Two methods were employed in the management of 18 patients with mediastinal infec-tions after open-heart surgery in a 10-year-period from 1980 to 1989.The first 3 cases weretreated with local debridement and drainage ...Two methods were employed in the management of 18 patients with mediastinal infec-tions after open-heart surgery in a 10-year-period from 1980 to 1989.The first 3 cases weretreated with local debridement and drainage of the involved areas.Of them,1 was cured and 2 de-veloped chronic osteomyelitis of the sternum with an average hospitalization of 91 d.The other 15cases were treated with radical debridement and closed retrosternal irrigation of antibiotic solutions.Fourteen out of the 15 cases were successfully cured with an average hospitalization of 15d and 1case suffered from a recurrence of infection.No hospital mortality occurred in this series and 2 latedeaths were not related to mediastinal infections.It is believed by the authors that radicaldebridement in association with retrosternal irrigation is a far much better method than localdebridement combined with drainage in the management of mediastinal infections afteropen-heart surgery.展开更多
The development of the heart-lung machine made repair of intracardiac lesions possible. One of the key requirements of the heart-lung machine was anticoagulation. Heparin was discovered by a medical student, Jay McLea...The development of the heart-lung machine made repair of intracardiac lesions possible. One of the key requirements of the heart-lung machine was anticoagulation. Heparin was discovered by a medical student, Jay McLean, working in the laboratory of Dr. William Howell at Johns Hopkins. John Gibbon contributed more to the successful development of the heart-lung machine than anyone else. His interest began as a young doctor since 1930s. Gibbon＇s work on the heart-lung machine took place over the next 20 years in laboratories at Massachusetts General Hospital, the University of Pennsylvania, and Thomas Jefferson University In 1937, he reported the first successful demonstration that life could be maintained by an artificial heart and lung, and the native heart and lungs could resume fimction. After World War II, Dr. Gibbon resumed his work and received support from IBM to build a heart-lung machine on a more sophisticated scale. Eventually, the team developed a larger oxygenator that the IBM engineers incorporated into a new machine. On May 6, 1953, Dr. Gibbon performed the first successful operation using an extracorporeal circuit on an 18-year-old girl with a large atrial septal defect. It wasn＇t until 1958, when a system that involved bubbling blood was perfected, that ＂heart-lung＂ machines came of age. Despite so many chill winds and cold rains, ＂heart-lung＂ machine, the budding rose of surgery, was eventually blossom brightly in the radiant rays of sunlight. John Gibbon＇s dream had become a reality. His work serves as an important example to surgeons who are struggling today with the surgical therapies and technologies of tomorrow.展开更多
Background Acute Stanford Type A Aortic Dissection(ATAAD)is a critical medical emergency characterized by significant morbidity and mortality.This study aims to identify specific gene expression patterns and RNA modif...Background Acute Stanford Type A Aortic Dissection(ATAAD)is a critical medical emergency characterized by significant morbidity and mortality.This study aims to identify specific gene expression patterns and RNA modification associated with ATAAD.Methods The GSE153434 dataset was obtained from the Gene Expression Omnibus(GEO)database.Differential expression analysis was conducted to identify differential expression genes(DEGs)associated with ATAAD.To validate the involvement of RNA modification in ATAAD,RNA modification-related genes(M6A,M1A,M5C,APA,A-to-I)were acquired from GeneCards,following by Least Absolute Shrinkage and Selection Operator(LASSO)regression analysis.A gene prediction signature consisting of key genes was established,and Real-time PCR was used to validate the gene expression in clinical samples.The patients were then divided into high and low-risk groups,and subsequent enrichment analysis,including Gene Ontology(GO),Kyoto Encyclopedia of Genes and Genomes(KEGG),Gene Set Enrichment Analysis(GSEA),Gene Set Variation Analysis(GSVA),and assessments of immune infiltration.A co-expression network analysis(WGCNA)was performed to explore gene-phenotype relationships and identify key genes.Results A total of 45 RNA modification genes were acquired.Six gene signatures(YTHDC1,WTAP,CFI,ADARB1,ADARB2,TET3)were developed for ATAAD diagnosis and risk stratification.Enrichment analysis suggested the potential involvement of inflammation and extracellular matrix pathways in the progression of ATAAD.The incorporation of pertinent genes from the GSE147026 dataset into the six-gene signature further validated the model's effectiveness.A significant upregulation in WTAP,ADARB2,and TET3 expression,whereas YTHDC1 exhibited a noteworthy downregulation in the ATAAD group.Conclusion Six-gene signature could serve as an efficient model for predicting the diagnosis of ATAAD.展开更多
Objective To evaluate the benefits of surgical repair acute type A aortic dissection(ATAAD)on survival of octogenarians.Methods Patients who underwent surgery for acute ATAAD from the multicenter European Registry of ...Objective To evaluate the benefits of surgical repair acute type A aortic dissection(ATAAD)on survival of octogenarians.Methods Patients who underwent surgery for acute ATAAD from the multicenter European Registry of Type A Aortic Dissection(ERTAAD)were the subjects of the present analysis.Results 326(8.4%)patients were aged≥80 years.Among 280 propensity score matched pairs,in-hospital mortality was 30.0%in patients aged≥80 years and 20.0%in younger patients(P=0.006),while 10-year mortality were 93.2%and 48.0%,respectively(P<0.001).The hazard of mortality was higher among octogenarians up to two years after surgery,but it became comparable to that of younger patients up to 5 years.Among patients who survived 3 months after surgery,10-year relative survival was 0.77 in patients aged<80 years,and 0.46 in patients aged≥80 years.Relative survival of octogenarians decreased markedly 5 years after surgery.Age≥85 years,glomerular filtration rate,preoperative invasive ventilation,preoperative mesenteric mal-perfusion and aortic root replacement were independent predictors of in-hospital mortality among octogenarians(AUC=0.792;E:O ratio=0.991;CITL=0.016;slope=1.096).An additive score was developed.A risk score≤1 was observed in 68.4%of patients,and their in-hospital mortality was 20.9%.Conclusions Provided a thoughtful patient selection,surgery may provide a survival benefit in patients aged≥80 years with ATAAD that,when compared to younger patients and the general population,may last up to 5 years after the procedure.These findings have significant epidemiologic and clinical relevance because of the increasing longevity of the population of the Western countries.展开更多
