Abstract： Quality of life （QOL） refers to an individual’s perception and subjective evaluation of their health and well-being, and has become an important index to evaluate the outcomes of clinical treatment in the last past decades. There are a large number of different instruments to evaluate QOL, and the 36-Item Short Form Health Survey （SF-36） is currently one of the most widely used instruments. In recent years, SF-36 has been used to evaluate QOL of valvular heart disease patients to investigate the risk factors those influence their postoperative QOL, provide more preoperative evaluation tools for clinical physicians, and improve postoperative outcomes of patients with valvular heart disease. However, it is now just the beginning to use SF-36 to examine QOL of valvular heart disease patients. Because of significant differences in sample size, follow-up period, country and culture, current research has some controversial results. This review focuses on the progress in evaluating QOL in postoperative patients with valvular heart disease using SF-36.
Abstract: The cyanotic congenital heart defect remains a focal point to study in congenital heart diseases. A successfully developed model of cyanotic congenital heart defect can contribute to a profound advancement of clinical diagnosis and treatment. Various kinds of animal models simulating cyanotic heart diseases have been created and improved step by step , such as experimental pulmonary arteriovenous fistulas, inferior vena cava-left atrium shunt, pulmonary artery-left atrium shunt and breeding animals in mionect ic environment. As an important means, they are used to investigate the animal’s pathophysilolgocal characteristics in cyanotic and hypoxic state. However, it need a further exploration since these models are not fully perfect yet.
Objective To evaluate outcomes of vacuum sealing drainage（VSD）for the treatment of wound infection after cardiac surgery.?Methods?We retrospectively analyzed clinical data of 70 patients（with valvular heart disease，congenital heart disease or coronary heart disease）who underwent cardiac surgery via mid-sternotomy and had postoperative wound infection from Jan. 2008 to Jan. 2012 in General Military Hospital of Guangzhou Command. According to different treatment strategy for wound infection, all the patients with wound infection （incision longer than 5 cm） were randomly divided into VSD group （n=35） and control group（n=35） by random number table，while VSD treatment was used for patients in VSD group and routine treatment was used for patients in control group. Treatment outcome，duration of wound infection, duration of antibiotic treatment and treatment cost were compared between the two groups.?Results?There was no in-hospital death in both groups. Wound exudate significantly decreased and fresh granulation tissue grew well in the wound in most VSD group patients after VSD treatment. The cure rate of VSD group was significantly higher than that of control group （94.3% vs. 60.0%，P＜0.05）. Duration of wound infection （12.9±3.4 d vs. 14.8±4.1 d；t=-2.094，P=0.040）and duration of antibiotic treatment （7.0±1.5 d vs. 8.3±1.9 d；t=-2.920，P=0.005） of VSD group were significantly shorter than those of control group. There was no statistical difference in treatment cost between the two groups. Fifteen patients in VSD group were followed up （42.9%） for 3 months with good wound healing, and 20 patients in VSD group were lost in follow-up.?Conclusion?VSD is effective for the treatment of wound infection after cardiac surgery with shortened treatment duration and similar treatment cost compared with routine treatment.
Abstract: Objective To observe the combined protective effects of U50 488H and hypothermia preservation on isolated rabbit hearts preconditioned. Methods Forty rabbits were randomly divided into five groups, 8 rabbits in each group. The perfusion model of isolated rabbit hearts was established by the Langendorff device. In the control group: the isolated rabbit hearts were preserved with the University of Wissconsin solution (UW ) for six hours; groupI : the isolated rabbit hearts were preconditioned with St. ThomasII cardioplegic solution containing U50 488H (1. 6mmo l/L ) and then preserved with hypothermic preservation for four hours; groupII ; the precondition was the same as group II , hypothermic preservat ion fo r six hours; group III : the precondit ion was the same as group I , hypothermic preservation for eight hours; group IV : the precondit on was the same as group I , hypothermic preservation for ten hours. The cardiac function, myocardial sarcoplasmic reticulum calcium ion adenosine triphosphatase (SRCa2+ -ATPase) act ivity and calcium ion concentrations in mitochondria were determined at thirty minutes after reperfusion. Results As the hypothermic preservation time increased from four to ten hours, the recovery rate of each index of cardiac function, coronary artery flow (Cf) and SRCa2+ -ATPase activity also decreased, but the calcium ion concentrations in the mitochondria increased. Cardiac function index recovery rates in group I and group II w ere higher than those in group III and groupIV respectively (P lt; 0. 05, 0. 01) ,meanwhile recovery rates of cardiac function index in group III were higher than that in group IV (P lt; 0. 05). Recovery rate of Cf in groupII ( 84. 56%±10. 38%)were higher than those in group III (79. 45%±9. 67% ) and group IV (68. 31%±6. 84% , P lt;0.01) , meanwhile the recovery rate of Cf in group III was higher than that in group IV (P lt; 0. 05). SRCa2+ -A Tpase activity in group II (4. 43±0. 41μmo l/m g?h)were higher than those in control group (3. 04±0. 22Lmo l/mg?h ) , group III (3. 26±0. 29Lmo l/m g?h) and group IV (2. 57±0. 63Lmo l/m g?h, P lt; 0. 05) , SRCa2+ -ATPase activity in group III was higher than that in group IV (P lt; 0. 01). The calcium ion concentrations in mitochondria in group II (38176±4. 30μmo l/g ?dw ) and in the control group (40. 23±3. 75μmol/g ?dw )were less than those in group III (43125±5116μmol/g?dw ) and groupIV (45. 78±3. 26μmol/g?dw , P lt; 0. 05, 0. 01) respect ively. Conclusion The hypothermic preservation time for isolated dono r’s hearts p re-treated with St. Thomas II cardioplegic solution containing U 50 488H should the kep tunder 8h. The myocardial protection effects of both UW solution and U50 488H- containing St. Thomas II cardioplegic solution on isolated dono r’s hearts appear to be the same at 6 hours.
