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find Author "顾承雄" 19 results
  • Off-pump Surgical Therapy for Mild-to Moderate-Ischemic Mitral Regurgitation Using a Self-designed Device

    Abstract: Objective To evaluate the effect of a surgical method for treating mild- to moderate-ischemic mitral regurgitation(IMR) using a self-designed device during off-pump coronary artery bypass grafting(OPCAB). Methods From September 2009 to August 2011, six patients(4 males, 2 females; age was 52-73 years) with mild- to moderate-IMR underwent OPCAB and concomitant mitral valvuloplasty using a self-designed device in Beijing An Zhen Hospital. Their degree of IMR, anteroposterior diameter of mitral annulus, left ventricular long-axis diameter, left ventricular short-axis diameter and left ventricular spherical index(left ventricular short-axis diameter/left ventricular long -axis diameter)were measured using transesophageal Doppler echocardiography before and after mitral valvuloplasty. Their mean aorta pressure, mean pulmonary artery pressure and central venous pressure were also measured via Swan-Ganz catheter before and after mitral valvuloplasty. Perioperative cardiac function indexes were compared. Results There was no in-hospital death. IMR of all patients disappeared postoperatively. After mitral valvuloplasty their anteroposterior diameter of mitral annulus(3.43±0.08 cm vs.3.68±0.08 cm;t=5.430, P=0.001), left ventricular short-axis diameter(4.80±0.21 cm vs.5.53±0.11 cm;t=7.530, P=0.001)and left ventricular spherical index(0.64±0.02 vs.0.74±0.01;t=11.110, P=0.002)significantly decreased than those before mitral valvuloplasty . But their left ventricular long-axis diameter and hemodynamic indexes did not change significantly after mitral valvuloplasty. All the six patients were followed up at the out-patient department 3 months postoperatively without autonomous symptoms. Their heart function improved to I class(New York Heart Association). Echocardiography showed 4 patients without IMR and 2 patients with trace of minimalIMR. Conclusion Off-pump surgical therapy for mild- to moderate- IMR during OPCAB can help the patients reverseremodeling of the left ventricle, avoid the risks of cardiopulmonary bypass and improve cardiac function with good short-term effects. This method may be a good choice for treating patients with IMR.

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • 心功能不全冠心病患者非体外循环冠状动脉旁路移植术的疗效分析

    分析心功能不全冠心病患者施行非体外循环冠状动脉旁路移植术(OPCAB)的临床资料,探讨其手术风险,提出治疗方案。 方法 将2004年1月至2008年6月首都医科大学附属北京安贞医院66例冠心病患者,按心功能不同分为3组,每组22例,组1:男18例,女4例;年龄55.3±9.1岁;术前左心室射血分数(LVEF)lt;30%;组2:男19例,女3例;年龄55.5±10.2岁;30%≤LVEFlt;40%;组3:男17例,女5例;年龄55.8±8.7岁;LVEF≥40%;组2和组3作为对照。观察围术期临床资料包括术前调整时间、移植血管支数、同期室壁瘤手术、呼吸机辅助呼吸时间、主动脉内球囊反搏(IABP)使用时间、住ICU时间、强心药种类、术后住院时间和住院费用等的改变。 结果 术后无死亡和严重并发症发生,均痊愈出院。组1术前调整时间(18.9±14.6 d vs. 10.8±7.4 d,P=0.023)、使用IABP例数(7 vs.1, P=0.012)、住ICU时间(3.0±0.7 d vs. 1.2±0.6 d,P=0.008)、强心药种类(1.6±0.7种 vs. 1.0±0.2种,P=0.000)、术后住院时间(17.4±12.1 d vs. 11.8±34 d,P=0.038)和住院费用(11.4±5.2万元 vs. 7.6±1.7万元,P=0.007)均多于组3,两组比较差异均有统计学意义。3组患者均获得随访,随访时间3~6个月,均生存,随访期间无明显心绞痛发作。 结论 心功能不全患者行OPCAB手术安全,但所需医疗资源多,须慎重选择。

    Release date:2016-08-30 05:56 Export PDF Favorites Scan
  • Analysis on the Clinical Efficacy of Offpump Sequential Bilateral Internal Mammary Artery Grafting Combined with Selective Arterialization of the Coronary Venous System

