ObjectiveTo investigate the feasibility, safety and accuracy of inserting a left atrial piezometer tube and pulmonary artery flotation catheter (PAFC)via the internal jugular vein (IJV)for postoperative monitoring of adult patients with pulmonary arterial hypertension (PAH)after open cardiac surgery. MethodsA prospective study was conducted in 100 patients aged over 18 years who underwent open cardiac surgery in Wuhan Asia Heart Hospital from 2010 to 2012. There were 43 male and 57 female patients with their age of 46-65 (47±16)years. All the patients were divided into 2 groups, including 50 patients with severe PAH who underwent heart valve replacement (HVR)in group A, and 50 patients with mild to moderate PAH who underwent HVR in group B. All the patients received insertion of ARROW 5 Fr three-cavity catheter by piercing the atrial septum via IJV for continuous monitoring of left atrial pressure (LAP), and insertion of ARROW 8 Fr high-flow sheath for PAFC implantation via IJV in the same side. LAP and pulmonary artery wedge pressure (PAWP)were continuously monitored after the patients entering the intensive care unit (ICU). The corelation and accuracy of LAP and PAWP were observed in the 2 groups. ResultsAll the patients successfully received continuous LAP and PAWP monitoring without serious catheter-related complications. There was no statistical difference in operation time or extracorporeal circulation time between group A and B (P > 0.05). There was statistical difference in postoperative mechanical ventilation time and length of ICU stay between the 2 groups (P < 0.05). Mean pulmonary artery pressure (PAPmean), mean LAP (LAPmean), mean PAWP (PAWPmean), and mean difference between PAWP and LAP (PAWP-LAPmean)of group A were significantly higher than those of group B (P < 0.01). PAWP was well correlated with LAP in both groups, and the correlation in group A was significantly milder than that in group B (P < 0.01). ConclusionIt is safe and feasible for LAP and PAFC monitoring via IJV after cardiac surgery. PAWP can not accurately reflect left ventricular preload, and LAP is more accurate to monitor left ventricular preload for patients with severe PAH.
Objective To evaluate the effectiveness of arthroscopic debridement and release for post-traumatic arthritis of subtalar joint. Methods Between January 2011 and December 2014, 14 cases of post-traumatic arthritis of the subtalar joint underwent arthroscopic debridement and release, and the clinical data were retrospectively analyzed. All patients were male, aged 42 years on average (range, 32-62 years). Calcaneus fracture was caused by falling from height; 8 cases received conservative treatment and the other 6 cases received open reduction and internal fixation. The mean interval from injury to operation was 3.4 years (range, 2-7 years). The arthroscopic debridement and release were performed through lateral portals. The injury degree of articular cartilage was classified as grade 3 in 4 cases and grade 4 in 10 cases based on Outerbridge rating. The degree of pain was assessed by visual analogue scale (VAS) and the function of joint was assessed by the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle Hindfoot Scale. Results All incisions healed by first intention and no complication occurred. The follow-up time was 18 months. Pain was relieved obviously; VAS was significantly decreased to postoperative 3.8±0.9 at 18 months from preoperative 7.7±1.2 (t=9.728,P=0.000), and AOFAS Ankle Hindfoot Scale was significantly increased to postoperative 59.1±8.8 from preoperative 37.6±8.2 (t=6.688,P=0.000). During follow-up, no patient was given arthrodesis and no worsened sign was found on the postoperative CT and MRI. Conclusion Arthroscopic debridement and release for post-traumatic arthritis of the subtalar joint can relieve clinical symptoms and delay subtalar arthrodesis.
Cardiovascular disease is one of the most common causes of death. Coronary artery stent implantation has been the most important method to cure coronary disease and inhibit angiostegnosis. However, restenosis and thrombus at the site of implanting cardiovascular devices remains a significant problem in the practice of interventional cardiology. Recently, lots of studies have revealed that endothelial impairment is considered as one of the most important mechanisms contributing to restenosis. As a result, the method of accelerating endothelial regeneration at the injury site could prevent restenosis and thrombus. Considering the surface modification of cardiovascular stent implantation, this paper summarizes the progress on this direction, especially for the prevention of cardiovascular restenosis. Furthermore, this paper also proposes the methods and the future developing prospects for accelerating in vivo re-endothelialization at the site of intravascular stent with different biological molecules.
