Circulation: Journal of the American Heart Association最新文献

Abstracts 4th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke 第四届心血管疾病和脑卒中的护理质量和结局研究科学论坛

Circulation: Journal of the American Heart Association Pub Date : 2002-10-15 DOI: 10.1161/circ.106.16.e76

L. Wilkins

引用次数: 0

First Clinical Results With a New Mechanical Connector for Distal Coronary Artery Anastomoses in CABG 冠状动脉远端吻合术中新型机械接头的首次临床结果

Circulation: Journal of the American Heart Association Pub Date : 2002-09-24 DOI: 10.1161/01.CIR.0000032892.55215.B5

F. Eckstein, L. Bonilla, L. Englberger, F. Eberli, S. Windecker, T. Berg, Michel J. Romanens, F. Immer, T. Carrel

{"title":"First Clinical Results With a New Mechanical Connector for Distal Coronary Artery Anastomoses in CABG","authors":"F. Eckstein, L. Bonilla, L. Englberger, F. Eberli, S. Windecker, T. Berg, Michel J. Romanens, F. Immer, T. Carrel","doi":"10.1161/01.CIR.0000032892.55215.B5","DOIUrl":"https://doi.org/10.1161/01.CIR.0000032892.55215.B5","url":null,"abstract":"BackgroundCoronary anastomoses are currently primarily carried out with the use of running nonabsorbable sutures. Recently, a renewed interest has developed for facilitated mechanical anastomotic devices especially for minimal invasive techniques or limited access surgery. The initial experience with the first successful creation of mechanical vein-to-coronary artery anastomoses in humans is reported. Methods and ResultsBetween November 2000 and June 2001, 14 patients scheduled for multivessel coronary artery bypass grafting (CABG) procedure were investigated. One vein graft-to-coronary artery anastomosis per patient was performed with the St. Jude Medical ATG Symmetry coronary connector system (stainless steel investigational device, not yet commercially available). We evaluated the overall performance of the device. Intraoperative flow measurements of the grafts using transit time methods were measured. A postoperative angiographic control was performed immediately after the procedure in all patients. Hemostasis was instantaneous in all cases and all anastomoses (mechanical n=14, sutured n=40) were patent. Mean intraoperative flow measurements for the mechanical anastomosed vein grafts was 75±25 mL/min. Three month angiogram or MRI angiography is available to date in 11 patients. Ten connector grafts were patent and 1 was occluded. There were no cardiac-related adverse events or return of angina; exercise tolerance tests and stress electrocardiograms were normal in all patients. ConclusionsThe St. Jude Medical ATG Symmetry coronary connector system is a new device for sutureless distal vein graft-to-coronary artery anastomoses in CABG. This system allows the construction of geometrically perfect anastomoses. This technology represents a further step in a new era of sutureless anastomoses in cardiac surgery.","PeriodicalId":10194,"journal":{"name":"Circulation: Journal of the American Heart Association","volume":"20 1","pages":"I-1-I-4"},"PeriodicalIF":0.0,"publicationDate":"2002-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73843082","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}

引用次数: 18

Cellular Cardiomyoplasty of Cardiac Fibroblasts by Adenoviral Delivery of MyoD Ex Vivo: An Unlimited Source of Cells for Myocardial Repair 体外腺病毒介导心肌成纤维细胞心肌成形术:心肌修复的无限细胞来源

Circulation: Journal of the American Heart Association Pub Date : 2002-09-24 DOI: 10.1161/01.CIR.0000032888.55215.B8

