人工腱索移植术治疗二尖瓣前叶脱垂

用ePTFE缝线作人工腱索行二尖瓣成形术8例,共做人工腱索21根,同期行冠状动脉搭桥2例、房间隔缺损修补1例、三尖瓣成形3例。术后1例出现二尖瓣中度反流,再次转机,加用edge to edge技术后,食管超声复查示轻度反流,其余患者无二尖瓣反流或轻微、轻度反流。随访1-30个月,二尖瓣反流均无明显加重。认为ePTFE作为人工腱索治疗二尖瓣前叶脱垂效果可靠,术中准确确定人工腱索的长度是关键,术中食管超声心动图检查可确定手术效果。

儿童先天性上睑下垂患者行额肌悬吊术后屈光改变的临床观察

BACKGROUND AND OBJECTIVE: To evaluate the postoperative visual acuity and refractive changes occurring after bilateral frontalis brow suspension surgery in pediatric patients with congenital blepharoptosis. PATIENTS ANDMETHODS: Twenty-three patients between 4 and 12 years old with severe congenital blepharoptosis (unilateral in 21 cases and bilateral in 2 cases; total of 25 eyes) and poor levator function underwent bilateral frontalis brow suspension surgery by Crawford’s double triangle method with 4:0 expanded polytetrafluoroethylene sutures. The non-ptotic eyes (21 eyes) undergoing frontalis brow suspension surgery served as the control group. All patients had best-corrected spectacle visual acuity (BCSVA) of more than 6/9 preoperatively in both eyes. Changes in the postoperative BCSVA, binocularity, relevant refractive parameters, lid position, lagophthalmos, lid lag, and tear break-up timewere evaluated in both groups for 12 weeks and appropriate statistical tests were applied. RESULTS: Significant differences were found in the baseline characteristics and the postoperative changes in the eyes with and without ptosis. However, these were found to be transient and did not result in any new cases of amblyopia postoperatively. No complications requiring revision of surgerywere seen. CONCLUSIONS: The changes in the BCSVA after frontalis brow suspension surgery are transient. Retinoscopy, manual keratometry, and corneal videokeratoscopy are simple and effective methods to evaluate the sequential refractive changes occurring in these eyes.

利用人工腱索修复儿童二尖瓣的中期疗效

We have used artificial chordal replacement with expanded polytetrafluoroethylene sutures for mitral valve repair in children and reported favorable early clinical results. In this article we evaluate the midterm results of mitral valve repair with expanded polytetrafluoroethylene sutures in 39 children. From April 1995 through September 2003, mitral valve repair with chordal replacement using expanded polytetrafluoroethylene sutures was performed in 39 patients. In all patients the preoperative grade of mitral regurgitation was moderate or more because of prolapse of the anterior mitral leaflet. The mean age and body weight at the time of the operation were 4.7±5.3 years(range, 1 month to 17.8 years) and 14.4±12.2 kg(range, 3.9-54.4 kg), respectively. The number of expanded polytetrafluoroethylene sutures ranged from 1 to 3(mean, 1.4). The mean follow-up period and body weight at the latest follow-up were 5.0±2.3 years(range, 1.1-8.5 years) and 25.7±16.4 kg(range, 6.9-73 kg), respectively. There were no operative or late deaths. Only one patient required mitral valve replacement, which occurred 17 days after repair. Two patients underwent redo mitral valve repair 2 and 5 years after initial repair, respectively. The actuarial freedom from reoperation at 5 and 8 years was 94.8%and 89.5%, respectively. At the latest follow-up, trivial or less mitral regurgitation was observed in 33(84.6%) patients. Mitral valve repair with expanded polytetrafluoroethylene sutures in children demonstrated favorable midterm outcome. The procedure is safe and effective,with potential for patients’growth.