Prognostic Role of Preoperative Tricuspid Annular Plane Systolic Excursion (TAPSE) in Mitral Valve Replacement (MVR) for Rheumatic Mitral Stenosis Patients

Tricuspid annular plane systolic excursion has been proposed as a simple and reproducible parameter for quantitative assessment of the right ventricular ejection fraction. The prognostic importance of preoperative TAPSE in patients with mitral valve replacement for rheumatic mitral stenosis patients is still under focused. Therefore, the objective of the study was to predict the outcome after MVR in rheumatic mitral stenosis patients in relation to preoperative TAPSE. This comparative cross-sectional study was conducted at the Department of Cardiac Surgery, National Heart Foundation Hospital and Research Institute. A total of 72 patients of rheumatic mitral stenosis patients who underwent mitral valve replacement were included in the study. They were divided into two groups: Group A and B. Group A included 36 patients with TAPSE 0.05) except for the preoperative TAPSE. Mean TAPSE of Group A was 13.17 (±1.40) and Group B was 18.61 (±1.57), the difference was statistically significant (p 0.05). Among the postoperative complications, including postoperative atrial fibrillation was higher in Group A (30.56%) than Group B (11.11%), mean ventilation time was higher in Group A (27.78%) than Group B (5.56%), length of intensive care was higher in Group A (33.33%) than Group B (11.12%), and hospital stay was higher in Group A (25.0%) than Group B (5.56%), (p < 0.05). Higher preoperative TASPE could be used as a prognostic tool for MVR in rheumatic mitral stenosis patients in our settings.

Isolated mitral valve replacement with Guangdong-Ⅰ porcine bioprostheses in rheumatic heart valve disease: analysis of 166 cases with long-term follow-up

Objective To study the long-term effects of mitral valve replacement with bioprostheses in rheumatic heart valve disease. Methods 166 patients with rheumatic heart valve disease underwent isolated mitral valve replacement from Jan. 1978 to Dec. 1985. 79 Patients were male and 87 female. Patients’ age ranged from 11 to 53 years [mean (29.4 ± 9.9) years]. The patients were classified into two groups: group 1 (age【 30 years) included 84 patients, group 2 (age≥30 years) 82 cases. Mean CTR is 0.68 *0.08. Most patients were in NYHA function class Ⅲ-Ⅳ. 76. 3% of patients had atrial fibrillation. 6 patients had pre-operative cerebral vascular accidents. Postoperative deaths were excluded. Follow-up extended from 0.4 year to 19.4 years. Results Actuarial estimate of survival rate at 14 years is (52.5 ± 7.0)%. Heart function was improved to class Ⅰ - Ⅱ in most of patients. Late structural valve deterioration occurred in 89 patients. Among them, 59 were re-operated. Actuarial estimate of freedom from

Mitral Valve Surgery for Functional Regurgitation: Insights into Heart Failure and Readmission

Background: Functional mitral regurgitation (FMR) is an increasing burden as population ages. Mitral valve repair (MVr) is the preferred surgical treatment of FMR despite limited evidence supporting its efficacy. Mitral valve replacement (MVR) is the alternative procedure typically reserved for patients who are at higher risk or refractory to MVr. The present study aims to determine which of the two procedures is more effective in the surgical treatment of FMR. Methods: 344 charts of FMR patients who received either MVr (n = 263) or MVR (n = 81) from 2004-2016 at our institution were reviewed. Treatment efficacy was assessed based on heart failure (HF)-readmission and survival rates within 5 years from discharge. Propensity score approach with inverse probability weighting and Cox regression models were employed to evaluate procedural impact on survival and rehospitalizations, respectively. Follow-up echocardiographic data from the original cohort was assessed for differences in metrics between procedural groups at >6 months (MVr: n = 75;MVR: n = 23) and 1 year (MVr: n = 75;MVR: n = 18) post-op. Results: MVR patients had a lower risk of being readmitted for HF within 5 years compared to the MVr group (HR-adj (95% CI): 0.60 (0.41 - 0.88), p = 0.008). MVR patients also had a higher overall risk of death (HR-adj (95% CI): 1.82 (1.05 - 3.16), p = 0.034) but this was borderline significantly different at 5 years cut-off (p = 0.057). Conclusions: Higher HF readmission in MVr patients than in sicker, higher surgical-risk MVR patients reflects the inadequacy of MVr to treat FMR. Novel approaches to MVR may be necessary to adequately manage FMR.