S. Etzion, I. Barbash, M. Feinberg, Parvin Zarin, L. Miller, E. Guetta, R. Holbová, R. Kloner, L. Kedes, J. Leor

{"title":"Cellular Cardiomyoplasty of Cardiac Fibroblasts by Adenoviral Delivery of MyoD Ex Vivo: An Unlimited Source of Cells for Myocardial Repair","authors":"S. Etzion, I. Barbash, M. Feinberg, Parvin Zarin, L. Miller, E. Guetta, R. Holbová, R. Kloner, L. Kedes, J. Leor","doi":"10.1161/01.CIR.0000032888.55215.B8","DOIUrl":"https://doi.org/10.1161/01.CIR.0000032888.55215.B8","url":null,"abstract":"BackgroundThe muscle-specific MyoD family of transcription factors function as master genes that are able to prompt myogenesis in a variety of cells. The purpose of our study was to determine whether MyoD could induce primary cardiac fibroblasts, isolated from infarcted myocardium or pericardium, to undergo myogenic conversion in a clinically relevant approach. Methods and ResultsPrimary rat fibroblasts from 7-day-old infarcted myocardium or normal pericardium were transfected by an E1/E3-deleted adenoviral vector carrying both a human MyoD cDNA driven by a CMV promoter and a green fluorescent protein (GFP) reporter gene driven by a second CMV promoter. Expression of MyoD caused myogenic differentiation of cultured fibroblasts, as defined by elongation and fusion into multinucleated myotubes, typical cross striation as identified by electron microscopy, and positive immunostaining for sarcomeric actin, fast myosin heavy chain (MHC), and actinin. The myogenic cells (1.5×106) were transplanted into the infarcted myocardium 7 days after coronary artery occlusion. By 1 month after transplantation, the converted fibroblasts gave rise to a cluster of myogenic cells that in a few hearts occupied a large part of the scar with positive immunostaining for the myogenic proteins fast-MHC and sarcomeric actin. A few cells expressed the gap junction protein connexin 43 in a disorganized manner. There was no positive staining in the control hearts treated with injections of untreated fibroblasts or culture medium. ConclusionsOur work shows that it is possible to exploit the unique capacity of MyoD to activate myogenesis in fibroblasts ex vivo and to create a vast source of autologous myogenic cells for transplantation.","PeriodicalId":10194,"journal":{"name":"Circulation: Journal of the American Heart Association","volume":"PP 1","pages":"I-125-I-130"},"PeriodicalIF":0.0,"publicationDate":"2002-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84545946","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}

引用次数: 45

The Effect of Cryo-Maze Procedure on Early and Intermediate Term Outcome in Mitral Valve Disease: Case Matched Study 冷冻迷宫手术对二尖瓣疾病早期和中期预后的影响:病例匹配研究

Circulation: Journal of the American Heart Association Pub Date : 2002-09-24 DOI: 10.1161/01.CIR.0000032883.55215.49

H. Nakajima, J. Kobayashi, K. Bando, K. Niwaya, O. Tagusari, Y. Sasako, T. Nakatani, S. Kitamura

{"title":"The Effect of Cryo-Maze Procedure on Early and Intermediate Term Outcome in Mitral Valve Disease: Case Matched Study","authors":"H. Nakajima, J. Kobayashi, K. Bando, K. Niwaya, O. Tagusari, Y. Sasako, T. Nakatani, S. Kitamura","doi":"10.1161/01.CIR.0000032883.55215.49","DOIUrl":"https://doi.org/10.1161/01.CIR.0000032883.55215.49","url":null,"abstract":"BackgroundThe maze procedure is an effective way to treat atrial fibrillation (AF) associated with mitral valve disease. In a last several years, cryoablation was substituted for atrial incision in many reports to simplify the maze procedure. However, there has been no comparative study to delineate the feasibility of the use of cryoablation. Methods and ResultsWe compared the early and intermediate-term results of the maze procedure including pulmonary venous isolation from the left atrium using cryoablation (CM) with our conventional (Kosakai) maze procedure (KM) including encircling incision around the orifices of pulmonary veins. One hundred and 10 pairs of patients were matched in the age, left atrial dimension >70 mm, duration of AF >0 years, previous cardiac surgery, mechanical valve implantation and concomitant aortic valve procedures. CM required significantly shorter cardiopulmonary bypass time (186±56 minute versus 214±47 minute, P =0.001) and aortic cross-clamp time (134±43 minute versus 144±37 minute, P =0.03) than KM with less chest tube drainage (590±353 mL versus 745±618 mL, P =0.02) for 12 hours after operation. The sinus rhythm restoration rate in CM group (85.4%) was comparable with KM group (86.4%) at discharge. In the late results, the actuarial freedom from recurrence of sustained AF at 3 years in CM group (97.7%) was not significantly (P =0.11) different from that in KM group (90.4%). The actuarial freedom from stroke at 3 years in CM group was 99.0%. ConclusionThe modification of the maze procedure including cryoablation for pulmonary venous isolation provided less aortic cross-clamp time and less amount of chest tube drainage with the comparable recovery and maintenance of sinus rhythm with KM. CM is a reliable and less invasive surgical option for the AF associated with mitral valve disease.","PeriodicalId":10194,"journal":{"name":"Circulation: Journal of the American Heart Association","volume":"23 1","pages":"I-46-I-50"},"PeriodicalIF":0.0,"publicationDate":"2002-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88423932","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}

