Abstract: Objective To summarize the experiences of treatment for prosthetic valve endocarditis (PVE), paying special emphasis on some interrelated conceptions of PVE, its microbiology, diagnosis, prevention and treatment. Methods From September 1979 to September 2009, 33 patients diagnosed to have PVE were treated in our department. There were 17 males and 16 females. Their age ranged from 19 to 57 years old with an average age of 34 years. The incidence of PVE was 1.48% （33/2 236）including 1.03%（16/1 551）, 3.00%（7/233）, 2.28%（10/438）, and 0% of PVE in mitral valve replacement (MVR), aortic valve replacement (AVR), double valve replacement (DVR), tricuspid valve replacement (TVR), respectively. Pure medical treatment (Penicillin or Vancomycin with other broadspectrum antibiotics, Fluconazole and Amphotericin) was performed on 22 patients. Combined medical and surgical treatment was performed in 11 patients. The patients underwent operation after adequate antibiotics treatment and general condition improvement. The infective tissue and vegetation were completely debrided after the infective prosthetic valve was removed. Before the new valve was transplanted, paravalvular tissue was cleaned with antibiotics, iodine solution and normal saline. Results Hospital death occurred in 19 patients (86.36%) and only 3 patients (13.64%) recovered in the group with pure medical treatment. The main reasons for death were infective shock and cardiac failure in 9 patients, and cerebral complications including embolism, bleeding and multipleorgan failure in 10 patients. For the group with combined medical and surgical treatment, 10 patients (90.91%) survived and only one patient (9.09%) died of multipleorgan failure. Follow-up was done in 13 patients for 6 months to 15 years averaging 41 months. During the follow-up, only one patient was reoperated because of the paravalvular leak eight year later. There was no PVE recurrence in all the rest patients. Conclusion Compared with pure medical treatment, combined medical and surgical treatment is a better solution for PVE.
Objective To summarize the experiences of surgical treatment for partial atrioventricular canal defect. Methods The data of 66 patients of surgical treatment for partial atrioventricular canal defect from January 1984 to December 2007 were analyzed retrospectively. The cleft of mitral valve presented in all of those patients. There were 52 cases with direct suture on cleft, 8 cases with direct suture with commissurroplasty, 1 case with posterior leaflet plasty, 3 cases with direct suture St.Jude ring and 2 cases mitral valve replacement. The ostium primum atrial septal defects were repaired with patches of Dacron in 12 cases and autologous pericardium in 54 cases. Coronary sinus was situated on the left atrium in 5 and ostium primum atrial septal defects were repaired in Kirklin’s way; the others in MeGoon’way. Meanwhile other heart abnormalities were done. Results There were two early deaths (3.03%), one patient died of heart arrhythmia and one patient died of respiratory failure. Complications of total A-V block was in 2 cases. Both of them were replanted with pace makers.52 cases were followed up, followup time was 5 months to 22 years(mean follow-up 15 years). All patients had better life. Four patients have been re -operated for different reasons post primary operation. One had good result after re-mitral valve replacement. One case died of acute renal failure and the other two died of low cardiac output syndrome. Conclusions Early operation is definitely recommended when the diagnosis is confirmed. Because the structure or function of mitral valve is saved, pulmonary hypertension is avoided and the mortality is lower in the future. The key points of operation are to rectify the mitral insufficiency, repair ostium primum atrial septal defects and avoid atrioventricular block. The patients of mild regurgitation of mitral valve have good results. Provided in those have more than middle regurgitation of mitral valve then their longterm results are poor.
Abstract:Objective To evaluate the effect of external stents on preventing vein graft neointima formation and medial thickening with non-restrictive macro porous polyester stent around porcine vein grafts. Methods Studies were performed by using ＂white race＂ pigs （n= 10） weight 25-30 kg. All the animals underwent bilateral saphenous vein into carotid artery bypass grafting. In each animal, a maeroporous stent was placed around a graft on one side and a control （unstented） graft on the opposite side. The polyester stent was shaped to cover both anastomoses completely. The size of the stem allowed unrestricted expansion of the graft in initial response to arterial pressure. After 35 days of surgery,all animals were taken to remove the grafts. Graft wall dimensions, platelet- derived growth factor （PDGF） expression and cell proliferation using proliferating cell nuclear antigen （PCNA） were measured on histological sections. Results Stents significantly reduced neointimal thickening （0. 4872 ± 0. 0706 mm vs. 0. 2259± 0. 0553mm,P〈0. 01）and medial thickening （0. 6246±0. 0859mm vs. 0. 4201±0. 0615mm,P〈0. 01）. Stents significantly reduced the percentage of cells expressing PDGF and PCNA. Media, intimal PCNA index was reduced from 7. 980/00± 4. 060/00 to 3.35±0.95%（P〈0.01）, PDGF index was reduced from 9.47%±5.35% to 2.67%± 0.97% （P 〈0. 01）. Conclusion External non-restrictive polyester stent can significantly inhibit neointimal formation and medial thickening, and may prevent late vein grafts restenosis.