BACKGROUND In patients with prosthetic valves, the perioperative outcomes, as well as the risk factors, following gastrointestinal surgery remain to be defined. Methods: From January 2010 to March 2018, the clinical data of 69 cases with prosthetic valves after gastrointestinal surgery retrospectively were collected. Univariate and multivariate analysis were applied to identify the risk factors associated with significant bleeding events and non-hemorrhagic complications. RESULTS Among 69 cases, 9 patients (13.0%) presented major bleeding events, and 21 patients (30.4%) presented non-hemorrhagic complications. Major bleeding events were significantly higher in patients with simple aortic valve replacement (AVR) than in other types of prosthetic valves (27.6% vs. 2.5%, P = 0.003), and there was no significant difference in the incidence of non-hemorrhagic complications. Simple AVR was the significant risk factor for major bleeding events (P = 0.043). Significant risk factors for non-hemorrhagic complications were operative duration ≥ 160 minutes (P = 0.021), duration from heart valve replacement to gastrointestinal surgery ≥ 84 months (P = 0.039), and simple AVR (P = 0.047). CONCLUSION The patients with simple AVR had a much higher bleeding risk following gastrointestinal surgery.
背景:在胃肠手术患者中，假瓣膜的围手术期结局和危险因素仍有待确定。方法:回顾性收集2010年1月至2018年3月69例胃肠手术后置换术瓣膜的临床资料。应用单因素和多因素分析来确定与重大出血事件和非出血性并发症相关的危险因素。结果69例患者中有9例(13.0%)出现大出血事件，21例(30.4%)出现非出血性并发症。单纯性主动脉瓣置换术(AVR)患者的大出血事件明显高于其他类型的人工瓣膜(27.6% vs. 2.5%， P = 0.003)，非出血性并发症的发生率无显著差异。单纯性AVR是大出血事件的重要危险因素(P = 0.043)。非出血性并发症的显著危险因素为手术时间≥160分钟(P = 0.021)、心脏瓣膜置换术至胃肠手术时间≥84个月(P = 0.039)和单纯AVR (P = 0.047)。结论单纯性AVR患者在胃肠道手术后出血风险较高。
{"title":"Perioperative Safety Evaluation of Gastrointestinal Surgery in Patients With Prosthetic Valves.","authors":"Ling Chen, Jieyuan Sun, Hao Chen, Feng Liu","doi":"10.1532/hsf.4533","DOIUrl":"https://doi.org/10.1532/hsf.4533","url":null,"abstract":"BACKGROUND\u0000In patients with prosthetic valves, the perioperative outcomes, as well as the risk factors, following gastrointestinal surgery remain to be defined. Methods: From January 2010 to March 2018, the clinical data of 69 cases with prosthetic valves after gastrointestinal surgery retrospectively were collected. Univariate and multivariate analysis were applied to identify the risk factors associated with significant bleeding events and non-hemorrhagic complications.\u0000\u0000\u0000RESULTS\u0000Among 69 cases, 9 patients (13.0%) presented major bleeding events, and 21 patients (30.4%) presented non-hemorrhagic complications. Major bleeding events were significantly higher in patients with simple aortic valve replacement (AVR) than in other types of prosthetic valves (27.6% vs. 2.5%, P = 0.003), and there was no significant difference in the incidence of non-hemorrhagic complications. Simple AVR was the significant risk factor for major bleeding events (P = 0.043). Significant risk factors for non-hemorrhagic complications were operative duration ≥ 160 minutes (P = 0.021), duration from heart valve replacement to gastrointestinal surgery ≥ 84 months (P = 0.039), and simple AVR (P = 0.047).\u0000\u0000\u0000CONCLUSION\u0000The patients with simple AVR had a much higher bleeding risk following gastrointestinal surgery.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114467572","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}
Yike Wang, Ya Wang, Xiaoxu Han, Han Zhang, Jianping Song
OBJECTIVE The purpose of this study is to identify the influencing factors of unplanned readmission in patients with the acute coronary syndrome (ACS) within 30 days after percutaneous coronary intervention (PCI). METHODS From November 1, 2018, to October 31, 2019, the clinical data of 1277 patients with acute coronary syndrome and percutaneous coronary intervention retrospectively were collected. After screening by exclusion and rejection criteria, a total of 936 patients finally entered the study. Patients were divided into the readmission group (57 cases) and the non-readmission group (879 cases), according to whether unplanned readmission occurred within 30 days after PCI. To analyze the influence of patients' age, past disease history, medication history, laboratory data, vascular diseases, and other factors on readmission and the clinical characteristics of readmission patients. RESULTS Fifty-seven patients had unplanned readmission within 30 days, and the readmission rate was 6.09%. The clinical features of readmission patients are older age, longer hospitalization days, more emergency percutaneous coronary intervention, more patients with diabetes history, and more patients diagnosed with ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction. Logistic regression analysis revealed that smoking index, number of diseased vessels, ACEF score, diabetes, and PCI status were the influencing factors of unplanned readmission of ACS patients within 30 days after PCI. CONCLUSION Smoking index, number of diseased vessels, ACEF score, diabetes, and PCI status are the influencing factors of unplanned readmission within 30 days after percutaneous coronary intervention for patients with acute coronary syndrome.
