“A Prospective Randomized Case-Control Study To Evaluate Mini Right Thoracotomy versus Conventional Sternotomy For Mitral Valve Repair In Rheumatic Heart Disease.”

Purpose: Right mini thoracotomy has been evaluated in many studies for mitral valve repair mainly in degenerative valvular disease but not in rheumatic heart disease. Mitral valve repair is more challenging in rheumatic etiology due to complexity of lesions. This prospective randomized case control study was designed to evaluate repair through mini right thoracotomy and to compare the clinical and echocardiographic outcomes with sternotomy in rheumatic patients. Methods: 25 patients of rheumatic heart disease underwent mitral valve repair through mini right thoracotomy (group I). Various clinical and functional parameters were compared with 25 patients of mitral valve repair through sternotomy (group II). On follow up the results were compared in both groups for clinical and echocardiographic parameters. Results: The various pre-operative demographic parameters were comparable in two groups. Equal rate of mitral valve repair (group I-21/25, 84% and group II-21/25, 84%) was achieved in both groups. The various intra-operative and post-operative clinical parameters were better in group I .There were equivalent functional and valve related outcomes in both groups in term of NYHA class (1.28 ± 0.613 vs 1.08 ± 0.276, P = 0.144), post-operative mitral valve area (2.43 ± 0.891 vs 2.82 ± 0.662, P = 0.090), incidence of more than mild mitral regurgitation (0) and mean pressure gradient across mitral valve (4.98 ± 3.33 vs 4.23 ± 1.5, P = 0.309). Conclusion: Mitral valve repair through mini right thoracotomy approach in rheumatic etiology is feasible and safe with equivalent rate of successful repair as compared to median sternotomy. It is associated with lesser morbidity, cosmetic advantage and lesser resource utilization.

Echocardiographic and Clinical Evaluation of Rheumatic Mitral Stenosis in Younger and Elderly Patients

Background: Rheumatic heart disease (RHD) is common form of heart disease among population, especially in developing countries like India. Mitral stenosis (MS) is majorly caused by rheumatic heart disease with mitral commissural adhesion, fibrosis and calcification of the chordae tendineae. The aim of present study was clinical and echocardiographic evaluation for mitral stenosis in RHD patients with different age group. Methods: This was a retrospective, nonrandomized, and single-centre study in which 203 consecutive patients presented rheumatic mitral stenosis. All the patients were divided into different age group viz. 65 years. Cardiovascular examination and echocardiography were done in each patient. Mitral valve area (MVA), mitral valve gradient (MVG) and left atrial (LA) diameter were assessed by echocardiography. Mitral valve score was recorded to analyse the degenerative changes in mitral valve structure. Results: A total of 203 patients (133 females) were enrolled and divided into three age groups. Patients with age above 65 years were considered as elderly and those patients with age below 40 years were considered as younger. Echocardiographic assessment showed mean 4.7 and 4.9 cm LA diameter, 0.92 and 0.86 cm2 MVA and 11.2 and 9.7 mm Hg MVG in younger and elderly patients respectively. Total mitral valve score has shown significant (p 2 had shown significant difference (p Conclusion: Present study provides unique contemporary data on characteristics and management of patients with rheumatic mitral stenosis. Majority of elderly patients are unsuitable for percutaneous commissurotomy due to degenerative changes in mitral valve structure.

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.

Severe mitral annular calcifi cation in rheumatic heart disease:A rare presentation

Severe mitral annular calcification(MAC)is frequently seen in patients with advanced age and chronic kidney disease,but it is rare in rheumatic heart disease(RHD).We hereby report a case of 45-year-old female with chronic RHD,who had severe MAC and mitral regurgitation.Fluoroscopy revealed a "crown"-like severe calcification of the mitral annulus.Autopsy of the heart revealed a calcified posterior mitral annulus,fused commissures,and calcified nodules at the atrial aspect of the mitral valve.

