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Longterm Observation of the Patients after Mitral Valve Replacement with or without Mild Aortic Valve Regurgitation

Abstract: Objective To observe the longterm condition of patients after mitral valve replacement with or without mild aortic valve regurgitation (AR) and discuss whether treatment of AR is necessary during the course of mitral valve replacement. Methods From March 1999 to April 2004, 88 patients who underwent mitral valve replacement (with or without mild AR before surgery) in West China Hospital of Sichuan University were followed up for 5 years or more. The patients were divided into two groups according to whether they had mild AR based on the result of preoperative echocardiography examination. In the AR group, there were 35 patients including 7 males and 28 females aged 49.26±11.87. By the New York Heart Association (NYHA) grading system before surgery, 4 patients were classified as Class Ⅱ, 26 Class Ⅲ and 5 Class Ⅳ. In the nonAR group, there were 53 patients including 7 males and 46 females aged 48.59±10.22. Using the NYHA grading system before surgery, we found there were 7 patients with Class Ⅱ cardiac function, 39 Class Ⅲ and 7 Class Ⅳ. After operation, all patients were followed up regularly and 5 years after surgery, patients were examined by echocardiography again. Results The followup period ranged from 5 to 9 years (6.39±1.26). There was no statistical difference in gender (P=0.394), age (P=0.841), preoperative cardiac function (P=0.960) and cardiac rhythm (P=0.732) between the two groups. For the AR group, after operation, NYHA heart function, left ventricle ejection fraction (LVEF) and left ventricle fraction shortening (LVFS) significantly increased or improved(Plt;0.05). In the nonAR group, after operation, NYHA heart function and LVEF significantly improved (Plt;0.05), while LVFS had no significant change (Pgt;0.05). Left [CM(159mm]ventricular dimensions (LVD) and aortic dimensions between the two groups had no significant difference afteroperation (Pgt;0.05). There was no significant difference in the number of AR cases before and after surgery (Pgt;005) in the AR group, while there was a significant difference in the nonAR group (Plt;0.05). Conclusion For patients with mild AR who underwent mitral valve surgery 5 to 9 years ago, there is little change in their AR condition. There is no need to treat mild AR preventively during the course of mitral valve replacement.

Plasma Angiotensin Converting Enzyme Level and Permanent Atrial Fibrillation with Mitral Valvular Disease

Objective To investigate whether angiotensin converting enzyme (ACE) have significant relation to permanent atrial fibrillation (Af) with mitral valvular diseases. Methods 124 consecutive lone mitral valvular disease patients who need surgery were studied. At baseline, all patients underwent a physical examination, 12lead electrocardiography and echocardiography. The plasma ACE level was measured in all patients by a radioimmunoassay technique. Patients who had permanent Af formed the Af group, and those who still kept sinus rhythm (SR) comprised the SR group. In Af group, patients were separated into two groups by the subgroup of mitral valvular disease ［mitral stenosis(MS) and mitral regurgitation(MR)］, then formed MSAf group and MRAf group. Results Af was diagnosed in 47.58% (59/124) of lone mitral valvular disease patients. Patients who had Af were older (by 6 years) than sinus rhythm patients and more frequently had a history of stroke. Mitral stenosis patients were easy to have Af (60.53% vs. 27.08%，Plt;0.05). The plasma level of ACEwas significantly higher in Af group than that in SR group (72.60 ±22.03 U/L vs. 56.40±17.96 U/L，Plt;0.05). In Af group, the ACE level in MSAf group was higher than that in MRAf group (82.92±18.75 U/L vs. 66.25±21.10 U/L，Plt;0.05). Mitral stenosis patients more frequently had a history of stroke than that of mitral regurgitation patients. Af correlated significantly with the level of ACE (r=0.089, P=0.021) and left atrial dimension (r=0.447, P=0.033). Conclusion We validated and extended the hypothesis that increasing ACE level predicted an increasing risk of Af in mitral valvular diseases. It was expressed significantly in mitral stenosis patients especially.

非手术治疗心瓣膜置换术后左心房血栓二例

外科治疗二尖瓣、三尖瓣置换术后三尖瓣血栓形成一例

Analysis of 85 infants of minimal median sternotomy for cardiac surgery under cardiopulmonary bypass

目的 探讨胸部正中小切口在婴幼儿先天性心脏病手术治疗中的可行性及效果。 方法 将我院 2016 年 5 月至 2016 年 10 月 170 例行手术治疗的常见先天性心脏病婴幼儿患者分为两组：常规组，85 例，男42例、女43例，年龄（6.9±2.1）个月，采用常规胸部正中切口；小切口组，85 例采用胸部正中小切口，男43例、女42例，年龄（6.4±1.8）个月。小切口手术切口于平第 3 肋间切开，止于剑突起始处上 0.5 cm，刚好放入小胸骨撑开器为好。 结果 两组患儿体外循环时间差异无统计学意义（P>0.05）。小切口组手术时间略长（P<0.05）。两组预后没有差别，但是小切口组伤口长度显著缩短[（7.8±0.8） cmvs. （4.0±0.5）cm，P<0.05]。 结论 正中小切口基本具有胸骨正中切口的优点，可显露心脏各部位，满足绝大部分心脏探查和手术操作需要，必要时仍可向上延长切口使心内操作不受限制等优点，故认为正中小切口在婴幼儿心脏手术中具有良好的安全性和美观性。

Diagnosis and treatment of aortopulmonary window associated with severe pulmonary hypertension

ObjectiveTo study the diagnosis and treatment of aortopulmonary window (APW) associated with severe pulmonary hypertension.MethodsThe clinical data of 23 patients with APW undergoing surgical treatment in The First Affiliated Hospital of Air Force Medical University from 2010 to 2018 were retrospectively reviewed. There were 9 male and 14 female patients. The age was 3-132 (4.63±2.14) months. The weight was 3.3-35.0 (17.3±3.6) kg.ResultsWindows were situated in the proximal of semilunar valve (type Ⅰ) in 8 patients, and distal of the aorta (type Ⅱ) in 14 patients, from proximal to distal (type Ⅲ) in only 1 patient. Eleven patients were isolated APW, the others were combined with cardiac defects. The mean pulmonary artery pressure was 68.4±7.5 mm Hg. All patients underwent surgical correction under general anesthesia and hypothermia cardiopulmonary bypass. All patients were discharged uneventfully, with an average follow-up time of 4 years. The patients showed good outcomes and no residual shunt after surgery, and the pulmonary artery pressure decreased to normal.ConclusionAPW is an uncommon congenital cardiac anomaly. The clinical presentation is an excessive left-to-right shunt, and most patients present early in life. Development of pulmonary hypertension and pulmonary vascular resistance is usually rapid. Operative treatment is indicated as soon as the diagnosis is established, regardless of the patient’s age, and most patients after surgery have a good long-term outcome.