Objective To investigate the effect of coronary artery bypass grafting (CABG) on patients with coronary heart disease and giant left ventricular dimension but without aneurysm. Methods The clinic data of 51 consecutive patients with coronary heart disease accompanied by enlarged left ventricle dimension without aneurysm, including 50 males and 1 female, undergoing CABG between January 2004 and December 2006 in Nanjing First Hospital of Nanjing Medical University was retrospectively reviewed. The patients were at the age of 54-61 years with an age of 57.5±3.2 years. All patients received CABG, combined with aortic valve replacement in 7, mitral valve replacement in 16, mitral valvoplasty in 17 and tricuspid valvoplasty in 7. After surgery, perioperative complications and mortality were closely observed and followup for a period of 37 months was carried out. Results The number of distal anastomoses per patient was 2.0-4.0(3.8±1.1). Four patients died perioperatively (7.8%), among whom 2 died from malignant ventricular fibrillation, 1 from acute kidney failure and 1 from stroke caused by severe low cardiac output syndrome. All other patients were discharged from hospital with good recovery. After operation, 5 patients had atrial fibrillation and 11 had ventricular fibrillation, but all of those patients survived after proper treatment. The followup period for 47 patients was 37-49 months (43±11months), with a followup rate of 100%. No death occurred during the follow-up. Ultrasound cardiography in the followup period showed that there was a decreased left ventricular enddiastolic dimension (59±2 mm vs. 68±5 mm; t=7.320, Plt;0.05) and an improved left ventricular ejection fraction (45%±17% vs. 34%±15%; t=4.770, Plt;0.05) compared with those before operation with statistical significance. Conclusion CABG is an effective surgical procedure in the treatment of coronary heart disease with giant left ventricular dimension but without aneurysm.
Abstract:Objective To investigate the reoperation indication,surgical timing and the key point of surgical treatment of prosthetic valve endocarditis （PVE） after valve replacement. Methods From February 2000 to July 2005,18 patients with PVE underwent surgery ,their clinical manifestation ,process of treatment and their prognosis outcome were analyzed. Results There were 3 patients （16.7 %） of early-death, 1 patient died of septic shock, and 2 patients died of multiple organ failure. Since 2003,there was no operative death for all 11 patients. There were 6 patients with respiratory insufficiency, 2 patients with renal insufficiency,which were recovered after treatment. The 15 survivors were followed up from 1 month to 5years. There was recurrence of infection in 1 patient who died after ineffective medical treatment. The other 14 patients recovered well. Conclusion It has high risk and high mortality for reoperation for PVE. Accurate reoperative indication,optimal surgical timing,radical debridment of infected tissue and correct perioperative use of antibiotics are the key factors to improve the reoperative result for PVE.
Objective To investigate the effect of combined carotid endarterectomy (CEA) and offpump coronary artery bypass grafting (OPCAB) on patients with carotid arteriostenosis and coronary heart diseases. Methods A total of 121 consecutive patients with carotid arteriostenosis and coronary artery diseases underwent CEA and OPCAB between January 2003 and December 2009 in Nanjing First Hospital of Nanjing Medical University. There were 81 males and 40 females, with their ages ranged from 62 to 72 years (67.2±4.5 years). All patients had 3vessel coronary artery lesions, and there were 3 cases of left main coronary artery lesion. Unilateral carotid arteriostenosis (≥50%) occurred in 95 patients, and bilateral (≥50%) in 26 patients. The occurrence of stroke, myocardial infarction, angina pectoris and other complications after operation was observed, and followup was carried out. Results All patients underwent unilateral CEA including 50 on the right side and 71 left. The mean block time of carotid artery in CEA was 20.5±7.0 minutes. The average number of distal grafts per patient in OPCAB was 2.9±0.3. None of the patients had stroke or myocardial infarction and no perioperative death occurred. Eightyseven patients felt well in terms of their neuropsycho symptoms; 32 felt no change; and 2 worsened. Follow-up was done for all the patients with a follow-up rate of 100%. The mean time of the follow-up was 67.5±12.5 months. During this period, none of the patients manifested stroke, myocardial infarction or neuropsycho symptoms. Conclusion Concomitant OPCAB and CEA is a safe and effective procedure in patients with carotid arteriostenosis and coronary artery diseases. It can reduce the rate of postoperative stroke significantly. However, longterm outcome of the procedure needs operative experience accumulation, longterm follow-up and observation, and serious research and illumination.
Objective To evaluate the left ventricular remodeling after valve replacement for valvular heart disease with giant left ventricle. Methods The clinical material of 92 patients with valvular heart disease and giant left ventricle after valve replacement was retrospectively reviewed. The results of ultrosonic cardial gram（UCG） and the changes of cardiac function before and after operation were compared. Results There was no operative death. The value of left ventricular end-diastolic dimension （LVEDD）, left ventricular end-systolic dimension （LVESD）, left atrial dimension （LAD）, left ventricular ejection fraction （LVEF）, left ventricular fractional shortening （LVFS）, stroke volume （SV） and cardiothoracic ratio in 2 weeks and 2 months after operation were more decreased than those before operation（P〈0. 05）. The value of LVEDD and LAD in 2 months after operation were much more decreased than those in 2 weeks after operation （P〈0. 05）. The cardiac function in early stage after operation was more decreased than that before operation,but the cases of cardiac functional class Ⅱ （38 cases, 41.3% ） in 2 months after operation was significantly more than those before operation （5 cases, 5.4 % ）. Conclusions The early effect of left ventricular remodeling is significant for valvular heart disease with giant left ventricle after valve replacement. The diameter of left ventricle and left atrial are significantly decreased after operation. The protection for cardiac function should be carefully taken in order to prevent the occurrence of complication after operation.
ObjectiveTo discuss the effect of Cabrol in treatment of Stanford type A aortic dissection.MethodsThe clinical data of patients whom were diagnosed with type A aortic dissection of Stanford in our hospital from January 2013 to January 2018 were retrospectively analyzed. All of 40 patients underwent Cabrol surgical procedure. There were 31 males and 9 females aged 26–75 (48.8±3.3) years. The surgical treatment effect of the patients was evaluated, mainly including the aortic index, the changes in cardiac function before and after operation, and the postoperative follow-up.ResultsAll the 40 patients completed the operation successfully. The diameter of ascending aorta and aortic sinus in postoperative patients were smaller than those before operation (P<0.05). Postoperative left ventricular ejection fraction and cardiac output increased, central venous pressure and left ventricular end-diastolic dimension decreased, and cardiac function indexes were significantly different from those before the operation (P<0.05). Seven patients suffered complications in postoperative follow-up including one stenting leakage, three neurological diseases and three acute renal failure. Two patients died postoperatively.ConclusionCabrol’s operation is effective in the treatment of Stanford type A aortic dissection, which can significantly improve the cardiac function of patients, simplify the anastomosis of coronary artery ostia and decrease amount of bleeding.