Background: Pulmonary hypertensive crisis (PHC) is a serious life-threatening complication in children with congenital heart disease (CHD) after surgery, with acute onset and high mortality. However, there is still no effective means to deal with this complication. Therefore, our department developed the left atrium and right ventricle duct bridging technique to treat children with PHC, and compare its effects with conventional methods of treatment to determine the best solution for dealing with this complication. Methods: A retrospective analysis of 41 children with CHD surgery and postoperative PHC in our hospital from January 2015 to December 2022 was performed. According to the rescue method, the group with conventional therapy combined with left atrium to right ventricle duct bridging treatment vs. simple conventional therapy were defined as group A and group B respectively, with 13 cases and 28 cases in each group. The success rate of rescue, the complication rate, the length of intensive care unit stay, the delayed chest closure duration, the duration of PHC, the ratio of pulmonary circulation/systemic circulation pressure, the oxygenation index and the cardiac index at 30 min, 1 h, 2 h, 4 h and 6 h after rescue were compared between the two groups. Results: There was a higher success rate of rescue (84.62% vs. 68.86%; p > 0.05), lower complication rate (15.38% vs. 21.43%; p > 0.05), shorter duration of PHC (6.77 ± 2.13 min vs. 13.07 ± 4.05 min; p = 0.000), shorter duration of delayed sternal closure (32.23 ± 5.46 h vs. 38.14 ± 8.61 h; p = 0.029) and shorter length of ICU stay (81.69 ± 8.31 h vs. 93.57 ± 16.84 h; p = 0.021) in group A; After the rescue, the pulmonary artery pressure and cardiopulmonary function recovery rate in group A were faster than those in group B. Conclusions: In conclusion, left atrial to right ventricular duct bridging therapy is more effective in the treatment of PHC after surgery for CHD.
背景：肺动脉高压危象（PHC）是先天性心脏病（CHD）患儿术后危及生命的严重并发症，发病急、死亡率高。然而，目前仍没有有效的方法来应对这一并发症。因此，我科开展了左心房和右心室管道桥接技术来治疗先天性心脏病患儿，并将其效果与常规治疗方法进行比较，以确定处理该并发症的最佳方案。方法：对2015年1月至2022年12月在我院接受CHD手术并术后出现PHC的41例患儿进行回顾性分析。根据抢救方法，将常规治疗联合左心房至右心室管道桥接治疗组与单纯常规治疗组分别定义为A组和B组，每组各13例和28例。比较两组抢救成功率、并发症发生率、重症监护室住院时间、延迟闭胸时间、PHC持续时间、抢救后30 min、1 h、2 h、4 h和6 h的肺循环/体循环压力比值、氧合指数和心脏指数。结果显示抢救成功率更高（84.62% vs. 68.86%；P > 0.05），并发症发生率更低（15.38% vs. 21.43%；P > 0.05），PHC持续时间更短（6.77 ± 2.13 min vs. 13.07 ± 4.05 min；P = 0.000），延迟胸骨闭合持续时间更短（32.23 ± 5.46 h vs. 38.14 ± 8.61 h；P = 0.000）。抢救后，A 组的肺动脉压和心肺功能恢复速度快于 B 组：总之，左心房至右心室管道桥接疗法在治疗先天性心脏病术后的肺动脉高压中更为有效。
{"title":"Comparative Analysis of Treatment Strategies for Postoperative Pulmonary Hypertensive Crisis in Congenital Heart Disease","authors":"Hailong Song, Lijing Cao, Xugang Wang, Huijun Zhang","doi":"10.59958/hsf.7621","DOIUrl":"https://doi.org/10.59958/hsf.7621","url":null,"abstract":"Background: Pulmonary hypertensive crisis (PHC) is a serious life-threatening complication in children with congenital heart disease (CHD) after surgery, with acute onset and high mortality. However, there is still no effective means to deal with this complication. Therefore, our department developed the left atrium and right ventricle duct bridging technique to treat children with PHC, and compare its effects with conventional methods of treatment to determine the best solution for dealing with this complication. Methods: A retrospective analysis of 41 children with CHD surgery and postoperative PHC in our hospital from January 2015 to December 2022 was performed. According to the rescue method, the group with conventional therapy combined with left atrium to right ventricle duct bridging treatment vs. simple conventional therapy were defined as group A and group B respectively, with 13 cases and 28 cases in each group. The success rate of rescue, the complication rate, the length of intensive care unit stay, the delayed chest closure duration, the duration