Objective To investigate the changed rules of the cardiac functions in rabbits and to provide theoretical gists for clinical diagnosis and treatment after blunt chest trauma(BCT). Methods Using the models of moderate to severe BCT with BIM-Ⅱ Bio-impactor in 20 rabbits to examinate the cardiac functions with cardiac catheterization, the single photonemission computed tomography(SPECT) and the Doppler echocardiography at preinjury and 1h, 2h, 4h, 6h, 8h, 12h and 24h after BCT. Results Central venous pressure( CVP）, left ventricular enddiastolic pressure (LVEDP) and the decreasing time constant of left intraventricular pressure (T) at 24h after trauma were higher obviously than those before trauma (Plt;0.05,0.01). The -dp/dtmax at 24h after trauma was lower markedly than that before trauma (Plt;0.05 ). The ejection fraction(EF),1/3 EF, 1/3 ejection rate（1/3ER） and the ratio of 1/3 filling rate (1/3FR) to 1/3ER of the right ventricle at 24h after impacted were lower markedly than those before impacted (Plt;0.05). The peak filling rate, 1/3 filling fraction, 1/3 filling rate, the ratio of peak filling rate to peak ejection rate and the ratio of 1/3FR to 1/3ER of the left ventricular at 24h after impacted were lower obviously than those before impacted (Plt;0.05, 0.01). Conclusion The cardiac functions are changed significantly after BCT. The expressions of the right ventricular dysfunctions mainly are systolic dysfunction while the left ventricular dysfunctions are mainly diastolic dysfunction after BCT. All the cardiac catheterization, SPECT and the Doppler echocardiography are beneficial to the diagnosis of cardiac dysfunction after BCT. The SPECT is more exactitude and the Doppler echocardiography is more cheaper.
Objective\ To investigate the clinical significance of measuring central venous pressure in patients after cardiac surgery.\ Methods\ Twenty four patients in postoperative cardiac surgery were randomly chosen, and investigated under three fettles:(1) The patients were sent into intensive care unit on mechanical ventilation; (2) They were all conscious and on mechanical ventilation 8 hours after operation; (3) 24 hours after operation, the patients were conscious with normal breathing.
Abstract: There is a 1% - 4% incidence of cardiac disease in pregnancy, and rheumatic heart disease is the most common diagnosis. On the condition that medical treatment is inefficacious, an open heart surgery should be performed. Because of the changes in physiological functions, there is a major difference between pregnant patients and the general population in perioperative management of valve replacement. Now , the pregnancy is not an absolute contraindication for cardiopulmonary bypass, though the incidence of mortality and birth defects remains high. It is helpful in decreasing complications and increasing survival rate by improving themethods of cardiopulmonary bypass, postoperative monitoring, anticoagulation etc. In this article, the progress in t reatments of perioperative period of cardiac valve replacement during pregnancy is reviewed.
Objective To study three-dimensional culturing methods of neonatal rat cardiac myocytes in simulated microgravity. Methods Neonatal rat primary cardiac myocytes were separated and seeded into polylactic acid scaffolds, stirredin spinner flasks for 24 hours, and then moved into rotary cell culture system for three-dimensional culture. The growth of cardiac myocytes was observed underinverted phase contrast microscope, scanning electron microscope and transmission electron microscope, and metabolic assay was assessed by MTT assay. Results Cardiac myocytes with sustained metabolic activity attached to the polylactic acid scaffolds, extended and confluenced. Pulsations of PLAcardiac myocytes was found in some areas. Conclusion The rotary cell culture system is suitable to develop neonatal rat cardiac myocytes culturing for three-dimensional modeling.
Cryptogenic stroke (CS) accounts for 25% of ischemic stroke. The etiology of undetermined stroke is unclear leading to untargeted secondary prevention, high recurrence rate, so the clinical burden of cryptogenic stroke is substantial. Cardiac magnetic resonance (CMR) imaging can identify more occult cardiac embolism that cannot be identified by standard cardiac assessment based on its excellent spatial resolution and contrast, three-dimensional imaging capacity and ability to depict soft tissues, to accelerate the initiation of optimal secondary prevention and improve the prognosis of patients. This review summarizes the application of CMR in the field of CS in recent years. Based on the latest evidence of diagnosis and management strategies, this paper proposes a cardiac diagnostic examination plan for CS patients, thereby improving the secondary prevention strategy of CS patients and improving their quality of life.