    Abstract: Objective To evaluate the clinical efficacy of sequential bilateral internal mammary artery grafting combined with selective coronary venous bypass graft (CVBG) during offpump coronary artery bypass surgery. Methods We retrospectively analyzed the clinical data of 38 patients with diffuse right coronary arteriostenosis undergoing operation in Anzhen Hospital of Capital Medical University from March 2004 to August 2010. Based on the operation method, the patients were divided into two groups. In the CVBG group, there were 17 patients including 11 males and 6 females with an average age of 46.1±6.2 years who underwent off-pump sequential bilateral internal mammary artery grafting combined with CVBG. In the control group, there were 21 patients including 14 males and 7 females with an average age of 45.9±5.7 years, and they underwent the off-pump sequential bilateral internal mammary artery grafting without CVBG. Blood flow of bridged vessels was measured. The perioperative parameters including number of grafts, tracheal intubation time, hospitalization time, complications, results of echocardiography, myocardial nuclide imaging and coronary angiography were compared between the two groups of patients. Results There was no hospital mortality or complications such as cerebral events, sternal and mediastinal infections. There was statistical difference in graft number between CVBG group and control group (3.3±1.1 vessels vs. 2.2±1.6 vessels, Plt;0.05). There were no statistical differences in internal mammary artery trunk blood flow (81.5±32.7 ml/min vs. 76.8±28.4 ml/min), left internal mammary artery trunk blood flow (32.5±18.8 ml/min vs. 28.1±167 ml/min) and right internal mammary artery trunk blood flow (39.6 ±19.0 ml/min vs. 35.9±18.3 ml/min) between CVBG and control group (Pgt;0.05). Followup was done for all the 38 patients with a follow-up rate of 100%. Follow-up time was 3.55 months (37.4±9.8 months). No angina symptoms occurred in CVBG group and myocardial blood supply of inferior wall in this groups improved obviously based on the results of electrocardiogram, while there were 8 cases of angina in the control group with inferior wall myocardial ischemia and ST-T changes according to the results of electrocardiogram (Plt;0.05). Heart functions were significantly improved in both groups three months after surgery. Through myocardial nuclide imaging, we found that myocardial blood supply of inferior wall was obviously improved in CVBG group. Coronary angiography in CVBG group showed that there was blood flow to myocardium in the arterialized vein. Conclusion Sequential bilateral internal mammary artery grafting combined with selective arterialization of the coronary venous system can be performed during offpump coronary artery bypass surgery. Cardiac functions and quality of life are improved after the surgery. This provides a new surgical method for diffuse right coronary lesions.

    Release date:2016-08-30 05:57 Export PDF Favorites Scan
  • 冠心病合并室壁瘤及二尖瓣关闭不全的外科治疗

    摘要: 目的 总结冠心病合并室壁瘤和二尖瓣关闭不全的外科治疗经验及效果。 方法 回顾性分析78例冠心病合并室壁瘤和二尖瓣关闭不全患者的临床资料,其中男45例,女33例;年龄42~70岁,平均年龄55岁。室壁瘤位于心尖部44例,外侧壁14例,下壁20例; 二尖瓣中度关闭不全48例,重度关闭不全30例。手术在低温体外循环下施行,室壁瘤线性缝合术24例,心内膜环缩、三明治缝合术36例,心内膜环缩、左心室补片成形术18例,同期血栓清除术13例;二尖瓣成形术42例,二尖瓣置换术36例;移植旁路血管1~6支(2.5±1.5支)。 结果 围术期死亡5例,死于败血症1例,多器官功能衰竭2例,心力衰竭2例。术中停机困难5例。术后主要并发症:低心排血量综合征、恶性心律失常和多器官功能衰竭。左心室舒张期末内径(55.6±1.2 mm vs. 68.2±4.0 mm),射血分数(45%±23% vs.34%±14%),心功能分级(NYHA,1.82±0.26级 vs. 3.36±0.56级)与术前比较差异均有统计学意义(Plt;0.05)。随访69例,随访率94.52%,随访时间25±8个月。随访期间无远期死亡,无症状复发。心功能Ⅰ~Ⅱ级58例,Ⅲ级9例,Ⅳ级2例, 较术前明显改善(Plt;0.05)。 结论 根据病理生理特点选择对心腔、血管和瓣膜全面处理的手术方式,加强围术期管理,手术治疗冠心病合并室壁瘤及二尖瓣关闭不全的近、远期疗效满意。

