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find Keyword "二尖瓣成形" 60 results
  • Minimally Invasive and Routine Mitral Valve Repair or Replacement for Patients with Single Mitral Valve Disease:A Case Control Study

    Objective To compare the clinical outcomes and safety of minimally invasive and routine mitral valve repair or replacement for patients with single mitral valve disease. Methods We retrospectively analyzed the clinical data of 67 patients with single mitral valve disease (without aortic valve and tricuspid valve lesion or other heart diseases including atrial septal defect) who underwent mitral valve repair or replacement in the First Affiliated Hospital of China Medical University between January and July 2011. The patients were divided into two groups according to different surgical approaches:the minimally invasive surgery group (n=29,8 males and 21 females,age 51.4±9.4 years) underwent minimally invasive mitral valve repair or replacement via right mini-thoractomy;and the routine surgery group (n=38,11 males and 27 females,age 53.6±11.9 years) underwent mitral valve repair or replacement via middle sternotomy. In the minimally invasive surgery group,9 patients underwent mitral valve repair while the other 20 patients underwent mitral valve replacement. And no patient underwent transition to routine operation. In the routine surgery group,15 patients underwent mitral valve repair and 23 patients underwent mitral valve replacement. Clinical outcomes and safety of the operations were compared between the two groups. Results There was no statistical difference in operation time between the two groups (207.9±18.1 min versus 198.4±27.5 min,P=0.076). The amount of postoperative drainage (126.7±34.5 ml versus 435.6±87.2 ml,P=0.000) and blood transfusion (red blood cell 1.4±0.8 U versus 2.3±1.1 U,P=0.000;blood plasma 164.3±50.4 ml versus 405.6±68.9 ml,P=0.000) of the minimally invasive surgery group were significantly lower than those of the routine surgery group. The cardiopulmonary bypass time (81.7±23.9 min versus 58.7±13.6 min,P=0.000) and aortic-clamping time (51.6±12.7 min versus 38.4±11.7 min,P=0.000) of the minimally invasive surgery group were significantly longer than those of the routine surgery group. The length of ICU stay (22.5±3.6 h versus 31.7±8.5 h,P=0.000),mechanical ventilation (7.4±3.2 h versus 11.2±5.1 h,P=0.000) and postoperative hospitalization (7.1±1.6 d versus 13.5±2.4 d,P=0.000) of the minimally invasive surgery group were significantly shorter than those of the routine surgery group. There was no statistical difference in postoperative complications between the two groups. Minimally invasive surgery group patients were followed up for 5.3±2.4 months with a follow-up rate of 72.4%(21/29). Routine surgery group patients were followed up for 5.5±3.8 months with a follow-up rate of 71.0%(27/38). There was no significant complication during follow-up in both two groups. Conclusion Minimally invasive mitral valve operation via right mini-thoracotomy is effective and safe with a good cosmetic result. Compared with routine operation,patients undergoing minimally invasive operation recover better and faster.

    Release date:2016-08-30 05:46 Export PDF Favorites Scan
  • 小儿先天性心脏病合并二尖瓣反流的外科治疗

    目的 分析小儿先天性心脏病合并二尖瓣反流的病理生理特点,总结其外科治疗经验。 方法 回顾性分析1999年12月至2011年5月武汉亚洲心脏病医院新疆医院282例小儿先天性心脏病合并二尖瓣反流行二尖瓣成形手术患者的临床资料,男119例,女163例;年龄1个月 ~ 14 (4.2±3.8)岁;体重4.6~57.0 (18.0±17.6) kg。根据不同病变采取综合多种方法进行二尖瓣成形,主要手术方式为自体心包条环缩后瓣环150例(53.2%),内外交界缝合106例(37.6%)。同期行室间隔缺损修补术148例,房间隔缺损修补术67例,动脉导管未闭闭合术47例,部分型房室间隔缺损矫治术20例,法洛四联症根治术15例,右心室双出口根治术12例等。 结果 本组二尖瓣反流的病理改变中瓣环扩张最常见,其次为瓣叶裂隙,腱索和乳头肌延长最少见。呼吸机辅助呼吸时间(20.6±30.1) h,住院时间(22.4±8.8) d。围术期无死亡,发生一过性血红蛋白尿3例,早期发生低心排血量15例,行短期腹膜透析10例,经相应治疗后好转,均顺利出院。随访282例,随访时间7个月至11年。随访期间再次行二尖瓣置换术2例,前向血流(1.3±0.4) m/s,无二尖瓣狭窄。二尖瓣反流2级48例(17.0%),3 ~4级12例(4.3%);左心室射血分数在正常范围内。 结论 小儿先天性心脏病合并二尖瓣反流患者行二尖瓣成形术,中期结果满意,自体心包条环缩后瓣环不会限制瓣环的发育。

