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Progress in Minimally Invasive Surgery for Atrial Fibrillation

Atrial fibrillation (AF) is difficult to cure for its complex etiology and long disease duration. Heart failure, sudden death and stroke are the main causes for consequent high mortality and morbidity. In recent years, minimally invasive surgery has made rapid progress, not only improved treatment efficiency of traditional Cox Maze procedure but also massively reduced surgical injuries, and has become a preferred treatment strategy for lone AF. Minimally invasive surgery and catheter ablation complement each other, and are likely to open up a new prospect of AF treatment.

The progress of complications of transcatheter aortic valve implantation

Surgical aortic valve replacement is the primary choice for the treatment of aortic valve stenosis. It can significantly improve the quality of life and life expectancy of patients, but some patients have risks such as advanced age and poor general conditions and can not receive open chest surgery. In 2002, a French doctor, Cribier, successfully performed transcatheter aortic valve implantation (TAVI) surgery on a patient with aortic stenosis. At present, the safety and effectiveness of TAVI surgery have been confirmed by many studies. However, its complications are also relatively common. This article summarizes the related reports at home and abroad.

Research progress of pulmonary hypertension due to left heart disease

Pulmonary hypertension due to left heart disease (PH-LHD) is the most common in various types of pulmonary hypertension. Although there are many treatments for pulmonary hypertension, it may be harmful when we adopt treatment without detrimental diagnosis and classification of pulmonary hypertension. Therefore, it is very crucial to have accurate diagnosis and classification of pulmonary hypertension before making treatment decisions. However, there are still some difficulties in the classification of pulmonary hypertension in clinical work. It is a great challenge with limited treatment to solve the PH-LHD which often has complicated pathophysiological mechanisms of precapillary and postcapillary pulmonary hypertension. Here, we review the research status of PH-LHD.

创新瓣膜器械与人工智能术前规划

腋动脉侧接人工血管插管法在深低温停循环手术中的应用

目的 介绍腋动脉侧接人工血管插管法在深低温停循环手术中的应用，总结其经验。 方法 2006年1月至2008年12月，我们在36例A型主动脉夹层的患者中应用腋动脉侧接人工血管插管法建立体外循环中的动脉灌注；将右侧腋动脉游离，全身肝素化，前后阻断腋动脉，于腋动脉前壁作一长约8~10 mm切口，用一直径8～10 mm、长约6～8 cm的人工血管与腋动脉行端侧吻合，侧接人工血管与普通升主动脉插管连接。 结果 施行腋动脉侧接人工血管顺利，成功率为100%，体外循环及选择性脑灌注满意。无腋动脉插管的相关并发症发生，除2例苏醒延迟外，其余均无神经系统并发症。手术死亡3例，死亡原因与腋动脉侧接人工血管插管无关。 结论 腋动脉侧接人工血管插管法作为心脏大血管深低温停循环手术中建立体外循环的动脉灌注及选择性脑灌注, 其方法简单、疗效可靠、无插管相关并发症,值得临床应用。

全主动脉弓置换加支架象鼻手术治疗A型主动脉夹层

目的 介绍全主动脉弓置换加支架象鼻手术治疗A型主动脉夹层的方法，总结其治疗经验。 方法 2007年1月至2008年11月，采用四分支人工血管行全主动脉弓置换加覆膜支架象鼻手术治疗A型主动脉夹层10例，其中急性夹层8例，慢性2例。10例均在深低温停循环及选择性脑灌注下完成手术,对5例合并主动脉瓣中至重度关闭不全的患者同期行Bentall手术，余5例行升主动脉置换术。 结果 1例于术后26 d因多器官功能衰竭死亡； 余9例均顺利康复出院，无严重神经系统并发症。术后随访2～25个月，均生存，心功能Ⅰ～Ⅱ级。 结论 采用四分支人工血管行全主动脉弓置换加覆膜支架象鼻手术是治疗A型夹层的有效手术方式，手术操作技术和脑保护措施是决定手术效果的关键。

A Modified Method for Aortic End Strengthening in Acute Type A Aortic Dissection Operation

