Introduction: Treatments for cardiovascular diseases have increasingly evolved with the tendency to offer minimally invasive or transcatheter procedures instead of conventional sternotomy surgery. In this context, we ...Introduction: Treatments for cardiovascular diseases have increasingly evolved with the tendency to offer minimally invasive or transcatheter procedures instead of conventional sternotomy surgery. In this context, we highlight minimally invasive mitral valve surgery (MIMVS), which has been shown to be an increasingly solid option with some superior results when compared to the conventional technique: better pain control, shorter hospital stays, shorter recovery time, shorter readmission rate in the first postoperative year, better aesthetic results, and lower overall cost. Aim: This study aims to evaluate the stages of MIMVS, by primary mitral valve consultation, in our service and compare these results with data from the literature. Methods: All electronic medical records of patients who underwent MIMVS for primary mitral valve injury in the Encore Hospital from January 2020 to February 2023 were analyzed. Tabulation and statistical analysis were performed using the Microsoft Excel<sup>®</sup> program. Quantitative variables were presented as means, standard deviations. Results: 46 patients were enrolled in our study (Age: 59.1 ± 12.4 years old;60.8% Female, BMI: 26 ± 4.4 Kg/m<sup>2</sup>, Low risk STS score: 82.6%). The observed 30-day mortality was 2.1%, plastic rate of 23.9%, blood transfusion rate of 41.3%, length of stay in an intensive care bed (ICB) of 3.3 ± 3.3 days and hospital stay of 6.4 ± 5.1 days. Conclusions: We noticed that the MIMVS results carried out in our service agree with data from national and international literature with approximately 1.3 days more hospitalization in ICB.展开更多
A 19-year-old woman with a bicuspid aortic valve was admitted because of active infective endocarditis with a root abscess. Four weeks of antibiotic therapy achieved negative blood cultures and normalized inflammatory...A 19-year-old woman with a bicuspid aortic valve was admitted because of active infective endocarditis with a root abscess. Four weeks of antibiotic therapy achieved negative blood cultures and normalized inflammatory signs;however, echocardiography revealed severe aortic regurgitation through an abscess cavity located at the root. The modified Ross procedure, in which the pulmonary autograft was reinforced with a prosthetic graft to prevent postoperative annular dilation, was successfully performed. The postoperative clinical course was uneventful, and echocardiography performed at 1 year showed trivial aortic regurgitation. Selection of homograft may benefit young woman who wishes to bear children, and covering pulmonary autograft by a prosthetic graft in order to prevent annular dilatation of autograft in patient with bicuspid aortic valve, may be allowed only under negative infection sign.展开更多
Background Recurrent atrial arrhythmia is very common in patients after mitral valve surgery plus mini-maze procedure.Investigation about the mechanism for these patients may have important implication to improve the ...Background Recurrent atrial arrhythmia is very common in patients after mitral valve surgery plus mini-maze procedure.Investigation about the mechanism for these patients may have important implication to improve the surgery strategy.Methods Mini-maze procedure was defined as follow: Pulmonary vein encircling incision and roof line connecting the two circles lesion,left atrial isthmus lesion,and the right atrial isthmus lesion.There were 517 patients with rheumatic valvular disease and pre-operative atrial fibrillation (AF) undergoing valve surgery plus mini-maze procedure in our hospital in the last 3 years,and 93 patients(18%) had recurrent atrial arrhythmia.Twelve patients(6 males and 6 females,mean age 53.8±7.8 ys) underwent electrophysiological study using 3-D mapping system(10 pts) or conventional mapping method(2 pts).Results The first recurrent time from surgery was 4.4±2.2 months.The mean follow-up time after catheter ablation was(12.0±6.0) months.One patient with sinus bradycardia had recurrent incessant atrial tachycardia (AT),but the AT was terminated by catheter position and never could be induced any more.She underwent a repeat procedure but failed just as the course in the first time, and was treated with DDDR pacemaker plus amiodarone.Six patients had 10 kinds of stable AT,including 5 at right atrial isthmus,2 at roof line,1 related to right atrial incision, 1 at anterior wall of left atrial,and 1 related to left superior pulmonary vene.All the stable AT were eliminated and remained sinus rhythm.Three patients had ATs with variable cycle length and the 3-D mapping suggested macro-reentry AT around mitral annulus.We tried to ablate at routine mitral isthmus and also in coronary sinus,but could not reach bi-directional conduction blocking.The other 2 patients were AF with reconnection at all previous ablation sites.Ablation strategy for AF included lesion at re-conduction sites and complex fractionated atrial electrogram.The patients with AF and mitral isthmus related AT were administrated with DC cardioversion and then took amiodarone.One AT and one AF recurred. Conclusions The recurrent atrial arrhythmia after mini-maze mostly related to reconnection at previous lesion sites and catheter ablation for AT could have a high success rate.It would be very hard to block mitral isthmus after valve replacement,so transmural lesion during surgery procedure is the most important strategy for preventing postoperative atrial arrhythmia.展开更多
