ObjectiveTo analyze the clinical presentations and radiological characteristics of pulmonary vein stenosis after radiofrequency ablation. MethodsClinical and radiological data of 2 patients with pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation were retrospectively analyzed and literatures were reviewed. ResultsBoth patients had undergone circumferential pulmonary vein isolation. The symptoms appeared approximately 2 months after the operation. The major symptoms were cough, hemoptysis, exacerbation of dyspnea and chest pain. Both patients were misdiagnosed as other diseases such as pneumonia in other hospitals, and the anti-infection therapy was invalid. Both CT scans showed parenchymal exudative consolidation with varying degrees of interstitial septal thickening and small nodules. Both patients were confirmed as pulmonary vein stenosis by CT angiography. Literature review identified 21 cases of pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation. The main clinical features are hemoptysis, chest pain, shortness of breath and cough. The most common features of thoracic radiological imaging are consolidation, groud-glass attenuation, pleural effusion and interstitial septal thickening. ConclusionsIf a patient presents with hemoptysis, dyspnea, chest pain or other clinical manifestations after ablation therapy and image findings show parenchymal exudative consolidation with interstitial septal thickening and multiple small nodules, the possibility of pulmonary vein stenosis should be considered. Contrast-enhanced CT combined with pulmonary vein imaging technology can clearly show the opening diameter of each pulmonary vein and its branches, so it is an important non-invasive examination method for the evaluation and diagnosis of pulmonary vein stenosis.
ObjectiveTo explore the feasibility of radiofrequency ablation of great saphenous varicose veins in ambulatory surgery.MethodsPatients who underwent radiofrequency ablation of great saphenous varicose veins between May 2018 and June 2019 in General Hospital of Northen Theater Command were prospectively selected. According to their choices of treatment modes, patients were divided into two groups, day surgery group and routine inpatient group. The preoperative waiting time, length of hospital stay, and hospitalization expenses of the two groups were compared. The postoperative pain, tenderness, and complications were followed up on the first day (the next day after operation), the third day, and the fourteenth day after operation, and the time of return to normal life and work and patients’ satisfaction in two groups were recorded.ResultsA total of 95 patients were enrolled, including 52 in the day surgery group and 43 in the routine inpatient group. There was no significantly difference in age, gender, heart rate, mean arterial pressure, or operation time between the two groups (P>0.05). Compared with the routine inpatient group, the day surgery group had shorter preoperative waiting time, shorter length of hospital stay, and lower hospitalization expenses (P<0.05). In the day surgery group, the time of return to normal life and the time of return to work were shorter and patients’ satisfaction was significantly higher than those in the routine inpatient group (P<0.05). There was no significant difference in pain, tenderness, or paresthesia scores between the two groups after surgery according to the follow-up assessment (P>0.05); the pain, tenderness, and paresthesia scores on the first day and the third day were significantly different from those on the fourteenth day after surgery, indicating that the longer the postoperative time of the two groups, the less pain, tenderness, and paresthesia scores were.ConclusionRadiofrequency ablation of great saphenous varicose veins in ambulatory surgery has a short hospital stay, low medical cost, high patient satisfaction, and can ensure the safety of treatment at the same time, which is worthy of clinical promotion
Abstract： Objectives To determine the atrial expression of the collagen Ⅰ, collagen Ⅲ and the transforming growth factorbeta 1 (TGF-β1) in patients with rheumatic heart disease (RHD) and permanent atrial fibrillation(PAF) and to investigate the relationship between the extent of atrial fibrosis and the effectiveness of radiofrequency maze procedure in patients with RHD and PAF. Methods A total of 40 patients with RHD and PAF (≥6 months) who underwent a radiofrequency maze procedure with concomitant valvular surgery were collected for the experimental group. We acquired 100 mg of the left auricle tissue in each patient and followed up these patients after 3, 6 months of [CM(158mm]surgery. Then we assigned these patients to nonAF group and persistent AF group according to the results of the 6month followup. Another 10 patients with RHD and sinus rhythm(SR) who underwent valvular surgery alone were assigned to SR group and their left auricle tissue was also obtained. In order to determine the extent of atrial fibrosis, we observed the amount of collagen volume fraction Ⅰ，Ⅲ(CVF-Ⅰ,CVF-Ⅲ) by semiquantitative analysis with picrosirius red staining method. Using the β actin protein as the endogenous reference gene, we detected the expressions of TGF-β1 mRNA by semiquantitative reverse transcriptionpolymerase chain reaction(RT-PCR) technique. Results Each group has the same clinical baseline. At 6month follow-up, 28 among the 40 patients were categorized into the nonAF group and 12 into the AF group. (1) Patients in the nonAF group and the AF group had higher mRNA expressions of TGF-β1, CVF-Ⅰ and CVF-Ⅰ/CVF-Ⅲ compared with the SR group (F=6.487, P=0.003; F=3.711, P=0.032; F=3.697, P=0.032). The AF group had higher mRNA expressions of TGF-β1, CVF-Ⅰ and CVF-Ⅰ/CVF-Ⅲ than the nonAF group (t=4.372, P=0.043; t=4.603, P=0.038; t=4.776, P=0.035). But the CVFⅢ had no significant differences among the three groups (P＞0.05). (2) The patients whose left atrial function recovered after Maze procedure had lower mRNA expression than those patients whose left atrial function did not recover in the nonAF group (t=5.570, P=0.027). (3) The TGF-β1 mRNA expression has a positive correlation with both the contents of CVF-Ⅰ and left atrial diameter (r=0.786, Plt;0.05; r=0.858, Plt;0.05). Multiple logistic regression analysis revealed that the mRNA expression levels of TGF-β1, CVF-Ⅰ and left atrial diameter were independently associated with the postoperative persistence of atrial fibrillation. Conclusion The extent of atrial fibrosis in patients with RHD and PAF may be related to the sinus rhythm restoration and maintenance after AF surgical radiofrequency ablation and the resumption of atrial function.
