Objective To compare the clinical characteristics and prognosis of patients who received two different intraventricular repair. Methods We retrospectively analyzed the clinical data of 24 complete transposition of the great arteries (TGA)/left ventricular outflow tract obstruction (LVOTO) patients who all received intraventricular repair. The patients were allocated into two groups including a REV group and a Rastelli group. There were 13 patients with 9 males and 4 females at median age of 25.2 (6, 72) months in the REV group. There were 11 patients with 10 males and 1 female at median age of 47.9 (14, 144) months in the Rastelli group. Results The age at operation (P=0.041), pulmonary valve Z value (P=0.002), and LVOT gradient (P=0.004), rate of multiphase operation between the REV group and the Rastelli group was statistically different. The mean follow-up time was 17.3 months. And during the follow-up, 1 patient had early mortality, 2 patients had early reintervention, 7 patients had postoperative RVOTO, and received Rastelli and larger VSD inner diameter were associated with postoperative RVOTO. Conclusion As the traditional surgery for TGA/LVOTO patients, the intraventricular repair has a low early mortality and low early reintervention. Modified REV is associated with postoperative peripheral pulmonary vein isolation (PVIS). Patients who received Rastelli operation and with larger VSD inner diameter are more likely to have postoperative RVOTO, but the reintervention for PVI and RVOTO during follow up is very low.
ObjectiveTo explore the value of transthoracic echocardiography (TTE) to monitor and evaluate aortic insufficiency (AI) within one year after the implantation of the left ventricular assist device (LVAD).MethodsWe retrospectively collected and analyzed the TTE data of 12 patients who received LVAD implantation from 2018 to 2020 in our hospital. All patients were males, with an average age of 43.3±8.6 years. We analyzed temporal changes in the aortic annulus (AA), aortic sinus (AoS), ascending aorta (AAo), the severity of AI and the opening of aortic valve before operation and 1 month, 3 months, 6 months and 12 months after LVAD implantation.ResultsAll 12 patients survived within 1 year after LVAD implantation. One patient was bridged to heart transplantation 6 months after implantation, and two patients did not receive TTE after 3 and 6 months. Compared to pre-implantation, AoS increased at 1 month after implantation (31.58±5.09 mm vs. 33.83±4.69 mm). The inner diameters of AA, AoS and AAo increased at 3, 6 and 12 months after LVAD implantation compared to pre-implantation (P<0.05), but all were within the normal range except for one patient whose AoS slightly increased before operation. After LVAD pump speed was adjusted, the opening of aortic valve improved. The severity of AI increased at 6 and 12 months after LVAD implantation compared to pre-implantation, and increased at 12 months compared to 6 months after LVAD implantation (P<0.05).ConclusionTTE can evaluate aortic regurgitation before and after LVAD implantation and monitor the optimization and adjustment of LVAD pump function, which has a positive impact on the prognosis after LVAD implantation.
ObjectiveTo explore the operative strategy after palliative shunt for correcting congenitally corrected transposition of great artery (cTGA) patients with left ventricular outflow tract obstruction (LVOTO) and cardiac malpostion.MethodsWe retrospectively analyzed the clinical data of 54 patients with onsecutive cTGA with LVOTO and cardiac malpositon from June 2011 to May 2019. The patients were devided into two groups. There were 24 patients (16 males and 8 females at mean age of 5.4±2.2 years) who underwent one and a half ventricle repair as a one and half ventricle group. And there were 30 patients (19 males and 11 females at age of 8.6±6.2 years) who underwent one ventricle repair operation as a one ventricle group. Follow-up data were collected by telephone interviews.ResultsThere was no statistical difference in systemic atrioventricular valve regurgitation and systemic ventricular ejection fraction between the two groups (P>0.05). Compared with one and a half ventricle group, the cardiopulmonary bypass time (CPB) time, mechanical ventilation time and intensive care unit stay were significant shorter than those in the one ventricle group (P<0.05), but prolonged pleural effusions developed more frequently in the one ventricle repair group (P<0.05). There was no in-hospital death but 1 follow-up death in each group. The follow-up time was 49 (17-38) months in the one and half ventricle group at follow-up rate of 93.9%, and 47 (12-85) months at follow-up rate at 90.9% in the one ventricle group. One and a half ventricle group had better systemic ventricular ejection fraction (EF) than that in the one ventricle repair group. And the rate of heart function (NYHA) class Ⅲ and class Ⅳ in one and a half ventricle group was lower than that in the ventricle group. No significant difference of survival and freedom from re-intervention probability between the two groups was found.ConclusionFor patients of correction of cTGA with LVOTO and cardiac malposition after palliative shunt, the one-and-a-half ventricular repair procedure is ideal operative strategy.