    Release date:2016-08-30 06:01 Export PDF Favorites Scan
  • Midterm and Longterm Clinical Outcome Analysis of Bilateral Internal Mammary Artery Composited Y Grafts for Coronary Artery Bypass Grafting

    Objective To evaluate midterm and longterm clinical outcome of bilateral internal mammary artery composited Y grafts for coronary artery bypass grafting (CABG), analyze risk factors for late death ,and to improve surgical results. Methods Between January 2000 and May 2004, One hundred and sixtyfive patients underwent bilateral internal mammary artery grafts for CABG, The clinical data, postoperative complications and survival results were retrospectively reviewed and analyzed. The preoperative and postoperative cardiac function was compared. All factors that may have affected the survival were analyzed by logistic regression, to identify significant variables associated with late death. Results Total 561 anastomosis sites of internal mammary arteries were completed with each patient received an average of 3.4 grafts.  There were no perioperative deaths. There were 16 patients with postoperative complications including recurrent angina, myocardial infarction, low cardiac output syndrome, sternal infection and so on. All patients were treated conservatively without reoperation. One hundred sixty patients(97%)were followed up of 5.6±1.2 years, there were 23 late deaths including 10 patients of cardiac related death in which 3 had recurrent myocardial infarction, 4 heart failure, and 3 arrhythmia; 13 patients of nocardiac related death in which 4 upper gastrointestinal hemorrhage, 3 cancer and 6 uncertain cause. 25 patients had major cardiac related events including recurrent angina 18, myocardial infarction 4, repeated revascularization 3. Left ventricular ejection fraction [CM(159mm]was significantly improved as compared with that before operation(54%±6% vs. 43%±12%, Plt;0.05). The 1-, 3-, 5-year actuarial survival rates and eventfree rates were 98.2%±0.3%, 96.2%±0.5%, 90.5%±1.9% and 95.5%±1.2%, 91.3%±2.1%, 86.6%±1.5%, respectively. According to statistical analysis, univariate analyses had proved that advancing age>65 years,diabetes,ejection fraction(EF) less than 30%,the New York Heart Association (NYHA) class Ⅲ/Ⅳ, and low cardiac output syndrome required placement of the intraaortic balloon pump were predictors associated with hospital major adverse cardiac events (Plt;0.05). Those variables entered into the logistic regression model and found to be independent predictors associated with increased late cardiac death included advancing age >65 years(OR=11.6), diabetes (OR=21.4), EF less than 30%(OR=37.5) and NYHA class Ⅲ/Ⅳ(OR=40.2). Conclusion Patients receiving bilateral internal mammary artery composited Y grafts have better longterm survival and reduced cardiac related events. Independent risk factors for late death are NYHA function class Ⅲ/Ⅳ, EF less than 30%, diabetes and advancing age >65 years.

    Release date:2016-08-30 06:06 Export PDF Favorites Scan
  • The Clinical Study of Endothelin during Perioperative Coronary Artery Disease

