Objective To investigate the feasibility and effect of stentedpulmonary autograft replacement and find out the best way to treat mitral valve diseases. Methods From August 2006 to October 2007, 20 male sheep at the age of about 1 year old underwent mitral valves replacement operation in Anzhen Hospital. Weight of these sheep was 50.0±6.0 kg. They were randomly divided into two groups. Ten sheep in the experimental group underwent RossⅡsurgery in which we first sutured pulmonary valve onto a pulmonary valve stent, transferred the valve to the mitral valve annulus and then reestablished the outflow tract of the right ventricle. The other 10 sheep in the control group underwent bioprosthetic valve replacement routinely. Ultrasonic cardiogram (UCG) was employed 6 hour after operation to measure the effective orifice area (EOA) of the mitral valve, mitral peak velocity of early filling, the peak pressure gradient (PPG), the extent of regurgitation, left ventricular enddiastolic dimension (LVEDD) and ejection fraction (EF). Results One sheep in the experimental group died of low cardiac output syndrome; one in the control group died of unmanageable bleeding during operation, and the others all survived. Six hours after operation, UCG of the experimental group showed that the heart valves were well fixed, valve echo was clear, and there was no perivalvular leakage or mitral valve stricture or regurgitation, but moderate pulmonary valve regurgitation occurred in 1 case and mild in 2. There was no significant difference between the two groups in PPG (11.86±1.28 mm Hg vs. 10.98±0.98 mm Hg,t= 1.670,P=0.110) and the mitral peak velocity of early filling (1.72±0.09 m/s vs. 1.65±0.07 m/s, t=1.680,P=0.110). However, EOA of the experimental group was smaller than the control group (2.23±0.09 cm2 vs. 2.39±0.08 cm2, t= 4.240,P= 0.001). Conclusion The experimental result of sheep mitral valves replacement with stentedpulmonary autograft is satisfying. The new mitral valves work well and the surgery method is feasible.
目的总结右胸前第3肋间小切口瓣膜置换/成形术的技术要点。 方法回顾性分析2011年1月至2014年6月我院行右胸前第3肋间小切口心脏瓣膜手术129例的临床资料，其中男57例、女72例，年龄23～65（42±17）岁。瓣膜病变患者股动静脉插管建立体外循环、经右胸前第3肋间小切口行瓣置换/成形术，其中行二尖瓣置换术49例，二尖瓣成形术21例，主动脉瓣置换术33例，二尖瓣+主动脉瓣双瓣膜置换术26例。 结果129例手术均顺利完成，切口长度5～7 cm，无感染及神经系统并发症发生，住院时间10～14 d，均痊愈出院。随访1～30个月，患者心功能改善，无死亡病例。 结论右胸前第3肋间小切口行瓣膜手术安全可靠，创伤小并具有美容效果。