引用次数: 79

Perfusion and Contractile Reserve in Chronic Dysfunctional Myocardium: Relation to Functional Outcome After Surgical Revascularization 慢性功能失调性心肌的灌注和收缩储备:与外科血运重建术后功能结局的关系

Circulation: Journal of the American Heart Association Pub Date : 2002-09-24 DOI: 10.1161/01.CIR.0000032911.33237.67

Jeroen J. Bax, D. Poldermans, A. Schinkel, E. Boersma, A. Elhendy, A. Maat, R. Valkema, E. Krenning, J. Roelandt

{"title":"Perfusion and Contractile Reserve in Chronic Dysfunctional Myocardium: Relation to Functional Outcome After Surgical Revascularization","authors":"Jeroen J. Bax, D. Poldermans, A. Schinkel, E. Boersma, A. Elhendy, A. Maat, R. Valkema, E. Krenning, J. Roelandt","doi":"10.1161/01.CIR.0000032911.33237.67","DOIUrl":"https://doi.org/10.1161/01.CIR.0000032911.33237.67","url":null,"abstract":"BackgroundChronic dysfunctional but viable myocardium may exhibit contractile reserve and/or intact perfusion. Segments with intact perfusion without contractile reserve are frequently observed inpatients with ischemic cardiomyopathy. The clinical relevance of this observation is unclear; in particular, the functional outcome after revascularization is unknown. Thus, contractile reserve (using low-dose dobutamine echocardiography) and perfusion (using resting 99mTc tetrofosmin) were evaluated in 114 patients with ischemic cardiomyopathy and the findings were related to functional outcome (9 to 12 months after revascularization). Methods and ResultsPatients (n=114) with ischemic cardiomyopathy undergoing surgical revascularization were evaluated for perfusion (using 99mTc tetrofosmin) and contractile reserve (using low-dose dobutamine echocardiography). Contractile function (two-dimensional echocardiography) was assessed before and 9 to 12 months after revascularization. In the 1 336 dysfunctional segments, perfusion was preserved in 51% of the segments and contractile reserve in 31% (P <.05); 47% of the segments with perfusion did not exhibit contractile reserve. The majority (66%) of segments with recovery of function postrevascularization had intact perfusion and contractile reserve; the majority (58%) of segments without functional recovery lacked both perfusion and contractile reserve. Interestingly, 22% of segments with functional recovery and 25% of segments without functional recovery showed intact perfusion without contractile reserve. ConclusionSegments with intact perfusion/contractile reserve have a high likelihood of recovery of function postrevascularization; segments without contractile reserve/perfusion have a low likelihood of recovery and segments with intact perfusion without contractile reserve have an intermediate likelihood of recovery.","PeriodicalId":10194,"journal":{"name":"Circulation: Journal of the American Heart Association","volume":"95 1","pages":"I-14-I-18"},"PeriodicalIF":0.0,"publicationDate":"2002-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83349894","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}

引用次数: 39

Transluminal Stent-Graft Placements for the Treatments of Acute Onset and Chronic Aortic Dissections 腔内支架植入治疗急性和慢性主动脉夹层

Circulation: Journal of the American Heart Association Pub Date : 2002-09-24 DOI: 10.1161/01.CIR.0000032877.55215.59

