From Feb. 1989 to May 1996, 170 patients underwent valve replacement with bileaflet heart valve prosthesis. There were 13 early deaths (mortality of 7-65% ), and 6 late deaths. The Preoperative cardiac function (NYHA)...From Feb. 1989 to May 1996, 170 patients underwent valve replacement with bileaflet heart valve prosthesis. There were 13 early deaths (mortality of 7-65% ), and 6 late deaths. The Preoperative cardiac function (NYHA) was grade Ⅱ in 96 cases, Ⅳ in 35 cases and Ⅲ to Ⅳ in 77. 1%.Follow-up of the survivors from 3 to 87 (average 39) months showed that most of them could do light and moderate physical labor, and cardiac function was restored to grade Ⅰ～ Ⅱ in 96. 4%. Anti-coagulating bleeding is a common complicaion. However, severe embolism and valve dysfunction had not been found- The authors analysed the causes of death and follow-up data, then emphasized that it was necessary that valve replacement be performed as early as possible, and bileaflet heart valve substitute was the best choice. Furthermore, therapy of little dose anti-coagulating drug(warfarin 1.5～3- 0mg/d) is safe and dependable to most of the patients.展开更多
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
Objective:To observe the cardiac output(CO)in animals and patients undergone valve replacement with Jiuling bileaflet mechanical valve prosthesis.Methods: 1.Animal experiments:6 sheep that subjected to mitral replacem...Objective:To observe the cardiac output(CO)in animals and patients undergone valve replacement with Jiuling bileaflet mechanical valve prosthesis.Methods: 1.Animal experiments:6 sheep that subjected to mitral replacement with a 21-mm-valve prosthesis were measured by open cardiac catheterization intraoperatively. Echocardiographic and open cardiac catheterization under dobutamine stress were performed on 2 sheep survival for 30 months post-operation.2.Patient measurements:CO of 14 cases of aortic valve and 10 cases of mitral valve was measured by open cardiac catheterization,and after 12 months,it was measured by echocardiography.Results:1. Animal experiments:The mean CO of 6 sheep was 2.5 L/min intraoperatively by catheterization,and that of 2 sheep survival for 30 months post-implant was 3.0 L/min by echocardiography and 2.9 L/min by catheterization,respectively.2.Patient measurements: The mean cardiac index of 4 patients with 21 mm valve replacement was(2.55±0.27) L/min/m2by catheterization,and was(2.84±0.13)L/min/m2 by echocardiography after 12 months.Conclusion:This study demonstrates that cardiac function on animals and patients return to normal activity after undergone the valve replacement,and the newly valve prosthesis shows excellent hemodynamic performance.展开更多
Objective： To summarize the clinical experiences of 21 patients treated with tricuspid valve replacement （TVR） and investigate the surgical indications and methods. Methods： Data from 21 patients who underwent TVR...Objective： To summarize the clinical experiences of 21 patients treated with tricuspid valve replacement （TVR） and investigate the surgical indications and methods. Methods： Data from 21 patients who underwent TVR from December 2002 to March 2009 were retrospectively collected and analyzed. The mean age was 48.86± 15.37 years （range： 20-72 years）. The underlying disease of the patients was classified as rheumatic （n = 10）, congenital （n = 8）, endocarditis （n = 2） or chest trauma （n = 1）. Previous cardiac surgery had been performed in 12 patients （57.14%）. Results： In-hospital death occurred in two patients （9.52%）. Postoperative morbidities included cardiac failure （n = 2）, bleeding related re-operation （n = 1）, and plural effusion （n = 2）. Conclusion： The early outcomes of TVR were acceptable. At the present time TVR can be performed through optimal perioperative management.展开更多
BACKGROUND Lack of mobilization and prolonged stay in the intensive care unit(ICU)are major factors resulting in the development of ICU-acquired muscle weakness(ICUAW).ICUAW is a type of skeletal muscle dysfunction an...BACKGROUND Lack of mobilization and prolonged stay in the intensive care unit(ICU)are major factors resulting in the development of ICU-acquired muscle weakness(ICUAW).ICUAW is a type of skeletal muscle dysfunction and a common complication of patients after cardiac surgery,and may be a risk factor for prolonged duration of mechanical ventilation,associated with a higher risk of readmission and higher mortality.Early mobilization in the ICU after cardiac surgery has been found to be low with a significant trend to increase over ICU stay and is also associated with a reduced duration of mechanical ventilation and ICU length of stay.Neuromuscular electrical stimulation(NMES)is an alternative modality of exercise in patients with muscle