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ASSESSMENT OF MYOCARDIAL VIABILITY WITH CONTRAST-ENHANCED MAGNETIC RESONANCE IMAGING AND COMPARISON WITH SINGLE-PHOTON EMISSION COMPUTED TOMOGRAPHY

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Chinese Medical Sciences Journal 2006年第4期21卷 239-244页

作者： Yi-ning Wang Zheng-yu Jin Zhu-hua Zhang Ling-yan Kong Li-bo Chen Lu Zhou Hong-yi Sun Heng Zhang Qi Miao department of Radiology department of Nuclear Medicine department of cardiacsurgery Peking Union Medical College Hospital Chinese Academy of Medical Sciences ＆ Peking Union Medical College Beijing 100730

Objective To compare contrast-enhanced magnetic resonance imaging （ceMRI） with nuclear metabolic imaging for the assessment of myocardial viability in patients with chronic ischemic heart disease. Methods Twenty patients with suspected chronic ischemic heart disease underwent ceMRI and technetium-99m sestamibi single-photon emission computed tomography （SPECT）. Patients with positive SPECT results also underwent 18 F-fluorodeoxyglucose （FDG） SPECT. In a 17-segment model, the segmental extent of hyperenhancement （SEH） by ceMRI was compared with segmental FDG and sestamibi uptake by SPECT. Correlation between the extent of hyperenhancement by ceMRI and left ventricular function was analyzed. Seven patients got negative results both in ceMRI and technetium-99m sestamibi SPECT. The rest 13 patients with positive results then underwent ^18F-FDG SPECT. In 221 segments of 13 patients, SEH was （2. 1±8.2）%, （25.0±13.7 ）%, and （57. 7±23.6 ）% in segments with normal metabolism/perfusion, metabolism/perfusion mismatch, and matched defects, respectively, and there were significant differences between either two of them （ all P 〈 0.05）. By receiver operating characteristic curve analysis, the area under the curve was 0. 95 for the differentiation between viable and non-viable segments. At the cutoff value of 34%, SEH optimally differentiated viable from non-viable segments defined by SPECT. Using this threshold, the sensitivity and specificity of ceMRI to detect non-viable myocardium as defined by SPECT were 92% and 93%, respectively. Hyperenhancement size by ceMRI was correlated negatively with the left ventricular ejection fraction （ r = - 0.90, P 〈 0.01 ） and positively with left ventricular volumes （ r = 0. 62 for end-diastolic volume, r = 0.75 for end-systolic volume, both P 〈 0.05 ）. Conclusion CeMRI allows assessment of myocardial viability with a high accuracy in patients with chronic ischemic heart disease.

关键词： magnetic resonance imaging single-photon emission computed tomography myocardialviability

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Totally percutaneous thoracic endovascular aortic repair with the preclosing technique： a case-control study

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Chinese Medical Journal 2011年第6期124卷 851-855页

作者： NI Zhong-han LUO Jian-fang HUANG Wen-hui LIU Yuan XUE Ling FAN Rui-xin CHEN Ji-yan department of Cardiology Guangdong General Hospital Guangdong Academy of Medical Sciences Guangzhou Guangdong 510080 China department of cardiacsurgery Guangdong General Hospital Guangdong Academy of Medical Sciences Guangzhou Guangdong 510080 China

