ObjectiveTo investigate the clinical features and prognosis of fibrinous mediastinum and evaluate the value of different examinations in diagnosis and evaluation. MethodsTwenty-eight patients with mediastinal fibrosis diagnosed between January 2015 and September 2020 in China-Japan Friendship Hospital were studied retrospectively. The Clinical manifestations, radiological characteristics, endoscopic features, echocardiography, V/Q SPECT, cardiac catheterization, treatment and prognosis were analyzed.ResultsThe main clinical symptoms were cough (77.6%), expectoration (57.1%), wheezing or suffocating (42.9%), dyspnea (39.3%). There were 67.9% of the cases who were considered previous or present tuberculosis. Imaging findings showed that the fat density in the mediastinum disappeared, the irregular soft tissue of the mediastinum surrounded the airway and pulmonary vessels, and many lymph nodes enlarged and calcified, and multiple bronchus and pulmonary vessels were compressed and narrowed. Pulmonary function was mainly manifested as obstructive ventilate dysfunction and decreased diffusion volume. Under bronchoscopy, the bronchial mucosa showed pigmentation, bronchial distortion or multiple stenosis, even occlusion, and bronchial mucosa edema or congestion. Echocardiography and catheterization of the right heart showed that pulmonary hypertension and diastolic cardiac dysfunction were common complications of fibrillary mediastinum. Pulmonary ventilation perfusion imaging showed impaired blood perfusion in 87.5% of patients and impaired ventilation perfusion in 37.5% of patients. The symptoms of some patients alleviated after anti-infective and symptomatic treatment, but the mediastinal fibrosis was irreversible, and the efficacy of anti-tuberculosis and glucocorticoid therapy was limited. ConclusionsFor patients with clinical consideration of fibrous mediastinum, chest enhanced CT should be performed for clear diagnosis. Relevant examinations, such as pulmonary function, endoscopic, echocardiography, should be conducted to evaluate whether the disease involves airway, pulmonary vessels, pericardium, superior vena cava and esophagus, as well as the degree of functional involvement. Attention should be paid to the evaluation of patients with pulmonary hypertension and diastolic cardiac insufficiency.
Objective To explore and compare the diagnostic value of blood pressure, brain natriuretic peptide (BNP), pulmonary artery systolic pressure (PASP) in evaluating right ventricular dysfunction (RVD) in patients with acute pulmonary embolism (APE). Methods A retrospective study was conducted on 84 APE patients who were diagnosed by computed tomographic pulmonary angiography. The patients were divided into a RVD group and a non-RVD group by echocardiography. Eighteen clinical and auxiliary examination variables were used as the research factors and RVD as the related factor. The relationship between these research factors and RVD were evaluated by logistic regression model, the diagnostic value of BNP and PASP to predict RVD was analyzed by receiver-operating characteristic (ROC) curve analysis. Results The patients with RVD had more rapid heart rate, higher diastolic blood pressure, higher mean arterial pressure, higher incidence of BNP>100 pg/ml and higher incidence of PASP>40 mm Hg (allP<0 05="" upon="" logistic="" regression="" model="" bnp="">100 pg/ml (OR=4.904, 95%CI 1.431–16.806, P=0.011) and PASP>40 mm Hg (OR=6.415, 95%CI 1.509–27.261, P=0.012) were independent predictors of RVD. The areas under the ROC curve to predict RVD were 0.823 (95%CI 0.729–0.917) for BNP, and 0.798 (95%CI 0.700–0.896) for PASP. Conclusions Blood pressure related parameters can not serve as a predictor of RVD. Combined monitoring of BNP level and PASP is helpful for accurate prediction of RVD in patients with APE.
Objective To access the efficacy and safety of different doses of metoprolol for patients with chronic heart failure. Methods We searched databases such as MEDLINE, EMbase, The Cochrane Library, CBM and CMCC. The search was conducted in March 2006. Randomised controlled trials, systematic reviews, and current guidelines of chronic heart failure were reviewed. The efficacy and safety of the high-dose (≥100 mg/d) and low-dose metoprolol (lt;100 mg/d) were compared. Results Only one small-scale, short-term randomised trial met our inclusion criteria. This found that metoprolol 100 mg/d was more effective than 25 mg/d and 50 mg/d. A sub-group analysis of MERIT-HF recommended individualized titration for drug administration. Most guidelines suggested that the administration of metoprolol CR/XL for chronic left ventricular systolic dysfunction should be performed by titrating up to 200 mg/d or the maximum tolerance dose. Patients receiving 100 mg/d might have more adverse events than those receiving a lower dose than this. However, in the long-term, it’s the benefits of high-dose treatment outweighed its risks. Race-related differences in tolerance or dose-related adverse effects were not found. Conclusion We couldn’t determine an optimal dose based on the existing evidence, but a target dose of metoprolol CR/XL 200 mg/d is safe and effective. We are unable to draw any conclusions about the relationship between dose and adverse effects.