    Release date:2016-08-30 05:46 Export PDF Favorites Scan
  • Clinical Analysis of Patients Undergoing Mitral Valvuloplasty for Anterior Mitral Leaflet Prolapse with Looped Artificial Chordae

    Objective To summarize surgical techniques,advantages and clinical outcomes of mitral valvuloplasty for anterior mitral leaflet prolapse with looped artificial chordae. Methods Clinical data of 13 patients with anteriormitral leaflet prolapse and severe mitral regurgitation (MR) who underwent mitral valvuloplasty with looped artificial chordaefrom January 2009 to December 2011 in Beijing Anzhen Hospital were retrospectively analyzed. There were 8 male and 5 female patients with their age of 21-61 (39.5±12.9) years. There were 10 patients with anterior mitral leaflet chordal rupture and 3 patients with anterior mitral leaflet elongation. Preoperative left ventricular end-diastolic diameter (LVEDD) was 52-65 (58.3±1.7) mm,and left ventricular ejection fraction (LVEF) was 53%-65% (58.8%±2.8%). All the patients underwent mitral valvuloplasty. We measured the neighboring normal chordae with a caliper for reference and constructed the artificial chordal loops on the caliper with expended polytetrafluoroethylene(ePTFE) CV4 Gore-Tex suture lines. Three to five loops were made and fixed to the papillary muscle with a Gore-Tex suture line and the free edge of the prolapsedanterior mitral leaflet with another Gore-Tex suture line,with the intervals between the loops of 5 mm. Left ventricular watertesting was performed to evaluate MR status,annuloplasty ring implantation or “edge to edge” technique was used if nece-ssary,and left ventricular water testing was performed again to confirm satisfactory closure of the mitral valve. Patientsreceived re-warming on cardiopulmonary bypass and the heart incision was closed. The effect of mitral annuloplasty was alsoassessed by transesophageal echocardiography (TEE) after heart rebeating. Warfarin anticoagulation was routinely used for 3 months after discharge. Results There was no perioperative death in this group. Twelve patients received satisfactory outcomes after 1-stage mitral valvuloplasty with looped artificial chordae and annuloplasty ring implantation. One patient didn’t receive satisfactory outcomes in the left ventricular water testing after mitral valvuloplasty with looped artificial chordae,but satisfactory outcome was achieve after “edge to edge” technique was used,and annuloplasty ring was not used for this patient. Postoperative echocardiography showed trivial to mild MR in all the patients,their LVEDD was significantly reducedthan preoperative LVEDD (47.5±2.1 mm vs. 58.3±1.7 mm,P<0.05),and there was no statistical difference between postoperative and preoperative LVEF(58.5%±2.6% vs. 58.8%±2.8%,P>0.05). All the patients were followed up for 3-36 (19.5±3.7) months. Echocardiography showed mild MR in 4 patients and none or trivial MR in 9 patients during follow-up.Conclusion Mitral valvuloplasty with looped artificial chordae is an effective surgical technique for the treatment of anterior mitral leaflet prolapse with satisfactory clinical outcomes,and this technique is also easy to perform.

