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find Keyword "主动脉瓣置换术" 167 results
  • Application of Three-dimensional CT Angiogram in Perioperative Evaluation for Patients Underwent Transapical Aortic Valve Implantation——The Initial Experience from West China hospital

    ObjectiveTo introduce the role of three dementional computed tomograph (3D-CT) for patients underwent transcatheter aortic valve implantation (TAVI) procedure in perioperative evaluation. MethodsFrom April 2014 to June 2015, we retrospectively analyzed clinical data of 28 patients with severe aortic stenosis underwent successful TAVI procedure using new second-generation device, who were enrolled in this study including 12 males and 16 females at mean age of 72.8±4.5 years. We used 3D-CT to get the perioperative relative evaluation, including valve morphology and calcification degree, annular diameter, aoronary ostium height, ascending aorta, aortic sinus diameter, left ventricular-aortic angle, optimal intraoperative angiogram projection angle. Based on the evaluation by 3D-CT image, the prosthesis size, balloon size, best intraoperative imaging projection angle and approach of apex were then chosen. ResultsAll patients with severe aortic stenosis underwent successful TAVI procedure with mean logistic Euro-SCORE I:26.2%±7.9%. CT image revealed that mean aortic annular diameter was 24.6±1.8 mm with mean valve prosthesis size 25.8±1.1 mm and pre-dilation balloon size 23.1±1.2 mm and 76.8% patients were of tricuspid aortic valve with severe calcification and 25% patients were of asymmetric calcification. Optimal intraoperative angiogram image was achieved in 92.9% patients with the help of preoperative CT image. There was a statistic difference in mean transvalvular gradient after valve implantation (54.1±15.3 mm Hg vs. 13.1±8.5 mm Hg, P<0.05). And there was no mortality or severe complication postoperatively. Conclusion3D-CT image palys an important role during perioperative evaluation of TAVI procedure and it can be helpful for Chinese doctors to operate TAVI successfully.

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  • 机械瓣主动脉瓣置换术后药物热一例

    Release date:2016-08-30 05:28 Export PDF Favorites Scan
  • Clinical Characteristics of Patients with Coronary Artery Disease Undergoing Isolated Aortic Valve Replacement

      Abstract:Objective To investigate clinical characteristics of patients with aortic valve disease and coronary artery disease (CAD), and improve the pertinence of clinical management. Methods Clinical data of 78 patients who were older than 50 years and underwent isolated aortic valve replacement (AVR) in General Hospital of Shenyang Command from January to October 2010. All the patients were divided into two groups according to whether they had CAD:20 patients with CAD in the CAD group, including 19 males and 1 female with their average age of 64.6±8.3 years, and 58 patients without  CAD in the control group, including 28 males and 30 females with their average age of 58.7±6.2 years. Clinical characteristics of AVR patients with CAD were analyzed by one-way analysis of variance and multiple factor analysis. Results  One-way analysis showed that the incidence of old age (P=0.000), male patients (P=0.004), diabetes (P=0.004), aortic regurgitation (P=0.034), valvular lesion (P=0.028), and postoperative mechanical ventilation time (P=0.008)of CAD group patients were significantly higher or longer than those of control group patients. Multiple factor analysis showed that independent clinical characteristics of AVR patients with CAD included male patients, old age, prolonged postoperative mechanical ventilation time, significantly decreased pulmonary arterial systolic pressure (PASP) at 6th postoperative month, and significant preoperative right ventricular diastolic dysfunction. Conclusion The screening age for possible CAD should be reasonably lowered if male patients with aortic valve disease have concomitant preoperative right ventricular  diastolic dysfunction and/or tricuspid aortic valve degeneration. Patients undergoing isolated AVR need to take medications to reverse left ventricular remodeling for a long time to avoid severe arrhythmia.