of PHC, the ratio of pulmonary circulation/systemic circulation pressure, the oxygenation index and the cardiac index at 30 min, 1 h, 2 h, 4 h and 6 h after rescue were compared between the two groups. Results: There was a higher success rate of rescue (84.62% vs. 68.86%; p > 0.05), lower complication rate (15.38% vs. 21.43%; p > 0.05), shorter duration of PHC (6.77 ± 2.13 min vs. 13.07 ± 4.05 min; p = 0.000), shorter duration of delayed sternal closure (32.23 ± 5.46 h vs. 38.14 ± 8.61 h; p = 0.029) and shorter length of ICU stay (81.69 ± 8.31 h vs. 93.57 ± 16.84 h; p = 0.021) in group A; After the rescue, the pulmonary artery pressure and cardiopulmonary function recovery rate in group A were faster than those in group B. Conclusions: In conclusion, left atrial to right ventricular duct bridging therapy is more effective in the treatment of PHC after surgery for CHD.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"86 26","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141664731","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: This study aimed to evaluate the predictive efficacy of the echocardiography-derived Tei index for the occurrence of major adverse cardiovascular events (MACE) within 1 year post-percutaneous coronary intervention (PCI) in patients with coronary heart disease (CHD). Methods: A total of 98 patients diagnosed with CHD and admitted to our hospital between January 2021 and May 2023 were retrospectively selected for this study, and the two groups were divided into good prognosis group (n = 67) and poor prognosis group (n = 31) according to whether cardiovascular adverse events occurred within 1 year after PCI. Univariate and multivariate logistic regression analyses were conducted to identify the influencing factors of adverse cardiovascular events in patients with CHD following PCI, and receiver operating characteristic (ROC) analysis was employed to evaluate the efficacy of myocardial performance index measured by echocardiography in predicting adverse cardiovascular events within 1 year post-PCI in patients with CHD. The inflammatory factors of patients with different Tei indices were compared before and 24 h after PCI. Results: The differences in general data, including preoperative Tei index, left anterior descending (LAD) level, left ventricular diameter in diastole (LVDd) level, and the number of cases with left ventricular outflow tract obstruction, were not statistically significant between two groups (p > 0.05). Left ventricular ejection fraction (LVEF), maximum left ventricular thickness, postoperative Tei index, plaque score, and carotid intima–media thickness (IMT) showed statistically significant differences (p < 0.05). The findings from logistic regression analysis, considering multiple factors, indicated that Tei index, plaque score, and carotid IMT were independent predictors for adverse cardiovascular events following PCI in patients with CHD (p < 0.05). ROC analysis demonstrated an impressive area under the curve of 0.967 for echocardiographic assessment of myocardial performance index as a predictor for adverse cardiovascular events within 1 year after PCI in patients with CHD. The standard error was 0.017, 95% confidence interval was 0.935–0.999, optimal cut-off value was 0.88, sensitivity was 95.0%, and specificity was 93.3%. The comparison of inflammatory factors among patients with different Tei index values before PCI did not yield any statistically significant differences (p > 0.05), and the comparison of inflammatory factors in patients with different Tei index 24 h after PCI. The levels of inflammatory cytokines in patients with Tei ≤0.5 were lower than those in patients with Tei >0.5 (p < 0.05). Conclusion: Evaluating the myocardial performance index through echocardiography holds considerable value in predicting MACE within one year following PCI in patients diagnosed with CHD.
