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2.
Int Heart J ; 58(6): 894-899, 2017 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-29118301

RESUMO

Totally thoracosopic mitral valve replacement (MVR) has been applied to mitral stenosis for many years. Three working ports are usually necessary, among which the longest port ranges from 6 to 8 cm. This study aimed to determine the safety and feasibility of the two-incision totally thoracoscopic approach for MVR, with the longest incision of 3 cm.From January 2014 to February 2016, 90 patients with mitral valve stenosis were retrospectively analyzed. Thirty-six (40%) patients were included in the two-incision group and 54 patients were operated on using the sternotomy approach. Perioperative variables and postoperative 3-month follow-up data were analyzed.All patients underwent MVR. Tricuspid valvuloplasty was performed in 23 (25.5%) patients with the Kay technique. The mean total surgery time, cardiopulmonary bypass, and cross-clamp times were longer in the two-incision group (266 ± 42 versus 200 ± 38 minutes; 156 ± 23 versus 121 ± 21 minutes; 100 ± 17 versus 80 ± 17 minutes, respectively) (P < 0.05). The mean postoperative mechanical ventilation time was shorter in the two-incision group (8.6 ± 2.5 versus 11.2 ± 2.6 hours, respectively) (P < 0.05). The mean volume of blood drainage was less in the two-incision group (497 ± 120 versus 730 ± 198 mL, respectively) (P < 0.05). Reopening occurred in one (sternotomy group, 1.8%) patient. No deaths, perivalvular leakage, infectious endocarditis, atelectasis of the lungs, or moderate tricuspid regurgitation were found at the 3-month follow-up.The two-incision totally thoracoscopic approach for MVR is safe and feasible. Concomitant tricuspid valvuloplasty can be conveniently performed. However, further clinical data are needed in future studies.


Assuntos
Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Valva Mitral , Toracoscopia/métodos , Adulto , Feminino , Implante de Prótese de Valva Cardíaca/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Toracoscopia/estatística & dados numéricos
3.
Interact Cardiovasc Thorac Surg ; 17(1): 213-5, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23559364

RESUMO

Dextrocardia associated with situs inversus totalis is a rare congenital condition. A small number of cases with these conditions have been reported who underwent myocardial revascularization via the on-pump or off-pump techniques. Among them, only 1 patient with dextrocardia and situs inversus totalis was reported to have the procedure performed with minimally invasive coronary surgery via a right anterior small thoracotomy. However, the case was a single-vessel disease and only one graft was achieved. We describe the case of a 65-year old female patient with triple-vessel obstructive coronary diseases who was successfully revascularized with three grafts using a minimally invasive technique. This was achieved via partial sternotomy and employing off-pump coronary artery bypass grafting.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea , Doença da Artéria Coronariana/cirurgia , Dextrocardia/complicações , Situs Inversus/complicações , Esternotomia/métodos , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico , Feminino , Humanos , Resultado do Tratamento
4.
Thromb Res ; 131(5): e196-201, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23453712

RESUMO

BACKGROUND: Pulmonary endarterectomy (PEA) is an effective treatment for chronic thromboembolic pulmonary hypertension (CTEPH) by dissecting the residual thrombus from the native vessel wall. The goal of PEA is to improve pulmonary hemodynamics and right ventricular dysfunction, and thus increase exercise capacity, alleviate symptoms and decrease mortality. The aim of this study, accordingly, was to assess the ability of echocardiography to provide a mechanism to monitor the time course of RV functional improvement after PEA. METHODS: Twenty-six consecutive adult patients who underwent PEA for CTEPH were included in the study. All the patients underwent transthoracic echocardiography and right heart catheterization before surgery. Follow-up echocardiography was performed within 3, 12, and 24 months of surgery. The parameters of right ventricle were compared with baseline data. RESULTS: In all cases, the RV was enlarged and systolic function was impaired before surgery. RV systolic pressure fell from 92±16 mm Hg before surgery to 41±9 mm Hg by the 3 month post-PEA follow-up (P<0.001). RV end-diastolic area and end-systolic area likewise decreased from 35.8±4.4 cm(2) to 26.6±4.8 cm(2) (P<0.001) and from 27.1±3.8 cm(2) to 17.9±3.8 cm(2) (P<0.001), respectively. The RV myocardial performance index also decreased from a ratio of 0.8±0.1 to 0.5±0.1 (P<0.001). The tricuspid annular plane systolic excursion increased from 8.8±0.6mm to 10.1±0.9 mm (P<0.001). Tricuspid regurgitation (TR) improved from a mean grade of 3.1±0.5 to 2.2±0.7 (P<0.001). At the 12 and 24 month follow-up examinations, RV systolic pressure and function remained improved, respectively. The RV systolic pressure remained above 50 mmHg in only two cases. CONCLUSION: In patients with CTEPH who undergo PEA, echocardiography is a useful tool for the evaluation of RV function. Echocardiographic measurements of RV size, systolic pressure, systolic function, and TR show significant improvement, and this effect is sustained for up to 24 months after surgery.


