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 rheumat...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.展开更多
Objective: To define the indications for cardiac surgeries through right anterolateral thoracotomy, and render it clinically feasible in a carefully controlled scope. Methods: Ninety-eight patients requiring cardiac s...Objective: To define the indications for cardiac surgeries through right anterolateral thoracotomy, and render it clinically feasible in a carefully controlled scope. Methods: Ninety-eight patients requiring cardiac surgeries were operated through this approaach. Incisions were made in the fourth or on intercostal space. The upper costal cartilage near the incision was routinely removed. Aortic cannulation was performed through the lateral wall of the aorta. The procedures on the heart itself were the same as that of the median sternotomy. Results: The average lengths of the incisions, for the male and female patients, were (10.6±3.2) cm and (10.3 ± 2.2) cm respectively. The mean bypass time was (61.3 ±t 25. 1) min, and the mean heart arrest time was (49.5±19.2) min. The postoperative drainage was (410± 125) ml. All but 1 patient with aortic valve operation had satisfactory exposure . The complications included chest pain (n = 5), rib fracture (n =3), pleural effusion (n=5), and pneumothorax(n=6). Conclusion: The right anterolateral tholacotomy was a satisfactory alternative of median sternotomy for the surgeries that can be performed through a right atrium access.展开更多
Objective: To compare the clinical outcomes of minimally invasive right subaxillary vertical thoracotomy and traditional median stemotomy through right atrium in treatment of common congenital heart diseases. Methods:...Objective: To compare the clinical outcomes of minimally invasive right subaxillary vertical thoracotomy and traditional median stemotomy through right atrium in treatment of common congenital heart diseases. Methods: Clinical data of 59 cases of common congenital heart diseases treated with minimally invasive right axillary vertical thoracotomy from May, 2011 to February, 2013 and 77 cases of same diseases with traditional median stemotomy in the past three years were retrospectively analyzed, including atrial septal defect, membranous ventricular septal defect and partial endocardial cushion defect. The results were compared from the two groups, including the time for operation and cardiopulmonary bypass, amount of blood transfusion, postoperative drainage, ventilation time, hospital stay, and prognosis. Results: No severe complications happened in both groups, like deaths or secondary surgery caused by bleeding. No significant differences were in CPB time and postoperative ventilator time between groups (P>0.05), while for all of the operative time, the length of incision, postoperative drainage and hospital stay, minimally invasive right axillary vertical thoracotomy was superior to median stemotomy, with statistically significant differences (P<0.05). In six month followup after operation, no complications of residual deformity and pericardial effusion were found in both groups by doing echocardiography, but mild pectus carinatum was found in 8 patients in the traditional median sternotomy group (traditional group), whereas patients in another group were well recovered. Conclusions: Minimally invasive right subaxillary vertical thoracotomy for common congenital heart diseases is as safe as traditional median stemotomy, without the increasing incidence of postoperative complications. Additionally, compared with traditional median stemotomy, minimally - invasive right subaxillary vertical thoracotomy is better in the aspects of hidden incision, appearance, and postoperative recovery.展开更多
Minimally invasive approaches for cardiac surgery in children have been lagging in comparison to the adult world.A wide range of the most common congenital heart defects in infants and children can be repaired suc-ces...Minimally invasive approaches for cardiac surgery in children have been lagging in comparison to the adult world.A wide range of the most common congenital heart defects in infants and children can be repaired suc-cessfully through a variety of non-sternotomy incisions.This has been shown to be associated with superior cos-metic results,shorter hospital stays,and rapid return to full activity compared to sternotomy.These approaches have been around for decades,but they have not been widely adopted for a variety of reasons.Right axillary thor-acotomy is one of these approaches that we believe should be the new standard for the repair of a wide variety of heart defects in children and will be the focus of our current review.展开更多
本文阐述了两例犬血管环异常(vascular ring anomaly,VRA)的CT血管造影(CT angiography,CTA)诊断及手术治疗。通过术前对患犬进行CTA诊断,进行经左侧第4肋间开胸动脉韧带切断的手术治疗,并在术后对病例1进行食道球囊扩张。CTA显示两只...本文阐述了两例犬血管环异常(vascular ring anomaly,VRA)的CT血管造影(CT angiography,CTA)诊断及手术治疗。通过术前对患犬进行CTA诊断,进行经左侧第4肋间开胸动脉韧带切断的手术治疗,并在术后对病例1进行食道球囊扩张。CTA显示两只犬均存在持久性右主动脉弓(persistent right aortic arch,PRAA),并分别伴有右侧颈动脉异位发育和持久性左前腔静脉。手术治疗后,食道狭窄基本得到纠正,返流消失。CTA可对VRA进行更精确地诊断,并有助于制订具体手术方案;犬PRAA的手术治疗效果良好。展开更多
文摘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.