{"title":"Analysis of Influencing Factors of Unplanned Readmission in Patients With Acute Coronary Syndrome Within 30 Days After PCI.","authors":"Yike Wang, Ya Wang, Xiaoxu Han, Han Zhang, Jianping Song","doi":"10.1532/hsf.4411","DOIUrl":"https://doi.org/10.1532/hsf.4411","url":null,"abstract":"OBJECTIVE\u0000The purpose of this study is to identify the influencing factors of unplanned readmission in patients with the acute coronary syndrome (ACS) within 30 days after percutaneous coronary intervention (PCI).\u0000\u0000\u0000METHODS\u0000From November 1, 2018, to October 31, 2019, the clinical data of 1277 patients with acute coronary syndrome and percutaneous coronary intervention retrospectively were collected. After screening by exclusion and rejection criteria, a total of 936 patients finally entered the study. Patients were divided into the readmission group (57 cases) and the non-readmission group (879 cases), according to whether unplanned readmission occurred within 30 days after PCI. To analyze the influence of patients' age, past disease history, medication history, laboratory data, vascular diseases, and other factors on readmission and the clinical characteristics of readmission patients.\u0000\u0000\u0000RESULTS\u0000Fifty-seven patients had unplanned readmission within 30 days, and the readmission rate was 6.09%. The clinical features of readmission patients are older age, longer hospitalization days, more emergency percutaneous coronary intervention, more patients with diabetes history, and more patients diagnosed with ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction. Logistic regression analysis revealed that smoking index, number of diseased vessels, ACEF score, diabetes, and PCI status were the influencing factors of unplanned readmission of ACS patients within 30 days after PCI.\u0000\u0000\u0000CONCLUSION\u0000Smoking index, number of diseased vessels, ACEF score, diabetes, and PCI status are the influencing factors of unplanned readmission within 30 days after percutaneous coronary intervention for patients with acute coronary syndrome.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129707068","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}
Junjunn Gu, Yulan Feng, Si Chen, Yingdan Cao, Kexin Li, Yanze Du, Ning Li, Haiyan Li
BACKGROUND Postoperative hypoxemia is a high-risk complication after acute type A aortic dissection (TAAD) surgery. Prone position (PP) is an effective treatment for acute respiratory failure, which may improve the gas exchange of the injured lung and the patient's survival. PP is reported to improve the respiratory condition after cardiac surgery. However, limited data exist on the effect of PP in patients who underwent acute TAAD surgery. METHODS We retrospectively analyzed the clinical outcomes of seven patients with severe hypoxemia who underwent PP after acute TAAD surgery. The results of arterial blood gas, chest X-ray, and survival were collected. RESULTS Seven patients (3 female, mean age 48.3±11.7 years) were recruited in this study. All patients received total arch replacement and frozen elephant trunk implantation procedure. The PaO2 at day 1 after PP was higher than before PP (126.3±49.3 vs. 77.8±15.5 mmHg). The oxygenation index rose sharply from 83.0 (80.0, 87.0) to 188.3±56.5 at day 3 after PP. There was no significant difference in heart rate between before and after PP procedure. Chest X-ray showed the diffuse shadow was significantly improved after PP. All patients responded well to PP, and all patients were discharged except for one patient, who died perioperatively due to multiple organ failure. CONCLUSIONS PP is a safe and feasible option for severe hypoxemia patients after TAAD surgery.