    Release date:2016-08-30 05:28 Export PDF Favorites Scan
  • Clinical Outcomes and Predictive Factor Analysis of Mild-to-moderate or Moderate Functional Mitral Regurgitationafter Aortic Valve Replacement in Patients with Severe Aortic Stenosis

    Objective To evaluate clinical outcomes of mild-to-moderate or moderate functional mitral regurgitation(FMR)after aortic valve replacement (AVR) in patients with severe aortic stenosis (AS),and analyze prognostic factors of these patients with mild-to-moderate or moderate FMR (2+to 3+). Methods From September 2008 to December 2011,a total of 156 patients with severe AS (peak aortic gradient (PAG)≥50 mm Hg) as well as FMR (2+to 3+) underwent surgical treatment in Zhongshan Hospital. There were 95 male and 61 female patients with their average age of 59.2±10.5 years. Detailed perioperative clinical data were collected,and postoperative patients were followed up. The ratio of FMRpreoperative/FMR postoperative was calculated. Patient age,gender,body weight,history of hypertension,ventricular arrhythmia,atrial fibrillation (AF),left ventricular ejection fraction (LVEF),left ventricular end-diastolic diameter (LVEDD),left atrial diameter (LAD),pulmonary artery hypertension (PAH),PAG were assessed by logistic multivariate regression analysis. Results Six patients died postoperatively,including 4 patients with low cardiac output syndrome and 2 patients with refractory ventricular arrhythmia. Perioperative mortality was 3.8%. The average follow-up time was 20.3±8.5 months and follow-up rate was 85.3% (133/156). Eight patients died during follow-up,including 3 patients with heart failure,2 patients with ventricular arrhythmia,and 3 patients with anticoagulation-related cerebrovascular accident. Multivariate regression analysis showed that FMR preoperative/FMR postoperative ratio was not correlated with age≥55 years,male gender,body weight≥80 kg,LVEDD≥55 mm,LVEF≤50%,history of hypertension or ventricular arrhythmia. However,LAD≥50 mm,PAH≥50 mm Hg,PAG≤75 mm Hg and preoperative AF were negatively correlated with postoperative FMR improvement. Conclusions Risk factors including LAD≥50 mm,PAH≥50 mm Hg,PAG≤75 mm Hg and preoperative AF are negatively correlated with postoperative improvement of FMR (2+to 3+). Patients with severe AS and above risk factors should receive concomitant surgical treatment for their FMR during AVR,since preoperative FMR(2+to 3+)usually does not improve or even aggravate after AVR.

    Release date:2016-08-30 05:46 Export PDF Favorites Scan
  • Methods and Results of Supra-annular Aortic Valve Replacement for Patients with Severely Damaged Aortic Annulus

    Abstract: Objective To summarize the methods and results of supra-annular aortic valve replacement(AVR) in patients with severely damaged aortic annulus. Methods Supra-annular AVR was performed in 5 patients between March 2008 and Dec. 2010 in Changhai Hospital, Second Military Medical University. There were 4 males and 1 female with their mean age of 46.3 years (ranging from 38 to 53 years). Non-specific infectious diseases were diagnosed in 4 patients who had severe paravalvular leakage after their first AVR operations (2 patients with Behcet’s disease and 2 patients with arteritis), and one patient had severe infectious endocarditis. All the patients had severely destroyed aortic annulus and could not undergo routine AVR. The prosthetic valves were fixed to the aortic sinus wall between the annulus and coronary arterial ostia, and the sutures passed through from the outside of aortic wall into the inside and prosthetic valve ring. Coronary artery bypass grafting was performed if the coronary ostium was involved. Results All patients recovered from the operations uneventfully, and were followed up from 6 months to 3 years. All patients were in New York Heart Association(NYHA) functional class Ⅰ or Ⅱ during the follow-up period, and paravalvalar leakage, pseudoaneurysm and aortic root aneurysm were not found by the examination of 3D computed tomographic angiography and echocardiography at 6 months(4 cases), 1 year(2 cases), and 3 years(1 case), respectively . Conclusions Supra-annular AVR is an alternative surgical method for patients with severely damaged aortic annulus. The procedure is simple and effective to prevent paravalvular leakage and pseudoaneurysm formation.