Critical aortic valve stenosis in newborns is the cause of a severe clinical condition with the onset of symptoms during first hours after birth.We present a clinical case of a successful surgical correction of a crit...Critical aortic valve stenosis in newborns is the cause of a severe clinical condition with the onset of symptoms during first hours after birth.We present a clinical case of a successful surgical correction of a critical aortic stenosis using a hybrid method applied in a newborn during the first day of life.The infant was diagnosed with a hypoplastic left heart complex with an intact atrial septum(aortic and mitral valves stenosis variant),that led to the cardiogenic shock and acute pulmonary edema.The procedure included bilateral banding of the pulmonary artery branches and atrioseptostomy with stenting of the interatrial septum.The surgery was performed through a median sternotomy.展开更多
Background The probability of prosthesis-patient mismatch(PPM)is high in aortic valve replacement surgery for small aortic valve annulus,which increases the postoperative prosthetic valve transvalvular pressure gradie...Background The probability of prosthesis-patient mismatch(PPM)is high in aortic valve replacement surgery for small aortic valve annulus,which increases the postoperative prosthetic valve transvalvular pressure gradient.Concurrent aortic annuloplasty is a commonly applied surgical procedure,but there is currently no uniform standard or guideline on the type of prosthetic valve that should be used during surgery.Therefore,this study aimed to analyze whether there was any difference in the short-term prognosis between the choice of mechanical valves and bioprosthetic valves during aortic valve replacement surgery with concomitant aortic annuloplasty by the Nicks procedure.Methods A retrospective analysis was conducted based on the clinical data from 55 patients undergoing aortic valve replacement surgery with concomitant annuloplasty by the Nicks procedure at the Cardiac Surgery Department of Guangdong Provincial People’s Hospital from November 2021 to December 2023.In this study,all patients received aortic annuloplasty by the Nicks procedure.Among these patients,30 were in the mechanical valve group,while the other 25 were in the bioprosthetic valve group.Data including left ventricular end-diastolic/endsystolic diameters,left ventricular ejection fraction,interventricular septal thickness,left ventricular posterior wall thickness,transvalvular pressure gradient,left ventricular fractional shortening,and left ventricular mass index were collected 1 week preoperatively and 1 week and 3 months postoperatively.Information on gender,age,body surface area,types of perioperative complications,operation time,complication rates,and outcomes was also collected.Results Among the 55 patients enrolled in this study,4 died.The main causes of death included postoperative low cardiac output syndrome,severe pulmonary infection,and multi-organ dysfunction.Meanwhile,there was a statistically significant difference in left ventricular end-diastolic diameter between the mechanical valve group and the biological valve group 1 week after surgery.However,differences in other indicators such as aortic crossclamp duration,cardiopulmonary bypass duration,postoperative ventilator support duration,postoperative intensive care unit(ICU)stay,total postoperative hospital stay,and echocardiography results 1 week and 3 months postoperatively were not significant between the two groups.Conclusions For patients undergoing aortic annuloplasty by the Nicks procedure in the aortic valve replacement surgery,the postoperative recovery time is not significantly different between the bioprosthetic and mechanical valve groups.Additionally,there is no notable difference in the improvement of left ventricular function or the reduction of PPM incidence between the two types of valves.[S Chin J Cardiol 2024;25(1):29-37].展开更多