背景:术后低氧血症是急性a型主动脉夹层(TAAD)手术后的高危并发症。俯卧位(俯卧位)是治疗急性呼吸衰竭的有效方法，可改善损伤肺的气体交换，提高患者的生存率。据报道，PP可以改善心脏手术后的呼吸状况。然而，关于PP对急性TAAD手术患者的影响的数据有限。方法回顾性分析7例急性TAAD术后重度低氧血症患者行PP治疗的临床结果。收集动脉血气、胸片、生存结果。结果共纳入7例患者，其中女性3例，平均年龄48.3±11.7岁。所有患者均行全弓置换术和冷冻象鼻植入术。术后第1天PaO2明显高于术前(126.3±49.3 vs. 77.8±15.5 mmHg)。术后第3天氧合指数由83.0(80.0,87.0)急剧上升至188.3±56.5，心率与术前无显著差异。胸部x线片显示PP术后弥漫性影明显改善，除1例患者因多器官功能衰竭围手术期死亡外，其余患者均出院。结论spp是TAAD术后严重低氧血症患者安全可行的治疗方案。
{"title":"Prone Position in Treatment of Hypoxemia in Patients Who Underwent Type A Aortic Dissection Surgery.","authors":"Junjunn Gu, Yulan Feng, Si Chen, Yingdan Cao, Kexin Li, Yanze Du, Ning Li, Haiyan Li","doi":"10.1532/hsf.4535","DOIUrl":"https://doi.org/10.1532/hsf.4535","url":null,"abstract":"BACKGROUND\u0000Postoperative hypoxemia is a high-risk complication after acute type A aortic dissection (TAAD) surgery. Prone position (PP) is an effective treatment for acute respiratory failure, which may improve the gas exchange of the injured lung and the patient's survival. PP is reported to improve the respiratory condition after cardiac surgery. However, limited data exist on the effect of PP in patients who underwent acute TAAD surgery.\u0000\u0000\u0000METHODS\u0000We retrospectively analyzed the clinical outcomes of seven patients with severe hypoxemia who underwent PP after acute TAAD surgery. The results of arterial blood gas, chest X-ray, and survival were collected.\u0000\u0000\u0000RESULTS\u0000Seven patients (3 female, mean age 48.3±11.7 years) were recruited in this study. All patients received total arch replacement and frozen elephant trunk implantation procedure. The PaO2 at day 1 after PP was higher than before PP (126.3±49.3 vs. 77.8±15.5 mmHg). The oxygenation index rose sharply from 83.0 (80.0, 87.0) to 188.3±56.5 at day 3 after PP. There was no significant difference in heart rate between before and after PP procedure. Chest X-ray showed the diffuse shadow was significantly improved after PP. All patients responded well to PP, and all patients were discharged except for one patient, who died perioperatively due to multiple organ failure.\u0000\u0000\u0000CONCLUSIONS\u0000PP is a safe and feasible option for severe hypoxemia patients after TAAD surgery.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132298583","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}
Composite hemangioendothelioma (CHE) is an extremely rare vascular neoplasm that is characterized by an admixture of benign, low-grade malignant, and malignant vascular components. It is usually located superficially in the dermis and subcutis of the extremities, and other sites involved include the head and neck region, oral mucosa, and viscera of the kidney and spleen. CHE has a low-grade malignant potential because it is locally aggressive. Here, we report a case of CHE in the heart in a 46-year-old man, who presented with a palpable mass arising from his right ventricle. Echocardiogram imaging revealed a 13.3 × 14.2 mm mass with high-signal intensity. Excision was performed, and microscopic examination revealed a heterogeneous mixture of vascular components, consisting of spindle-cell hemangioma, retiform hemangioendothelioma, and epithelioid-like hemangioendothelioma areas. To our knowledge, this is the first report on the behavior of this distinctive vascular neoplasm occurring in the right ventricle. Due to the unclear biological behavior of CHE in the heart and the paucity of cases, no further therapy was undertaken despite the risk of local recurrence and distant metastasis. The result of a six-month follow-up after surgery was disease-free.