{"title":"Value of Echocardiographic Evaluation of Myocardial Performance Index in Predicting Major Adverse Cardiovascular Events Within 1 Year after Percutaneous Coronary Intervention in Patients with Coronary Heart Disease","authors":"Junfang Yang, Fangwei You, Jinglei Wang","doi":"10.59958/hsf.7493","DOIUrl":"https://doi.org/10.59958/hsf.7493","url":null,"abstract":"Objective: This study aimed to evaluate the predictive efficacy of the echocardiography-derived Tei index for the occurrence of major adverse cardiovascular events (MACE) within 1 year post-percutaneous coronary intervention (PCI) in patients with coronary heart disease (CHD). Methods: A total of 98 patients diagnosed with CHD and admitted to our hospital between January 2021 and May 2023 were retrospectively selected for this study, and the two groups were divided into good prognosis group (n = 67) and poor prognosis group (n = 31) according to whether cardiovascular adverse events occurred within 1 year after PCI. Univariate and multivariate logistic regression analyses were conducted to identify the influencing factors of adverse cardiovascular events in patients with CHD following PCI, and receiver operating characteristic (ROC) analysis was employed to evaluate the efficacy of myocardial performance index measured by echocardiography in predicting adverse cardiovascular events within 1 year post-PCI in patients with CHD. The inflammatory factors of patients with different Tei indices were compared before and 24 h after PCI. Results: The differences in general data, including preoperative Tei index, left anterior descending (LAD) level, left ventricular diameter in diastole (LVDd) level, and the number of cases with left ventricular outflow tract obstruction, were not statistically significant between two groups (p > 0.05). Left ventricular ejection fraction (LVEF), maximum left ventricular thickness, postoperative Tei index, plaque score, and carotid intima–media thickness (IMT) showed statistically significant differences (p < 0.05). The findings from logistic regression analysis, considering multiple factors, indicated that Tei index, plaque score, and carotid IMT were independent predictors for adverse cardiovascular events following PCI in patients with CHD (p < 0.05). ROC analysis demonstrated an impressive area under the curve of 0.967 for echocardiographic assessment of myocardial performance index as a predictor for adverse cardiovascular events within 1 year after PCI in patients with CHD. The standard error was 0.017, 95% confidence interval was 0.935–0.999, optimal cut-off value was 0.88, sensitivity was 95.0%, and specificity was 93.3%. The comparison of inflammatory factors among patients with different Tei index values before PCI did not yield any statistically significant differences (p > 0.05), and the comparison of inflammatory factors in patients with different Tei index 24 h after PCI. The levels of inflammatory cytokines in patients with Tei ≤0.5 were lower than those in patients with Tei >0.5 (p < 0.05). Conclusion: Evaluating the myocardial performance index through echocardiography holds considerable value in predicting MACE within one year following PCI in patients diagnosed with CHD.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"28 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141836005","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: This study aimed to explore the effect of early cardiac recovery training on the cardiac function and life quality of elderly patients undergoing coronary artery bypass grafting (CABG). Methods: Elderly patients who underwent CABG in our hospital from January 2022 to November 2023 were selected as the subjects, and their clinical data were retrospectively analyzed. In accordance with the different rehabilitation intervention methods of the patients, they were separated into control group (C group) and research group (R group). The C group received conventional rehabilitation intervention, and the R Group received early cardiac recovery training intervention. The cardiac function indices and quality of life of the two groups were compared at baseline (T1) at admission, 1 day before surgery (T2), 7 days after surgery (T3), and 30 days after surgery (T4). Results: At T2 and T4, the left ventricular ejection fraction (LVEF) levels and 6-min walking test (6-MWT) of the C and R groups were sharply higher than those at T1 (p < 0.05). At T3, the LVEF levels and 6-MWT distance of both groups were sharply lower than those at T1 (p < 0.05). Compared with the levels at T3, the LVEF levels; the 6-MWT; and the global, physical, emotional, and social levels of the C and R groups at T2 and T4 significantly increased (p < 0.05). At T1, the LVEF level; the 6-MWT; and the global, physical, emotional, and social levels of the C group was not statistically significant compared with those of the R group (p > 0.05). At T2, T3, and T4, the LVEF levels; the 6-MWT; and the global, physical, emotional, and social levels of the R group were sharply higher than those of the C group (p < 0.05). Conclusion: Early cardiac recovery training can effectively ameliorate the cardiac function and improve the quality of life of elderly patients undergoing CABG.
{"title":"Effects of Early Cardiac Rehabilitation Training on Cardiac Function and Quality of Life in Elderly Patients Undergoing Coronary Artery Bypass Grafting: A Retrospective Study","authors":"Linzhong Zhang, Meng Wang, Hui Song","doi":"10.59958/hsf.7281","DOIUrl":"https://doi.org/10.59958/hsf.7281","url":null,"abstract":"Objective: This study aimed to explore the effect of early cardiac recovery training on the cardiac function and life quality of elderly patients undergoing coronary artery bypass grafting (CABG). Methods: Elderly patients who underwent CABG in our hospital from January 2022 to November 2023 were selected as the subjects, and their clinical data were retrospectively analyzed. In accordance with the different rehabilitation intervention methods of the patients, they were separated into control group (C group) and research group (R group). The C group received conventional rehabilitation intervention, and the R Group received early cardiac recovery training intervention. The