Pulmonary hypertension due to left heart disease (PH-LHD) is the most common in various types of pulmonary hypertension. Although there are many treatments for pulmonary hypertension, it may be harmful when we adopt treatment without detrimental diagnosis and classification of pulmonary hypertension. Therefore, it is very crucial to have accurate diagnosis and classification of pulmonary hypertension before making treatment decisions. However, there are still some difficulties in the classification of pulmonary hypertension in clinical work. It is a great challenge with limited treatment to solve the PH-LHD which often has complicated pathophysiological mechanisms of precapillary and postcapillary pulmonary hypertension. Here, we review the research status of PH-LHD.
Surgical aortic valve replacement is the primary choice for the treatment of aortic valve stenosis. It can significantly improve the quality of life and life expectancy of patients, but some patients have risks such as advanced age and poor general conditions and can not receive open chest surgery. In 2002, a French doctor, Cribier, successfully performed transcatheter aortic valve implantation (TAVI) surgery on a patient with aortic stenosis. At present, the safety and effectiveness of TAVI surgery have been confirmed by many studies. However, its complications are also relatively common. This article summarizes the related reports at home and abroad.
This study reports the first successful clinical application of a robotic-assisted system in transcatheter balloon-expandable aortic valve implantation using the Edwards SAPIEN 3 valve. Two male patients, aged 60 and 63 years, respectively, presented with severe aortic stenosis confirmed by echocardiography and computed tomography, showing significant valvular calcification and elevated transvalvular pressure gradients, meeting the indications for transcatheter aortic valve implantation (TAVI). Both procedures were performed via the right femoral artery using a robotic-assisted delivery and positioning system developed by Shanghai Surgerii Medical Technology Co., Ltd. The operator controlled the delivery system and valve positioning precisely through the console, while the assistant performed balloon expansion and valve deployment. Both procedures were completed successfully without intraoperative complications. The operative times were 75 minutes and 67 minutes, with fluoroscopy times of 16 minutes and 23 minutes, and radiation doses of 714 mGy and 971 mGy, respectively. Postoperative echocardiography demonstrated well-functioning prosthetic valves, with mean transvalvular pressure gradients of 3.9 mm Hg and 8.0 mm Hg, and none or trivial paravalvular leakage. No coronary obstruction, conduction disturbance, or vascular complications were observed.This report represents the world’s first clinical use of a robotic-assisted system for balloon-expandable TAVI. It confirms the feasibility and safety of robotic assistance in transcatheter valve delivery and positioning, offering a new approach to enhance procedural precision and stability, and providing valuable insights for the future development of intelligent, minimally invasive therapies for structural heart disease.
Transcatheter aortic valve replacement (TAVR) for severe aortic stenosis is growing rapidly. The use of new heart valves prosthesis has improved surgical safety and efficacy. This report described a 72-year-old male patient with severe aortic stenosis combined with severe aortic regurgitation, who was evaluated at moderate-high risk of surgery and received a transapical TAVR using the Ken-Valve heart valve. The transcatheter operation time was 8 min, and the blood loss was 50 mL. The tracheal intubation was removed immediately after the surgery. Transesophageal echocardiography on the 4th postoperative day showed that the aortic valve leaflets worked well, and there was no valve orifice and paravalvular leakage. The patient was discharged on the 5th day after the surgery without complications. Transapical TAVR using Ken-Valve was an easy surgical procedure for aortic valve disease, and had short operation time.
Transcatheter aortic valve replacement (TAVR) techniques have been rapidly developed in recent years. Current guidelines and studies mainly focus on aortic stenosis patients treated by transfemoral approach, but they are not completely appropriate to patients with isolated aortic regurgitation or other patients who need transapical TAVR (TA-TAVR), which affects the standardized treatment of those patients. Therefore, our team pronounced the operational standards for TA-TAVR, based on fully reviewing the literatures worldwide, combined with the opinions of experts from 15 heart centers with rich experience in carrying out TA-TAVR in China. This standard aims to provide clinicians with standardized diagnosis and treatment principles of TA-TAVR and improve the quality of TA-TAVR in China.
The technique of transcatheter aortic valve implantation has become increasingly mature. Although the transapical approach has a certain degree of minimally invasive trauma, it still has the characteristics such as heart beating without cardiopulmonary bypass, and the low technical requirements of catheter guide wire. In particular, the valve path is short and coaxial, which is easy to manipulate, and pure regurgitation and stenosis can be easily operated and are not subject to the limit of peripheral artery stenosis. It is still one of China's main approaches for transcatheter aortic valve replacement. Its perioperative management still has specific features and differs from the femoral artery approach. In addition, there is little relevant literature abroad. Therefore, domestic experts in this field were organized to discuss the development of perioperative management specifications to provide reference and techniques support for developing this field in China and further improve the quality of clinical operation and perioperative management. It will provide more safe and more effective medical services to these patients.
