ObjectiveTo analyze the surgical procedures and clinical effects of surgical treatment for patients with hypertrophic obstructive cardiomyopathy (HOCM). MethodsWe retrospectively analyzed the clinical data of sixty-five consecutive patients with HOCM who underwent modified Morrow procedure in Wuhan Asia Heart Hospital between June 2010 and December 2013. There were 40 males and 25 females with mean age of 48.4±11.5 years (ranged 18-70 years). ResultsThere was no in-hospital mortality. There was no valve injury or ventricular septal perforation occurred during operation. Postoperative LVOT gradient, interventricular septum (IVS), left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF) and mitral regurgitation (MR) were significantly lower than preoperative values (P<0.05). Complete atrioventricular block occurred in 3 patients, complete left bundle branch block occurred in 7 patients, and left anterior division block occurred in 3 patients. All patients were followed up for 6-35 months. During the following-up time, the clinical symptoms diminished in 55 patients and ameliorated significantly in other 10 patients. All patients had a NewYork Heart Association functional class Ⅰ/Ⅱ during the follow-up. ConclusionSurgical septal myectomy can eliminate obstruction of left ventricular outflow tract and relief symptoms obviously. The early and mid-term outcomes are satisfactory.
Objective To summarize the clinical features and results of surgical treatment of complex congenital heart disease(CCHD) in infants, investigate the operative indications and improve the operative effect. Methods From November 1999 to June 2008, 323 infants with CCHD were operated in Wuhan Asia Heart Hospital. There were 202(62.5%) male and 121(37.5%) female aged from 4 days to 36 months. The average age was 18.4 months. The range of weight was 4-15 kg, and the average weight was 9.9 kg. There were 218 cases with tetralogy of fallot(TOF), 41 with double outlet right ventricle(DORV), 12 with total anomalous pulmonary venous drainage（TAPVD）, 8 with complete endocardial cushion defect（TECD）, 15 with coarctation of aorta（CoA）, 2 with aortapulmonary window（AP Window） associated with interrupted aortic arch(IAA) and patent ductus arteriosus (PDA), 2 with persistent truncus arteriosus (PTA), 9 with single ventricle（SV）, 2 with Ebstein’s anomaly, 10 with pulmonary atresia（PA）, 3 with transposition of great arteries（TGA）and 1 with corrected transposition of great arteries（cTGA）. Two hundred and ninetyseven patients underwent I stage correction, 26 underwent palliative operation. All the corrective operations were performed under hypothermic cardiopulmonary bypass（CPB）. Results The cardiopulmonary bypass(CPB) time and aortic cross clamping time were 89±34 min and 48±39 min, respectively. All the patients were followed up by telephone or mail. The follow-up time was 1-72 months. Eight patients（2.5%） died after operation, 7 of them died in the early period of operation(within 1 month). Two patients died of long operation time and CPBdependence, 3 died of ventilatordependence, 1 died of cardiac arrest caused by aspiration following multiple organ dysfunction syndrome（MODS）after resuscitation, and 1 died of continuous hypoxia and cardiac arrest after central shunt operation. There was 1 mediumterm death, which was caused by laryngitis complicated with pulmonary infection. There were 315 survivals（97.5%）. Ninetyfive cases had complications(29.4%), all discharged after symptomatic treatment. The [CM(159mm]improved cardiac function was in gradeⅠ-Ⅱ. The respiratory tract infection reduced and the weight increased significantly. Conclusion Early detection, early diagnosis and early surgical treatment are important for CCHD in infants and the surgical results are satisfactory. The surgical procedure should be chosen according to individual abnormality. Surgeons should pay attention not only to the operation indications and satisfactory correction of the abnormality, but also to the staging operation.
