Objective To discuss left ventricular reconstruction methods and effectivness in patients with left ventricular aneurysm after myocardial infarction. Methods Between June 2003 and August 2008, 23 patients with left ventricular aneurysm after myocardial infarction were treated. Of them, 13 were male and 10 were female with an average age of 61.2 years (range, 47-74 years). According to New York Heart Association (NYHA) criteria for cardiac function, there were 3 cases of grade I, 6 cases of grade II, 10 cases of grade III, and 4 cases of grade IV. The coronary arteriongraphy showed singlevesseldisease in 2 cases, double-vessel disease in 5 cases, triple-vessel disease in 16 cases. The locations of ventricular aneurysm were the apex cordis in 18 cases, antetheca and parieslateral is in 4 cases, and interior wall in 1 case. The left ventricular ejection fraction was 36.52%± 12.15%, and left ventricular diastol ic final diameter was (62.30 ± 6.52 ) mm. Nine patients received standard l inear repair, 6 patients received standard l inear repair after endocardial ring shrinkage, and 8 patients received patch suture after endocardial ring shinkage. Results Two cases died perioperatively, and re-thoracotomy was performed to stop bleeding in 1 case. Incisions healed by first intention in the other patients without early compl ication. Twentyone patients were followed up 7-48 months (median, 19 months). At 6 months after surgery, the left ventricular ejection fraction 46.52% ± 9.41% were significanly improved when compared with that at preoperation (t=2.240, P=0.023); the left ventricular diastol ic final diameter (52.23 ± 5.11) mm were significantly decreased when compared with that at preoperation (t=2.170, P=0.035). The cardiac function according to NYHA criteria was at grade I in 8 cases and at grade II in 13 cases. One patient died of cerebral hemorrhage at 18 months after operation and the activities of daily l iving recoverd in the others. Conclusion Individual theraputic methods are used according to patients’ different conditions for left ventricular aneurysm after myocardial infarction.
Objective To study the mid-term and long-term postoperative results of Bentall procedure in patients with Marfan syndrome. Methods From February 2009 to July 2016, ten adolescent patients (mean age of 12.30±2.31 years ranged 9-16 years, mean height of 172.50±12.55 mm, mean weight of 48.60±17.08 kg) underwent Bentall procedure in our hospital. All these teenage patients were with Marfan syndrome, 6 boys and 4 girls. Five of them underwent mitral valve replacement procedure at the same time while 2 of them with tricuspid valvuloplasty. Results No mortality was found in hospitalization. One patient suffered respiratory failure after surgery. No renal failure, mediastinal infection or re-operation caused by bleeding were observed. All were well followed up for 62 months. One died of malignant arrhythmia, the other were in good condition with the latest interview. Conclusion Teenage patients with Marfan syndrome who underwent Bentall procedure have favorable outcomes in mid-term and long-term follow-up, they probably will not suffer anti-coagulation complications and restriction of growth.
Objective To summarize the clinical experience of capture technology in the large diameter of abdominal aortic aneurysm in endovascular repair of abdominal aortic aneurysm(EVAR). Methods We retrospectively analyzed clinical data of 6 patients with abdominal aortic aneurysm (maximum diameter of 6.0 cm or bigger) in our hospital between July 2013 and May 2014.There were 3 males and 3 females at age of 76.2(73–81) years. Two patients of ruptured abdominal aortic aneurysm, in EVAR, established orbit using the capture technology successfully. Results The capture technology made the thread through the proximal tumor neck smoothly, successful repaired. One patient of rupture of abdominal aortic aneurysm was dead after 10 hours. One patient was lost to follow-up. Four patients were followed up for 3 to 11 months. The four patients had not occurred bracket displacement, internal leakage, thrombosis, or other serious complications. Conclusion For the patients with larger abdominal aortic aneurysm, capture technology may be used to the thread through the proximal tumor neck, to build a convey or track easily, to shorten the operation time, to improve the success rate of surgery.
