Qingyu Wu

Myotomy After Previous Coronary Artery Bypass Grafting for Treatment of Myocardial Bridging

A 57-year-old man with a long history of frequent chest pain was admitted to our cardiac center. Four years ago, he underwent coronary artery bypass grafting (CABG) with the left internal mammary artery (LIMA) to the distal segment of the left anterior descending coronary artery (LAD) grafting for myocardial bridging (MB) in LAD despite having β-blockers and calcium channel blockers. However, the patient still had recurrent angina within 3 months after the operation. ECG showed negative T wave in leads V1 and V2. On echocardiography, left ventricular ejection fraction was 60% with normal regional wall motion. The repeat coronary angiography showed a MB in the proximal LAD about 3 cm in length with 90% systolic narrowing of the LAD, and the LIMA graft was totally occluded (Figure 1A through 1C). The …

Ascending-to-Descending Aortic Bypass via Posterior Pericardium for Complex Coarctation of Aorta

Abstractu2002 We introduce our surgical experience in treating recurrent aortic coarctation or coarctation associated with intracardiac abnormalities, which is difficult to manage. Four patients underwent the operation with hypothermic cardiopulmonary bypass. During the surgery, the posterior pericardium was opened and the thoracic aorta was dissected and sidebiting clamped, and an end‐to‐side anastomosis of the artificial graft to the descending aorta was performed. The graft was passed in between the inferior vena cava and the inferior right pulmonary vein and posterior to the pericardium. After that, the aorta was clamped and intracardiac repair was finished. Then the proximal artificial graft was anastomosed to the right side of the ascending aorta with heart beating. All patients recovered smoothly. There was no early or late death, without bleeding or other complications after operation. Conclusion: “Complex coarctation” can be treated with ascending‐to‐descending aortic bypass via posterior pericardium and satisfied result can be achieved.

Lactic Dehydrogenase in the In Vitro Evaluation of Hemolytic Properties of Ventricular Assist Device

Ventricular assist devices (VADs) can effectively improve the survival rate of patients with end-stage heart failure, but the hemolytic complications induced by long-time VAD support have received wide attention recently. The conventional evaluation method of the hemolytic properties of VADs by the indicator of plasma free hemoglobin (PFH) concentration is used but not sensitive enough to meet the needs of the actual examinations. In this study, an experimental method was applied for the evaluation of the injuries and damages caused by VADs to erythrocytes by both indicators of PFH and lactic dehydrogenase (LDH) in the in vitro hemolysis assay of VADs. The changes of LDH and PFH concentrations in plasma with the shear stress and the exposure time under a fixed shear stress were measured and analyzed to investigate the sensitivity and accuracy of the evaluation of erythrocyte damage by LDH. Furthermore, through 24 h in vitro hemolysis tests, the changes of LDH and PFH concentrations in blood samples were measured in combination with the microscopic histological changes and ultrastructural changes of erythrocytes, to assess the possibility of LDH evaluating the hemolysis of VADs. The changes of the concentration of LDH were more sensitive than those of PFH to different shear stress and exposure times, especially lower stress. Meanwhile, in the 24 h in vitro hemolysis assay, the PFH concentration in the blood samples showed no significant changes in the first 8 h, while the LDH concentration increased significantly in the first 3 h, which was consistent with the morphological changes of erythrocytes. Compared with the changes of the PFH concentration, the LDH concentration is sensitive to the damage of erythrocytes caused by VADs. It was considered that LDH could be applied as an additional indicator in the evaluation of erythrocyte damage and hemolytic properties of VADs in combination with the normalized index of hemolysis, for the more accurate assessment of the blood compatibility of VADs.

Persistent Fifth Aortic Arch with Interrupted Aortic Arch

Persistent fifth aortic arch (PFAA) is one of the rarest congenital anomalies. We report a seven‐month‐old male with PFAA with upper arch interruption and lower arch coarctation diagnosed by echocardiogram and multidetector computed tomography. doi: 10.1111/jocs.12450 (J Card Surg 2015;30:284–287)

Anatomic repair of Ebstein's anomaly with isolated anterior leaflet downward displacement

