. Concentration of serum cTnT was 0. 057±0. 056 μg/L in healthy people, 0. 069±0. 032 μg/L in patients who underwent thoracotomy for non-heart surgery, 0. 328±0. 472 μg/L in patients with VMC, 0. 388±0. 279 μg/L in patients with DCM, 4. 259± 4. 619 μg/L in patients with AMI, 8. 55±6. 78 μg/L in patients who had undergone operation without cardioplegia and 16. 03±6. 01 μg/L in heart operation patients. In patients with VCM and DCM, serum cTnT was more specific and sensitive than CK-MB and LDI for diagnosing myocardial injury. In patients with AMI and heart operation patients, the increasing multiple of serum cTnT was obviously higher than that of CK-MB and LD1. 72 h after heart operation, cTnT was still higher than normal, while CK-MB had returned to normal level. Serum cTnT had higher specificity and sensitivity and longer diagnostic period in diagnosing myocardial injury. Moreover, cTnT assay could indicate the degree of myocardial injury. So, quantitative analysis of cTnT can be used as a routine examination in the diagnosis of myocardial injury.
基金supported by Medical Scientific Research Foundation of Guangdong Province(No. B2013019)grants from Administration of Traditional Chinese Medicine of Guangdong Province (No. 20121258 & No. 20132075)
文摘Background： Poor healing wounds or postoperative infection after open-heart surgery are most commonly seen, especially in secondary surgery for heart diseases, with an incidence rate of 2.2% after a valve replacement surgery. If not treated in time or the infection progresses, it can lead to sternal infection, even mediastinal and pericardial infection, causing a higher mortality rate. It becomes a really troublesome and complicated case when a poor healing occurs in midsternal incision after the heart valve surgery and a higher medical cost may be needed. Methods From January 2009 to February 2013, 162 patients who underwent heart valve surgery through midsternal incision approach and had a poor healing of wound were observed for prospective randomized controlled trial. The patients were randomly assigned to a vacuum sealing drainage group （n = 81） who received vacuum sealing drainage for healing of the wound or a control group （n = 81） who received traditional treating for the infected wound. Their therapeutic effects, healing time and treatment costs, etc were compared. Results Two patients from the vacuum sealing drainage group came back to hospital for repair due to dehiscence of the incision after discharge, and no patient died. Six patients from the control group came back to hospital for repair due to dehiscence of the incision after discharge, two came back to hospital for surgery due to chronic osteomyelitis, and one patient died two weeks later after surgery due to severe chest infection. Wound healing time for vacuum sealing drainage group was 14.6 ± 3.6 days, which was significantly shorter than that of the control group （21.2 ± 7.8 days, P 〈 0.05）, while the medical costs showed no significant difference between the two groups （P 〉 0.05）. Seventy-eight patients （96.29%） in the vacuum sealing drainage group showed a good healing of the wound and sternum after a six-month follow-up. Conclusion The use of vacuum sealing drainage technique in poor-healing wounds after heart valve surgery through midsternal incision approach could achieve good therapeutic efficacy, with shorter wound healing time and similar costs as traditional treatment.
文摘The management of patients with coexisting diseases who undergo cardiac surgery is a subject to controversial discussions as the operative mortality is thought to be increased by simultaneous procedures. Traditionally, the surgical procedures have been staged with the cardiac surgery performed first followed by the visceral operation at a later date. However, especially in cases of malignant disease (e. g. pulmonary or abdominal) the curative treatment is delayed and the additional costs of two settings have to be considered. 1 Although encouraging results have been reported concerning simultaneous pulmonary tumor resection, carotid endarterectomy or abdominal aneurysm repair, 2-5 detailed knowledge concerning further coexisting non-cardiac diseases requiring surgical therapy is still lacking. In some extremely rare cases patients suffer from more than just one coexisting disease of different origins: the current report focuses on a 61-year-old female patient suffering from ischemic heart disease, occlusion of the innominate artery and a retrosternal goiter as an incidental finding. She was treated in a simultaneous procedure with three operations in only one setting. The perioperative features of this special case are reflected in the following course.
