ObjectiveTo investigate the relationship of 24-hour ambulatory pulse pressure (24hPP) with left ventricular mass index (LVMI) in elderly essential hypertension patients.
MethodsThe data of 110 elderly patients with essential hypertension from January to December 2012 were collected in the study. All patients received 24-hour ambulatory blood pressure monitoring and echoeardiographic examination 24hPP and LVMI were calculated according to the results of 24-hour ambulatory blood pressure monitoring and echocardiographic measurements. The patients were divided into group A [24hPP<60 mm Hg (1 mm Hg=0.133 kPa), n=70] and group B (24hPP≥60 mm Hg, n=40).
ResultsThe 24-hour systolic blood pressure and 24hPP for patients in group B were significantly higher than those in group A (P<0.001). Compared with group A patients, the interventricular septal thickness, left ventricular posterior wall thickness, left ventricular mass and left ventricular mass index were significantly higher in group B (P<0.05). Pearson correlation analysis showed that 24hPP had a positive correlation with LVMI in the elderly essential hypertension patients (r=0.33, P<0.001). Multiple stepwise regression analysis showed that 24hPP was the main factor for the increase of LVMI in elderly essential hypertension patients (β=0.90, P<0.001).
ConclusionThe 24hPP is positively correlated with LVMI in elderly essential hypertension patients. The 24hPP is an important risk factor for left ventricular structural damage in elderly essential hypertensive patients.
The implantation of a left ventricular assist device (LVAD) is an important therapeutic tool for patients with end-stage heart failure, which can either help patients transit to the heart transplantation stage or serve as destination therapy until the end of their lives. In recent years, the third generation of LVAD has evolved rapidly and several brands have been marketed both domestically and internationally. The number of LVAD implantations has been increasing and the long-term survival rate of implanted patients has improved, so this device has a broad development perspective. This article summarizes the current status, usage standards and precautions, and common complications after implantation of LVAD, as well as looks forward to the future development of LVAD, hoping to be helpful for researchers who are new to this field.
ObjectiveTo analyze risk factors of early outcomes of mitral valvuloplasty (MVP)for the treatment of degenerative mitral regurgitation (DMR).
MethodsClinical data of 132 DMR patients who underwent MVP in Fu Wai Hospital between January 1, 2011 and November 1, 2011 were retrospectively analyzed. A total of 114 patients (86.4%)were followed up after discharge with their mean age of 51.21±12.78 years, including 76 males (66.7%). Preoperative risk factors of early outcomes of MVP were analyzed.
ResultsAmong those patients, there were 25 patients with atrial fibri-llation (AF)(21.9%). Preoperative ejection fraction was 63.88%±6.93%. Preoperative echocardiography showed left ventricular end-diastolic diameter (LVEDD)was 31.61±5.51 mm/m2. There were 66 patients (57.9%)with tricuspid regurg-itation, and 34 patients (29.8%)underwent concomitant tricuspid valvuloplasty including 10 patients (8.8%)who received tricuspid annuloplasty rings. Two patients died postoperatively, 2 patients underwent re-operation of mitral valve replacement or MVP respectively. Postoperative echocardiography showed moderate or severe mitral regurgitation in 15 patients. Preoperative risk factors of early outcomes of MVP included AF (36.8% vs. 18.9%, P=0.035), large LVEDD (34.02±3.76 mm/m2 vs. 31.15±5.68 mm/m2, P=0.042)and functional mitral regurgitation (15.8% vs. 1.1%, P=0.007). Multivariate analysis showed greater postoperative LVEDD reduction significantly lowered the incidence of postoperative events (HR 0.002, 95% CI < 0.001-0.570, P=0.031).
ConclusionsEnlargement of the left ventricle is an independent preoperative risk factor for early outcomes of MVP for DMR patients. Greater postoperative LVEDD reduction significantly lowers the incidence of postoperative events.
Abstract： Objective To investigate the cause, treatment， and prevention strategy of early left ventricular rupture after mitral valve replacement （MVR）. Methods We retrospectively analyzed clinical data of 7 patients who had early left ventricular rupture after MVR， among a total of 2 638 MVR patients， between May 1981 and November 2010 in General Hospital of Shenyang Military District. There were 2 male patients and 5 female patients with their age ranging from 28 to 71 years old. One patient was New York Heart Association （NYHA） functional classⅡand 6 patients were NYHA functional classⅢ. Preoperative echocardiography showed that their left ventricular ejection fraction （LVEF） was 49%-60% and their left ventricular end diastolic volume （LVEDV） was 29-42 ml. All the patients underwent prothetic valve replacement under moderate hypothermia， general anesthesia and extracorporeal circulation. Results All the 7patients underwent surgical repair for their early left ventricular rupture. There were 2 patients with TypeⅠ， 4 patients with TypeⅡ， and 1 patient with TypeⅢleft ventricular rupture. Four patients died of hemorrhagic shock or low cardiac output syndrome. Three patients were successfully healed and discharged from hospital 7-15 days after the operation. The 3 surviving patients were followed up for 4.5-18.0 years, and they all had good general condition and satisfactory quality of life. No late pseudo-aneurysm was found during follow-up. Conclusions Early left ventricular rupture is difficult to repair with a high mortality. Effective prevention strategy should be applied to avoid it as much as possible. Once left ventricular rupture occurs during the surgery， extracorporeal circulation should be quickly established， and it’s possible to save patients’ life by reliable intracardiac and epicardial repair according to patients’ individual condition.