ObjectiveTo analyze clinical outcomes of coronary artery bypass grafting (CABG) without concomitant surgical ventricular restoration (SVR) for patients with coronary artery disease (CHD) and left ventricular aneurysm (LVA). MethodsA total of 105 patients with CHD and LVA underwent surgical treatment in Wuhan Asia Heart Hospital from January 2008 to December 2012. Among them,74 patients were found to have no clear boundary LVA,poor wall motion or no obvious contradictory wall motion during surgical exploration,and didn't received SVR,including 59 male and 15 female patients with their age of 60.96±9.09 years. Coronary angiography showed 5 patients with single-vessel disease,10 patients with double-vessel disease,45 patients with triple-vessel disease,and 14 patients with left main and triple vessel disease. Intraoperative findings showed no clear boundary LVA in 30 patients,apical thinning without obvious LVA in 29 patients,LVA without obvious contradictory wall motion but thickening of the apex in 15 patients. All the 74 patients received CABG including 62 patients undergoing on-pump CABG and 12 patients undergoing off-pump CABG. Seventy patients received left internal mammary artery to left anterior descending anastomosis,and 2 patients received endarterectomy of the left anterior descending coronary artery. For moderate to severe mitral regurgitation,3 patients received concomitant mitral valvuloplasty,and 2 patients received concomitant mitral valve replacement. One patient received concomitant aortic valve replacement for severe aortic stenosis. ResultsPostoperatively,2 patients (2.7%) died of malignant arrhythmia and hypoxic ischemic encephalopathy respectively. Six patients received intra-aortic balloon pump (IABP) support for low cardiac output syndrome,perioperative myocardial infarction and malignant arrhythmias. Seventy patients were followed up after discharge for 24-60 (43±12) months. During follow-up,left ventricular thrombus was found in 8 patients,disappeared within 1 year after warfarin treatment in 5 patients,and no thromboembolic event happened. Echocardiogram showed that LVA disappeared in 18 patients (25.7%). Ejection fraction (EF) at discharge,6 months and 1 years after discharge were significantly higher than preoperative EF (EF at 6 months after discharge versus preoperative EF:44%±6% vs. 39%±5%). Left ventricular end-diastolic diameter (LVEDD,LVEDD at 6 months after discharge versus preoperative LVEDD:54.37±6.28 mm vs. 59.24±6.24 mm) and left ventricular end-systolic diameter (LVESD) were significantly reduced compared with preoperative values (P<0.01). But as time went by,LVEDD and LVESD gradually became larger than those values at discharge. ConclusionFor patients with CHD and LVA,CABG without SVR,which is decided according to actual surgical exploration,can significantly improve postoperative EF,LVEDD and LVESD,but left ventricular enlargement may happen progressively after discharge.
ObjectiveTo explore the current research status of endovascular treatment for isolated superior mesenteric artery dissection (ISMAD) so as to provide a reference for vascular surgeons and patients in selecting treatment methods. MethodThe recent domestic and international literature on the endovascular treatment for ISMAD was collected and summarized. ResultsThe current endovascular treatment methods for ISMAD mainly included catheter-directed thrombolysis and stent placement. For the ISMAD patients with true intraluminal thrombus formation, true luminal occlusion, and partial embolization of branch vessels, the catheter-directed thrombolysis was performed by continuously pumping urokinase locally to dissolve thrombus and improve distal blood supply. The stent placement mainly included two main types: bare stent placement and covered stent placement, both aiming to promote true lumen recanalization, false lumen thrombosis, and vascular remodeling through mechanical support and blood flow redirection. The bare stents had unique advantages such as being well-developed, offering a wide range of options, and having stable performance. However, covered stents were superior to bare stents in terms of mid-term patency rate and in-stent restenosis. ConclusionsWith the development of technology, endovascular treatment has become an indispensable method for ISMAD patients. Extensive multicenter cases reports from both domestic and international studies have supported the safety and efficacy of endovascular treatment. Catheter-directed thrombolysis and stent placement (bare stent and covered stent) offer targeted solutions for various types of ISMAD patients, providing more minimally invasive and effective treatment.
