【摘要】目的 探討胸部X線片檢查發現的主動脈弓鈣化與冠心病的不同臨床表現類型的相關性。方法 回顧分析2006年7月-2008年2月期間經冠狀動脈造影證實的冠心病患者的臨床資料,對比分析胸部平片所見的主動脈弓鈣化情況與冠心病不同臨床類型的相互關系。結果 116例經冠狀動脈造影證實的冠心病患者納入研究。其中,穩定型心絞痛40例,急性冠脈綜合征76例(不穩定型心絞痛21例、非ST段抬高心肌梗死38例、ST段抬高心肌梗死17例)。40例穩定型心絞痛患者中,有主動脈弓鈣化者21例,占52.5%;76例急性冠脈綜合征患者中,有主動脈弓鈣化者22例,占28.9%。與急性冠脈綜合征相比,更多的穩定型心絞痛患者合并有主動脈弓鈣化(χ2=6232,P=0013)。結論 在不同的冠心病臨床類型,主動脈弓鈣化更易在穩定型心絞痛患者中發現。【Abstract】 Objective To investigate the relationships between calcification of aortic arch and different clinical classification of coronary artery disease. Methods The clinical data of patients with coronary artery diease who diagnosed by arteriography from July 2006 to February 2008, were retrospectively analyzed. The Xray data on calcification of aortic arch and clinical characteristics of patients with coronary artery disease confirmed by coronary angiography were analyzed. The relationship between coronary calcification of aortic arch which showed by Xray and different clinical classification of coronary artery disease were comparatively analyzed. Results Among the total of 116 patients, 40 stable angina and 76 acute coronary syndrome were included, and 21 (52.5%) and 22 (28.9%) patients with calcification of aortic arch were observed respectively. In comparison to patients with acute coronary syndrome, more stable angina patients were complicated with calcification of aortic arch (χ2 =6232,P=0013). Conclusion It is more likely to document calcification of aortic arch in patients with stable angina.
Objective
To evaluate the outcome of surgical repair of interrupted aortic arch (IAA) combined with anomalies.
Methods
We retrospectively analyzed the clinical data of 48 patients with IAA combined with anomalies undergoing one-stage biventricular repair in Shanghai Children's Medical Center from November 2006 to April 2016. There were 25 males and 23 females with a median age of 29 d (range, 8 to 91 d) and a mean weight of 3.80±0.67 kg. All patients underwent end-to-end anastomosis with patch augmentation, and relief of left ventricular outflow tract obstruction (LVOTO) was performed in 11 patients.
Results
In IAA children with anomalies, 39 (81.3%) suffered noncomplex lesions and 9 (18.8%) complex lesions. Mean follow-up was 72.1±19.7 months for 38 patients. There were 6 in-hospital deaths and 3 patients died during follow-up. The early survival rate was 87.5%, 5-year rate 83.3% and 10-year rate 81.3%. Reintervention was required in 10 patients, including 8 with subsequent LVOTO and 2 with anastomotic stenosis.
Conclusion
End-to-end anastomosis with patch augmentation is effective for IAA.
Objective
To investigate the combined effects of digastric muscle low frequency modulated medium frequency electro-acupuncture therapy and voice training for dysphagia in patients who underwent aortic arch surgery.
Methods
Forty-two consecutive patients with dysphagia after aortic arch surgery between October 2014 and November 2017 were divided into two groups including an observation group and a control group. There were 21 patients in each group. There were 17 males and 4 females at age of 51.0±6.5 years in the observation group, while 18 males and 3 females at age of 49.8±7.3 years in the control group. The patients in the observation group underwent electroacupuncture therapy and voice training (20 min per day for each therapy, 2 weeks), while the patients in the control group only received safe swallowing education and rehabilitation guidance (2 weeks). The test results, such as fibrolaryngoscope and functional oral intake scale (FOIS) score, and the data of computer phonatory detection, before and after the intervention were compared.
Results
The fibrolaryngoscope of vocal cords significantly decreased and the FOIS score significantly increased after digastric muscle low frequency modulated medium frequency electro-acupuncture therapy and voice training in the observation group(6.30 vs. 4.60, P<0.05). Bucking was obviously reduced. The indicators of hoarse degree, such as median pitch, fundamental frequency, jitter (0.60%±0.96%vs. 1.99%±1.86%, P=0.033), shimmer (2.47%±4.26% vs. 5.89%±3.66%, P=0.043), maximum phonation time (15.31±9.10 s vs. 3.72±8.83 s, P=0.006), maximum and loud phonation time (9.30±5.73 s vs. 2.32±2.99 s, P=0.039), mean noise-to-harmonics ratio (23.99±10.17 vs .9.98±9.37, P=0.006) and mean harmonics-to-noise ratio (0.03±0.02 vs. 0.17±0.23, P=0.019) improved after the treatment in both groups. But the improvement in the observation group was significantly better than that in the control group.