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

Rheumatic valvular heart disease treated with traditional Chinese medicine:A case report

BACKGROUND Rheumatic heart disease(RHD)is an autoimmune disease that leads to irreversible valve damage and heart failure.Surgery is an effective treatment;however,it is invasive and carries risks,restricting its broad application.Therefore,it is essential to find alternative nonsurgical treatments for RHD.CASE SUMMARY A 57-year-old woman was assessed with cardiac color Doppler ultrasound,left heart function tests,and tissue Doppler imaging evaluation at Zhongshan Hospital of Fudan University.The results showed mild mitral valve stenosis with mild to moderate mitral and aortic regurgitation,confirming a diagnosis of rheumatic valve disease.After her symptoms became severe,with frequent ventricular tachycardia and supraventricular tachycardia>200 beats per minute,her physicians recommended surgery.During a 10-day preoperative waiting period,the patient asked to be treated with traditional Chinese medicine.After 1 week of this treatment,her symptoms improved significantly,including resolution of the ventricular tachycardia,and the surgery was postponed pending further follow-up.At 3-month follow-up,color Doppler ultrasound showed mild mitral valve stenosis with mild mitral and aortic regurgitation.Therefore,it was determined that no surgical treatment was required.CONCLUSION Traditional Chinese medicine treatment effectively relieves symptoms of RHD,particularly mitral valve stenosis and mitral and aortic regurgitation.

The perioperative treatments of severe rhumatic heart disease with valve insufficiency

Objective To study the perioperative treatments for severe rheumatic heart disease with valve insuffciency. Methods Group 1 ( n = 25 ): mitral or/and arotic valve insufficiency, group 2 ( n = 17): valve stenosis and group 3 ( n = 14): simple congenital heart diseases. The load- independent index-end systolic elastance (Ees), pre-load recruited stroke work ( PRSW ), and the quantitive analyses of myocardial ultrastructure were observed and analyzed pre- and post-operatively. Results Ees was lower after operation than before operation in group 1, and it was a bit lower after operation in group 2. PRSW was significantly lower after operation than before operation in group 1, and it was similar before and after operation in group 2. The pre-load before operation and after-load after operation in group 1 increased. Vc%, Vvmyo% and Vvmit% were significantly lower in group 1 than in group 2. Ejection fraction (EF) was significantly lower after operation than before operation in group 1, and it was similar

Application of Percutaneous Balloon Mitral Valvuloplasty in Patients of Rheumatic Heart Disease Mitral Stenosis Combined with Tricuspid Regurgitation

Background： Tricuspid regurgitation （TR） is frequently associated with severe mitral stenosis （MS）, the importance of significant TR was often neglected. However, TR influences the outcome of patients. The aim of this study was to investigate the efficacy and safety of percutaneous balloon mitral valvuloplasty （PBMV） procedure in rheumatic heart disease patients with mitral valve （MV） stenosis and tricuspid valve regurgitation. Methods： Two hundred and twenty patients were enrolled in this study due to rheumatic heart disease with MS combined with TR. Mitral balloon catheter made in China was used to expand MV. The following parameters were measured before and after PBMV： MV area （MVA）, TR area （TRA）, atrial pressure and diameter, and pulmonary artery pressure （PAP）. The patients were followed for 6 months to 9 years. Results： After PBMV, the MVAs increased significantly （1.7 ± 0.3 cm2 vs. 0.9 ± 0.3 cm2, P 〈 0.01）; TRA significantly decreased （6.3 ± 1.7 cm2 vs. 14.2 ± 6.5 cm2, P 〈 0.01）, right atrial area （RAA） decreased significantly （21,5 ± 4.5 cm2 vs. 25.4 ± 4.3 cm〈 P 〈 0.05）, TRA/RAA （%） decreased significantly （29.3 ± 3.2% vs. 44.2 ± 3.6%, P 〈 0.01）. TR velocity （TRV） and TR continue time （TRT） as well as TRV - TRT decreased significantly （ 183.4± 9.4 cm/s vs. 254.5 ± 10.7 cm/s, P 〈 0.01 ; 185.7 ± 13.6 ms vs. 238.6 ±l 1.3 ms, P 〈 0.01 ; 34.2 ±5.6 cm vs. 60.7 ± 8.5 cm, P 〈 0.01, respectively）, The postoperative left atrial diameter （LAD） significantly reduced （41.3 ± 6.2 mm vs. 49.8± 6.8 mm, P 〈 0.01） and the postoperative right atrial diameter （RAD） significantly reduced （28.7 ±5.6 mm vs. 46.5 ± 6.3 mm, P 〈 0.01 ）; the postoperative left atrium pressure significantly reduced （ 15.6 ± 6.1 mmHg vs. 26.5 ± 6.6 mmHg, P 〈 0.01 ）, the postoperative right atrial pressure decreased significantly （ 13.2 ±2.4 mmHg vs. 18.5 ±4.3 mmHg, P 〈 0.01 ）. The pulmonary arterial pressure decreased significantly after PBMV （48.2 ± 10.3 mmHg vs. 60.6 ±15.5 mmHg, P 〈 0.01）. The symptom of chest tightness and short of breath obviously alleviated. All cases followed-up for 6 months to 9 years （average 75± 32 months）, 2 patients with severe regurgitation died （1 case of massive cerebral infarction, and 1 case of heart failure after 6 years and 8 years, respectively）, 2 cases lost access. At the end of follow-up, MVA has been reduced compared with the postoperative （1.4 ± 0.4 cm2 vs. 1.7 ±0.3 cm2, P 〈 0.05）; LAD slightly increased compared with the postoperative （45.2 ± 5.7 mm vs. 41.4 ± 6.3 mm, P 〈 0.05）, RAD slightly also increased compared with the postoperative （36.1 ± 6.3 mm vs. 28.6 ± 5.5 mm, P 〈 0.05）, but did not recover to the preoperative level. TRA slightly increased compared with the postoperative, but the difference was not statistically significant （P 〉 0.05）. The PAP and left ventricular ejection fraction appeared no statistical difference compared with the postoperative （P 〉 0.05）, the remaining patients without serious complications. Conclusions： PBMV is a safe and effective procedure for MS combined with TR in patients of rheumatic heart disease. It can alleviate the symptoms and reduce the size of TR. It can also improve the quality-of-life and prognosis. Its recent and mid-term efficacy is certain. While its long-term efficacy remains to be observed.

