{"title":"The value of video assisted thoracoscopic surgery of total thymectomy in the treatment of thymic tumor through subsagittal incision","authors":"Qi-Fu Guo, Min Zheng, Ye Xu, Wenliang Qian, Chen Zhu, Ning Wang, Wen Zhao, Jing Yang","doi":"10.3760/CMA.J.CN112434-20190524-00172","DOIUrl":"https://doi.org/10.3760/CMA.J.CN112434-20190524-00172","url":null,"abstract":"2018年3月至2019年3月期间采用剑突下切口胸腔镜全胸腺切除术治疗9例胸腺肿瘤患者，其中男6例，女3例；年龄24～83岁，平均(54.8±15.2)岁。患者术前均常规行胸部增强CT检查明确诊断，了解胸腺肿物与周围组织、血管关系，术前均未行肿物穿刺活检。全组手术过程顺利，无围手术期死亡，无输血、加用肋间切口和中转开胸。术后无迟发出血、肺部感染、肺不张、胸腔积液、胸腔或纵隔积气、重症肌无力等并发症。全组随访1～12个月，期间无肿瘤复发及特殊不适，疗效满意。经剑突下切口胸腔镜全胸腺切除术治疗胸腺肿瘤安全有效，创伤小，痛苦少，患者恢复快，值得临床推广应用。","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":"22 1","pages":"188-190"},"PeriodicalIF":0.0,"publicationDate":"2020-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83190415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-25DOI: 10.3760/CMA.J.CN112434-20190723-00246
Zhou Zhao, Li-xue Zhang, Guo-dong Zhang, Xiangui Zhang, Xuan Wang, Junxue Gao, G. Fan, B. Lian, Jing Liu, Gang Liu, Shenglong Chen, Yu Chen
Objective To observate the changing trend of flow of in-situ bilateral internal mammary artery as grafts during perioperative period in patients undergoing coronary artery bypass grafting(CABG), and to compare the parameters of flow between LIMA and RIMA. Methods A total of 57 patients , 50 males and 7 femails, mean aged(57.8±10.1) years, underwent bilateral IMA CABG in our hospital from August 2016 to January 2019. Transthoracic ultrasound of IMA examination was performed before CABG. The blood flow, the PI(pulsation index) and other parameters were measured and recorded by intraoperative TTFM. Results There was no significant difference of the average diameter and PI between LIMA and RIMA, but the preoperative flow of RIMA is higher(P=0.026) in our study. There was no significant difference of the average flow and PI between LIMA and RIMA recorded by TTFM(P>0.05), but the higher diastolic flow(DF) in LIMA grafts(P=0.022) compared with RIMA grafts may be associated with the different target sites(P<0.05). Compared with the preoperative flow and PI of IMA, the intraoperative flow and PI of both LIMA and RIMA grafts were better(P<0.001). Conclusion Compared with the preoperative flow of IMA, both flow of LIMA and RIMA are better. In spite of the targets exist difference , there are no significant difference of the average flow and PI between LIMA graft and RIMA graft recorded by TTFM. Key words: Internal mammary artery; Coronary artery bypass grafting; Transit-time flowmeter; Transthoracic arterial ultrasound
{"title":"Perioperative study of blood flow of in-situ BIMA in coronary artery bypass grafting","authors":"Zhou Zhao, Li-xue Zhang, Guo-dong Zhang, Xiangui Zhang, Xuan Wang, Junxue Gao, G. Fan, B. Lian, Jing Liu, Gang Liu, Shenglong Chen, Yu Chen","doi":"10.3760/CMA.J.CN112434-20190723-00246","DOIUrl":"https://doi.org/10.3760/CMA.J.CN112434-20190723-00246","url":null,"abstract":"Objective \u0000To observate the changing trend of flow of in-situ bilateral internal mammary artery as grafts during perioperative period in patients undergoing coronary artery bypass grafting(CABG), and to compare the parameters of flow between LIMA and RIMA. \u0000 \u0000 \u0000Methods \u0000A total of 57 patients , 50 males and 7 femails, mean aged(57.8±10.1) years, underwent bilateral IMA CABG in our hospital from August 2016 to January 2019. Transthoracic ultrasound of IMA examination was performed before CABG. The blood flow, the PI(pulsation index) and other parameters were measured and recorded by intraoperative TTFM. \u0000 \u0000 \u0000Results \u0000There was no significant difference of the average diameter and PI between LIMA and RIMA, but the preoperative flow of RIMA is higher(P=0.026) in our study. There was no significant difference of the average flow and PI between LIMA and RIMA recorded by TTFM(P>0.05), but the higher diastolic flow(DF) in LIMA grafts(P=0.022) compared with RIMA grafts may