ObjectiveTo analyze clinical features and surgical strategies of Ebstein's anomaly (EA) in adults. MethodsSeventy-eight adult patients with EA underwent surgical treatment in Fu Wai Hospital from January 2008 to December 2011. There were 24 males and 54 females with their age of 18-54 (33.0±9.5) years. Preoperatively, 72 patients were in NYHA class Ⅰ or Ⅱ, and 6 patients were in NYHA class Ⅲ or Ⅳ. Clinical presentations mainly included exercise capacity deterioration and exertional dyspnea. Preoperative echocardiography showed downward displacement of the septal leaflet (SL) of the tricuspid valve (TV) of 34.8±12.7 (20-60) mm. Three patients had severe dysplasia or agenesis of tricuspid SL. Downward displacement of the posterior leaflet (PL) of TV was 46.8±11.6 (20-70) mm, and 1 patient had agenesis of tricuspid PL. Average TV annulus was significantly enlarged with 60±10 (37-70) mm. Mean atrialized portion of the right ventricle was about 40%. There were 18 patients with moderate tricuspid regurgitation (TR) and 60 patients with moderate-to-severe TR. Seventy-five patients received tricuspid valvuloplasty (TVP). Fifty-six patients received plication of the atrialized right ventricle (ARV), 20 patients received ARV resection, and 2 patients didn't receive any specific management of ARV. Thirty-two patients received TVP with a prosthetic ring. Three patients underwent tricuspid valve replacement. ResultsTwo patients died posto-peratively, and in-hospital mortality was 2.5%. Postoperative recovery of the survival patients was good. There was no severe atrioventricular block or other complication. Echocardiography before discharge showed good function of TV without moderate or more severe TR. Mean follow-up was 26 months. None of the patients needed re-operation. ConclusionThe incidence of acute heart failure in EA adults is low. TVP is the main surgical procedure to achieve main goals of surgical treatment including improvement in heart function, exercise capacity and quality of life.
ObjectiveTo analyze risk factors of early outcomes of mitral valvuloplasty (MVP)for the treatment of degenerative mitral regurgitation (DMR). MethodsClinical data of 132 DMR patients who underwent MVP in Fu Wai Hospital between January 1, 2011 and November 1, 2011 were retrospectively analyzed. A total of 114 patients (86.4%)were followed up after discharge with their mean age of 51.21±12.78 years, including 76 males (66.7%). Preoperative risk factors of early outcomes of MVP were analyzed. ResultsAmong those patients, there were 25 patients with atrial fibri-llation (AF)(21.9%). Preoperative ejection fraction was 63.88%±6.93%. Preoperative echocardiography showed left ventricular end-diastolic diameter (LVEDD)was 31.61±5.51 mm/m2. There were 66 patients (57.9%)with tricuspid regurg-itation, and 34 patients (29.8%)underwent concomitant tricuspid valvuloplasty including 10 patients (8.8%)who received tricuspid annuloplasty rings. Two patients died postoperatively, 2 patients underwent re-operation of mitral valve replacement or MVP respectively. Postoperative echocardiography showed moderate or severe mitral regurgitation in 15 patients. Preoperative risk factors of early outcomes of MVP included AF (36.8% vs. 18.9%, P=0.035), large LVEDD (34.02±3.76 mm/m2 vs. 31.15±5.68 mm/m2, P=0.042)and functional mitral regurgitation (15.8% vs. 1.1%, P=0.007). Multivariate analysis showed greater postoperative LVEDD reduction significantly lowered the incidence of postoperative events (HR 0.002, 95% CI < 0.001-0.570, P=0.031). ConclusionsEnlargement of the left ventricle is an independent preoperative risk factor for early outcomes of MVP for DMR patients. Greater postoperative LVEDD reduction significantly lowers the incidence of postoperative events.
ObjectiveTo explore clinical features and surgical strategies for patients with aortic dissection (AD) manifesting as pure aortic regurgitation (AR), avoid preoperative misdiagnosis, and provide reference for clinical diagnosis and treatment. MethodsClinical data of 5 AD patients who were preoperatively diagnosed as pure AR in Beijing Fu Wai Hospital from January 2005 to May 2012 were retrospectively analyzed. There were 4 male and 1 female patients with their median age of 41 (34-53) years. All the 5 patients were diagnosed as AD during the operation. One patient received aortic valvuloplasty, 1 patient received Wheat procedure, and 3 patients received Bentall procedure. Clinical manifestations, accessory examinations, intraoperative findings, surgical strategies and follow-up results were summarized. ResultsNo postoperative death or complication occurred in this study. Echocardiogram of patient 1 before discharge showed that transverse diameters of the ascending aorta and aortic sinus decreased with satisfactory closure of aortic valves but no AR. Echocardiogram and CT all showed normal function in mechanical valves and patent blood vessel prosthesis in the other 4 patients. All the 5 patients were followed up for 4 (1-5) years and were alive during follow-up. Echocardiogram showed normal function in mechanical valves and patent blood vessel prosthesis without paravalvular leak in 4 patients and mild AR in 1 patient. ConclusionAD manifesting as pure AR is rare and easily misdiagnosed preoperatively. Careful analysis of medical history and accessory examinations can reduce the risk of misdiagnosis. Appropriate surgical strategies should be chosen according to intraoperative findings of intimal tears and aortic sinus damage of AD.