    Release date:2016-08-30 05:47 Export PDF Favorites Scan
  • Mitral Valve Repair with Artificial Chordae in 78 Patients with Mitral Valve Prolapse

    Objective To analyze early and midterm outcomes and summarize clinical experience of mitral valve repair with artificial chordae for degenerative mitral regurgitation (MR). Methods Clinical data of 78 patients with degenerative MR who underwent mitral valve repair with Gore-Tex artificial chordae from October 2008 to December 2011 in General Hospita1 of Shenyang Military Command were retrospectively analyzed. There were 47 male patients and 31female patients with their age of 52.7±9.6 years,who all had degenerative MR. Operation techniques included simple GoreTex artificial chordae replacement in 15 patients,artificial chordae replacement plus quadrangular resection of the posterior leaflet in 58 patients,artificial chordae replacement plus quadrangular resection of the posterior leaflet and Sliding technique in 5 patients. One to three (2.15±1.05) Gore-Tex artificial chordae were used for each patient,and annuloplasty ring was used for all the patients. Thirty-nine patients underwent concomitant tricuspid valvuloplasty. Intraoperative transesophagealechocardiography showed none obvious MR in 62 patients,trivial MR in 13 patients and mild MR in 3 patients. All thepatients were followed up after discharge. Echocardiography was used to evaluate heart function and MR degree duringfollow-up. Results There was no in-hospital death in this group. Postoperative complications included sinus bradycardiain 5 patients,supraventricular tachycardia in 8 patients,late cardiac tamponade in 1 patient,and permanent pacemakerimplantation in 1 patient. Seventy patients were followed up for 1-2 years with the follow-up rate of 89.74% (70/78). Duringfollow-up,1 patient died of cerebral embolism 13 months after discharge,and all the other patients remained alive. There were 60 patients with NYHA classⅠand 9 patients with NYHA classⅡ. Echocardiography at 1 year after dischargeshowed that left atrial diameter,left ventricular end-diastolic diameter,left ventricular end-systolic diameter,and pulmonary artery systolic pressure were significantly smaller or lower than preoperative values (P<0.05),left ventricular ejection fraction (68.00%±7.00% vs. 55.00%±6.00%) and cardiac output were significantly higher than preoperative values(P<0.05),and MR degree (ratio of regurgitation beam area and left atrial area) was significantly reduced compared with preoperative MR degree (3.45%±5.56% vs. 39.55%±9.86%,P<0.05). No artificial chordae rupture was found. There were47 patients without MR and 22 patients with trivial MR during follow-up. Conclusion Gore-Tex artificial chordae replacement is a safe and effective surgical technique for the treatment of degenerative MR.

    Release date:2016-08-30 05:47 Export PDF Favorites Scan
  • Off-pump Surgical Therapy for Mild-to Moderate-Ischemic Mitral Regurgitation Using a Self-designed Device

    Abstract: Objective To evaluate the effect of a surgical method for treating mild- to moderate-ischemic mitral regurgitation(IMR) using a self-designed device during off-pump coronary artery bypass grafting(OPCAB). Methods From September 2009 to August 2011, six patients(4 males, 2 females; age was 52-73 years) with mild- to moderate-IMR underwent OPCAB and concomitant mitral valvuloplasty using a self-designed device in Beijing An Zhen Hospital. Their degree of IMR, anteroposterior diameter of mitral annulus, left ventricular long-axis diameter, left ventricular short-axis diameter and left ventricular spherical index(left ventricular short-axis diameter/left ventricular long -axis diameter)were measured using transesophageal Doppler echocardiography before and after mitral valvuloplasty. Their mean aorta pressure, mean pulmonary artery pressure and central venous pressure were also measured via Swan-Ganz catheter before and after mitral valvuloplasty. Perioperative cardiac function indexes were compared. Results There was no in-hospital death. IMR of all patients disappeared postoperatively. After mitral valvuloplasty their anteroposterior diameter of mitral annulus(3.43±0.08 cm vs.3.68±0.08 cm;t=5.430, P=0.001), left ventricular short-axis diameter(4.80±0.21 cm vs.5.53±0.11 cm;t=7.530, P=0.001)and left ventricular spherical index(0.64±0.02 vs.0.74±0.01;t=11.110, P=0.002)significantly decreased than those before mitral valvuloplasty . But their left ventricular long-axis diameter and hemodynamic indexes did not change significantly after mitral valvuloplasty. All the six patients were followed up at the out-patient department 3 months postoperatively without autonomous symptoms. Their heart function improved to I class(New York Heart Association). Echocardiography showed 4 patients without IMR and 2 patients with trace of minimalIMR. Conclusion Off-pump surgical therapy for mild- to moderate- IMR during OPCAB can help the patients reverseremodeling of the left ventricle, avoid the risks of cardiopulmonary bypass and improve cardiac function with good short-term effects. This method may be a good choice for treating patients with IMR.

