This study was performed to assess the influence of the cryoinjury on the dynamics of wavefronts and to determine whether they can convert ventricular fibrillation (VF) to ventricular tachycardia (VT) in fibrillating right ventricular (RV) of swines using an optical mapping system. A cryoinjury with a diameter of 12 mm was created on the epicardium of perfused RV of swines (n = 6) and optical mapping were taken from baseline until 10 minutes after the cryoinjury. Out of 35 cryoinjuries, the images were possible to be interpreted in 32. The optical action potential could not be observed in either the cryoinjury or peri-injury sites at 1 and 3 minutes, was observed in only the cryoinjury site at 5 minutes, and recovered in both sites at 10 minutes. The cycle length of the tachycardia was 135.9 +/- 23.6 msec at baseline, 176.2 +/- 79.3 msec at 1 minute, 187.6 +/- 97.9 msec at 3 minutes, 185.5 19.2 msec at 5 minutes, and 152.1 +/- 64.1 msec at 10 minutes. The cycle lengths at 1, 3, and 5 minutes after the cryoinjury were significantly more prolonged than that at baseline (p = 0.001, p = 0.006, p = 0.016). After the cryoinjury, the VF changed to VT in 9 (28.0%), and terminated in 2 (6.3%). These changes were observed mainly within 5 minutes after cryoinjury. The cryoinjury had anti-fibrillatory effects on the tissue with VF. This phenomenon was related to a decreasing mass and stabilizing wavefronts.
Ventricular Fibrillation/*physiopathology ; Tachycardia, Ventricular/*physiopathology ; Swine ; Heart Ventricles/*physiopathology/surgery ; Female ; Disease Models, Animal ; *Cryosurgery ; Animals

In the era before reperfusion therapy, ventricular septal rupture complicated 1~3% of acute myocardial infarctions (AMI) usually 3-5 days after onset. Studies have reported a positive correlation between the incidence of septal perforation and total occlusion of the coronary arteries. A 70-year old female patient was referred to the emergency room with the diagnosis of acute anterior myocardial infarction (MI) and recent cerebral infarction. The coronary angiogram showed a 90% stenosis at the mid-portion of the left anterior descending artery (LAD), and the lesion was successfully treated by percutaneous coronary intervention (PCI) with stent implantation. After PCI, the anterior wall motion improved on the follow-up echocardiogram. However, on the 20th hospital day, the patient condition deteriorated suddenly with pulmonary congestion. The echocardiography revealed a 1.3 cm ventricular septal defect at the apical septum with a left-to-right shunt. We report this rare case of delayed septal rupture in a patient with patent LAD after PCI and recovery of wall motion.
Ventricular Septal Rupture/*etiology ; Time Factors ; Stents ; Myocardial Infarction/*complications/surgery ; Humans ; Heart Ventricles/*physiopathology ; Heart Septum/*physiopathology ; Female ; Angioplasty, Transluminal, Percutaneous Coronary ; Aged ; Acute Disease

BACKGROUNDAcute myocardial infarction can result in left ventricular aneurysm, which may in turn cause congestive heart failure, ventricular arrhythmia and thromboembolic events. This study evaluates results achieved with a modified linear closure of left ventricular aneurysms during off-pump coronary artery bypass surgery.

METHODSFrom January 2001 to May 2004, 75 patients were operated on for nonruptured, postinfarctional, left ventricular aneurysm during off-pump coronary artery bypass surgery. Repair was completed on the beating heart to minimize ischaemia and allow assessment of wall function and viability to guide closure. All patients presented with symptoms of angina and congestive heart failure or ventricular arrhythmia. The majority (75%) of the patients were in NYHA functional class III or IV. Preoperative ejection fraction was 26% +/- 9%. The mean left ventricular, end diastolic diameter was (57.5 +/- 7.1) mm. The ventricular preoperative and postoperative performances were compared. chi2 test and Student's t test were used to analyse the outcomes. A P value less than 0.05 was considered significant.