cardiac function indices and quality of life of the two groups were compared at baseline (T1) at admission, 1 day before surgery (T2), 7 days after surgery (T3), and 30 days after surgery (T4). Results: At T2 and T4, the left ventricular ejection fraction (LVEF) levels and 6-min walking test (6-MWT) of the C and R groups were sharply higher than those at T1 (p < 0.05). At T3, the LVEF levels and 6-MWT distance of both groups were sharply lower than those at T1 (p < 0.05). Compared with the levels at T3, the LVEF levels; the 6-MWT; and the global, physical, emotional, and social levels of the C and R groups at T2 and T4 significantly increased (p < 0.05). At T1, the LVEF level; the 6-MWT; and the global, physical, emotional, and social levels of the C group was not statistically significant compared with those of the R group (p > 0.05). At T2, T3, and T4, the LVEF levels; the 6-MWT; and the global, physical, emotional, and social levels of the R group were sharply higher than those of the C group (p < 0.05). Conclusion: Early cardiac recovery training can effectively ameliorate the cardiac function and improve the quality of life of elderly patients undergoing CABG.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":" 686","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141669523","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}
Amin Tjubandi, T. W. Soetisna, AmilianaMardiani Soesanto, Renan Sukmawan, S. Supomo, B. Setianto, Woro Ayu Sekararum, M. Mansyur
Background: The current study was done to assess the efficacy and safety of the island flap rotation technique as a novel method for severe mitral valve regurgitation. Methods: Twenty-three patients were selected to undergo mitral valve repair with the island flap rotational technique. It takes the principle of doing quadrangular resection of the P2 leaflet and flipping the dissected area so that the ruptured primary chordae are replaced with the secondary or tertiary chordae. Transesophageal echocardiography parameters were evaluated before surgery and 1 week after surgery, just prior to discharge. Results: The procedure was done successfully with 100% mitral regurgitation reduction to ≤1+ along with significantly reduced left ventricular end-diastolic diameter (p = 0.001) and left atrial dimension (p = 0.000). The left ventricular ejection fraction was significantly reduced after the procedure (p = 0.000). Older age significantly affects the presence of residual mitral regurgitation (p = 0.02). No thromboembolic adverse events and mortality were observed during the 3-month follow-up. Conclusions: The use of island flap rotation technique as a novel method for severe mitral regurgitation with P2 lesions has been proven to be effective and safe with preserving the valve tissue.
{"title":"Island Flap Rotation Technique as a Novel Repair Surgery Method for Severe Degenerative Mitral Valve Regurgitation","authors":"Amin Tjubandi, T. W. Soetisna, AmilianaMardiani Soesanto, Renan Sukmawan, S. Supomo, B. Setianto, Woro Ayu Sekararum, M. Mansyur","doi":"10.59958/hsf.7471","DOIUrl":"https://doi.org/10.59958/hsf.7471","url":null,"abstract":"Background: The current study was done to assess the efficacy and safety of the island flap rotation technique as a novel method for severe mitral valve regurgitation. Methods: Twenty-three patients were selected to undergo mitral valve repair with the island flap rotational technique. It takes the principle of doing quadrangular resection of the P2 leaflet and flipping the dissected area so that the ruptured primary chordae are replaced with the secondary or tertiary chordae. Transesophageal echocardiography parameters were evaluated before surgery and 1 week after surgery, just prior to discharge. Results: The procedure was done successfully with 100% mitral regurgitation reduction to ≤1+ along with significantly reduced left ventricular end-diastolic diameter (p = 0.001) and left atrial dimension (p = 0.000). The left ventricular ejection fraction was significantly reduced after the procedure (p = 0.000). Older age significantly affects the presence of residual mitral regurgitation (p = 0.02). No thromboembolic adverse events and mortality were observed during the 3-month follow-up. Conclusions: The use of island flap rotation technique as a novel method for severe mitral regurgitation with P2 lesions has been proven to be effective and safe with preserving the valve tissue.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":" 874","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141669171","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}
Yu-Chuz Zhang, Zheng Wu, Shaoping Wang, Jinghua Liu
Background: The in-hospital outcomes of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with left ventricular systolic dysfunction (LVSD) and chronic total occlusion (CTO) remain unclear. Methods: From 2014 to 2020, patients with LVSD and CTO who underwent PCI or CABG were collected. The primary endpoint was in-hospital major adverse cardiac or cerebrovascular events (MACCE), defined as the composite of all-cause mortality, cardiovascular mortality, stroke, myocardial infarction (MI), and target vessel revascularization. Inverse probability of treatment weighting (IPTW) was performed to evaluate the association between revascularization strategies and in-hospital outcomes. The hazard ratio (HR) and 95% confidence interval (CI) were calculated using the Cox proportional hazards model. Results: Of the 773 patients who met the inclusion criteria, 543 (70.2%) underwent PCI, and 230 (29.8%) underwent CABG. The primary endpoint was observed in 25 (3.2%) patients. The incidence of in-hospital MACCE (6.5% vs. 1.8%, p < 0.001) was significantly higher in the CABG group than in the PCI group. After IPTW, the risk of in-hospital MACCE was not found to be significantly different between CABG and PCI groups (HR = 1.81; 95% CI: 0.37–8.82; p = 0.460). Compared with patients who underwent PCI, those who underwent CABG exhibited a significantly higher risk of MI (HR = 6.92; 95% CI: 1.24–38.60; p = 0.027). Conclusions: Patients with LVSD and CTO could experience better outcomes with PCI, which offers a safer alternative coronary revascularization strategy and a reduced risk of MI.