Abstract: Objective To evaluate the treatment efficacy of post-infarction left ventricular pseudo-aneurysm (LVPA) through surgical procedure, and explore the diagnosis and differential diagnosis details of LVPA. Methods Between May 1993 and July 2007, 7 cases were diagnosed through echocardiography aided with left ventriculography or multi-sliced computer tomography (MSCT) or magnetic resonance imaging (MRI); 6 cases with LVPA were surgically treated through different procedure that included direct closure, cut and patching or cut and sandwiching procedure choose according to its location, anatomical morphology, and comorbidity; accompanied diseases were treated by coronary artery bypass grafting(CABG) procedure. Results Six cases were diagnosed before surgery, and 1 case was diagnosed during the surgical procedure. One died from the cardiac tamponade due to rupture of LVPA before the surgical procedure, so the inhospital mortality was 14.3%（1/7）. There was no operative death. With the follow-up from 2 months to 13 years of the 6 operational survivors, 1 case died from cardiac rupture and pericardial tamponade 4 years after the repair procedure. Of the 5 surviving LVPA, the left ventricular ejection fraction(LVEF) values were from 43% to 52%, and 3 cases were in New York Heart Association (NYHA) class Ⅰ, and 2 cases were in NYHA class Ⅱ. Conclusion Echocardiography, aided with left ventriculography or MSCT or MRI, is an effective measure for diagnosis of LVPA. Surgical procedure is an effective measure to treat LVPA,but different surgical procedures, accompanied with homeochronous CABG procedure,should be adopted to deal with LVPA according its location, anatomical morphology, and accompanied deformity. The perioperative and mid-long term efficacy were good for the surgical treatment of LVPA, but it is imperative to pay attention to prevention of the recurrence and the late rupture of repaired LVPA.
Transcatheter left ventricular assist pump (LVAP) is widely used in cardiogenic shock, post-circulatory hypoperfusion syndrome and high-risk percutaneous coronary intervention (PCI), and its application scenarios cover various complex environments such as ICU, operating room, emergency department and catheterization room. It is important to quickly and accurately implant the transcatheter LVAP and monitor its position in real time. This paper reported 2 male patients with high-risk PCI, aged 47 and 45 years, both with triple coronary artery disease and reduced ejection fraction (<35%). The domestically produced transcatheter LVAP was implanted using an echocardiography guidance technology system, and PCI treatment was performed under the assistance of the interventional pump. The operation was smooth, and the interventional pump assisted for 1 h in 2 patients, and the pump was successfully removed. There were no obvious complications related to the pump and PCI after the operation, and the patients were discharged smoothly.
Abstract: Objective To investigate changes of left ventricularregional systolic function after surgical treatment of left ventricular aneurysm (LVA) by realtime threedimensional echocardiography (RT-3DE). Methods From February 2009 to February 2010, 14 consecutive patients who were diagnosed to have coronary artery diseases with LVA underwent surgical repair and coronary artery bypass grafting (LVA group) in our hospital. All patients of the LVA group were followed up for a mean period of 4 months. Twodimensional echocardiography (2DE) and RT-3DE were performed before operation and during the follow-up. Left ventricular regional ejection fraction (EF) was acquired by Qlab software analysis. At the same time, 12 healthy persons were included as controls (control group). Statistical analyses were carried out to compare left ventricular regional EF between the LVA group (before operation and 4 months after operation) and the control group. Results Contrary to the control group, preoperative regional EF of the LVA group increased from apex to base. In addition to the inferior basal segment, lateralinferior basal segment and anteriorinferior basal segment, regional EF in the remaining 14 segments were significantly lower than that of the control group (P＜0.05). At postoperative followup, regional EF recovered the increase from base to apex, and there was no significant difference between anteriorinferior segment and lateral segment regional EF of the LVA group and those of the control group (P＞0.05), while regional EF of other segments in the LVA group was lower than that in the control group (P＜0.05). Conclusion RT-3DE is an effective method to assess left ventricular regional systolic function in patients with LVA. After LVA repair and coronary artery bypass grafting, regional systolic function will restore to the normal direction of progressive increase, and some nonaneurysm segments systolic function will go back to normal.
ObjectiveTo summarize the indication and surgical experiences of valve replacement, high-risk factors and long-term results for aortic regurgitation and large left ventricle.
MethodsWe retrospectively analyzed the clinical data of 42 patients with aortic regurgitation and left ventricle end-diastolic diameter (LVEDD) ≥70 mm and left ventricle end-systolic diameter (LVESD) ≥ 50 mm in our hospital from March 2004 through December 2012. There were 38 males and 4 females,aged 16-73 (45.86±14.99) years. The patients underwent aortic valve replacement, who were evaluated by echocardiography at pre-operation, pre-discharge and early follow-up. The follow up period was 12-132 months.
ResultsEarly death occurred in one patient. And five patients died during the follow-up. One week after surgery in 41 patients, LVEDD (62.00±13.21 mm), LVESD (50.71±14.02 mm), indexed LVEDD (35.23±8.58 mm/m2), indexed LVESD (28.92±9.08 mm/m2), LVEF (46.41%±12.49%), were significantly smaller than those before the operation (P<0.01). Heart function grades, preoperative EF, LVEDD and indexed LVEDD were the predictors for left ventricular function recovery. One-year, 5-year, 10-year survival rate was 92.9%, 90.2%, 83.8%, respectively.
ConclusionMost of patients with aortic regurgitation and large left ventricle still have indications for surgical treatment, but severe left ventricular dysfunction and ventricular arrhythmia are high risk factors for long-term survival.