RESULTSHospital mortality was 1.3% (1/75). Coronary artery bypass was performed with an average of (3.3 +/- 1.2) grafts per patient. At the time of followup, all the patients had no symptoms. The mean NYHA class and ejection fraction increased significantly (P < 0.001). The mean left ventricular, end diastolic diameter decreased significantly (P < 0.001).

CONCLUSIONSSurgical closure of left ventricular aneurysm can be performed during off-pump coronary artery bypass. The operation is associated with a low inhospital mortality and morbidity. A postoperative improvement in the early term cardiac functions and symptoms and quality of life was documented, increasing our expectations of an increased long-term survival.

Adult ; Aged ; Aged, 80 and over ; Coronary Artery Bypass ; Female ; Heart Aneurysm ; physiopathology ; surgery ; Heart Ventricles ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Stroke Volume ; Ventricular Dysfunction, Left

BACKGROUNDThe primary cause of ischemic heart failure (HF) is myocardial infarction (MI) resulting in left ventricle (LV) wall motion abnormality secondary to ventricular remodeling. A prospective, nonrandomized study conducted in China was designed to assess safety and efficacy of the percutaneous ventricular restoration therapy using Parachute device (CardioKinetix, Inc., CA, USA) in ischemic HF patients as a result of LV remodeling after anterior wall MI.

METHODSThirty-one patients with New York Heart Association (NYHA) Class II, III ischemic HF, ejection fraction between 15% and 40%, and dilated akinetic or dyskinetic anterior-apical wall without the need to be revascularized were enrolled from seven sites in China from October to December 2014. The Parachute device was implanted through femoral artery. All patients received low-dose aspirin and anticoagulation with warfarin for at least 12 months postdevice implantation. The primary end-point was the assessment of efficacy as measured by the reduction in LV end-systolic volume index (LVESVI) against baseline LVESVI at 3 months postdevice implantation, determined by the echocardiography and measured by echocardiography core laboratory. Quality of life was assessed using EQ-5D and visual analog scale (VAS). For quantitative data comparison, paired t-test (normality data) and signed-rank test (abnormality data) were used; application of signed-rank test was for the ranked data comparison.

RESULTSA change in LVESVI as measured by echocardiography from the preimplant baseline to 3-month postdevice implantation revealed a statistically significant reduction from 77.5 ± 20.0 ml/m2 to 53.1 ± 17.0 ml/m2 (P < 0.0001). The trial met its primary end-point. Of the 31 patients, the procedural success was 96.8%. Overall, NYHA HF class assessment results showed an improvement of more than half a class at 3 months (P < 0.001). Quality of life assessed by the VAS value increased 11.5 points (P < 0.01), demonstrating improvement at 3 months.

CONCLUSIONThe favorable outcomes observed in the high-risk patients provide reassuring safety and efficacy data to support adoption of this technology as a therapeutic option for ischemic HF patients.

TRIAL REGISTRATIONClinicalTrials.gov, NCT02240940; https://clinicaltrials.gov/ct2/show/NCT02240940.

Aged ; China ; Female ; Heart Failure ; physiopathology ; surgery ; Heart Ventricles ; physiopathology ; surgery ; Humans ; Male ; Middle Aged ; Prospective Studies ; Prosthesis Implantation ; adverse effects ; methods ; Stroke Volume ; physiology ; Treatment Outcome ; Ventricular Remodeling ; physiology