ObjectiveTo investigate the efficacy of bipolar radiofrequency ablation for left ventricular aneurysm-related ventricular arrhythmia associated with mural thrombus. MethodsFifteen patients with left ventricular aneurysm-related frequent premature ventricular contractions associated with mural thrombus were enrolled in Beijing Anzhen Hospital between June 2013 and June 2015. There were 11 male and 4 female patients with their age of 63.5±4.8 years. All patients had a history of myocardial infarction, but no cerebral infarction. All patients received bipolar radiofrequency ablation combined with coronary artery bypass grafting, ventricular aneurysm plasty and thrombectomy. Holter monitoring and echocardiography were measured before discharge and 3 months following the operation. ResultsThere was no death during the operation. Cardiopulmonary bypass time was 92.7±38.3 min. The aortic clamping time was 52.4±17.8 min.The number of bypass grafts was 3.9±0.4. All the patients were discharged 7-10 days postoperatively. None of the patients had low cardiac output syndrome, malignant arrhythmias, perioperative myocardial infarction, or cerebral infarction in this study. Echocardiography conducted before discharge showed that left ventricular end diastolic diameter was decreased (54.87±5.21 cm vs. 60.73±6.24 cm, P=0.013). While there was no significant improvement in ejection fraction (45.20%±3.78% vs. 44.47%±6.12%, P=1.00) compared with those before the surgery. The number of premature ventricular contractions[4 021.00 (2 462.00, 5 496.00)beats vs. 11 097.00 (9 327.00, 13 478.00)beats, P < 0.001] and the percentage of premature ventricular contractions[2.94% (2.12%, 4.87%) vs. 8.11% (7.51%, 10.30%), P < 0.001] in 24 hours revealed by Holter monitoring were all significantly decreased than those before the surgery. At the end of 3-month follow-up, all the patients were angina and dizziness free. Echocardiography documented that there was no statistical difference in left ventricular end diastolic diameter (55.00±4.41 mm vs. 54.87±5.21 mm, P=1.00). But there were significant improvements in ejection fraction (49.93%±4.42% vs. 45.20%±3.78%, P=0.04) in contrast to those before discharge. Holter monitoring revealed that the frequency of premature ventricular contractions[2 043.00 (983.00, 3 297.00)beats vs. 4 021.00 (2 462.00, 5 496.00)beats, P=0.03] were further lessened than those before discharge, and the percentage of premature ventricular contractions[2.62% (1.44%, 3.49%)vs. 8.11% (7.51%, 10.30%), P < 0.001] was significantly decreased than those before the surgery, but no significant difference in contrast to those before discharge. ConclusionThe recoveries of cardiac function benefit from integrated improvements in myocardial ischemia, ventricular geometry, pump function, and myocardial electrophysiology. Bipolar radiofrequency ablation can correct the electrophysiological abnormality, significantly decrease the frequency of premature ventricular contractions, and further improve the heart function.
