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find Keyword "瓣膜置换术" 114 results
  • Changes of Left Ventricular Morphology and Contractile Function after Heart Valve Replacement of Patients with Valvular Heart Disease and Giant Left Ventricle:A Systematic Review

    Objective To conduct a systematic review to evaluate preoperative and postoperative changes of echocardiography indexes which reflect left ventricular morphology and contractile function after heart valve replacement of patients with valvular heart disease with giant left ventricle. Methods We electronically searched CBMdisc, VIP database,Wanfang database, CNKI database, PubMed and ScienceDirect from time of establishment of each database to June 2012 to identify literatures addressing heart valve replacement for patients with valvular heart disease and giant left ventricle. Quality of included literatures was evaluated, and relevant data were extracted to conduct meta-analysis. Preoperative and postoperative changes of echocardiography indexes of patients undergoing heart valve replacement were compared. R2.15.2 software was used for statistical analysis. Results Twelve retrospective cohort studies were included in this study involving 833 patients. The quality of included literature was relatively high. Meta-analysis showed that left ventricular end-diastolic diameter (LVEDD) at 2 weeks, 6 months, 1 year, 2 to 3 years postoperatively were reduced by 11.72 mm[95% CI (9.52,13.92), P<0.001], 20.02 mm [95% CI (18.28, 21.76), P<0.001], 22.48 mm [95% CI (19.55, 25.40), P<0.001] and 24.69 mm [95% CI (22.21, 27.18), P<0.001] respectively compared with preoperative value. Left ventricularend-systolic diameter (LVESD) at 2 weeks, 6 months, 1 year, 2 to 3 years postoperatively were reduced by 7.74 mm [95% CI (3.76, 11.72), P<0.001], 15.54 mm [95% CI (12.55, 18.54), P<0.001], 18.84 mm [95% CI (15.54, 21.14),P<0.001] and 21.02 mm[95% CI (17.67, 24.37), P<0.001] respectively compared with preoperative value. Compared with preoperative value, left ventricular ejection fraction (LVEF) decreased by 7% at 2 weeks postoperatively [95% CI (1%, 12%), P=0.013], increased by 9% at 6 months postoperatively [95% CI (-14%, -3%), P=0.002], increased by 11% at 1 year postoperatively [95% CI (-22%, 0%), P=0.041], and increased by 13% at 2-3 years postoperatively [95% CI (4%, 21%), P=0.004]. Compared with preoperative value, left ventricular fraction shortening (LVFS) decreased by 0.05 at 2 weeks postoperatively [95% CI (0.03, 0.07), P<0.001], increased by 0.02 at 6 months postoperatively [95% CI (0.00, 0.04), P=0.055], increased by 0.03 at 1 year postoperatively [95% CI (0.00, 0.06), P=0.035], and increased by 6% at 2-3 years postoperatively [95% CI (0.02, 0.11), P=0.008]. Conclusions LVEED and LVESD of patients with valvular heart disease and giant left ventricle continuously decrease after heart valve replacement, especially in the first 6 months postoperatively, and return to normal in 2 to 3 years. LVEF and LVFS decrease in the first 2 weeks postoperatively, then start to increase, are higher than preoperative values at 6 months, and return to normal in 2 to 3 years. Heart valve replacement is conducive for the recovery of left ventricular morphology and systolic function of patients with valvular heart disease and giant left ventricle.

