Objective To investigate the correlation between the left atrial hydrodynamic change and atrial fibrillation (AF) in the patients with rheumatic mitral stenosis. Methods According to cardiac rhythm before operation, 49 patients with rheumatic mitral stenosis accompanying chronic AF were divided into two groups,group A: AF, 25 cases; group B: sinus rhythm, 24 cases. Control group : 29 healthy volunteers were examined. By using echocardiography, left atrial hydrodynamics were tested, and repeated 6-8 months after the operation. Results Left atrial stress (LAS), left atriala area (LAA) and left atrial volume(LAV) in group A after operation was much lower than before operation, LAS after operation in group B was also lower than before operation(Plt;0.01). Before operation, LAS in group A was significantly lower than that in group B, LAA and LAVwere larger. After operation, LAA and LAV in group A were significantly larger than those in group B(Plt;0.01). LAS, LAA and LAV in group A and group B before and after operation were higher than those in control group. Conclusion Left atrial hydrodynamic enviroment in patients with mitral stenosis has not reached normal even after valve replacement, LAS may be an important factor of causing AF.
ObjectiveTo evaluate myocardial segmental motion function in left ventricular of patients with rheumatic mitral stenosis by using the technology of real-time three-dimensional echocardiography (RT-3DE). MethodsWe retrospectively analyzed the clinical data of 14 patients with rheumatic mitral stenosis between October and November 2014 in our hospital as a trial group. There were 4 males and 10 females with a mean age of 50.9±9.0 years ranging from 34 to 64 years. We chose 11 healthy individuals as a control group. There were 7 males and 4 females with a mean age of 49.5±9.7 years ranging from 32 to 67 years. Both the two groups were subjected to myocardial performance evaluation using two-dimensional echocardiography (2DE) and real-time three-dimensional echocardiography (RT-3DE) to examine the left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), longitudinal strain, circumferential strain, area strain, and lateral strain of each left ventricular myocardial segments. Result RT-3DE detected that the trial group had significantly lower values of LVEF, LVEDV and LVESV than those of the control group (P < 0.05). RT-3DE also revealed that the trial group had a significantly weaker longitudinal strain than the control group (P < 0.05). ConclusionRT-3DE is an accurate technology for assessing myocardial motion and function in patients with rheumatic mitral valve disease.
Surgical treatment of atrial septal defect (ASD) mainly includes occlusion or repair under cardiopulmonary bypass. Surgical treatment of atrial fibrillation includes transcatheter radiofrequency ablation or Maze surgery under cardiopulmonary bypass. There are many treatments for ASD patients combined with atrial fibrillation, but each has its own advantages and disadvantages. We reported an ASD patient combined with atrial fibrillation treated by totally endoscopic "one-stop" radiofrequency ablation and simultaneous transthoracic ASD occlusion of atrial fibrillation, with good postoperative results.
ObjectiveTo evaluate the performance and safety of a novel device for left atrial appengdage (LAA) closure in dogs. MethodsThrough the fourth left intercostal, the LAA clips were implanted at the base of LAA in six dogs. Macroscopic pathology, histopathology and biological detection were performed at 7 d, 60 d, 90 d, 180 d after implan-tation respectively. ResultsThe devices were all successfully implanted at the base of LAA. There is no transposition of the LAA clips. Complete fibrosis and atrophy of LAA occurred at 60 d after implantation. LAA closure was completed with a new endothelial tissue layer developed on the occluded orifice of the left atrium after 60 d after implantation. The level of atrial natriuretic peptide did not decrease significantly after the device implantation (275.64±60.00 pg/ml vs. 248.34±56.10 pg/ml, P=0.529). ConclusionThe novel device for LAA closure achieved easy, reliable and safe closure of the LAA in canine model.
