Objective To analyze the efficacy of off-pump coronary artery bypass grafting (OPCABG) in elderly patients with coronary artery disease complicated with moderate ischemic mitral regurgitation. Methods The clinical data of patients aged≥70 years with coronary artery disease complicated with moderate mitral regurgitation, and undergoing OPCABG from January 2009 to January 2020 in Beijing Anzhen Hospital were retrospectively analyzed. The echocardiographic indicators of the patients were compared preoperatively, postoperatively before discharge and during the follow-up. Results Finally 239 patients were enrolled. There were 136 males and 103 females, aged 74.1±3.2 years. Before postoperative discharge, 49 (20.5%) patients had no mitral regurgitation, 144 (60.3%) mild regurgitation, 46 (19.2%) moderate regurgitation, and 0 severe regurgitation. The area of mitral regurgitation was significantlyimproved (2.5±1.8 cm2 vs. 5.6±1.0 cm2, P<0.001). There were 10 (4.2%) patients of hospital death, 23 (9.6%) of low cardiac output, 3 (1.3%) of myocardial infarction, and 8 (3.3%) of nervous system injury after operation. As a result, 208 (90.8%) patients were followed up and the mean follow-up time was 3.4 years (range 1-9 years). The cumulative survival rates at postoperative 2, 4, 6, and 8 years were 95.8%, 88.0%, 78.4%, and 73.1%, respectively. Postoperative follow-up showed significant improvements compared with those before surgery in the area of mitral regurgitation, left ventricular ejection fraction, left ventricular end-diastolic and left ventricular end-systolic diameters (all P＜0.05). Duirng the follow-up, the major adverse cardiac and cerebrovascular events were all cause death in 22 (10.6%) patients, including cardiac death in 17 (8.2%) patients, myocardial infarction in 7 (3.4%) patients, heart failure in 24 (11.5%) patients, cerebrovascular events in 11 (5.3%) patients, re-hospitalization due to heart disease in 23 (11.1%) patients, and none of the patients with myocardial infarction were revascularized. Conclusion The mid- and long-term outcomes of OPCABG in the treatment for elderly patients with coronary artery disease complicated with moderate ischemic mitral regurgitation is good.
This study aimed to explore the possible association between single nucleotide polymorphism (SNP) rs189037 C > T in the promoter region of ataxia telangiectasia mutated (ATM) gene and essential hypertension (EH). We performed a case-control study to collect randomly 369 hospitalized patients aged 50 years and above. They were divided into EH group (190 patients) and control group (179 subjects) according to the diagnostic criteria of hypertension. The SNP rs189037 genotyping was performed using polymerase chain reaction-restriction fragment length polymorphism. The genotype frequencies of ATM gene polymorphism rs189037 for the whole sample were 33.9% CC, 48.0% CT, and 18.1% TT. There was no significant difference in the genotype frequency distributions of the SNP rs189037 between EH and control groups (P=0.619). After adjustment of the major confounding factors, the SNP rs189037 was still not associated with EH (P > 0.05). We further analyzed data from different groups divided by genders and age respectively, and the relationship was retained (P > 0.05). In addition, we found that the percentage of the TT genotype was much lower in coronary artery disease (CAD) patients than those in the CC or CT genotype (OR=0.49, 95% CI=0.26~0.90, P=0.021). In conclusion, our study suggests that SNP rs189037 in the promoter of ATM gene is not associated with EH. But it is related to the incidence of CAD, and TT genotype seems to be a protective factor for CAD.
摘要:目的:評價64層螺旋CT對冠心病的診斷價值。方法:對25例典型病例的CT圖片進行分析、總結,觀察64層螺旋CT對冠狀動脈的管腔狹窄程度及冠脈內斑塊性質的顯示能力,并對橋血管和支架通暢性進行觀察。結果:近端冠脈中度以上狹窄的敏感度、準確度、陽性預測值分別為93.5%,90.3%,88.5%,對左主干及前降支病變診斷價值較高;對冠狀動脈內軟斑塊顯示較佳;對橋血管及支架通暢和有無再狹窄顯示良好。結論:MSCT冠狀動脈成像在冠心病篩查及冠狀動脈支架術后和搭橋術后的隨訪發揮重要作用。Abstract: Objective: To study the diagnose value of 64slice spiral CT for coronary heart disease. Methods:The CT pictures of 25 typical cases of coronary heart disease were analyzed so as to survey the displaying ability coronal arterial stenosis, its degree and the character plaques, the patency of bypass graft and stents by 64slice spiral CT. Results:The sensitivity, accuracy, positive predictive value for RCA1 narrow above moderate was 93.5%, 90.3%, 88.5% respectively. For LM and LAD, its diagnose value was high. The coronary soft or fibrous plaque, stent and bypass graft were displayed well. Conclusion:MSCT plays an important role in filtering coronary heart disease and reexamination after stents and bypass.
