Objective To delineate the utility and results of intraoperative transesophageal echocardiography (TEE) in the evaluation of patients undergoing robot-assisted cardiac surgery. Methods Intraoperative TEE was performed in 193 patients undergoing robot-assisted procedures in cardiac surgery over a period of 4 years. (1) Before CPB, a comprehensive TEE was performed to document the lesions and their precise localization. ( 2 ) During establishment of peripheral CPB, a arterial cannula was placed percutaneously into the right internal jugular vein and passed into the superior vena cava; a venous cannula was inserted into the right common femoral vein and passing it into the inferior vena cava with its tip just inferior to the inferior vena cava-right atrium junction; a arterial perfusion cannula was passed into the ascending aorta with its tip approximately 3 cm from the aortic valve under TEE guidance. (3) After weaning from CPB, TEE was performed to evaluate the efficiency of the procedure. Results (1) The concordance with surgical findings concerning the lesions and precise localization was 100% and 98. 8% among all the patients, respectively. (2) All cannulae were located in the correct position. (3) TEE confirmed successful procedures with no concomitant complication in all the patients. Conclusion Intraoperative TEE is a valuable adjunct in the assessment of robot-assisted cardiac surgery.

OBJECTIVETo evaluate the role of intraoperative transesophageal echocardiography (TEE) during robotic atrial myxoma excision.

METHODSThirty-eight consecutive patients undergoing robotic atrial myxoma excision from September 2007 to August 2012 were enrolled in the study. During the procedure, TEE was performed to document the myxoma position, its attachment, and hemodynamic information before cardiopulmonary bypass (CPB). During establishment of peripheral CPB, TEE was used to guide placement of the cannulae in the inferior vena cava (IVC), superior vena cava (SVC), and ascending aorta (AAO). After weaning from CPB, TEE was performed to evaluate the effect of the procedure.

RESULTSThe accuracy of TEE for the position or its attachment of the myxoma was 100%. All the cannulae in the SVC, IVC and AAO were located in correct position. In all patients, TEE confirmed successful excision.

CONCLUSIONIntraoperative TEE is a valuable adjunct in patients undergoing robotic atrial myxoma excision.

Adolescent ; Adult ; Aged ; Echocardiography, Transesophageal ; methods ; Female ; Heart Neoplasms ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Monitoring, Intraoperative ; methods ; Myxoma ; diagnostic imaging ; surgery ; Robotics ; Young Adult

OBJECTIVETo detect the heterogeneity of mitochondrial DNA (mtDNA) in black and white hair of patients with type 2 diabetes.

METHODSMtDNA was extracted from the hair shaft of the patients to amplify two target DNA fragment from mtDNA coding region and control region using PCR. The differences in the heterogeneity in the target DNA fragment was analyzed between diabetic patients and the control group with denaturing high-performance liquid chromatography (DHPLC).

RESULTSIn the control subjects and diabetic patients, the mtDNA heterogeneity in the black hair was 3% and 10% in 20-45 year-old groups and 9% and 17% in 45-70 year-old groups, as compared to 9%, 20%, 21%, and 40% in the white hair, respectively. The mtDNA heterogeneity in the black and white hair was both higher in the diabetic patients than in the control subjects of the same age group, and was also higher in older age subgroups in both control and diabetic groups (P<0.05). The white hair mtDNA showed a significantly higher heterogeneity than the black hair mtDNA in the two age groups of diabetic patients and in 45-70 year-old control group (P<0.05).

CONCLUSIONThe mtDNA heterogeneity in the hair increases in type 2 diabetic patients and show an association with aging.

Adult ; Age Factors ; Aging ; genetics ; Chromatography, High Pressure Liquid ; methods ; DNA, Mitochondrial ; genetics ; Diabetes Mellitus, Type 2 ; genetics ; metabolism ; Female ; Genetic Heterogeneity ; Hair ; metabolism ; Humans ; Male ; Middle Aged ; Young Adult

OBJECTIVE: To retrospectively assess the value of intraoperative transesophageal echocardiography (TEE) during robotic mitral valve (MV) replacement. METHODS: Intraoperative TEE was performed in 21 patients undergoing robotic MV replacement for severe rheumatic mitral stenosis between November 2008 and December 2010. During the procedure, TEE was performed to document the mechanism of rheumatic mitral stenosis (leaflet thickening and calcification, commissural fusion or chordal fusion) before cardiopulmonary bypass (CPB). During the establishment of peripheral CPB, TEE was used to guide the placement of the cannulae in the inferior vena cava (IVC), superior vena cava (SVC), and ascending aorta (AAO). After weaning from CPB, TEE was performed to evaluate the effect of the procedure. RESULTS: Accuracy of TEE was 100% for rheumatic mitral stenosis. All the cannuli in the SVC, IVC and AAO were located in the correct position. In all patients, TEE confirmed successful procedure. CONCLUSION TEE is useful in the assessment of robotic MV replacement.
Adult ; Aged ; Cardiac Surgical Procedures ; methods ; Echocardiography, Transesophageal ; methods ; Female ; Heart Valve Prosthesis Implantation ; Humans ; Male ; Middle Aged ; Mitral Valve ; surgery ; Mitral Valve Stenosis ; diagnostic imaging ; surgery ; Monitoring, Intraoperative ; methods ; Retrospective Studies ; Robotics ; methods

Objective To investigate the value of computer-assisted quantification of pulmonary embolism volume(PEV)in identifying mild-to-high-risk acute pulmonary embolism(APE).Methods We retrospectively enrolled 143 patients with suspected APE confirmed by computed tomography pulmonary angiography(CTPA)at Yan'an University Affiliated Hospital from January 2017 to December 2020.According to the 2018 Chinese Guidelines for Diagnosis,Treatment and Prevention of Pulmonary Thromboembolism,all the patients were divided into low-risk group(n=88)and mild-to-high-risk group(n=55).We collected the patients'basic demographic data,clinical manifestations,and serum levels of N-terminal-B type natriuretic peptide precursor(NT-proBNP)and D-dimer.Based on CTPA images,the degree of pulmonary thromboembolism was artificially evaluated to obtain the pulmonary artery occlusion index(PAOI).The thrombus was segmented using the pulmonary embolism detection tool based on digital lung,and PEV was calculated.We compared the differences in clinical and laboratory indicators and PAOI and PEV between the two risk groups.We analyzed the value of PAOI and PEV in identifying mild-to-high-risk APE using receiver operating characteristic(ROC)curves,and used Logistic regression analysis to identify independent risk factors in predicting mild-to-high-risk APE.Different models were established.Results Compared with the low-risk group,APE patients in the mild-to-high-risk group were older(P＜0.05),had lower diastolic blood pressure(P＜0.05),higher levels of D-dimer and NT-proBNP(P＜0.05),lower levels of platelet count,arterial oxygen partial pressure and arterial carbon dioxide partial pressure(P＜0.05),and higher levels of PAOI and PEV(P＜0.001).ROC curve analysis showed that the area under the curve for PEV in identifying mild-to-high-risk APE was 0.809(95％CI:0.734-0.884),while that for PAOI was 0.753(95％CI:0.667-0.839).Logistic regression analysis showed that PEV and NT-proBNP were independent risk factors for mild-to-high-risk APE(P＜0.05).Conclusion PEV and NT-proBNP are independent risk factors for mild-to-high-risk APE.