Objective To investigate clinical outcomes of one and a half ventricle repair for acute right ventricular dysfunction after biventricular repair. Methods Clinical data of 5 pediatric patients with congenital heart diseases who underwent emergency bidirectional Glenn shunt without cardiopulmonary bypass for acute right ventricular dysfunction after biventricular repair，converting the operation into one and a half ventricle repair，from February 2007 to June 2012 in Qingdao Women and Children Hospital were retrospectively analyzed. There were 4 male patients and 1 female patient with their age of 7-18 months and body weight of 6-13 kg. Preoperative diagnosis included pulmonary atresia with intact ventricular septum （PA/IVS） in 1 patient，tricuspid stenosis （TS） with ventricular septal defect （VSD） and atrial septal defect （ASD） in 2 patients，and tricuspid stenosis with tetralogy of Fallot （TOF） in 2 patients. Postoperative care focused on cardiopulmonary support and control of pulmonary artery pressure. Results Mean pulmonary artery pressure （mPAP） was 12-18 mm Hg at 72 hours after emergency bidirectional Glenn shunt. Mechanical ventilation time was 3-182 hours and ICU stay was 2-13 days. Postoperatively 1 patient died of pulmonary hypertension crisis. The other 4 patients were discharged with their transcutaneous oxygen saturation in the resting state of 93%-99%，which was improved in different degrees compared with preoperative value. These 4 patients were followed up from 6 months to 4 years. Three patients were in NYHA classⅠand 1 patient was in NYHA class Ⅱ during follow-up. Echocardiography showed smooth vena cava to pulmonary artery anastomosis without thrombosis formation. Conclusion One and a half ventricle repair can be used as an adjunct surgical strategy for acute right ventricular dysfunction after biventricular repair.
Objective To systematically review whether the prevalence of left ventricular diastolic dysfunction was higher in systemic sclerosis (SSc) patients. Methods The Cochrane Library, PubMed, EMbase, CBM, CNKI and WanFang Data databases were electronically searched to collect the studies about comparing echocardiographic parameters in SSc patients and controls from January 1990 to June 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software. Results A total of 22 studies involving 1 146 patients were included. The results of meta-analysis showed that: compared to controls, patients with SSc had prolonged left isovolumetric relaxation time (MD=10.40, 95%CI 4.04 to 16.77, P=0.001), higher trans-mitral A-wave velocity (MD=0.11, 95%CI 0.07 to 0.15, P<0.000 01), prolonged mitral deceleration time (MD=8.04, 95%CI 2.66 to 13.42,P=0.003), larger mean left atrial dimension (MD=1.43, 95%CI 0.11 to 2.76, P=0.03), higher estimated pulmonary artery pressure (MD=11.35, 95%CI 6.08 to 16.6, P<0.001), higher E/E’ ratio (MD=2.08, 95%CI 0.19 to 3.96,P=0.03) and lower trans-mitral E-wave velocity (MD=–0.03, 95%CI –0.05 to –0.01, P=0.000 3), mitral E/A ratio (MD=–0.24, 95%CI –0.32 to –0.15, P<0.000 01) and trans-mitral E’-wave velocity (MD=–1.52, 95%CI –2.44 to –0.60,P=0.001). There were no differences in left ventricular ejection fraction, isovolumetric end-systolic dimension, septal end-diastolic thickness and posterior wall end-diastolic thickness, trans-mitral A’-wave velocity, E’/A’ ratio. Conclusion SSc patients are more likely to have echocardiographic parameters of LVDD. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.
ObjectiveTo analyze the early outcomes of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) patients with severe left ventricular dysfunction after surgical repair, and to explore the predictors for extracorporeal membrane oxygenation (ECMO) support for these patients.MethodsThe clinical data of ALCAPA patients with severe left ventricular dysfunction (left ventricular ejection fraction<40%) who underwent coronary artery reimplantation in the pediatric center of our hospital from 2013 to 2020 were retrospectively analyzed. The patients were divided into an ECMO group and a non-ECMO group. Clinical data of the two groups were compared and analyzed.ResultsA total of 64 ALCAPA patients were included. There were 7 patients in the ECMO group, including 4 males and 3 females aged 6.58±1.84 months. There were 57 pateints in the non-ECMO group, including 30 males and 27 females aged 4.34±2.56 months. The mortality of the patients was 6.25% (4/64), including 2 patients in the ECMO group, and 2 in the non-ECMO group. The postoperative complications rate was significantly higher in the ECMO group than that in the non-ECMO group (P=0.041). There were statistical differences in the cardiopulmonary bypass time [254 (153, 417) min vs. 106 (51, 192) min, P=0.013], aortic cross-clamping (ACC) time (89.57±13.66 min vs. 61.58±19.57 min, P=0.039), and preoperative left ventricular end-diastolic diameter/body surface area (132.32±14.71 mm/m2 vs. 108.00±29.64 mm/m2, P=0.040) between the two groups. Multivariate logistic regression analysis showed that ACC time was an independent risk factor for postoperative ECMO support (P=0.005). Receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curve was 0.757, the sensitivity was 85.70%, specificity was 66.70%, with the cut-off value of 66 min.ConclusionACC time is an independent risk factor for postoperative ECMO support. Patients with an ACC time>66 min have a significantly higher risk for ECMO support after the surgery.