BackgroundGeriatric patients with multivessel coronary artery disease （CAD） are a challenging group to treat; these cases elicit dis-cussion within heart teams regarding the actual benefit of undertaking major surge...BackgroundGeriatric patients with multivessel coronary artery disease （CAD） are a challenging group to treat; these cases elicit dis-cussion within heart teams regarding the actual benefit of undertaking major surgery on these patients and often lead to abandon the surgical option. Percutaneous procedures represent an important option, but coronary anatomy may be unfavorable. Off-pump coronary artery bypass （OPCAB） provides good quality graft on left anterior descending （LAD） without exposing the patient to cardiopulmonary bypass, and might be the ideal choice in patients with multiple comorbidities, not eligible to percutaneous or on-pump procedures. The objective of this study was to compare survival during a mid-term follow-up in high-risk patients with no percutaneous alternative, either treated with OPCAB or discharged in medical therapy.MethodsWe retrospectively evaluated from June 2008 to June 2013, 83 high-risk patients with multivessel CAD were included： 42 were treated with incomplete off-pump revascularization using left internal mammary artery （LIMA） on LAD; 41 were discharged in optimal medical therapy （OMT）, having refused surgery. Follow-up ended in March 2015, with a telephonic interview. Primary endpoint was survival from all-cause mortality; secondary endpoints were survival from cardiac-related mortality and freedom from non-fatal major adverse cardiac events （MACEs）.ResultsDuring follow up, 11 deaths in OPCAB group and 27 deaths in OMT group occurred. Death was due to cardiac factors in 6 and 15 patients, respectively. MACEs were observed in 6 patients in OPCAB group and in 4 patients in OMT group. With regards to survival from all-cause mortality, patients who underwent OPCAB survived more than those dis-charged in OMT （Log Rank ＆lt; 0.001）, and OMT group carries a propensity score-adjusted hazard ratio of 3.862 （P ＆lt; 0.001）. With regards to survival from cardiac-related events, patients who underwent OPCAB survived more than those discharged in OMT （Log Rank = 0.002）, and OMT group carries a propensity score-adjusted hazard ratio of 3.663 （P = 0.010）. There is no statistically significant difference concerning freedom from MACEs （Log Rank = 0.273）.ConclusionsFor high-risk patients with multivessel CAD, not eligible to on-pump complete revascularization surgery or percutaneous procedures, incomplete revascularization with OPCAB LIMA-on-LAD offers benefits in survival when compared to OMT alone.展开更多
Objective. To investigate the roles of apoptosis in the pulmonary artery remodeling of pulmonary hypertension secondary to hypoxia and illustrate the relative genes expression. Methods. Thirty rats were divided into h...Objective. To investigate the roles of apoptosis in the pulmonary artery remodeling of pulmonary hypertension secondary to hypoxia and illustrate the relative genes expression. Methods. Thirty rats were divided into hypoxia group（ 10％ O2, 8h/d） and normal control group. On the 15th day of hypoxia, pulmonary artery pressure and right ventricular hypertrophy index were measured and pulmonary artery vessels were studied by light microscope. Then terminal deoxynucleotidyl transferase- mediated dUTP nick- end labeling（ TUNEL） technique was used to detect nucleosomal DNA fragmentation of apoptotic cells. In situ hybridization and RT- PCR were used to detect the expression level of bcl- 2 and bax. Results. The pulmonary artery pressure and right ventricular hypertrophy index of hypoxia group were increased significantly, the pulmonary artery wall of hypoxic group become incrassate than control group. Apoptotic cells can be found in lung with hypoxia or without hypoxia. Compared with control group, apoptotic index of hypoxic group decreased significantly. Through the methods of in situ hybridization and RT- PCR, we found the expression of bcl- 2 increased whereas bax decreased significantly in the hypoxic group. Conclusion. The alternation in bcl- 2 and bax expression induced by hypoxia play an important role in the pulmonary artery remodeling which is the main pathologic change of pulmonary hypertension secondary to hypoxia.展开更多
Objective: To investigate the cytotoxicity and cytocompatibility of chitin fiber reinforced polycaprolactone composite in vitro in order to provide useful scientific basis for clinical application. Methods: Cell morph...Objective: To investigate the cytotoxicity and cytocompatibility of chitin fiber reinforced polycaprolactone composite in vitro in order to provide useful scientific basis for clinical application. Methods: Cell morphology observation, MTT and DNA assay were used to evaluate the influence of the composite on the morphology, growth and proliferation of cultured L-929 cells. Results: The composite did not impair the morphology of cultured cells in vitro. MTT and DNA assay demonstrated that the growth and proliferation of the cultured cells were not significantly inhibited by the composite. Conclusion : The composites have fine cytocompatibility and are safe for clinical use of reconstruction of chest wall defects.展开更多
Papillary fibroelastoma cardiac tumor. The most is the most common valvular common non-valvular site these minors present is the left ventricle, where they usually manifest as ischemic strokes or myocardial infarction...Papillary fibroelastoma cardiac tumor. The most is the most common valvular common non-valvular site these minors present is the left ventricle, where they usually manifest as ischemic strokes or myocardial infarction. Although these tumors also have a risk of embolization into the peripheral system, reports of such events are exceedingly rare.展开更多
Granulomatous lobular mastitis(GLM) is a rare and chronic benign inflammatory disease of the breast. Difficulties exist in the management of GLM for many front-line surgeons and medical specialists who care for patien...Granulomatous lobular mastitis(GLM) is a rare and chronic benign inflammatory disease of the breast. Difficulties exist in the management of GLM for many front-line surgeons and medical specialists who care for patients with inflammatory disorders of the breast. This consensus is summarized to establish evidence-based recommendations for the management of GLM. Literature was reviewed using PubMed from January 1, 1971 to July 31, 2020. Sixty-six international experienced multidisciplinary experts from 11 countries or regions were invited to review the evidence.Levels of evidence were determined using the American College of Physicians grading system, and recommendations were discussed until consensus. Experts discussed and concluded 30 recommendations on historical definitions,etiology and predisposing factors, diagnosis criteria, treatment, clinical stages, relapse and recurrence of GLM. GLM was recommended as a widely accepted definition. In addition, this consensus introduced a new clinical stages and management algorithm for GLM to provide individual treatment strategies. In conclusion, diagnosis of GLM depends on a combination of history, clinical manifestations, imaging examinations, laboratory examinations and pathology.The approach to treatment of GLM should be applied according to the different clinical stage of GLM. This evidencebased consensus would be valuable to assist front-line surgeons and medical specialists in the optimal management of GLM.展开更多
