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Progress in Surgical Treatment of Secondary Tricuspid Insufficiency

Abstract： Tricuspid insufficiency founded in the setting of left-sided heart disease is usually secondary tricuspid insufficiency caused by tricuspid valve annular dilation. Some patients had rheumatic tricuspid valve diseases. Tricuspid valve repair rather than valve replacement is recommend for functional tricuspid regurgitation. Linear annuloplasty and ring annuloplasty are two main tricuspid valve repair methods. However, the indications for treatment of secondary tricuspid regurgitation remain controversial. The optimal surgical repair technique to eliminate secondary tricuspid regurgitation remains challenging. In this article, we review the assessment of tricuspid valve lesions, criteria for correction, and surgical management of secondary tricuspid insufficiency.methods. However, the indications for treatment of secondary tricus

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.

双孔三尖瓣畸形的诊断与治疗

目的 分析双孔三尖瓣畸形的诊断与治疗特点，总结治疗经验。 方法 回顾性分析中南大学湘雅二医院2008年8~12月收治的3例双孔三尖瓣畸形患者的病例资料，其中男1例，女2例；年龄20~67岁。1例术前临床诊断为法洛四联症，行法洛四联症矫治术，缝闭三尖瓣副孔；1例术前临床诊断为部分型心内膜垫缺损合并三尖瓣关闭不全，行心内膜垫缺损矫治术，未处理三尖瓣副孔；1例术前临床诊断为风湿性心脏病、二尖瓣重度狭窄、二尖瓣闭式扩张术后、主动脉瓣狭窄合并关闭不全、三尖瓣关闭不全、心房颤动，行二尖瓣置换、主动脉瓣置换、三尖瓣成形术，缝闭三尖瓣副孔。 结果 3例患者手术时间170~192 min，体外循环时间120~143 min，主动脉阻断时间77~95 min；术后3~5 d复查彩色超声心动图提示：结果均正常，术后7～8 d均康复出院；出院后分别于1个月、3个月、6个月及1年行常规检查，恢复良好；彩色超声心动图提示：无三尖瓣反流，三尖瓣副孔处无异常血流。 结论 双孔三尖瓣畸形副孔有独立的瓣叶、腱索和乳头肌，能启闭自如。尸检是其主要诊断手段，其次为手术和彩色超声心动图检查。仅三尖瓣副孔伴有瓣膜关闭不全或狭窄的患者有血流动力学异常时才需手术处理。

Surgical Treatment for Patients with Coronary Heart Disease and Ventricular Aneurysm

Objective　To summarize clinical characteristics and treatment results of adult patients with coronary heart disease and ventricular aneurysm，and evaluate surgical outcomes. Methods Clinical data of 86 adult patients with coronary heart disease and ventricular aneurysm who underwent surgical treatment in Fu Wai Hospital from January 2011 to November 2012 were retrospectively analyzed. There were 70 male and 16 female patients with their average age of 57.7±10.6 years and average body weight of 71.7±10.5 kg. Preoperative echocardiography or left ventriculography showed left ventricular thrombus in 22 patients. Coronary angiography showed 47 patients with 3 vessel disease，29 patientswith 2 vessel disease，and 10 patients with single vessel disease. Sixteen patients underwent direct linear suturing of theaneurysm off pump，39 patients underwent simple linear suturing under cardiopulmonary bypass，15 patients received endoventricular purse-string reconstruction，and 16 patients received endoventricular purse-string reconstruction and patch plasty. Three patients underwent reexploration for bleeding. Sixty-four patients received concomitant coronary artery bypass grafting（CABG）. Results Postoperatively 2 patients（2.3%） died of refractory ventricular fibrillation and multiple organ dysfunction syndrome respectively. Patients undergoing concomitant CABG received 2.3±1.2 grafts on the average. Seventy-eightpatients （92.9%） were followed up for 2-24 months after discharge. During follow-up，patients’ angina symptoms significantlyresolved，heart function improved in varying degrees，and no new sign of myocardial ischemia was found on electrocardiogram.Left ventricular ejection fraction （LVEF） was significantly higher than preoperative LVEF（51%±7% vs. 41%±9% ，t=6.20，P=0.00），and left ventricular end-diastolic diameter （LVEDD） was significantly smaller than preoperative LVEDD （54.2±6.2 mm vs. 56.0±6.8 mm，t=4.60，P=0.00） . Conclusion Ventricular aneurysm repair and concomitant CABG （or ventricular septal perforation repair，mitral valvuloplasty et al） are positive and effective treatment strategies for postinfarction ventricular aneurysm. Satisfactory clinical outcomes can be achieved by individualized treatment based on appropriate surgical strategies according to the size of ventricular aneurysm.

