Transapical transcatheter mitral valve implantation with J-valve in patients with degenerated mitral bioprostheses.

BACKGROUND: Due to the widespread application of bioprosthetic valve in the treatment of mitral valve disease in recent years, the incidence of valve failure has increased significantly, which is facing the need of reoperation. For high-risk patients, transcatheter mitral valve-in-valve placement is increasingly being used as an alternative to surgical reoperation. CASE PRESENTATION: Here we report the successful transapical transcatheter mitral valve-in-valve implantations of J-Valves in 3 patients with high risk of mitral bioprostheses failure. All patients were discharged successfully, and the follow-up results were good 30 days after operation without major complication. CONCLUSIONS: For high-risk patients, transcatheter implantation of the J-valve is a feasible solution for the treatment of degenerated mitral bioprostheses.

Mitral degenerative valve leaflets suspected as primary valvular tumor: a case report.

BACKGROUND: Echocardiography plays an important role in the diagnosis of heart disease. Sometimes, however, it may also provide misdiagnosis information. CASE PRESENTATION: We report a rare case of a misdiagnosis of primary mitral valvular tumor with severe regurgitation by preoperative echocardiography. During the surgery, the true lesion was found to be mitral valve leaflet prolapse due to degenerative mitral valve disease. CONCLUSION: For individual patient, the best clinical decision not only needs the extensive application of echocardiography, but also needs the combination of clinical symptoms and more auxiliary examination.

Delayed Presentation Injury of Descending Aorta and Bronchus Due to Sewing Needle Penetration: A Case Report.

We report a case of a tracheal foreign body caused by a sewing needle. After about four months, the patient showed delayed dry cough and hemoptysis. The sewing needle that pierced the tracheal wall damaged the aorta, and we performed endovascular stenting to prevent arterial bleeding and removed it under a bronchoscope. The patient smoothly recovered after the operation. This case proves that treatment strategies for patients with foreign bodies in the trachea can be individualized.

Surgical treatment of left atrial dissection caused by percutaneous coronary intervention.

Left atrial dissection (LatD), also known as left atrial intramural haematoma, is a rare condition that requires rapid diagnosis and frequently calls for timely surgical intervention. Diagnosis can be challenging because of a lack of definitive clinical criteria, and a patient's situation can be complicated by co-morbidities, including unstable haemodynamics. We surgically repaired a case of LatD related to percutaneous coronary intervention (PCI). The operation went smoothly, and the patient was discharged one week after the operation. For LatD patients with co-morbidities, especially haemodynamic disorders, active surgical intervention is recommended.

Modified Mini-Maze for Atrial Fibrillation with Interruption of Inferior Vena Cava.

A 57-year-old female with paroxysmal atrial fibrillation and an interrupted inferior vena cava (IVC) was referred to our hospital for radiofrequency ablation. Transseptal puncture and left atrium ablation failed through a standard IVC approach via the femoral vein due to intrahepatic interruption of IVC. We performed a modified mini-maze procedure in this patient through the left thoracic cavity under video-assisted thoracoscopic surgery (VATS). We can successfully complete pulmonary vein (PV) isolation, left atrium box isolation, cardiac ganglia ablation, Marshall ligament ablation, and coronary sinus epicardium ablation using this technique.

Atrioesophageal fistula after atrial fibrillation catheter ablation: A case report.

RATIONALE: Atrioesophageal fistula (AEF) is a rare but serious complication of atrial fibrillation (AF) catheter ablation with associated high mortality rates. PATIENT CONCERNS: A 42-year-old male patient who underwent catheter ablation in local hospital 20 days ago because of persistent AF was admitted to our Emergency Room with unconsciousness and high axillary temperature and white blood cell count. Craniocerebral CT scan found multiple infarct lesions in both frontal and occipital lobes. Pneumatosis between the left atrium and the esophagus was observed in the chest CT. DIAGNOSES: AEF. INTERVENTIONS: We performed a salvage operation of the left atrium debridement, and left atrium patch repairing under extracorporeal circulation. We opened the mediastinum, and dissected the esophageal perforation. A special irrigating catheter with multiple side ports on the tip was placed from the esophagus to the posterior mediastinum through the esophageal orificium fistulae. We also inserted a gastrointestinal tube to the jejunum under gastroscopy. Three additional drainage tubes were inserted into the esophageal bed and the right thoracic cavity. OUTCOMES: The procedure was successful. But 7 days later, the patient's family chose to forgo treatment due to multiple cerebral infarcts, respiratory and blood system infection, liver failure, and other complications. LESSONS: AEF is a rare but fatal complication after catheter ablation. Heightened vigilance is required for early recognition of the AEF. Surgical treatment should be performed as early as possible, especially before the neurological complications occur.

Laser ultrasonic imaging for defect detection on metal additive manufacturing components with rough surfaces.