Assuntos
Hipertensão Pulmonar/cirurgia , Disfunção Ventricular Direita/cirurgia , Adolescente , Adulto , Idoso , Endarterectomia/métodos , Feminino , Seguimentos , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Ultrassonografia , Disfunção Ventricular Direita/diagnóstico por imagem , Disfunção Ventricular Direita/fisiopatologia , Adulto Jovem
5.
Cardiovasc Pathol ; 20(2): 77-83, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-20117024

RESUMO

Postinfarct congestive heart failure is one of the leading causes of morbidity and mortality in industrialized countries. It is controversial whether embryonic stem cells are feasible sources for in situ cardiac regeneration in infarcted hearts. In order to investigate whether the infarcted cardiac microenvironment could selectively promote embryonic stem cell differentiation into cardiomyocytes, we assessed the cardiac differentiation potential of mouse embryonic stem cells (mESCs) injected into normal (n=16) or acutely infarcted rat hearts (n=18). We found that the transplanted 4',6-diamidino-2-phenylindole (DAPI)-labeled mESCs were able to survive and form stable intracardiac grafts both in normal and infarcted hearts, along with macrophages found specifically in the engraftment area. Two to four weeks after mESC transplantation, we found that more DAPI-positive mESCs differentiated into cardiomyocytes, marked by cardiac troponin T (cTnT), in normal than those in infarcted hearts (2.67±0.79% vs. 1.06±0.52%, P<.01). However, the discrepancy between the percentage of DAPI-positive cells that express cTnT in normal and that in infarcted hearts was diminished after 4 weeks (1.17±0.98% vs. 1.07±1.02%, P>.05), when the transverse striation began to present in the mESCs-derived cardiomyocytes. In addition, mESCs differentiated into vimentin-positive cardiac fibroblasts in normal and infracted hearts. Our results indicated that transplanted mESCs cannot only survive but differentiate into cardiomyocytes in infarcted rat hearts. However, the infarcted cardiac microenvironment cannot selectively promote mESCs differentiation into cardiomyocytes.


Assuntos
Diferenciação Celular/fisiologia , Células-Tronco Embrionárias/citologia , Células-Tronco Embrionárias/transplante , Infarto do Miocárdio/patologia , Miócitos Cardíacos/citologia , Animais , Feminino , Fibroblastos/citologia , Imunofluorescência , Camundongos , Infarto do Miocárdio/terapia , Ratos , Ratos Sprague-Dawley , Transplante de Células-Tronco , Transplante Heterólogo
6.
Chin Med J (Engl) ; 123(8): 979-83, 2010 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-20497700