The article presents two patients with pseudotruncus treated surgically under moderate or profound hypothermia and CPB with excellent results. The risk factors related to the operative mortality, and a brief introduct...The article presents two patients with pseudotruncus treated surgically under moderate or profound hypothermia and CPB with excellent results. The risk factors related to the operative mortality, and a brief introduction of the some operative techniques are discussed.展开更多
Background Prognostic significance of prosthesis-patient mismatch(PPM)after mitral valve replacement(MVR)remains uncertain because of the limited studies reporting inconsistent or even contrary results.This meta-analy...Background Prognostic significance of prosthesis-patient mismatch(PPM)after mitral valve replacement(MVR)remains uncertain because of the limited studies reporting inconsistent or even contrary results.This meta-analysis pooled results of all available studies comparing early and late prognoses between patients with significant mitral PPM and those without.Methods Studies were identified by searching Pubmed,Excerpta Medica Database,Cochrane Central Register of Controlled Trials,and Clinical Trials.gov.Impact of PPM on postoperative hemodynamic results,thirty-day mortality,overall mortality,mortality of thirty-day survivors,and primary morbidity after MVR was evaluated via meta-analysis.Robustness of pooled estimates,source of heterogeneity,and publication bias were assessed via sensitivity analyses,meta-regression as well as subgroup analysis stratified according to methodological or clinical heterogeneity,or sequential omission method,and funnel plot or Begg's and Egger's tests,respectively.Results Nineteen cohort studies involving 9302 individuals(PPM group:n=5109,Control group:n=4193)were included for meta-analysis.Total PPM and severe PPM prevalence were 3.8%–85.9%and 1%–27%,with a mean value of 54.9%and 14.1%,respectively.As compared with control group,mitral PPM group demonstrated a poorer postoperative hemodynamic status of higher mean and peak residual transprosthetic pressure gradients(TPG),higher postoperative systolic pulmonary artery pressure(SPAP)and less reduction,higher postoperative pulmonary hypertension(PH)prevalence and less PH regression,smaller net atrioventricular compliance,less NYHA class decrease,higher postoperative functional tricuspid regurgitation prevalence and less regression.The PPM group also revealed a higher thirty-day mortality,long-term overall mortality,mortality of thirty-day survivors,and postoperative congestive heart failure prevalence,which were positively correlated with the severity of PPM if it was classified into tri-level subgroups.Left ventricular end-diastolic diameter,postoperative atrial fibrillation(AF)prevalence,and the AF regression were analogous between groups.Most pooled estimates were robust according to sensitivity analyses.Male patients and bioprosthesis implantation proportion were prominent source of between-study heterogeneity on thirty-day mortality.Publication bias was not significant in tests for all the outcomes,except for SPAP and TPG.Conclusions Mitral PPM would result in poorer postoperative hemodynamics and worse early and late prognosis.Severe PPM must be avoided since deleterious impact of mitral PPM was severity dependent.展开更多
Objectives Postoperative atrial fibrillation （AF） has been associated with less favorable outcomes in patients undergoing coronary artery bypass graft surgery （CABG） and may result in increased post-operative morb...Objectives Postoperative atrial fibrillation （AF） has been associated with less favorable outcomes in patients undergoing coronary artery bypass graft surgery （CABG） and may result in increased post-operative morbidity and mortality. A systematic review and meta-analysis of published studies was conducted to examine the risk factors of occurrence AF after CABG. Methods Using the Medline database, the Cochrane clinical trials database and online clinical trial databases, we reviewed all randomized controlled trials （RCTs） and observational studies examining the risk factors of occurrence of AF after CABG. We searched for literature published April 2009 or earlier. Results Our review identified 8 studies （observational studies）, involving 14548 patients, that examined the risk factors of occurrence of AF after CABG. Although studies provide conflicting results, the overall outcomes suggests that advanced age, previous hypertension, numbers of bridge vessels may increase the occurrence of AF after CABG, while no significant difference of diabetes, preoperative myocardial infarction, and preoperative medication of 13 -Blocker have been observed between the AF patients and no-AF patiens. Conclusions Patients with advanced age, previous hypertension and more numbers of bridge vessels had higher risk for the occurrence of AF after CABG, and perioperative medication and care must be intensified to decrease the postoperative occurrence ofAF（J Geriatr Cardio12009; 6：162-167）.展开更多
Objective：To investigate the feasibility of bone marrow stromal cells （BMSCs） differenti ating into cardiomyocyte like cells in heterogeneous cardiomyocytes microenvironment in vitro. Methods： Mouse GFP-BMSCs were...Objective：To investigate the feasibility of bone marrow stromal cells （BMSCs） differenti ating into cardiomyocyte like cells in heterogeneous cardiomyocytes microenvironment in vitro. Methods： Mouse GFP-BMSCs were isolated by centrifugation through a Ficoll step gradient and purified by plating culture and depletion of the non-adherent cells. Neonatal rat cardiomyocytes （CMs） were isolated by enzymatic dissociation from hearts of 1-to 2-day old Sprague-Dawley （SD） rats and differentially plated to remove fibroblasts. Mouse GFP-BMSCs were cocuhured with neonatal rat CMs through direct and indirect contact, respectively. Cardiomyogenic differentiation of BMSCs was evaluated by immunostaining with an- ti-a-actin monoclonal antibody and observing synchronous contraction with adjacent CMs by phase contrast microphotography. Results： On day 7 of cocuhure, GFP-BMSCs （CMs ： BMSCs：4 ： 1）attached to nonfluorescent contracting cells （rat-derived CMs） showed myotube-like formation and started to contract synchronously with adjacent cardiomyocytes. About 10% of the fluorescent GFP-BMSCs were cardiomyocyte-like cells as determined by cell morphology and positive actin staining. Conclusion;Direct cell to-cell interaction with CMs is crucial for cardiomyogenic differentiation of BMSCs in heterogeneous CMs microenvironment in vitro. This provides a novel inducing pathway for directional differentiation of cardiovascular tissue engineering seed cells.展开更多