ObjectiveTo investigate the perioperative change of parathyroid hormone (PTH) and its effect on cardiac function in patients with rheumatic heart disease.MethodsFrom January 2018 to June 2019, 76 patients were randomly divided into calcium supplement group (n=39) and control group (n=37). Mitral valve replacement was performed in both groups with cardiopulmonary bypass (CPB). Blood gas was measured immediately and every 6 h within 24 h after CPB. The patients in the calcium supplement group were given 1 g of calcium gluconate when hypocalcemia occurred, while the control group received no calcium supplementation. Values of radial arterial blood PTH and calcium ion (Ca2+) were measured in the two groups before operation (T1), at 30 min after starting CPB (T2), immediately after stopping CPB (T3), at 24 h after operation (T4), and at 48 h after operation (T5), respectively.ResultsThere were 71 patients enrolled in this study finally, including 38 in the calcium supplement group and 33 in the control group. The PTH values of patients in the two groups gradually increased, reached the peak at T3 time-point, then began to recover gradually. There was no significant difference between the two groups at T1, T2 or T3 time-point (P>0.05), while there were significant differences at T4 and T5 time-points (P<0.05). The Ca2+ values of the two groups gradually decreased after CPB, and gradually increased after blood ultrafiltration. There was no significant difference between the two groups at T1 or T3 time-point (P>0.05), while there were significant differences at T2, T4 and T5 time-points (P<0.05). The postoperative 24-hour values of ejection fraction (EF) and cardiac troponin T (cTnT) and the 72-hour total amount of epinephrine used in the calcium supplement group were (42.66±4.18)%, (1 881.17±745.71) ng/L, and (3.04±0.86) mg, respectively, and those in the control group were (40.76±3.39)%, (2 725.30±1 062.50) ng/L, and (4.69±1.37) mg, respectively. There were statistically significant differences in EF, cTnT and the 72-hour total amount of epinephrine used between the two groups (P<0.05). Values of PTH at T4 and T5 time-points were respectively negatively correlated with postoperative 24-hour value of EF (r=-0.324, P=0.006; r=-0.359, P=0.002), positively correlated with postoperative 24-hour value of cTnT (r=0.238, P=0.046; r=0.248, P=0.037) and the 72-hour total amount of epinephrine used (r=0.324, P=0.006; r=0.383, P=0.001).ConclusionsHyperparathyroidism occures after CPB, and calcium supplementation could relieve the hyperparathyroidism. Hyperparathyroidism may be related to postoperative cardiac insufficiency.
Acute kidney injury (AKI) is a complication with high morbidity and mortality after cardiac surgery. In order to predict the incidence of AKI after cardiac surgery, many risk prediction models have been established worldwide. We made a detailed introduction to the composing features, clinical application and predictive capability of 14 commonly used models. Among the 14 risk prediction models, age, congestive heart failure, hypertension, left ventricular ejection fraction, diabetes, cardiac valve surgery, coronary artery bypass grafting (CABG) combined with cardiac valve surgery, emergency surgery, preoperative creatinine, preoperative estimated glomerular filtration rate (eGFR), preoperative New York Heart Association (NYHA) score>Ⅱ, previous cardiac surgery, cadiopulmonary bypass (CPB) time and low cardiac output syndrome (LCOS) are included in many risks prediction models (>3 times). In comparison to Mehta and SRI models, Cleveland risk prediction model shows the best discrimination for the prediction of renal replacement therapy (RRT)-AKI and AKI in the European. However, in Chinese population, the predictive ability of the above three risk prediction models for RRT-AKI and AKI is poor.
ObjectiveTo evaluate the performance of nuchal translucency (NT) measurement in the first trimester of pregnancy as a marker for congenital heart defects (CHD). MethodsFrom January 2010 to December 2012, middle-low risk pregnant women were prospectively evaluated at the Department of Ultrasound in West China Second Hospital of Sichuan University about Nuchal translucency and echocardiography. ResultsNT measurements was performed in 2 443 women from 2 764 pregnancy women, and a total of 2 125 case could be used in data analysis. NT measurement >2.5 mm was found in 68 fetuses, and 11 cases were diagnosed as CHD (prevalence 5.2/1 000). The sensitivity and specificity of NT measurement >2.5 mm for CHD were 45.5% and 87%, respectively. ConclusionIncreasing nuchal translucency might increase the risk of CHD in fetuses, and could be used as a method to diagnosis CHD.
Acute renal failure(ARF) is a serious complication after cardiac surgery. It is an important influential factor of increasing mortality, extending mechanical ventilation time and intensive care unit time, resulting in cognition functional impairment and respiratory function failure et al, and increasing cost of hospitalization. Extracorporeal circulation, intra-aortic balloon pump, renal inadequacy before surgery, diabetes and peripheral vascular disease are all risk factors of ARF after operation. These factors can lead to ARF by constriction of capacitance vessel, filling defect of renal and ischemia-reperfusion injury et al. Appropriate drug treatment, haemodialysis and hemofiltration could protect renal function and improve prognosis of ARF.
Transesophageal echocardiogram (TEE) can promote the quality of cardiac surgery and reduce peri-operative complications, and thus has been gradually accepted by cardiac surgeons. Through an esophageal probe, TEE can clearly visualize the internal structure of the heart without interrupting surgical procedure. As a newly developed technology which breaks the limitations tied to the traditional two-dimensional TEE, the realtime threedimensional transesophageal echocardiogram (RT3D-TEE) has the advantages of showing threedimensional structure of the heart and providing full range of anatomical information of the heart. Furthermore, it can precisely analyze the anatomical structure of the abnormal heart valves and provide assessment of the change of heart volume. Relying on its unique imaging property, it can largely facilitate preoperative decision-making and provide realtime intraoperative guidance as well as accurate postoperative evaluation. It has now been successfully applied in various types of cardiac surgical procedures including valve repair surgery, congenital heart defect intervention, cardiac mass removal as well as heart function evaluation. In this article, we will review the applications of RT3D-TEE in cardiac surgery, and try to form a basis for its further clinical application.