{"title":"The First Case of Composite Hemangioendothelioma in The Heart.","authors":"Xiaojie Zhang, Shiqiang Wang, Mei Jin","doi":"10.1532/hsf.4587","DOIUrl":"https://doi.org/10.1532/hsf.4587","url":null,"abstract":"Composite hemangioendothelioma (CHE) is an extremely rare vascular neoplasm that is characterized by an admixture of benign, low-grade malignant, and malignant vascular components. It is usually located superficially in the dermis and subcutis of the extremities, and other sites involved include the head and neck region, oral mucosa, and viscera of the kidney and spleen. CHE has a low-grade malignant potential because it is locally aggressive. Here, we report a case of CHE in the heart in a 46-year-old man, who presented with a palpable mass arising from his right ventricle. Echocardiogram imaging revealed a 13.3 × 14.2 mm mass with high-signal intensity. Excision was performed, and microscopic examination revealed a heterogeneous mixture of vascular components, consisting of spindle-cell hemangioma, retiform hemangioendothelioma, and epithelioid-like hemangioendothelioma areas. To our knowledge, this is the first report on the behavior of this distinctive vascular neoplasm occurring in the right ventricle. Due to the unclear biological behavior of CHE in the heart and the paucity of cases, no further therapy was undertaken despite the risk of local recurrence and distant metastasis. The result of a six-month follow-up after surgery was disease-free.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131712914","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 Although the most common causes of left ventricular aneurysm (LVA) is ischemic disease, other infectious, traumatic, genetic and iatrogenic etiologies exist. With the improvement of medical therapy for ischemic disease and earlier interventions such as PCI, the incidence of large LVA (>3cm) and surgical treatment for it is increasingly rare. Case study: We describe a case report and literature review of a giant LVA in a patient, who presented with unclear etiology. A 61-year-old male was referred to our tertiary center. He underwent aneurysmectomy and mitral valve replacement for a giant (10cm x 10cm) LVA with severe mitral regurgitation. Conclusion: Surgery for LVA is becoming less common. Early intervention can restore cardiac geometry with good short and long-term surgical outcomes, especially in patients with preserved EF. Ultimately, a giant ventricular aneurysm remains an indication for surgical intervention. Patients with markedly reduced EF may derive reduced benefits from aneurysmectomy.
{"title":"That's No Moon, It's a Giant Left Ventricular Aneurysm: A Case Report and Literature Review.","authors":"Tom Liu, Huzaifa A. Shakir","doi":"10.1532/hsf.4537","DOIUrl":"https://doi.org/10.1532/hsf.4537","url":null,"abstract":"BACKGROUND\u0000Although the most common causes of left ventricular aneurysm (LVA) is ischemic disease, other infectious, traumatic, genetic and iatrogenic etiologies exist. With the improvement of medical therapy for ischemic disease and earlier interventions such as PCI, the incidence of large LVA (>3cm) and surgical treatment for it is increasingly rare. Case study: We describe a case report and literature review of a giant LVA in a patient, who presented with unclear etiology. A 61-year-old male was referred to our tertiary center. He underwent aneurysmectomy and mitral valve replacement for a giant (10cm x 10cm) LVA with severe mitral regurgitation. Conclusion: Surgery for LVA is becoming less common. Early intervention can restore cardiac geometry with good short and long-term surgical outcomes, especially in patients with preserved EF. Ultimately, a giant ventricular aneurysm remains an indication for surgical intervention. Patients with markedly reduced EF may derive reduced benefits from aneurysmectomy.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129249495","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}
Alexander D Ghannam, N. Amoroso, Mohammad F. Mathbout, A. Kilic, L. Witer, Sanford M Zeigler, D. Steinberg, M. Katz, Nicolas H. Pope
Coronary artery pseudoaneurysms are extremely rare and most often occur after trauma or endovascular procedures [Aoki 2008; Kar 2017]. Delay in diagnosis or treatment may lead to coronary thrombosis with resultant ischemia or hemorrhage subsequent tamponade. Here, we present the case of a 66-year-old female who developed a coronary artery pseudoaneurysm of a non-grafted vessel three weeks after coronary artery bypass grafting. To avoid re-sternotomy, the pseudoaneurysm was successfully managed with a covered coronary stent and mini-left anterior thoracotomy to evacuate the hemopericardium and relieve tamponade.