    Release date:2016-08-30 05:45 Export PDF Favorites Scan
  • Construction of an Anticoagulation Therapy Database of Chinese Patients after Heart Valve Replacement

    Abstract: Objective To construct an Anticoagulation Therapy Database of Chinese Patients after Heart Valve  Replacement in accordance with blood coagulation characteristics of Chinese patients, fill the gap of Chinese clinical research in valvular heart diseases, and provide a scientific and objective basic data and information exchange platform. Methods  A national multicentre,prospective and cohort clinical research method was applied to establish an anticoagulation therapy database of Chinese patients after heart valve replacement, using the Internet as a platform. A case report form (CRF), which was in line with the actual situation of Chinese anticoagulation patients after heart valve surgery, was formulated through the discussion of experts from 36 cardiovascular surgery centers in China in the starting meeting of National Science  amp; Technology Support Program during the Twelfth Five-year Plan Period.We planned to prospectively include patients receiving warfarin anticoagulation therapy and formal anticoagulation monitoring after heart valve replacement from January 1, 2011 to December 31, 2014. Database was constructed using warehousing technology, which allowed not only data monitoring, query and statistics, but also regular  data backup and system updates. Results A network database entitled Anticoagulant Therapy Database of Chinese Patients  after Heart Valve Replacement was constructed and linked with the homepage of Chinese Journal of Clinical Thoracic and Cardiovascular Surgery (http://www. zgxxwkzz. com), which constituted a national Internet information platform. From 1 January 2011 to 1 December 2012, 8 452 anticoagulation patients after heart valve replacement from 34 level-3A hospitals in China had been registered in the database. Further follow-up of these patients was being carried out in respective hospitals. Conclusion A large multi-center and open database and network information platform has been constructed. The database variables are in line with clinical characteristics of Chinese anticoagulation patients after heart valve replacement, which provide scientific and objective basic data and support for future clinical research and systemic analysis.

    Release date:2016-08-30 05:28 Export PDF Favorites Scan
  • Tissue Doppler Strain Rate Imaging to Evaluate the Impact of Dopamine and Milrinone on Left Ventricular Function of Patients Undergoing Heart Valve Replacement

    Abstract: Objective To use tissue Doppler strain rate imaging to evaluate the impact of low dose dopamine and milrinone on systolic and diastolic function of the left ventricle of patients undergoing heart valve replacement. Methods  Forty patients undergoing selective heart valve replacement in West China Hospital of Sichuan University between March and May 2011 were included in this study. All the patients were randomized into 2 groups with 20 patients in each group: milrione group and dopamine group. After anesthesia induction and before cardiopulmonary bypass setup, left ventricular ejection fraction (LVEF) was measured by echocardiography. Tissue Doppler strain rate imaging was used to measure the left ventricular lateral wall and midventricular segment from the four-chamber view, which was compared with Doppler parameters. Results LVEF, ratio of early-diastolic to end-diastolic velocity (E/A) of transmitral flow, ratio of mitral  inflow velocity to early diastolic velocity in the annulus (E/Et) of both 2 groups were significantly different between before and after dopamine and milrinone administration (P<0. 05). In the milrinone group, 4 segments systolic peak velocity (Vs), 1 segment early diastolic peak velocity (Ve), 4 segments late diastolic peak velocity (Va), 3 segments Ve/Va ratio, 2 segments systolic peak strain rate (SRs), 2 segments late diastolic peak strain rate (SRa), and 3 segments early diastolic peak strain rate SRe/SRa ratio after dopamine and milrinone administration were significantly higher than those before dopamine  and milrinone administration (P<0. 05). In the dopamine group, 4 segments systolic peak velocity (Vs), 1 segment Ve, 4 segments Va, 1 segment Ve/Va ratio, 2 segments SRs, 1 segment SRe, 1 segment SRa, and 1 segment SRe/SRa ratio after dopamine and milrinone administration were significantly higher than those before dopamine and milrinone administration (P<0.05). To compare the milrione group and dopamine group after medication administration, 2 segments Vs, 4 segments Va, 1 segment SRe, 1 segment SRa, 2 segments Ve/Va ratio, and 2 segments SRe/SRa ratio of the milrione group were significantly higher than those of the dopamine group (P<0.05), and 1 segment Vs, two segments SRs of the milrione group were significantly lower than those of the dopamine group (P<0.05). Conclusion Both milrinone and dopamine can improve left ventricular systolic function of perioperative patients undergoing heart valve replacement assessed by tissue Doppler strain rate imaging, while milrinone can improve the diastolic function of the left ventricle on the long axis more significantly.

