Chinese Journal of Thoracic and Cardiovaescular Surgery最新文献

{"title":"The impact of preoperative dual antiplatelet therapy on early outcome of acute type A aortic dissection patients undergoing aortic surgery","authors":"Fucheng Xiao, Y. Ge, Chengnan Li, Z. Qiao, Haiou Hu, Li-Zhong Sun, Junming Zhu","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.12.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.12.006","url":null,"abstract":"Objective \u0000To evaluate the impact of preoperative dual antiplatelet therapy on early outcome of acute type A aortic dissection(ATAAD) patients undergoing aortic surgery. \u0000 \u0000 \u0000Methods \u0000From December 2015 to November 2017, 45 consecutive patients with ingestion of aspirin and clopidogrel underwent aortic repair surgery at our center. 37 out of 45 patients(83%) were propensity-matched with 74 control ATAAD patients without antiplatelet therapy undergoing aortic surgery in 1∶2 fashion. Thereby, bleeding-related outcome(death, reoperation for bleeding, postoperative blood loss within 12 h ≥2 000 ml and usage of rFⅦa) and blood transfusion requirement were compared. \u0000 \u0000 \u0000Results \u0000Bleeding-related outcome occurred in 14(18.9%) and 9(24.3%) patients in control and antiplatelet group respectively(P=0.51). Postoperative blood loss within 12 hours was 490 ml in control group, compared to 500 ml in the antiplatelet group(P=0.85). There were no significant differences among the two groups in transfusion requirements of red blood cells, platelets and fresh frozen plasma. Multivariate regression analysis identified antiplatelet therapy as an nonsignifcant risk factor for bleeding-related outcome(OR=2.97, 95%CI: 0.87-10.21, P=0.08). \u0000 \u0000 \u0000Conclusion \u0000Preoperative dual antiplatelet therapy was not associated with increased risk of bleeding-related outcome and transfusion requirement, and was not a contraindication of emergent surgery for ATAAD patients. \u0000 \u0000 \u0000Key words: \u0000Aortic dissection; Aortic disease; Antiplatelet therapy","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88486721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular repair combined with fenestrated stent grafts in treating aortic arch lesions","authors":"Wentao Gao, Min Zhou, Guangmin Yang, Muzhapa Maihemutijiang, Ming Zhang, Wei Wang, Dian Huang, Xiaoqiang Li","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.12.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.12.007","url":null,"abstract":"Objective \u0000To evaluate endovascular repair combined with fenestrated stent grafts for the treatment of aortic dissection or aneurysm involving aortic arch. \u0000 \u0000 \u0000Methods \u0000From Jun 2017 to Dec 2018, 30 patients of complicated aortic arch lesions were treated with endovascular repair combined with fenestrated endografts. 26 male and 4 female, aged(53±16) years. All patients had hypertension. 12 cases were treated via needle based in situ fenestration, another 16 cases using physician modified stent grafts, while 2 cases combining these two methods to achieve optimal fenestration. Patients were followed by receiving CTA for mortality, patency of bridging stents, endoleaks and complications. \u0000 \u0000 \u0000Results \u0000Operations were performed successfully in all cases. The median follow-up is 8.5 months. There was no aorta-related mortality. 1 patient developed cerebral infarction and 1 had hydropericardium. Type Ⅲ endoleaks were observed in 5 patients, no reintervention. All target vessels were patent during the follow up. \u0000 \u0000 \u0000Conclusion \u0000Fenestrated stent grafts shows satisfactory short-term outcomes in treating aortic arch lesions. \u0000 \u0000 \u0000Key words: \u0000Aortic arch; TEVAR; Fenestrated stent grafts","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80173686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cystic aneurysm of the azygos vein-case series","authors":"Xiaojun Du, Hong Xie, Yan Zhang, Lilian Tu, Fangfang Han, Fan Yang, Shi Zhou, Jiarong Xiao","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.12.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.12.010","url":null,"abstract":"囊状奇静脉瘤是少见的肿瘤样疾病，病因与发病机制待明确。多数患者为偶然发现，典型病例影像学表现可能有一定的特征性，需与纵隔内肿瘤相鉴别。治疗方法尚缺乏统一规范。