Aortic and mitral valve replacement with retrograde perfusion in the beating heart

Objective To estimate the value of aortic valves and combined mitral valve replacement with retrograde perfusion in beating hearts.Methods Continuous retrograde coronary sinus perfusion with beating hearts was used in 83 patients undergoing aortic valve or aortic valve combined with mitral valve replacement,without application of cardioplegia.After aortic valve replacement,the retrograde perfusion wes changed to antegrade perfusion for mitral valve replacement or correction of the other deformities(group A).Cold blood cardioplegia solution(15℃)was infused at intervals in 20 cases(group B).The following parameters were tested:lactate,ET,CTn-T and MDA in blood;myocardial ultra-structure;and cardiac rhythm and cardiac output (co).Results All biochemical values increased after cardiopulmonary bypass(P ＜ 0.05 - 0.01).Empty and beating heart sinus rhythm was maintained in group A.Myocardial ultrastructure did not change significantly.The pump was stopped smoothly as the surgical procedure finished.No postoperative low cardiac output syndrome or arrhythmia was observed.Eight-one patients recovered smoothly,two died from renal failure or infective shock.When the pump stopped,all patients in group B were supported by 5 - 10 μg· kg-1· min-1 dopamine.Transient pacing was used in 9 patients.One patient died from low cardiac output syndrome.Conclusion This method is a good myocardial protection which simulates physiologic status.It is applicable to aortic valve and combined mitral valve replacement of patients with large heart or heart failure and long time aortic cross-clamping.Ideal clinical effect can be achieved.

Balloon aortic valvuloplasty as a bridge-to-decision in high risk patients with aortic stenosis： a new paradigm for the heart team decision making

Background Whilst the majority of the patients with severe aortic stenosis can be directly addressed to surgical aortic valve replace- ment （AVR） or transcatheter aortic valve implantation （TAVI）, in some instances additional information may be needed to complete the diagnostic workout. We evaluated the role of balloon aortic valvuloplasty （BAV） as a bridge-to-decision （BTD） in selected high-risk patients. Methods Between 2007 and 2012, the heart team in our Institution required BTD BAV in 202 patients. Very low left ventricular ejection fraction, mitral regurgitation grade 〉 3, frailty, hemodynamic instability, serious comorbidity, or a combination of these factors were the main drivers for this strategy. We evaluated how BAV influenced the final treatment strategy in the whole patient group and in each specific subgroup. Results Mean logistic European System for Cardiac Operative Risk Evaluation （EuroSCORE） was 23.5%±15.3%, age 81 ± 7 years. In-hospital mortality was 4.5%, cerebrovascular accident 1% and overall vascular complications 4% （0.5% major; 3.5% minor）. Of the 193 patients with BTD BAV who survived and received a second heart team evaluation, 72.6% were finally deemed eligible for definitive treatment （25.4% for AVR; 47.2% for TAVI）： 96.7% of patients with left ventricular ejection fraction recovery; 70.5% of patients with mitral regurgitation reduction; 75.7% of patients who underwent BAV in clinical hemodynamic instability; 69.2% of frail patients and 68% of patients who presented serious comorbidities. Conclusions Balloon aortic valvuloplasty can be considered as bridge-to- decision in high-risk patients with severe aortic stenosis who cannot be immediate candidates for definitive transcatheter or surgical treatment.

Acute Decompensated Heart Failure Secondary to Structural Valve Degeneration of a Bioprosthetic Valve

Heart valve replacement is a common cardiac surgical procedure used to treat native valvular diseases such as aortic and mitral stenosis and regurgitation. These procedures reduce the morbidity and mortality associated with diseased native valves and yet come at the expense of prosthetic valve complications. Structural valve degeneration is one such complication. We present a case of a critically ill elderly man who had undergone mitral valve replacement 14 years prior to his current presentation. Only after admission through the emergency department was a transesophageal echocardiogram obtained and the diagnosis of prosthetic valve degeneration made. He subsequently underwent successful replacement of his diseased prosthetic valve.