be associated with the different target sites(P<0.05). Compared with the preoperative flow and PI of IMA, the intraoperative flow and PI of both LIMA and RIMA grafts were better(P<0.001). \u0000 \u0000 \u0000Conclusion \u0000Compared with the preoperative flow of IMA, both flow of LIMA and RIMA are better. In spite of the targets exist difference , there are no significant difference of the average flow and PI between LIMA graft and RIMA graft recorded by TTFM. \u0000 \u0000 \u0000Key words: \u0000Internal mammary artery; Coronary artery bypass grafting; Transit-time flowmeter; Transthoracic arterial ultrasound","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":"16 1","pages":"175-179"},"PeriodicalIF":0.0,"publicationDate":"2020-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81689604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-25DOI: 10.3760/CMA.J.CN112434-20190521-00167
Dalei Guo, Yan Liu, P. Su, Xitao Zhang, Junbo Yan, Song Gu, Jie Gao, Y. Gou, Yue Xin, Qianwei Wang
Objective To investigate the best neutralization ratio of protamine and heparin during off-pump coronary artery bypass grafting(OPCABG) by analyzing the advantages and disadvantages of heparin residue after OPCABG. Methods From July 2018 to January 2019, 112 patients undergoing elective OPCABG were included in this study. The patients’ whole blood was drawn at 2 time points, including before entering operating room and entering intensive care unit, to receive thrombelastography(TEG) and heparinase-modified thromboelastography(hmTEG) . Conventional coagulation indexes such as activated coagulation time(ACT) were also detected. All the patients were divided into 3 groups, the non-heparin residue group(30 cases), heparin residue group 1(42 cases) and heparin residue group 2(40 cases) according to the laboratory results of TEG, hmTEG and ACT. We observed the dosage of each group of protamine and heparin, as well as the ratio of heparin and protamine. The changes of R time in TEG and ACT between 3 groups were analyzed and compared. Postoperative chest tube drainage at postoperative 12 h and 48 h, cTnI peak value, incidence of perioperative myocardial infarction(MI), incidence of reoperation and poor wound healing, amount of blood loss and transfusion, and acute renal injury were compared between the 3 groups. Results No significant trio-group differences existed in basic clinical characteristics(all P>0.05). Postoperative R(CKH)time was similar in the 3 groups(P>0.05). Comparing with heparin residue group 1 and heparin residue group 2, the ACT after protamine neutralizing heparin and postoperative R time were decreased, the dosage of protamine, ratio of heparin and protamine, cTnI peak value were increased in the non-heparin residue group(P 0.05). The perioperative myocardial infarction, incidence of reoperation and poor wound healing, postoperative acute renal injury and time of in ICU stay showed no significant differences between the 3 groups(P>0.05). Conclusion Moderate heparin residue after OPCAB suggests that it has myocardial protective effect, and does not significantly increase the risk of bleeding. A large number of heparin residues can affect the coagulation function and lead to bleeding tendency, increase the amount of blood loss and transfusion. It is reasonable to make ACT after protamine neutralize heparin higher than the level of ACT before operation, and not higher than 20% of the level before operation. Key words: Heparin; Protamine; Coronary artery bypass grafting, off-pump; Thromboelastograph