    Objective To study the characteristics of endothelin(ET) and hemodynamics parameters in patients with coronary artery disease (CAD) in perioperative period and aim to find out some rules and useful suggestions for clinical trial. Methods Fortyseven patients were divided into 5 groups: patients undergoing coronary artery bypass grafting (CABG) and resection of left ventricular aneurysm(CABG+LVAN group),patients undergoing classical CABG(CABG group), patients undergoing offpump coronary artery bypass grafting (OPCAB group), patients undergoing transmyocardial laser revascularization (TMLR group), and group control, patients undergoing mitral valve replacement because of rheumatic heart disease(RHD). The ET was measured in the following time: before operation, before aortic clamping(or before revascularization or before TMLR), aortic declamping(or just after revascularization or just TMLR), 3 h, 6 h, 24 h after reperfusion. CI was measured before operation, 3 h, 6 h and 24 h after reperfusion, respectively. Results ET Compared in each group: in CABG+LVAN group, it significantly increased when aortic declamping (69.93±7.20 pg/ml),at 3 h (89.99±5.76 pg/ml),6 h (60.94±8.69 pg/ml) and, 24 h (6899±10.30 pg/ml) after reperfusion than that beforeoperation (40.17±13.37 pg/ml,Plt;0.05); in CABG group, ET significantly increased when reperfusion(66.59±4.86 pg/ml), at 3 h (95.97±10.72 pg/ml), 6 h (61.51±765 pg/ml) and, 24 h (57.85±6.34 pg/ml) after reperfusion than that beforeoperation(43.22±9.13 pg/ml,Plt;0.05); in OPCAB group, ET increased significantly when reperfusion(66.47±5.90 pg/ml) than that beforeoperation(44.80±6.51 pg/ml,Plt;0.05), and then returned to normal level; in TMLR group,there is no difference before and after operation; in control group, ET increased significantly after operation. ET compared between different groups: ET level was higher in CABG group than that in OPCAB group at 3 h after reperfusion(95.97±10.72 pg/ml vs.59.72±4.81 pg/ml,Plt;0.05). Although CI significantly increased after myocardial reperfusion in all groups, the CI was significantly higher in OPCAB group than that in CABG group at 3 h after reperfusion(3.25±0.05 pg/ml vs. 2.17±0.46 L/min·m2,Plt;0.05). Conclusions In patients with CAD, the ET increases after operation, but the increasing levels are different among the different groups. In patients with OPCAB, the changes of ET and hemodynamics are mild, and heart function recovers quickly, so OPCAB is a very good choice for CAD surgical therapy if the indications are suitable; In patients with classical CABG, the changes of ET are obvious, and the heart function recovers a little bit slowly, but they all can return to normal level at 24 h after operation; TMLR is a good supplement for CAD therapy.

    Release date:2016-08-30 06:05 Export PDF Favorites Scan
  • The Use of Prostaglandin E1Dur ing Off-pump Coronary Artery Bypass Graf ting in Patien ts of Old Age

    Abstract:  Objective To invest igate the effect of p ro staglandin E1 (PGE1 ) during off-pump co ronary artery bypass graft ing (O PCAB ).  Methods  F rom O ct. 2005 to Dec. 2005, 40 consecut ive pat ients w ho underw ent O PCAB w ere random ly divided into two group s. The cont ro l group received convent ional t reatment w h ile the PGE1 group received cont inuous int ra2vena PGE1 infusion ( 5220 ngouml;k g?m in) fo r 24248 hours. The perioperat ivehemodynam ic indexes, including cardiac index (C I) , system ic vascular resistance ( SVR ) , pulmonary vascular resistance (PVR ) , and hematocrit (HCT ) , coagulation index (C I) , partial pressure of oxygen in artery (PaO 2 ) ,serum creat inine (Cr) and blood urea nitrogen (BUN ) were measured and compared.  Results Postoperative SVR and PVR decreased and C I increased significantly in the PGE1 group (P lt; 0. 05). Postoperative HCT decreased in the both group patients. Coagulation index decreased significantly on the operation day, but then increased in both groups on the next day after operation, with the increase in the PGE1 group significantly less than control group (P lt;0. 05). Postoperative serum Cr and BUN increased significantly in the both groups, especially in the control group (P lt; 0105).  Conclus ion PGE1 has potential beneficial effect on patients undergoing OPCAB.

    Release date:2016-08-30 06:08 Export PDF Favorites Scan
  • Applying Modified Robicsek Chest Closure and Bilateral Pectoralis Major Muscle Flaps during Off-pump Coronary Artery Bypass Graft

    目的通过改良Robicsek法胸骨固定及双侧胸大肌内侧头转移在非体外循环冠状动脉旁路移植术(OPCAB)患者胸骨固定中的应用,探讨此技术在预防OPCAB术后胸骨并发症的作用。 方法回顾性分析2011年2月至2013年4月北京安贞医院46例符合高危人群指征的心脏病患者行改良Robicsek法胸骨固定及双侧胸大肌内侧头转移手术的临床资料。男17例,女29例;年龄63~82(68.6±4.6)岁。 结果46例患者手术过程顺利,无1例发生胸骨并发症。1例死于围手术期心肌梗死、左心力衰竭,其余患者术后肌瓣存活良好。45例术后14 d拆线,伤口愈合良好。所有患者出院后1个月、6个月进行随访,皮肤切口愈合良好,胸骨固定良好,无窦道形成,未见反常呼吸运动,胸廓外形良好。 结论相对于传统闭合切口的方法,对可能发生胸骨合并症的高危人群,采用改良Robicsek法胸骨固定及双侧胸大肌内侧头转移术有一定的优势,能降低胸骨裂开及切口感染的概率,从而降低全身感染的概率,缩短患者康复时间,减轻心理压力。