Rheumatoid Nodule Causing Perforation of Anterior Mitral Leaflet and Severe Mitral Regurgitation: A Rare Case Report

Rheumatoid arthritis (RA) is a systemic disorder that is chronic in nature and difficult to treat. RA presents in many variants. Here we present an interesting case only seldom described before. Our patient presented to emergency room with acute shortness of breath and was seen to have acute pulmonary edema. Patient later had urgent echocardiography which revealed severe mitral regurgitation from ruptured anterior leaflet. Patient was taken for heart valve replacement and was found to have RA nodule on ruptured leaflet. There are cases involving aortic valve but to our knowledge there are no reports of RA nodule on mitral leaflet.

复脉益心方辅助治疗风湿性心脏瓣膜病患者的临床疗效及对其心功能、基质金属蛋白酶-9、N末端前体脑利钠肽水平的影响

目的 探讨复脉益心方辅助治疗风湿性心脏瓣膜病患者的疗效及对其心功能、血清基质金属蛋白酶-9(Matrix metalloprotein-9,MMP-9)水平、N末端前体脑利钠肽(N-terminal precursor brain natriuretic peptide,NT-pro BNP)水平的影响。方法 选取2021年2月—2022年2月期间湖南中医药大学第一附属医院收治的风湿性心脏瓣膜病患者88例作为研究对象。采用随机数字表法将患者分为对照组和观察组,每组各44例。两组患者均接受二尖瓣置换术治疗,术后根据病情给予西医常规治疗,观察组术后在常规西医治疗基础上联合复脉益心方治疗。治疗4周后,观察比较两组患者临床疗效、安全性,治疗前后中医证候积分,MMP-9、NT-pro BNP水平、心功能指标(每分钟心输出量、每搏输出量、心脏指数、左心室射血分数)、生活质量评分(社会限制、体力限制、症状、情绪)变化情况。结果 治疗后两组患者心悸、疲乏、气短、盗汗或自汗、心烦、失眠多梦评分均较治疗前降低,差异有统计学意义(P<0.05);且观察组心悸、疲乏、气短、盗汗或自汗、心烦、失眠多梦评分均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者血清MMP-9和NT-pro BNP水平均较治疗前明显降低,差异有统计学意义(P<0.05);且观察组血清MMP-9和NT-pro BNP水平均明显低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者每分钟心输出量、每搏输出量、心脏指数及左心室射血分数指标均较治疗前明显升高,差异有统计学意义(P<0.05);且观察组每分钟心输出量、每搏输出量、心脏指数及左心室射血分数指标均高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者社会限制、体力限制、症状及情绪评分均较治疗前明显降低,差异有统计学意义(P<0.05);且观察组社会限制、体力限制、症状及情绪评分均低于对照组,差异有统计学意义(P<0.05)。治疗后观察组总有效率95.45%(42/44)明显高于对照组79.55%(35/44),差异有统计学意义(P<0.05)。治疗期间,两组患者肝肾功能、血常规均未发生异常,术后也未出现明显用药不良反应。结论 复脉益心方辅助二尖瓣置换术治疗风湿性心脏瓣膜病,能够降低MMP-9、NT-proBNP水平,有助于改善患者心功能,保护心肌,快速缓解患者临床症状,提高生活质量。