Objectives： To explore possible mechanisms of connexin40 （Cx40） remodeling by detecting Cx40 mRNA expression of the crista terminalis and left atrium （LA） in patients with rheumatic heart disease （RHD） associat...Objectives： To explore possible mechanisms of connexin40 （Cx40） remodeling by detecting Cx40 mRNA expression of the crista terminalis and left atrium （LA） in patients with rheumatic heart disease （RHD） associated chronic atrial fibrillation （AF）. Methods： Twenty patients were enrolled in this study, who underwent surgical operation for RHD-associated mitral disease, including l0 with sinus rhythms （rhythm group） and l0 with AF （AF group）. Another 6 patients with non-RHD sinus rhythms were divided into the control group. A small amount of myocardial tissue was cut from the crista terminalis and the LA posterior wall during the valvular replacement operation. Cx40 mRNA expression was assayed by real-time fluorescent quantitation polymerase chain reaction （RT-PCR）. Results： There was no significant difference in Cx40 mRNA expression in the crista terminalis and LA posterior wall between the 3 groups, and there was no significant difference in Cx40 mRNA expression between the crista terminalis and LA within each group. Conclusion： Based on the finding in previous studies that there existed evident remodeling of atrial Cx40 protein in patients with chronic RHD, the results of the present study suggest that the mechanism of Cx40 remodeling probably lies in the post transcriptional level.展开更多
The emergency treatment of thoracic injuries varies of general conditions and modern warfare. However, there are no unified battlefield treatment guidelines for thoracic injuries in the Chinese People's Liberation...The emergency treatment of thoracic injuries varies of general conditions and modern warfare. However, there are no unified battlefield treatment guidelines for thoracic injuries in the Chinese People's Liberation Army(PLA). An expert consensus has been reached based on the epidemiology of thoracic injuries and the concept of battlefield treatment combined with the existing levels of military medical care in modern warfare. Since there are no differences in the specialized treatment for thoracic injuries between general conditions and modern warfare, first aid, emergency treatment, and early treatment of thoracic injuries are introduced separately in three levels in this consensus. At Level Ⅰfacilities, tension pneumothorax and open pneumothorax are recommended for initial assessment during the first aid stage. Re-evaluation and further treatment for hemothorax, flail chest, and pericardial tamponade are recommended at Level Ⅱ facilities. At Level Ⅲ facilities, simple surgical operations such as emergency thoracotomy and debridement surgery for open pneumothorax are recommended. The grading standard for evidence evaluation and recommendation was used to reach this expert consensus.展开更多
Aortic valve disease is a prevalent disorder that affects approximately 2% of the general adult population. Surgical aortic valve replacement is the gold standard treatment for symptomatic patients. This treatment has...Aortic valve disease is a prevalent disorder that affects approximately 2% of the general adult population. Surgical aortic valve replacement is the gold standard treatment for symptomatic patients. This treatment has demonstrably proven to be both safe and effective. Over the last few decades, in an attempt to reduce surgical trauma, different minimally invasive approaches for aortic valve replacement have been developed and are now being increasingly utilized. A narrative review of the literature was carried out to describe the surgical techniques for minimally invasive aortic valve surgery and report the results from different experienced centers. Minimally invasive aortic valve replace- ment is associated with low perioperative morbidity, mortality and a low conversion rate to full sternotomy. Long-term survival appears to be at least comparable to that reported for conventional full sternotomy. Minimally invasive aortic valve surgery, either with a partial upper stemotomy or a right anterior minithoracotomy provides early- and long-term benefits. Given these benefits, it may be considered the standard of care for isolated aortic valve disease.展开更多
Background Experiencing a pandemic can be very unsettling and may have a negative impact on the mental health of frontline healthcare workers(HCWs).This may have serious consequences for the overall well-being of HCWs...Background Experiencing a pandemic can be very unsettling and may have a negative impact on the mental health of frontline healthcare workers(HCWs).This may have serious consequences for the overall well-being of HCWs,which in turn may adversely affect patient safety and the productivity of the institution.Aims We designed a study to assess the prevalence of generalised anxiety disorder(GAD),depression and work-related stress experienced by the National Health Service staff in a large tertiary London hospital treating patients with COVID-19 during the current active phase of the COVID-19 era.Methods An anonymous survey was designed with demographic data and three questionnaires.The Generalised Anxiety Disorder-7(GAD-7)and Patient Health Questionnaire-9 were used to assess anxiety and depression,respectively.The Health and Safety Executive Management Standards Indicator Tool was used to assess work-related stress.Staff from multiple specialties embracing cardiothoracic surgery,cardiology,respiratory medicine,endocrinology,oncology,imaging,anaesthesia and intensive care at our hospital were asked to complete the questionnaire between 25 May and 15 June 2020.Results A total of 302 staff members(106 males and 196 females)completed the survey.The overall prevalence of GAD and depression was 41.4%and 42.7%,respectively.The prevalence of GAD and depression was significantly higher in females than in males and was statistically significant.Nurses were four times more likely to report moderate to severe levels of anxiety and depression as compared with doctors.Work-related stress was also observed to be prevalent in our surveyed population with the following standards:relationships,role,control and change showing a need for improvement.Conclusions Our study presents early evidence suggestive of a high prevalence of GAD,depression and work-related stress in HCWs.It is imperative that coherent strategies are implemented to improve the healthcare work environment during this pandemic and mitigate further injury to the mental health status of the healthcare population.展开更多
A best evidence topic was devised in light of a structured protocol. What is the advantage of （minl＂mally invasive） approach in （frail patients） undergoing （aortic valve replacement）？ In cardiac outpatient cl...A best evidence topic was devised in light of a structured protocol. What is the advantage of （minl＂mally invasive） approach in （frail patients） undergoing （aortic valve replacement）？ In cardiac outpatient clinic you review an 85-year old male with severe aortic valve stenosis, low left ventricular ejection fraction and creatinine clearance of less than 50 mL/min. Other comorbidities include treated pulmonary hypertension, mild cognitive impairment, marked limitation of ordinary physical activity and depression. You resolve to determine whether to recommend mim＇mally invasive or conventional aortic valve replacement （AVR） or transcathe- ter aortic valve implantation （TAVI）, however you are not sure of the differences of the impact of frailty on preopera- tive risk for each approach; hence you investigate the best evidence on the topic.展开更多