RESUMO

BACKGROUND: Pulmonary endarterectomy is safe and effective surgical treatment for chronic thromboembolic pulmonary hypertension. This study aimed to evaluate the efficacy of pulmonary endarterectomy in treatment of thromboembolic pulmonary hypertension. METHODS: A retrospective study of 15 patients who underwent pulmonary endarterectomy in Beijing Chaoyang Hospital was performed. Obvious pulmonary hypertension and hypoxemia were observed in all patients. Bilateral pulmonary endarterectomy was performed under cardiopulmonary bypass with profound hypothermic circulatory arrest. RESULTS: Two patients (2/15) died of residual postoperative pulmonary hypertension and bleeding complication. The other 13 cases had significant decrease in systolic pulmonary artery pressure ((92.8 +/- 27.4) mmHg vs. (49.3 +/- 18.6) mmHg) and pulmonary vascular resistance ((938.7 +/- 464.1) dynesxsxcm(-5) vs. (316.8 +/- 153.3) dynesxsxcm(-5)), great improvement in cardiac index ((2.31 +/- 0.69) Lxmin(-1)xm(-2) vs. (3.85 +/- 1.21) Lxmin(-1)xm(-2)), arterial oxygen saturation (0.67 +/- 0.11 vs. 0.96 +/- 0.22) and mixed venous O(2) saturation (0.52 +/- 0.12 vs. 0.74 +/- 0.16) postoperatively compared to preoperative data. Mid-term follow-up showed that the cardiac function of all cases returned to NYHA class I or II, with great improvement in 6-minute walking distance ((138 +/- 36) m) and quality of life. CONCLUSIONS: Bilateral pulmonary endarterectomy using cardiopulmonary bypass with the aid of deep hypothermia and circulatory arrest can effectively reduce pulmonary hypertension and provide good mid-term hemodynamic and symptomatic results with low surgical mortality rate and few complications.


Assuntos
Endarterectomia/métodos , Hipertensão Pulmonar/cirurgia , Tromboembolia/cirurgia , Adolescente , Adulto , Ecocardiografia , Endarterectomia/efeitos adversos , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
7.
Arch Med Res ; 40(5): 339-44, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19766895

RESUMO

BACKGROUND AND AIMS: We undertook this study in order to investigate the electrophysiological properties of grafted mouse embryonic stem cell (ES)-derived cardiomyocytes in mouse hearts. METHODS: We generated transgenic D3 ES cells that carry the alpha-myosin heavy-chain promoter-driven enhanced green fluorescent protein (EGFP) gene. ES-derived cardiomyocytes (10 days) were purified by fluorescent-activated cell sorting and then transplanted into the left ventricle of syngeneic mice. Finally, hearts were removed and the EGFP+ cardiomyocytes were dissociated from the host heart for patch clamp study. RESULTS: Morphological studies showed that EGFP+ cardiomyocytes were round and small before transplantation. Majority of cells were larger and longer with clear cross striations at the fourth week. Colocalization of EGFP and 4',6-diamidino-2-phenylindole-labeled nuclei of transplanted cells with cardiomyocyte markers for cardiac troponin T, as detected by immunofluorescent microscopy, indicated the survival of grafted cells. The patch clamp study revealed that the ES-derived cardiomyocytes possessed pacemaker-like action potential (AP) before transplantation. Four weeks after transplantation, grafted cells retained the characteristic of intermediate embryonic ventricular-like AP distinct from triangular AP of adult mouse ventricular myocytes, along with the loss of cellular excitability and downregulation of pacemaker current, suggesting that these grafted cells were not as mature as native ventricular cells. CONCLUSIONS: Transplanted ES-derived cardiomyocytes display accelerated differentiation and loss of automaticity, indicating that the long-term effectiveness of ES cell-based biological pacemakers can also be problematic.


Assuntos
Diferenciação Celular/fisiologia , Células-Tronco Embrionárias/fisiologia , Coração/fisiologia , Miócitos Cardíacos/fisiologia , Animais , Linhagem Celular , Separação Celular , Fenômenos Eletrofisiológicos , Células-Tronco Embrionárias/citologia , Ventrículos do Coração/citologia , Masculino , Camundongos , Miócitos Cardíacos/citologia , Técnicas de Patch-Clamp , Transplante de Células-Tronco
8.
Chin Med J (Engl) ; 122(24): 2928-32, 2009 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-20137476