weakness.A major advantage of NMES is that it can be applied even in sedated patients in the ICU,a fact that might enhance early mobilization in these patients.AIM To evaluate safety,feasibility and effectiveness of NMES on functional capacity and muscle strength in patients before and after cardiac surgery.METHODS We performed a search on Pubmed,Physiotherapy Evidence Database(PEDro),Embase and CINAHL databases,selecting papers published between December 2012 and April 2023 and identified published randomized controlled trials(RCTs)that included implementation of NMES in patients before after cardiac surgery.RCTs were assessed for methodological rigor and risk of bias via the PEDro.The primary outcomes were safety and functional capacity and the secondary outcomes were muscle strength and function.RESULTS Ten studies were included in our systematic review,resulting in 703 participants.Almost half of them performed NMES and the other half were included in the control group,treated with usual care.Nine studies investigated patients after cardiac surgery and 1 study before cardiac surgery.Functional capacity was assessed in 8 studies via 6MWT or other indices,and improved only in 1 study before and in 1 after cardiac surgery.Nine studies explored the effects of NMES on muscle strength and function and,most of them,found increase of muscle strength and improvement in muscle function after NMES.NMES was safe in all studies without any significant complication.CONCLUSION NMES is safe,feasible and has beneficial effects on muscle strength and function in patients after cardiac surgery,but has no significant effect on functional capacity.展开更多
Although surgical aortic valve replacement is the standard therapy for severe aortic stenosis(AS),about one third of patients are considered inoperable due to unacceptable surgical risk.Under medical treatment alone t...Although surgical aortic valve replacement is the standard therapy for severe aortic stenosis(AS),about one third of patients are considered inoperable due to unacceptable surgical risk.Under medical treatment alone these patients have a very poor prognosis with a mortality rate of 50%at 2 years.Transcatheter aortic valve implantation(TAVI)has been used in these patients,and has shown robust results in the only randomized clinical trial of severe AS treatment performed so far.In this review,we will focus on the two commercially available systems:Edwards SAPIEN valve and CoreValve Revalving system.Both systems have demonstrated success rates of over 90%with 30-d mortality rates below 10%in the most recent transfemoral TAVI studies.Moreover,long-term studies have shown that the valves have good haemodynamic performance.Some studies are currently exploring the non-inferiority of TAVI procedures vs conventional surgery in high-risk patients,and long-term clinical results of the percutaneous valves.In this article we review the current status of TAVI including selection of patients,a comparison of available prostheses,results and complications of the procedure,clinical outcomes,and future perspectives.展开更多
Pulmonary valve implant is frequently necessary in children and adults with congenital heart disease.Infective endocarditis represents a rare but life-threatening complication after transcatheter pulmonary valve impla...Pulmonary valve implant is frequently necessary in children and adults with congenital heart disease.Infective endocarditis represents a rare but life-threatening complication after transcatheter pulmonary valve implantation.There are various treatments for native or prosthetic valve endocarditis.Surgical intervention,combined with intravenous antibiotic treatment,is of paramount importance,in case of concomitant mediastinal infection,in order to ensure the radical debridement of all infected tissue,avoiding any recurrent endocarditis.In this report,we describe a rare case of mediastinitis,associated with an infected endocarditis,occurring 8 months after Melody(Medtronic,Minneapolis,USA)valve implant,successfully treated with the implantation of a homograft to reconstruct the right ventricular outflow tract.展开更多