T. Shimono, N. Kato, F. Yasuda, Tomoaki Suzuki, U. Yuasa, K. Onoda, T. Hirano, K. Takeda, I. Yada

{"title":"Transluminal Stent-Graft Placements for the Treatments of Acute Onset and Chronic Aortic Dissections","authors":"T. Shimono, N. Kato, F. Yasuda, Tomoaki Suzuki, U. Yuasa, K. Onoda, T. Hirano, K. Takeda, I. Yada","doi":"10.1161/01.CIR.0000032877.55215.59","DOIUrl":"https://doi.org/10.1161/01.CIR.0000032877.55215.59","url":null,"abstract":"BackgroundTransluminal stent-graft placement (TSGP) for aortic dissection is a relatively new procedure. We performed TSGPs to seal the primary entry site to treat and prevent complications of aortic dissection. The early to mid-term outcomes were analyzed.Methodsand Results—Thirty-seven patients with a primary intimal tear in descending aorta underwent TSPG. TSGP was performed in 16 acute onset dissections (AOD) with dissection-related complications instead of emergency surgery. Eight AOD without complications were treated to prevent aneurysmal enlargement. Thirteen chronic dissections were treated to prevent rupture. TSGP was technically successful in all cases. One patient with prehospital rupture died. The hospital mortality rate was of 2.7% overall, 6.3% in AOD with complications, 0% in AOD without complications and in chronic dissections. One persistent endoleak required open surgery, and 1 intimal tear was caused by the stent-graft, necessitating an additional TSGP. The primary success rate was 94.4% overall. After hospital discharge, no patient died or suffered aortic rupture during an average follow-up of 24.5 months. New intimal tears caused by the stent-grafts and a secondary endoleak developed in 3 AOD patients. One open procedure and 2 additional TSGPs were performed. Actuarial survival rate and cardiovascular event-free rate at 2 years are 97.3% and 78.3% overall, 93.8% and 48.0% in AOD with complications, 100% and 87.5% in AOD without complications, and both 100% in chronic dissections. ConclusionsTSGP is a reasonable treatment option for aortic dissection. However, delayed intimal tear formations caused by the stent-graft is a problem that requires further investigation.","PeriodicalId":10194,"journal":{"name":"Circulation: Journal of the American Heart Association","volume":"24 1","pages":"I-241-I-247"},"PeriodicalIF":0.0,"publicationDate":"2002-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81741345","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}

引用次数: 126

Safety of Aprotinin Use and Re-Use in Pediatric Cardiothoracic Surgery 抑肽酶在小儿心胸外科手术中的使用和重复使用的安全性

Circulation: Journal of the American Heart Association Pub Date : 2002-09-24 DOI: 10.1161/01.CIR.0000032902.33237.09

R. Jaquiss, N. Ghanayem, M. Zacharisen, K. Mussatto, J. Tweddell, S. Litwin

{"title":"Safety of Aprotinin Use and Re-Use in Pediatric Cardiothoracic Surgery","authors":"R. Jaquiss, N. Ghanayem, M. Zacharisen, K. Mussatto, J. Tweddell, S. Litwin","doi":"10.1161/01.CIR.0000032902.33237.09","DOIUrl":"https://doi.org/10.1161/01.CIR.0000032902.33237.09","url":null,"abstract":"BackgroundHypersensitivity reactions to aprotinin have been reported in adult cardiac surgical patients undergoing initial and re-exposure to the medication. This study describes the incidence and impact of aprotinin hypersensitivity reactions in children undergoing cardiothoracic surgery. Methods and ResultsIn this retrospective review of our entire experience with aprotinin (n=865), 681 first exposures, 150 second exposures, and 34 third or higher exposures were examined. Reactions were classified as mild (generalized cutaneous erythema, Type A) or severe (unexplained cardiopulmonary instability after aprotinin exposure, Type B). Records of patients sustaining a reaction were reviewed to assess the impact of the reaction on outcome and to survey reaction management strategies. Reactions occurred in 7 of 681 first exposures (1.0%), of which 2 were Type A and 5 were Type B. In second exposures, there were reactions in 2 of 150 (1.3%), of which both were Type B. In 34 third or higher exposures, there was only 1 reaction (2.9%), which was Type B. Reactions were no more likely on second, third, or higher exposure than on initial exposure. Skin testing had a negative predictive value of 98.9% and a positive predictive value of 20%. Anti-aprotinin IgE was undetectable in 7 of 8 reactor cases tested. No adverse sequelae were attributed to aprotinin reaction. ConclusionsThe risk of hypersensitivity reactions to aprotinin is low in children undergoing cardiothoracic surgery, even with multiple exposures to the medication. Reactions are more likely with re-exposure, and risk increases with multiple exposures. Neither skin testing nor assays for IgE identified reactors.","PeriodicalId":10194,"journal":{"name":"Circulation: Journal of the American Heart Association","volume":"16 1","pages":"I-90-I-94"},"PeriodicalIF":0.0,"publicationDate":"2002-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89288398","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}