RESUMO

BACKGROUND: Atrial fibrillation (AF) is one of the most common arrhythmia after coronary artery bypass grafting (CABG), which not only increases the suffering of the patients, but also prolongs hospital stay and enhances cost of care, especially for patients older than 70 years. This study was designed to evaluate the efficacy and safety of low-dose amiodarone in the prevention of AF after CABG, especially for the elderly. METHODS: Two hundred and ten senile patients undergoing off-pump CABG were included in this prospective, randomized, double-blind and placebo controlled study. Patients were given 10 mg/kg of amiodarone (low-dose amiodarone group, n = 100) or placebo (control group, n = 110) daily for 7 days before surgery and followed by 200 mg of amiodarone or placebo daily for 10 days postoperatively. RESULTS: Postoperative AF occurred in 16 patients (16%) receiving amiodarone and in 36 (37.7%) patients receiving placebo (P = 0.006). AF occurred at (58.13 +/- 16.63) hours after CABG in the low-dose amiodarone group and at (45.03 +/- 17.40) hours in the control group (P = 0.018). The maximum ventricular rate during AF was significantly slower in the low-dose amiodarone group ((121.42 +/- 28.91) beats/min) than in the control group ((134.11 +/- 30.57) beats/min, P = 0.036). The duration of AF was (10.92 +/- 9.56) hours for the low-dose amiodarone group compared with (14.81 +/- 10.37) hours for the control group (P = 0.002). The postoperative left ventricular ejection fraction (LVEF) was significantly improved in the low-dose amiodarone group (from (59.9 +/- 10.3)% to (63.4 +/- 11.4)%, P = 0.001), and significantly higher compared with the control group ((58.5 +/- 10.7)%, P = 0.002). Both groups had a similar incidence of complication other than rhythm disturbances (12.0% vs 16.4%, P = 0.368). The low-dose amiodarone group patients had shorter hospital stays ((11.8 +/- 3.2) days vs (13.8 +/- 4.7) days, P = 0.001) and lower cost of care (RMB (79 115 +/- 16 673) Yuan vs RMB (84 997 +/- 21 587) Yuan, P = 0.031) than that of control group patients. The in-hospital mortality was not significantly different between the two groups (1.0% vs 0.9%, P = 0.946). CONCLUSIONS: Perioperative low-dose oral amiodarone appeared to be cost-effective in the prevention and delay of new-onset postoperative AF in aged patients. It significantly reduced ventricular rate and duration of AF after CABG, decreased hospital cost and stay, as well as promoted the amelioration of left ventricular systolic function. Furthermore, low-dose amiodarone was safe to use and well tolerated with low toxic and side effects, and did not increase the risk of complications and mortality. It is proved to be a first-line therapy and as routine prophylaxis for AF after CABG, especially for elderly patients complicated with left ventricular dysfunction.


Assuntos
Amiodarona/administração & dosagem , Antiarrítmicos/administração & dosagem , Fibrilação Atrial/prevenção & controle , Ponte de Artéria Coronária/efeitos adversos , Idoso , Fibrilação Atrial/etiologia , Método Duplo-Cego , Esquema de Medicação , Feminino , Humanos , Masculino , Resultado do Tratamento
9.
Cardiovasc Drugs Ther ; 22(6): 479-85, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18853243

RESUMO

OBJECTIVE: The effects of resveratrol treatment on ventricular arrhythmia, survival, and late cardiac remodeling were evaluated in rats with myocardial infarction (MI). METHODS: Three groups of rats (S: ham-operated, MI, and MI pre-treated with resveratrol) were treated in an in vivo MI model by ligation of left anterior descending coronary artery. The electrocardiogram signals were monitored and recorded for 24 h using an implanted telemetry transmitter. The incidence of ventricular arrhythmias during the first 24-h after MI was also evaluated. Meanwhile, invasive in vivo electrophysiology with pacing in the right ventricle was performed in each group to assess the inducibility of ventricular arrhythmias. RESULTS: Administration of resveratrol significantly suppressed the MI-induced ventricular tachycardia and ventricular fibrillation (0.4 +/- 0.2 in Resv group vs. 7.1 +/- 2.2 in MI group episodes per hour per rat, P < 0.01). Data also showed that the incidence of inducible ventricular tachycardia was lower in the Resv group than the MI group (46% vs. 81%, P < 0.01). The infarct size and mortality in the Resv group at 14 weeks were reduced by 20% and 33%, respectively, compared with the MI groups. Results from patch clamp recording revealed that resveratrol inhibited L-type calcium current (I (Ca-L)), and selectively enhanced ATP-sensitive K(+) current (I (K,ATP)) in a concentration-dependent manner. CONCLUSION: These results suggested that the emerging anti-arrhythmic character induced by resveratrol treatment in rat hearts could be mainly accounted for by inhibition of I (Ca-L) and enhancement of I (K,ATP). Administration of resveratrol also improved the long-term survival by suppressing left ventricular remodeling.