Transcatheter aortic valve replacement (TAVR) has been confirmed to be safety and efficacy for high-risk elderly aortic stenosis, and the clinical effect of TAVR for medium and low-risk aortic stenosis is not worse than that of surgery. The development of surgical techniques and instruments has made cardiologists attempt to broaden the surgical indications. Many elderly and high-risk patients with pure native aortic regurgitation have been treated “off label” with similar techniques, completing artificial valve replacement, restoring valve function and improving the prognosis. However, due to the high requirements of surgical techniques and surgical complications, there is a lack of randomized controlled studies to confirm its safety and effectiveness. Unlike aortic stenosis, native aortic regurgitation presents unique challenges for transcatheter valves. In this article, the authors review current advances in the treatment of aortic valve regurgitation with TAVR.
ObjectiveTo evaluate the early and mid-term outcomes of total thoracoscopic Box Lesion radiofrequency ablation in patients with atrial fibrillation.MethodsThe clinical data of 31 patients with atrial fibrillation who underwent total thoracoscopic Box Lesion radiofrequency ablation between November 2011 and March 2018 at the Department of Cardiac Surgery in our hospital were retrospectively analyzed, including 23 males and 8 females at an average age of 66.17±8.32 years. All patients did not have concomitant severe organic heart disease which required surgical intervention.ResultsThere were 20 patients with paroxysmal atrial fibrillation, 8 with persistent atrial fibrillation, and 3 with long-standing persistent atrial fibrillation. Twenty-nine patients got the 3-year follow-up, and 2 patients were lost to the follow-up 6 months after the surgery. The procedure was successfully performed in all patients, with an average operation time of 113.00±26.00 min. There was no perioperative death or related complication. All patients were restored to sinus rhythm immediately after surgery. Five patients got atrial fibrillation during postoperative hospitalization, which reverted to sinus rhythm after electrical cardioversion. The rate of sinus rhythm maintenance was 62.9%, 55.9% and 52.4% in postoperative 1, 2 and 3 years, respectively. No patient died during the period, and no procedure-related complication was observed.ConclusionTotal thoracoscopic Box Lesion radiofrequency ablation effectively shortens operation time, and reduces surgical trauma and procedure-related complications, meanwhile, ensures the surgical outcomes.
Objective To analyze the metabolic characteristics of myocardial infarction (MI) using metabolomics to better understand its pathogenesis and to explore new therapeutic directions for MI. Methods Serum metabolites in ten acute MI mice and five sham-control mice were analyzed by UHPLC-QqQ/MS, and SPSS was used for statistical analysis. MetaboAnalyst 5.0 was used to analyze the metabolic pathways of the differential metabolites and build a metabolic network. Results One hundred and twenty-nine metabolites were detected by UHPLC-QqQ/MS. Significant serum metabolite differences were found between MI mice and normal controls. Fifty out of 129 metabolites in serum were associated with MI. In addition, the most important metabolic pathways were D-glutamate metabolism, alanine, aspartate and glutamate metabolism, glycine, serine and threonine metabolism, glyoxylate and dicarboxylate acid metabolism. ConclusionMetabolites in serine-related metabolic pathways reduce in serum in MI. We propose a new therapeutic direction for myocardial protection in MI.
Objective To modify the method for aortic end strengthening in acute type A aortic dissection operation, and investigate its clinical efficacy. Methods We modified the method for aortic end strengthening in acute aortic dissection operation based on ‘Sandwich method’ in the department of thoracic and cardiovascular surgery of West China Hospital. From January 2006 to December 2008, twentyeight patients with acute type A aortic dissection underwent modified aortic end strengthening operation. We made adventitia turn over and enfold to strengthen the aortic end in 10 cases, and placed stripshaped felt or pericardium belts between dissection (between adventitia and intima)and inner intima and strengthened the aortic end by suture in 18 cases. The hemorrhage of anastomotic stoma and the postoperative early prognosis were observed. Results No bleeding complication was found in all the cases. Two cases died, one died of severe low cardiac output syndrome and another died of multiple organ failure. No nervous system complication was found except that 2 cases had delayed revival. No sternum and surgical incision related complication was found. The rest 26 cases were cured and discharged. Conclusion The modified method for aortic end strengthening can not only strengthen the aortic end but also make people be able to find the petechia of anastomotic stoma clearly, then stitch hemostasia could be done effectively. The method is easy to implement and effective, it should be extend in clinic.