Conclusion
The combination of digastric muscle low frequency modulated medium frequency electro-acupuncture therapy and voice training on dysphagia in patients who underwent aortic arch surgery can significantly improve the swallowing function of patients. Meanwhile, it also helps the recovery of phonic function and improves the ability of feeding and communication in these patients.
Objective
To study surgical indication, technique for treating acute Stanford type A aortic dissection involving repair of the aortic arch using Sun’s procedure with preservation of autologous brachiocephalic artery.
Methods
We retrospectively analyzed the clinical data of 28 consecutive patients (23 males, 5 females) who underwent operations on acute Stanford type A aortic dissection using Sun’s procedure with preservation of autologous brachiocephalic artery in our hospital between August 2011 and October 2013. The mean age was 29-62 (47±8) years. There were 26 patients with hypertension and 2 patients with Mafan syndrome. Sun’s procedure with preservation of autologous brachiocephalic artery was performed in all patients, concomitant procedure included aortic root replacement (Bentall) in 4 patients, aortic root replacement (Bentall) and mitral valve replacement (MVR) in 1 patient, aortic valsalva sinus plasty in 6 patients.
Results
The cardiopulmonary bypass time was 167±37 min. The cross clamp time was 80±22 min. Selective cerebral perfusion time was 29±5 min. One patient died postoperatively from acute hepatic failure. Two patients suffered from transient neurologic deficit and recovered after treatment during follow-up. Computed tomography angiography (CTA) of aorta was performed in each patient before discharged from the hospital. The patency of the anastomotic site at brachiocephalic artery was identified. Descending aortic true lumen was significantly expanded. There was only 2 patients with endoleak and total thrombosis of false lumen was found near stent graft with 25 patients. The 27 patients were followed up for 47 (36-62) months. One patient with descending thoracic aortic dilatation underwent thoracoabdoninal aortic replacement. One combined with acute endometrial tear underwent thoracic endovascular aortic repair.
Conclusion
Sun’s procedure with preservation of autologous brachiocephalic artery is safe and effective in the treatment of acute Stanford type A dissection in patients without brachiocephalic artery involved. Low mortality and complication rate are achieved, but the long-term results need the further follow-up.
Objective To investigate diagnostic and treatment strategies of patients with congenital heart diseases and right aortic arch. Methods Clinical data of 27 children who underwent surgical correction for congenital heartdiseases and right aortic arch in Children’s Heart Center of Beijing Children’s Hospital from January 1，2012 to April 1，2013 were retrospectively analyzed. There were 20 male and 7 female patients with their age of 10.96±12.08 months and body weight of 7.70±3.13 kg. All the patients had right aortic arch，including 14 children with tetralogy of Fallot，9 childrenwith ventricular septal defect，1 child with patent ductus arteriosus，1 child with pulmonary artery sling and 2 children with isolated double aortic arch. Thirteen children were found to have a vascular ring including aberrant left subclavian artery and double aortic arch. All the patients received surgical correction for their intracardiac anomalies and concomitant transposition of the left subclavian artery for aberrant left subclavian artery or division of the nondominal arch for double aortic arch. Results Three children died perioperatively including 1 child who was unable to be weaned from cardiopulmonary bypass，1 child without vascular ring who died 7 days postoperatively，and 1 child with double aortic arch who died of acuterespiratory distress syndrome. There was another child who gave up further postoperative treatment. Twenty-three children were followed up for 3-17 months after discharge. Echocardiography showed satisfactory correction of their intracardiac anomalies. All the patients alive recovered well with good pulses in arteries of both arms. Conclusion Careful strategiesare needed for surgical correction of patients with congenital heart diseases and concomitant right aortic arch. Comprehensivepreoperative evaluation including contrast-enhanced CT and magnetic resonance imaging is helpful for clinical decision making in diagnosis and treatment. Clinical outcomes of 1-stage surgical correction of vascular ring and other concomitant intracardiac anomalies are satisfactory with good short-term results.
Objective To summarize the experiences of single stage repair of persistent fifth aortic arch associated with stenosis and interrupted aortic arch and other cardiac anomalies,and to improve surgical effect of the diseases． Methods From Jan．2000 to May 2008，five patients with persistent fifth aortic arch were operated in this hospita1，the age at operation was 1.8-108.0 months and body weight 3.7-31.0 kg．Three patients had chronic heart failure and respiratory infection repeatedly.All patients received single stage repair. Results There were two early hospital deaths，one patient’s parents gave up all the therapy because of cardiac insufficiency, pulmonary hypertension crisis and severe pulmonary infection; another one died of severe pulmonary hypertension crisis，the low cardiac outflow and left heart failure. Three patients were followed up, followup time was 55.67±48.64 months. The results were excellent,and one patient had been followed up for 8 years,the latest magnetic resonance imaging showed that diameter of the enlarged fifth aortic arch was 9.3 mm. Conclusion Persistent fifth aortic arch operation can achieve good exposure,less incisional wound and excellent recovery through midline sternotomy.Because of systemic hypertension and the affection of associated anomalies the operation should be performed as early as possible.