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • 二尖瓣成形术治疗二尖瓣反流89例临床分析

    目的 总结二尖瓣成形术治疗二尖瓣反流患者的临床经验,分析其疗效。 方法 回顾性分析2007 年1 月至 2011 年 7月中国医科大学附属第一医院采用二尖瓣成形术治疗89 例二尖瓣中重度反流患者的临床资料,其中男 51例,女 38 例;年龄21~64 (48.6±13.6)岁;病程1周~21 年。术前经食管超声心动图及术中探查发现二尖瓣中度反流(Ⅲ级) 40 例,重度反流 (Ⅳ级) 49 例。56例二尖瓣脱垂,脱垂病变累及A2区4例、A3区5例、P2区25例、P3区14例,累及多处8例;其中二尖瓣腱索断裂37例,腱索冗长脱垂19例;瓣环扩大42例。手术方式:前叶腱索转移4 例 , 前叶人工腱索 6 例 ,前叶裂缝合2例,交界部缝合 6 例 ,后叶矩形切除加 Sliding (滑行) 技术43 例,后叶折叠缝合成形14例,后叶人工腱索12例,缘对缘成形 10 例和心包补片修补瓣叶穿孔 1 例,其中2种以上修复方式9例。全部患者均使用成形环加固瓣环。手术中应用注水试验和食管超声心动图检查评价成形效果。 结果 无围术期死亡。术后心脏超声心动图提示:二尖瓣无反流 (0 级)15 例,微量反流 (Ⅰ级)41 例,轻度反流 (Ⅱ级) 23 例,轻至中度反流 (Ⅲ级)10 例。所有患者均无二尖瓣狭窄。术后随访77例(86.52%),随访时间3~58 (12.3±18.7) 个月。随访期间1例死于脑血管意外;1例行二尖瓣置换术。 结论 综合运用多种二尖瓣成形技术治疗二尖瓣中重度反流,可获得良好的临床疗效。

    Release date:2016-08-30 05:51 Export PDF Favorites Scan
  • Clinical Application of Homemade Flexible Annuloplasty Ring in Mitral Valve Repair

    Abstract: Objective To summarize the clinical results of homemade flexible annuloplasty ring in mitral valve repair, in order to discuss the appropriate ring size. Methods Sixtysix patients (55 males,and 11 females with a mean age of 44.62±15.94 years) with mitral insufficiency underwent mitral valve repair with homemade flexible annuloplasty ring from April 2002 to November 2009 in Fu Wai Hospital. In order to choose the ring with an appropriate size, we made and kept to the following principles: if the intercommissural distance was bigger than size 30, we chose a ring 2size smaller; if the measured distance was smaller than size 30, 1size smaller ring would be chosen. Patients were followed by echocardiography to observe the mitral valve function. Results All patients were cured and discharged from the hospital. The results of echocardiography showed mild to moderate regurgitation in 1 patient, mild regurgitation in 11 patients, and normal mitral function or trace regurgitation in the rest 54 patients. Mitral valve forward velocity was 1.40±0.30 m/s with no mitral stenosis or systolic anterior motion (SAM) of the anterior mitral leaflet. Fiftyone patients were followed up from 2 months to 7 years(24.60±25.90 months). The results of echocardiography on 38 patients showed that 1 patient had moderate regurgitation, 5 patients had mild to moderate regurgitation, 9 patients had mild regurgitation and others had normal mitral function or trace regurgitation. For these 38 patients included in the followup study, mitral valve forward velocity was 1.50±0.40 m/s with no mitral stenosis, SAM or left ventricular outlet tract obstruction. During the followup, the left atrium size (43.19±10.48 mm vs. 48.59±9.40 mm, t=4.524, P=0.000) and left ventricular end diastolic diameter (52.64±7.35 mm vs. 6269±8.77 mm, t=7.607, P=0.000) decreased significantly than the preoperative size and diameter respectively.  The application of restrictive homemade flexible annuloplasty ring in mitral valve annuloplasty had satisfactory, durable and stable clinical results.