Objective: To assess the outcome of valve replacement under mild hypothermia on pump-beating heart and to discuss the risk factors of cardiac valve surgery. Methods: In the period from November 1997 to May 2003, a tot...Objective: To assess the outcome of valve replacement under mild hypothermia on pump-beating heart and to discuss the risk factors of cardiac valve surgery. Methods: In the period from November 1997 to May 2003, a total of 800 cases of valve replacement were carried out in our institute. The clinical data were reviewed and the technique of mild hypothermia and pump-beating heart to replace cardiac valve was described in detail. Results: 800 patients, 308 male and 492 female, with age range from 8 to 66 years, weighing 19 to 88 kg, underwent operation. The average cardiopulmonary bypass time was (109.38± 40.64) min, the average clamping time of the vena cava was (77.87±27.99) min and the average mechanical ventilation time was (17.78±12.21) h. There were 17 patients died in the early postoperative stage with an early mortality rate of 2.13%. The causes of death were failure in the weaning of extracorporeal circulation in 2 cases, severe low output syndrome in 3 cases, ventricular fibrillation in 3 cases, obstruction of coronary ostium of mechanical prosthetic valve in 1 case, hepatic failure in 2 cases, pulmonary failure in 1 case, multiorgan failure in 4 cases, and prosthetic valve dysfunction in 1 case. Severe postopertive complications occurred in 51 cases (6.375%), which included reexploration because of excessive bleeding in 16 cases (2.0%), lavage of poststernal infection in 2 cases (0.25%), postoperative strike in 7 cases (0.875%), pulmonary failure in 5 cases (0.625%), hepatic failure in 4 cases (0.5%), multiorgan failure in 11 cases (1.375%), ventricular arrhythmia in 5 cases (0.625%) and peripheral circulation failure in 1 case (0.125%). Conclusion: Mild hypothermia and pump-beating heart result in satisfying clinical outcome in patients undergoing valve replacement. The integrated sequenced deairing procedure ensures the avoidance of air embolism during operation. Pump-beating heart technique offers a safe and practical option especially in patients with severe critical valvular disorder.展开更多
Aortic arch aneurysms are rarely isolated entities, and most frequently associated with either ascending or descending aorta pathologies. Association with aortic valve stenosis is uncommon and traditional surgical tre...Aortic arch aneurysms are rarely isolated entities, and most frequently associated with either ascending or descending aorta pathologies. Association with aortic valve stenosis is uncommon and traditional surgical treatment is always challenging. Here we report a minimally invasive and endovascular management of these two pathologies in a 89-year-old man with LAD-stented ischemic cardiomyopathy. We describe our initial therapeutic strategy, per procedure difficulties and final management of this challenging case. Finally, we discuss the different therapeutic options for the endovascular treatment of aortic arch aneurysm associated with aortic valve stenosis.展开更多
Atrial fibrillation （AF） is fairly common in patients with chronic mitral valve disease and a markedly dilated left atrium. These patients rarely return to sinus rhythm spontaneously, even after a successful mitral...Atrial fibrillation （AF） is fairly common in patients with chronic mitral valve disease and a markedly dilated left atrium. These patients rarely return to sinus rhythm spontaneously, even after a successful mitral valve operation. The Maze procedure, developed by Cox and associates,15 has been used in patients undergoing a mitral valve operation. Restoration of normal sinus rhythm and atrial contraction in such patients have been reported by some groups. This study will summarize retrospectively a group of patients who underwent the Cox Maze procedure for the treatment of AF associated with rheumatic mitral valve disease in China.展开更多
文摘Introduction: Treatments for cardiovascular diseases have increasingly evolved with the tendency to offer minimally invasive or transcatheter procedures instead of conventional sternotomy surgery. In this context, we highlight minimally invasive mitral valve surgery (MIMVS), which has been shown to be an increasingly solid option with some superior results when compared to the conventional technique: better pain control, shorter hospital stays, shorter recovery time, shorter readmission rate in the first postoperative year, better aesthetic results, and lower overall cost. Aim: This study aims to evaluate the stages of MIMVS, by primary mitral valve consultation, in our service and compare these results with data from the literature. Methods: All electronic medical records of patients who underwent MIMVS for primary mitral valve injury in the Encore Hospital from January 2020 to February 2023 were analyzed. Tabulation and statistical analysis were performed using the Microsoft Excel<sup>®</sup> program. Quantitative variables were presented as means, standard deviations. Results: 46 patients were enrolled in our study (Age: 59.1 ± 12.4 years old;60.8% Female, BMI: 26 ± 4.4 Kg/m<sup>2</sup>, Low risk STS score: 82.6%). The observed 30-day mortality was 2.1%, plastic rate of 23.9%, blood transfusion rate of 41.3%, length of stay in an intensive care bed (ICB) of 3.3 ± 3.3 days and hospital stay of 6.4 ± 5.1 days. Conclusions: We noticed that the MIMVS results carried out in our service agree with data from national and international literature with approximately 1.3 days more hospitalization in ICB.