{"title":"In-Hospital Outcomes of Revascularization in Patients with Left Ventricular Systolic Dysfunction and Coronary Chronic Total Occlusion","authors":"Yu-Chuz Zhang, Zheng Wu, Shaoping Wang, Jinghua Liu","doi":"10.59958/hsf.7637","DOIUrl":"https://doi.org/10.59958/hsf.7637","url":null,"abstract":"Background: The in-hospital outcomes of percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with left ventricular systolic dysfunction (LVSD) and chronic total occlusion (CTO) remain unclear. Methods: From 2014 to 2020, patients with LVSD and CTO who underwent PCI or CABG were collected. The primary endpoint was in-hospital major adverse cardiac or cerebrovascular events (MACCE), defined as the composite of all-cause mortality, cardiovascular mortality, stroke, myocardial infarction (MI), and target vessel revascularization. Inverse probability of treatment weighting (IPTW) was performed to evaluate the association between revascularization strategies and in-hospital outcomes. The hazard ratio (HR) and 95% confidence interval (CI) were calculated using the Cox proportional hazards model. Results: Of the 773 patients who met the inclusion criteria, 543 (70.2%) underwent PCI, and 230 (29.8%) underwent CABG. The primary endpoint was observed in 25 (3.2%) patients. The incidence of in-hospital MACCE (6.5% vs. 1.8%, p < 0.001) was significantly higher in the CABG group than in the PCI group. After IPTW, the risk of in-hospital MACCE was not found to be significantly different between CABG and PCI groups (HR = 1.81; 95% CI: 0.37–8.82; p = 0.460). Compared with patients who underwent PCI, those who underwent CABG exhibited a significantly higher risk of MI (HR = 6.92; 95% CI: 1.24–38.60; p = 0.027). Conclusions: Patients with LVSD and CTO could experience better outcomes with PCI, which offers a safer alternative coronary revascularization strategy and a reduced risk of MI.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"119 52","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141666543","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}
We present a rare case of lipomatous hypertrophy of the atrial septum (LHAS) characterized by the abnormal accumulation of adipose tissue within the interatrial septum, forming a tumor-like mass. The reported incidence of LHAS is 2.2–8%, with advancements in imaging techniques expanding diagnostic opportunities. A 75-year-old female with a history of meningioma, right breast cancer, cholecystolithiasis, and ovarian cyst; comorbidities, including diabetes, hypertension, and hyperlipidemia; and a body mass index of 33 kg/m2 underwent resection for an enlarging interatrial septal tumor, ultimately leading to the diagnosis of LHAS. Imaging revealed a 36 mm × 28 mm tumor extending from the atrial septum into the right atrium, with a computed tomography value of –76 HU. Histopathologically, the tumor was mainly composed of mature adipocytes along with hypertrophied myocardial fibers and scattered brown adipocytes, confirming the diagnosis of LHAS. Although LHAS is often managed with observation following diagnosis, our report on surgical intervention presents a rare and noteworthy occurrence. This case highlights the importance of recognizing and addressing the rare occurrence of LHAS, which often requires surgical intervention in cases of tumor enlargement. The successful resection and diagnosis of LHAS in this patient underscore the importance of considering this condition in the differential diagnosis of cardiac tumors.