Assuntos
Infarto do Miocárdio/tratamento farmacológico , Estilbenos/administração & dosagem , Taquicardia Ventricular/prevenção & controle , Terpenos/administração & dosagem , Administração Oral , Animais , Canais de Cálcio Tipo L/efeitos dos fármacos , Estimulação Cardíaca Artificial/métodos , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Esquema de Medicação , Eletrocardiografia , Canais KATP/efeitos dos fármacos , Masculino , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/prevenção & controle , Técnicas de Patch-Clamp , Próteses e Implantes , Ratos , Ratos Sprague-Dawley , Resveratrol , Sesquiterpenos , Estilbenos/química , Estilbenos/uso terapêutico , Taxa de Sobrevida , Taquicardia Ventricular/tratamento farmacológico , Taquicardia Ventricular/etiologia , Telemetria , Terpenos/química , Terpenos/uso terapêutico , Fatores de Tempo , Fibrilação Ventricular/tratamento farmacológico , Remodelação Ventricular/efeitos dos fármacos , Remodelação Ventricular/fisiologia
10.
Chin Med Sci J ; 20(3): 194-7, 2005 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16261892

RESUMO

OBJECTIVE: To evaluate the improving reliability and safety of thromboendarterectomy and perioperative management for chronic pulmonary thromboembolism. METHODS: The clinical data of 12 cases with chronic pulmonary thromboembolism, who underwent thromboendarterectomy assisted by low flow or circulation arrest with deep hypothermia, were reviewed retrospectively. RESULTS: Pulmonary artery pressure decreased 20 to 40 mmHg immediately after surgical procedures in 9 cases. The postoperative pulmonary edema at various degrees happened in 12 cases, among them, 1 died of severe lung infection and pulmonary re-embolism at 19 days postoperation. Computed tomography pulmonary angiography and angiography of 11 cases indicated that the original obstruction of pulmonary artery disappeared. During the follow-up period of 2 months to 5 years, the clinical symptoms and activity was improved. CONCLUSION: Thromboendarterectomy is an effective treatment for chronic pulmonary thromboembolism. The outcome of the surgical procedure needs to be further investigated and followed up regularly according to an evaluative system, because it might be influenced by multiple factors.


Assuntos
Endarterectomia/métodos , Embolia Pulmonar/cirurgia , Adulto , Idoso , Pressão Sanguínea , Doença Crônica , Edema/etiologia , Endarterectomia/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
11.
Zhonghua Wai Ke Za Zhi ; 43(6): 345-7, 2005 Mar 15.
Artigo em Chinês | MEDLINE | ID: mdl-15854334

RESUMO

OBJECTIVE: To evaluate the perioperative management and safety of pulmonary thromboendarterectomy for chronic pulmonary thromboembolism. METHODS: From March 1999 to March 2004, 12 patients with chronic pulmonary thromboembolism received thromboendarterectomy. The operation was performed under cardio-pulmonary bypass with low flow or circulative arrest and deep hypothermia. The clinical data of the 12 cases were reviewed retrospectively. RESULTS: Pulmonary pressure immediately decreased 20 to 40 mm Hg (1 mm Hg = 0.133 kPa) after operation in 6 cases. Various degrees of postoperative pulmonary edema happened in 8 cases. One patient died at the 19th day after operation due to severe lung infection and pulmonary re-embolism. Eleven patients were followed-up for 2 months to 5 years, the clinical symptom and routine daily activity were improved after surgery. CONCLUSION: Pulmonary thromboendarterectomy is an effective treatment for chronic pulmonary thromboembolism. It is very important to management of postoperative reperfusion injury and pulmonary edema. A key point to enhance the safety of surgical treatment for chronic pulmonary thromboembolism is preoperative correct evaluation and indication selection.


Assuntos
Endarterectomia/métodos , Embolia Pulmonar/cirurgia , Adulto , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
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