Heart Aneurysm ; mortality ; pathology ; surgery ; Humans ; Mitral Valve Insufficiency ; mortality ; physiopathology ; surgery ; Myocardial Infarction ; mortality ; physiopathology ; surgery ; Ventricular Dysfunction, Left ; pathology ; surgery

Objective To assess the safety, tolerability and efficacy of preoperative low dose intravenous amiodarone in the prevention of atrial fibrillation (AF) after off-pump coronary artery bypass grafting (OPCAB). Methods Two hundred patients with coronary atheroselerotic heart disease underwent selected OPCAB and were randomly divided into two groups: control group (100 cases) and experimental group (100 cases). Patients in control group were given conventional medicines and placebo, and patients in experimental group were treated with low dose intravenous amiodarone daily for 4 days before surgery. They were given conventional medicines after surgery. Results After the off-pump coronary artery bypass grafting, the incidence of AF, ventricular rate and the duration of AF in the experimental group were lower than those in control group [15% vs. 41%, χ2=16.766, P=0.000; (126.0±20.8) times/ min vs. (150.0±25.6) times/ min, t=0.478, P =0. 017; (8. 0±8. 6) h vs. (12.0±9.6) h, t=0. 439, P=0. 019]. No significant difference were found in the incidence of side effect between low close amiodarone group and the control group. Conclusions Prophylactic application of low dose intravenous arniodarone before off-pump coronary artery bypass grafting can safely and effectively reduce the postoperative ventricular rate and the incidence of AF, shorten the duration of AF, promote the rehabilitation and slightly improve the clinical symptoms.

Objective To evaluate the results of a modified linear plieatinn of left ventricular aneurysms during off-pump coro- nary artery bypass surgery,Methods From January 2001 to June 2006,206 patients were operated on for nonruptured postinfarefion left ventrieular aneurysm during off-pump coronary artery bypass surgery.Repair was completed on the beating heart to minimize isch- emia and allowed assessment of wall function and viability.All patients presented with symptoms of angina and congestive heart failure or ventricular arrhythmia.The NYHA functional class of the patients ranged from grade 1]to grade IV.Preoperative ejection fraction and left ventricular end-diastolic diameter were 0.41?0.06 and(57.4?6.8)mm.The ventricular preoperative and postoperative performances were compared.Results Hospital mortality was 0.5 %(1/206).Coronary artery bypass was performed with an average of 2.9?0.9 grafts per patient.At the time of follow-up,all the patients had no symptoms.The mean NYHA class and ejection frac- tion increased significantly(P

Coronary Artery Bypass, Off-Pump ; methods ; Coronary Artery Disease ; surgery ; Humans ; Male ; Middle Aged ; Saphenous Vein ; transplantation

AIM: To study the role of injury and phenotype shift of liver sinusoidal endothelial cells in the development of portal hypertension of liver cirrhosis in rats. METHODS: The rat liver cirrhosis model was established by peritoneal injection of dimethylnitrosamine (DMN) (at a dose of 10 mg?kg~(-1), 3 times a week, for 4 weeks). The dynamic changes of liver cirrhosis were observed at different time points (1 day, 2 days, 3 days, 1 week, 2 weeks, 4 weeks, 6 weeks and 8 weeks). The pressure of portal vein (Ppv), the expression of CD44, von Willebrand factor (vWF), endothelin-1 (ET-1) mRNA and endothelial nitric oxide synthase (eNOS) mRNA, the serum hyaluronic acid (HA) content and liver ET-1 content were measured. RESULTS: Compared with the normal control rats, CD44 positive staining was weak in the 1 day model rats, and the numbers of fenestrae of sinusoidal endothelial cells (SECs) rapidly decreased, but serum HA content rapidly increased (P

OBJECTIVETo evaluate the early and medium-term curative effect of water sac blocking used in the proximal anastomosis during off-pump coronary artery bypass (OPCAB) in the patients with serious calcified ascending aorta.