{"title":"A Surgical Case of Lipomatous Hypertrophy of the Atrial Septum","authors":"Masato Hayakawa, Yuka Higuma, Akira Hirata, Maki Ogawa, R. Ikemura, Satoshi Yamashiro, Kiyoshi Iha","doi":"10.59958/hsf.7055","DOIUrl":"https://doi.org/10.59958/hsf.7055","url":null,"abstract":"We present a rare case of lipomatous hypertrophy of the atrial septum (LHAS) characterized by the abnormal accumulation of adipose tissue within the interatrial septum, forming a tumor-like mass. The reported incidence of LHAS is 2.2–8%, with advancements in imaging techniques expanding diagnostic opportunities. A 75-year-old female with a history of meningioma, right breast cancer, cholecystolithiasis, and ovarian cyst; comorbidities, including diabetes, hypertension, and hyperlipidemia; and a body mass index of 33 kg/m2 underwent resection for an enlarging interatrial septal tumor, ultimately leading to the diagnosis of LHAS. Imaging revealed a 36 mm × 28 mm tumor extending from the atrial septum into the right atrium, with a computed tomography value of –76 HU. Histopathologically, the tumor was mainly composed of mature adipocytes along with hypertrophied myocardial fibers and scattered brown adipocytes, confirming the diagnosis of LHAS. Although LHAS is often managed with observation following diagnosis, our report on surgical intervention presents a rare and noteworthy occurrence. This case highlights the importance of recognizing and addressing the rare occurrence of LHAS, which often requires surgical intervention in cases of tumor enlargement. The successful resection and diagnosis of LHAS in this patient underscore the importance of considering this condition in the differential diagnosis of cardiac tumors.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":" 56","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141670853","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}
H. Ko, K. Lee, Yochun Jung, In Seok Jeong, Sang Yun Song, S. Oh, K. Na
Coronary artery vasospasm during non-coronary artery surgeries is an extremely rare but potentially life-threatening event. Diagnosing coronary artery vasospasm during surgery is particularly challenging, and identifying the underlying etiology is even more challenging. Herein, we present a case of coronary artery vasospasm that occurred during cardiac tumor resection in a patient who had recently undergone percutaneous coronary intervention for acute ST-elevation myocardial infarction.
{"title":"Intraoperative Coronary Artery Vasospasm Mimicking Acute Coronary Stent Thrombosis: A Case Report","authors":"H. Ko, K. Lee, Yochun Jung, In Seok Jeong, Sang Yun Song, S. Oh, K. Na","doi":"10.59958/hsf.6873","DOIUrl":"https://doi.org/10.59958/hsf.6873","url":null,"abstract":"Coronary artery vasospasm during non-coronary artery surgeries is an extremely rare but potentially life-threatening event. Diagnosing coronary artery vasospasm during surgery is particularly challenging, and identifying the underlying etiology is even more challenging. Herein, we present a case of coronary artery vasospasm that occurred during cardiac tumor resection in a patient who had recently undergone percutaneous coronary intervention for acute ST-elevation myocardial infarction.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":" 26","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141671025","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}
Umran Karaca, B. Ozyaprak, T. Onur, A. Onur, A. Balkaya, G. Erkan, Mesut Engin
Objective: We sough to evaluate the effects of cardiopulmonary bypass (CPB) on the intracranial area using ultrasound-guided optic nerve sheath diameter (ONSD), a noninvasive and easy to use technique. Methods: We prospectively studied 67 patients aged 18–80. Ultrasound (USG) measured the ONSD of the patients, and the threshold ONSD was accepted as 5.5 mm. Patients were divided into two groups according to ONSD during CPB. Group 1: ONSD less than 5.5 mm, and Group 2: ONSD at or greater than 5.5 mm. Demographic data, comorbidities, intraoperative and postoperative findings, and complications were recorded. Results: There was no difference between the groups regarding demographic data and comorbidities (p > 0.05). The amount of fresh frozen plasma and erythrocyte suspension transfusions were statistically significantly higher in Group 2 (p < 0.05). Bleeding between the groups, intravenous fluid administered, and urine output were higher in Group 2 but was not statistically significant. There was no statistical difference in the mean extubation time, intensive care and hospital stay, and postoperative complications between the groups (p > 0.05). There was no mortality in Group 1, but two patients in Group 2 died. A statistically significant increase on ONSD was observed in Group 2 compared to Group 1 (p < 0.001). Conclusion: We observed that the increase in ONSD was greater in open heart surgeries that required increased blood and blood product transfusion. However, prospective studies are needed to investigate its clinical effects.