文摘Objective: To define the indications for cardiac surgeries through right anterolateral thoracotomy, and render it clinically feasible in a carefully controlled scope. Methods: Ninety-eight patients requiring cardiac surgeries were operated through this approaach. Incisions were made in the fourth or on intercostal space. The upper costal cartilage near the incision was routinely removed. Aortic cannulation was performed through the lateral wall of the aorta. The procedures on the heart itself were the same as that of the median sternotomy. Results: The average lengths of the incisions, for the male and female patients, were (10.6±3.2) cm and (10.3 ± 2.2) cm respectively. The mean bypass time was (61.3 ±t 25. 1) min, and the mean heart arrest time was (49.5±19.2) min. The postoperative drainage was (410± 125) ml. All but 1 patient with aortic valve operation had satisfactory exposure . The complications included chest pain (n = 5), rib fracture (n =3), pleural effusion (n=5), and pneumothorax(n=6). Conclusion: The right anterolateral tholacotomy was a satisfactory alternative of median sternotomy for the surgeries that can be performed through a right atrium access.
基金supported by college medical journal clinicalspecial funds(11321587)
文摘Objective: To compare the clinical outcomes of minimally invasive right subaxillary vertical thoracotomy and traditional median stemotomy through right atrium in treatment of common congenital heart diseases. Methods: Clinical data of 59 cases of common congenital heart diseases treated with minimally invasive right axillary vertical thoracotomy from May, 2011 to February, 2013 and 77 cases of same diseases with traditional median stemotomy in the past three years were retrospectively analyzed, including atrial septal defect, membranous ventricular septal defect and partial endocardial cushion defect. The results were compared from the two groups, including the time for operation and cardiopulmonary bypass, amount of blood transfusion, postoperative drainage, ventilation time, hospital stay, and prognosis. Results: No severe complications happened in both groups, like deaths or secondary surgery caused by bleeding. No significant differences were in CPB time and postoperative ventilator time between groups (P>0.05), while for all of the operative time, the length of incision, postoperative drainage and hospital stay, minimally invasive right axillary vertical thoracotomy was superior to median stemotomy, with statistically significant differences (P<0.05). In six month followup after operation, no complications of residual deformity and pericardial effusion were found in both groups by doing echocardiography, but mild pectus carinatum was found in 8 patients in the traditional median sternotomy group (traditional group), whereas patients in another group were well recovered. Conclusions: Minimally invasive right subaxillary vertical thoracotomy for common congenital heart diseases is as safe as traditional median stemotomy, without the increasing incidence of postoperative complications. Additionally, compared with traditional median stemotomy, minimally - invasive right subaxillary vertical thoracotomy is better in the aspects of hidden incision, appearance, and postoperative recovery.
文摘Minimally invasive approaches for cardiac surgery in children have been lagging in comparison to the adult world.A wide range of the most common congenital heart defects in infants and children can be repaired suc-cessfully through a variety of non-sternotomy incisions.This has been shown to be associated with superior cos-metic results,shorter hospital stays,and rapid return to full activity compared to sternotomy.These approaches have been around for decades,but they have not been widely adopted for a variety of reasons.Right axillary thor-acotomy is one of these approaches that we believe should be the new standard for the repair of a wide variety of heart defects in children and will be the focus of our current review.
文摘本文阐述了两例犬血管环异常(vascular ring anomaly,VRA)的CT血管造影(CT angiography,CTA)诊断及手术治疗。通过术前对患犬进行CTA诊断,进行经左侧第4肋间开胸动脉韧带切断的手术治疗,并在术后对病例1进行食道球囊扩张。CTA显示两只犬均存在持久性右主动脉弓(persistent right aortic arch,PRAA),并分别伴有右侧颈动脉异位发育和持久性左前腔静脉。手术治疗后,食道狭窄基本得到纠正,返流消失。CTA可对VRA进行更精确地诊断,并有助于制订具体手术方案;犬PRAA的手术治疗效果良好。