The management of pulmonary atresia with intact ventricular septum (PA/IVS) remains controversial. The goal of separating systematic and pulmonary circulation can be achieved by biventricular or uni-ventricular (Fontan or one and a half ventricle repair) strategies. Although outcomes have been improved, these surgical procedures are still associated with high mortality and morbidity. An optimal strategy for definitive repair has yet to be defined. We searched databases for genetically randomized controlled trials (RCTs) comparing biventricular with uni-ventricular repair for patient with PA/IVS. Data extraction and quality assessment were performed following the guidelines of the Cochrane Collaboration. Primary outcome measures were overall survival, and secondary criteria included exercise function, arrhythmia-free survival and treatment-related mortality. A total number of 669 primary citations were screened for relevant studies. Detailed analysis revealed that no RCTs were found to adequately address the research question and no systematic meta-analysis would have been carried out. Nevertheless, several retrospective analyses and case series addressed the question of finding right balance between biventricular and uni-ventricular repair for patient with PA/IVS. In this review, we will discuss the currently available data.
Arrhythmias, Cardiac ; physiopathology ; prevention & control ; Cardiac Valve Annuloplasty ; methods ; mortality ; Fontan Procedure ; methods ; mortality ; Heart Defects, Congenital ; mortality ; pathology ; surgery ; Heart Ventricles ; abnormalities ; pathology ; surgery ; Humans ; Pulmonary Atresia ; mortality ; pathology ; surgery ; Retrospective Studies ; Survival Analysis ; Treatment Outcome

OBJECTIVETo observe the changes of surface ECG and cell couplings between sinoatrial node cells and myocardial cells following transplantion of pedicled autologous sinoatrial node tissue graft into the right ventricle of a canine model of complete atrioventricular block.

METHODSTen healthy dogs were randomized into transplantation group and control group. Pedicled autologous sinoatrial node tissue grafts were transplanted into the right ventricle in the transplantation group, while the sinoatrial nodes were only excised in the control group after placement of temporary myocardial pacing wires. The changes of surface ECG were observed at 1, 2, 3 and 4 weeks postoperatively. At 4 weeks, complete atrioventricular block was induced in the dogs by radiofrequency ablation of the His bundle. The heart rate of the dogs in both groups were recorded after the injection of isoproternol (ISO) from the femoral vein, and the transplanted tissue graft was observed under optical and transmission electron microscopes.

RESULTSNo significant changes occurred in the surface ECG. All the dogs showed ECG waveforms specific of complete heart block after the ablation, and the ventricular heart rates were similar between the two groups (P>0.05). The ventricular heart rate did not undergo obvious changes after ISO injection (P>0.05). The transplanted pedicled autologous sinoatrial node survived in the dogs and the sinoatrial node cells established desmosome junctions with the myocardial cells, but the number of junctions was not sufficient to support heart pacing.

CONCLUSIONDesmosome junction can occur between ventricular myocardial cells and sinoatrial node cells at the edge of transplanted pedicled autologous sinoatrial node tissue.

Animals ; Atrioventricular Block ; physiopathology ; surgery ; Cardiotonic Agents ; pharmacology ; Dogs ; Electrocardiography ; Female ; Heart Rate ; drug effects ; Heart Ventricles ; surgery ; Intercellular Junctions ; Isoproterenol ; pharmacology ; Male ; Myocardium ; cytology ; Sinoatrial Node ; cytology ; transplantation ; Tissue Transplantation ; Transplantation, Autologous

A 67-year-old Chinese woman with comorbidities of chronic obstructive lung disease, hypertension and prior coronary artery bypass surgery presented with severe functional mitral regurgitation (MR) and severely depressed left ventricular function. She was in New York Heart Association (NYHA) Class II-III. Due to high surgical risk, she was referred for percutaneous treatment with the MitraClip valve repair system. This procedure is typically performed via the femoral venous system and involves a transseptal puncture. A clip is delivered to grasp the regurgitant mitral valve leaflets and reduce MR. This was performed uneventfully in our patient, with reduction of MR from 4+ to 1+. She was discharged on post-procedure Day 2 and her NYHA class improved to Class I. This was the first successful MitraClip procedure performed in Asia and represents a valuable treatment option in patients with severe MR, especially those with functional MR or those at high surgical risk.
Aged ; Cardiac Surgical Procedures ; methods ; Cardiology ; instrumentation ; methods ; Catheters ; Echocardiography ; methods ; Equipment and Supplies ; Female ; Heart Ventricles ; physiopathology ; Humans ; Mitral Valve ; surgery ; Mitral Valve Insufficiency ; surgery ; Pulmonary Disease, Chronic Obstructive ; complications ; Risk ; Ultrasonography, Doppler ; methods ; Ventricular Dysfunction, Left ; surgery