Objective To explore the impact of the women taking warfarin throughout pregnancy after mechanical valve replacement on the children’s physical and mental development.Methods A total of 12 children whose mothers had taken mechanical valve replacement before pregnancy were enrolled in the experimental group in this study, for determination of their physical and mental development. The following indicators were measured: a) Physical development indexes: height, weight, sitting height, head circumference, chest circumference; b) Mental development indexes: intelligence quotient (IQ), and development quotient (DQ) which included adaptability, big movement, fine motor, language, and individual-society. According to the 1?∶?2 matching ratio, 24 children of the healthy women were selected in the control group, and then the difference of each index between the two groups was analyzed. Results In the aspects of both physical development indexes and mental development indexes, there were no significant differences in the children aged 0 to 3 yrs, 4 to 6 yrs, and 6 to 12 yrs in the two groups (Pgt;0.05). Conclusion After mechanical valve replacement, women taking oral anticoagulant warfarin in daily dose not exceeding 5mg are safe, and there are no negative effects on children’s physical and mental development.
Objective To evaluate the clinical effectiveness of valve-sparing aortic root replacement (VSARR) in the treatment of patients with dilated aortic root after operation for tetralogy of Fallot (TOF). Methods A retrospective analysis was conducted on clinical data of TOF patients with aortic root dilation who underwent VSARR in our hospital from 2016 to 2022. Results Finally 14 patients were collected, including 8 males and 6 females, with a median age of 22 years ranging from 12-48 years. Among them, 5 patients had severe aortic valve regurgitation, 4 moderate regurgitation, and 5 mild or no regurgitation. Six patients had sinus of valsalva dilation, and 8 significant dilation of the ascending aorta. One patient had residual shunt due to ventricular septal defect, and 9 severe pulmonary valve regurgitation. The David procedure was performed in 10 patients, Yacoub procedure in 2 patients, and Florida sleeve in 2 patients. There was no perioperative mortality in the group. The median follow-up time was 2.9 years (ranging from 0.4 to 6.0 years). One patient had mild aortic valve regurgitation, and the rest had minimal or no regurgitation. One patient had mild stenosis of the left ventricular outflow tract, and the rest patients had no obvious stenosis. Conclusion VSARR is a satisfactory treatment for aortic root dilation in patients with TOF, with no significant increase in the incidence of left ventricular outflow tract stenosis or aortic regurgitation during mid-term follow-up.
Objective To evaluate the preliminary effect of tricuspid annuloplasty for patients with dilated tricuspidannulus and left-sided heart valve surgery by employing combined bicuspidization and modified Kay annuloplasty. Methods?Combined bicuspidization and modified Kay annuloplasty were performed in 158 patients with dilated tricuspidannulus （tricuspid annulus diameter/body surface area≥21 mm/m2） and left-sided heart valve surgery in West China Hospitalbetween January 2010 and May 2011. There were 27 male and 131 female patients whose age ranged from 17 to 74 （45.9±10.4） years. A total of 92 patients had atrial fibrillation and 66 patients were in sinus rhythm. The severity of tricuspid regurgitation（TR）was graded 0 through 5 as determined by echocardiography.?Results?All the patients recovered from surgery and were discharged from hospital. The average cardiopulmonary bypass time was 100.8±30.5 （range, 54 to 273） min, and the average aortic cross clamping time was 64.5±22.0（range, 25 to 162）min. The average lowest esophageal temperature during aortic cross clamping was 28.5±1.1（range, 26.3 to 34.1）?℃. The average postoperative follow-up was 11.0±5.0 （range, 3 to 19） months. The postoperative TR severity was significantly lower than preoperative TR severity （2.2±1.3 versus 0.4±0.8， P＜0.05）. The postoperative right atrium diameter, right ventricle diameter and left atrium diameter were significantly lower than preoperative measurements （56.5±11.1 mm versus 47.5±8.9 mm， P＜0.05；22.4±4.4 mm versus 20.1±3.3 mm， P＜0.05；62.8±20.1 mm versus 51.9±14.1 mm， P＜0.05）. During follow-up, 5 patients had moderate or severe TR （3.2%， 5/158, moderate in 4 patients, moderate to severe in 1 patient）. There was no significant difference between preoperative and postoperative left ventricle ejection fraction （60.4%±7.9% vervsus 59.6%±8.2%， P＞0.05）.?Conclusion?It is reasonable to perform tricuspid annuloplasty for patients with dilated tricuspid annulus and left-sided heart valve surgery according to their index of tricuspid annulus diameter/body surface area （≥21 mm/m2）. To prevent postoperative residue or progression of TR in patients with dilated tricuspid annulus,it is effective to employ combined bicuspidization and modified Kay annuloplasty.
ObjectiveTo summarize the application experience of off-pump total arterial coronary artery bypass grafting with left internal thoracic artery and bilateral radial arteries, and evaluate its safety and efficacy. MethodsThe clinical data of the patients with severe multiple coronary arteries stenosis undergoing off-pump total arterial coronary artery bypass grafting with left internal thoracic artery and bilateral radial arteries in the Affiliated Hospital of University of Electronic Science and Technology ＆ Sichuan Provincial People’s Hospital from November 2020 to April 2023 were retrospectively analyzed. Results Finally 24 patients were enrolled. There were 23 males and 1 female. The mean age was 53.63±4.33 years. The cardiac function class was from grade Ⅱ to Ⅲ according to New York Heart Association. There were 3.17±0.38 distal anastomoses. Y graft in 12 patients and sequential graft in 4 patients were performed. Coronary endarterectomy in 1 patient, intraaortic balloon pump (IABP) catheter implantation in 10 patients, and thymoma resection in 1 patient were also performed simultaneously. The operation time was 308.13±30.39 mi. The ventilator support time was 15.42±7.42 h, and the intensive care unit stay time was 46.08±27.32 h. The postoperative hospital stay time was 11.71±1.90 d. There were no death, but acute renal failure in 1 patient and cerebral infarction in 1 patient were found after operation. The postoperative left ventricular end diastolic diameter by echocardiogram before discharge was significantly reduced, the postoperative left ventricular ejection fraction and short axis shortening rate were significantly increased, compared to preoperative ones (P≤0.05). All arterial grafts were patent suggested through coronary artery computed tomography angiography (CTA) examination before discharge. All patients were followed up for 14.58±8.75 months. No angina recurrence and death were found. All arterial grafts were still patent in 16 patients suggested through coronary artery CTA or angiography examination at 1 year after operation. Conclusion Off-pump total artery coronary artery bypass grafting with left internal thoracic artery and bilateral radial arteries for patient with severe multiple coronary arteries stenosis is safe and effective. For high-risk patient, IABP assistance during operation is recommended.