引用次数: 37

Combined Procedure of Surgical Repair and Cell Transplantation for Left Ventricular Aneurysm: An Experimental Study 手术修复与细胞移植联合治疗左室动脉瘤的实验研究

Circulation: Journal of the American Heart Association Pub Date : 2002-09-24 DOI: 10.1161/01.CIR.0000032905.33237.C7

Y. Sakakibara, K. Tambara, F. Lu, T. Nishina, G. Sakaguchi, N. Nagaya, K. Nishimura, Ren-Ke Li, R. Weisel, M. Komeda

{"title":"Combined Procedure of Surgical Repair and Cell Transplantation for Left Ventricular Aneurysm: An Experimental Study","authors":"Y. Sakakibara, K. Tambara, F. Lu, T. Nishina, G. Sakaguchi, N. Nagaya, K. Nishimura, Ren-Ke Li, R. Weisel, M. Komeda","doi":"10.1161/01.CIR.0000032905.33237.C7","DOIUrl":"https://doi.org/10.1161/01.CIR.0000032905.33237.C7","url":null,"abstract":"BackgroundThis study was designed to investigate the efficacy of the combined procedure of left ventricular (LV) repair and fetal cardiomyocyte transplantation (CM-TX) in a rat myocardial infarction model. Methods and ResultsA moderate-sized LV aneurysm was created by proximal ligation of the left coronary artery in 47 Lewis rats. Four weeks later, they were underwent another operation and received culture medium injection (n=10; group I), fetal CM-TX (n=10; group II), purse-string LV repair with culture medium injection (n=14; group III), or LV repair with fetal CM-TX (n=13; group IV). They were echocardiographically followed-up during the subsequent 4 weeks, and cardiac catheterization was performed in the final week. In the late period, LV dimension in group IV was smaller than that in group III (end-diastolic dimension, 0.92±0.02 versus 1.01±0.03 cm, P= 0.0090; end-systolic dimension, 0.62±0.02 versus 0.74±0.04 cm, P= 0.0093; at the fourth week), although they initially showed similar decreases in both groups. At the final week, end-systolic elastance was higher in group IV than in groups I, II, or III (0.61±0.10 versus 0.19±0.03, 0.30±0.09, 0.33±0.07 mm Hg/&mgr;L, P= 0.0002, 0.0037, and 0.0042, respectively). ConclusionsFetal CM-TX exerted preventive effects against late LV dilation and dysfunction after LV repair in the rat model. The results suggest that repair surgery combined with fetal CM-TX may enhance the surgical benefits for patients with LV aneurysm in the long term.","PeriodicalId":10194,"journal":{"name":"Circulation: Journal of the American Heart Association","volume":"10 1","pages":"I-193-I-197"},"PeriodicalIF":0.0,"publicationDate":"2002-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76191530","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}

引用次数: 33

Mechanistic Insights Into Posterior Mitral Leaflet Inter-Scallop Malcoaptation During Acute Ischemic Mitral Regurgitation 急性缺血性二尖瓣反流时二尖瓣后小叶扇贝间错位的机制探讨

Circulation: Journal of the American Heart Association Pub Date : 2002-09-24 DOI: 10.1161/01.CIR.0000032874.55215.82