急性心肌梗死室间隔穿孔介入封堵后残余分流致急性左心衰竭一例

感染性心内膜炎104例的临床分析

目的　探索感染性心内膜炎的临床特点及治疗结果，以提高其临床疗效。 方法 回顾性分析2008年1月至2009年12月北京阜外心血管病医院104例感染性心内膜炎患者的临床资料，其中男64例、女40例，平均年龄40.8岁，血培养阳性47例（45.2％）。超声心动图检查提示：90例（86.5%）心脏瓣膜或流出道有赘生物，赘生物位于主动脉瓣36例，二尖瓣32例，三尖瓣11例，右心室流出道3例，多个瓣膜6例。据血培养结果行药物或外科手术治疗，术前及术后应用敏感抗生素治疗。 结果 全组33例行内科药物治疗，病死率为33.3% （11/33）；72例行外科手术清除赘生物及进行心脏基础病变治疗，病死率为4.1% （3/72）。死亡原因1例为低心排血量，1例感染，1例脑梗塞。赘生物培养均为阴性。体外循环时间（117.5±63.3） min，主动脉阻断时间（82.7±44.8） min。总的中位住院时间30.9 d，术后住院时间13 （6～41） d。术后有3例感染再发，2例因为瓣周漏引起感染再发，1例行瓣膜成形术后感染再发。 结论 基础心脏病仍是感染性心内膜炎常见病因。早期、有效、规律的抗生素治疗仍是治疗基础，及时的外科治疗可降低病死率。

Early and Mid-term Results of Reduction Ascending Aortoplasty

ObjectiveTo assess early and mid-term outcomes and our clinical experience of reduction ascending aortoplasty (RAA) for patients with aortic valve disease and ascending aortic dilatation, and improve treatment effects. MethodsClinical data of 36 patients with aortic valve disease and ascending aortic dilatation who underwent aortic valve replacement and RAA in Fu Wai Hospital between January 2002 and August 2010 were retrospectively analyzed. There were 26 male and 10 female patients with their age of 7-72 (51±16) years. Ascending aorta diameter (AAD) was measured by echocardiography preoperatively, postoperatively, during follow-up and compared. ResultsThere was no perioperative death. Cardiopulmonary bypass time was 96.2±28.3 minutes, and aortic cross-clamp time was 69.2±22.1 minutes. Posto-perative hospital stay was 11.0±7.8 days. All the 36 patients were followed up after discharge for 1.1-9.0 (4.0±2.3) years. During follow-up, there was 1 death, but none of the patients needed reoperation. Echocardiography showed normal aortic valve function. Postoperative AAD was significantly smaller than preoperative AAD (36.4±6.1 mm vs. 46.8±4.6 mm, t=13.12, P=0.00). AAD during follow-up was significantly larger than postoperative AAD (40.8±6.8 mm vs. 36.4±6.1 mm, t=-2.64, P=0.01) but significantly smaller than preoperative AAD (40.8±6.8 mm vs. 46.8±4.6 mm, t=3.48, P=0.00). ConclusionEarly and mid-term outcomes of RAA are satisfactory for patients with aortic valve disease and ascending aortic dilatation, but long-term results need further observation.