风湿性二尖瓣合并主动脉瓣病变的外科手术与预后研究

目的:探讨合并轻度及以下或中重度主动脉瓣病变患者的临床情况,研究合并中度主动脉瓣病变患者是否需合并同期手术治疗。方法:本研究为单中心、回顾性队列研究。回顾性收集2016年1月至2022年8月,于首都医科大学附属北京安贞医院接受风湿性二尖瓣手术治疗的844例患者信息,进行为期6年的随访。主要终点事件为随访期间发生中重度主动脉瓣病变。对合并中度主动脉瓣病变患者,通过倾向性评分匹配及逆概率加权调整两组基线资料,使用Cox回归分析计算风险比(HR),使用Logistic回归分析计算比值比(OR)。结果:①共纳入844例风湿性二尖瓣手术患者,合并轻度、中度、重度主动脉瓣病变患者行同期主动脉瓣手术的比例分别为11.0%(38/346)、57.8%(115/199)、94.4%(85/90)。②在风湿性二尖瓣手术合并主动脉瓣中度病变的患者中,经倾向性评分匹配后,手术组随访期间主要终点事件较未手术组少(5.7%vs.23.1%,P=0.023),同期行主动脉瓣手术能够显著降低随访期间中重度主动脉瓣病变率(OR=0.20,95%CI:0.04-0.68,P=0.026),但两组随访期间死亡率及再手术率均差异无统计学意义。在逆概率加权匹配后,仍得到相同的结果。结论:对风湿性二尖瓣疾病合并中度主动脉瓣病变,同期行主动脉瓣外科手术可显著降低随访期间主动脉瓣中重度病变发生率,但对患者死亡及再手术无明显影响。

全胸腔镜二尖瓣置换术同期心脏不停跳三尖瓣成形术安全性及有效性的临床研究

目的比较全胸腔镜二尖瓣置换术同期行三尖瓣人工瓣环成形术与正中开胸二尖瓣置换术同期行三尖瓣人工瓣环成形术的手术结果及短期疗效。方法回顾性分析2014年1月至2021年12月在广西壮族自治区人民医院接受二尖瓣置换术同期行三尖瓣人工瓣环成形术治疗三尖瓣反流(TR)的94例患者临床资料。68例接受正中开胸二尖瓣置换术同期心脏不停跳三尖瓣人工瓣环成形术(正中开胸组),26例接受全胸腔镜二尖瓣置换术同期心脏不停跳三尖瓣人工瓣环成形术(全胸腔镜组)。通过倾向性匹配评分(PSM)减少选择偏倚,最终得到26对病例进行分析。比较两组基本信息、手术治疗及术后随访资料,包括心脏彩超结果、手术住院相关指标等。结果全胸腔镜组手术时间、体外循环时间及阻断时间长于正中开胸组,差异有统计学意义(P<0.05)。术后1个月心脏彩超检查结果显示,两组二尖瓣收缩期血流速度、二尖瓣压差、压力减半时间(PHT)、TR面积、右心房内径(RAD)、右心室内径(RVD)以及房颤发生率比较差异无统计学意义(P>0.05)。两组术后24个月TR复发率比较差异无统计学意义(P>0.05)。术后24个月心脏彩超检查结果显示,正中开胸组二尖瓣压差显著低于全胸腔镜组(P<0.05),但两组二尖瓣收缩期血流速度、PHT、TR面积、RAD、RVD、左心室射血分数(LVEF)以及瓣周漏、房颤、肺动脉高压发生率比较差异无统计学意义(P>0.05)。结论全胸腔镜二尖瓣手术置换术同期行三尖瓣人工瓣环成形术与正中开胸二尖瓣置换术同期行三尖瓣人工瓣环成形术的疗效相当,两种手术方式均可用于临床治疗二尖瓣、三尖瓣联合瓣膜病变。