Due to the abnormal structure and function of the cardiac valves, cardiac valve disease gradually appears the expansion of left ventricular inner diameter and volume. When the left ventricular end-diastolic dimension and volume expand severely, it becomes a giant left ventricle. Surgical valve replacement is still one of the main treatment methods for this disease. The degree of postoperative ventricular recovery is closely related to perioperative mortality and long-term prognosis. However, the existing clinical preoperative assessment methods still cannot accurately predict the degree of postoperative left ventricular recovery and long-term prognosis of such patients, so it is difficult to determine the optimal operation timing and surgical methods for patients. Therefore, we reviewed the existing literature and discussed different evaluation methods of the giant left ventricle associated with valvular disease before surgery, so as to optimize the perioperative treatment of such patients, clarify the timing of surgery and improve the prognosis.
Abstract： Objective?To evaluate clinical experiences and long-term outcome of morphologic left ventricle （mLV） retraining for congenitally corrected transposition of the great arteries （cCTGA）. Methods From May 2005 to May 2011, 24 patients with cCTGA anomaly underwent left ventricle retraining by means of pulmonary artery banding in Fu Wai Hospital. There were 13 males and 11 females with their age of 0.17-22.00 （3.73±4.35） years and body weight of 5.10-61.00（15.71±10.95）kg. Major concomitant malformations included tricuspid valve insufficiency （TR）in 23 patients （mild in 11 patients, moderate in 7 patients, severe in 5 patients）, restrictive ventricular septal defect in 18 patients, atrial septal defect in 5 patients, patent foramen ovale in 5 patients, patent ductus arteriosus in 4 patients, mild pulmonary stenosis in 5 patients, and aortic coarctation in 1 patient. All the patients were preoperatively diagnosed by echocardiography, cardiovascular angiography or cardiac catheterization. The mLV end diastolic diameter （mLVEDD） was 8-32（21.56±6.60）mm, posterior wall thickness of mLV was 2-7 （4.29±1.52）mm , mLV to morphologic right ventricle （mRV） pressure ratio （mLV/mRV） was 0.12-0.65 （0.41±0.12）. Pulmonary artery banding operation was performed through upper partial sternotomy or median sternotomy without circulatory arrest. Results The mLV/mRV pressure ratio reached to 0.57-0.93 （0.76±0.10） under direct pressure monitoring after surgery. There was no in-hospital death in this group. Echocardiography before discharge showed that the structure and function of the two ventricles were good, the interventricular septum moved partially towards mRV, mLVEDD was increased slightly, and there was a tendency of reduced TR. Postoperative follows-up was from 1 to 35 months, and there was no late death during follow-up. All the patients were in good general condition with stable vital signs and New York Heart Association （NYHA） classⅠ-Ⅱ. The mLVEDD was 14-40 （26.17±7.11） mm, posterior wall thickness of mLV was 4-9 （4.95±1.44）mm, mLV/mRV pressure ratio was 0.52-0.98 （0.72±0.16） , and TR was significantly decreased. Fourteen patients successfully underwent staged complete double-switch procedure. Conclusion Left ventricle retraining is a safe and effective method to train mLV for cCTGA patients. Pressure load and posterior wall thickness of mLV are increased, mLV cavity is dilated, and TR is significantly reduced after the surgery.