文摘A 19-year-old woman with a bicuspid aortic valve was admitted because of active infective endocarditis with a root abscess. Four weeks of antibiotic therapy achieved negative blood cultures and normalized inflammatory signs;however, echocardiography revealed severe aortic regurgitation through an abscess cavity located at the root. The modified Ross procedure, in which the pulmonary autograft was reinforced with a prosthetic graft to prevent postoperative annular dilation, was successfully performed. The postoperative clinical course was uneventful, and echocardiography performed at 1 year showed trivial aortic regurgitation. Selection of homograft may benefit young woman who wishes to bear children, and covering pulmonary autograft by a prosthetic graft in order to prevent annular dilatation of autograft in patient with bicuspid aortic valve, may be allowed only under negative infection sign.
文摘Background Recurrent atrial arrhythmia is very common in patients after mitral valve surgery plus mini-maze procedure.Investigation about the mechanism for these patients may have important implication to improve the surgery strategy.Methods Mini-maze procedure was defined as follow: Pulmonary vein encircling incision and roof line connecting the two circles lesion,left atrial isthmus lesion,and the right atrial isthmus lesion.There were 517 patients with rheumatic valvular disease and pre-operative atrial fibrillation (AF) undergoing valve surgery plus mini-maze procedure in our hospital in the last 3 years,and 93 patients(18%) had recurrent atrial arrhythmia.Twelve patients(6 males and 6 females,mean age 53.8±7.8 ys) underwent electrophysiological study using 3-D mapping system(10 pts) or conventional mapping method(2 pts).Results The first recurrent time from surgery was 4.4±2.2 months.The mean follow-up time after catheter ablation was(12.0±6.0) months.One patient with sinus bradycardia had recurrent incessant atrial tachycardia (AT),but the AT was terminated by catheter position and never could be induced any more.She underwent a repeat procedure but failed just as the course in the first time, and was treated with DDDR pacemaker plus amiodarone.Six patients had 10 kinds of stable AT,including 5 at right atrial isthmus,2 at roof line,1 related to right atrial incision, 1 at anterior wall of left atrial,and 1 related to left superior pulmonary vene.All the stable AT were eliminated and remained sinus rhythm.Three patients had ATs with variable cycle length and the 3-D mapping suggested macro-reentry AT around mitral annulus.We tried to ablate at routine mitral isthmus and also in coronary sinus,but could not reach bi-directional conduction blocking.The other 2 patients were AF with reconnection at all previous ablation sites.Ablation strategy for AF included lesion at re-conduction sites and complex fractionated atrial electrogram.The patients with AF and mitral isthmus related AT were administrated with DC cardioversion and then took amiodarone.One AT and one AF recurred. Conclusions The recurrent atrial arrhythmia after mini-maze mostly related to reconnection at previous lesion sites and catheter ablation for AT could have a high success rate.It would be very hard to block mitral isthmus after valve replacement,so transmural lesion during surgery procedure is the most important strategy for preventing postoperative atrial arrhythmia.
文摘Critical aortic valve stenosis in newborns is the cause of a severe clinical condition with the onset of symptoms during first hours after birth.We present a clinical case of a successful surgical correction of a critical aortic stenosis using a hybrid method applied in a newborn during the first day of life.The infant was diagnosed with a hypoplastic left heart complex with an intact atrial septum(aortic and mitral valves stenosis variant),that led to the cardiogenic shock and acute pulmonary edema.The procedure included bilateral banding of the pulmonary artery branches and atrioseptostomy with stenting of the interatrial septum.The surgery was performed through a median sternotomy.