右美托咪定对退行性二尖瓣关闭不全患者二尖瓣置换术后早期心率变异性的影响

目的探讨右美托咪定对行二尖瓣置换术(Mitral valve replacement,MVR)的退行性二尖瓣关闭不全患者术后心率变异性(Heart rate variability,HRV)的影响。方法回顾性分析2020-2022年北部战区总医院心血管外科择期行二尖瓣置换术的退行性二尖瓣关闭不全患者的病例资料,根据右美托咪定使用情况,将患者分为对照组(未用右美托咪定,n=47)、按需给药组(使用次数≤3次,n=68)、规律给药组(使用次数≥5次,总剂量≥1000μg/ml,n=35)。分别记录三组患者术后HRV指标[正常窦性心搏RR间期标准差(Standard deviation of normal-to-normal intervals,SDNN)、24 h内每5 min正常RR间期平均值的标准差(Standard deviation of the average of normal-to-normal intervals,SDANN)、相邻RR间期差值高于50 ms的占比(Percentage of adjacent NN intervals differing by more than 50 milliseconds,PNN50)、24 h内相邻正常RR间期差值的均方根(Root mean square of successive RR-intervals differences,rMSSD)]等。结果三组患者术前PNN50、SDNN、SDANN、rMSSD比较,差异均无统计学意义(P>0.05);三组患者术后1周PNN50、rMSSD比较差异有统计学意义(P<0.05),而三组术后1周SDNN、SDANN差异无统计学意义(P>0.05)。按需给药组、规律给药组的术后1组rMSSD、PNN50均低于对照组(P<0.05),且规律给药组的术后1周rMSSD、PNN50均低于按需给药组(P<0.05)。结论二尖瓣置换术后应用右美托咪定对行性二尖瓣关闭不全患者总体心脏自主神经功能稳态影响不大;右美托咪定可使二尖瓣置换术后PNN50、rMSSD降低,按需给药组患者心脏副交感神经功能相对稳定。MVR围手术期使用右美托咪定应按需给药,以减轻患者术后疼痛,改善睡眠质量,同时减少对患者心脏迷走神经系统的不良影响。

3D打印技术在结构性心脏病的新进展

3D打印技术在结构性心脏病临床介入治疗中有着广泛的应用,可直观了解患者相关部位解剖、术前进行手术模拟、辅助制定手术策略。3D打印在经导管瓣膜病、瓣周漏、先天性心脏病、肥厚型心肌病、左心耳封堵等复杂结构性心脏疾病临床治疗方面发挥着显著的辅助作用。个体化心血管3D打印辅助指导结构性心脏病精准治疗,可降低手术相关风险、提高手术治疗效果。

Heart function and hemodynamics

930054 Clinical assessment of left ventricularfunction by equilibrium radionuclide ventriculo-graphy before and after mitral valve replace-ment.CHU Yinping(褚银平),et al.2nd Hosp,Shanxi Med Coll,Taiyuan.Chin Cir J 1992;7(5):457-458.Equilibrium radionuclide ventriculographywas used to estimate the left ventricular(LV)function in control subjects(Group 1;n=8)and in 24 patients of mitral valvular diseasesChina Medical Abstracts(Internal Medicine)

急诊经导管主动脉瓣置换术应用于急性心力衰竭患者的临床疗效分析

目的分析急诊经导管主动脉瓣置换术(TAVR)应用于急性心力衰竭患者的临床疗效及远期预后的影响因素。方法回顾性研究2016年1月至2020年12月武汉亚洲心脏病医院行急诊TAVR的急性心力衰竭患者的临床资料,主要结局指标为在院全因死亡率,使用Kaplan-Meier曲线进行生存分析。结果共计19例患者行急诊TAVR,平均年龄为(73.9±4.7)岁,男15例(78.9%)。住院期间死亡3例,其中2例为心肺复苏术后在体外膜肺氧合和主动脉内球囊反搏辅助下行TAVR,术后因多器官功能衰竭死亡,另外1例于TAVR术中出现心搏骤停抢救无效死亡。16例患者好转出院,进入随访,随访时间3~46个月,平均随访时间为19个月,随访期内死亡4例,死亡率为25.0%。根据术前是否合并二尖瓣中度以上的反流分为两组进行分析发现,两组生存率比较,差异有统计学意义(P=0.028),合并二尖瓣中度以上反流患者的生存率更低。结论对于药物治疗无效、血流动力学不稳定的急性心力衰竭或心原性休克患者,急诊TAVR治疗具有一定可行性。同时合并二尖瓣反流的患者可能远期生存率更低。