ObjectiveTo analyze the efficacy of one-stop carotid endarterectomy (CEA) and off-pump coronary artery bypass grafting (OPCABG) for patients with coronary artery disease (CAD) combined with carotid artery stenosis. MethodsThe clinical data of patients with CAD and severe carotid artery stenosis who underwent one-stop CEA and OPCABG in our department from March 2018 to June 2021 were retrospectively analyzed. Before the surgery, all patients routinely underwent coronary and carotid angiography to diagnose CAD and carotid artery stenosis. All patients underwent CEA first and then OPCABG in the simultaneous procedure. ResultsA total of 12 patients were enrolled, including 9 males and 3 females, aged 58-69 (63.7±3.4) years. All patients had unilateral severe carotid artery stenosis, and the degree of stenosis was 70%-90%. The lesions of carotid artery stenosis were located in the bifurcation of carotid artery or the beginning of internal carotid artery. All patients successfully underwent one-stop CEA combined with OPCABG. The number of bridging vessels was 2-4 (2.8±0.6). The operation time of CEA was 16-35 (25.7±5.6) min. There was no death during the perioperative or follow-up periods. No serious complications such as stroke and myocardial infarction occurred during the perioperative period. During the follow-up of 6-40 months, the patency rate of arterial bridge was 100.0% (12/12), and that of venous bridge was 95.5% (21/22). Cervical vascular ultrasound showed that the blood flow of carotid artery was satisfactory. ConclusionOne-stop CEA and OPCABG can be safely and effectively used to treat CAD and carotid artery stenosis. The early and middle-term curative effect is satisfactory.
摘要:目的:了解血肌酐清除率受損是否與冠心病患病率存在聯系。方法:納入2006年7月至2008年2月期間經冠狀動脈造影證實的冠心病患者及年齡、性別匹配的對照組,按血肌酐清除率值將患者分為正常［≥90 mg/（mL·173 m2)］,輕度受損［≥60 mg/（mL·1.73 m2）,lt;90 mg/（mL·1.73 m2)］和明顯受損［lt;60 mg/（mL·1.73 m2)］。比較冠心病組與對照組各組人群的比例有無差異。結果:研究期間共納入冠心病組和對照組患者各116例。在冠心病組中,血肌酐清除率正常患者82例、輕度受損29例、重度受損5例,對照組中,正常患者98例、輕度受損13例、重度受損5例,〖JP3〗兩組比較分布有統計學差異(χ2值7.517,P=0.023)。與對照組比較,冠心病組的血清肌酐值無明顯差異（Pgt;005)，〖JP〗冠心病組（103.29±51.08） μmol/L,對照組（102.67±41.21）μmol/L。結論:血肌酐清除率降低是冠心病的危險因素。Abstract: Objective: To disclose the relation of the estimated glomerular filtration rate (eGFR) and coronary artery disease. Methods：We analyzed eGFR in the patients with coronary artery disease confirmed by coronary angiography and the control, and compared the proportion of patients with reduced renal function in the different groups. Results: A total 116 cases were included in each group. Among these patients, normal renal function, mildly and severe reduced renal function was documented in 82, 29 and 5 in coronary artery disease group, and in 98, 13 and 5 in the control group, respectively. In comparison to the control, more patients with reduced eGFR were found in coronary artery disease group (χ2 value 7.517,P=0.023), although no significant difference was observed between both groups（Pgt;0.05). Conclusion: Reduced eGFR, even if mildly, could be regarded as the risk factor of coronary artery disease.
ObjectiveTo investigate surgical treatment strategies for diffuse coronary artery disease (CAD).
MethodsFrom January 2003 to June 2013, 92 patients with diffuse CAD received complete coronary revascularization including coronary artery bypass grafting (CABG)and coronary endarterectomy (CE)in the First Affiliated Hospital of China Medical University. There were 63 male and 29 female patients with their age of 52-81 (68.7±10.5)years. After CE and during follow-up, coronary CT angiography (CTA)was used to assess graft patency, and improvement of patients' cardiac function and angina symptoms were observed.
ResultsTarget vessel diameter of the 92 patients was all larger than 1.5 mm after CE. Sixty-three patients (with 69 CE grafts)received intraoperative graft blood flow measurement, showing 59 grafts (85.5%)with satisfactory blood flow[blood flow 13-42 (23.4±12.7)ml/min, pulsatility index (PI)1.6-4.2 (2.1±1.1)]. Six patients (6.5%)had perioperative myocardial infarction (MI), and 4 patients (4.3%)died within 30 days after surgery including 2 patients with acute MI and cardiogenic shock, 1 patient with low cardiac output syndrome and multiple organ failure, and 1 patient with massive cerebral infarction. Seventy-three patients (83%)were followed up for 6-108 (49.3±26.7)months after discharge, and 15 patients were lost during follow-up. During follow-up, coronary CTA showed graft patency of 83.9% after CE. Four patients (5.5%)died including 1 patient with heart failure and pulmonary infection, 1 patient of unexplained sudden death, 1 patient with cerebral hemorrhage, and 1 patient with lung cancer. Five-year survival rate was 87% after CE. Six months after CE, ejection fraction (EF)was significantly higher than preo-perative EF (55.6%±9.7% vs. 50.2%±10.5%, P < 0.05), patients' cardiac function significantly improved, and their angina symptoms were significantly relieved.