ObjectiveTo explore the progresses of diagnosis and treatment for endoleaks after endovascular repair of abdominal aortic aneurysm (EVAR). MethodsThe literatures on studying the classification, diagnosis and management, risk factor, and treatment for the endoleaks after EVAR were reviewed and analyzed. ResultsEndoleak was a common and particular complication after EVAR and its represented persistence meant failure of the EVAR treatment. Accurate detection and classification were essential for the proper management and the treatment method for the endoleak was determined by the different source. Type Ⅰ and type Ⅲ endoleak required urgent treatment， type Ⅱ and type Ⅴ were considered less urgently but may be observed continuously. A variety of techniques including extension endografts or cuff, balloon angioplasty, bare stents, and a combination of transvascular and direct sac puncture embolization techniques were allowed to treat the vast majority of these endoleaks. ConclusionsEndoleak after EVAR is still the main clinical problem to be solved. The characters of endoleak still are not fully revealed. The diagnosis and treatment remained equivocal, which requires further study.
The treatment of chronic thoracoabdominal aortic dissection aneurysm remains a major challenge in aortic surgery. Open surgery is the mainstream treatment at present. New devices for endovascular treatment of chronic thoracoabdominal aortic dissection are gradually applied in clinical practice. The hybrid procedure is a combination of open and endovascular procedures. The appropriate treatment should be selected according to the patient's age, anatomy, genetic aortic disease, and comorbidities.
Objective To evaluate the clinical efficacy and safety of endovascular therapy for spontaneous isolated superior mesenteric artery dissection (SISMAD). Methods The clinical data of 17 patients with SISMAD, who were treated at author's hospital during the period from March 2009 to May 2016, were retrospectively analyzed. According to the Sakamoto angiographic classification, patients were divided into typeⅠ (n=3), typeⅡ (n=5), and type Ⅲ (n=9). Three patients with type Ⅰ were treated with conservative treatment first, and then 2 were treated with endovascular therapy as the poor reaction. The other patients were treated with endovascular treatment right a way. Results Conservative treatment was success in 1 case, 16 patients were treated with endovascular treatment, the technical success rate was 100%, one stent was used in 11 patients and two stents were used in 5 patients, and the blood in the true lumen of superior mesenteric artery (SMA) restored, no major complications occurred. Seventeen patients were followed-up for 3-36 months (mean of 19 months) and the followed-up rate was 100%, no abdominal pain occurred in 17 cases, CTA showed that no dissecting aneurysm was observed and the stents were patent of SMA. Conclusion Interventional therapy is a safe and effective method for SISMAD.
ObjectiveTo understand risk factors of abdominal aortic aneurysm (AAA) rupture and the latest progress.MethodThe domestic and foreign related literatures on risk factors affecting AAA rupture were retrieved and reviewed.ResultsBesides some definite risk factors of AAA rupture, including age, gender, hypertension, smoking, family history, complications (such as diabetes mellitus, hypertension, dyslipidemia, etc.), the biomechanical factor was the crucial factor of AAA rupture, including the aortic compliance, aortic wall peak value of pressure, aortic wall calcification, and hemodynamics. The latest imaging methods such as the high resolution ultrasound, function and molecular imaging, and phase contrast magnetic resonance imaging could provide technical supports for the prediction of AAA rupture.ConclusionsThere are many risk factors affecting AAA rupture. Clinicians might prevent and make individualize treatment for AAA rupture according to its risk factors, and risks of AAA rupture could be more accurately assessed with help of new medical imaging examination.
Objective To investigate pathogenesis and therapeutic prospect of abdominal aortic aneurysm (AAA). Methods Relevant literatures about pathogenesis and ways of treatment for AAA in recent years were reviewed. Results The formation of AAA are associated with heredity, anatomy, environment and biochemistry and other factors. All factors influence and interact with each other. The metabolic disequilibrium of aortic intermediate extracellular matrix plays an important role in the pathogenesis of AAA. The main reasons for the formation of AAA may be the increase of activity of matrix metalloproteinases and the disequilibrium of genetic expressions of elastin and collagen. The therapy of AAA includes surgical and medical treatment. The methods of medical treatment are still in the process of exploration and research. Conclusion The formation of AAA is a synergistical result of multiple factors, and medical treatment is an important supplement of surgical treatment.