Background The conventional thoracic endovascular aortic repair （TEVAR） involves groin incisions under general or epidural anesthesia. As technology moves towards less invasive procedures, a total percutaneous approach is *** this study, we describe a Preclosing technique and investigate its safety and efficacy for femoral access sites management, and evaluate its advantages as compared to those of traditional surgical cutdown *** The Preclosing technique involves two or multiple 6 F Perclose Proglide devices deployed in the femoral artery before upsizing to a 20-25 F sheath. The sutures were secured to close the arteriotomy at the end of the procedure. The medical records of patients who underwent thoracic endovascular aortic repairs using the Preclosing technique between December 2009 and November 2010 （group A） were compared with those using surgical femoral cutdown from January 2008 to November 2009 （group B）. Outcome measures included rates of technical success, early complications, anesthesia method, procedure time, cardiac care unit （CCU） stay, time from procedure to discharge,hospital stay, procedure expense, hospital *** Between the two groups, there were no significant differences in baseline characteristics, in the endograft models or profiles. The technical success rate was 100.0% （85/85） in group A vs. 97.4% （147/151） in group B （P 〈0.05）.There was no access-related mortality in both groups. Compared with group B, the incidence of early complications were fewer in group A, 9.4% （8/85） vs. 22.5% （34/151）（P 〈0.01）. Local anesthesia with conscious sedation was used more often in group A, 68.2% （58/85） vs. 51.7% （78/151） in group B （P〈0.01）. The procedure duration was shorter, （96±33）minutes in group Avs. （127±41） minutes in group B （P〈0.01）. The length of the CCU stay, the duration from procedure to discharge, and the hospital stay were both reduced in group A, （117.3±88.3） hours, （7.5±5.3） days and （15.3±6.8） days vs. （13

关键词： endovascular aortic repair percutaneous preclosing technique

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CHANGES ON RECEPTOR EXPRESSIONAND PRODUCTION OF INTERLEUKIN-2 IN CIRCULATING LYMPHOCYTE POPULATION AFTER OPEN HEART SURGERY

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Chinese Medical Sciences Journal 1997年第4期12卷 220-223页

作者：罗爱林田玉科金士翱 department of Anesthesiology Tongji Hospital Tongji Medical University Wuhan 430030

To evaluate the change of perioperative cell mediated immunity after cardiac operation with cardiopul-monary bypass (CPB), so as to provide some information for timely prevention and treatment against post-operative immunological disorder, 40 patients were studied. By searching for the effects of CPB and anes-thesia, interleukln-2 receptor (IL-2R) expression upon the surface of peripheral blood mononuclear cells(PBMC), as well as interleukin-2 (IL-2) production in vitro was traced 55 min after anesthesia, at end ofCPB, on postoperative 1, 7, and 14 day versus preanesthesia control. Our data demonstrated that expres-sion of IL-2R on PBMC was significantly suppressed in all comparing with the baseline value, meanwhile,IL-2 production in vitro also statistically dropped. However,no statistical difference was found on perioper-ative IL 2R expression and IL-2 synthesis in the cholecystectomy group. We conclude that postoperativeimmunological disorder seems to be the main factor, which could be denoted as reduced IL 2R expressionon PBMC and lL-2 synthesis in vitro for sepsis, even multiple system organ failure developed after cardiacsurgery.

关键词： interleukin-2 receptor interleukin-2 open heart surgery

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Influence of cirrhosis in cardiac surgery outcomes

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World Journal of Hepatology 2015年第5期7卷 753-760页

作者： Juan C Lopez-Delgado Francisco Esteve Casimiro Javierre Josep L Ventura Rafael Maez Elisabet Farrero Herminia Torrado David Rodríguez-Castro Maria L Carrio Intensive Care department Hospital Universitari de BellvitgeIDIBELL (Institut d’Investigació Biomèdica BellvitgeBiomedical Investigation Institute of Bellvitge) Physiological Sciences Ⅱ department Universitat de BarcelonaIDIBELL (Institut d’Investigació Biomèdica BellvitgeBiomedical Investigation Institute of Bellvitge)

Liver cirrhosis has evolved an important risk factor for cardiac surgery due to the higher morbidity and mortality that these patients may suffer compared with general cardiac surgery *** presence of contributing factors for a poor outcome,such as coagulopathy,a poor nutritional status,an adaptive immune dysfunction,a degree of cirrhotic cardiomyopathy,and a degree of renal and pulmonary dysfunction,have to be taken into account for surgical evaluation when cardiac surgery is needed,together with the degree of liver disease and its primary *** associated pathophysiological characteristics that liver cirrhosis represents have a great influence in the development of complications during cardiac surgery and the postoperative *** the population of cirrhotic patients who are referred for cardiac surgery is small and recommendations come from small series,since liver cirrhotic patients have increased their chance of survival in the last 20 years due to the advances in their medical care,which includes liver transplantation,they have been increasingly considered for cardiac ***,there is an expected rise of cirrhotic patients within the cardiac surgical population due to the increasing rates of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis,especially in western *** consequence,a more specific approach is needed in the assessment of care of these patients if we want to improve their *** this article,we review the pathophysiology and outcome prediction of cirrhotic patients who underwent cardiac surgery.