ObjectiveTo explore the effectiveness of levosimendan versus dobutamine for the patients with severe valvular disease in perioperative period. Methods A randomized, single-blind, and controlled study was conducted in 59 patients with severe valvular disease in perioperative period. There were 48 males and 11 females at average age of 51±14 years (ranged from 18 to 70 years). The patients received Swan-Ganz catheterization with pulmonary capillary wedge pressure (PCWP)≥15 mm Hg, cardiac index (CI)≤2.5 L/(min·m2), and hemodynamic stability. They were divided into a levosimendan group (n=25) and a dobutamine group (n=34) to receive levosimendan or dobutamine injection intravenously for 24 hours on base of anti-heart failure treatment by random digital table. ResultsIn the levosimendan group, the level of PCWP was lower than the baseline level with a statistical difference(12.51±8.76 mm Hg vs. 20.11±8.04 mm Hg, P < 0.01) after 24 hours' treatment, and the level of CI was higher than the baseline level with a statistical difference (2.58±0.72 L/(min·m2) vs. 2.01±0.54 L/(min·m2), P < 0.05) after 24 hours' treatment. In the levosimendan group, the changes of pulmonary capillary wedge pressure (PCWP), pulmonary arterial mean pressure (PAMP), sequential vascular response (SVR), and left ventricular ejection fraction (LVEF) were more obvious compared with those in the dobutamine group with statistical differences (all P < 0.05) after 24 hours' treatment. The offline time and ICU stay in the levosimendan group reduced compared with those of the dobutamine group with statistical differences (47.3±10.4 h vs. 52.5±7.6 h, P < 0.05; 5.3±2.2 d vs. 6.8±3.5 d, P < 0.05). There was no statistical difference in the incidence of adverse events between the two groups (P > 0.05). ConclusionCompared with dobutamine, levosimendan can improve hemodynamic stability of patients with severe valvular disease in perioperative period with good tolerability and safety.
ObjectiveTo explore the reason of failure in noninvasive positive pressure ventilation (NPPV) for treatment of postoperative hypoxemia, in order to better guide use of NPPV after cardiac surgery. MethodsWe retrospectively analyzed the clinical data of 64 patients after heart surgery with undergoing NPPV treatment due to hypoxemia in our hospital between January 2012 and December 2013 year.There were 49 males and 15 females at age of 28 to 87 years. There were 17 patients with NPPV failure. The related factors for failure of NPPV were analyzed. ResultsFactors associated with failure of NPPV included smoking history, preoperative pulmonary function abnormalities, blood transfusion amount > 1 000 ml, simplified acute physiology score Ⅱ(SAPS Ⅱ) before NPPV > 35 points, oxygenation index (PaO2/FiO2) < 100 mm Hg before NPPV, PaO2/FiO2 < 150 mm Hg after NPPV treatment for 1 h, mechanical ventilation time > 72 h at the first time, and pneumonia (P < 0.05). The SAPS Ⅱ > 35 points before NPPV and pneumonia were the independent risk factors for NPPV treatment failure for postoperative hypoxemia. ConclusionPostoperative NPPV for heart disease should be according to the cause of low oxygen and severity. For patients with SAPS less than 35 points before NPPV or patients with pneumonia, NPPV should not be used. In the process of NPPV, if clinical effect is not satisfied, it should be converted to invasive ventilation immediately.
ObjectiveTo summarize the experience of intra-aortic balloon pump (IABP) application on coronary artery bypass grafting（CABG）during perioperative period. MethodsWe retrospectively analyzed the data of 82 patients undergoing simple CABG operation in Wuhan Asia Heart Hospital between January 2011 and December 2013. There were 50 male and 32 female patients at age of 49-75 (63.6±11.5) years. The patients were divided into three groups including a group A (12 patients, preoperative-placed IABP), a group B(39 patients , postoperative active placed IABP), and a group C (31 patients, postoperative passive placed IABP). The clinical effects of the three groups were compared. ResultsThere were significantly statistic differences in sequential organ failure assessment (SOFA) score after postoperative 48 hours, ventilator supporting time, IABP supporting time, catecholamine drug usage time, infection incidence, incidence of ventricular arrhythmia, ICU retention time, postoperative hospital stay, CBP usage rate, and postoperative mortality (P<0.05) among the three groups with worse effect in the group C. ConclusionTaking IABP support during CABG perioperative period is an effective treatment. Preventively preoperative and actively postoperative placing IABP can improve the treatment effects significantly. Therefore, patients should apply CABG as soon as possible without hesitation when IABP indications occur.