Left atrial appendage flow velocity in rheumatic mitral stenosis

The left atrial appendage ( LAA ) has been considered a relatively insignificant portion of the cardiac anatomy. Because thrombi have been found to have a predilection to form within the LAA, a better understanding of the LAA is necessary. Transesophageal echocardiography (TEE) is a technique that makes clear imaging of the

人工腱索在二尖瓣关闭不全后叶成形术中的应用及近中期疗效

目的了解人工腱索在二尖瓣关闭不全后叶病变中应用的可行性及近中期临床效果。方法选取在河北医科大学第二医院心脏外科,诊断二尖瓣脱垂伴关闭不全接受二尖瓣成形治疗的患者99例,其中单纯前叶脱垂41例,单纯后叶脱垂44例,前后叶均脱垂4例,交界脱垂10例。针对48例存在后叶脱垂的患者采用人工腱索的方法纠正二尖瓣后叶关闭不全。结果接受应用人工腱索纠正瓣膜后叶关闭不全的48例患者,随访13~81个月,平均(40.60±15.57)个月,术后1年因二尖瓣病变再次接受手术者0例,术后2年接受再次手术者共2例,术后5年接受再次手术者共2例,占全部后叶成型患者的4.2%。术后患者左心室射血分数、左心室舒张末径、二尖瓣血液返流面积以及心脏功能均较术前明显改善,差异有统计学意义(P<0.05)。随访数据显示术后6个月~1年这些指标改善更加明显。二尖瓣血液返流面积,随时间的延长,有逐渐增加的趋势,但目前资料尚未显示差异有统计学意义(P<0.05)。术后二尖瓣口血液流速、左心室流出道血液流速,以及二尖瓣瓣口面积均在正常值范围,未出现二尖瓣口狭窄。结论应用人工腱索治疗二尖瓣后叶脱垂是有效的,临床可以取得可靠的疗效。

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。

心腔内超声指导下经皮二尖瓣球囊成形术2例

过去30年间,经皮二尖瓣球囊成形术在X线和床旁超声指导下完成。但仍有部分大心房的二尖瓣狭窄患者行球囊扩张失败。心腔内超声指导下经皮二尖瓣球囊成形术精准可行,可减少并发症的发生,提高该类高龄复杂病例的成功率。本病例报道2例重度二尖瓣狭窄患者,经心腔内超声引导行经皮二尖瓣球囊成形术,手术成功,未发生相关并发症,为临床治疗二尖瓣狭窄提供一定的参考。

