Surgical intervention and outcome for treatment of myocardial bridging refractory to medication.

INTRODUCTION: Myocardial bridging (MB) is a common and usually benign inborn coronary abnormality that may lead to anginal symptoms, acute coronary syndrome, arrhythmias, and rarely sudden cardiac death. MB are most commonly localized in the middle segment of the left anterior descending coronary artery (LAD). The treatment of LAD-MB is still challenging. Our objective was to assess the short- and long-term results of surgical procedures in patients with LAD-MB who had chest pain refractory to medical therapy. METHODS: Between March 2005 and January 2020, 26 patients (19 males and 7 females; mean 55.8 ± 12.4 years) with MB underwent surgery. All MB was located in the mid-segment of the LAD with a mean length of 4.2 ± 1.7 cm. Coronary angiography before surgery demonstrated LAD-MB with systolic compression more than or equal to 70% in all patients. RESULTS: Twenty-five patients underwent myotomy and one patient underwent coronary artery bypass grafting (CABG). All patients survived and recovered uneventfully. Neither hospital or late death nor major complications occurred. Follow-up time was 3-173 months (mean 55.7 months). Follow-up of coronary angiography or computed tomography scan performed in 16 patients demonstrated restoration of coronary blood flow and myocardial perfusion without significant residual compression of the artery. All patients were symptom-free and are currently in NYHA Class I. CONCLUSION: The symptomatic LAD-MB patients who are refractory to medication should actively undergo the surgical intervention such as myotomy and CABG to eliminate the clinical symptoms and achieve satisfactory results by follow-up findings. Myotomy is a preferred procedure because of its safety and satisfactory results.

Modified Peritoneal Dialysis for Treatment of Acute Renal Failure after Complex Congenital Heart Surgery in Infants.

BACKGROUND: Acute kidney injury (AKI) is one of the common complications in infants and children after complex congenital heart surgery. Peritoneal dialysis (PD) is usually applied for renal replacement therapy (RRT), especially in infants. We investigated the efficacy and safety of modified PD for the treatment of acute renal failure and congestive heart failure after cardiac surgery for congenital heart disease in infants. METHODS: We retrospectively analyzed five consecutive patients from October 2015 to February 2017. The patients were aged from four days to five years old, and all had acute renal failure and congestive heart failure after cardiac surgery. In the five patients treated with modified PD (five males; average weight: 11.2 ± 5.5 kg), we used the Seldinger technique percutaneous abdominal puncture 16 G single lumen central venous catheter instead of the Tenckhoff peritoneal dialysis catheter as a PD catheter. Modified PD was intermittent. We recorded and monitored circulation and metabolism index. RESULTS: Five cases (100%) with modified PD were restored to normal renal function. Congestive heart failure was gradually alleviated, and pulmonary and cardiovascular function were improved. Urine volume increased. Neither peritonitis nor catheter leakage occured in any of our cases. Urine volume increased due to PD, from 0.16 + 0.18 mL/kg*h before PD to 2.63 + 1.05 ml/kg*h at the end of PD (P < .05). Serum creatinine, serum urea nitrogen, and serum K+ changed from 85.0 ± 36.5 µmol/L, 17.1 ± 7.5 mmol/L, and 4.57 ± 0.30 mmol/L before PD, to 76.0 ± 36.7 µmol/L, 20.1 ± 11.0 mmol/L, and 4.42 ± 0.42 mmol/L at the end of PD, respectively (P > .05). Acidosis, hyperkalemia, hypoxemia and low cardiac output syndrome were improved. All patients were cured and discharged with normal renal function. CONCLUSION: We conclude that modified single lumen central venous catheter for PD is a safe, feasible, and less invasive therapeutic strategy for AKI in infants undergoing cardiac surgery, and is worthy of being widely applied in clinical practice.

Revascularization by carotid artery stenting and off-pump coronary artery bypass.

BACKGROUND: The optimal management of patients with concomitant carotid and coronary artery disease remains controversial currently. The purpose of this study was to evaluate the safety and efficacy of hybrid or staged revascularization by carotid artery stenting (CAS) and off-pump coronary artery bypass (OPCAB) in the treatment of these patients. METHODS: From September 2006 to January 2011, 59 consecutive patients with carotid and coronary artery disease underwent either hybrid (n = 20) or staged (n = 39) CAS and OPCAB, the perioperative and long-term outcomes were analysed. The primary endpoint was the incidence of stroke, perioperative myocardial infarction (MI) or death within 30 days of the procedures. RESULTS: No death occurred post-operatively. Two patients (2/20) in hybrid group and two patients (2/39) in staged group suffered from non-fatal stroke. The combined incidence of stroke, MI or death at 30 days was 10.0% in hybrid group and 5.1% in staged group (P = 0.875). The median follow-up time was 44 months (range, 28 to 80 months) with 57 patients (96.6%) available. During follow-up period, one patient had non-fatal stroke in hybrid group and one patient suffered from MI in staged group, respectively. There was no significant difference of long-term event-free survival between the two groups (log-rank test, P = 0.390). CONCLUSION: Our findings demonstrate that for patients with carotid and coronary artery disease, both hybrid and staged revascularization by CAS and OPCAB are feasible and safe therapeutic strategies with good early and long-term outcomes. However, our results have to be substantiated by larger scale studies and randomized trials.