Objective: To construct an animal model of chronic ischemic myocardium, and evaluate it by ultrasonic integrated backscatter (IBS) and Doppler tissue imaging (DTI). Methods: An Ameroid constrictor was placed around th...Objective: To construct an animal model of chronic ischemic myocardium, and evaluate it by ultrasonic integrated backscatter (IBS) and Doppler tissue imaging (DTI). Methods: An Ameroid constrictor was placed around the porcine left circumflex coronary artery (LCX). The calibrated average image intensity (%AII), cyclic variation of IBS (CVIB), transmural gradient index (TGI) of CVIB in lateral-posterior wall (LPW), and DTI spectrum of LPW in left ventricular papillary muscle level short axis view (LVPM-SAM) and apical four chamber view (AP-4CV) at normal state, 2, 4, 6 and 8 weeks postoperatively were measured. Results: Normal %AII, CVIB and TGI were 2.29±0.32, 9.69±2.22dB and 0.22±0.08, respectively. The %AII increased gradually postoperatively. The CVIB decreased also gradually, and the decrease was higher in subepicardium than in subendocardium. Most of TGI decrease occurred from 2 to 4 weeks postoperatively and became zero at 8 weeks (P<0.01); Normal V S (peak systolic velocity) of AP-4CV was higher than that of LVPM-SAM (P<0.01). V E (peak early diastolic velocity) of AP-4CV was lower than that of LVPM-SAM (P<0.05). V S and V E were all decreased after operation (P<0.01). The decrease of V S in AP-4CV was greater than that in LVPM-SAM. Conclusion: The pathological changes of the myocardium in human ischemic heart disease (IHD) are similar to that of Ameriod model. IBS and DTI can detect echo changes and ventricular wall motion in chronic ischemic myocardium, and provide more information for clinical investigation and treatment of IHD.展开更多
文摘Two methods were employed in the management of 18 patients with mediastinal infec-tions after open-heart surgery in a 10-year-period from 1980 to 1989.The first 3 cases weretreated with local debridement and drainage of the involved areas.Of them,1 was cured and 2 de-veloped chronic osteomyelitis of the sternum with an average hospitalization of 91 d.The other 15cases were treated with radical debridement and closed retrosternal irrigation of antibiotic solutions.Fourteen out of the 15 cases were successfully cured with an average hospitalization of 15d and 1case suffered from a recurrence of infection.No hospital mortality occurred in this series and 2 latedeaths were not related to mediastinal infections.It is believed by the authors that radicaldebridement in association with retrosternal irrigation is a far much better method than localdebridement combined with drainage in the management of mediastinal infections afteropen-heart surgery.
文摘The development of the heart-lung machine made repair of intracardiac lesions possible. One of the key requirements of the heart-lung machine was anticoagulation. Heparin was discovered by a medical student, Jay McLean, working in the laboratory of Dr. William Howell at Johns Hopkins. John Gibbon contributed more to the successful development of the heart-lung machine than anyone else. His interest began as a young doctor since 1930s. Gibbon＇s work on the heart-lung machine took place over the next 20 years in laboratories at Massachusetts General Hospital, the University of Pennsylvania, and Thomas Jefferson University In 1937, he reported the first successful demonstration that life could be maintained by an artificial heart and lung, and the native heart and lungs could resume fimction. After World War II, Dr. Gibbon resumed his work and received support from IBM to build a heart-lung machine on a more sophisticated scale. Eventually, the team developed a larger oxygenator that the IBM engineers incorporated into a new machine. On May 6, 1953, Dr. Gibbon performed the first successful operation using an extracorporeal circuit on an 18-year-old girl with a large atrial septal defect. It wasn＇t until 1958, when a system that involved bubbling blood was perfected, that ＂heart-lung＂ machines came of age. Despite so many chill winds and cold rains, ＂heart-lung＂ machine, the budding rose of surgery, was eventually blossom brightly in the radiant rays of sunlight. John Gibbon＇s dream had become a reality. His work serves as an important example to surgeons who are struggling today with the surgical therapies and technologies of tomorrow.
基金supported by the Funding for Wu Jieping Medical Foundation’s special funding fund for clinical research(No.320.6750.2022-11-26)Scientific Research Project of Heilongjiang Provincial Health Commission(No.20220404021089)Open Project Program of Key Laboratory of Preservation of Human Genetic Resources and Disease Control in China(Harbin Medical University)Ministry of Education(No.LPHGRD2022-002)。
文摘Background Acute Stanford Type A Aortic Dissection(ATAAD)is a critical medical emergency characterized by significant morbidity and mortality.This study aims to identify specific gene expression patterns and RNA modification associated with ATAAD.Methods The GSE153434 dataset was obtained from the Gene Expression Omnibus(GEO)database.Differential expression analysis was conducted to identify differential expression genes(DEGs)associated with ATAAD.To validate the involvement of RNA modification in ATAAD,RNA modification-related genes(M6A,M1A,M5C,APA,A-to-I)were acquired from GeneCards,following by Least Absolute Shrinkage and Selection Operator(LASSO)regression analysis.A gene prediction signature consisting of key genes was established,and Real-time PCR was used to validate the gene expression in clinical samples.The patients were then divided into high and low-risk groups,and subsequent enrichment analysis,including Gene Ontology(GO),Kyoto Encyclopedia of Genes and Genomes(KEGG),Gene Set Enrichment Analysis(GSEA),Gene Set Variation Analysis(GSVA),and assessments of immune infiltration.A co-expression network analysis(WGCNA)was performed to explore gene-phenotype relationships and identify key genes.Results A total of 45 RNA modification genes were acquired.Six gene signatures(YTHDC1,WTAP,CFI,ADARB1,ADARB2,TET3)were developed for ATAAD diagnosis and risk stratification.Enrichment analysis suggested the potential involvement of inflammation and extracellular matrix pathways in the progression of ATAAD.The incorporation of pertinent genes from the GSE147026 dataset into the six-gene signature further validated the model's effectiveness.A significant upregulation in WTAP,ADARB2,and TET3 expression,whereas YTHDC1 exhibited a noteworthy downregulation in the ATAAD group.Conclusion Six-gene signature could serve as an efficient model for predicting the diagnosis of ATAAD.
基金supported by the Finnish Heart Associationby the Sigrid Jusélius Foundation.