ObjectiveTo evaluate the efficacy and safety of cardiac surgery concomitant with bipolar radiofrequency ablation(BRFA) for the patients with heart disease and atrial fibrillation(AF). MethodsFrom April 2008 to September 2014, clinical data of 167 patients(43 males, 124 females) of organic-heart-disease patients combined with atrial fibrillation were analyzed retrospectively in our hospital. Within 167 patients, 102 patients underwent bipolar radiofrequency ablation without aortic cross-clamping were as a trial group and the other 65 patients underwent cardiac surgery and bipolar radiofrequency ablation with aortic cross-clamping were as a control group. And there were no significant difference in the age and gender between the two groups. ResultsThe time of radiofrequency ablation was 23.1±5.0 minutes in all the patients and there was no significant difference between the two groups(P=0.279). The extracorporeal circulation time was 156.6±56.4 minutes and the aortic cross-clamping time was 82.1±42.6 minutes. There was a significant difference between two groups in extracorporeal circulation time and aortic cross-clamping time. One patient underwent bipolar radiofrequency ablation with aortic cross-clamping died of severe pulmonary infection and multiple organ dysfunction syndrome(MODS) in one month after the surgery. The duration of follow-up was 1-77(35.3±3.5) months. The sinus rhyme conversion rate was estimated by electrocardiogram(ECG) in 1 month, 3 months, 6 months, 12 months, 36 months, 60 months after operation. The sinus rhyme conversion rates were 85.3%(133/156), 83.4%(126/151), 82.7%(115/139), 77.0%(94/122), 75.9%(41/54), and 72.0%(18/25). There was no significant difference during the follow-up in all of the sinus rhyme conversion rate. During the fellow-up, 2 patients died. One died after 1 month and another died after 6 months after their hospital-discharges. ConclusionThe efficacy and safety of cardiac surgery concomitant with bipolar radiofrequency ablation is satisfied. It can reduce the time of myocardial ischemia in bipolar radiofrequency ablation without aortic cross-clamping. It is beneficial to critical patients.
ObjectiveTo investigate the restoration of left atrial function and its relationship with atrial fibrosis of patients after mitral valve replacement (MVR)and concomitant radiofrequency ablation (RFA)for atrial fibrillation (AF). MethodsClinical data of 32 patients with mitral valve disease and chronic AF who underwent surgical treatment in General Hospital of Shenyang Military Area Command from January to August 2010 were retrospectively analyzed in this cohort study. There were 11 male and 21 female patients with their age of 49.8±8.7 years. There were 14 patients with rheumatic mitral stenosis (MS), 8 patients with rheumatic MS and mitral regurgitation, and 10 patients with mitral valve prolapse. Preoperative AF duration was 3.6±4.6 years. All the patients received MVR and concomitant RFA for AF. According to the cutting off extent of left atrial fibrosis (10.9%), all the 32 patients were divided into 2 groups. There were 19 patients with more severe left atrial fibrosis ( > 10.9%)in group A and 13 patients with milder left atrial fibrosis ( < 10.9%)in group B. Immunohistochemistry was performed to examined left atrial fibrosis, and echocardiography was performed to examined the structure and function of left atrium. ResultsThere was no perioperative death. Cardiopulmonary bypass time was 84.6±22.6 minutes, aortic cross-clamping time was 47.6±15.6 minutes, and ICU stay was 3.2±1.5 days. All the 32 patients were followed up for longer than 6 months (1.3±0.6 years). The extent of left atrial fibrosis of the 32 patients was 4.8%-18.3% (10.7%±4.2%). There was no statistical difference in left atrial diameter (LAD), left atrial fractional area change (LAFAC)or mitral annular motion between group A and group B preoperatively and 3 months after surgery respectively (P > 0.05). At 6 month after surgery, LAD of group B was significantly smaller than that of group A (P < 0.05), late diastolic mitral annular velocity (Am)of group B was significantly higher than that of group A (P < 0.05), and there was also some improvement in LAFAC of group B compared with group A (P=0.067). Among the 32 patients, 28 patients (87.5%)restored sinus rhythm (SR)3 months after surgery, and 21 patients (65.6%)maintained SR longer than 6 months after surgery. Patients in group B were more likely to maintain SR than patients in group A (P=0.010). ConclusionImprovement of left atrial function can be observed 6 month after MVR and concomitant RFA for AF, which is related to the extent of left atrial fibrosis.
ObjectiveTo summarize clinical advantages and outcomes of minimally invasive mitral valve replacement (MVR) combined with atrial fibrillation (AF) radiofrequency ablation via right minithoracotomy. MethodsEight patients with mitral valve disease and AF who received surgical therapy in the First Hospital of China Medical University between October 2009 and October 2012 were included in the study. There were 4 males and 4 females with their age of 34-67 (52.4±17.5) years. All the patients underwent minimally invasive MVR combined with AF radiofrequency ablation via right minithoracotomy. Clinical outcomes were summarized. ResultsThere was no in-hospital death or conversion to conventional sternotomy in this group. Two patients received biological valve replacement and 6 patients received mechanical prosthesis. Operation time was 207.9±18.1 minutes, cardiopulmonary bypass time was 81.7±23.9 minutes, and chest drainage amount was 126.7±34.5 ml. AF recurred in 1 patient on the 3rd postoperative day. All the patients were in sinus rhythm at discharge. These patients were followed up for 18.3±7.4 months. During follow-up, 1 patient had AF recurrence. Seven patients were in NYHA class Ⅰ, and 1 patients was in NYHA class Ⅱ. ConclusionMinimally invasive MVR combined with AF radiofrequency ablation via right minithoracotomy can achieve satisfactory clinical results and esthetic appearance, and is a good choice for patients with mitral valve disease and AF.