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  • 心脏瓣膜手术后并发溶血性贫血的治疗

    目的 探讨心脏瓣膜手术后并发溶血性贫血的外科治疗方法及效果。方法 1998年1月至2007年12月,广东省人民医院广东省心血管病研究所共治疗11例心瓣膜手术后并发溶血性贫血患者,男9例,女2例;年龄15~57岁(40±14岁)。风湿性心瓣膜病6例,退行性心瓣膜病2例,先天性心瓣膜病2例,感染性心内膜炎1例。第一次手术:行二尖瓣置换术(MVR)2例,双瓣膜置换术(DVR)4例,二尖瓣人工瓣环成形术5例。第二次入院血红蛋白55~92 g/L(76±14 g/L),红细胞压积0.19~0.31(0.25±0.04),网织红细胞百分比0.08~0.17(0.12±0.04),总胆红素34.70~91.50 μmol/L(56.00±19.10 μmol/L),非结合胆红素23.40~54.90 μmol/L(38.60±12.30 μmol/L)。所有患者均先给予内科治疗,10例患者经内科治疗无效后再次行心瓣膜置换术或心瓣膜成形术治疗,另1例给予内科保守治疗。结果 再次手术治疗10例,术后死亡1例,死于溶血性贫血、肾功能衰竭和多器官功能衰竭;其他9例经再次手术治疗后痊愈出院,贫血症状消失,血常规检查正常。内科保守治疗治愈1例。随访10例,随访时间2个月至11年,心功能Ⅰ级8例,Ⅱ级2例,无晚期死亡。1例感染性心内膜炎患者出院时仍有轻度肾功能不全,随访3个月时肾功能完全恢复正常,随访1年心功能良好,无溶血症状。 结论 心瓣膜手术后并发溶血性贫血,如经内科治疗无效应尽早行再次心瓣膜手术治疗,可获得良好的效果。

    Release date:2016-08-30 05:56 Export PDF Favorites Scan
  • Comparison Analysis Between Chordal Transposition and Chordal Shortening in Repairing Anterior Leaflet Prolapse