本文报道我中心收治的3例囊状奇静脉血管瘤诊疗情况，结合已发表文献，对囊状奇静脉血管瘤的流行病学特点、发病机制、诊断和治疗做一回顾。","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78085907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"China transcatheter aortic valve implantation(TAVI) technology heart team model","authors":"Xu Meng, Zhiyun Xu, Haibo Zhang","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.12.002","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.12.002","url":null,"abstract":"","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76445925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical treatment of severe aortic stenosis with septal hypertrophy","authors":"Gongcheng Huang, Liliang Shu, Chen Huang, Z. Xiaohua, Ma Guofeng, Yue Wang, Fan Feng, Jing Xu","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.11.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.11.006","url":null,"abstract":"Objective \u0000To summarize the experience of surgical treatment of 18 cases of severe aortic stenosis with ventricular septum hypertrophy. \u0000 \u0000 \u0000Methods \u0000Clinical data of 18 patients with severe aortic stenosis admitted to the first affiliated hospital of zhengzhou university from January 2013 to December 2016 were collected. There were 7 males and 11 females. The mean age was (50.4±4.2) years old. All patients were diagnosed with severe stenosis of main artery valve by echocardiography before surgery, with mean aortic valve orifice area (0.57±0.11) cm2, cardiac function (NYHA classification) grade Ⅱ in 4 patients, grade Ⅲ in 9 patients, and grade Ⅳ in 5 patients. There were 8 patients with mild aortic valve insufficiency, 4 patients with mild to moderate mitral valve insufficiency, 2 patients with moderate to severe aortic valve insufficiency, 3 patients with ascending aorta dilatation (ascending aorta inner diameter>4.5 cm), and 1 patient with atrial fibrillation. Interventricular septum thickness (15.82±2.04)mm, left ventricular posterior wall thickness (14.04±1.28)mm, ratio of interventricular septum thickness to left ventricular posterior wall thickness (IVS/LVPW) 1.12±0.91, inner diameter of left ventricular outflow tract (19.01±1.74)mm, cross-lobe differential pressure (102±8.40) mmHg (1 mmHg=0.133 kPa), left ventricular ejection fraction (LVEF) mean 0.49±0.05. Left ventricular end-diastolic diameter (LVEDD) (53.33±4.00) mm, left ventricular end-systolic diameter (LVESD) (27.11±1.99) mm, and left ventricular mass index (277.1±37.3) g/m2. All patients underwent aortic valve replacement (AVR) and partial interventricular septum resection under general anesthesia and conventional extracorporeal circulation, 2 patients underwent mitral valve formation (artificial valve ring), 2 patients underwent ascending aorta formation, and 1 patient underwent ascending aorta wrapping. During the operation, the time of extracorporeal circulation, aortic occlusion, number of defibrillation during the operation, type of valve implantation and postoperative complications were recorded. Regular follow-up was conducted to analyze the changes of various indexes at different preoperative and postoperative time. \u0000 \u0000 \u0000Results \u0000There was no death in the whole group. 2 patients were treated with temporary pacemakers. After drug treatment, sinus rhythm was restored on the 3rd and 6th day after surgery, and temporary pacemakers were removed. Echocardiography reexamination 1 week after the operation showed that all patients had a good artificial valve function and 2 patients had minor regurgitation of mitral valve. The difference in pressure across the valve, inner diameter of the left ventricular outflow tract, cardiac function classification, ventricular septum thickness, valve orifice area, and left ventricular mass index were significantly improved compared with the preoperative level (P<0.05). LVEF, LVEDD, and LVESD were compared with the preoperative level (P<0.05). Af","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77776739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical research of reintervention for children with postoperative valve disease","authors":"K. Luo, Jinghao Zheng, Zhongqun Zhu, Qi Sun, Xiaomin He, Zhiwei Xu, Jinfen Liu","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.11.