文摘Objective To evaluate the benefits of surgical repair acute type A aortic dissection(ATAAD)on survival of octogenarians.Methods Patients who underwent surgery for acute ATAAD from the multicenter European Registry of Type A Aortic Dissection(ERTAAD)were the subjects of the present analysis.Results 326(8.4%)patients were aged≥80 years.Among 280 propensity score matched pairs,in-hospital mortality was 30.0%in patients aged≥80 years and 20.0%in younger patients(P=0.006),while 10-year mortality were 93.2%and 48.0%,respectively(P<0.001).The hazard of mortality was higher among octogenarians up to two years after surgery,but it became comparable to that of younger patients up to 5 years.Among patients who survived 3 months after surgery,10-year relative survival was 0.77 in patients aged<80 years,and 0.46 in patients aged≥80 years.Relative survival of octogenarians decreased markedly 5 years after surgery.Age≥85 years,glomerular filtration rate,preoperative invasive ventilation,preoperative mesenteric mal-perfusion and aortic root replacement were independent predictors of in-hospital mortality among octogenarians(AUC=0.792;E:O ratio=0.991;CITL=0.016;slope=1.096).An additive score was developed.A risk score≤1 was observed in 68.4%of patients,and their in-hospital mortality was 20.9%.Conclusions Provided a thoughtful patient selection,surgery may provide a survival benefit in patients aged≥80 years with ATAAD that,when compared to younger patients and the general population,may last up to 5 years after the procedure.These findings have significant epidemiologic and clinical relevance because of the increasing longevity of the population of the Western countries.
文摘BackgroundGeriatric patients with multivessel coronary artery disease （CAD） are a challenging group to treat; these cases elicit dis-cussion within heart teams regarding the actual benefit of undertaking major surgery on these patients and often lead to abandon the surgical option. Percutaneous procedures represent an important option, but coronary anatomy may be unfavorable. Off-pump coronary artery bypass （OPCAB） provides good quality graft on left anterior descending （LAD） without exposing the patient to cardiopulmonary bypass, and might be the ideal choice in patients with multiple comorbidities, not eligible to percutaneous or on-pump procedures. The objective of this study was to compare survival during a mid-term follow-up in high-risk patients with no percutaneous alternative, either treated with OPCAB or discharged in medical therapy.MethodsWe retrospectively evaluated from June 2008 to June 2013, 83 high-risk patients with multivessel CAD were included： 42 were treated with incomplete off-pump revascularization using left internal mammary artery （LIMA） on LAD; 41 were discharged in optimal medical therapy （OMT）, having refused surgery. Follow-up ended in March 2015, with a telephonic interview. Primary endpoint was survival from all-cause mortality; secondary endpoints were survival from cardiac-related mortality and freedom from non-fatal major adverse cardiac events （MACEs）.ResultsDuring follow up, 11 deaths in OPCAB group and 27 deaths in OMT group occurred. Death was due to cardiac factors in 6 and 15 patients, respectively. MACEs were observed in 6 patients in OPCAB group and in 4 patients in OMT group. With regards to survival from all-cause mortality, patients who underwent OPCAB survived more than those dis-charged in OMT （Log Rank ＆lt; 0.001）, and OMT group carries a propensity score-adjusted hazard ratio of 3.862 （P ＆lt; 0.001）. With regards to survival from cardiac-related events, patients who underwent OPCAB survived more than those discharged in OMT （Log Rank = 0.002）, and OMT group carries a propensity score-adjusted hazard ratio of 3.663 （P = 0.010）. There is no statistically significant difference concerning freedom from MACEs （Log Rank = 0.273）.ConclusionsFor high-risk patients with multivessel CAD, not eligible to on-pump complete revascularization surgery or percutaneous procedures, incomplete revascularization with OPCAB LIMA-on-LAD offers benefits in survival when compared to OMT alone.
文摘Objective. To investigate the roles of apoptosis in the pulmonary artery remodeling of pulmonary hypertension secondary to hypoxia and illustrate the relative genes expression. Methods. Thirty rats were divided into hypoxia group（ 10％ O2, 8h/d） and normal control group. On the 15th day of hypoxia, pulmonary artery pressure and right ventricular hypertrophy index were measured and pulmonary artery vessels were studied by light microscope. Then terminal deoxynucleotidyl transferase- mediated dUTP nick- end labeling（ TUNEL） technique was used to detect nucleosomal DNA fragmentation of apoptotic cells. In situ hybridization and RT- PCR were used to detect the expression level of bcl- 2 and bax. Results. The pulmonary artery pressure and right ventricular hypertrophy index of hypoxia group were increased significantly, the pulmonary artery wall of hypoxic group become incrassate than control group. Apoptotic cells can be found in lung with hypoxia or without hypoxia. Compared with control group, apoptotic index of hypoxic group decreased significantly. Through the methods of in situ hybridization and RT- PCR, we found the expression of bcl- 2 increased whereas bax decreased significantly in the hypoxic group. Conclusion. The alternation in bcl- 2 and bax expression induced by hypoxia play an important role in the pulmonary artery remodeling which is the main pathologic change of pulmonary hypertension secondary to hypoxia.
基金Supported by the Sci & Tech Development Foundation of Shang-hai (No. 024419076)
文摘Objective: To investigate the cytotoxicity and cytocompatibility of chitin fiber reinforced polycaprolactone composite in vitro in order to provide useful scientific basis for clinical application. Methods: Cell morphology observation, MTT and DNA assay were used to evaluate the influence of the composite on the morphology, growth and proliferation of cultured L-929 cells. Results: The composite did not impair the morphology of cultured cells in vitro. MTT and DNA assay demonstrated that the growth and proliferation of the cultured cells were not significantly inhibited by the composite. Conclusion : The composites have fine cytocompatibility and are safe for clinical use of reconstruction of chest wall defects.
文摘Papillary fibroelastoma cardiac tumor. The most is the most common valvular common non-valvular site these minors present is the left ventricle, where they usually manifest as ischemic strokes or myocardial infarction. Although these tumors also have a risk of embolization into the peripheral system, reports of such events are exceedingly rare.
基金supported by Improving the Ability of Diagnosis and Treatment of Difficult Diseases (ZLYNXM202009)。
文摘Granulomatous lobular mastitis(GLM) is a rare and chronic benign inflammatory disease of the breast. Difficulties exist in the management of GLM for many front-line surgeons and medical specialists who care for patients with inflammatory disorders of the breast. This consensus is summarized to establish evidence-based recommendations for the management of GLM. Literature was reviewed using PubMed from January 1, 1971 to July 31, 2020. Sixty-six international experienced multidisciplinary experts from 11 countries or regions were invited to review the evidence.Levels of evidence were determined using the American College of Physicians grading system, and recommendations were discussed until consensus. Experts discussed and concluded 30 recommendations on historical definitions,etiology and predisposing factors, diagnosis criteria, treatment, clinical stages, relapse and recurrence of GLM. GLM was recommended as a widely accepted definition. In addition, this consensus introduced a new clinical stages and management algorithm for GLM to provide individual treatment strategies. In conclusion, diagnosis of GLM depends on a combination of history, clinical manifestations, imaging examinations, laboratory examinations and pathology.The approach to treatment of GLM should be applied according to the different clinical stage of GLM. This evidencebased consensus would be valuable to assist front-line surgeons and medical specialists in the optimal management of GLM.