Surgical repair of a variety of congenital heart diseases involves repair of the right ventricular outflow tract(RVOT)with valved or non-valved conduit to connect the right ventricle(RV)to the pulmonary artery(PA)or j...Surgical repair of a variety of congenital heart diseases involves repair of the right ventricular outflow tract(RVOT)with valved or non-valved conduit to connect the right ventricle(RV)to the pulmonary artery(PA)or just patch enlargement of the native RVOT.With time,this RV-PA conduit will degenerate with deterioration of function,either causing pulmonary stenosis or pulmonary regurgitation.This RVOT dysfunction may result in RV dilation,RV dysfunction,and eventual RV failure and arrhythmias.Multiple surgical pulmonary valve replacement(PVR)is often required throughout the patient’s lifetime.Patients are subjected to increased risks with each additional cardiac operation.Transcatheter PVR(TPVR)has been developed over the past two decades as a valuable non-surgical alternative to restore the RVOT and RV function,and hence reduce patients’lifetime risks related to surgery.This article will discuss the long-term results of TPVR which are demonstrated to be comparable to surgical results and the latest development of large pulmonary valves which will allow TPVR to be performed on native or larger RVOT.展开更多
Heart diseases remain the top threat to human health,and the treatment of heart diseases changes with each passing day.Convincing evidence shows that three-dimensional(3D)printing allows for a more precise understandi...Heart diseases remain the top threat to human health,and the treatment of heart diseases changes with each passing day.Convincing evidence shows that three-dimensional(3D)printing allows for a more precise understanding of the complex anatomy associated with various heart diseases.In addition,3D-printed models of cardiac diseases may serve as effective educational tools and for hands-on simulation of surgical interventions.We introduce examples of the clinical applications of different types of 3D printing based on specific cases and clinical application scenarios of 3D printing in treating heart diseases.We also discuss the limitations and clinically unmet needs of 3D printing in this context.展开更多
文摘From Feb. 1989 to May 1996, 170 patients underwent valve replacement with bileaflet heart valve prosthesis. There were 13 early deaths (mortality of 7-65% ), and 6 late deaths. The Preoperative cardiac function (NYHA) was grade Ⅱ in 96 cases, Ⅳ in 35 cases and Ⅲ to Ⅳ in 77. 1%.Follow-up of the survivors from 3 to 87 (average 39) months showed that most of them could do light and moderate physical labor, and cardiac function was restored to grade Ⅰ～ Ⅱ in 96. 4%. Anti-coagulating bleeding is a common complicaion. However, severe embolism and valve dysfunction had not been found- The authors analysed the causes of death and follow-up data, then emphasized that it was necessary that valve replacement be performed as early as possible, and bileaflet heart valve substitute was the best choice. Furthermore, therapy of little dose anti-coagulating drug(warfarin 1.5～3- 0mg/d) is safe and dependable to most of the patients.
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Objective:To observe the cardiac output(CO)in animals and patients undergone valve replacement with Jiuling bileaflet mechanical valve prosthesis.Methods: 1.Animal experiments:6 sheep that subjected to mitral replacement with a 21-mm-valve prosthesis were measured by open cardiac catheterization intraoperatively. Echocardiographic and open cardiac catheterization under dobutamine stress were performed on 2 sheep survival for 30 months post-operation.2.Patient measurements:CO of 14 cases of aortic valve and 10 cases of mitral valve was measured by open cardiac catheterization,and after 12 months,it was measured by echocardiography.Results:1. Animal experiments:The mean CO of 6 sheep was 2.5 L/min intraoperatively by catheterization,and that of 2 sheep survival for 30 months post-implant was 3.0 L/min by echocardiography and 2.9 L/min by catheterization,respectively.2.Patient measurements: The mean cardiac index of 4 patients with 21 mm valve replacement was(2.55±0.27) L/min/m2by catheterization,and was(2.84±0.13)L/min/m2 by echocardiography after 12 months.Conclusion:This study demonstrates that cardiac function on animals and patients return to normal activity after undergone the valve replacement,and the newly valve prosthesis shows excellent hemodynamic performance.
文摘Objective： To summarize the clinical experiences of 21 patients treated with tricuspid valve replacement （TVR） and investigate the surgical indications and methods. Methods： Data from 21 patients who underwent TVR from December 2002 to March 2009 were retrospectively collected and analyzed. The mean age was 48.86± 15.37 years （range： 20-72 years）. The underlying disease of the patients was classified as rheumatic （n = 10）, congenital （n = 8）, endocarditis （n = 2） or chest trauma （n = 1）. Previous cardiac surgery had been performed in 12 patients （57.14%）. Results： In-hospital death occurred in two patients （9.52%）. Postoperative morbidities included cardiac failure （n = 2）, bleeding related re-operation （n = 1）, and plural effusion （n = 2）. Conclusion： The early outcomes of TVR were acceptable. At the present time TVR can be performed through optimal perioperative management.