{"title":"Dialectical analysis of heparin residue in perioperative period of off-pump coronary artery bypass grafting","authors":"Dalei Guo, Yan Liu, P. Su, Xitao Zhang, Junbo Yan, Song Gu, Jie Gao, Y. Gou, Yue Xin, Qianwei Wang","doi":"10.3760/CMA.J.CN112434-20190521-00167","DOIUrl":"https://doi.org/10.3760/CMA.J.CN112434-20190521-00167","url":null,"abstract":"Objective \u0000To investigate the best neutralization ratio of protamine and heparin during off-pump coronary artery bypass grafting(OPCABG) by analyzing the advantages and disadvantages of heparin residue after OPCABG. \u0000 \u0000 \u0000Methods \u0000From July 2018 to January 2019, 112 patients undergoing elective OPCABG were included in this study. The patients’ whole blood was drawn at 2 time points, including before entering operating room and entering intensive care unit, to receive thrombelastography(TEG) and heparinase-modified thromboelastography(hmTEG) . Conventional coagulation indexes such as activated coagulation time(ACT) were also detected. All the patients were divided into 3 groups, the non-heparin residue group(30 cases), heparin residue group 1(42 cases) and heparin residue group 2(40 cases) according to the laboratory results of TEG, hmTEG and ACT. We observed the dosage of each group of protamine and heparin, as well as the ratio of heparin and protamine. The changes of R time in TEG and ACT between 3 groups were analyzed and compared. Postoperative chest tube drainage at postoperative 12 h and 48 h, cTnI peak value, incidence of perioperative myocardial infarction(MI), incidence of reoperation and poor wound healing, amount of blood loss and transfusion, and acute renal injury were compared between the 3 groups. \u0000 \u0000 \u0000Results \u0000No significant trio-group differences existed in basic clinical characteristics(all P>0.05). Postoperative R(CKH)time was similar in the 3 groups(P>0.05). Comparing with heparin residue group 1 and heparin residue group 2, the ACT after protamine neutralizing heparin and postoperative R time were decreased, the dosage of protamine, ratio of heparin and protamine, cTnI peak value were increased in the non-heparin residue group(P 0.05). The perioperative myocardial infarction, incidence of reoperation and poor wound healing, postoperative acute renal injury and time of in ICU stay showed no significant differences between the 3 groups(P>0.05). \u0000 \u0000 \u0000Conclusion \u0000Moderate heparin residue after OPCAB suggests that it has myocardial protective effect, and does not significantly increase the risk of bleeding. A large number of heparin residues can affect the coagulation function and lead to bleeding tendency, increase the amount of blood loss and transfusion. It is reasonable to make ACT after protamine neutralize heparin higher than the level of ACT before operation, and not higher than 20% of the level before operation. \u0000 \u0000 \u0000Key words: \u0000Heparin; Protamine; Coronary artery bypass grafting, off-pump; Thromboelastograph","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":"50 1","pages":"180-184"},"PeriodicalIF":0.0,"publicationDate":"2020-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88185288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-25DOI: 10.3760/CMA.J.ISSN.1001-4497.2020.02.003
Suwei Chen, Yongliang Zhong, Chengnan Li, Y. Ge, Z. Qiao, R. Qi, Haiou Hu, Junming Zhu, Li-Zhong Sun
Objective To summarize the surgical treatment strategy for aortic injury caused by trauma. Methods From January 2009 to January 2018, 34 patients with TAI were treated in Beijing Anzhen Hospital. 10 had hypertension. 23 cases were males. There were 31 cases caused by traffic accidents, 2 cases were fall injuries, and 1 case was bruise. 9 cases were thoracic aortic pseudoaneurysm, 6 cases were thoracic aorta, and 19 cases were aortic dissection. 29 patients underwent TEVAR and 5 patients underwent OR (2 patients with type A aortic dissection undergoing Bentall + Sun's procedure, 1 patient with type B aortic dissection and 2 patients with thoracic aortic pseudoaneurysm undergoing stented elephant trunk procedure). Results The follow-up time was (45.09±23.10) months. The mean age of patients undergoing OR or TEVAR was (44.80±20.57) years old, (45.93±11.01) years old; the mean operation time was(403.20±30.30) minutes, (105.72±27.76) minutes; the mean hospitalization (19.00±6.04), (5.76±3.08) days. There were no deaths in the two groups. 2 patients uundergoing TEVAR had left upper limb numbness. Conclusion The treatment of patients with TAI should be based on the general condition, the classification of injury, the involving regions and anatomical features to choose different treatments. In addition, the long-term prognosis of patients remains to be determined. Key words: Aortic disease; Trauma; Stented elephant trunk procedure; Thoracic aortic endovascular repair