{"title":"Investigation of the Effect of Cardiopulmonary Bypass on Optic Nerve Sheath Diameter","authors":"Umran Karaca, B. Ozyaprak, T. Onur, A. Onur, A. Balkaya, G. Erkan, Mesut Engin","doi":"10.59958/hsf.7499","DOIUrl":"https://doi.org/10.59958/hsf.7499","url":null,"abstract":"Objective: We sough to evaluate the effects of cardiopulmonary bypass (CPB) on the intracranial area using ultrasound-guided optic nerve sheath diameter (ONSD), a noninvasive and easy to use technique. Methods: We prospectively studied 67 patients aged 18–80. Ultrasound (USG) measured the ONSD of the patients, and the threshold ONSD was accepted as 5.5 mm. Patients were divided into two groups according to ONSD during CPB. Group 1: ONSD less than 5.5 mm, and Group 2: ONSD at or greater than 5.5 mm. Demographic data, comorbidities, intraoperative and postoperative findings, and complications were recorded. Results: There was no difference between the groups regarding demographic data and comorbidities (p > 0.05). The amount of fresh frozen plasma and erythrocyte suspension transfusions were statistically significantly higher in Group 2 (p < 0.05). Bleeding between the groups, intravenous fluid administered, and urine output were higher in Group 2 but was not statistically significant. There was no statistical difference in the mean extubation time, intensive care and hospital stay, and postoperative complications between the groups (p > 0.05). There was no mortality in Group 1, but two patients in Group 2 died. A statistically significant increase on ONSD was observed in Group 2 compared to Group 1 (p < 0.001). Conclusion: We observed that the increase in ONSD was greater in open heart surgeries that required increased blood and blood product transfusion. However, prospective studies are needed to investigate its clinical effects.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":" 31","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141670954","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}
Background: To examine the correlation between the preoperative elevated aspartate aminotransferase (AST)/alanine transaminase (ALT) (De Ritis) ratio and the drainage volume in patients after aortic arch surgery. Methods: This retrospective cohort study was conducted from January 2017 to December 2018. The exposure factor was the preoperative AST/ALT ratio and the primary outcome was the total amount of the drainage volume. The optimal AST/ALT ratio cutoff value was determined by the maximum Youden index. Accordingly, we defined the ratio ≥0.92 as a high AST/ALT ratio and <0.92 as a low AST/ALT ratio. Based on the median drainage volume of all participants, we dichotomized the study population: patients with a total drainage volume of 1670 mL or more were classified into high-output group (HOPG) and the remaining patients were classified into the low-output group (LOPG). Univariable and multivariable logistic regression analyses were conducted to investigate the correlation between the elevated AST/ALT ratio and drainage volume. Results: 425 participants were enrolled. 213 participants were divided into the LOPG and the others were in the HOPG. 244 participants were divided into the low AST/ALT ratio group. In the univariable logistic regression analysis, the odds ratio (OR) and 95% condifence interval (CI) for the large drainage volume in participants with elevated AST/ALT ratio were 1.810 and 1.226–2.670 (p = 0.003). After adjustments with the confounders, multivariable logistic regression analysis showed an elevated AST/ALT ratio was significantly associated with the total amount of drainage volume (OR = 1.725, 95% CI 1.115–2.669, p = 0.014). Conclusions: Preoperative elevated AST/ALT ratio is an independent risk factor for the pericardial and mediastinal drainage volume in patients undergoing aortic arch surgery. It might represent a novel marker for individual risk assessment for cardiac surgery.
{"title":"Elevated AST/ALT (De Ritis) Ratio is a Risk Factor of Drainage Volume after Aortic Arch Surgery","authors":"Wei-Cheng Yan, Qiaoni Zhang, Tianlong Wang, Jing Sun, Xiangyang Qian, Bingyang Ji","doi":"10.59958/hsf.6933","DOIUrl":"https://doi.org/10.59958/hsf.6933","url":null,"abstract":"Background: To examine the correlation between the preoperative elevated aspartate aminotransferase (AST)/alanine transaminase (ALT) (De Ritis) ratio and the drainage volume in patients after aortic arch surgery. Methods: This retrospective cohort study was conducted from January 2017 to December 2018. The exposure factor was the preoperative AST/ALT ratio and the primary outcome was the total amount of the drainage volume. The optimal AST/ALT ratio cutoff value was determined by the maximum Youden index. Accordingly, we defined the ratio ≥0.92 as a high AST/ALT ratio and <0.92 as a low AST/ALT ratio. Based on the median drainage volume of all participants, we dichotomized the study population: patients with a total drainage volume of 1670 mL or more were classified into high-output group (HOPG) and the remaining patients were classified into the low-output group (LOPG). Univariable and multivariable logistic regression analyses were conducted to investigate the correlation between the elevated AST/ALT ratio and drainage volume. Results: 425 participants were enrolled. 