    Release date:2016-08-30 05:28 Export PDF Favorites Scan
  • Clinical Outcomes of Nitroglycerin Perfusion via the Aortic Root before Heart Re-beating for Patients Undergoing Heart Valve Replacement

    Abstract: Objective To explore clinical outcomes of nitroglycerin perfusion via the aortic root before heart re-beating  for patients undergoing heart valve replacement. Methods A total of 254 patients with valvular heart diseases underwent  heart valve replacement in Beijing Anzhen Hospital from January 2008 to December 2011. According to whether or not they received nitroglycerin perfusion via the aortic root before heart re-beating during cardiopulmonary bypass (CPB), all the 254 patients were randomly divided into two groups, the nitroglycerin group and the control group. There were 134 patients  in the nitroglycerin group including 57 males and 77 females with their average age of 58.47±12.34 years. They received aortic root perfusion of 5 mg nitroglycerin diluted into 20 ml after full de-airing of the heart, and repeated aspiration was performed 8 to 10 times before heart re-beating during CPB. Aortic cross-clamp was released after the heart showed signs of automatic re-beating, and the aortic root was squeezed in high frequency by hand to make sure that the aorta was squeezed to close each time. In the control group, there were 120 patients including 64 males and 56 females with their average  age of 61.85±11.97 years. Patients in the control group received routine procedures of CPB except nitroglycerin perfusion before heart re-beating. Automatic heart re-beating rate, CPB supporting time after heart re-beating, postoperative usage of inotropic drugs, mechanical ventilation time, perioperative morbidity and length of hospital stay were compared between the 2 groups, and patients were followed up and further evaluated. Results There was no in-hospital death. CPB supporting time after heart re-beating(12.32±9.76 min vs. 23.43±10.33 min, t=-1.233, P=0.000), dopamine usage[3.45±2.33 μg/ (kg?min) vs. 5.67±3.12 μg/ (kg?min) , t=-0.943 , P=0.034] and epinephrine usage [0.026±0.013 μg/ (kg?min) vs. 0.056±0.021 μg/ (kg?min) , t=-0.822 , P=0.027] of the nitroglycerin group were significantly shorter or lower than those of the control group. Automatic heart re-beating rate of the nitroglycerin group was significantly higher than that of the control group [97.01% vs. 66.67 % , χ 2 =-2.115 , P=0.000]. A total of 121 patients in the nitroglycerin group were followed up for 2-36 months, and 13 patients were lost during follow-up. There was no death during follow-up.  Conclusion For patients undergoing heart valve replacement, some myocardial protection strategies including nitroglycerin  perfusion via the aortic root before heart re-beating, use of norepinephrine, and aortic root squeezing in high frequency by hand can significantly increase the automatic heart re-beating rate, shorten the CPB supporting time after heart re-beating, and improve postoperative clinical outcomes.

    Release date:2016-08-30 05:28 Export PDF Favorites Scan
  • 急性人工瓣膜功能障碍六例临床分析

    目的 探讨急性人工瓣膜功能障碍的早期诊断及合理治疗措施。 方法 回顾性分析2011年1月至2012年1月武汉亚洲心脏病医院6例急性人工瓣膜功能障碍患者的临床资料,其中男3例,女3例;年龄28~61岁。风湿性心脏瓣膜病5例,退行性心脏瓣膜病1例;行主动脉瓣置换术1例,二尖瓣置换术3例,二尖瓣、主动脉瓣双瓣膜置换术2例。心瓣膜置换术后2个月~8年8个月出现急性人工瓣膜功能障碍,6例患者入院后均在24 h内因心力衰竭表现难以纠正而行气管内插管+有创呼吸机治疗;4例患者于入院后24 h内行急诊外科手术治疗,2例患者放弃手术治疗。 结果 人工瓣膜的主要病理改变为血栓形成、瓣膜赘生物形成、组织水肿、内膜增生和瓣叶活动度降低。经手术治疗的4例患者无围术期死亡,均痊愈出院;未行手术治疗的2例患者均于48 h内死于心力衰竭 。随访4例,随访时间12~23个月,随访期间4例患者均酌情服用利尿剂、血管紧张素转换酶抑制剂、华法林等药物,术后3个月、6个月、1年复查心脏超声心动图提示人工瓣膜功能良好,术后1年患者心功能均恢复至Ⅰ~Ⅱ级。 结论 急诊床旁经胸超声心动图检查对急性人工瓣膜功能障碍的早期诊断有重要的价值;尽早行外科手术治疗是挽救该类患者生命最有效的手段。

