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心脏瓣膜置换术中射频消融治疗心房颤动

重症心脏瓣膜病心瓣膜置换术体外循环经验

连续静脉-静脉血液透析治疗冠状动脉旁路移植术后慢性肾功能衰竭一例

Minimally Invasive Mitral Valve Replacement Combined with Atrial Fibrillation Radiofrequency Ablation via Right Minithoracotomy

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.

Mitral Valve Repair for Mitral Bileaflet Prolapse

ObjectiveTo conclude the outcomes of mitral valve repair for mitral bileaflet prolapse. MethodsWe retrospectively analyzed the clinical data of 14 patients with mitral bileaflet prolapse in our hospital between June 2010 and March 2013. There were 10 males and 4 females with at age of 46.9±12.0 years. We used one technique in 4 patients, two techniques in 9 patients, three techniques in 1 patient. ResultsMean follow-up time was 13.1±7.2 months. There was no perioperative death. No reoperation occurred. No or trace mitral regurgitation (MR) was found in 13 patients. Slight MR was found in one patient. ConclusionThe early metaphase results of mitral valve repair for mitral bileaflet prolapse are satisfactory if the appropriate surgery method is chosen.

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。

The effect of mild hypothermia on multiple organ dysfunction system post-cardiac surgery: a case control study

Objective To summarize the effect of mild hypothermia on post-cardiac surgery patients with multiple organ dysfunction system(MODS). Methods We retrospectively analyzed the clinical data of 90 patients with MODS after cardiac surgery under cardiopulmonary bypass(CPB) from May 2010 through June 2014 in our hospital. There were 57 males and 33 females at 61±6 years. The patients were divided into two groups including a NT group (without pre-hypothermia treatment,n=32) and a HT group(with pre-hypothermia treatment,n=58). Results Of the 90 patients, totally 18 patients died, 8 patients (13.8%) in the HT group, 10 patients (31.2%) in the NT group with a statistical difference (P<0.05). In the NT group, 12 patients (37.5%) were treated by intra-aortic balloon pump (IABP), and 9 patients (15.5%) in the HT group with a statistical difference between the two groups (P<0.05). The patients' heart rate (HR) decreased significantly after the application of hypothermia. The HR of difference between the two groups at 36 h was significant (P<0.05). The mean aortic pressure (MAP) in the HT group was lower than that of the NT group significantly at 0 h, because we used sedation and muscular relaxation agent. But the MAP in the HT group was significantly higher than that of the NT group after hypothermia 36 h (P<0.05). In the HT group, pressure of oxygen (PO2), mixed venous oxygen saturation (SvO2), and lactic acid (Lac) were improved significantly compared with those of the NT group significantly (P<0.05). There was no statistical difference in prothrombin time (PT) or activated partial thromboplastin time (APTT) between the two groups (P>0.05). But there was a statistical difference in platelet (PLT) between the two groups at 36 h (P<0.05). The aspartate aminotransferase (AST), alannine aminotransferase (ALT), creatinine (Cr) were improved significantly in the HT group (P<0.05). Conclusion Mild hypothermia can improve the organ function effectively. It can slow the MODS development speed and win the time of protection and further treatment for cells and organs. It is an effective and safety therapeutic technique for MODS after cardiac surgery.

右胸小切口微创二尖瓣手术同期行心房颤动双心房射频消融术

目的总结右胸前外侧小切口微创二尖瓣手术同时行心房颤动（房颤）双心房射频消融术的临床经验。 方法回顾性分析2012年1～10月中国医科大学附属第一医院二尖瓣病变合并持续性心房颤动11例患者的临床资料，其中男4例、女7例，年龄（54.5±6.5）岁。所有患者均经股动静脉内插管建立体外循环，经第3或第4肋间入胸，经房间沟切口行二尖瓣手术，以单极笔行肺静脉口射频消融，以双极笔经右心房切口行右心房及右侧肺静脉口射频消融，封闭左心耳。缝合左右心房切口。2例行二尖瓣成形术，其余9例行二尖瓣置换术。 结果手术时间（282.9±67.8）min，体外循环时间（165.7±39.8）min，主动脉阻断时间（109.9±29.7）min，术后机械通气时间（7.4±3.2）h，住ICU时间（26.5±5.3）h，胸腔引流量（119.7±24.5）ml。随访时间（5.1±1.9）个月，术后3个月复查，窦性心律8例，阵发性心房颤动1例，持续性心房颤动2例。 结论经右胸前外小切口行微创二尖瓣手术同期行心房射频消融术，术后恢复快，美容效果好，临床疗效满意。

Regional citrate anticoagulation continuous venous-venous hemodialysis in acute hepatic & kidney injury after cardiovascular surgery

Objective To investigate the effects and feasibility of regional citrate anticoagulation continuous venous-venous hemodialysis(RCA-CVVHD) in acute hepatic & kidney injury after cardiovascular surgery. Methods Ten patients with acute kidney injury combined with acute hepatic injury after cardiovascular surgery were involved in this study. There were 5 males and 5 females at age of 35-69(58.2±12.7) years. All of them were treated by RCA-CVVHD. Blood samples were collected before treatment, 12 h, 24 h, 48 h, and 72 h after treatment. Results There was no statistical difference between post- and pre-treatment regarding with pH value (7.47±0.12 vs. 7.50±0.06 vs. 7.48±0.04 vs. 7.48±0.03 vs. 7.45±0.05, P>0.05) or BE value (0.91±9.97 mmol/L vs. 2.36±3.92 mmol/L vs. –0.22±3.09 mmol/L vs. 1.87±3.58 mmol/L vs. –1.05±1.12 mmol/L, P>0.05). There was a statistical difference in iCa (1.09±0.09 mmol/L vs. 1.15±0.08 mmol/L vs. 1.17±0.08 mmol/L vs. 1.24±0.09 mmol/L vs. 1.16±0.06 mmol/L), Na+ (149.44±6.84 mmol/L vs. 144.33±3.35 mmol/L vs. 143.13±3.52 mmol/L vs.141.25±5.52 mmol/L vs. 136.71±4.92 mmol/L), and tCa/iCa (2.07±0.11 vs. 2.10±1.12 vs. 2.17±0.69 vs. 2.23±1.05 vs. 2.30±0.11), respectively. Conclusion RCA-CVVHD used in patients with acute hepatic impairment is safe and feasible.