ABSTRACT
Objective Investigate the therapeutic strategies of hypertrophic obstructive cardiomyopathy ( HOCM ) com-bined with mitral regurgitation(MR).Methods From January 2014 to January 2017, 34 patients with HOCM complicated with moderate to severe MR were enrolled.All patients underwent modified Morrow surgery.Compare the clinical data of pa-tients before and after surgery and the results of one year after surgery .Results There is no patient died during hospitaliza-tion, and all were discharged smoothly without serious complications ( ventricular septal perforation, complete atrioventricular block, etc.) .Results of echocardiography 1 week after surgery suggested: Left ventricular outflow tract pressure difference [(93.36 ±7.93) mmHg vs.(16.73 ±2.02) mmHg,1 mmHg=0.133 kPa, P<0.01], left ventricular outflow tract velocity[(472.40 ±22.12)cm/s vs.(188.40 ±14.16)cm/s, P<0.01], interventricular septal thickness [(19.43 ±0.77) mm vs.(16.45 ±0.76) mm, P<0.01], mitral valve structure and function were good, and MR area [(8.41 ±0.69)cm2 vs. (3.04 ±0.73)cm2, P<0.01], all of which were significantly lower than that before surgery, and the differences were statis-tically significant.Although the results of echocardiography 1 week after surgery indicated that the left ventricular ejection frac-tion(LVEF) was significantly lower than that before surgery(0.67 ±0.07 vs.0.65 ±0.07, P=0.01), the symptoms of the patients were significantly improved, and the cardiac function(NYHA classification) was grade I～II.The results of echocar-diography after 1 year of follow-up suggested that: Left ventricular outflow tract pressure difference [(93.36 ±7.93) mmHg vs.(16.98 ±2.33) mmHg, P<0.01], left ventricular outflow tract velocity [(472.40 ±22.12)cm/s vs.(189.33 ±14.23) cm/s, P<0.01], ventricular septal thickness [(19.43 ±0.77) mm vs.(16.55 ±0.83) mm, P <0.01], mitral valve structure and function well, MR area [(8.41 ±0.69) cm2 vs.(2.95 ±0.66) cm2, P<0.01], and the MR area was signifi-cantly decreased compared with that before operation .The difference was statistically significant .Results of echocardiography 1 week and 1 year after surgery suggest:Left ventricular outflow tract pressure difference [(16.73 ±2.02) mmHg vs.(16.98 ± 2.33) mmHg, P>0.05], left ventricular outflow tract velocity [(188.40 ±14.16)cm/s vs.(189.33 ±14.23)cm/s, P>0.05], ventricular septal thickness [(16.45 ±0.76) mm vs.(16.55 ±0.83) mm, P>0.05], MR area [(3.04 ±0.73) cm2 vs.(2.95 ±0.66) cm2, P>0.05], no statistical significance.One year after the operation, the symptoms and quality of life were significantly improved .Conclusion Hypertrophic obstructive cardiomyopathy often combined with mitral regurgita-tion, modified Morrow operation can fully clear the left ventricular outflow tract, which can eliminate MR and SAM signs, and the results are satisfactory.
ABSTRACT
Objective To investigate the effects of interventticular septal thickness (IST) on postoperative trans-aonic valve pressure after aortic valve replacement (AVR).Methods 273 patients were divided into 3 groups with different mechanical valves and postoperative trans-aortic valve pressure (TAVP).Hemodynamic parameters including left ventricular end diastolic diameter,left ventricular end systolic diameter,ejection fraction and IST were analyzed.Results There was no significant difference in left ventricular diastolic diameter,left ventricular systolic diameter and ejection fraction in three groups with different mechanical valves ( P ＞ 0.05 ).In patients with St.Jude Regent valve,preoperative IST in severe TAVP group was significantly thicker than those of moderate and mild groups ( P ＜ 0.05 ).In patients with On-x valve,preoperative IST in severe and moderate TAVP groups were thicker than that of mild group ( P ＜0.05 ).In patients with other mechanical valve,preoperative IST in severe TAVP group is greater than those of moderate and mild groups ( P ＜ 0.05 ).Conclusion Interventricular septal thickness did have positive influence on postoperative trans-aortic valve pressure after AVR.When IST was more than 13.6mm,the postoperative trans-aortic valve pressure after aortic valve replacement was higher than the IST was less than 13.6mm.When IST was thicker than 15.3mm,partial ventticular septal resection or replacement of stentless valve should be considered.