Objective To study palliative surgical strategies for patients with complex congenital heart diseases， and improve their clinical outcomes and survival rate.?Methods We retrospectively analyzed clinical data of 95 patients with complex congenital heart diseases who underwent palliative surgical repair in Union Hospital of Tongji Medical College，Huazhong University of Science and Technology from January 2004 to May 2011. There were 68 male patients and 27female patients with their age ranging from 1 month to 37 years. Modified Blalock-Taussig shunt （B-T shunt） was performed in 12 patients， modified Brock’s procedure in 23 patients， bidirectional Glenn procedure in 55 patients and pulmonary artery banding in 5 patients. Surgical strategies and influential factors of treatment outcomes were analyzed.?Results There were 10 in-hospital death with the overall mortality of 10.5% （10/95）. All the surviving patients were discharged successfully. Main postoperative complications included low cardiac output syndrome， hypoxemia and pneumonia. All the surviving patients were followed up for 5 months to 6 years， and in New York Heart Association （NYHA） functional class ⅠorⅡduring follow-up. During follow-up， nine patients after modified Brock’s procedure received radical repair， and 6 patients after bidirectional Glenn procedure received total cavopulmonary connection.?Conclusion A considerable numberof patients with complex congenital heart diseases may miss their best timing for surgical repair， which significantlyinfluences their surgical outcomes. We need to choose best palliative surgical strategy for these patients according to their pulmonary artery development condition， heart malformation characteristics and final treatment goal.
Abstract： Objective To construct an Anticoagulation Therapy Database of Chinese Patients after Heart Valve Replacement in accordance with blood coagulation characteristics of Chinese patients， fill the gap of Chinese clinical research in valvular heart diseases， and provide a scientific and objective basic data and information exchange platform. Methods A national multicentre，prospective and cohort clinical research method was applied to establish an anticoagulation therapy database of Chinese patients after heart valve replacement， using the Internet as a platform. A case report form （CRF）， which was in line with the actual situation of Chinese anticoagulation patients after heart valve surgery， was formulated through the discussion of experts from 36 cardiovascular surgery centers in China in the starting meeting of National Science amp; Technology Support Program during the Twelfth Five-year Plan Period.We planned to prospectively include patients receiving warfarin anticoagulation therapy and formal anticoagulation monitoring after heart valve replacement from January 1, 2011 to December 31, 2014. Database was constructed using warehousing technology， which allowed not only data monitoring， query and statistics， but also regular data backup and system updates. Results A network database entitled Anticoagulant Therapy Database of Chinese Patients after Heart Valve Replacement was constructed and linked with the homepage of Chinese Journal of Clinical Thoracic and Cardiovascular Surgery （http：//www. zgxxwkzz. com）， which constituted a national Internet information platform. From 1 January 2011 to 1 December 2012， 8 452 anticoagulation patients after heart valve replacement from 34 level-3A hospitals in China had been registered in the database. Further follow-up of these patients was being carried out in respective hospitals. Conclusion A large multi-center and open database and network information platform has been constructed. The database variables are in line with clinical characteristics of Chinese anticoagulation patients after heart valve replacement， which provide scientific and objective basic data and support for future clinical research and systemic analysis.
Objective To investigate clinical diagnosis，timing of surgery and perioperative therapeutic strategies for blood culture-negative infective endocarditis （IE）. Methods Clinical data of 240 IE patients who were admitted tWuhan Asia Heart Hospital between July 2008 and July 2012 were retrospectively analyzed. According to their blood cultureresults，all the patients were divided into blood culture-negative group and blood culture-positive group. In the blood culture-negative group，there were 158 patients including 88 male and 70 female patients with their age of 51.3±10.1 years. In the blood culture-positive group，there were 82 patients including 45 male and 37 female patients with their age of 48.9±9.8 years. All the patients underwent surgical treatment，and the surgical procedures included complete vegetations excision，debridement of infected valves，removal of necrotic tissue around the annulus，and concomitant heart valve replacement or intracardiac repair. Postoperatively，all the patients received routine monitoring in ICU，cardiac glycosides，diuretics，other symptomatic treatment and adequate dosages of antibiotics for 4-6 weeks. Results Four patients died postoperatively in this study including 1 patient for low cardiac output syndrome and 3 patients for multiple organ dysfunction syndrome，1 patient in the blood culture-positive group and 3 patients in the blood culture-negative group respectively. There was no statistical difference in surgical mortality between the 2 groups （χ2=0.15，P=0.70）. All the other patients were discharged successfully and followed up for 6 to 36 months with the median follow-up time of 22 months. During follow-up, 2 patients died including 1 patient for cerebral infarction 2 years after surgery and another patient for cerebral hemorrhage 3 yearsafter surgery. Conclusion Patients with blood culture-negative IE should receive adequate dosage and duration of broad-spectrum antibiotics to control the infection rapidly, and aggressive surgical therapy to decrease in-hospital mortality and improve their quality of life and prognosis.