    Release date:2016-08-30 05:48 Export PDF Favorites Scan
  • 70岁以上瓣膜病患者心瓣膜置换术235例临床分析

    摘要: 目的 总结70岁以上老年患者心瓣膜置换术的治疗经验,以提高手术效果。 方法 回顾性分析1998年5月至2009年6月期间上海交通大学附属第一人民医院收治的235例70岁以上老年心脏瓣膜病患者的临床资料,其中男103例,女132例;年龄70~89岁(73.4±4.2岁)。病种为风湿性心脏瓣膜病165例,非风湿性心脏瓣膜病(包括缺血性瓣膜病、退行性瓣膜病变等)70例;行二尖瓣置换术(MVR)146例,主动脉瓣置换术(AVR)54例,双瓣膜置换术(BVR)34例,其中同期行冠状动脉旁路移植术(CABG)56例,三尖瓣成形术136例,三尖瓣置换术5例,术中行心房颤动消融5例。全组中采用生物瓣膜141例,机械瓣94例。 结果 术后早期死亡15例(6.3%),死亡原因为:严重低心排血量综合征5例,多器官功能不全综合征6例,严重心律失常3例、心脏骤停1例。术后主要并发症有:低心排血量综合征15例(6.3%),大出血(引流量gt;1 000 ml) 23例(9.8%),切口感染3例(1.3%),呼吸功能不全17例(7.2%),阵发性室上性心动过速23例(9.8%),肺部感染14例(5.9%),肾功能不全2例(0.8%),心脏压塞、再次开胸止血11例(4.7%)。全组出院220例,术后6个月随访172例,无死亡患者;心功能恢复至Ⅰ~Ⅱ级146例,Ⅲ~Ⅳ级26例。 结论 只要加强围手术期管理,提高术中的手术技巧,对70岁以上老年心脏瓣膜病患者行手术治疗是相对安全、可行的。

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  • Surgical Treatment for Hypertrophic Obstructive Cardiomyopathy Complicated by Infective Endocarditis

    Abstract:?Objective?To analyze surgical procedures and clinical outcomes for patients with hypertrophic obstructive cardiomyopathy (HOCM) complicated by infective endocarditis.?Methods?We retrospectively analyzed clinical data of 7 patients with HOCM complicated by infective endocarditis who underwent modified Morrow procedure,removal of intracardiac vegetation,and valve replacement in Fu Wai Hospital from Sep. 2006 to Feb. 2012. There were 5 male patients and 2 female patients with their mean age of 39.80±13.60 years(ranging 21-55). Postoperative clinical outcomes were observed. Preoperative and postoperative left ventricular outflow tract (LVOT) gradients, left atrium (LA) diameter,left ventricular ejection fraction (LVEF) and heart function were compared.?Results?There was no in-hospital death and perioperative survival rate was 100% in this group. Bacteria vegetations were multiply detected on the mitral valve leaflet (7 cases), aortic valve leaflet (4 cases) and ventricular septum (1 case) with their diameter of 2-19 mm. Blood culture showed Staphylococcus aureus (3 cases),Squirrel aureus (1 case) . Postoperatively, first-degree atrioventricular block occurred in 2 patients, complete left bundle branch block in 1 patient, left anterior division block in 2 patients, and all these complications were not treated. Postoperative LVOT gradient and LA diameter were significantly lower than preoperative values (P<0.05), and cardiac function was significantly improved in these patients. All the patients underwent transthoracic echocardiography at a mean follow-up of 13.00±17.19 (1-49) months in outpatient service. The clinical symptoms of all these patients were diminished or significantly ameliorated and their quality of life was considerably improved. All the patients had NYHA classⅠorⅡ without any reintervention or death during follow-up.?Conclusion?Modified Morrow procedure and valve replacement is a good surgical strategy for patients with HOCM complicated by infective endocarditis with satisfactory early and mid-term clinical outcomes.

    Release date:2016-08-30 05:51 Export PDF Favorites Scan
  • Effects of βreceptor Blocker on Intraventricular Pressure Gradient after Aortic Valve Replacement