    Release date:2016-08-30 05:45 Export PDF Favorites Scan
  • Impact of Recombinant Human Growth Hormone on T Lymphocyte Subsets in Perioperative Patients with Rheumatic Heart Disease: A Randomized Controlled Trial

    Objective To explore the impact of recombinant human growth hormone (rhGH) on T lymphocyte subsets in patients with rheumatic heart disease during the perioperative period of heart valve replacement. Methods A total of 65 patients with rheumatic valvular heart disease who received heart valve replacement in Department of Cardiothoracic Surgery of Xiangyang Central Hospital from June 1, 2011 to March 31, 2012 were enrolled in this double-blind randomized controlled clinical study. All the patients were divided into 2 groups by random number produced by SAS software:the trial group and the control group. There were 35 patients in the trial group including 19 males and 16 females with their average age of 50.57 years, and 30 patients in the control group including 16 males and 14 females with their average age of 49.87 years. Apart from routine cardiac glycosides, diuretics, glucose-insulin-potassium solution, and postoperative anti-infective therapy, patients in the trial group also received subcutaneously injection of rhGH 5 U (1 ml)daily from 1 day before surgery to 3 days after surgery, and patients in the control group received subcutaneously injection of normal saline 1 ml as placebo. Peripheral venous blood samples were taken in the morning 2 days before surgery and 1 st, 3 rd, 7 th day after surgery respectively. Percentages of CD3+, CD4+, CD8+ were examined timely by flow cytometry and CD4+ /CD8+ ratio was calculated. Results In the control group, percentages of CD3+, CD4+ and CD4+ /CD8+ ratio on the 1st, 3rd, 7th postoperative day were significantly lower than preoperative levels, and percentages of CD8+ on the 1st and 3rd postoperative day were significantly lower than preoperative level (P<0.05). In the trial group, percentages of CD3+, CD4+, and CD8+ on the 1st and 3rd postoperative day were significantly lower than preoperative levels(P<0.05), while percentages of CD3+, CD4+, and CD8+ on the 7th postoperative day were not statistically different from preoperative levels (P>0.05); CD4+ /CD8+ ratio on the 1st postoperative day was significantly lower than preoperative level (P<0.05), while CD4+ /CD8+ ratios on the 3rd and 7th postoperative day were not statistically different from preoperative level (P>0.05). There was no statistical difference in preoperative T lymphocyte subsets between the trial group and the control group (P>0.05). The percentages of CD4+ and CD4+/CD8+ ratio in the trial group were significantly higher than those of the control group on the 1st postoperative day (P<0.05), while the percentages of CD3+ and CD4+ and CD4+ /CD8+ratio in the trial group were significantly higher than those of the control group on the 3rd and 7th postoperative day(P<0.05). Conclusion Use of rhGH can significantly increase T lymphocyte subsets expression, enhance body cellular immunity, and improve postoperative recovery of patients with rheumatic valvular heart disease during the perioperative period of heart valve replacement.