{"title":"Surgical treatment strategy for traumatic aortic injury","authors":"Suwei Chen, Yongliang Zhong, Chengnan Li, Y. Ge, Z. Qiao, R. Qi, Haiou Hu, Junming Zhu, Li-Zhong Sun","doi":"10.3760/CMA.J.ISSN.1001-4497.2020.02.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2020.02.003","url":null,"abstract":"Objective \u0000To summarize the surgical treatment strategy for aortic injury caused by trauma. \u0000 \u0000 \u0000Methods \u0000From January 2009 to January 2018, 34 patients with TAI were treated in Beijing Anzhen Hospital. 10 had hypertension. 23 cases were males. There were 31 cases caused by traffic accidents, 2 cases were fall injuries, and 1 case was bruise. 9 cases were thoracic aortic pseudoaneurysm, 6 cases were thoracic aorta, and 19 cases were aortic dissection. 29 patients underwent TEVAR and 5 patients underwent OR (2 patients with type A aortic dissection undergoing Bentall + Sun's procedure, 1 patient with type B aortic dissection and 2 patients with thoracic aortic pseudoaneurysm undergoing stented elephant trunk procedure). \u0000 \u0000 \u0000Results \u0000The follow-up time was (45.09±23.10) months. The mean age of patients undergoing OR or TEVAR was (44.80±20.57) years old, (45.93±11.01) years old; the mean operation time was(403.20±30.30) minutes, (105.72±27.76) minutes; the mean hospitalization (19.00±6.04), (5.76±3.08) days. There were no deaths in the two groups. 2 patients uundergoing TEVAR had left upper limb numbness. \u0000 \u0000 \u0000Conclusion \u0000The treatment of patients with TAI should be based on the general condition, the classification of injury, the involving regions and anatomical features to choose different treatments. In addition, the long-term prognosis of patients remains to be determined. \u0000 \u0000 \u0000Key words: \u0000Aortic disease; Trauma; Stented elephant trunk procedure; Thoracic aortic endovascular repair","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":"9 1","pages":"79-82"},"PeriodicalIF":0.0,"publicationDate":"2020-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75635769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-25DOI: 10.3760/CMA.J.ISSN.1001-4497.2020.02.002
Bing Liu, Shengli Jiang, Lin Zhang
Objective To study the clinical characteristics and surgical conditions of valve surgery in elderly patients over 75 years old. Methods Datas of patients over 75 years old with valve surgery in our hospital from January 2014 to January 2019 were retrospectively analyzed. 73 cases were analyzed, accounting for 5.3%(73/1 372) of the cardiac valve operations performed during the same period.There were 46 males and 27 females, with an average age of 77.35 years(75-88 years). The main diagnoses were MR 28 cases(38.3%), MS 8 cases(11.0%), AR 7 cases(9.6%), AS+ AR 7 cases(9.6%) and AS 6 cases (8.2%). There were 28 cases(38.4%) of MVR+ TVP, 20 cases(27.4%) of AVR, and 11 cases(15.1%) of MVR.Pacemakers were installed in 2 patients(2.7%) and coronary artery bypass grafting was performed in 14 patients(19.2%). Results There were statistically significant differences in left atrial end-diastolic diameter(LA), left ventricular end-diastolic diameter(LV), right atrial end-diastolic diameter(RA) and ejection fraction(EF) before and after surgery(P 0.05) in surgical interception time, extracorporeal circulation time, postoperative ventilator time, ICU time, surgical complications, postoperative liver and kidney functioninsufficiencyand mortality, as compared with 150 cases of valve surgery under 60 years old(P>0.05). Conclusion Mitral regurgitation is the most common valvular disease in senile patients over 75 years old, the cardiac structure is improved significantly after surgery, and the risk of surgery is the same as that in normal age groups. Therefore, valvular surgery issafe in elderly patients over 75 years old. Key words: Senile valve; Clinical characteristics; Surgery; Safety