213 participants were divided into the LOPG and the others were in the HOPG. 244 participants were divided into the low AST/ALT ratio group. In the univariable logistic regression analysis, the odds ratio (OR) and 95% condifence interval (CI) for the large drainage volume in participants with elevated AST/ALT ratio were 1.810 and 1.226–2.670 (p = 0.003). After adjustments with the confounders, multivariable logistic regression analysis showed an elevated AST/ALT ratio was significantly associated with the total amount of drainage volume (OR = 1.725, 95% CI 1.115–2.669, p = 0.014). Conclusions: Preoperative elevated AST/ALT ratio is an independent risk factor for the pericardial and mediastinal drainage volume in patients undergoing aortic arch surgery. It might represent a novel marker for individual risk assessment for cardiac surgery.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"197 s673","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138995041","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}
Background: This study aimed to select anesthesia-induced zinc finger protein-related gene biomarkers that predict cardiovascular function during off-pump coronary artery bypass grafting (OPCABG). Methods: Gene expression data from GSE4386 included 20 post-anesthesia and 20 pre-anesthesia atrial tissue samples. Zinc finger protein-related genes (ZFPRGs) were searched in the UniProt database and anesthesia-induced differentially expressed genes (DEGs) were identified Weighted gene co-expression network analysis (WGCNA) was used to screen hub genes, and three machine learning algorithms were used to further screen for cardiovascular biomarkers. Diagnostic accuracy was evaluated using a nomogram model. Gene set enrichment analysis was used to analyze the pathways enriched by the biomarkers. A microRNA (miRNA)-mRNA-transcription factor (TF) regulatory network was established to explore the potential regulatory mechanisms of these biomarkers. Disease-related drugs were predicted using the Comparative Toxicogenomics Database (CTD). Results: A total of 1102 cardioprotection-related DEGs were selected between the pre- and post-anesthesia groups. Additionally, 1095 hub genes were obtained based on WGCNA, and 2274 ZFPRGs were downloaded from the UniProt database. After Venn analysis and machine learning, ZNF420, RNF135, and BNC2 were selected as cardioprotection-related zinc finger biomarkers during OPCABG. Receiver operating characteristic (ROC) curves and nomogram models confirmed the diagnostic value and accuracy of the three cardioprotective biomarkers. Pathway enrichment analysis revealed that ZNF420 is involved in the cell cycle and the tricarboxylic acid cycle. RNF135 and BNC2 were enriched in the oxidative phosphorylation pathway. In the constructed miRNA-mRNA-TF network, miR-182-5p and miR-16-5p simultaneously regulated three cardioprotective biomarkers. Conclusion: Three cardioprotection-related zinc finger protein biomarkers (ZNF420, RNF135, and BNC2) were identified using OPCABG samples.
{"title":"Identification of Anesthetic-Induced Cardiovascular Biomarkers in Off-Pump Coronary Artery Bypass Grafting Surgery Using Weighted Gene Co-Expression Network Analysis and Machine Learning","authors":"Jinxiu Hou, Jing Li","doi":"10.59958/hsf.6809","DOIUrl":"https://doi.org/10.59958/hsf.6809","url":null,"abstract":"Background: This study aimed to select anesthesia-induced zinc finger protein-related gene biomarkers that predict cardiovascular function during off-pump coronary artery bypass grafting (OPCABG). Methods: Gene expression data from GSE4386 included 20 post-anesthesia and 20 pre-anesthesia atrial tissue samples. Zinc finger protein-related genes (ZFPRGs) were searched in the UniProt database and anesthesia-induced differentially expressed genes (DEGs) were identified Weighted gene co-expression network analysis (WGCNA) was used to screen hub genes, and three machine learning algorithms were used to further screen for cardiovascular biomarkers. Diagnostic accuracy was evaluated using a nomogram model. Gene set enrichment analysis was used to analyze the pathways enriched by the biomarkers. A microRNA (miRNA)-mRNA-transcription factor (TF) regulatory network was established to explore the potential regulatory mechanisms of these biomarkers. Disease-related drugs were predicted using the Comparative Toxicogenomics Database (CTD). Results: A total of 1102 cardioprotection-related DEGs were selected between the pre- and post-anesthesia groups. Additionally, 1095 hub genes were obtained based on WGCNA, and 2274 ZFPRGs were downloaded from the UniProt database. After Venn analysis and machine learning, ZNF420, RNF135, and BNC2 were selected as cardioprotection-related zinc finger biomarkers during OPCABG. Receiver operating characteristic (ROC) curves and nomogram models confirmed the diagnostic value and accuracy of the three cardioprotective biomarkers. Pathway enrichment analysis revealed that ZNF420 is involved in the cell cycle and the tricarboxylic acid cycle. RNF135 and BNC2 were enriched in the oxidative phosphorylation pathway. In the constructed miRNA-mRNA-TF network, miR-182-5p and miR-16-5p simultaneously regulated three cardioprotective biomarkers. Conclusion: Three cardioprotection-related zinc finger protein biomarkers (ZNF420, RNF135, and BNC2) were identified using OPCABG samples.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":" 31","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138964346","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}
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