ObjectiveTo assess early and mid-term outcomes and our clinical experience of reduction ascending aortoplasty (RAA) for patients with aortic valve disease and ascending aortic dilatation, and improve treatment effects. MethodsClinical data of 36 patients with aortic valve disease and ascending aortic dilatation who underwent aortic valve replacement and RAA in Fu Wai Hospital between January 2002 and August 2010 were retrospectively analyzed. There were 26 male and 10 female patients with their age of 7-72 (51±16) years. Ascending aorta diameter (AAD) was measured by echocardiography preoperatively, postoperatively, during follow-up and compared. ResultsThere was no perioperative death. Cardiopulmonary bypass time was 96.2±28.3 minutes, and aortic cross-clamp time was 69.2±22.1 minutes. Posto-perative hospital stay was 11.0±7.8 days. All the 36 patients were followed up after discharge for 1.1-9.0 (4.0±2.3) years. During follow-up, there was 1 death, but none of the patients needed reoperation. Echocardiography showed normal aortic valve function. Postoperative AAD was significantly smaller than preoperative AAD (36.4±6.1 mm vs. 46.8±4.6 mm, t=13.12, P=0.00). AAD during follow-up was significantly larger than postoperative AAD (40.8±6.8 mm vs. 36.4±6.1 mm, t=-2.64, P=0.01) but significantly smaller than preoperative AAD (40.8±6.8 mm vs. 46.8±4.6 mm, t=3.48, P=0.00). ConclusionEarly and mid-term outcomes of RAA are satisfactory for patients with aortic valve disease and ascending aortic dilatation, but long-term results need further observation.
ObjectiveTo investigate clinical outcomes of mitral valvuloplasty (MVP)for the treatment of infective endocarditis (IE)and mitral regurgitation (MR). MethodsFrom March 2002 to January 2012, 33 patients with IE and MR underwent MVP in Fu Wai Hospital. There were 23 male and 10 female patients with their age of 10-67 (35.7±17.8)years. Thirteen patients had previous cardiac anomalies. Preoperatively, there were 5 patients with mild MR, 15 patients with moderate MR and 13 patients with severe MR. There were 5 patients in New York Heart Association (NYHA)functional classⅠ, 23 patients in classⅡ, 4 patients in classⅢ and 1 patient in classⅣ. All the patients received MVP including 14 patients received MVP in active phase of IE. Concomitantly, 6 patients received aortic valve replacement, 5 patients received tricuspid valvuloplasty, 1 patient received coronary artery bypass grafting, 1 patient received resection of left atrial myxoma and 1 patient received repair of aortic sinus aneurysm. Surgical procedures included pericardial patch closure of leaflet perforation in 5 patients, leaflet excision and suturing in 17 patients, double-orifice method in 3 patients, chordae transfer and artificial chordae implantation in 5 patients, and annuloplastic ring implantation in 15 patients. ResultsOne patient died of acute myocardial infarction 7 days after the operation. All other 32 patients were successfully discharged. Echocardiography before discharge showed left ventricular end-diastolic diameter (LVEDD, 48.9±7.6 mm)and left atrial diameter (LAD, 31.7±7.4 mm)were significantly smaller than preoperative values (P=0.000). Thirty-two patients were followed up for 6-125 (73.0±38.6)months. There was no death, IE recurrence, bleeding or thromboembolism during follow-up. One patient received mitral valve replacement for mitral stenosis 3 years after discharge. There were 25 patients in NYHA func-tional classⅠ, 5 patients in classⅡand 2 patients in classⅢ. There were 4 patients with mild MR, 1 patient with moderate MR, and 26 patients had no MR. One patient had faster mitral inflow at diastolic phase (1.7 m/s). One patient had moderate aortic regurgitation. LVEDD and LAD during follow-up were not statistically different from those before discharge. Left ventricular ejection fraction during follow-up was significantly higher than that before discharge (60.9%±6.6% vs. 57.5%±6.7%, P=0.043). ConclusionMVP is a reliable surgical procedure for patients with IE and MR, and can significantly reduce left atrial and left ventricular diameter and improve cardiac function postoperatively.
ObjectiveTo examine the cause of failure of mitral valve repair. MethodWe retrospectively anal-yzed the clinical data of 89 consecutive patients with non-rheumatic mitral valve diseases who underwent reoperation for failure of mitral valve repair in our hospital from January 2009 through January 2016. There were 54 males and 35 females at age of 36.2±17.4 years. ResultsThere were 16 patients with reoperation of mitral valve repairs and 73 patients of mitral valve replacements. The failure reasons of initial mitral valve repair were technique-related in 63 patients (70.8%) and valve-related in 18 patients (20.2%). Technique-related causes of repair failure included leaflet suture dehiscence (20 patients, 22.5%), edge-to-edge procedure (11 patients, 12.4%), leaflet thickening or retraction (11 patients, 12.4%), ring dehiscence (8 patients, 9.0%), inappropriate annuloplasty (6 patients, 6.7%), incomplete repair (4 patients, 4.5%), and chordal elongation or rupture (3 patients, 3.4%). Median interval since previous repair was 4.0 (0.04-18.0) years for the technique-related failure group, and 9.7 (0.21-35.6) years for valve-related failure group (P < 0.05). ConclusionTechnique-related factors are main causes of repair failure, which include leaflet suture dehiscence, edge-to-edge procedure, and leaflet thickening or retraction. Reoperation for technique-related failure needs to be adopted early.