文摘The article presents two patients with pseudotruncus treated surgically under moderate or profound hypothermia and CPB with excellent results. The risk factors related to the operative mortality, and a brief introduction of the some operative techniques are discussed.
基金supported by the National Natural Scientific Foundation of China(No.81770477)Shanghai Science and Technology Fund(17ZR1438100)。
文摘Background Prognostic significance of prosthesis-patient mismatch(PPM)after mitral valve replacement(MVR)remains uncertain because of the limited studies reporting inconsistent or even contrary results.This meta-analysis pooled results of all available studies comparing early and late prognoses between patients with significant mitral PPM and those without.Methods Studies were identified by searching Pubmed,Excerpta Medica Database,Cochrane Central Register of Controlled Trials,and Clinical Trials.gov.Impact of PPM on postoperative hemodynamic results,thirty-day mortality,overall mortality,mortality of thirty-day survivors,and primary morbidity after MVR was evaluated via meta-analysis.Robustness of pooled estimates,source of heterogeneity,and publication bias were assessed via sensitivity analyses,meta-regression as well as subgroup analysis stratified according to methodological or clinical heterogeneity,or sequential omission method,and funnel plot or Begg's and Egger's tests,respectively.Results Nineteen cohort studies involving 9302 individuals(PPM group:n=5109,Control group:n=4193)were included for meta-analysis.Total PPM and severe PPM prevalence were 3.8%–85.9%and 1%–27%,with a mean value of 54.9%and 14.1%,respectively.As compared with control group,mitral PPM group demonstrated a poorer postoperative hemodynamic status of higher mean and peak residual transprosthetic pressure gradients(TPG),higher postoperative systolic pulmonary artery pressure(SPAP)and less reduction,higher postoperative pulmonary hypertension(PH)prevalence and less PH regression,smaller net atrioventricular compliance,less NYHA class decrease,higher postoperative functional tricuspid regurgitation prevalence and less regression.The PPM group also revealed a higher thirty-day mortality,long-term overall mortality,mortality of thirty-day survivors,and postoperative congestive heart failure prevalence,which were positively correlated with the severity of PPM if it was classified into tri-level subgroups.Left ventricular end-diastolic diameter,postoperative atrial fibrillation(AF)prevalence,and the AF regression were analogous between groups.Most pooled estimates were robust according to sensitivity analyses.Male patients and bioprosthesis implantation proportion were prominent source of between-study heterogeneity on thirty-day mortality.Publication bias was not significant in tests for all the outcomes,except for SPAP and TPG.Conclusions Mitral PPM would result in poorer postoperative hemodynamics and worse early and late prognosis.Severe PPM must be avoided since deleterious impact of mitral PPM was severity dependent.
文摘Objectives Postoperative atrial fibrillation （AF） has been associated with less favorable outcomes in patients undergoing coronary artery bypass graft surgery （CABG） and may result in increased post-operative morbidity and mortality. A systematic review and meta-analysis of published studies was conducted to examine the risk factors of occurrence AF after CABG. Methods Using the Medline database, the Cochrane clinical trials database and online clinical trial databases, we reviewed all randomized controlled trials （RCTs） and observational studies examining the risk factors of occurrence of AF after CABG. We searched for literature published April 2009 or earlier. Results Our review identified 8 studies （observational studies）, involving 14548 patients, that examined the risk factors of occurrence of AF after CABG. Although studies provide conflicting results, the overall outcomes suggests that advanced age, previous hypertension, numbers of bridge vessels may increase the occurrence of AF after CABG, while no significant difference of diabetes, preoperative myocardial infarction, and preoperative medication of 13 -Blocker have been observed between the AF patients and no-AF patiens. Conclusions Patients with advanced age, previous hypertension and more numbers of bridge vessels had higher risk for the occurrence of AF after CABG, and perioperative medication and care must be intensified to decrease the postoperative occurrence ofAF（J Geriatr Cardio12009; 6：162-167）.
文摘Objective：To investigate the feasibility of bone marrow stromal cells （BMSCs） differenti ating into cardiomyocyte like cells in heterogeneous cardiomyocytes microenvironment in vitro. Methods： Mouse GFP-BMSCs were isolated by centrifugation through a Ficoll step gradient and purified by plating culture and depletion of the non-adherent cells. Neonatal rat cardiomyocytes （CMs） were isolated by enzymatic dissociation from hearts of 1-to 2-day old Sprague-Dawley （SD） rats and differentially plated to remove fibroblasts. Mouse GFP-BMSCs were cocuhured with neonatal rat CMs through direct and indirect contact, respectively. Cardiomyogenic differentiation of BMSCs was evaluated by immunostaining with an- ti-a-actin monoclonal antibody and observing synchronous contraction with adjacent CMs by phase contrast microphotography. Results： On day 7 of cocuhure, GFP-BMSCs （CMs ： BMSCs：4 ： 1）attached to nonfluorescent contracting cells （rat-derived CMs） showed myotube-like formation and started to contract synchronously with adjacent cardiomyocytes. About 10% of the fluorescent GFP-BMSCs were cardiomyocyte-like cells as determined by cell morphology and positive actin staining. Conclusion;Direct cell to-cell interaction with CMs is crucial for cardiomyogenic differentiation of BMSCs in heterogeneous CMs microenvironment in vitro. This provides a novel inducing pathway for directional differentiation of cardiovascular tissue engineering seed cells.
基金Supported by the National Natural Science Foundation of China(30070749).
文摘Objectives： To explore possible mechanisms of connexin40 （Cx40） remodeling by detecting Cx40 mRNA expression of the crista terminalis and left atrium （LA） in patients with rheumatic heart disease （RHD） associated chronic atrial fibrillation （AF）. Methods： Twenty patients were enrolled in this study, who underwent surgical operation for RHD-associated mitral disease, including l0 with sinus rhythms （rhythm group） and l0 with AF （AF group）. Another 6 patients with non-RHD sinus rhythms were divided into the control group. A small amount of myocardial tissue was cut from the crista terminalis and the LA posterior wall during the valvular replacement operation. Cx40 mRNA expression was assayed by real-time fluorescent quantitation polymerase chain reaction （RT-PCR）. Results： There was no significant difference in Cx40 mRNA expression in the crista terminalis and LA posterior wall between the 3 groups, and there was no significant difference in Cx40 mRNA expression between the crista terminalis and LA within each group. Conclusion： Based on the finding in previous studies that there existed evident remodeling of atrial Cx40 protein in patients with chronic RHD, the results of the present study suggest that the mechanism of Cx40 remodeling probably lies in the post transcriptional level.
