查看更多>>摘要：When Denton Cooley started the Texas Heart Institute Journal 40 years ago, he could not have known how long it would last or the success it would see. Authors and reviewers have come and gone, editors-in-chief have come and gone, but the Texas Heart Institute and the Journal have remained strong. Our first volume in 1974 included a modest 55 articles; in recent years, we have published as many as 250 articles. Our readership has also increased, from a handpicked list in the beginning to 50,000 strong now. The Journal has been indexed by numerous worldwide indexing organizations, including the National Library of Medicine (PubMed) since 1993, retroactive to Volume 1, Issue 1.
查看更多>>摘要：Do you remember when cardiac pacemakers were bigger than car batteries and sat on the floor next to the patient's bed? Did you ever treat intractable peripheral edema with Southey tubes? Were intravenous fluids made in the hospital where you worked, and were those fluids administered through reusable rubber tubing? Was poliomyelitis rampant in your day, and did you ever have a patient in an "iron lung"?If you answered "yes" to any of these questions, you probably trained in the late 1940s or, as I did, in the early 1950s. Medicine in those days was much different from what it is now, as further illustrated by the following examples: Most medical students and house officers were unmarried, and only about 5% of them were women. On each teaching unit, there was a small "student lab" where medical students, interns, or both, did all of the initial and follow-up blood counts, urinalyses, stool guaiac tests, stains of sputum and various other specimens, and microscopic evaluation of pleural, peritoneal, cerebrospinal, pericardial, and joint fluids. House officers had no formal contracts-just a handshake and a spoken pledge to work diligently.
查看更多>>摘要：Winter of 1942: Greece, World War II. The Italian occupation first, then the German occupation in the second year. The freedom fighters are now shooting Germans, who in turn are hanging and shooting civilians. I am 11 years old.7 PM: One hour past the curfew imposed by the occupation. My youngest brother goes into the yard to gather cut wood for the stove. He returns with another boy, who has climbed over the fence to ask for our father s help. Our young visitor's father, a man with diabetes, is said to have high fever and an abscess in his jaw.My mother has just enough time to put a sandwich into my father's coat pocket. Who knows when he will come back, if at all? My father gets his bag and follows the boy to his house, taking the same route that the boy had taken. Mother quickly crosses herself in front of the Virgin Mary icon.From time to time, we can hear gunshots in the town. We do our best to console my younger brother, who has started crying.
查看更多>>摘要：The levels of brain natriuretic peptide (BNP) and monocyte chemoattractant protein-1 (MCP-1) are known to be increased in the sera of subjects with heart failure. Existing models do not account for the biomass of thrombus that occurs in patients undergoing myocardial infarction. In this study, we compared the expressions of sheep-derived genes for BNP, MCP-1, and atrial natriuretic peptide in a new large-animal model of thrombus-induced heart failure. Thrombus of autologous platelets was injected directly into the left circumflex coronary arteries of sheep. Cardiac ischemic injury was evaluated by troponin I levels, and heart failure progression was monitored with the aid of echocardiogram-based evaluation. After outlined time intervals, the sheep were killed and their hearts excised for tissue sampling. Reverse transcription polymerase chain reaction, Western blot, and enzyme-linked immunosorbent assay (ELISA) tests were performed to establish gene and protein expressions. At 72 hours after embolization, myocardial BNP and MCP-1 expressions had increased significantly in the ischemic region, compared either with the nonischemic region or with tissue from healthy sheep. As heart failure progressed to 90 days after embolization, the expression of BNP in the ischemic region decreased, whereas its expression in the nonischemic region increased several fold. In contrast, MCP-1 gene expression showed no changes in either tissue after 90 days of embolization. Plasma levels of BNP, determined by Western blot and ELISA, also correlated with the gene-expression studies. Our results show regional changes in BNP and MCP-1, as well as differences in the expression of these 2 genes.
查看更多>>摘要：Understanding the influence of sex differences on predictors of cardiac mortality rates in chronic heart failure might enable us to lengthen lifetimes and to improve lives. This study describes the influence of sex on cardiovascular mortality rates among chronic heart failure patients. From January 2003 through December 2009, we evaluated 637 consecutive patients (409 men and 228 women) with chronic heart failure, who ranged in age from 18 through 94 years (mean age, 64 ± 13 yr) and ranged in New York Heart Association (NYHA) functional class from II through IV. The mean follow-up period was 38 ± 15 months, the mean age was 64 ± 13 years, and the mean left ventricular ejection fraction was 0.27 ± 0.11. By the end of the study, both sexes had similar cardiovascular mortality rates (36% men vs 37% women, P=0.559). In Cox regression analysis, NYHA functional class, triglyceride level, and history of coronary artery disease were independent predictors of cardiovascular death for women with chronic heart failure. For men with chronic heart failure, the patient's age, ejection fraction, and sodium level were independent predictors of cardiovascular death. In a modern tertiary referral heart failure clinic, decreased triglyceride levels were, upon univariate analysis, predictors of poor outcomes for both men and women. However, upon Cox regression analysis, reduced triglyceride levels were independent predictors of cardiac death only in women.