Defects or discontinuities are inevitable during the melting and consolidation process of metal additive manufacturing. Online inspection of microdefects during the processing of layer-by-layer fusion is urgently needed for quality control. In this study, the laser ultrasonic C-scan imaging system is established to detect the surface defects of selective laser melting (SLM) samples that have a different surface roughness. An autosizing method based on the maximum correlation coefficient and lag time is proposed to accurately measure the defect length. The influences of the surface roughness on the laser ultrasound signal-to-noise ratio distribution and defect sizing accuracy are also studied. The results indicate that the proposed system can detect notches with a depth of 50 µm and holes with a diameter of 50 µm, comparable in size to raw powder particles. The average error for the length measurement can reach 1.5% if the notch is larger than 2 mm. Meanwhile, the sizing error of a 1 mm length notch is about 9%. In addition, there is no need to remove the rough surface of the as-built SLM samples during the detection process. Hence, we propose that the laser ultrasonic imaging system is a potential method for online inspection of metal additive manufacturing.

Iatrogenic Dissection of The Right Coronary Artery and The Ascending Aorta Secondary to Percutaneous Coronary Intervention: A Case Report.

Iatrogenic dissections of coronary artery and aorta is a rare and potentially fatal event, often following percutaneous coronary intervention (PCI). The prognosis of patients often depends on early accurate diagnosis and timely and effective treatment. There are no definite guidelines for the treatment of acute coronary artery dissection caused by PCI. Here, we report a 50-year-old patient with iatrogenic dissection of the right coronary artery and type A aortic dissection who underwent PCI for chest pain. We performed emergency surgery of right coronary artery ostium repair, aortic valvoplasty, ascending aorta replacement, and aortic arch descending stent implantation for the patient. The operation went smoothly, and the patient successfully was discharged two weeks after the operation.

Treatment experience of thoracic aortic aneurysm recurrence after multiple surgeries for Marfan syndrome: A case report.

RATIONALE: Marfan syndrome (MFS), an autosomal dominant hereditary disease, often results in structural and functional abnormalities of the aortic wall. Because of residual aortic aneurysm or aortic dissection, patients with MFS usually need repeat operations after the first operation. PATIENT CONCERNS: A patient diagnosed with MFS who had undergone 2 surgeries because of abdominal aortic dissection aneurysm and Stanford A type aortic dissection at different times. DIAGNOSES: MFS. INTERVENTIONS: Due to aneurysmal dilatation of the residual descending aorta, we performed the third surgery for him through using 2 artificial stent grafts to fix and package the area of the remaining vessel in our hospital. OUTCOMES: The result was good, and the patient was discharged successfully. LESSONS: Using artificial material to repair and wrap the area of the residual vessel during the first surgery can provide an anchor area for future endovascular stent implantation and also offer a possibility for stent implantation in patients with MFS.

A Rare Giant Pulmonary Aneurysm with Left Lung Compression: A Case Report with Insights from the Literature.

Pulmonary artery aneurysm (PAA) is a rare condition that results from several pathologies. Here, we report a case of a rare giant PAA accompanied by left lung compression due to recurrent chest tightness for >13 years. Through this case and review of the literature, we explore the treatment options to improve the diagnosis and treatment of PAA. We found that patients with PAA may survive longer even if they also have pulmonary hypertension. In addition, it is recommended that if a PAA diameter is >5.5 cm or if the PAA diameter has increased by >0.5 cm in 6 months, the PAA should be operated on as soon as possible. Conservative treatment can be recommended in patients with congenital PAA if pulmonary arterial pressure is normal.

Relational Network for Knowledge Discovery through Heterogeneous Biomedical and Clinical Features.

Biomedical big data, as a whole, covers numerous features, while each dataset specifically delineates part of them. "Full feature spectrum" knowledge discovery across heterogeneous data sources remains a major challenge. We developed a method called bootstrapping for unified feature association measurement (BUFAM) for pairwise association analysis, and relational dependency network (RDN) modeling for global module detection on features across breast cancer cohorts. Discovered knowledge was cross-validated using data from Wake Forest Baptist Medical Center's electronic medical records and annotated with BioCarta signaling signatures. The clinical potential of the discovered modules was exhibited by stratifying patients for drug responses. A series of discovered associations provided new insights into breast cancer, such as the effects of patient's cultural background on preferences for surgical procedure. We also discovered two groups of highly associated features, the HER2 and the ER modules, each of which described how phenotypes were associated with molecular signatures, diagnostic features, and clinical decisions. The discovered "ER module", which was dominated by cancer immunity, was used as an example for patient stratification and prediction of drug responses to tamoxifen and chemotherapy. BUFAM-derived RDN modeling demonstrated unique ability to discover clinically meaningful and actionable knowledge across highly heterogeneous biomedical big data sets.

Totally endoscopic congenital heart surgery compared with the traditional heart operation in children.