    Release date:2016-08-30 05:46 Export PDF Favorites Scan
  • Application and Significance of Coronary Angiography Prior to Heart Valve Replacement for Patients with Rheumatic Valvular Heart Disease

    Objective To explore clinical application and significance of coronary angiography (CAG) prior to heart valve replacement for patients with rheumatic valvular heart disease (RVHD). Methods We retrospectively analyzed clinical data of 313 RVHD patients who underwent heart valve replacement in the First Affiliated Hospital of Chongqing Medical University from January 2002 to June 2012. All the patients received screening CAG before surgery. According to CAG results,313 patients were divided into two groups. In the coronary artery lesion (CAL) group,there were 29 patients including 17 male and 12 female patients with their age of 60.0±5.2 years. In the non-coronary artery lesion (non-CAL)group,there were 284 patients including 98 male and 186 female patients with their age of 57.0±5.4 years. Surgicaloutcomes were compared between the two groups. Univariate analysis and multivariate logistic regression were performed to analyze risk factors of CAL for RVHD patients. Results CAG showed 29 patients with CAL,and the overall prevalence of CAL was 9.27%. In CAL group,11 patients underwent concomitant coronary artery bypass grafting with 2.2 grafts for each patient on the average. Postoperatively 1 patient (3.45%) died of low cardiac output syndrome (LCOS). In non-CAL group,5 patients (1.76%) postoperatively died mainly because of LCOS,ventricular fibrillation,sudden cardiac arrest or respiratory failure. Cardiopulmonary bypass time and aortic cross-clamp time of CAL group were significantly longer than those of non-CAL group (P<0.05). There was no statistical difference in postoperative mortality,incidence of LCOS,acute renal failure,respiratory failure,reexploration for bleeding,intraoperative blood loss,mechanical ventilation time or hospital stay between the two groups(P>0.05). There was no significant correlation between the types of valvular lesions and CAL. Age≥ 55 years (OR=5.534,P=0.005),male gender (OR=2.335,P=0.038) and diabetes mellitus (OR=4.265,P=0.006) were independent risk factors of CAL for RVHD patients undergoing heart valve replacement. Conclusion For RVHD patients with independent risk factors of CAL (age≥55 years,male gender and diabetes mellitus),CAG must beseriously considered before heart valve replacement. RVHD patients with CAL can obtain similarly satisfactory surgicaloutcomes of heart valve replacement as RVHD patients without CAL by appropriate surgical strategy and strengthened perio-perative management.

    Release date:2016-08-30 05:47 Export PDF Favorites Scan
  • 老年先天性矫正型大动脉转位行心瓣膜置换术一例

    Release date:2016-08-30 05:47 Export PDF Favorites Scan
  • 二尖瓣、主动脉瓣联合置换术后左心辅助循环成功一例

    Release date:2016-08-30 05:47 Export PDF Favorites Scan
  • 心脏机械瓣膜置换术后抗凝治疗的安全性

    目的 探讨心脏机械瓣膜置换术后服用华法令的安全剂量及抗凝期间的注意事项。 方法 回顾性分析1999 年12 月至2010 年10 月皖南医学院附属弋矶山医院132 例行心脏瓣膜置换术后进行华法令抗凝治疗患者的临床资料,其中男73 例,女59 例;年龄27 ~ 78 岁;术后口服华法令抗凝,随访3 个月~ 10 年,分析华法令应用情况及其并发症发生情况。 结果 手术时间(240±96) min,体外循环时间(112±52) min,主动脉阻断时间(81±23) min。全组术后出现皮肤紫癜2 例,死亡2 例。随访117 例,随访率90%(117/130),随访期间月经期月经量过多导致贫血4 例,血尿3 例,反复鼻衄或牙龈出血共4 例,消化道出血1 例,脑出血1 例,下肢栓塞1 例,脑梗死1 例,均治愈或好转。 结论 心脏机械瓣膜置换术后正确服用华法令抗凝治疗,及时监测,注意各种干扰因素可以明显降低并发症的发生率。

    Release date:2016-08-30 05:48 Export PDF Favorites Scan
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