目的:应用应变率探讨不同左心室构型的原发性高血压患者左心室长轴方向应变－应变率成像的变化,及其与EF、FS及二尖瓣血流测量评价左室功能的对照研究。方法:采用M型、二维、多普勒超声及应变率成像技术,测量左室室壁厚度、左室内径、EF、FS,二尖瓣血流频谱E、A及左室平均应变ε,应变率S、e、a。结果:高血压离心性肥厚组EF、FS明显低于对照组,高血压其余各组EF、FS与对照组无统计学差异;收缩期应变率S应变ε在五组间差异均有显著性意义:高血压各组较正常对照组减小(I--Ⅴ呈递减);舒张期应变率e减低、a增高,e/a比值减小,各组间存在统计学差异(Plt;0.05); E/A,e/a结果大体一致。结论:应变率成像为临床提供了一个敏感、简便、可靠的评价原发性高血压患者左室心肌功能的指标。
Objective To systematically evaluate the effectiveness and safety of calcium channel blockers (CCBs) and angiotensin-converting enzyme inhibitors (ACEIs) used alone v.s. used in combination on the reversion of left ventricular hypertrophy (LVH) in Chinese essential hypertension (EH) patients. Methods The following databases were searched, including, Cochrane Library (Issue 7, 2011), PubMed (1980 to 2011), EMbase (1990 to 2011), CBM (1978 to 2011), CNKI (1994 to 2011), VIP (1989 to 2011), and WanFang Data (1998 to 2011). The studies were screened, and the quality was evaluated according to predefined inclusion and exclusion criteria, and then Meta-analysis was conducted by using RevMan 5.1 software. Results A total of 10 studies involving 859 patients were included. The results of Meta-analysis showed that the CCBs plus ACEIs group (the combination group) was superior to the CCBs group in improving EH patients’ systolic pressure (SBP) (MD= –6.49, 95%CI –10.55 to –2.43), diastolic pressure (DBP) (MD= –4.48, 95%CI –6.76 to –2.21), left ventricular mass index (LVMI) (MD= –5.31, 95%CI –8.43 to –2.19), interventricular septal thickness (IVST) (MD= –1.33, 95%CI –2.00 to –0.66) and left ventricular posterior wall thickness (LVPWT) (MD= –0.87, 95%CI –1.41 to –0.33). In addition, compared with the ACEIs group, the combination group was greatly superior in decreasing LVMI (MD= –11.54, 95%CI –15.06 to –8.01), IVST (MD= –0.76, 95%CI –1.25 to –0.27) and LVPWT (MD= –0.80, 95%CI –1.01 to –0.59). But clinical effectiveness was similar between the combination group and the CCBs group or the ACEIs group in aspects of the left ventricular end diastolic diameter (LVEDD), fraction shortening (FS) and ejection fractions (EF) (Pgt;0.05). Conclusion The combination therapy of CCBs with ACEIs is superior to either the CCBs or the ACEIsmonothrepy in regression of left ventricular hypertrophy. Because of the low methodological quality and small sample, this conclusion needs to be proved by more high-quality, large-scale and multicenter randomized controlled trials in the future.
ObjectiveTo investigate the surgical strategies and clinical efficacy of transmitral septal myectomy in the treatment of recurrent left ventricular outflow tract obstruction (LVOTO) after alcohol septal ablation. MethodsThe clinical data of patients with recurrent LVOTO after alcohol septal ablation from July 2020 to July 2021 in the Department of Cardiac Surgery, Guangdong Provincial People's Hospital were retrospectively analyzed. Patients were preoperatively evaluated by echocardiography, cardiac magnetic resonance imaging, cardiac computed tomography, 3D modeling and printing technology. A personalized surgical strategy was preoperatively developed according to multimodality imaging assessment, while visual exploration was performed on the digital model and simulated surgical resection was performed on the printed model. Results Two female patients were enrolled, aged 62 years and 64 years, respectively. Totally endoscopic transmitral extended myectomy was successfully performed on both patients with aortic cross-clamping time of 96 min and 85 min, respectively. LVOTO was relieved immediately (subaortic peak pressure gradient decreased from 100 mm Hg to 4 mm Hg and from 84 mm Hg to 6 mm Hg, respectively) and the mitral regurgitation significantly improved after the procedure. No patient had complete atrioventricular block or required permanent pacemaker implantation. The patients were discharged uneventfully without postoperative complications. ConclusionPersonalized totally endoscopic transmitral extended myectomy combined with multimodality imaging assessment and 3D modeling and printing has an acceptable clinical effect in patients with recurrent LVOTO after alcohol septal ablation. The procedure can precisely resect the hypertrophic septal myocardium while avoiding serious complications such as septal perforation or complete atrioventricular block.