{"title":"Clinical characteristics and safety of valvular surgery in elderly patients aged over 75 years","authors":"Bing Liu, Shengli Jiang, Lin Zhang","doi":"10.3760/CMA.J.ISSN.1001-4497.2020.02.002","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2020.02.002","url":null,"abstract":"Objective \u0000To study the clinical characteristics and surgical conditions of valve surgery in elderly patients over 75 years old. \u0000 \u0000 \u0000Methods \u0000Datas of patients over 75 years old with valve surgery in our hospital from January 2014 to January 2019 were retrospectively analyzed. 73 cases were analyzed, accounting for 5.3%(73/1 372) of the cardiac valve operations performed during the same period.There were 46 males and 27 females, with an average age of 77.35 years(75-88 years). The main diagnoses were MR 28 cases(38.3%), MS 8 cases(11.0%), AR 7 cases(9.6%), AS+ AR 7 cases(9.6%) and AS 6 cases (8.2%). There were 28 cases(38.4%) of MVR+ TVP, 20 cases(27.4%) of AVR, and 11 cases(15.1%) of MVR.Pacemakers were installed in 2 patients(2.7%) and coronary artery bypass grafting was performed in 14 patients(19.2%). \u0000 \u0000 \u0000Results \u0000There were statistically significant differences in left atrial end-diastolic diameter(LA), left ventricular end-diastolic diameter(LV), right atrial end-diastolic diameter(RA) and ejection fraction(EF) before and after surgery(P 0.05) in surgical interception time, extracorporeal circulation time, postoperative ventilator time, ICU time, surgical complications, postoperative liver and kidney functioninsufficiencyand mortality, as compared with 150 cases of valve surgery under 60 years old(P>0.05). \u0000 \u0000 \u0000Conclusion \u0000Mitral regurgitation is the most common valvular disease in senile patients over 75 years old, the cardiac structure is improved significantly after surgery, and the risk of surgery is the same as that in normal age groups. Therefore, valvular surgery issafe in elderly patients over 75 years old. \u0000 \u0000 \u0000Key words: \u0000Senile valve; Clinical characteristics; Surgery; Safety","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":"15 1","pages":"74-78"},"PeriodicalIF":0.0,"publicationDate":"2020-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73565962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Discovery of tracheal diverticulum using HRCT scan in patients with chronic cough: four cases report and literature review","authors":"Qi-Fu Guo, Min Zheng, Ye Xu, Wenliang Qian, Chen Zhu, Ning Wang, Wen Zhao, Jing Yang","doi":"10.3760/CMA.J.ISSN.1001-4497.2020.02.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2020.02.009","url":null,"abstract":"对2018年8月至2019年3月上海交通大学医学院附属同仁医院诊治的4例气管憩室导致慢性咳嗽患者的临床和病理资料进行分析，胸部高分辨HRCT检查显示，胸廓入口处气管旁右侧后壁的类圆形或不规则囊状或柱状气体影，连续横断薄层扫描或多平面重建等后处理技术发现气囊与气管之间无或有一较细的管道相连，气管镜检查均未见明显异常通道，术后病理报告示气管憩室。经颈部沿皮纹横弧形切口顺利切除气管憩室，术后慢性咳嗽症状消退，随访2～8个月，疗效满意。","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":"55 1","pages":"107-110"},"PeriodicalIF":0.0,"publicationDate":"2020-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74813294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To discuss whether balloon atrial septostomy(BAS) can provide safe and effective left ventricular venting for venoarterial extracorporeal membrane oxygenation(V-A ECMO). Methods From March 2017 to January 2019, 9 patients received BAS for left ventricular venting during V-A ECMO treatment in our hospital, including 5 males and 4 females, aged 12-72 years. There were 3 cases of severe myocarditis, 4 cases of low cardiac output after cardiac surgery, and 2 cases of acute myocardial infarction. Basic data, procedure data, outcome and