    Objective To compare chordal transposition and chordal shortening in repairing anterior leaflet prolapse (ALP), and explore the surgical indications as well as merits and demerits of these two techniques. 〖WTHZ〗Methods We retrospectively reviewed the data of 90 ALP patients recruited into Anzhen Hospital between March 1986 and March 2008, and classified them into chordal shortening group (n=23) and chordal transposition group (n=67). KaplanMeier survival curve and freedom from reoperation curve were established to compare the two groups. Univariate analysis and multivariate logistic analysis regression were used to identify independent risk factors for early death and late cardiac events. 〖WTHZ〗Results There were three perioperative deaths in chordal shortening group(13.0%), and three deaths in chordal transposition group (4.4%), and the difference was not significant (χ2=2.019,P=0.155). The follow-up time ranged from 1 month to 18 yrs(7.70±5.41 yrs). There were 5 late deaths, of which 3 were in chordal shortening group and 2 in chordal transposition group. The KaplanMeier survival curve showed that 5-year survival rate of chordal shortening group was significantly lower than chordal transposition group (70.00%±18.24% vs.98.00%±1.98%,χ2=12.50, P=0.000); And the KaplanMeier freedom from reoperation curve showed [CM(159mm]that 5-year reoperation rate of chordal shortening group was also significantly lower than chordal transposition group (83.30%±15.20% vs.96.10%±2.71%,χ2=10.27,P≤0.001). By the univariate analysis, we found that age>55 yrs old, concomitant CABG procedure, New York Heart Association (NYHA) function class Ⅲ-Ⅳ, preoperative heart failure history, aortic clamping time>90 min, and preoperative lefe ventricular ejection fraction (LVEF)<45% were the risk factors for perioperative death and risk factors for late cardiac events included postoperative mitral regurgitation>2+, chordal shortening technique, preoperative heart failure history, and aortic clamping time>90 min. The multivariate logistic analysis regression showed that aortic clamping time>90 min, concomitant CABG procedure, preoperative LVEF<45% were the independent predictors for perioperative death, and NYHA class ⅢⅣ, chordalshortening technique and residual mitral regurgitation>2+ were the independent predictors for the late cardiac events. Conclusion (1) There is no statistically difference between chordal transposition and chordal shortening in the perioperative survival rate. (2) Chordal transposition has a relative superiority to chordal shortening in terms of 5-year survival rate. (3) Chordal transposition has a higher mid and longterm rate of freedom from reoperation than chordal shortening. (4) Although chordal transposition has a lower incidence of reoperation and ahigher mid and longterm survival rate, the indication for it is restricted to less extensive ALP and patients with transferrable chord in the posterior leaflet. Chordal shortening is an independent risk factor for late events.

    Release date:2016-08-30 05:59 Export PDF Favorites Scan
  • Mild Functional Tricuspid Regurgitation Approach to Mitral Valve Repair

    Abstract: Objective To explore whether clinically mild functional tricuspid regurgitation should be addressed at the time of mitral valve repair (MVP) for moderate or severe mitral regurgitation due to myxomatous degeneration. Methods We retrospectively analyzed the outcomes of 135 patients with moderate or severemitral regurgitation due to myxomatous degeneration with mild functional tricuspid regurgitation. All patients were treated between January 1993 and March 2008 in the Department of Cardiothoracic Surgery of Changhai Hospital, the Second Military Medical University. We divided the patients into a MVP group (n=76) and a MVP+tricuspid valvuloplasty (TVP) group(n=59) according to whether they underwent combined TVP, and observed the perioperative mortality rate, degree of tricuspid regurgitation, and compared survival rate, and freedom from longterm moderate or severe tricuspid regurgitation after operation. Cox regression was used to analyzethe risk factors for longterm moderate or severe tricuspid regurgitation after operations. Results (1) There were no deaths during the perioperative period, and postoperative transthoracic echocardiography of all patients indicated that tricuspid regurgitation was mild or less. (2) Survival rate at 5 years, 10 years after operations in MVP group was 98.4%, 95.0%, respectively, and survival rate at 5 years, 10 years after operations in MVP+TVP group was 100.0%, 93.7%, respectively, and there was no significant difference in the survival rate after operations between the two groups(P=0.311), butthere was a significant difference in the freedom from longterm moderate or severe tricuspid regurgitation after operations between the two groups (P=0.040). Multivariate Cox regression showed that preoperative pulmonary artery pressure gt;30 mm Hg (95%CI 1.127 to 137.487, P=0.040 )and atrial fibrillation (95%CI 1.177 to 23.378, P=0.030) wereindependent risk factors for longterm moderate or severe tricuspid regurgitation afteroperations.Conclusion TVP is necessary for most patients undergoing MVP for moderate or severe mitral regurgitation due to myxomatous degeneration who have coexistent mild functional tricuspid regurgitation, especially those patients with preoperative pulmonary artery pressure gt;30 mm Hg or atrial fibrillation.

    Release date:2016-08-30 05:57 Export PDF Favorites Scan
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