文摘BACKGROUND Lack of mobilization and prolonged stay in the intensive care unit(ICU)are major factors resulting in the development of ICU-acquired muscle weakness(ICUAW).ICUAW is a type of skeletal muscle dysfunction and a common complication of patients after cardiac surgery,and may be a risk factor for prolonged duration of mechanical ventilation,associated with a higher risk of readmission and higher mortality.Early mobilization in the ICU after cardiac surgery has been found to be low with a significant trend to increase over ICU stay and is also associated with a reduced duration of mechanical ventilation and ICU length of stay.Neuromuscular electrical stimulation(NMES)is an alternative modality of exercise in patients with muscle weakness.A major advantage of NMES is that it can be applied even in sedated patients in the ICU,a fact that might enhance early mobilization in these patients.AIM To evaluate safety,feasibility and effectiveness of NMES on functional capacity and muscle strength in patients before and after cardiac surgery.METHODS We performed a search on Pubmed,Physiotherapy Evidence Database(PEDro),Embase and CINAHL databases,selecting papers published between December 2012 and April 2023 and identified published randomized controlled trials(RCTs)that included implementation of NMES in patients before after cardiac surgery.RCTs were assessed for methodological rigor and risk of bias via the PEDro.The primary outcomes were safety and functional capacity and the secondary outcomes were muscle strength and function.RESULTS Ten studies were included in our systematic review,resulting in 703 participants.Almost half of them performed NMES and the other half were included in the control group,treated with usual care.Nine studies investigated patients after cardiac surgery and 1 study before cardiac surgery.Functional capacity was assessed in 8 studies via 6MWT or other indices,and improved only in 1 study before and in 1 after cardiac surgery.Nine studies explored the effects of NMES on muscle strength and function and,most of them,found increase of muscle strength and improvement in muscle function after NMES.NMES was safe in all studies without any significant complication.CONCLUSION NMES is safe,feasible and has beneficial effects on muscle strength and function in patients after cardiac surgery,but has no significant effect on functional capacity.
文摘Although surgical aortic valve replacement is the standard therapy for severe aortic stenosis(AS),about one third of patients are considered inoperable due to unacceptable surgical risk.Under medical treatment alone these patients have a very poor prognosis with a mortality rate of 50%at 2 years.Transcatheter aortic valve implantation(TAVI)has been used in these patients,and has shown robust results in the only randomized clinical trial of severe AS treatment performed so far.In this review,we will focus on the two commercially available systems:Edwards SAPIEN valve and CoreValve Revalving system.Both systems have demonstrated success rates of over 90%with 30-d mortality rates below 10%in the most recent transfemoral TAVI studies.Moreover,long-term studies have shown that the valves have good haemodynamic performance.Some studies are currently exploring the non-inferiority of TAVI procedures vs conventional surgery in high-risk patients,and long-term clinical results of the percutaneous valves.In this article we review the current status of TAVI including selection of patients,a comparison of available prostheses,results and complications of the procedure,clinical outcomes,and future perspectives.
文摘Pulmonary valve implant is frequently necessary in children and adults with congenital heart disease.Infective endocarditis represents a rare but life-threatening complication after transcatheter pulmonary valve implantation.There are various treatments for native or prosthetic valve endocarditis.Surgical intervention,combined with intravenous antibiotic treatment,is of paramount importance,in case of concomitant mediastinal infection,in order to ensure the radical debridement of all infected tissue,avoiding any recurrent endocarditis.In this report,we describe a rare case of mediastinitis,associated with an infected endocarditis,occurring 8 months after Melody(Medtronic,Minneapolis,USA)valve implant,successfully treated with the implantation of a homograft to reconstruct the right ventricular outflow tract.
文摘Surgical repair of a variety of congenital heart diseases involves repair of the right ventricular outflow tract(RVOT)with valved or non-valved conduit to connect the right ventricle(RV)to the pulmonary artery(PA)or just patch enlargement of the native RVOT.With time,this RV-PA conduit will degenerate with deterioration of function,either causing pulmonary stenosis or pulmonary regurgitation.This RVOT dysfunction may result in RV dilation,RV dysfunction,and eventual RV failure and arrhythmias.Multiple surgical pulmonary valve replacement(PVR)is often required throughout the patient’s lifetime.Patients are subjected to increased risks with each additional cardiac operation.Transcatheter PVR(TPVR)has been developed over the past two decades as a valuable non-surgical alternative to restore the RVOT and RV function,and hence reduce patients’lifetime risks related to surgery.This article will discuss the long-term results of TPVR which are demonstrated to be comparable to surgical results and the latest development of large pulmonary valves which will allow TPVR to be performed on native or larger RVOT.
基金This study was supported by the National key R&D plan(No.2020YFC2008100)the Science and Technology Innovation Team Project of the Shaanxi Innovation Capability Support Plan(No.S2020-ZC-TD-0029)the Science Foundation for Distinguished Young Scholars of Shaanxi Natural Science Basic Research Program(No.S2018-JC-JQ-0094)。
文摘Heart diseases remain the top threat to human health,and the treatment of heart diseases changes with each passing day.Convincing evidence shows that three-dimensional(3D)printing allows for a more precise understanding of the complex anatomy associated with various heart diseases.In addition,3D-printed models of cardiac diseases may serve as effective educational tools and for hands-on simulation of surgical interventions.We introduce examples of the clinical applications of different types of 3D printing based on specific cases and clinical application scenarios of 3D printing in treating heart diseases.We also discuss the limitations and clinically unmet needs of 3D printing in this context.