follow-up were recorded. Results BAS were successfully performed in 9 patients. Procedure time on average was 42.2 min. Anterior mediastinal hematoma occurred in 1 case. There were no other procedure-related complications in the rest cases. No pulmonary edema or thrombosis occurred in all 9 cases during ECMO. No closure procedure was performed. Conclusion BAS is a safe and effective method for left ventricular venting. The procedure is conductive to the recovery of patients with severe left heart failure. Key words: Atrial septostomy; Transseptal puncture; Extracorporeal membrane oxygenation; Left ventricular venting
{"title":"Application of ballon atrial septostomy for left heart venting during extracorporeal membrane oxygenation","authors":"Dingyang Li, Gangcheng Zhang, Q. Shen, Yan Liu, Naiwen Cao, Yueting Zhou","doi":"10.3760/CMA.J.ISSN.1001-4497.2020.02.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2020.02.005","url":null,"abstract":"Objective \u0000To discuss whether balloon atrial septostomy(BAS) can provide safe and effective left ventricular venting for venoarterial extracorporeal membrane oxygenation(V-A ECMO). \u0000 \u0000 \u0000Methods \u0000From March 2017 to January 2019, 9 patients received BAS for left ventricular venting during V-A ECMO treatment in our hospital, including 5 males and 4 females, aged 12-72 years. There were 3 cases of severe myocarditis, 4 cases of low cardiac output after cardiac surgery, and 2 cases of acute myocardial infarction. Basic data, procedure data, outcome and follow-up were recorded. \u0000 \u0000 \u0000Results \u0000BAS were successfully performed in 9 patients. Procedure time on average was 42.2 min. Anterior mediastinal hematoma occurred in 1 case. There were no other procedure-related complications in the rest cases. No pulmonary edema or thrombosis occurred in all 9 cases during ECMO. No closure procedure was performed. \u0000 \u0000 \u0000Conclusion \u0000BAS is a safe and effective method for left ventricular venting. The procedure is conductive to the recovery of patients with severe left heart failure. \u0000 \u0000 \u0000Key words: \u0000Atrial septostomy; Transseptal puncture; Extracorporeal membrane oxygenation; Left ventricular venting","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":"99 41 1","pages":"89-93"},"PeriodicalIF":0.0,"publicationDate":"2020-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85744252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-25DOI: 10.3760/CMA.J.ISSN.1001-4497.2020.02.004
Chuan Wang, Tongxun Li, Fan Zhang, C. Gu, Jing-xing Li
Objective To explore the outcomes and mechanisms of coronary endarterectomy combined with electrocautery in patients with diffused coronary artery disease undergoing coronary artery bypass grafting (CABG). Methods From January 2017 to September 2018, 300 patients undergoing CABG with left anterior descending artery endarterectomy were randomly divided into two groups, after fully informed the risks and other related issues regarding the operations. All the patients in the two groups were treated with CABG. In the study group, patients underwent electrocautery immediately after endarterectomy, whereas in the control group, patients underwent endarterectomy only. The electrocardiogram and serological examination (TNI, IL-6 and TNF-a) were performed at 2 h, 24 h, 72 h and 120 h after operation. The follow-up duration was 1 year. Results Nine patients in the study group, and 25 patients in the control group had ST segment elevation. The levels of TNI, IL-6 and TNF-a were continuously increased in both groups, and reached the peak at 24 h, then decreased slowly. The levels of TNF-a were significantly lower at 2 h postoperatively in the study group (P=0.01). There was no significant difference in the levels of TNI and IL-6 between the two groups. The levels of TNI, TNF-a and IL-6 were significantly lower in the electrocautery group at 24 h, 72 h, and 120 h after operation(P<0.05). One year after operation, incidences