Objective To investigate clinical diagnosis，timing of surgery and perioperative therapeutic strategies for blood culture-negative infective endocarditis （IE）. Methods Clinical data of 240 IE patients who were admitted tWuhan Asia Heart Hospital between July 2008 and July 2012 were retrospectively analyzed. According to their blood cultureresults，all the patients were divided into blood culture-negative group and blood culture-positive group. In the blood culture-negative group，there were 158 patients including 88 male and 70 female patients with their age of 51.3±10.1 years. In the blood culture-positive group，there were 82 patients including 45 male and 37 female patients with their age of 48.9±9.8 years. All the patients underwent surgical treatment，and the surgical procedures included complete vegetations excision，debridement of infected valves，removal of necrotic tissue around the annulus，and concomitant heart valve replacement or intracardiac repair. Postoperatively，all the patients received routine monitoring in ICU，cardiac glycosides，diuretics，other symptomatic treatment and adequate dosages of antibiotics for 4-6 weeks. Results Four patients died postoperatively in this study including 1 patient for low cardiac output syndrome and 3 patients for multiple organ dysfunction syndrome，1 patient in the blood culture-positive group and 3 patients in the blood culture-negative group respectively. There was no statistical difference in surgical mortality between the 2 groups （χ2=0.15，P=0.70）. All the other patients were discharged successfully and followed up for 6 to 36 months with the median follow-up time of 22 months. During follow-up, 2 patients died including 1 patient for cerebral infarction 2 years after surgery and another patient for cerebral hemorrhage 3 yearsafter surgery. Conclusion Patients with blood culture-negative IE should receive adequate dosage and duration of broad-spectrum antibiotics to control the infection rapidly, and aggressive surgical therapy to decrease in-hospital mortality and improve their quality of life and prognosis.
Objective To explore the impact of ischemic postconditioning on ischemia-reperfusion injury in isolatedelderly rat hearts and their relation with P-Akt. Methods A total of 30 healthy elderly SD rats (21-23 months old， male or female) with their body weight of 450-500 g were divided into 3 groups: control group， ischemia-reperfusion group， and postconditioning group， with 10 rats in each group. Coronary artery blood flow，myocardial infarction size， phosphorylatedAkt （p-Akt） expression， and changes in myocardium and mitochondria were detected. Results Coronary artery blood flow of the postconditioning group was significantly higher than that of the ischemia-reperfusion group （6.4±1.2 ml/min vs.3.1±1.2 ml/min， P＜0. 01）， and myocardial infarction size of the postconditioning group was significantly smaller thanthat of the ischemia-reperfusion group （35.0%±2.0% vs. 55.7%±3.6%， Plt;0. 05）. The expression of P-Akt was significantlyhigher， and myocardial fibers and mitochondria were preserved better in the postconditioning group than the ischemia-reperfusion group. Conclusion Ischemic postconditioning can protect isolated elderly rat hearts against ischemia-reperfusion injury， which may be related to P-Akt activation.
ObjectiveTo investigate and evaluate the safety and efficacy of Bentall operation in the reoperation of patients with small aortic root or annulus.MethodsBentall procedure was performed in 24 patients with small aortic root or annulus in our hospital from September 2014 to December 2019. There were 18 males and 6 females with a mean age of 31-68 (45.70±15.27) years. All patients had undergone a previous replacement of the aortic valve including 20 patients receiving valve replacement, 2 patients aortic root replacement with a valved conduit and 2 patients bioprothesis replacement.ResultsThere was no early death in hospital and one death during the 30-day postoperative period. Re-thoracotomy due to bleeding was necessary in only 2 patients and no bleeding was related to the proximal anastomosis of the conduit. One patient performed pacemaker implantation for heart block after the procedure. The mean sizes of implanted aortic valve prosthesis were 22.75±1.78 mm. A mean gradient across the aortic valve prostheses in the postoperative echocardiographic examination was 11.17±2.24 mm Hg.ConclusionBentall procedure is safe and allows a larger size of prosthesis implantation in patients with small aortic annulus or root after previous aortic valve or complete root replacement, resulting in good postoperative hemodynamic characteristics and short-term clinical results.