基金supported by the "Thirteenth Five-Year Plan" Special Project in Military Logistics Scientific Program(AWS16J032)the Innovation Project of Military Medicine(16CXZ017)
文摘The emergency treatment of thoracic injuries varies of general conditions and modern warfare. However, there are no unified battlefield treatment guidelines for thoracic injuries in the Chinese People's Liberation Army(PLA). An expert consensus has been reached based on the epidemiology of thoracic injuries and the concept of battlefield treatment combined with the existing levels of military medical care in modern warfare. Since there are no differences in the specialized treatment for thoracic injuries between general conditions and modern warfare, first aid, emergency treatment, and early treatment of thoracic injuries are introduced separately in three levels in this consensus. At Level Ⅰfacilities, tension pneumothorax and open pneumothorax are recommended for initial assessment during the first aid stage. Re-evaluation and further treatment for hemothorax, flail chest, and pericardial tamponade are recommended at Level Ⅱ facilities. At Level Ⅲ facilities, simple surgical operations such as emergency thoracotomy and debridement surgery for open pneumothorax are recommended. The grading standard for evidence evaluation and recommendation was used to reach this expert consensus.
文摘Aortic valve disease is a prevalent disorder that affects approximately 2% of the general adult population. Surgical aortic valve replacement is the gold standard treatment for symptomatic patients. This treatment has demonstrably proven to be both safe and effective. Over the last few decades, in an attempt to reduce surgical trauma, different minimally invasive approaches for aortic valve replacement have been developed and are now being increasingly utilized. A narrative review of the literature was carried out to describe the surgical techniques for minimally invasive aortic valve surgery and report the results from different experienced centers. Minimally invasive aortic valve replace- ment is associated with low perioperative morbidity, mortality and a low conversion rate to full sternotomy. Long-term survival appears to be at least comparable to that reported for conventional full sternotomy. Minimally invasive aortic valve surgery, either with a partial upper stemotomy or a right anterior minithoracotomy provides early- and long-term benefits. Given these benefits, it may be considered the standard of care for isolated aortic valve disease.
文摘Background Experiencing a pandemic can be very unsettling and may have a negative impact on the mental health of frontline healthcare workers(HCWs).This may have serious consequences for the overall well-being of HCWs,which in turn may adversely affect patient safety and the productivity of the institution.Aims We designed a study to assess the prevalence of generalised anxiety disorder(GAD),depression and work-related stress experienced by the National Health Service staff in a large tertiary London hospital treating patients with COVID-19 during the current active phase of the COVID-19 era.Methods An anonymous survey was designed with demographic data and three questionnaires.The Generalised Anxiety Disorder-7(GAD-7)and Patient Health Questionnaire-9 were used to assess anxiety and depression,respectively.The Health and Safety Executive Management Standards Indicator Tool was used to assess work-related stress.Staff from multiple specialties embracing cardiothoracic surgery,cardiology,respiratory medicine,endocrinology,oncology,imaging,anaesthesia and intensive care at our hospital were asked to complete the questionnaire between 25 May and 15 June 2020.Results A total of 302 staff members(106 males and 196 females)completed the survey.The overall prevalence of GAD and depression was 41.4%and 42.7%,respectively.The prevalence of GAD and depression was significantly higher in females than in males and was statistically significant.Nurses were four times more likely to report moderate to severe levels of anxiety and depression as compared with doctors.Work-related stress was also observed to be prevalent in our surveyed population with the following standards:relationships,role,control and change showing a need for improvement.Conclusions Our study presents early evidence suggestive of a high prevalence of GAD,depression and work-related stress in HCWs.It is imperative that coherent strategies are implemented to improve the healthcare work environment during this pandemic and mitigate further injury to the mental health status of the healthcare population.
文摘A best evidence topic was devised in light of a structured protocol. What is the advantage of （minl＂mally invasive） approach in （frail patients） undergoing （aortic valve replacement）？ In cardiac outpatient clinic you review an 85-year old male with severe aortic valve stenosis, low left ventricular ejection fraction and creatinine clearance of less than 50 mL/min. Other comorbidities include treated pulmonary hypertension, mild cognitive impairment, marked limitation of ordinary physical activity and depression. You resolve to determine whether to recommend mim＇mally invasive or conventional aortic valve replacement （AVR） or transcathe- ter aortic valve implantation （TAVI）, however you are not sure of the differences of the impact of frailty on preopera- tive risk for each approach; hence you investigate the best evidence on the topic.
文摘Objective: To construct an animal model of chronic ischemic myocardium, and evaluate it by ultrasonic integrated backscatter (IBS) and Doppler tissue imaging (DTI). Methods: An Ameroid constrictor was placed around the porcine left circumflex coronary artery (LCX). The calibrated average image intensity (%AII), cyclic variation of IBS (CVIB), transmural gradient index (TGI) of CVIB in lateral-posterior wall (LPW), and DTI spectrum of LPW in left ventricular papillary muscle level short axis view (LVPM-SAM) and apical four chamber view (AP-4CV) at normal state, 2, 4, 6 and 8 weeks postoperatively were measured. Results: Normal %AII, CVIB and TGI were 2.29±0.32, 9.69±2.22dB and 0.22±0.08, respectively. The %AII increased gradually postoperatively. The CVIB decreased also gradually, and the decrease was higher in subepicardium than in subendocardium. Most of TGI decrease occurred from 2 to 4 weeks postoperatively and became zero at 8 weeks (P<0.01); Normal V S (peak systolic velocity) of AP-4CV was higher than that of LVPM-SAM (P<0.01). V E (peak early diastolic velocity) of AP-4CV was lower than that of LVPM-SAM (P<0.05). V S and V E were all decreased after operation (P<0.01). The decrease of V S in AP-4CV was greater than that in LVPM-SAM. Conclusion: The pathological changes of the myocardium in human ischemic heart disease (IHD) are similar to that of Ameriod model. IBS and DTI can detect echo changes and ventricular wall motion in chronic ischemic myocardium, and provide more information for clinical investigation and treatment of IHD.