ABSTRACT
ObjectiveTo compare the effects of preventative intra-aortic balloon pump (IABP) insertion with intra-or post-operative IABP insertion in high-risk patients undergoing coronary artery bypass grafting (CABG).MethodsFrom Jan 2008 to May 2011,one hundred and four patients received CABG or off-pump CABG (OPCABG) and IABP therapy in our hospital.The enrolled criteria of IABP insertion included left ventricular ejection fraction (EF) less than 0.40,unstable angina,AMI,left main stenosis,emergency CABG,refractory ventricular arrhythmia.Group1 included thirty eight patients with preoperative IABP insertion,thirty one for intra-operative IABP insertion ( group 2 ) and thirty four for postoperative IABP insertion ( group 3 ).The indications for IABP insertion for group 2 and 3 were unstable hemodynamics,failure to wean off cardiopulmonary bypass and low output syndrome during or after operation.Clinical data including operative mortality,ventricular fibrillation,chest drainage,hospital stay,ICU stay,ventilator supporting time,IABP supporting time,EF improvement rate,mechanical assist device and Inotropic drugs utilizations were analyzed among three groups.ResultsGroup 1 demonstrated good therapeutic results.There were significant statistic differences in operative mortality ( group 1 2.6％,group 2 12.9％,Group 3 47.1％),hospital stay[group 1 (23.6 ± 9.8) days,group 2 (21.5 ±9.7) days,group 3 (28.9 ±13.3) days],ICU stay[group 1 (2.3 ± 1.1 ) days,group 2 (3.5 ± 1.5 ) days,group 3 (5.2 ± 3.4) days],ventilator supporting time [group 1 (29.5 ± 23.0) hours,group 2 (38.7 ± 20.6) hours,group 3 (84.1 ± 48.0) hours],IABP supporting time [group 1 (77.0 ± 43.7 ) hours,group 2 ( 93.8 ± 44.8 ) hours,group 3 ( 121.5 ± 71.7 ) hours],EF improvement rate [group 1 (7.5 ± 7.2),group 2 ( 8.5 ± 7.5 ),group 3 (2.0 ± 6.7)],inotropic drugs utilization[group 1 ( 3.7 ± 4.9) days,group2 (6.2±4.6) days,group3 (10.8±5.4) days](P＜0.05).ConclusionComparing with intra- or post-operative IABP insertion,high-risk patients undergoing CABG could significantly benefit from preventative IABP insertion.Early IABP insertion was recommended for high-risk patients undergoing coronary artery bypass grafting.
ABSTRACT
Objective To analysis of risk factors for left atrial thrombosis in patients with rheumatic mitral stenosis.Methods From January 2001 to December 2008, 2277 patients with rheumatic mitral stenosis underwent operations in our hospital. There were 737 males and 1540 female, the age ranged from 19 to 84 years [average (50.9 ±10.2) years]. Left atrial thrombosis group (554 cases) and no thrombosis group (1723 cases) were divided, retrospectively collected data were analyzed with univariate and multivariate Logistic regression. Results 12 bvariables, including age, mitral valve orifice area, left atrial diameter, left ventricular diastole diameter, CRP, gender , degree of mitral stenosis, or regurgitation, degree of bicuspid regurgitation, degree of pulmonary hypertension, atrial fibrillation and heart function had statistic difference between two groups. With multivariate Logistic regression for these 12 factors, age, mitral valve orifice area, left atrial diameter, degree of mitral regurgitation and atrial fibrillation were found to be the affecting factors for left atrial thrombosis in patients with rheumatic mitral stenosis. Conclusion For patients with rheumatic mitral stenosis, age, mitral valve orifice area, left atrial diameter and atrial fibrillation are the risk factors for left atrial thrombosis. Mitral regurgitation is a protective factor for left atrial thrombosis.