{"title":"Native Coronary Artery Pseudoaneurysm after Coronary Artery Bypass Grafting.","authors":"Alexander D Ghannam, N. Amoroso, Mohammad F. Mathbout, A. Kilic, L. Witer, Sanford M Zeigler, D. Steinberg, M. Katz, Nicolas H. Pope","doi":"10.1532/hsf.4531","DOIUrl":"https://doi.org/10.1532/hsf.4531","url":null,"abstract":"Coronary artery pseudoaneurysms are extremely rare and most often occur after trauma or endovascular procedures [Aoki 2008; Kar 2017]. Delay in diagnosis or treatment may lead to coronary thrombosis with resultant ischemia or hemorrhage subsequent tamponade. Here, we present the case of a 66-year-old female who developed a coronary artery pseudoaneurysm of a non-grafted vessel three weeks after coronary artery bypass grafting. To avoid re-sternotomy, the pseudoaneurysm was successfully managed with a covered coronary stent and mini-left anterior thoracotomy to evacuate the hemopericardium and relieve tamponade.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122413554","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 The transcatheter closure of atrial septal defect could be completed without the balloon-sizing technique, so we evaluated long-term outcomes compared with closure using balloon sizing, which was the conventional method. Even without using the balloon-sizing technique, transcatheter closure of atrial septal defect might be safe and effective. METHODS We included 124 patients with isolated atrial septal defects who underwent device closure without balloon sizing between 2012 and 2016, and we further included 257 patients as a control group. Patients who received closure with multiple devices or who experienced postoperative residual defects were excluded. Immediate procedural results, as well as long-term outcomes for closure without balloon sizing, were investigated and compared with the control group. RESULTS The procedural success rate was 96.7%, and there were no mortalities. No embolization or cardiac erosions were observed; however, one patient experienced residual shunt, and another developed progressed mitral regurgitation during the follow-up period (983±682 days). Newly onset persistent atrial fibrillation developed in one patient (1.0%). There were no significant differences in procedures or follow-up between the study and control groups. Despite the shorter procedural time in the study group, fluoro time was not different. Atrial arrhythmias were more frequently observed in the control group, but the difference was not significant. Persistent atrial fibrillation was observed in two patients in the control group (0.8%). CONCLUSIONS Transcatheter closure of atrial septal defect can be performed safely and effectively without using the balloon-sizing technique. The long-term outcomes were similar to outcomes with balloon sizing.
{"title":"Outcomes After Transcatheter Closure of Atrial Septal Defect Without Using a Balloon-Sizing Technique: A Randomized Controlled Comparison with Closures Using a Balloon-Sizing Technique.","authors":"Beom Joon Kim, Jinyoung Song, J. Huh, I. Kang","doi":"10.1532/hsf.4571","DOIUrl":"https://doi.org/10.1532/hsf.4571","url":null,"abstract":"BACKGROUND\u0000The transcatheter closure of atrial septal defect could be completed without the balloon-sizing technique, so we evaluated long-term outcomes compared with closure using balloon sizing, which was the conventional method. Even without using the balloon-sizing technique, transcatheter closure of atrial septal defect might be safe and effective.\u0000\u0000\u0000METHODS\u0000We included 124 patients with isolated atrial septal defects who underwent device closure without balloon sizing between 2012 and 2016, and we further included 257 patients as a control group. Patients who received closure with multiple devices or who experienced postoperative residual defects were excluded. Immediate procedural results, as well as long-term outcomes for closure without balloon sizing, were investigated and compared with the control group.\u0000\u0000\u0000RESULTS\u0000The procedural success rate was 96.7%, and there were no mortalities. No embolization or cardiac erosions were observed; however, one patient experienced residual shunt, and another developed progressed mitral regurgitation during the follow-up period (983±682 days). Newly onset persistent atrial fibrillation developed in one patient (1.0%). There were no significant differences in procedures or follow-up between the study and control groups. Despite the shorter procedural time in the study group, fluoro time was not different. Atrial arrhythmias were more frequently observed in the control group, but the difference was not significant. Persistent atrial fibrillation was observed in two patients in the control group (0.8%).\u0000\u0000\u0000CONCLUSIONS\u0000Transcatheter closure of atrial septal defect can be performed safely and effectively without using the balloon-sizing technique. The long-term outcomes were similar to outcomes with balloon sizing.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126918824","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}