Objective To evaluate the longterm results of coronary artery bypass grafting (CABG) in treating cardiac diseases with heart insufficiency by analyzing the longterm survival rate and heart failure exemption rate of the patients. Methods A total of 239 patients who had coronary heart disease with left heart dysfunction (LVEFlt;40%) were enrolled in our study. Among the patients, there were 215 males and 24 females aged from 32 to 78 years old with an average age of 59.1. Before operation, 193 patients had a past history of myocardial infarction and 31 had angina. According to the New York heart function assessment (NYHA), 26 patients were categorized as class Ⅰ, 106 as class Ⅱ, 73 as class Ⅲ and 34 as class Ⅳ. Coronary angiography showed 10 cases (4.2%) of single vessel disease, 35 cases (14.6%) of double vessel disease and 194 cases (81.2%) of triple vessel disease. The result of preoperative ultrasound cardiogram showed that LVEF was 35.7%±4.6%. All patients received CABG, including 153 (64.0%) onpump surgeries and 86 (35.9%) offpump surgeries. Selective operation was done on 237 patients and there were 2 emergency cases. Valve repair or replacement, ventricular aneurysmectomy or aneurysm plication were not carried out during the operation. Results There were 1 to 6 (3.4±1.1) bypass grafting vessels in each case. Five (2.09%) patients died during the hospital stay, among which 2 died of low cardiac output and circulation failure, 1 died of malignant arrhythmia, 1 died of renal failure, and 1 died of coma with multiorgan failure. The followup period was 512±1.79 years. During the followup, 18 patients (7.7%) were lost and 29 patients died. Among them, there were 24 cardiac deaths and the cardiac death rate at the first year and the fifth year was 2.8% and 9.4% respectively. There were 40 cases of heart failure during the followup period. The exemption rate of heart failure was 93.7% and 81.8% at the first year and the fifth year respectively. The survival rate was 97.2% at the first year and 89.3% at the fifth year. Conclusion The longterm result of CABG in treating patients with ischemic heart insufficiency is satisfying.
Objective To analyze the clinical features of patients with acute pulmonary embolism ( APE) with normal blood pressure and right ventricular dysfunction. Methods 130 hospitalized patients with normotensive APE between January 2009 and January 2012 were retrospectively analyzed. The patients underwent transthoracic echocardiography to determine if they were complicated with RVD. The clinical features, risk factors, diagnosis, and treatment were analyzed and compared between the normotensive APE patients with or without RVD. Results 41 normotensive APE patients with RVD were as RVD group, and other 89 patients without RVD were as non-RVD group. The incidences of syncope ( 34.1% vs. 7.8% ) , tachycardia( 41.4% vs. 21.3% ) , P2 hyperthyroidism( 46.3% vs. 25.8% ) , jugular vein filling ( 12.1% vs. 1.1% ) , and cyanosis ( 26.8% vs. 8.9% ) were all significantly higher in the RVD group than those in the non-RVD group ( P lt; 0.05) . Computed tomography pulmonary angiography ( CTPA) revealed that the incidences of thromboembolism involving proximal pulmonary artery ( 58. 3% vs. 8. 3% ) and thromboembolism involving lobar pulmonary ( 77.8% vs.51.2% ) were also higher in the RVD group ( P lt; 0.001, P = 0.025 ) . In the RVD group, the patients were assigned to received thrombolysis plus anticoagulation therapy, or anticoagulation therapy alone. The clinical indicators ( heart rate, PaCO2 , AaDO2 , SPAP, TRPG) were all statistically improved after thrombolysis or anticoagulation treatment ( P lt;0.001) . But compared with the patients who underwent anticoagulation therapy alone, the cost of treatment and the incidence of minor bleeding were significantly higher, and the levels of AaDO2 , SPAP and TRPG were statistically lower in the patients with thrombolysis plus anticoagulation therapy. Conclusions For APE patients with central pulmonary embolism demonstrated by CTPA, syncope, and tachycardia, transthoracic echocardiograph should be performed as early as possible to confirm RVD diagnosis. For normotensive APE patients with RVD, anticoagulant treatment can achieve higher efficacy of costeffectiveness ratio.