ObjectiveTo observe the changes of peripheral blood lymphocyte subsets of patients with primary hepatocellular carcinoma (PHCC) treated with radiofrequency ablation (RFA). MethodsThe data of 70 cases of hospitalized patients with PHCC that voluntary accepted RFA diagnosed by clinical and pathological in our hospital between July 2011 and December 2014 were collected. According to the numbers of HCC lesions, 70 cases were divided into single focus group (n=41) and multifocal group (n=29). The changes of their immune parameters before and after RFA were analyzed. Results①The ratioes of peripheral blood CD3+/CD19-, CD3+/CD4+, CD4+/CD8+, and NK cells on 7 days and 14 days after RFA treatment of 70 cases were significantly higher than those on 1 day before RFA treatment (P < 0.05). The ratio of CD3+/CD8+ T cells reduced from 1 day before RFA treatment to 14 days after RFA treatment, but the difference was no statistically significant (P > 0.05).②The changing trend of peripheral blood lymphocyte subsets before and after RFA treatment in single focus group and multifocal group were similar to the above.③Compared with single focus group, the ratioes of peripheral blood CD3+/CD19-, CD3+/CD4+, CD4+/CD8+, and NK cells before and after RFA treatment in multifocal group were lower, and the ratio of CD3+/CD8+ T cells was higher, but the difference were not statistically significant (P > 0.05). ConclusionRFA can not only destroy small PHCC foci, but also to significantly improve immune function and enhance the anti-tumor effect.
ObjectiveTo investigate efficacy and safety of three-step radiofrequency ablation (RFA) in treatment for giant hepatic hemangioma (GHH,diameter ≥5 cm) with symptoms. MethodsThe patients with GHH met the inclusion criteria were collected.The main steps were as follows:The first step was to destroy the main arteries of the tumor to block the blood.The second step was to withdraw the blood of the tumor to shrink the tumor.The third step was to damage the shrunk tumor by RFA. ResultsThere were 13 patients with GHH met the inclusion criteria.The median preoperative diameter was 8.0 cm.The median volume of withdrawing blood was 78 mL.The median diameter after withdrawing blood was 5.3 cm.The diameters between after and before withdrawing blood had a significant difference (P<0.01).The time for damaging tumor blood supply was (4.4±1.0) min.The median frequency of tumor RFA was 4 times.The median time of tumor RFA was 16 min.The median time of total operation was 20 min.There were 3 cases of tumor residual after RFA,10 cases were met full damage,and the damage rate was 85.9%-100% with an average of 97.0%.The hospital stay after RFA was (3.9±1.2) d.One case was remission after conservative treatment because of complication. ConclusionThe preliminary results of limited cases in this study show that three-step RFA for GHH is effective and safe,but it needs to be researched for large samples data.
ObjectiveTo investigate the short-term efficacy and safety of thoracoscopy-assisted epicardial radiofrequency ablation for atrial fibrillation (AF) and/or left atrial appendage exclusion (LAAE).MethodsThe clinical data of 12 patients with solitary AF admitted to Beijing Tiantan Hospital from November 2018 to August 2020 were retrospectively analyzed, including 7 males and 5 females, with an average age of 65.2±5.3 years. Of them, 2 had paroxysmal AF, 1 had persistent AF and 9 had permanent AF.ResultsNo patient died during hospitalization, 5 patients underwent radiofrequency ablation for AF and LAAE, and 6 received LAAE alone. The operation time was 293±70 min in radiofrequency ablation for AF+LAAE patients and 71±14 min in LAAE patients. Two patients restored sinus rhythm, two restored after electric cardioversion, and one remained AF in AF+LAAE patients. Postoperatively, 1 patient had pleural effusion and 1 had subcutaneous emphysema. No stroke was observed.ConclusionThoracoscopy-assisted radiofrequency ablation for AF and/or LAAE reduce the risk of procedure, and provide alternative approach to treat AF-associated diseases. However, large sample size studies using prospective cohort designs are required to corroborate the present findings.