七氟烷对风湿性心脏病二尖瓣置换术患者房颤发生率的影响

目的探讨七氟烷对心脏瓣膜置换患者房颤发生率的影响及可能机制。方法将2011年5月至2013年8月需在全身麻醉低温体外循环下行二尖瓣置换术的慢性风湿性心脏病二尖瓣狭窄伴房颤患者48例（ASA分级Ⅱ-Ⅲ级）,分为研究组24例和观察组24例。所有患者麻醉诱导采用静脉注射咪达唑仑0.1 mg/kg、依托咪酯0.3 mg/kg、芬太尼5μg/kg、维库溴铵0.15 mg/kg。麻醉维持,研究组吸入七氟烷1.0%-3.0%,观察组吸入异氟烷1.0%-3.0%,按需间断推注芬太尼和维库溴铵。记录手术过程及术后24 h内房颤事件的发作次数。同时,在麻醉诱导前、体外循环开始后6 h及24 h分别收集血清,运用ELISA方法检测血清中C反应蛋白（C reactive protein,CRP）及转化生长因子-β1（transforming growth factor-β1,TGF-β1）的表达水平。结果研究组房颤事件的发作率下降（16.7%）明显低于观察组（62.5%,P〈0.05）。两组患者血清中CRP及TGF-β1在麻醉诱导前及体外循环后6 h表达均明显升高,而24 h后逐渐下降,但研究组升高和下降趋势均无观察组明显,差异具有统计学意义（P〈0.05）。结论七氟烷具有降低风湿性心脏病二尖瓣狭窄伴房颤患者瓣膜置换术房颤事件发生率,其可能与抑制CRP及TGF-β1表达相关。

实时三维超声心动图评价风湿性心脏病单纯二尖瓣狭窄患者左房功能的研究

目的应用实时三维超声心动图(RT-3DE)评价风湿性心脏病单纯二尖瓣狭窄(MS)患者左房功能。方法应用RT-3DE测量30例风湿性心脏病MS患者及50例正常对照左房最大容积(LAV_(max))、左房最小容积(LAV_(min))、左房收缩前容积(LAV_(pre)),计算左房总射血容量(TASV)、左房被动射血容量(PASV)、左房主动射血容量(AASV)、左房扩张指数(LAEI)、左房整体射血分数(LAEF)、左房被动射血分数(LAEF_(passive))、左房主动射血分数(LAEF_(active))。对以上容积及射血量数据均经体表面积(BSA)校正,得到左房最大容积指数(LAV_(max)I)、左房最小容积指数(LAV_(min)I)、左心房收缩前容积指数(LAV_(pre)I)、左房总射血容量指数(TASVI)、左房被动射血容量指数(PASVI)、左房主动射血容量指数(AASVI),分析上述数据与二尖瓣口面积(MVA)的相关性。结果 (1)MS组LAVmaxI、LAVminI、LAV_(pre)I均高于对照组(P<0.05);(2)MS组TASVI、PASVI、AASVI与对照组差异无统计学意义(P>0.05);(3)MS组LAEI、LAEF、LAEFpassive、LAEF_(active)均低于对照组(P<0.05);(4)MS组LAV_(max)I、LAV_(min)I、LAV_(pre)I、LAEF、LAEFpassive与MVA相关(r=-0.432、-0.421、-0.440、0.352、0.401,P<0.05),TAVSI、PASVI、AASVI、LAEI、LAEF_(active)与MVA无相关性(P>0.05)。结论风湿性心脏病MS患者左房存储器功能、管道功能、泵功能均降低。RT-3DE可评价风湿性心脏病MS窦性心律患者左房功能。

风湿性心脏病左房室瓣狭窄伴心房纤颤临床路径中的药学服务研究

目的评价药学服务对风湿性心脏病左房室瓣狭窄伴心房纤颤患者临床路径的干预效果。方法根据原卫生部颁发的《风湿性左房室瓣狭窄(内科)临床路径》(2010版)设计风湿性心脏病左房室瓣狭窄伴心房纤颤药学服务路径,采用随机、平行对照临床研究,选取2012年1月—2014年1月山东大学附属临沂市人民医院心内科收治的风湿性心脏病左房室瓣狭窄伴心房纤颤患者200例,采用随机数字表法分为药学服务组102例,对照组98例,排除不符合标准者后,药学服务组60例,对照组60例,药学服务组在常规临床路径管理的基础上由临床药师主导药学服务过程,优化药物选择,对患者进行药学监护。以患者的抗凝治疗达标率〔国际标准化比值(INR)达标率〕、药物不良事件(出血/栓塞事件)发生率、住院时间、药品费用、住院总费用、药占比为观察指标。结果两组患者住院期间INR达标率间差异无统计学意义〔32.1%(44/137)与21.7%(28/129);χ2=3.648,P=0.056〕,出院时INR达标率间差异无统计学意义〔41.7%(25/60)与26.7%(16/60);χ2=3.001,P=0.083〕,药学服务组患者住院期间INR<1.6或INR>3.0的发生率较对照组降低〔39.4%(54/137)与63.6%(82/129);χ2=15.507,P<0.001〕。对于两组中入院首次监测INR不达标患者,药学服务组患者出院时INR达标率高于对照组,差异有统计学意义〔38.1%(16/42)与13.3%(6/45);χ2=7.050,P=0.008〕。两组患者不良事件发生率比较,差异无统计学意义(P>0.05);两组患者住院时间、药品费用、住院总费用、药占比比较,差异均无统计学意义(P>0.05)。结论以药学服务路径对风湿性心脏病左房室瓣狭窄伴心房纤颤临床路径住院患者进行全程化的药学服务,可明显提高患者住院期间的抗凝治疗达标率,且安全性较好。

