目的探讨临床应用微创经胸小切口封堵术治疗室间隔缺损（ventricular septal defect，VSD）的初步经验 方法回顾性分析我院心外科2006年4月至2013年12月施行微创经胸小切口封堵术治疗205例VSD患者的临床资料。其中，男112例、女93例，年龄4个月～62（10.2± 12.5）岁，无合并其它心内畸形，术前经胸超声心动图筛查，术中经食管超声心动图监测、引导，胸骨下段小切口或左胸第3肋间胸骨旁小切口行VSD封堵术。术后密切随访病情，定期随访心电图、胸部X线片（后前位+左侧位）、超声心动图。 结果全组患者无死亡。封堵成功200例（97.6%），封堵失败转行体外循环下手术修补5例，术后并发VSD残余漏3例，无新发主动脉瓣及三尖瓣反流、封堵伞脱落、二次开胸、完全性房室传导阻滞、溶血等并发症。 结论微创经胸小切口VSD封堵术安全、有效，技术日臻成熟，临床应用值得推广，但仍需注意团队医师间配合以及指征把握。
ObjectiveTo analyze the risk factors of the death associated with infective endocarditis, and to evaluate the timing of surgical treatment of infective endocarditis. MethodsWe retrospectively analyzed the clinical data of 62 patients with infective endocarditis in our hospital between August 2015 and August 2017. There were 43 males and 19 females at age of 19–75 (46.1±16.6) years. The clinical data were divided into a death group and a survival group, a paravalvular leakage group and a no periannular leakage group, an emergency operation group and a non-emergency operation group.The risk factors of infective endocarditis and the choice of operation time were analyzed. ResultsThree of the 62 patients (4.8%) died after surgery. Postoperative perivalvular leakage (regurgitation over 2 mm) in 8 patients, accounting for 12.9% of the total. Univariate analysis showed that albumin content, creatinine level, total cardiopulmonary bypass time and ascending aorta occlusion time were significantly associated with early postoperative mortality (P<0.05). The results of logistic analysis showed that age, preoperative albumin level, creatinine level, total cardiopulmonary bypass time, and ascending aorta occlusion time were significantly associated with early postoperative perivascular leakage (P<0.05), and long ascending aorta occlusion time is an independent risk factor for early death (P<0.05). There was no statistical difference in early death and the perivalve leakage between the emergency operation and the non emergency operation. ConclusionPatients with infective endocarditis should accept early surgical treatment. The choice of surgical approach should be selected according to the actual situation of patients. And we should pay more attention to albumin and creatinine levels in preoperative patients. In the operation, to shorten extracorporeal circulation time and aortic clamping time can improve the prognosis of patients.