文摘Background The probability of prosthesis-patient mismatch(PPM)is high in aortic valve replacement surgery for small aortic valve annulus,which increases the postoperative prosthetic valve transvalvular pressure gradient.Concurrent aortic annuloplasty is a commonly applied surgical procedure,but there is currently no uniform standard or guideline on the type of prosthetic valve that should be used during surgery.Therefore,this study aimed to analyze whether there was any difference in the short-term prognosis between the choice of mechanical valves and bioprosthetic valves during aortic valve replacement surgery with concomitant aortic annuloplasty by the Nicks procedure.Methods A retrospective analysis was conducted based on the clinical data from 55 patients undergoing aortic valve replacement surgery with concomitant annuloplasty by the Nicks procedure at the Cardiac Surgery Department of Guangdong Provincial People’s Hospital from November 2021 to December 2023.In this study,all patients received aortic annuloplasty by the Nicks procedure.Among these patients,30 were in the mechanical valve group,while the other 25 were in the bioprosthetic valve group.Data including left ventricular end-diastolic/endsystolic diameters,left ventricular ejection fraction,interventricular septal thickness,left ventricular posterior wall thickness,transvalvular pressure gradient,left ventricular fractional shortening,and left ventricular mass index were collected 1 week preoperatively and 1 week and 3 months postoperatively.Information on gender,age,body surface area,types of perioperative complications,operation time,complication rates,and outcomes was also collected.Results Among the 55 patients enrolled in this study,4 died.The main causes of death included postoperative low cardiac output syndrome,severe pulmonary infection,and multi-organ dysfunction.Meanwhile,there was a statistically significant difference in left ventricular end-diastolic diameter between the mechanical valve group and the biological valve group 1 week after surgery.However,differences in other indicators such as aortic crossclamp duration,cardiopulmonary bypass duration,postoperative ventilator support duration,postoperative intensive care unit(ICU)stay,total postoperative hospital stay,and echocardiography results 1 week and 3 months postoperatively were not significant between the two groups.Conclusions For patients undergoing aortic annuloplasty by the Nicks procedure in the aortic valve replacement surgery,the postoperative recovery time is not significantly different between the bioprosthetic and mechanical valve groups.Additionally,there is no notable difference in the improvement of left ventricular function or the reduction of PPM incidence between the two types of valves.[S Chin J Cardiol 2024;25(1):29-37].
文摘Objective: To assess the outcome of valve replacement under mild hypothermia on pump-beating heart and to discuss the risk factors of cardiac valve surgery. Methods: In the period from November 1997 to May 2003, a total of 800 cases of valve replacement were carried out in our institute. The clinical data were reviewed and the technique of mild hypothermia and pump-beating heart to replace cardiac valve was described in detail. Results: 800 patients, 308 male and 492 female, with age range from 8 to 66 years, weighing 19 to 88 kg, underwent operation. The average cardiopulmonary bypass time was (109.38± 40.64) min, the average clamping time of the vena cava was (77.87±27.99) min and the average mechanical ventilation time was (17.78±12.21) h. There were 17 patients died in the early postoperative stage with an early mortality rate of 2.13%. The causes of death were failure in the weaning of extracorporeal circulation in 2 cases, severe low output syndrome in 3 cases, ventricular fibrillation in 3 cases, obstruction of coronary ostium of mechanical prosthetic valve in 1 case, hepatic failure in 2 cases, pulmonary failure in 1 case, multiorgan failure in 4 cases, and prosthetic valve dysfunction in 1 case. Severe postopertive complications occurred in 51 cases (6.375%), which included reexploration because of excessive bleeding in 16 cases (2.0%), lavage of poststernal infection in 2 cases (0.25%), postoperative strike in 7 cases (0.875%), pulmonary failure in 5 cases (0.625%), hepatic failure in 4 cases (0.5%), multiorgan failure in 11 cases (1.375%), ventricular arrhythmia in 5 cases (0.625%) and peripheral circulation failure in 1 case (0.125%). Conclusion: Mild hypothermia and pump-beating heart result in satisfying clinical outcome in patients undergoing valve replacement. The integrated sequenced deairing procedure ensures the avoidance of air embolism during operation. Pump-beating heart technique offers a safe and practical option especially in patients with severe critical valvular disorder.
文摘Aortic arch aneurysms are rarely isolated entities, and most frequently associated with either ascending or descending aorta pathologies. Association with aortic valve stenosis is uncommon and traditional surgical treatment is always challenging. Here we report a minimally invasive and endovascular management of these two pathologies in a 89-year-old man with LAD-stented ischemic cardiomyopathy. We describe our initial therapeutic strategy, per procedure difficulties and final management of this challenging case. Finally, we discuss the different therapeutic options for the endovascular treatment of aortic arch aneurysm associated with aortic valve stenosis.
文摘Atrial fibrillation （AF） is fairly common in patients with chronic mitral valve disease and a markedly dilated left atrium. These patients rarely return to sinus rhythm spontaneously, even after a successful mitral valve operation. The Maze procedure, developed by Cox and associates,15 has been used in patients undergoing a mitral valve operation. Restoration of normal sinus rhythm and atrial contraction in such patients have been reported by some groups. This study will summarize retrospectively a group of patients who underwent the Cox Maze procedure for the treatment of AF associated with rheumatic mitral valve disease in China.