Objective To evaluate clinical results of concomitant mitral valve replacement （MVR） and modified maze procedure with Atricure bipolar radiofrequency for chronic atrial fibrillation （AF）. Methods Clinical data of 59 patients with mitral valve diseases and chronic AF who underwent concomitant MVR and bipolar radiofrequency ablation in Subei People’s Hospital from June 2010 to September 2012 were retrospectively analyzed. There were 22 male and 37 female patients with their age of 29-71 （48±11） years. The AF duration was 1.2-26.0 （7.2±3.4） years. Preoperatively，there were 20 patients with New York Heart Association （NYHA） class Ⅱ，31 patients with NYHA class Ⅲ and 8 patients with NYHA class Ⅳ. There were 32 patients with moderate to severe mitral stenosis，9 patients with moderate to severe mitral regurgitation and 18 patients with combined mitral stenosis and regurgitation. There were 42 patients with tricuspid regurgitation. The left artial dimension was 39-98 （55.2±8.9） mm. Left atrial thrombus was found in 9 patients. Atricure bipolar radiofrequency system was used for right atrial ablation under normothermic cardiopulmonary bypass （CPB） with beating heart first，then for ablations of the left and right pulmonary vein orifices and left atrium under moderate hypothermia with heart arrest. MVR was performed after ablation procedures were completed. Amiodarone was routinely used postoperatively and patients were periodically followed up after discharge. Results There was no in-hospital death. CPB time was 65-180 （99±28）minutes，aortic cross-clamping time was 46-123 （69±17）minutes，and ablation time was 15-28 （21±4）minutes. Postoperatively，heart rhythm immediately changed to sinus rhythm （SR） in 44 patients，remained AF in 10 patients and atrial flutter in 1 patient. Temporary pacemaker was used for 4 patients with bradycardia （3 patients recovered SR and 1 patient remained AF later）. Fifty-eight patients were followed up after discharge for 6-33 months，and 1 patient was lost during follow-up. Patients’ SR rate was 86.2 % （50/58），91.4% （53/58），89.7 % （52/58），84.6 % （33/39）and 71.4 % （5/7）at discharge，3 months，6 months，1 year and 2 years after discharge respectively. There was no thrombotic event during follow-up. Conclusion Concomitant MVR and modified maze procedure with Atricure bipolar radiofrequency is a safe procedure for chronic AF with good short-term results.
Objective To evaluate the value of preoperative B-type natriuretic peptide （BNP） level in predicting new onset atrial fibrillation （AF） in patients after coronary artery bypass grafting （CABG）. Methods We electronically searched PubMed，EMbase，Cochrane library，CNKI and VIP databases from the establishment of those databases to November 2012. Evaluation standard of diagnostic tests was used to identify and screen literatures which investigated correlations between preoperative BNP levels and new onset AF of patients after CABG. Quality Assessment of Diagnostic Accuracy Studies （QUADAS） was used to evaluate study quality of included literatures. RevMan 5.0 was used for heterogeneity test. Meta-Disc 1.4 software was used for meta-analysis. Included studies were weighted and then combined. Sensitivity，specificity，diag- nostic odds ratio （DOR），positive likelihood ratio，negative likelihood ratio and corresponding 95% confidence interval（95% CI）were calculated. Summary receiver operating characteristic （SROC） curve was drawn，and the area under the SROC curve （AUC） was analyzed. Results A total of 236 studies were identi?ed，and 5 studies met the eligibility criteria including 802 patients for analysis. There were 228 patients with postoperative new onset AF，and 574 patients without postoperative AF. The quality of the included literature was relatively high. DOR of preoperative elevated BNP level with postoperative new onset AF was 4.15 with 95% CI 2.90 to 5.95. Pooled sensitivity was 0.78 with 95% CI 0.72 to 0.83，pooled specificity was 0.58 with 95% CI 0.54 to 0.58，pooled positive likelihood ratio was 1.91 with 95% CI 1.42 to 1.56，pooled negative likelihood ratio was 0.42 with 95% CI 0.32 to 0.54，and the AUC of SROC was 0.79 （Q=0.72）. Conclusion Preoperative elevated BNP level is significantly correlated with new onset AF after CABG，is a powerful predictor of postoperative AF，and can be used to predict new onset AF after CABG to a certain extent of reliability.
ObjectiveTo study on the relationship of serum apelin level with inflammation in patients with atrial fibrillation (AF). MethodsWe recruited 58 patients with valvular heart disease who admitted in our hospital between October 2014 and December 2014 and planned to undergo surgery, including 29 patients with persistent AF (an AF group) and 29 patients with sinus rhythm (a SR group). There were 14 males and 15 females in the AF group at an average age of 57±8 years. There were 20 males and 9 females in the SR group at an average age of 54±10 years. The left atrial diameter (LAD) and ejection fraction (EF) were detected by echocardiography. The levels of serum apelin and interleukin-6 (IL-6) were measured by enzyme linked immuno sorbent assay, and the level of high-sensitivity C-reactive protein (hs-CRP) were determined by turbidimetric inhibition immuno assay. ResultsCompare with the SR group, the serum apelin level (201.94±71.96 pg/ml vs. 286.72±129.33 pg/ml) and EF (54.52%±3.94% vs. 56.41%±2.85%) were significantly lower in the AF group, while the hs-CRP (5.58±12.90 mg/L vs. 1.89±3.55 mg/L), IL-6 (2.59±0.64 pg/ml vs. 2.26±0.55 pg/ml) and LAD (57.10±11.69 mm vs. 43.07±5.31 mm) were significantly higher in the AF group (P<0.05). Correlation analysis showed that the apelin level was negatively correlated with hs-CRP and LAD (r=-0.308, P=0.019; r=-0.313, P=0.017), and were positively correlated with EF (r=0.265, P=0.044). ConclusionSerum apelin level is significantly lower in patients with AF and levels of inflammation makers are significantly higher. Apelin may be closely related to AF and inflammation, and may take part in the occurrence and maintenance of AF through the regulation of inflammatory processes.