of ST segment elevation in the study group were significantly lower than that in the control group, and there was no significant difference in restenosis rate and myocardial infarction rate. Conclusion Endarterectomy combined with electrocautery may prevent the restenosis of the lumen and blood turbulence, smooth the inner wall of the vessel, slow down the release of inflammatory factors in the peripheral blood, inhibit the expression of inflammatory factors in the vessels, and reduce the myocardial damage. The short-term effect was satisfactory; the long-term anti-inflammatory and antithrombotic effect still need further investigations. Key words: Endarterectomy; Electrocautery; Inflammatory response; Thrombosis
目的探讨弥漫性冠状动脉病变行冠状动脉搭桥术(CABG)患者行冠状动脉内膜切除术联合电切术的疗效及机制。方法选取2017年1月至2018年9月行CABG合并左前降支内膜切除术的300例患者，在充分告知手术风险及相关问题后，随机分为两组。两组患者均行冠脉搭桥治疗。在研究组中，患者在动脉内膜切除术后立即进行电灼，而在对照组中，患者仅进行动脉内膜切除术。分别于术后2 h、24 h、72 h、120 h进行心电图和血清学检查(TNI、IL-6、TNF-a)。随访时间为1年。结果研究组9例，对照组25例出现ST段抬高。两组TNI、IL-6、TNF-a水平均持续升高，并在24 h达到峰值，随后缓慢下降。研究组术后2 h TNF-a水平明显低于对照组(P=0.01)。两组间TNI和IL-6水平无显著差异。电灼组患者术后24 h、72 h、120 h TNI、TNF-a、IL-6水平均显著低于对照组(P<0.05)。术后1年研究组ST段抬高发生率明显低于对照组，再狭窄率和心肌梗死率差异无统计学意义。结论电切联合动脉内膜切除术可防止管腔再狭窄和血流动荡，使血管内壁光滑，减缓外周血中炎症因子的释放，抑制血管中炎症因子的表达，减轻心肌损伤。短期效果令人满意;其长期抗炎和抗血栓作用仍需进一步研究。关键词:动脉内膜切除术;电烙术;炎症反应;血栓形成
{"title":"Study on the coronary endarterectomy combined with electrocautery in the treatment of diffuse coronary artery disease","authors":"Chuan Wang, Tongxun Li, Fan Zhang, C. Gu, Jing-xing Li","doi":"10.3760/CMA.J.ISSN.1001-4497.2020.02.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2020.02.004","url":null,"abstract":"Objective To explore the outcomes and mechanisms of coronary endarterectomy combined with electrocautery in patients with diffused coronary artery disease undergoing coronary artery bypass grafting (CABG). Methods From January 2017 to September 2018, 300 patients undergoing CABG with left anterior descending artery endarterectomy were randomly divided into two groups, after fully informed the risks and other related issues regarding the operations. All the patients in the two groups were treated with CABG. In the study group, patients underwent electrocautery immediately after endarterectomy, whereas in the control group, patients underwent endarterectomy only. The electrocardiogram and serological examination (TNI, IL-6 and TNF-a) were performed at 2 h, 24 h, 72 h and 120 h after operation. The follow-up duration was 1 year. Results Nine patients in the study group, and 25 patients in the control group had ST segment elevation. The levels of TNI, IL-6 and TNF-a were continuously increased in both groups, and reached the peak at 24 h, then decreased slowly. The levels of TNF-a were significantly lower at 2 h postoperatively in the study group (P=0.01). There was no significant difference in the levels of TNI and IL-6 between the two groups. The levels of TNI, TNF-a and IL-6 were significantly lower in the electrocautery group at 24 h, 72 h, and 120 h after operation(P<0.05). One year after operation, incidences of ST segment elevation in the study group were significantly lower than that in the control group, and there was no significant difference in restenosis rate and myocardial infarction rate. Conclusion Endarterectomy combined with electrocautery may prevent the restenosis of the lumen and blood turbulence, smooth the inner wall of the vessel, slow down the release of inflammatory factors in the peripheral blood, inhibit the expression of inflammatory factors in the vessels, and reduce the myocardial damage. The short-term effect was satisfactory; the long-term anti-inflammatory and antithrombotic effect still need further investigations. Key words: Endarterectomy; Electrocautery; Inflammatory response; Thrombosis","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":"278 1","pages":"83-88"},"PeriodicalIF":0.0,"publicationDate":"2020-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76820563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：