ObjectiveTo explore the risk factors and predictive value of acute kidney injury (AKI) after total aortic arch replacement.MethodsThe clinical data of patients undergoing total aortic arch replacement in our hospital from January 2018 to June 2019 were retrospectively analyzed, and patients receiving preoperative renal replacement therapy and missing creatinine values were excluded. According to whether postoperative AKI occurred, patients were divided into an AKI group and a control group. The univariate and multivariate analyses (logistic regression) were used to explore the independent risk factors of AKI. The receiver operating characteristic curve was used to analyze the significant factors in predicting the occurrence of AKI after total aortic arch replacement.ResultsA total of 162 patients were included in the study, including 135 (83.3%) males and 27 (16.7%) females, with an average age of 52.61±9.90 years (range: 22 to 73 years). The incidence of AKI was 68.5% (n=111). The results of univariate and multivariate analyses showed that the postoperative serum cystatin C level (OR=76.145, 95%CI 15.575-372.260, P<0.01) was an independent risk factor for AKI after total aortic arch replacement. When its cut-off value was above 1.08 mg/L, the specificity for predicting postoperative AKI was 70.59%, and the sensitivity was 85.59%.ConclusionThe postoperative cystatin C level is an independent risk factor for AKI after total aortic arch replacement and has predictive value.
ObjectiveTo compare the cerebral protective effect of unilateral and bilateral antegrade selective cerebral perfusion during total aortic arch replacement, particularly with respect to neuropsychological outcome.MethodsFrom June 2003 to March 2004, 16 patients who underwent total aortic arch replacement were randomly allocated to one of two methods of brain protection: unilateral antegrade selective cerebral perfusion (unilateral group, n =8) or bilateral antegrade cerebral perfusion (bilateral group, n =8). Preoperative and postoperative neurological examination, brain computed tomography(CT) scan, and cognitive function tests were performed.ResultsAll patients survived the operations and were discharged from hospital. No new brain infarction occurred. Transient neurologic dysfunction occurred in 1 patient of each group. There were no intergroup differences in the scores of preoperative and post operative cognitive function ( P gt;0.05).ConclusionBoth methods of brain protection for patients undergoing total aortic arch replacement result in favorable and similar effect of brain protection in term of cognitive function provided the circle of Willis is patent and collateral flow is adequate.
ObjectiveTo investigate the best anatomical classification, surgical timing, procedure and clinical outcomes of congenital vascular ring.MethodsThe clinical data of 58 patients who underwent congenital vascular ring surgery in Pediatric Surgery Center, Fuwai Hospital between 2014 and 2019 were retrospectively analyzed. There were 32 (55.2%) males and 26 (44.8%) females with a median age of 16.5 (2-73) months. Preoperative symptoms, imaging examinations, anatomical classifications, surgical procedures and postoperative recovery were assessed.ResultsThere were 20 (34.5%) patients of double aortic arch, 22 (37.9%) patients of right aortic arch with left arterial duct or ligament, 15 (25.9%) patients of left aortic arch with aberrant right subclavian artery, and 1 (1.7%) patient of circumflex aorta with cervical aorta arch. The median ventilator supporting time was 6.0 (0-648) h, and the median hospital stay time was 14.5 (7-104) d. One patient with coarctation of aorta died of severe pulmonary infection during perioperative period, and the others survived without symptoms and reoperation after discharge. The median follow-up time was 7.0 (1-62) months.ConclusionFor children with unexplained dyspnea and dysphagia, or with right aortic arch, preoperative imaging examinations such as computed tomography or magnetic resonance imaging are required to confirm the diagnosis of vascular ring. Surgical correction of congenital vascular ring is safe and reliable, and can effectively relieve symptoms. The mortality rate and reoperation rate are low, and the follow-up results are satisfactory.
Objective
To evaluate the short- and middle-term outcomes of surgical treatment for distal aortic arch lesions using stented elephant trunk implantation combined with transposition of left subclavian artery to left common carotid artery.
Methods
The clinical data of 14 patients with distal aortic arch lesions undergoing stented elephant trunk procedure with left subclavain artery transposition under hypothermic cardiopulmonary bypass (CPB) with antegrade selective cerebral perfusion from May 2009 to November 2015 in our hospital were retrospectively reviewed. All of them were males with a mean age of 52±14 years ranging from 20 to 69 years. Hypertension was observed in nine patients, coronary artery disease in five and prior cerebral infarction in one. History of percutaneous coronary intervention was noted in one patient, history of Bentall operation in one, ligation of patent ductus arteriosus in one and endovascular aneurysm repair in one.
Results
There was no hospital death. Concomitant procedures included coronary artery bypass grafting in two patients and plasty of the ascending aorta replacement in one. Mean duration of mechanical ventilation and ICU stay was 21±7 h and 43±19 h, respectively. All patients survived and were discharged. One patient was lost to follow-up and no patient died during the follow-up. Postoperative computed tomography revealed good patency of the anastomotic site between the left subclavian artery and the left common carotid artery.
Conclusion
Stented elephant trunk procedure with left subclavain artery transposition obtains satisfactory surgical results in patients with distal aortic arch lesions.