冠状动脉旁路移植术治疗冠心病合并中度缺血性二尖瓣反流的近远期疗效分析

目的:评估单纯冠状动脉旁路移植术(CABG)治疗冠心病合并中度缺血性二尖瓣反流的近远期效果,以探讨最佳的治疗方案。方法:2009年1月至2018年12月,共有822例冠心病合并中度缺血性二尖瓣反流的患者在首都医科大学附属北京安贞医院接受治疗,其中750例行单纯冠状动脉旁路移植术(CABG组),72例同期行二尖瓣修复(MVP)或二尖瓣置换术(MVR)(CABG+MV组),通过倾向性评分匹配后(5:1匹配),共有384例患者纳入分析,其中CABG组320例,CABG+MV组64例。通过对比,评估两组患者外科治疗术后的效果。结果:两组患者均成功接受了手术治疗。围术期患者死亡19例,其中CABG组17例(5.3%),CABG+MV组2例(3.1%),两组间比较差异无统计学意义(P=0.461)。围术期发生MACCE事件21例,其中CABG组18例(5.6%),CABG+MV组3例(4.7%),两组间比较差异无统计学意义(P=0.763)。患者术后随访时间为(51.48±21.59)个月,期间死亡59例,其中CABG组50例(15.6%),CABG+MV组9例(14.1%),两组间比较差异无统计学意义(P=0.752)。随访期间发生MACCE事件80例,其中CABG组67例(20.9%),CABG+MV组13例(20.3%),两组间比较差异无统计学意义(P=0.911)。累积生存率(P=0.88)及MACCE事件免除率(P=0.77)两组间比较差异也无统计学意义。结论:对于冠心病合并中度缺血性二尖瓣反流的患者,单纯行CABG术与CABG+MV术相比,近远期疗效相当。

二尖瓣成形术与二尖瓣置换术治疗风湿性心脏病患者疗效的Meta分析

目的:系统评价二尖瓣成形术和二尖瓣置换术治疗风湿性心脏病后的临床疗效。方法:利用计算机检索万方数据库、中国知网、维普、中国生物医学文献数据库、The Cochrane Library临床试验注册数据库、PubMed、EMbase,检索日期从建库至2022年7月,查找所有关于二尖瓣成形术和二尖瓣置换术治疗风湿性心脏病的临床对照研究。纳入符合研究的文章并对其进行质量评价,收集一般资料(作者姓名、出版年份、随访时间、年龄、性别)和观测指标(30 d死亡率;长时间随访生存率;再手术率)。对收集数据应用Review Manager 5.4软件进行Meta分析。结果:共纳入16篇文献,包括10310例患者,其中二尖瓣成形组3258例,二尖瓣置换组7052例。Meta分析显示,二尖瓣成形组的早期死亡率(OR=0.59,95%CI:0.45~0.77,P<0.05)低于二尖瓣置换组,但再手术率显著高于二尖瓣置换组(HR=2.09,95%CI:1.58~2.76,P<0.01)。而二尖瓣置换组的长时间随访生存率显著低于二尖瓣成形组(HR=0.62,95%CI:0.45~0.85,P=0.003)。结论:对于风湿性心脏病患者,二尖瓣成形术可以降低早期死亡率,并且能改善长期生存情况,但有再次手术的风险。

Treatment of More Than Moderate Ischemic Mitral Regurgitation in Patients Undergoing Left Ventricular Reconstruction