Objective To modify the method for aortic end strengthening in acute type A aortic dissection operation, and investigate its clinical efficacy. Methods We modified the method for aortic end strengthening in acute aortic dissection operation based on ‘Sandwich method’ in the department of thoracic and cardiovascular surgery of West China Hospital. From January 2006 to December 2008, twentyeight patients with acute type A aortic dissection underwent modified aortic end strengthening operation. We made adventitia turn over and enfold to strengthen the aortic end in 10 cases, and placed stripshaped felt or pericardium belts between dissection (between adventitia and intima)and inner intima and strengthened the aortic end by suture in 18 cases. The hemorrhage of anastomotic stoma and the postoperative early prognosis were observed. Results No bleeding complication was found in all the cases. Two cases died, one died of severe low cardiac output syndrome and another died of multiple organ failure. No nervous system complication was found except that 2 cases had delayed revival. No sternum and surgical incision related complication was found. The rest 26 cases were cured and discharged. Conclusion The modified method for aortic end strengthening can not only strengthen the aortic end but also make people be able to find the petechia of anastomotic stoma clearly, then stitch hemostasia could be done effectively. The method is easy to implement and effective, it should be extend in clinic.

The Effective Orifice Area and Haemodynamics of 19mm St. Jude Regent Valve——An Early in Vivo Study

Abstract: Objective To investigate the in vivo effective orifice area (EOA) and whether prosthesispatient mismatch (PPM) is going to happen after 19mm St.Jude Regent valves replacement were performed. Methods Twentythree patients with valvular heart diseases were divided into 2 groups according to aortic annular diameter. 19mm St. Jude Regent valves were replaced in aortic valve place (Regent valve group), and 21mm other doubleleaflet mechanical valves were replaced in aortic place (other valves group). All of the operations were accomplished under cardiopulmonary bypass in West China Hospital. All of the patients were followed up in 3 to 6 months after their surgery processes. Color Doppler echocardiography was used to measure the hemodynamic parameters in their followup. Then left ventricular mass (LV mass), EOA and effective orifice area index (EOAI) etc. were calculated and compared by using SPSS 12.0. Results No cardiac episodes were detected during the perioperative period and 36 months after operation. LVmass reduced in 36 months after operation in both groups. No statistical significance of EOA, EOAI and LVmass reduction were detected between the two groups. Conclusions (1)The EOA and in vivo hemodynamic effects of 19mm Regent valve are similar to 21mm other double leaflet mechanical valve. (2)It is safe to use 19mm Regent valve in those patients whose aortic annular diameter are small and need double valve replacement. Using 19mm Regent valve will not cause short time cardiac episodes and PPM. (3)More further works should be done to make sure what is the standard of PPM in Chinese people, such as enlarging the patients number and prolonging the followup time. (4) Further clinical and followup works should be done to make St.Jude Regent valve’s feature out.

牛心包生物瓣膜的临床应用

目的 报告牛心包生物瓣膜置换治疗瓣膜疾病的临床经验和手术效果。 方法 自2003年1月至2005年12月，52例患者接受心瓣膜置换术，其中心功能分级(NYHA)Ⅱ级11例，Ⅲ级34例，Ⅳ级7例，36例患者合并心房颤动；行二尖瓣置换术25例，三尖瓣置换术6例，主动脉瓣置换术13例，肺动脉瓣置换术1例，主动脉瓣加二尖瓣置换术6例，二尖瓣加三尖瓣置换术1例；术后通过电话随访患者恢复情况。 结果 住院期间死亡1例，手术死亡率为1.9％（1／52）；术后并发呼吸道感染2例，51例患者均顺利康复出院；术后住院时间10.8±3.3d（6～22d）。术后随访37例，随访时间15d～24个月，随访率72.5％（37／51），心功能均恢复到Ⅰ~Ⅱ级，无1例患者出现出血和栓塞，无再次瓣膜手术。 结论 生物瓣膜具有较高的手术安全性，患者的心功能恢复较好，术后出血、栓塞、瓣膜毁损和感染性心内膜炎、再次瓣膜手术的发生率可能较低，具有较好的疗效，患者的生活质量较高。

心包粘液脂肪肉瘤一例