OBJECTIVEnEbsteins anomaly with isolated anterior leaflet downward displacement is rare and has not been reported in the literature to our knowledge. In this article, our experience of the surgical treatment in 6 cases with this anomaly is reported.nnnMETHODSnFrom November 2005 to November 2013, 6 patients (3 male, 3 female, aged 2-39 years) with Ebsteins anomaly and isolated anterior leaflet downward displacement received anatomic repair at the First Hospital of Tsinghua University. The diagnosis was made by echocardiography and confirmed at operation. Surgery was performed under hypothermic cardiopulmonary bypass. Surgical technique included excision of a huge atrialized portion of the right ventricle located in the anterior wall of the heart; reconstruction of the right ventricle by repairing the V-shaped defect left by the excision procedure; detachment, repair, and reimplantation of the anterior leaflet; and reconstitution of the right atrioventricular connection. Intraoperative transesophageal echocardiography was used to evaluate the position, morphology, structure, and function of the tricuspid valve, as well as right ventricular function.nnnRESULTSnFive patients were discharged uneventfully, and 1 patient died of postoperative pneumonia. Atxa0follow-up from 2 months to 7 years, no notable tricuspid valve regurgitation or stenosis was found and all patients were maintaining a normal lifestyle. The 27-year-old female patient gave birth to a normal infant uneventfully 3 years after surgery.nnnCONCLUSIONSnEbsteins anomaly with isolated anterior leaflet downward displacement is a complex and severexa0abnormality, and has several unique anatomic and clinical features and specific surgical requirements. Preoperative diagnosis can be made by clinical investigation and echocardiography. Excellent results can be achieved by anatomic correction.

TREATMENT OF PAEDIATRIC ATRIAL TACHYCARDIA ORIGINATING FROM ATRIAL APPENDAGES BY RADIOFREQUENCY CATHETER ABLATION UNDER THREE DIMENSIONAL ELECTROANATOMIC MAPPING SYSTEM COMBINED WITH APPENDECTOMY

Objectives To evaluate the electrocardiographic characteristics of atrial tachycardia (AT) originating from atrial appendages in children and to investigate the effects of radiofrequency catheter ablation (RFCA) under guidance of CARTO system and appendectomy. Methods Of the 17 children with incessant AT receiving RFCA under CARTO system in our electro cardiac lab, five were diagnosed as AT originating from atrial appendages, age 8.1±4.6 (3.2∼12.8) years. Male:Female 1:4. AT appeared to be incessant in all of these five children, resisting to diverse antiarrhythmic drugs or only minimal effects were gained. Decreased cardiac systolic function were detected in four children (80%) whose left ventricular ejection fraction (LVEF) were 44%∼50%. Electroanatomical mapping under CARTO system revealed atrial appendage origin for these five children, RFCA by cooled tip catheter (Navi-Star THERMO COOL) were performed at the location of earliest AT origin. We investigated the P′ wave configurations in electrocardiogram of this AT type and effects of RFCA. Appendectomy was used for patients with AT recurrence after RFCA, and effects of this surgical procedure were evaluated. Results Increased focal automaticity was regarded as electro physiologic mechanism for AT originating from atrial appendages proved by CARTO mapping. Three from right atrial appendage (RAA) and two from left atrial appendage (LAA). P′ wave configuration for AT from RAA: (1) positive P′wave in I and aVL leads; (2) positive P′ wave in II, III and aVF leads; (3) negative and double-peak P′ wave in V1 lead. P′ wave configuration for AT from LAA: (1) negative P′ wave in I and aVL leads; (2) positive P wave in II, III and aVF leads (3) positive P′ wave in V1 lead (1 case) or bidirectional P′ wave with positive tendency (1 case). Immediate success rate for RFCA was 100%. three recurred (60%) during follow-up (5–14u2005months). Of these recurred, two originated from RAA (2/3, 66.7%) and one from LAA (1/2, 50%). Appendectomies were performed under general anaesthesia with beating heart, reversions to sinus rhythm were gained at time the appendages were incised. No recurrence was detected during 5–14u2005months follow-up. Conclusions (1) The electrocardiographic characteristics of AT originating from atrial appendages in children are unique. (2) RFCA under CARTO mapping system by cooled tip cather is safe and effective for AT originating from atrial appendages in children while recurrence rate is high. (3) Appendectomy for AT originating from atrial appendage is reliable, while the assurance of AT origin by CARTO mapping system should be gained preoperatively.