关键词： Liver cirrhosis Cardiac surgery Outcomes Coagulopathy Nutritional status Adaptive immunedysfunction Cirrhotic cardiomyopathy

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The Initial Tangent of the Femoral Arterial Pressure Increase Is an Estimate of Left Ventricular Contractility in Patients Undergoing cardiacsurgery

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Open Journal of Anesthesiology 2014年第9期4卷 207-216页

作者： Matthias Langin Christian Kowalski Frank Christ Bernhard Zwissler Hille Kisch-Wedel department of Anesthesiology Ludwig Maximilians UniversityMunichGermany

Purpose: Assessment of contractile function is a major challenge in patients with left ventricular dysfunction, especially during cardiac surgery. The initial tangent of the femoral arterial pressure increase (tanin) has recently been described to be an estimate of left ventricular (LV) contractility. To confirm these findings tanin was compared to various indices of LV performance in patients undergoing cardiac surgery. Methods: Data from 17 patients were evaluated retrospectively. Myocardial performance was estimated by the echocardiographic indices ejection fraction (EF), shortening fraction (FS), circumferential fiber shortening velocity (Vcf), the parameters of pulse contour analysis area under the curve (AUC) and tanin. Measurements were taken before and after cardiopulmonary bypass (CPB). Results: Tanin increased significantly (813 ± 216 mmHg/s vs. 1490 ± 450 mmHg/s, p < 0.05) after CPB, as well as Vcf (0.89 ± 0.14 circ/s vs. 1.47 ± 0.27 circ/s, p < 0.05) and EF (65% ± 7% vs. 74% ± 6%, p < 0.05). FS did not change (40.7% ± 7% vs. 46.5% ± 5%, p = 0.30). AUC significantly dropped after CPB (435 ± 54 mmHg*s vs. 263 ± 27 mmHg*s). Tanin and Vcf correlated strongly (r = 0.70, p < 0.001), while tanin showed only weak correlation with EF (r = 0.36, p = 0.037). There was no significant correlation with FS (r = 0.31, p = 0.079). Tanin and AUC correlated inversely (r = -0.62, p < 0.001). Conclusions: While showing little or no correlation with EF and FS respectively, tanin correlated well with the less preload-dependent parameter Vcf, thus suggesting that tanin may be used as an easily accessible estimate of LV contractility during cardiac surgery.

关键词： Arterial Pressure Wave Form Analysis Left Ventricular Contractility cardiacsurgery

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HYPOTHERMIC CARDIOPLEGIA TO PROTECT THE MYOCARDIUM IN HEART SURGERY

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Chinese Medical Journal 1979年第8期

作者：尚德延 department of Anesthesiology Institute of Cardiovascular DiseasesChinese Academy of Medical SciencesBeijing

The cffect of hypothermic cardioplegia inprotecting myocardial function during cardiacsurgery under extracorporeal circulation wasclinically investigated in 525 *** lowestmyocardial temperature after coronary perfu-sion with the cardioplegic solution precooled toabout 4 C was about 15 *** withother local cooling methods to keep the heartin a deep hypothermic state,complete cardio-plegia and excellent myocardial protection wereobtained as shown by the spontaneous return ofsinus cardiac beat without need for electric de-fibrillation occurred in about two thirds of thecases and much less vasopressors were neededafter the *** of a Chinese medi-cinal herb,Radix astragali 黄芪 was tried in partof the cases and it’s pharmacology is *** with other myocardialprotection methods,it was found to be a simpleand very efficacious *** better re-sults might be achieved if the serum potassiumlevel and acid-base balance were well regulatedthroughout anesthesia and perfusion and thebody temperature rewarmed to nearly normalat the end of surgery.

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