A comparison of results of sparing treatment obtained at 2, 4 and 6 years of follow-up in subjects with descending aortic atherosclerotic aneurysms (DAAs), and during the period between 1.5 and 8.9 years in subjects w...A comparison of results of sparing treatment obtained at 2, 4 and 6 years of follow-up in subjects with descending aortic atherosclerotic aneurysms (DAAs), and during the period between 1.5 and 8.9 years in subjects with dissecting thoracoabdominal aortic aneurysms (DTAAs) has been made. All subjects received conservative treatment to maintain optimal levels of BP, cholesterol and LDL cholesterol, as well as to reduce oxidative and inflammatory processes in aorta, strengthen aortic walls and stabilize the course of the disease. Rapid negative changes (diameter increased by more than 5 mm within a 6-month period) and the absence of contraindications for surgery prompted us to perform open or endovascular aortic repair. Available data suggest that both DAAs and TAAs are comorbidities, which at any time can abruptly terminate patient’s life, and operative treatment guarantees no safety from ruptures. When using sparing treatment of DAA, survival rates were 90.1% at 2 years, 76.8% at 4 years, and 59.4% at 6 years, with uniform survival increment mainly due to comorbidity. Survival rate seen in TAA group (81.8%) was more acceptable due to a younger age of patients.展开更多
Background:Ebstein’s anomaly(EA)is a rare and complex congenital heart anomaly,and the effect of surgical treatment is not ideal.This study aims to introduce our experience in management strategies,surgical technique...Background:Ebstein’s anomaly(EA)is a rare and complex congenital heart anomaly,and the effect of surgical treatment is not ideal.This study aims to introduce our experience in management strategies,surgical techniques,and operative indications for patients with Ebstein’s anomaly.Methods:A retrospective study of 258 operations was performed in 253 patients by the same cardiac surgeon in The First Hospital of Tsinghua University between March 2004 and January 2020.32 patients had previously received cardiac surgery in other hospitals.The clinical data including diagnosis,operative indications,techniques,pathological changes,and survival rates were collected and analyzed.Results:Anatomical correction was performed in 203(78.7%)operations,1½ventricle repair in 38(14.7%)operations,tricuspid valve repair only in four operations(1.6%),tricuspid valve replacement in ten(3.9%),total cavopulmonary connection(TCPC)in two(0.8%),and Glenn operation in one operation(0.4%).Reoperation was performed in five patients(2.0%)during hospitalization.Among them,tricuspid valve replacement was performed in one patient,1½ventricle repair in two patients,and tricuspid valve annulus reinforcement in two patients.Five patients died with an early mortality rate of 2.0%.Complete atrioventricular conduction block was complicated in one patient(0.4%).A total of 244 patients was followed up(four in the 253 patients lost)with a duration of 3.0-168.0(87.6±38.4)months.Cardiac function of 244 patients improved significantly with mean New York Heart Association(NYHA)functional class recovery from 3.5 to 1.1.The mean grade of tricuspid valve regurgitation improved from 3.6 to 1.5.Three late deaths(1.2%)occurred.The survival rates at five and ten years after surgery were 98.6%and 98.2%,respectively.Reoperation was performed in five patients(2.0%)during the follow-up period.Conclusion:Based on our management strategies and operative principles and techniques,anatomical correction of EA is capable of achieving excellent long-term results,and low rates of TCPC,1½ventricle repair and valvular replacement.展开更多
文摘A comparison of results of sparing treatment obtained at 2, 4 and 6 years of follow-up in subjects with descending aortic atherosclerotic aneurysms (DAAs), and during the period between 1.5 and 8.9 years in subjects with dissecting thoracoabdominal aortic aneurysms (DTAAs) has been made. All subjects received conservative treatment to maintain optimal levels of BP, cholesterol and LDL cholesterol, as well as to reduce oxidative and inflammatory processes in aorta, strengthen aortic walls and stabilize the course of the disease. Rapid negative changes (diameter increased by more than 5 mm within a 6-month period) and the absence of contraindications for surgery prompted us to perform open or endovascular aortic repair. Available data suggest that both DAAs and TAAs are comorbidities, which at any time can abruptly terminate patient’s life, and operative treatment guarantees no safety from ruptures. When using sparing treatment of DAA, survival rates were 90.1% at 2 years, 76.8% at 4 years, and 59.4% at 6 years, with uniform survival increment mainly due to comorbidity. Survival rate seen in TAA group (81.8%) was more acceptable due to a younger age of patients.
文摘Background:Ebstein’s anomaly(EA)is a rare and complex congenital heart anomaly,and the effect of surgical treatment is not ideal.This study aims to introduce our experience in management strategies,surgical techniques,and operative indications for patients with Ebstein’s anomaly.Methods:A retrospective study of 258 operations was performed in 253 patients by the same cardiac surgeon in The First Hospital of Tsinghua University between March 2004 and January 2020.32 patients had previously received cardiac surgery in other hospitals.The clinical data including diagnosis,operative indications,techniques,pathological changes,and survival rates were collected and analyzed.Results:Anatomical correction was performed in 203(78.7%)operations,1½ventricle repair in 38(14.7%)operations,tricuspid valve repair only in four operations(1.6%),tricuspid valve replacement in ten(3.9%),total cavopulmonary connection(TCPC)in two(0.8%),and Glenn operation in one operation(0.4%).Reoperation was performed in five patients(2.0%)during hospitalization.Among them,tricuspid valve replacement was performed in one patient,1½ventricle repair in two patients,and tricuspid valve annulus reinforcement in two patients.Five patients died with an early mortality rate of 2.0%.Complete atrioventricular conduction block was complicated in one patient(0.4%).A total of 244 patients was followed up(four in the 253 patients lost)with a duration of 3.0-168.0(87.6±38.4)months.Cardiac function of 244 patients improved significantly with mean New York Heart Association(NYHA)functional class recovery from 3.5 to 1.1.The mean grade of tricuspid valve regurgitation improved from 3.6 to 1.5.Three late deaths(1.2%)occurred.The survival rates at five and ten years after surgery were 98.6%and 98.2%,respectively.Reoperation was performed in five patients(2.0%)during the follow-up period.Conclusion:Based on our management strategies and operative principles and techniques,anatomical correction of EA is capable of achieving excellent long-term results,and low rates of TCPC,1½ventricle repair and valvular replacement.