查看更多>>摘要：Patients with permanent pacemaker or automatic implantable cardioverter-defibrillator (AICD) leads have an increased prevalence of tricuspid regurgitation. However, the roles of cardiac rhythm and lead-placement duration in the development of severe tricuspid regurgitation are unclear. We reviewed echocardiographic data on 26 consecutive patients who had severe tricuspid regurgitation after permanent pacemaker or AICD placement; before treatment, they had no organic tricuspid valve disease, pulmonary hypertension, left ventricular dysfunction, or severe tricuspid regurgitation. We compared the results to those of 26 control subjects who had these same devices but no more than mild tricuspid regurgitation. The patients and control subjects were similar in age (mean, 81 ± 6 vs 81 ± 8 yr; P=0.83), sex (male, 42% vs 46%; P=0.78), and left ventricular ejection fraction (0.60 ± 0.06 vs 0.58 ± 0.05; P=0.4). The patients had a higher prevalence of atrial fibrillation (92% vs 65%; P=0.01) and longer median duration of pacemaker or AICD lead placement (49.5 vs 5 mo; P <0.001). After adjusting for age, sex, and right ventricular systolic pressure by multivariate logistic regression analysis, we found that atrial fibrillation (odds ratio=6.4; P=0.03) and duration of lead placement (odds ratio=1.5/yr; P=0.001) were independently associated with severe tricuspid regurgitation. Out study shows that atrial fibrillation and longer durations of lead placement might increase the risk of severe tricuspid regurgitation in patients with permanent pacemakers or AICDs.
查看更多>>摘要：Residual muscular ventricular septal defects are surgical challenges, especially after the repair of complex congenital heart defects. We investigated perventricular device closure as a salvage technique in pediatric patients who had postoperative residual muscular ventricular septal defects. From February 2009 through June 2011, 14 pediatric patients at our hospital had residual muscular ventricular septal defects after undergoing surgical repair of complex congenital heart defects. Ten patients met our criteria for perventricular device closure of the residual defects: significant left-to-right shunting (Qp/Qs >1.5) or substantial hemodynamic instability (a defect ≥ 2 mm in size). The patients' mean age was 20.4 ± 13.5 months, and their mean body weight was 10 ± 3.1 kg. The median diameter of the residual defects was 4.2 mm (range, 2.5-5.1 mm). We deployed a total of 11 SQFDQ-II Muscular VSD Occluders (Shanghai Shape Memory Alloy Co., Ltd.; Shanghai, China) in the 10 patients, in accord with conventional techniques of perventricular device closure. The mean procedural duration was 31.1 ± 9.1 min. We recorded the closure and complication rates perioperatively and during a 12-month follow-up period. Complete closure was achieved in 8 patients; 2 patients had persistent trivial residual shunts. No deaths, conduction block, device embolism, or other complications occurred throughout the study period. We conclude that perventricular device closure is a safe, effective salvage treatment for postoperative residual muscular ventricular septal defects in pediatric patients. Long-term studies with larger cohorts might further confirm this method's feasibility.
查看更多>>摘要：Cardiovascular surgery and interventions are continuously developing fields; in recognition of these changes, the Current Trends educational series is now the Current Trends in Aortic and Cardiovascular Surgery and Interventions. This, the 9th Current Trends, brought the interventional aspects of aortic repair to the forefront with the addition of my esteemed colleague, Zvonimir Krajcer, as Activity Co-Director. As always, we did our utmost to bring you leaders in aortic repair from throughout the world. These international leaders included Tirone E. David of Canada, Tom Treasure of England, Marcelo Ferreira of Brazil, Francesco Serino of Italy, and W.P. Van Zyl of South Africa. Updates from our Houston cadre-William E. Cohn, O.H. "Bud" Frazier, and Charles D. Fraser, Jr., among others-showed the continued innovation that is characteristic of the Texas Medical Center.
查看更多>>摘要：The new (2010) American Heart Association/American College of Cardiology guidelines present a dilemma to the cardio-aortic surgical community regarding bicuspid aortic valve (BAV) when found in combination with pure aortic insufficiency (AI) (no aortic stenosis) and with proximal aortic aneurysmal disease. The new guidelines recommend resection at 5.0 cm, and there are additional indications for resection at 4.5 cm in patients who have genetically triggered aortic conditions. The denomination inherent in this general recommendation will affect many patients, including a significant number of "4.5 to 5.0 cm" BAV patients who have proximal aortic aneurysms and physiologically normal valves, near-normal valves, valves with pure AI, or eminently repairable cusps. As a result, the task and challenge facing the cardio-aortic surgical community is to spare and repair these valves when possible and when appropriate.
查看更多>>摘要：Although aortic valve repair has been performed since the early days of open-heart surgery, the introduction of intraoperative transesophageal echocar-diography (TEE) and better understanding of the functional anatomy of the aortic valve have helped the development of newer surgical approaches to aortic valve repair in patients with aortic insufficiency (AI) or aortic root aneurysm. Transesophageal echocardiography is the best diagnostic tool to determine the mechanism of AI and the geometric relationships among various components of the aortic root, to select candidates for aortic valve repair, and to evaluate valve function in the operating room. In addition, TEE can help in the evaluation of cusp morphology, prolapse, and degree of coaptation, and in the recognition of sinotubular-junction dilation. Aortic valve repair is feasible in a high proportion of patients with isolated AI caused by cusp prolapse, dilation of the aortic root, or both. Several procedures have been developed to repair aortic cusps during conservative procedures on the aortic valve.
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