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.11.007","url":null,"abstract":"Objective \u0000The purpose of this report was to discuss and evaluate the timing and outcome of reintervention for children with postoperative valve disease. \u0000 \u0000 \u0000Methods \u0000The clinical data of 139 patients with postoperative valve disease who received reintervention at SCMC from Sep. 2004 to Mar. 2019 were retrospectively analysed, including 85 males and 54 females. The age ranged from 8-175 months, and the weight ranged from 6.2-75.9 kg. With a mid-long term follow-up (2-133 months), the echocardiography result showed: 40 cases of aortic valve disease, 49 cases of mitral valve disease, 32 cases of tricuspid valve disease and 18 cases of pulmonary valve disease. All patients underwent reintervetion treatment, the distribution of reintervention methods were shown as follow: 47 cases of valve replacement, 40 cases of valvuloplasty, 23 cases of annuloplasty and 29 case of valve reconstruction. \u0000 \u0000 \u0000Results \u0000There were 6 in-hospital deaths with a mortality of 4.3%. The death cases included 2 cases of aortic disease, 2 cases of mitral disease, 1 case of tricuspid disease and 1 case of pulmonary disease. The early postoperative causes of death were acute myocardial failure, multiple organ failure and severe hyoxemia. Three delayed deaths occurred 8-26 months after operation because of cardiac insufficiency and cardiac shock. All survivors were under a follow-up of 4-148 months. The echocardiography showed the velocity of 92.3% valve stenosis patients had decreased significantly (P<0.05); the insufficient grades of 84.9% patients had reduced and maintained under morderate degree. 6 cases occurred aggravated insufficiency or stenosis and received reoperation in mid-term follow-up included 3 cases of aortic valve, 2 cases of pulmonary valve and 1 case of mitral valve. The cardiac function of survival patients has been improved after reintervtion, 83.1% patients maintained cardiac function at NYHA Ⅰ/Ⅱ at follow-up. The long-term survival rates of 4 valve disease were all over 90%. \u0000 \u0000 \u0000Conclusion \u0000The anatomical structure of chilidren’s valve is complicated and various, valve insufficiency and stenosis often occured after operation. The timing of reintervetion should focus on clinic symptom and cardiac function.The operation should be individually designed according to valve anatomy, which could effectly correct abnormal valve structure, promote cardiac function and improve living quality. \u0000 \u0000 \u0000Key words: \u0000Valve disease of children; Valvular insufficiency; Valvular stenosis; Reintervention","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72913221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of vacuum bell in the treatment of pectus excavatum","authors":"Qian Zhang, Na Zhang, Cheng-hao Chen, Jie Yu, Q. Zeng","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.11.015","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.11.015","url":null,"abstract":"The treatment of pectus excavatum has always given priority to surgical treatment, the vacuum bellis used as aconservative treatment and auxiliary operationin the treatment of pectus excavatum at present. And its role in the treatment of pectus excavatum is gradually accepted by doctors at home and abroad. We also have more and more recognition and understanding about its application. In this paper, we review vacuum bell on the usage, indications and contraindications, side effects, using effects, intraoperative use, optimum age for use, correlation study of negative pressure and mechanics.","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83950711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A control study of measuring thoracic cage indexes in 3-17 years old healthy children and children with pectus excavatum","authors":"Qian Zhang, Q. Zeng, Na Zhang, Cheng-hao Chen, Jie Yu, Jihang Sun, Yun Peng","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.11.001","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.11.001","url":null,"abstract":"Objective \u0000To provide data references for Nuss procedure biomechanics research, and to understand morphological pathological changes in children with pectus excavatum. \u0000 \u0000 \u0000Methods \u0000A retrospective study was conducted for 434 cases of pectus excavatum from January 2009 to December 2015 in our institution. The anterior rib width(RW), anterior intercostal space width(IS) and thickness of the rib in the middle(RT) on the right side of 3-7 ribs had been measured in each patient. The widths were compared between the IS of children with pectus excavatum and the bar which currently used in clinic. The measurement indexes were compared between healthy children and children with pectus excavatum. \u0000 \u0000 \u0000Results \u0000The IS of prepubertal children with pectus excavatum was less than the width of bar which currently used in clinic (12.7 mm). Children with pectus excavatum compared with healthy children, the IS from 4 to 6 and the 5th RW of children with pectus excavatum were less than healthy children (P<0.05), the 3rd and 4th RT were greater than healthy children (P<0.05). \u0000 \u0000 \u0000Conclusion \u0000The measured values will be useful for the improvement of pectus bar and Nuss procedure biomechanics research. By morphology contrast, it reflects the pectus excavatum deformity has some restriction in thoracic development and the cardiopulmonary function. \u0000 \u0000 \u0000Key words: \u0000Pectus excavatum; Ribs; Nuss procedure; X-ray","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88587225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The clinical application of extracorporeal membrane oxygenation in the perioperative period of general thoracic surgery","authors":"Weizhao Huang, Hong-yu Ye, Ying-meng Wu, Z. Cheng, X. Liao, Yi Liang, Binfei Li, Hai-ming Jiang","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.11.012","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.11.012","url":null,"abstract":"回顾性分析体外膜肺氧合(ECMO)技术在普胸外科中的应用，总结临床经验。2012年1月至2018年10月共21例普胸外科患者采用ECMO救治，其中男16例，女5例；年龄24～65岁，平均(48.3±10.7)岁。术后急性呼吸窘迫综合征(ARDS)6例，肺移植4例，复杂胸部手术4例，胸部外伤3例，心肺复苏和急性肺栓塞各2例。9例心肺支持患者采用V-A ECMO方式，12例呼吸支持患者采用V-V ECMO方式，平均支持(71.7±42.4)h。2例不能顺利撤机，其中1例因缺氧致中枢神经系统严重损害，且有严重血液破坏，放弃治疗；另1例死于严重出血、循环衰竭。住院死亡5例，分别为术后ARDS 2例，心肺复苏、肺栓塞、胸部外伤各1例。主要并发症为严重出血3例、感染3例、严重血液破坏1例。1例肺移植患者因出血行二次手术。本组研究结果显示ECMO辅助可为胸外科危重症患者的围手术期治疗提供有效的呼吸循环支持，严格掌握适应证、控制并发症有助于提高整体疗效。","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73540960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Summary and treatment of special situations in subxiphoid uniportal VATS surgery","authors":"Jichen Qu, Xin Huang, Deping Zhao, Jian Chen, G. Jiang, Lei Jiang","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.11.005","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.11.005","url":null,"abstract":"Objective \u0000To explore the special situation in subxiphoid uniportal VATS surgery and summarize the treatment strategies. \u0000 \u0000 \u0000Methods \u0000In September 2014, the subxiphoid uniportal VATS surgery was carried out. Up to now, our research team has completed more than 300 subxiphoid uniportal VATS operations, especially including 242 cases of subxiphoid uniportal VATS segmentectomy and 22 cases of subxiphoid uniportal VATS mediastinal tumor resection. Some special situations were encountered during the operation, including cardiac arrest, pericardial tamponade, innominate venous injury, severe arrhythmia, difficulty in positioning the lung segment, and difficulty in positioning the small nodule et al. \u0000 \u0000 \u0000Results \u0000Some patients changed the surgical procedure during surgery due to intraoperative emergencies such as severe arrhythmia, heart problems, intraoperative bleeding. Postoperative complications mainly included thoracotomy and hemostasis, continuous air leak after operation, pulmonary hematoma, arrhythmia, and no perioperative death. \u0000 \u0000 \u0000Conclusion \u0000Under the subxiphoid uniportal VATS surgery is an important manifestation of the minimally invasive technique of the chest. It is safe and feasible to select suitable cases, master the thoracoscopic technique and special surgical techniques. Special situations during subxiphoid uniportal VATS surgery should be known. \u0000 \u0000 \u0000Key words: \u0000Thoracoscopy; Uniportal; Subxiphoid; Operative complications","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80951903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}