Modified Peritoneal Dialysis for Treatment of Acute Renal Failure after Complex Congenital Heart Surgery in Infants

BACKGROUNDnAcute kidney injury (AKI) is one of the common complications in infants and children after complex congenital heart surgery. Peritoneal dialysis (PD) is usually applied for renal replacement therapy (RRT), especially in infants. We investigated the efficacy and safety of modified PD for the treatment of acute renal failure and congestive heart failure after cardiac surgery for congenital heart disease in infants.nnnMETHODSnWe retrospectively analyzed five consecutive patients from October 2015 to February 2017. The patients were aged from four days to five years old, and all had acute renal failure and congestive heart failure after cardiac surgery. In the five patients treated with modified PD (five males; average weight: 11.2 ± 5.5 kg), we used the Seldinger technique percutaneous abdominal puncture 16 G single lumen central venous catheter instead of the Tenckhoff peritoneal dialysis catheter as a PD catheter. Modified PD was intermittent. We recorded and monitored circulation and metabolism index.nnnRESULTSnFive cases (100%) with modified PD were restored to normal renal function. Congestive heart failure was gradually alleviated, and pulmonary and cardiovascular function were improved. Urine volume increased. Neither peritonitis nor catheter leakage occured in any of our cases. Urine volume increased due to PD, from 0.16 + 0.18 mL/kg*h before PD to 2.63 + 1.05 ml/kg*h at the end of PD n(P < .05). Serum creatinine, serum urea nitrogen, and serum K+ changed from 85.0 ± 36.5 μmol/L, 17.1 ± 7.5 mmol/L, and 4.57 ± 0.30 mmol/L before PD, to 76.0 ± 36.7 μmol/L, 20.1 ± 11.0 mmol/L, and 4.42 ± 0.42 mmol/L at the end of PD, respectively (P > .05). Acidosis, hyperkalemia, hypoxemia and low cardiac output syndrome were improved. All patients were cured and discharged with normal renal function.nnnCONCLUSIONnWe conclude that modified single lumen central venous catheter for PD is a safe, feasible, and less invasive therapeutic strategy for AKI in infants undergoing cardiac surgery, and is worthy of being widely applied in clinical practice.

Surgical resection of giant left ventricular fibromas in children

Primary cardiac tumors in infancy and childhood are rare and usually benign. We report two children with giant left ventricular fibromas and discuss their surgical management.

Surgical Treatment of Large Left Ventricular Fibroma in Children

Primary cardiac tumors are rare in children, with the prevalence of 0.0017–0.28% in autopsy series.[1] Benign tumors account for over 90% of the total. Cardiac fibromas (CFs) represent the second most common benign cardiac tumor in the pediatric population following rhabdomyomas. Patients can be asymptomatic or present with palpitations, cardiac murmur, arrhythmias, congestive heart failure, and even sudden death according to the size and location of the tumor. Surgical resection should be considered as the best option in symptomatic patients.[2,3] This study reported four surgical cases of large left ventricular fibroma in children.

Intraoperative Transesophageal Echocardiography in the Operation of Ebstein's Anomaly: A Retrospective Study

Background: Ebsteins anomaly (EA) has various spectrums in clinical and anatomic features. This study aimed to report the experience of two-dimensional intraoperative transesophageal echocardiography (2D-ITEE) during the EA surgery and to analyze the characteristics of the tricuspid valve (TV) by comparing the data from 2D-ITEE with the results from the surgery. Methods: 2D-ITEE data of 164 patients with EA who were operated in the First Hospital of Tsinghua University between July 2004 and April 2014 were retrospectively analyzed in this study. 2D-ITEE was applied in all patients. Downward displacement distances were measured, and the numbers of downward displacement or absent leaflets were compared with that of the surgery and with that of the two-dimensional-transthoracic echocardiogram (2D-TTE). Data comparison was performed using the Chi-square test. Results: The anterior leaflet partial or total downward displacement was 37.76 ± 17.50 mm in 54 cases, absent in one patient; septal leaflet downward displacement was 29.07 ± 12.34 mm in 134 cases, absent in 17 cases; and posterior leaflet downward displacement was 43.18 ± 19.16 mm in 115 cases, absent in 34 cases. Statistically, there was no significant difference between the results from 2D-ITEE and that of 2D-TTE. The consistency rates of 2D-ITEE with operation for septal and posterior leaflets were 93.2% and 96.1%, respectively, while the rate for anterior was only 40.1%, which was significantly different. Color Doppler flow image showed severe regurgitation in 150 cases and moderate in 14 cases. After surgical correction, moderate regurgitation of TV was found in 58 cases with 2D-ITEE, repair was performed again until the effect was satisfied. No complication occurred relating to the use of 2D-ITEE. Conclusions: 2D-ITEE could help diagnose anterior leaflet, evaluate the effect of TV repair, increase operational success rate, and reduce complication.