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  • Repairing of Ischemic Mitral Regurgitation by Chained Double Stitching without Shaping Ring

    ObjectiveTo attempt an innovative mitral valvuloplasty by chained double stitching without shaping ring to repair ischemic mitral regurgitation (IMR) and to evaluate the clinical efficacy of this new procedure. MethodsWe retrospectively analyzed the clinical data of 12 patients with coronary artery disease and IMR underwent the innovative mitral valvuloplasty by chained double stitching without shaping ring in our hospital from August 2012 to December 2013. There were 10 males and 2 females at the mean age of 60±10 years ranging from 42 to 76 years. The cardiac functional parameters and condition of mitral regurgitation were compared among the period of preoperation, discharging and follow-up. ResultsTwelve patients were recovered and discharged from hospital with the New York Heart Association (NYHA) classification of heart function at class Ⅰ-Ⅱ. NYHA classification, grade of mitral regurgitation and regurgita- tion area were statistically improved on both the phase of discharge and follow-up compared with that of the pre-operation (P<0.05). Compared with preoperative left ventricular ejection fraction (LVEF), LVEF of discharging was statistically amelio- rative (P<0.05). And there was a statistic difference of NYHA classification of cardiac function in the phase of follow-up than that of discharging (P<0.05). ConclusionMitral valvuloplasty by chained double stitching without shaping ring is one reliable choice of treating IMR. The cardiac function and the living quality of the patients are statistically improved on the early stage and metaphase after operation, but long-term efficacy of this surgical procedure need be further assessed.

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  • The implication of anastomotic port exploration and dredging in coronary artery bypass grafting

    ObjectiveTo evaluate the changes of the flow parameters before and after the anastomotic port exploration and dredging during coronary artery bypass grafting by using the transit time flow measurement (TTFM).MethodsA total of 167 patients who underwent continuous coronary artery bypass grafting and anastomotic port exploration and dredging surgery in Beijing Anzhen Hospital from 2018 to 2019 were enrolled in this study. There were 136 male and 31 female patients aged 41-82 (58.35±17.26) years. If the probe entered and exited the anastomotic port smoothly, it was recorded as a non-resistance group; if the resistance existed but the probe could pass and exit, it was recorded as a resistance group; if the probe could not pass the anastomotic port for obvious resistance, it was recorded as the stenosis group. In the stenosis group, the grafts were re-anastomosed and the flow parameters were re-measured by TTFM.ResultsA total of 202 anastomotic ports were carried out by exploration and dredging. Among them, 87 anastomosis (43.1%) were in the non-resistance group, and there was no significant change in the blood flow volume (BFV) and pulsatility index (PI) before and after exploration and dredging (6.16±3.41 mL/min vs. 6.18±3.44 mL/min, P=0.90; 7.06±2.84 vs. 6.96±2.49, P=0.50). Sixty-four anastomosis (31.7%) were in the resistance group, the BFV was higher after exploration and dredging than that before exploration and dredging (17.11±7.52 mL/min vs. 4.96±3.32 mL/min, P<0.01), while the PI was significantly smaller (3.78±2.20 vs. 8.58±2.97, P<0.01). Fifty-one anastomosis (25.2%) were in the stenosis group, and there was no significant change in the BFV and PI before and after exploration and dredging (3.44±1.95 mL/min vs. 3.48±2.11 mL/min, P=0.84; 10.74±4.12 vs. 10.54±4.11, P=0.36). After re-anastomosis, the BFV was higher (16.48±7.67 mL/min, P<0.01) and the PI deceased (3.43±1.39, P<0.01) than that before exploration and dredging.ConclusionThe application of anastomotic exploration and dredging can reduce the occurrence of re-anastomosis, and promptly find and solve the stenosis of the distal coronary artery, improve the poor perfusion of distal coronary, and thus improves the prognosis of patients.

    Release date:2021-03-19 01:41 Export PDF Favorites Scan
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