METHODSThirty-one patients with serious calcified ascending aorta who underwent OPCAB were enrolled in this study from January 2005 to May 2009 as experimental group in which the water sac blocking was used in the proximal anastomosis during OPCAB. There were 23 male and 8 female patients with the age of (69±8) years. Sixty-three patients without calcified ascending aorta who underwent OPCAB at the corresponding period were selected randomly as control group in which lateral-mural clamp on ascending aorta was used in the proximal anastomosis during OPCAB. There were 39 male and 24 female patients with the age of (60±9) years. Preoperative and postoperative heart functional indexes were compared in 3 months and the short and the mid-term outcomes were followed up.

RESULTSNo deaths happened in the two groups. Postoperative incidence rate of cerebral stroke in control group was relatively higher than experimental group, but there was no significant difference between the two groups (P<0.05). All the patients had no symptoms 3 months after operation. Heart function and ejection fraction were increased significantly (P<0.05), meanwhile left ventricular end-diastolic diameter were decreased notably (P<0.05). The follow-up rate was 91.5% and the survival rate was 96.0% and left ventricular function decreased slightly (P<0.05) up to the end of November 2009. Seven patients more than two years after operation received coronary angiography which showed proximal anastomotic stoma was patent.

CONCLUSIONFor patients with serious calcified ascending aorta, the short and medium-term result of water sac blocking used in proximal anastomosis was simple, effective and safe.

Aged ; Anastomosis, Surgical ; methods ; Aorta ; surgery ; Coronary Artery Bypass, Off-Pump ; Coronary Artery Disease ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Treatment Outcome

BACKGROUNDLeft ventricular (LV) dyssynchrony has been described to occur in patients with myocardial infarction. Dyssynchrony of left ventricular mechanical contraction produces adverse hemodynamic consequences. This study aimed to test the capacity of geometric rebuilding by aneurysm plication to restore a more synchronous contractile pattern after a mechanical, rather than electrical, intervention.

METHODSA total of sixty patients with anterior myocardial infarction, QRS duration < 120 ms, electively undergoing operation between January 2008 and January 2010 were included for analysis. Real-time 3-dimensional echocardiography was performed to assess LV function, LV systolic and diastolic dyssynchrony by measuring ejection fraction (EF), peak ejection rate (PER), peak filling rate (PFR) and LV dyssynchrony. LV dyssynchrony was defined as the systolic dyssynchrony of the time to reach the minimum systolic volume for 16 LV segments, expressed in percent cardiac cycle, systolic dyssynchrony index (SDI). We compared changes of LV dyssynchrony at different interval times.

RESULTSLV contraction was significantly asynchronous because preoperative SDI was higher, EF, PER and PFR were lowered. Compared with function after operation, LV mechanical intraventricular resynchronization was improved with decreased SDI ((8.7 ± 0.5)% vs. (14.3 ± 1.6)%, P = 0.01); LV function was improved with EF increasing ((43 ± 9)% vs. (37 ± 7)%, P = 0.001), and LV systolic and diastolic dyssynchrony was improved with more rapid PFR (199.4 ± 15.6 vs. 148.4 ± 21.2, P = 0.002) and PER (212.4 ± 14.5 vs. 156.3 ± 26.2, P = 0.001).

CONCLUSIONSSystolic and diastolic dyssynchrony was highly prevalent in patients with aneurysm, irrespective of QRS duration. Aneurysm plication produces a mechanical intraventricular resynchronization.

Aged ; Aneurysm ; surgery ; Echocardiography, Three-Dimensional ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; diagnostic imaging ; surgery ; Radiography

BACKGROUNDLeft ventricular aneurysm (LVA) is one of the serious complications after acute myocardial infarction. We attempted to evaluate the preliminary efficacy of LVA repair combined with epicardial radiofrequency ablation for ventricular arrhythmia during off-pump coronary artery bypass grafting (OPCAB).

METHODSFrom June 2009 to April 2011, 31 patients with LVA had angina symptoms and ventricular arrhythmia. In all patients, circular and cross-shaped radiofrequency epicardial ablations were performed using unipolar ablation pen along the border between the aneurysm wall and normal cardiac tissue and in the central zone of the aneurysms, followed by a linear placation of ventricular aneurysms on beating heart.