Fan Zhang, Zebing Zheng, Taowu Gong, Zhaoqiong Zhu
In this medical report, we successfully implemented anesthesia management for an infant with congenital heart disease undergoing congenital diaphragmatic hernia (CDH) repair. Left-sided CDH was diagnosed on a postnatal chest X-ray on day 1 of her life. The child was complicated with congenital heart diseases and pulmonary hypertension and showed severe dyspnea immediately after birth. Thoracoscopic CDH repair puts forward high requirements for anesthesia. Neonatal CDH combined with congenital heart disease brings more challenges to anesthesia. For high-risk premature neonates, anesthesia selections are essential, as those factors directly affect the prognosis. We report the application of S-ketamine as an anesthetic in this kind of operation for the first time. The postoperative recovery was uneventful. This case report reviews anesthesia management of critical CDH neonates, hoping to provide information to healthcare professionals unfamiliar with the treatment of this kind of patient.
{"title":"Anesthesia Management of a Premature Neonate with Congenital Heart Disease during Emergency Diaphragmatic Hernia Surgery: A Case Report.","authors":"Fan Zhang, Zebing Zheng, Taowu Gong, Zhaoqiong Zhu","doi":"10.1532/hsf.4499","DOIUrl":"https://doi.org/10.1532/hsf.4499","url":null,"abstract":"In this medical report, we successfully implemented anesthesia management for an infant with congenital heart disease undergoing congenital diaphragmatic hernia (CDH) repair. Left-sided CDH was diagnosed on a postnatal chest X-ray on day 1 of her life. The child was complicated with congenital heart diseases and pulmonary hypertension and showed severe dyspnea immediately after birth. Thoracoscopic CDH repair puts forward high requirements for anesthesia. Neonatal CDH combined with congenital heart disease brings more challenges to anesthesia. For high-risk premature neonates, anesthesia selections are essential, as those factors directly affect the prognosis. We report the application of S-ketamine as an anesthetic in this kind of operation for the first time. The postoperative recovery was uneventful. This case report reviews anesthesia management of critical CDH neonates, hoping to provide information to healthcare professionals unfamiliar with the treatment of this kind of patient.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131514487","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 Vasopressin can constrict peripheral arteries without constricting the pulmonary artery. Theoretically, vasopressin is suitable for the perioperative treatment of pulmonary hypertension. Few studies have investigated the use of pituitrin (a substitute for vasopressin) after cardiac defect repair surgery. This study aimed to analyze the effect of pituitrin on hemodynamics and to determine whether pituitrin can be used after surgical repair in adult patients with pulmonary arterial hypertension-congenital heart disease (PAH-CHD). METHODS A pulmonary artery catheter was used in all the patients for hemodynamic monitoring. Hemodynamic parameters were recorded before and at 0.5 h, 1 h, 6 h, 12 h and 24 h after pituitrin administration. The changes in the hemodynamic parameters before and after pituitrin use were analyzed through repeated measures analysis of variance. RESULTS A total of 110 patients with PAH-CHD underwent repair surgery; 23 patients were included in further analysis, including 11 with atrial septal defect, 9 with ventricular septal defect, and 3 with patent ductus arteriosus. Ten (43.5%) were men, with a mean age of 29.4 ± 6.8 years. Hemodynamic parameters before and after the oxygen test were as follows: radial artery oxygen saturation, 91.5% ± 4.4 vs. 97.9 ± 2.4%; pulmonary vascular resistance, 10.5 ± 1.8 Wood units (wu) vs. 5 ± 1.2 wu; systemic-pulmonary blood flow ratio (QP/QS), 1.1 ± 0.2 vs. 2.1 ± 0.9. With prolonged use, the systolic blood pressure of the radial artery increased significantly (P = 0.001), that of the pulmonary artery decreased significantly (P = 0.009), and RP/s decreased significantly (P < 0.001). CONCLUSION Pituitrin as an alternative to vasopressin can increase arterial pressure, decrease pulmonary artery pressure, and reduce the pulmonary artery pressure/arterial pressure ratio after repair surgery in adult patients with PAH-CHD.