D. Lai, F. Tibayan, T. Myrmel, T. Timek, P. Dagum, G. Daughters, D. Liang, N. Ingels, D. C. Miller

{"title":"Mechanistic Insights Into Posterior Mitral Leaflet Inter-Scallop Malcoaptation During Acute Ischemic Mitral Regurgitation","authors":"D. Lai, F. Tibayan, T. Myrmel, T. Timek, P. Dagum, G. Daughters, D. Liang, N. Ingels, D. C. Miller","doi":"10.1161/01.CIR.0000032874.55215.82","DOIUrl":"https://doi.org/10.1161/01.CIR.0000032874.55215.82","url":null,"abstract":"BackgroundThree-dimensional dynamics of the 3 individual scallops within the posterior mitral leaflet during acute ischemic mitral regurgitations have not been previously measured. MethodsRadiopaque markers were sutured to the mitral annulus, papillary muscle tips, and leaflet edges in 13 sheep. Immediately postoperatively, under open-chest conditions, 3-D marker coordinates were obtained using high-speed biplane videofluoroscopy before and during echocardiographically verified acute ischemic mitral regurgitation produced by occlusion of the left circumflex coronary artery. ResultsDuring acute ischemic mitral regurgitation, at end systole, the anterolateral edge of the central scallop was displaced 0.8±0.9 mm laterally and 0.9±0.6 mm apically away from the anterolateral scallop; such displacement correlated with lateral displacement of the lateral annulus (R2=0.7, SEE=0.7 mm, P <0.001) and movement of the right lateral annulus away from the nonischemic anterior papillary tip (R2=0.6, SEE=0.8 mm, P =0.002), respectively. End-systolic displacement of the posteromedial edge of the central scallop was 1.4±0.9 mm anteriorly and 0.9±0.6 mm laterally away from the posteromedial scallop, corresponding to anterior displacement of the mid-lateral annulus (R2=0.5, SEE=1.0 mm, P <0.001). ConclusionsMalcoaptation of the scallops within the posterior leaflet during acute left ventricular ischemia is a novel observation. The primary geometric mechanism underlying scallop malcoaptation in acute ischemic mitral regurgitation was annular dilatation, which hindered leaflet coaptation by drawing the individual scallops apart. These findings support the use of annular reduction in the repair of ischemic mitral regurgitation and also suture closure of prominent subcommissures between posterior leaflet scallops.","PeriodicalId":10194,"journal":{"name":"Circulation: Journal of the American Heart Association","volume":"41 1","pages":"I-40-I-45"},"PeriodicalIF":0.0,"publicationDate":"2002-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82388319","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}

引用次数: 50

Neurodevelopmental Outcome After Congenital Heart Surgery: Results From an Institutional Registry 先天性心脏手术后的神经发育结果:来自机构登记的结果

Circulation: Journal of the American Heart Association Pub Date : 2002-09-24 DOI: 10.1161/01.CIR.0000032915.33237.72

J. Forbess, Karen J. Visconti, C. Hancock-Friesen, R. C. Howe, D. Bellinger, R. Jonas

{"title":"Neurodevelopmental Outcome After Congenital Heart Surgery: Results From an Institutional Registry","authors":"J. Forbess, Karen J. Visconti, C. Hancock-Friesen, R. C. Howe, D. Bellinger, R. Jonas","doi":"10.1161/01.CIR.0000032915.33237.72","DOIUrl":"https://doi.org/10.1161/01.CIR.0000032915.33237.72","url":null,"abstract":"ObjectiveIncreased survival in children with critical congenital heart disease (CHD) has raised interest in the neurodevelopmental sequelae of these lesions. This investigation is part of an institutional effort to examine the neurodevelopment of 5-year-old children following repair or palliation of CHD. MethodsWe performed a battery of neuropsychological tests on a sample of 243 children between 1998 and 2001. ResultsIn the sample as a whole, mean full-scale (FSIQ), verbal (VIQ), and performance (PIQ) IQ scores were in the normal range (96.8±15.9, 97.8±14.6, and 96.3±17.1, respectively). Anatomic, demographic, and perioperative factors were assessed for impact on neurodevelopment. In multiple regression analysis, lower socioeconomic status (SES) and the diagnosis of velocardiofacial syndrome (VCFS) predicted a lower FSIQ (P =0.01, and P =0.001, respectively). A single ventricle diagnosis (P =0.06), longer postoperative ICU stay (P =0.08), and cumulative duration of hypothermic circulatory arrest (HCA) (P =0.09) approached significance as predictors of lower FSIQ. ConclusionChildren with CHD, on the whole, appear to be performing within the average range in terms of intellectual abilities. Lower SES and VCFS are associated with lower IQ scores. Trends toward worse outcomes were observed in single ventricle patients, biventricular patients with longer postrepair ICU stays, and patients subjected to longer periods of HCA.","PeriodicalId":10194,"journal":{"name":"Circulation: Journal of the American Heart Association","volume":"102 1","pages":"I-95-I-102"},"PeriodicalIF":0.0,"publicationDate":"2002-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80519678","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}

引用次数: 169