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风湿性心瓣膜病伴心房颤动546例临床分析

目的 总结风湿性心瓣膜病合并心房颤动的发病特点和外科治疗经验。 方法 回顾性分析1998年12月至2004年11月期间收治的546例风湿性心瓣膜病合并心房颤动患者的临床资料，其中行二尖瓣置换术383例，主动脉瓣置换术5例，二尖瓣和主动脉瓣双瓣膜置换术158例。在心脏不停跳下手术459例，常规体外循环心脏停搏下手术87例；术中同期行改良Cox迷宫III型手术13例，左心房折叠术45例，三尖瓣成形术245例。 结果 全组患者均顺利完成手术，体外循环时间59～219min。术后早期死亡10例（1.83%, 10/546) ，死于多器官功能衰竭和急性呼吸窘迫综合征。术后早期发生血色素尿11例，早期二次开胸探查止血7例，瓣周漏2例，均经相应的处理治愈。术后随访387例，随访时间1年，随访结果：窦性心律自动转为心房颤动17例，未接受迷宫手术由心房颤动转为窦性心律12例，13例接受迷宫手术患者术后心房颤动均转为窦性心律。远期死亡2例,分别死于出院后18个月和23个月。其余患者无严重的出血和血栓栓塞并发症发生。 结论 风湿性二尖瓣关闭不全较二尖瓣狭窄更易引发心房颤动，但发生左心房血栓的几率减小，浅低温心脏不停跳心瓣膜置换术结合双心房迷宫手术可作为治疗心瓣膜病合并心房颤动的一种有效手术方法。

巨大室间隔缺损合并三尖瓣骑跨一例

二尖瓣置换同期射频消融术后延迟左心室破裂一例

Analysis of the influence of COVID-19 infection on the early clinical efficacy of patients undergoing single valve replacement surgery: A retrospective cohort study

Objective To explore the impact of COVID-19 infection on the early clinical efficacy of valve replacement patients. MethodsThe perioperative data of patients who underwent single valve replacement in our center from January to February 2023 were collected continuously. According to the COVID-19 infection situation, the patients were divided into a COVID-19 infected group and a non-infected group. The relevant data of the two groups were compared, including general situation, comorbidities, operation time, aortic occlusion time, postoperative ventilator use time, intensive care unit (ICU) stay time, myocardial enzyme profile and respiratory related complications were statistically analyzed. The primary end point of the study was the incidence of postoperative respiratory and circulatory system complications, and the secondary end point was postoperative myocardial enzyme profiles in both groups. ResultsA total of 136 patients were included, including 53 males and 83 females, with an average age of 53.4±10.2 years. Thirty-two patients underwent aortic valve replacement, 102 mitral valve replacement, and 2 tricuspid valve replacement.There was no significant difference in the incidence of postoperative disease between the two groups (9.09% vs. 11.43%, P=0.654), and the duration of postoperative mechanical ventilation in the novel coronavirus infection group [913.50 (465.50, 1 251.00) min vs. 1 201.00 (1 003.75,1 347.75) min, P=0.001], ICU stay time [2 (2, 3) d vs. 3 (2, 3) d, P＜0.001) was a new champions league group, the myocardial enzyme spectrum [TnI-I: 2.66(1.19, 5.65) ng/mL vs. 4.76 (2.55, 7.93) ng/mL, P=0.001; BNP: 192.00 (100.93, 314.75) pg/mL vs. 608.5 (249.75, 1150) pg/mL, P＜0.001], and the difference was statistically significant. Conclusion For single valvular disease patients undergoing elective surgery, the short-term efficacy of surgical treatment after recovery from COVID-19 infection was relatively good, and the incidence of in-hospital mortality and postoperative complications was not significantly increased.