背景:加压素可以收缩外周动脉而不收缩肺动脉。理论上，加压素适用于肺动脉高压的围手术期治疗。很少有研究调查心脏缺损修复手术后垂体后叶素(一种抗利尿激素的替代品)的使用。本研究旨在分析垂体后叶素对血流动力学的影响，探讨成人肺动脉高压-先天性心脏病(PAH-CHD)患者手术修复后是否可以使用垂体后叶素。方法所有患者均采用sa肺动脉导管进行血流动力学监测。记录垂体后叶素给药前及给药后0.5 h、1 h、6 h、12 h、24 h血流动力学参数。通过重复测量方差分析分析垂体后叶素使用前后血流动力学参数的变化。结果共110例PAH-CHD患者行修复手术;23例患者纳入进一步分析，其中房间隔缺损11例，室间隔缺损9例，动脉导管未闭3例。男性10例(43.5%)，平均年龄29.4±6.8岁。血氧试验前后血流动力学参数:桡动脉血氧饱和度:91.5%±4.4 vs. 97.9±2.4%;肺血管阻力:10.5±1.8 Wood units (wu) vs. 5±1.2 wu;系统-肺血流比(QP/QS): 1.1±0.2 vs. 2.1±0.9。随着使用时间的延长，桡动脉收缩压显著升高(P = 0.001)，肺动脉收缩压显著降低(P = 0.009)， RP/s显著降低(P < 0.001)。结论垂体后叶素替代血管加压素可使成年PAH-CHD患者修复术后动脉压升高，肺动脉压降低，肺动脉压/动脉压比降低。
{"title":"Perioperative Use of Pituitrin after Cardiac Defect Repair in Adult Patients with Severe Pulmonary Hypertension.","authors":"YunTao Li, Mingwui Tung, Jianping Xu, Guangyu Pan, Rui Jiang","doi":"10.1532/hsf.4569","DOIUrl":"https://doi.org/10.1532/hsf.4569","url":null,"abstract":"BACKGROUND\u0000Vasopressin can constrict peripheral arteries without constricting the pulmonary artery. Theoretically, vasopressin is suitable for the perioperative treatment of pulmonary hypertension. Few studies have investigated the use of pituitrin (a substitute for vasopressin) after cardiac defect repair surgery. This study aimed to analyze the effect of pituitrin on hemodynamics and to determine whether pituitrin can be used after surgical repair in adult patients with pulmonary arterial hypertension-congenital heart disease (PAH-CHD).\u0000\u0000\u0000METHODS\u0000A pulmonary artery catheter was used in all the patients for hemodynamic monitoring. Hemodynamic parameters were recorded before and at 0.5 h, 1 h, 6 h, 12 h and 24 h after pituitrin administration. The changes in the hemodynamic parameters before and after pituitrin use were analyzed through repeated measures analysis of variance.\u0000\u0000\u0000RESULTS\u0000A total of 110 patients with PAH-CHD underwent repair surgery; 23 patients were included in further analysis, including 11 with atrial septal defect, 9 with ventricular septal defect, and 3 with patent ductus arteriosus. Ten (43.5%) were men, with a mean age of 29.4 ± 6.8 years. Hemodynamic parameters before and after the oxygen test were as follows: radial artery oxygen saturation, 91.5% ± 4.4 vs. 97.9 ± 2.4%; pulmonary vascular resistance, 10.5 ± 1.8 Wood units (wu) vs. 5 ± 1.2 wu; systemic-pulmonary blood flow ratio (QP/QS), 1.1 ± 0.2 vs. 2.1 ± 0.9. With prolonged use, the systolic blood pressure of the radial artery increased significantly (P = 0.001), that of the pulmonary artery decreased significantly (P = 0.009), and RP/s decreased significantly (P < 0.001).\u0000\u0000\u0000CONCLUSION\u0000Pituitrin as an alternative to vasopressin can increase arterial pressure, decrease pulmonary artery pressure, and reduce the pulmonary artery pressure/arterial pressure ratio after repair surgery in adult patients with PAH-CHD.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129206321","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}
Vivendar Sihag, Wen-yu Li, Abdullah Hagar, Yong Peng, Yuan Feng, Sandeep Bhushan, Mao Chen