RESULTSAll the patients showed complete recovery. The average number of grafted vessels was 2.7 ± 1.3. Intraoperative examinations revealed that the ventricular arrhythmia was effectively controlled by radiofrequency ablation. All cases had been followed up for one year. Holter monitoring revealed a significant reduction in ventricular arrhythmias (P < 0.05). Echocardiography showed significant increase in left ventricular ejection fraction (P < 0.05) and decrease in left ventricular end-diastolic diameter (P < 0.05).

CONCLUSIONSFor patients with ventricular aneurysm and preoperative malignant arrhythmia, aneurysm repair plus epicardial radiofrequency ablation in OPCAB was found to be an effective and feasible therapeutic technique. However, medium- to long-term therapeutic efficacy of this method remains to be determined by future studies and observations.

Aged ; Arrhythmias, Cardiac ; surgery ; Catheter Ablation ; Coronary Artery Bypass, Off-Pump ; Female ; Heart Aneurysm ; complications ; Heart Ventricles ; surgery ; Humans ; Male ; Middle Aged ; Pericardium ; surgery

BACKGROUNDOff-pump coronary artery bypass surgery (OPCAB) has been widely applied in recent years as a less invasive method of myocardial revascularization. This study evaluated the sequential bilateral internal mammary artery grafting combined with selective arterialization of the coronary venous system during OPCAB.

METHODSFrom April 2004 to August 2010, patients with diffuse right coronary lesions were studied retrospectively and divided into two groups. Group 1 included seventeen patients who underwent this surgery while group 2 included twenty-one patients without right coronary artery surgical therapy. All patients presented with symptoms of angina. Blood flow of bridged vessels was measured. The perioperative ventricular parameters including left ventricular ejection fraction and end diastolic diameter were compared. During follow-up, myocardial nuclide imaging and coronary angiography were carried out.

RESULTSOff-pump coronary artery bypass was performed with an average of 3.6 grafts per patient. Hospital mortality was zero. At the time of follow-up, the patients in group 1 recovered better than in group 2 (P < 0.05). In both groups, the mean New York Heart Association (NYHA) class and ejection fraction increased significantly (P < 0.001) and the mean left ventricular end-diastolic diameter decreased significantly (P < 0.05). Myocardial blood supply of inferior wall in group 1 was obviously improved by myocardial nuclide imaging. Coronary angiography for eight patients in group 1 verified that there was blood flow to myocardium in the arterialized vein.

CONCLUSIONSSequential bilateral internal mammary artery grafting combined with selective arterialization of the coronary venous system can be performed during OPCAB. A postoperative improvement in the cardiac functions and the quality of life was documented, increasing our expectation for extensive application.

Coronary Angiography ; Coronary Artery Bypass, Off-Pump ; methods ; Coronary Vessels ; surgery ; Female ; Humans ; Male ; Mammary Arteries ; transplantation ; Middle Aged ; Retrospective Studies ; Treatment Outcome

Objective To construct three-dimensional finite element model of lumbar spondylolysis,then to verify its validity by comparison of biomechanics in vitro.Method According to the radiological data of a patient with lumbar spondylolysis,the bone and intervertebral disc of L4-S1 were reconstructed by Simpleware software.The lumbar attaching ligaments and articular capsule were added into simulating model by Ansys software.The three-dimensional finite element model of lumbar spondylolysis was finally simulated successfully,and validated by lumbar spondylolysis biomechanical experiment in vitro.Results The reconstruction of digital model contained the bones of lumbar spine which include vertebral cortical bone,cancellous bone,facet joint,pedicle,lamina,transverse process and spinous process,as well as the annulus fibrosus,nucleus pulposus,superior and inferior end-plates.Besides,anterior and posterior longitudinal ligaments,flavum ligament,supraspinal and interspinal ligaments and articular capsule of facet joint are also attached.The model consisted of 281,261 nodes and 661,150 elements.Imitation of spondylolysis is well done in this model.The validity of the model was verified by comparison of the results of biomechanics in vitro which involved in the trends under loading of stress/strain of L4 inferior facet process,L5 superior and inferior facet process,S1 superior facet process and the trends of stress/strain of lateral and medial L4 inferior facet process.Conclusions Three-dimensional model of lumbar spondylolysis is reconstructed using finite element analysis,and can be further used in the research in biomechanics of lumbar spondylolysis.