ConclusionCABG with CE can improve coronary revascularization for patients with diffuse CAD, and short-and long-term results are satisfactory.
Gut microbiota and its metabolites in various human diseases have gradually become a research hotspot in the current medical community. And coronary artery disease is currently one of the most threatening clinical cardiovascular diseases in the world, so the use of gut microbiota and its metabolites in the development of its pathophysiology has also received more and more attention. Therefore, this paper reviews the effects of gut microbiota and its metabolites on coronary artery disease, as well as the research progress of intervening gut microbiota and its metabolites as therapeutic targets, hoping to expand the future research direction in this field and provide new ideas with treating coronary artery disease.
Objective To evaluate the outcome and explore the mechanism of coronary vein bypass grafting （CVBG） performed by anastomosing the right internal mammary artery with the middle cardiac vein via off-pump surgery. Methods Twelve Chinese experimental miniswines （either male or female, age from 7 to 10 months, body weight 40±5 kg） with severely diffuse stenosis in the right coronary artery were randomly divided into control group and experiment group with 6 miniswines in each group, using a random number table method. CVBG was performed in the experiment group and sham surgery was performed in the control group. To assess cardiac function, graft flow, graft patency and micro-circulation reperfusion of ischemia myocardium, following measurements were conducted. Eight weeks after right coronary endarterectomy, transthoracic echocardiography was performed for both groups. Coronary angiography, graft flow and echocardiography were performed or measured 6 hours and 3 months after CVBG or sham surgery. Measurement of myocardial blood flow with non-radioactive colored microspheres was also conducted 3 months after surgery for two groups. Results There was no statistical difference in cardiac function 8 weeks after right coronary endarterectomy between the two groups. There were significant improvements in cardiac systolic and diastolic function （ejection fraction 3 months after operation: 52%±6% vs. 44%±5%, t=-2.500, P=0.031） in the experiment group after CVBG compared with the control group. Graft flow of the experiment group 6 hours and 3 months after CVBG were 44.50±5.86 ml/min and 43.33±5.01ml/min respectively （P=0.718）, and pulsatility index （PI） was 0.73±0.14 and 0.80±0.14 respectively（P=0.858）. Internal mammary artery grafts and the anastomoses were all patent without stenosis, documented by coronary artery angiography for the experiment group 6 hours and 3 months after CVBG. Myocardial flow in all aspects especially in the subendocardial layer, estimated by non-radioactive colored microsphere injection, was significantly higher in the experiment group after CVBG than that of the control group, transmural flow was 0.33±0.05ml/（g ? min） vs. 0.19±0.03 ml/（g ? min） （P＜0.05）. Conclusion Ischemic conditions of the myocardium can be relieved by CVBG using internal mammary artery in a short-term to medium-term period. The mechanism may be due to improvement of the myocardial micro-circulation.
Coronary artery disease (CAD) is a cardiovascular disease mainly caused by atherosclerosis, which involves a variety of pathophysiological mechanisms such as lipid metabolism, inflammatory response, and endothelial dysfunction. Fetuin B is a glycoprotein secreted by the liver, which can participate in many processes such as cell inflammation, vascular calcification, and lipid metabolism, and is closely related to the pathogenesis of CAD. This article reviews the relationship between fetuin B and CAD and the mechanism of its occurrence and development, in order to provide new choices and methods for the prevention, diagnosis, and treatment of CAD.
ObjectiveTo investigate the perioperative results and safety of minimally invasive direct coronary artery bypass grafting (MIDCAB) treatment of anterior descending artery disease through a small left thoracic incision assisted by thoracoscopy. MethodsThe clinical data of 92 patients who received MIDCAB in our hospital from May 2014 to October 2018 were retrospectively analyzed, including 72 (78.26%) males aged 42-78 (61.2±7.48) years, and 20 (21.74%) females aged 30-80 (61.30±12.26) years. The perioperative complications, blood product use, left heart function changes, ventilator use time, ICU stay, hospital stay and other indicators were analyzed. ResultsTwo (2.17%) patients were transferred to thoracotomy, 5 (5.43%) patients received blood products during the operation, 2 (2.17%) were subjected to secondary thoracotomy to stop bleeding, 4 (4.34%) had postoperative hypoxemia and 1 (1.08%) was reintubated. The ventilator use time was 3-227 (22.35±35.39) hours, the ICU stay was 16-777 (78.85±108.62) hours, and the postoperative hospital stay was 2-36 (8.86±6.05) days. One (1.08%) patient died in hospital. ConclusionMIDCAB for anterior descending artery disease has good perioperative results, especially for solitary anterior descending artery disease, which can reduce the use of blood products, and shorten the time of ventilator use after operation, ICU stay and hospital stay.