Objective:While evidence-based clinical guidelines recommend chordal-sparing mitral valve replacement,rather than mitral valve repair,in patients with severe ischemic mitral regurgitation(IMR)undergoing coronary artery bypass grafting,there are no similar recommendations for patients undergoing left ventricular reconstruction(LVR).This study aimed to compare the clinical outcomes of mitral valve repair and replacement in patients undergoing LVR complicated by more than moderate IMR.Methods:In this single-center cohort study,a total of 74 consecutive patients who underwent LVR and mitral valve surgery(repair group:59;replacement group:15),during the period from March 2000 to March 2021 at Fuwai Hospital(Beijing,China)were retrospectively enrolled.Survival rates were calculated with the Kaplan-Meier method and compared using the log-rank test.Univariate Cox analysis was performed to evaluate possible confounders,followed by adjustment in multivariate analysis.The primary outcome was survival free of major adverse cardiovascular and cerebrovascular events(MACCE).Results:Median follow-up time was 59.4 months.Compared with mitral valve replacement,mitral valve repair was associated with increased risk of perioperative use of ventricular assist device(22.0%vs.0,P=0.045).There was no difference in overall survival(hazard ratio(HR),1.10;95%confidence interval(CI),0.31-3.93;Plogrank=0.888)and MACCE-free survival(HR,1.54;95%CI,0.65-3.65;Plogrank=0.319),even after multivariate Cox regression(HR,1.35;95%CI,0.37-4.88;PCox=0.646;and HR,1.41;95%CI,0.57-3.44;PCox=0.455,respectively).Furthermore,while no differences were observed in ejection fraction and left ventricular end-diastolic diameter on follow-up echocardiography,mitral valve repair was associated with an increased risk of recurrent mitral regurgitation(P=0.041).Conclusions:In patients undergoing LVR complicated by more than moderate IMR,both concomitant mitral valve repair and replacement can be successfully achieved with comparable overall and MACCE-free survival outcomes;however,mitral valve replacement may be superior to mitral valve repair for persistent correction of mitral dysfunction.

心脏跳动中二尖瓣置换术234例临床分析

目的 报告 2 34例浅低温体外循环心脏跳动中二尖瓣替换术经验 ,完善手术技术。方法 浅低温体外循环 (30～32℃ ) ,不阻断主动脉 ,不灌注心脏停搏液 ,保持心脏缓慢空跳进行二尖瓣替换术。结果 全组 2 34例病人均顺利完成手术 ,早期死亡 2例 ,手术死亡率 0 .85 %。结论 心脏不停跳二尖瓣置换术是一种安全可行的术式 ,可有效减轻心脏缺血再灌注损伤 ,值得进一步研究和推广应用。

浅低温体外循环心脏跳动二尖瓣置换术对心肌保护的体视学研究

目的用体视学定量法对比分析两种二尖瓣置换术(MVR)对心肌超微结构的影响,旨在为浅低温体外循环心脏不停跳心内直视手术对心肌保护效果作进一步客观的评价。方法将40例风湿性心脏病二尖瓣病变患者随机分为两组进行手术,20例在浅低温体外循环心脏不停跳下行MVR(不停跳组),20例在中低温冷血停搏液灌注心脏停跳下行MVR(停跳组)。两组均分别于体外循环前后切取少许心肌组织,用计算机图像分析系统对心肌超微结构的体视学定量进行对比分析。结果两组线粒体各参数在转流前差异无显著性(P均>0.05)。停跳组在转流中、后线粒体平均直径(Dmit)、平均截面积(Amit)较转流前增大,但体密度(Vmit)、面数密度(Namit)、比表面(δmit)较不停跳组减少,差异均有显著性(P<0.05或P<0.01);两组肌原纤维体密度(Vvmyo)在转流前、转流中变化不大,差异均无显著性(P均>0.05),而转流后停跳组肌原纤维Vvmyo、比表面(δmyo)均较不停跳组减少,差异有显著性(P<0.05和P<0.01)。结论浅低温体外循环心脏跳动中心内直视手术是一种较接近生理状态的心肌保护方法,能最大程度地减轻心肌缺血、缺氧损伤,避免再灌注损伤,最大程度地保持心肌细胞形态结构的完整性,从而获得较理想的心肌保护效果。

瓣膜置换术中心脏停跳和不停跳体外循环比较

目的比较心脏停跳 (AH)和不停跳 (BH)瓣膜置换术 (VR)体外循环 (CPB)管理及效果的异同。方法观察201例VR患者 ,其中AH90例 ,BH111例。比较两组在CPB期间及术后相关指标的改变。结果两组相比 ,BH组转流时间和阻断时间较短、使用库血例数和库血用量、钾和碳酸氢钠用量、术中失血量等均较少(P<0.05)。结论心脏不停跳瓣膜置换手术在CPB管理方面优于心脏停跳瓣膜置换手术。