风湿性二尖瓣狭窄并发肺动脉高压患者二尖瓣置换术后早期临床转归分析

目的:分析风湿性二尖瓣狭窄患者二尖瓣置换术后的早期临床转归。方法:回顾分析128例因风湿性二尖瓣狭窄行二尖瓣置换术患者的临床资料,根据心脏彩超估测的肺动脉收缩压(SPAP)结果分为A组(30 mm Hg≤SPAP<50 mm Hg,n=70)和B组(SPAP≥50 mm Hg,n=58),比较2组一般资料、手术相关资料、围手术期结果及早期随访结果。结果:2组间除SPAP、肺功能及右心室内径外,其余术前指标差异均无统计学意义。围手术期死亡5例,A组2例,B组3例。术后机械通气时间及ICU治疗时间B组均大于A组(P均<0.05)。术后2组患者SPAP均较术前下降(P均<0.05)。术后6个月复查心脏彩超显示2组病例人工瓣膜功能良好;A组SPAP升高至术前水平或以上患者2例,B组11例,2组相比,差异有统计学意义(χ2=7.644,P=0.006)。结论:二尖瓣狭窄患者的术前肺动脉压高增加了术后复发肺动脉高压的风险,早期临床转归也相对较差。

风心病二尖瓣狭窄合并肺动脉高压的肺病理研究

目的:观察风湿性心脏病(风心病)二尖瓣狭窄肺动脉高压患者肺病理改变特点,为临床处理提供理论依据。方法:选择37例风心病二尖瓣狭窄合并肺动脉高压的手术换瓣患者,在手术时取右肺中叶组织,对其病理改变进行定性和定量研究。以6例主动脉瓣病变、肺动脉压正常、行主动脉瓣置换术的患者为对照。结果:风心病二尖瓣狭窄合并肺动脉高压患者的肺组织结构存在着不同程度的改变。严重肺动脉高压组的肺肌型动脉中层厚度指数(MT/R)明显高于肺动脉高压组和对照组,肺动脉高压组的MT/R也明显高于对照组。根据MT/R的病理分级,81%的患者在轻至中度。结论:肺血管病变的严重程度和术前肺动脉压力有关,但大部分患者的肺血管病理改变仅为轻到中度。

经食道超声心动图在二尖瓣球囊扩张术前对左心房血栓检出的研究

目的 :探讨经食道超声心动图 (TEE)对风湿性心脏病中重度二尖瓣狭窄 (二尖瓣口面积为 0 92± 0 2 1cm2 )患者左心房和 (或 )左心耳血栓的诊断价值。方法 :2 41例准备经皮二尖瓣球囊扩张的患者术前检查 ,所有病例经胸超声心动图 (TTE)未发现或可疑左心房和(或 )左心耳血栓 ,并至少禁食 4小时后进行TEE。结果 :76 ( 32 % )例经TEE显示左心耳和 (或 )左心房内附壁血栓。以TEE为标准 ,TTE诊断左心耳血栓的敏感性和特异性分别为 2 5 %和 94%。结论 :大多数二尖瓣狭窄病例左心房血栓发生在左心耳内 ,TTE探查左心耳血栓敏感性低 。

“纽扣状”转移保留二尖瓣全装置瓣膜置换及其对左心功能的影响

目的:探讨风湿性心脏病二尖瓣病变以狭窄为主的患者采用"纽扣状"转移保留全瓣装置二尖瓣置换的方法及对左心功能的影响。方法:对80例二尖瓣狭窄需行二尖瓣置换的患者分为A组(术中"纽扣状"保留全部二尖瓣瓣下结构)、B组(术中仅保留二尖瓣后瓣及瓣下结构)和C组(术中未保留瓣下结构);术前、术后3～6个月行超声心动图检查。结果:A组术后左室舒张末、收缩末容积,左室射血分数,短轴缩短率的改善优于B、C组,对于射血分数的改善A组显著优于B、C组。A、B组主动脉阻断时间较C组延长,但A、B两组无明显差异。总体转流时间C组较A、B两组缩短。结论:风湿性心脏病以二尖瓣狭窄为主的患者行瓣膜置换时可采用"纽扣状"转移保留全部瓣下装置,患者术后早期心功能的改善优于部分保留者和不保留者。