Objective To explore the pulmonary arterial pressure level in patients with predialysis chronic kidney disease ( CKD) and its relationship to cardiac structure and function. Methods 397 patients with predialysis CKD and 50 healthy subjects were enrolled. Cardiac structure was evaluated by Doppler echocardiography. Glomerular filtration rate ( GFR ) were assessed by radiant 99mTc-DTPA.Differences of PAP, BNP, LA, IVST, LVDd, LVDs, LVEF, LVMI and the correlation of PAP with cardiac structure and function were examined. Results The PAP level in the predialysis CKD patients was much higher than that in the healthy subjects [ ( 33. 13 ±9. 00) mm Hg vs. ( 29. 43 ±3. 71) mmHg, P lt;0. 01] .18. 9% of the CKD patients were complicated with pulmonary hypertension. PAP was higher in the CKD patients in stages 4-5 than those CKD patients in stages 1-3 [ ( 35. 90 ±9. 34) mmHg vs. ( 32. 08 ±8. 62)mmHg, P lt;0. 01) ] , so as to the prevalene of pulmonary hypertension ( 21. 60% vs. 13. 47% , P lt;0. 01) .Compared with the healthy, the level of lnBNP [ ( 3. 59 ±1. 63) pg/mL vs. ( 2. 88 ±1. 51) pg/mL, P lt;0. 01] , LA [ ( 40. 42 ±6. 77) mmvs. ( 36. 75 ±4. 94) mm, P lt; 0. 01) ] , LVPW [ ( 9. 55 ±1. 96) mm vs.( 8. 54 ±0. 88) mm, P lt; 0. 01) ] , IVST [ ( 9. 76 ±1. 75) mm vs. ( 8. 71 ±0. 90) mm, P lt; 0. 01) ] , LVMI[ ( 105. 61 ±36. 47) g/m2 vs. ( 87. 41 ±17. 08) g/m2 , P lt; 0. 01) ] were all much higher. There was a negative correlation between PAP and GFR( r = - 0. 461, P lt;0. 01) , and positive correlations between PAP and LA ( r=0. 491, P lt; 0. 01) , LVPW ( r =0. 298, P lt;0. 01) , IVST ( r = 0. 613, P lt;0. 01) , lnBNP ( r =0. 536, P lt;0. 01) , LVMI ( r = 0. 382, P lt;0. 01) . LVMI and lnBNP were both independent risk factors of PAP. The regression equation: y = 16. 447 + 0. 105x1 + 1. 724x2 ( F = 23. 482, P = 0. 000) , y: PAP( mm Hg) , x1 : LVMI( g/m2 ) , x2 : lnBNP( pg/mL) . Conclusions Pulmonary hypertension is a common morbidity of predialysis CKD patients, and deteriorates with degression of renal function. PAP is related to indexes of cardiac structure ( LVMI, LA, LVPW, IVST) and index of cardiac function ( lnBNP) . LnBNP and LVMI are independent risk factors of PAP.
ObjectiveTo explore the anatomical characteristics and surgical strategies of atrioventricular septal defect (AVSD) with left ventricular outflow tract (LVOT) stenosis.MethodsThe clinical data of 11 AVSD patients with LVOT stenosis who underwent surgeries in our hospital from 2008 to 2019 were retrospectively analyzed, including 6 males and 5 females with a median age of 15.0 (7.6-22.0) years.ResultsThere were 3 patients of complete AVSD and 8 patients of partial AVSD. Subaortic stenosis resulted from discrete subaortic membrane in 3 patients, diffused subaortic membrane in 4 patients, hypertrophied muscle bundles in 3 patients and distorted valve frame in 1 patient. Among these patients, 5 patients underwent LVOT stenosis and AVSD repairs simultaneously for the first time, 5 patients underwent LVOT stenosis repair for the second time and 1 patient for the third time. No postoperative death occurred. The postoperative LVOT flow velocity decreased dramatically after LVOT stenosis repair compared with preoperative one [449.0 (393.0, 507.5) cm/s vs. 212.0 (183.0, 253.5) cm/s, P<0.05].ConclusionSurgical results of AVSD combined with LVOT stenosis are satisfactory, but the restenosis should be paid attention to via long-term follow-up.