OBJECTIVE: Totally endoscopic surgery compared with the conventional heart operation in children is described in this article to find a preferable treatment for congenital heart diseases. METHODS: Between May 2000 and December 2007, 708 children with congenital heart disease were divided into two groups: endoscopic group and conventional group. For the endoscopic group, all children underwent total endoscopic procedures with peripheral cardiopulmonary bypass, transthoracic aortic cross-clamp, and antegrade cardioplegia, whereas for the conventional group, all children were operated in traditional way. Three 1-2-cm intercostal ports in the right chest were used for access in the endoscopic group. The intrathoracic part of the operation was performed completely under two-dimensional video, using conventional instruments. Directly closureed of the atrial septal defect was performed in 74 cases, patch closureed of the atrial septal defect in 48 cases, directly closureed of the ventricular septal defect in 158 cases, patch closureing of the ventricular septal defect in 116 cases. For the conventional group, all operations were done with traditional median sternotomy. Directed closureing of the atrial septal defect was performed in 38 cases, patch closed of the atrial septal defect in 56 cases, directly closureed of the ventricular septal defect in 76 cases, patch closureed of the ventricular septal defect in 142 cases. RESULTS: There was no hospital mortality in both groups. For the endoscopic group, operations were performed successfully in 390 (98.5 %) patients, enlarging a port to a 5-cm incision in 4 children. Reoperation was necessary in two children, and no conversion to median sternotomy incision was necessary. The mean duration of operation was 132 ± 48 min, and cardiopulmonary bypass and aortic cross-clamp times were 54 ± 16 min and 25 ± 8 min, respectively. Major postoperative complications occurred in nine (2.3 %, p < 0.05) cases. For the conventional group, all children were operated by median sternotomy, and the mean duration of operation was 118 ± 41 min (p < 0.05); cardiopulmonary bypass and aortic cross-clamp times were 51 ± 13 min and 21 ± 6 min (p < 0.05), respectively. Major postoperative complications occurred in 16 (5.1 %) cases. Also, the intensive care unit stay time (8.3 ± 2.8 h versus 8.9 ± 2.9 h, p < 0.01), postoperative drainage (120 ± 21 ml versus 433 ± 140 ml, p < 0.05), and hospital time (8.6 ± 1.8 days versus 11.5 ± 1.9 days, p < 0.05) were statistically different. CONCLUSIONS: Totally endoscopic closed chest congenital heart surgery in children was feasible and safe. The results were similar or even superior to the traditional operations due to the decreased use of blood products and shortened hospital time. Degree of satisfaction with cosmetic result and postoperative comfort were very high. Therefore, endoscopic surgery will become a new popular choice for some congenital heart disease patients in the future.

A comparative study: diffusion weighted whole body imaging with background body signal suppression and hybrid Positron Emission Computed Tomography on detecting lesions in oncologic clinics.

OBJECTIVE: To compare diffusion weighted whole body imaging with background body signal suppression (DWIBS) with hybrid Positron Emission Computed Tomography (HPET/CT) on clinical value in oncology. METHODS: 43 patients with oncological diseases were enrolled in our hospital from October, 2008 to April, 2010. All the cases underwent DWIBS and HPET/CT within 14 days. Combined with other imagings, lesions detected by both modalities were evaluated. Lesions were confirmed by pathology, cytology or clinical diagnosis (needed no less than 6 months and three times follow-up). RESULTS: The overall detection rate of the DWIBS and HPET/CT were 90.3% (261/289), 86.6% (251/289), concordant ratio of the two modalities was 88.2% (255/289). There was no statistical difference between DWIBS and HPET/CT on detecting lesions (P>0.05). HPET/CT was significantly more sensitive in detecting lesions in lung (P<0.05), whereas DWIBS was more sensitive in identifying lesions in brain and bone (P<0.05). With regard to finding lesions in liver and lymph node, the two procedures had no significant difference (P>0.05). CONCLUSION: DWIBS and HPET/CT have a certain degree of consistency in terms of identifying lesions. However, they have advantages and disadvantages in some organs or tissues, which should be taken into full consideration in clinical practice.

Dissociation between visual line bisection and mental number line bisection in schizophrenia.

Many studies of hemispatial neglect patients have indicated that spatial attention processes operate similarly in visual space and number space. However, some studies have indicated a dissociation of processing between visual line bisection and mental number bisection. A number of investigations have suggested that schizophrenic patients show a mild right pseudo-neglect on visual line bisection tasks. The present study was designed to determine if a functional link exists between performance of visual line and number line bisection in schizophrenic patients. Groups of 40 schizophrenic patients and 40 controls performed each bisection task. In the visual line bisection task, schizophrenic patients showed a significant leftward bias relative to the healthy controls for 9 different line lengths. No significant difference in bias was found between the 2 groups on the mental line bisection task. These results indicated that schizophrenic patients may exhibit attention deficit with respect to visual space but not number space, suggestive of the dissociation of processing between visual line bisection and mental number line bisection. These results provide more insight into the correlation between the visual line and number bisection tasks in schizophrenic patients.