    Abstract: Objective To investigate the effects of βreceptor blocker on intraventricular pressure gradient and left ventricle remodeling after valve replacement for critical aortic stenosis. Methods Fifty-six patients with critical aortic stenosis underwent aortic valve replacement surgery from January 2008 to January 2010 in the First Affiliated Hospital of Zhengzhou University. Thirtytwo of them who were followed up were selected to be enrolled in this study. The patients were divided into two groups under the same basis of clinical features. Twelve patients in the experimental group received oral βreceptor blocker (Metoprolol, 6.2525.00 mg once, twice daily). The rest 20 patients in the control group had no βreceptor blocker. The various indicators of ultrasound cardiogram (UCG) shortly after operation (within a week) and long after operation (6-24 months) were compared between the two groups. Results No death occurred in both groups, and chest distress, shortness of breath and other symptoms were obviously alleviated. Although left ventricular endsystolic dimension (LVESD) and left ventricular outflow tract dimension (LVOTD) of both groups increased 6-24 months after operation, compared with the early postoperative period, only the increase of LVOTD in the experimental group showed statistical difference (t=-47.937, P=0.001). In both groups, interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT), filament band velocity of left ventricular outflow tract (V), intraventricular pressure gradient (G) and left ventricular mass index (LVMI) of the later period after operation were significantly lower than those of the early postoperative period. All these indicators in the experimental group showed significant differences (t=7.781, P=0.001;t=5.749, P=0.001; t=2.637, P=0.023; t=7.167, P=0.001; t=100.061, P0.001), while only V, G, and LVMI showed statistical differences in the control group (t=4.051, P=0.001; t= 4.759, P= 0.001; t=-0.166,P=0.001). EF in the experimental group also indicated significant difference compared with early period after aortic valve replacement (t=-6.621, P=0.001). EF between two groups indicated no significant difference (t=-0.354,P=0.726). But differences between the two groups in LVEDD, IVS, G, and LVMI were all statistically significant in the later period after surgery (t=-2.494, P=0.018; t=-3.434, P=0.002;t=-2.171,P=0.038; t=-2.316, P=0.028). Conclusion β-receptor blocker is a safe and reliable drug for those patients who have undergone aortic valve replacement surgery for critical aortic stenosis, and can decrease significantly the residual intraventricular pressure gradient and accelerate left ventricular cardiac remodeling. 

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  • 白塞氏病合并主动脉瓣置换术后瓣周漏的临床分析

    摘要: 目的 总结白塞氏病所致主动脉瓣置换术后发生瓣周漏的外科治疗经验,探讨相关手术方式和解决方法。 方法 回顾性分析第二军医大学附属长海医院收治的4例白塞氏病所致主动脉瓣置换术后瓣周漏患者的临床资料,均为男性,年龄24~50岁(36±7岁)。其中3例为主动脉瓣重度关闭不全行主动脉瓣置换术后出现瓣周漏行改良Bentall手术,另1例为升主动脉瘤、主动脉瓣重度关闭不全行Wheat术后出现瓣周漏行改良Bentall手术。 结果 4例患者术后恢复顺利,无并发症发生。均痊愈出院。术后随访1~24个月,心功能恢复至Ⅰ~Ⅱ级。3~6个月定期行超声心动图和全主动脉血管造影检查,未发现主动脉瓣周漏复发,人工机械瓣膜功能良好,人工主动脉血管通畅。 结论 白塞氏病合并主动脉瓣或升主动脉病变如单纯行心瓣膜置换术,术后人工瓣膜脱落的发生率较高,改良Bentall手术方式是解决问题的良好方法。

    Release date:2016-08-30 06:03 Export PDF Favorites Scan
  • Preserving Effect on Myocardium in Porcine Aortic Valve Replacement by Minimal Extracorporeal Circulation

    Objective To observe preserving effect on myocytes in porcine aortic valve replacement with minimal extracorporeal circulation (MECC). Methods 7 pigs were collected as experimental animals and undertook aortic valve replacement with MECC. Morphological and immunofluorescence intensity changes of right atrial and left ventricular tissues were observed. Results HE staining showed that there were not significant changes and edema or injury of myocytes of right atriums and left ventricles between preoperation and postoperation. Immunofluorescence staining showed complement C3b/c in right atrial myocardial tissues after the operation were a little ber, and innate antibody IgG were a little ber in left ventricular myocardial tissues but similarly weak in right atrial myocardial tissues pre- and post-operation. There was not significant changes in HSPG staining in pre-and post-operative right atrial myocardial tissues, but HSPG were obviously weaker in left ventricular myocardial tissues after the operation. Conclusion MECC is effective on support of porcine aorta valve replacement.

    Release date:2016-08-30 06:09 Export PDF Favorites Scan
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