BACKGROUND The present study aims to evaluate how nutritional status may affect transcatheter aortic valve implantation (TAVI) outcomes. MATERIALS AND METHODS This is a retrospective study of 383 TAVI patients. In-hospital, 1-month, and 12-month survival was evaluated. Since most patients undergoing TAVI are over 75 years old, the NRI definition for a geriatric population (GNRI) was used. Preoperative baseline clinical and laboratory data were collected and then the corresponding nutritional status was calculated, including Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index (PNRI), and Controlling Nutritional Status Score (CONUT). Survival analysis and receiver operating characteristic curve (ROC) analysis were used to evaluate the correlation between these parameters and TAVI outcome. RESULTS By CONUT and GNRI scores, 168 (58.9%) and 40 (14.0%) patients were considered to have mild malnutrition, respectively. By using PNI, CONUT, and GNRI scores, 16 (5.7%), 29 (10.3%), and 39 (13.7%) patients were moderately or severely malnourished. Survival analysis showed that patients with worse nutritional status had a worse prognosis regardless of the nutritional score used. Subgroup analysis showed that these differences remained significant in subgroups of patients over age 75. COX multivariate analysis showed that GNRI, PNI, and CONUT were independently associated with all-cause mortality during the follow-up. CONCLUSION Patients with worse nutritional status had a worse prognosis regardless of the nutritional score used. Subgroup analysis showed that these differences remained significant in subgroups of patients over age 75. GNRI, PNI, and CONUT were independent predictors of all-cause mortality after TAVI.
{"title":"The Impact of Nutritional Status on the Outcome of Transcatheter Aortic Valve Implantation.","authors":"Vivendar Sihag, Wen-yu Li, Abdullah Hagar, Yong Peng, Yuan Feng, Sandeep Bhushan, Mao Chen","doi":"10.1532/hsf.4547","DOIUrl":"https://doi.org/10.1532/hsf.4547","url":null,"abstract":"BACKGROUND\u0000The present study aims to evaluate how nutritional status may affect transcatheter aortic valve implantation (TAVI) outcomes.\u0000\u0000\u0000MATERIALS AND METHODS\u0000This is a retrospective study of 383 TAVI patients. In-hospital, 1-month, and 12-month survival was evaluated. Since most patients undergoing TAVI are over 75 years old, the NRI definition for a geriatric population (GNRI) was used. Preoperative baseline clinical and laboratory data were collected and then the corresponding nutritional status was calculated, including Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index (PNRI), and Controlling Nutritional Status Score (CONUT). Survival analysis and receiver operating characteristic curve (ROC) analysis were used to evaluate the correlation between these parameters and TAVI outcome.\u0000\u0000\u0000RESULTS\u0000By CONUT and GNRI scores, 168 (58.9%) and 40 (14.0%) patients were considered to have mild malnutrition, respectively. By using PNI, CONUT, and GNRI scores, 16 (5.7%), 29 (10.3%), and 39 (13.7%) patients were moderately or severely malnourished. Survival analysis showed that patients with worse nutritional status had a worse prognosis regardless of the nutritional score used. Subgroup analysis showed that these differences remained significant in subgroups of patients over age 75. COX multivariate analysis showed that GNRI, PNI, and CONUT were independently associated with all-cause mortality during the follow-up.\u0000\u0000\u0000CONCLUSION\u0000Patients with worse nutritional status had a worse prognosis regardless of the nutritional score used. Subgroup analysis showed that these differences remained significant in subgroups of patients over age 75. GNRI, PNI, and CONUT were independent predictors of all-cause mortality after TAVI.","PeriodicalId":257138,"journal":{"name":"The heart surgery forum","volume":"102 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115565445","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：