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find Keyword "心脏瓣膜疾病" 26 results
  • 胸腔镜辅助下主动脉瓣置换术临床分析

    目的总结经右胸骨旁第2肋上缘至第3肋下缘斜切口行胸腔镜辅助下主动脉瓣置换术的临床经验。 方法回顾性分析2012年9月至2014年2月上海远大心胸医院腔镜科施行手术治疗38例单纯主动脉瓣病变患者的临床资料,其中男25例、女13例,年龄32~58(46±13)岁。先天性主动脉瓣二瓣化畸形12例,风湿性病变22例,退行性病变4例,均采用全身麻醉双腔气管内插管,股动、静脉插管建立体外循环,经右胸骨旁第2肋上缘至第3肋下缘斜切口行胸腔镜辅助下主动脉瓣置换术。 结果全组患者术后恢复良好,均治愈出院。全组平均手术时间、体外循环时间、主动脉阻断时间分别为(184±28)min、(83±21)min、(58±16)min。术后平均机械通气时间为(8±4)h。术后住ICU时间和住院时间分别为(26±12)h和(8±5)d。术后24 h平均胸腔引流量为(350±296)ml。本组2例患者因主动脉瓣环偏小需延长手术切口以改善手术术野;1例患者术后引流量较多再次开胸止血;术中无中转开胸患者。其他并发症包括切口愈合不良2例(5.3%),胸腔积液及气胸各1例(2.6%)。 结论经右胸骨旁第2肋上缘至第3肋下缘斜切口完成胸腔镜辅助下主动脉瓣置换术术野显露良好,美容效果好,患者术后恢复快,临床可选择性应用。

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  • Surgery for Combined Valvular and Coronary Atheroselerotie Heart Disease

    Technical advances both in cardiac surgery and relating to anesthesia,cardiopulmonary bypass and myocardial protection have significantly improved the prognosis for patients combined with coronary heart disease and heart valve disease. In addition to technology, variable factors that affect operative survival following combined operation include the severity of valvular disease, the number of coronary vessels affected, impairment of left ventricular function and both age and gender differences. In this article, we review the outcome of surgical intervention for heart valve disease combined with coronary heart disease and discuss future prospects in this field.

    Release date:2016-08-30 06:26 Export PDF Favorites Scan
  • Combined Cardiac Valve Surgery and Coronary Artery Bypass Grafting: Report of 81 Cases

    Objective To retrospectively review the clinical experience and early surgical results of combined cardiac valve surgery and coronary artery bypass grafting (CABG). Methods From Jan. 2000 to Dec. 2005, combined valve surgery and CABG was performed in 81 patients. 37 patients were rheumatic heart disease with coronary stenosis, and 44 patients were coronary artery disease with valvular dysfunction. Single vessel disease was in 18 patients, two vessels disease in 9 and triple-vessel disease in 54. All the patients received sternotomy and combined valve surgery and CABG under cardiopulmonary bypass. Mitral valve repair and CABG were done in 26 patients. Valve replacement and CABG were done in 55 patients with 49 mechanical valves and 16 tissue valves. Four patients had left ventricular aneurysm resection concomitantly. The number of distal anastomosis was 3.12 5= 1.51 with 66 left internal mammary arteries bypassed to left anterior descending. Post-operative intra-aortic balloon pump was required in 4 cases for low cardiac output syndrome. Results Two patients died of low cardiac output syndrome with multiple organs failure. 79 patients had smooth recovery and discharged from hospital with improved heart function. 64 patients had completed follow-up with 5 late non cardiac related death in a mean follow-up period of 14.2 months. Conclusion Combined one stage valve surgery and CABG is effective with acceptable morbidity and mortality.

    Release date:2016-08-30 06:22 Export PDF Favorites Scan
  • Reflections on the era of valvular intervention—The perspective of surgeons

    In recent years, the number of interventions for valvular heart disease has been increasing day by day, and it has become a hot topic in the field of cardiovascular surgery. Given the aging global population and trends in the prevalence of valvular disease and the broadening of indications for transcatheter aortic valve replacement (TAVR), a breakthrough of 130000 TAVR procedures is expected by 2026. In the new technology development period, the development potential and technical advantages of heart valve interventional therapy should be faced squarely. This paper focuses on key issues such as comparison of outcomes after TAVR versus surgical aortic valve replacement (SAVR), prosthetic valve endocarditis after TAVR, and broadening of indications for TAVR, as well as recommendations on how surgeons face the era of TAVR. We hope that this article will help and attract the attention of cardiac surgeons.

    Release date:2021-12-27 11:31 Export PDF Favorites Scan
  • Tricuspid Valve Replacement: A Report of 13 Cases

    Abstract: Objective To summarize the clinical experience of 13 patients of tricuspid valve replacement and to investigate the indication and method. Methods From January 1994 to December 2005, the clinical datum of the thirteen patients suffering from tricuspid valve disease were reviewed, including rheumatic heart disease 6 cases, congenital heart disease 3 cases, infective endocarditis 3 cases and right ventricular tumor 1 case. All the cases underwent tricuspid valve replacement. Results Two reoperative rheumatic heart disease patients died early after operation and their cardiac function was New York Heart Association (NYHA) class Ⅳ before operation. The followup interval was 3 months to 12 years in 11 cases. There were 2 late death, one died of recurrence of infective endocarditis, and another died of the recurrence of the tumor. One Ebstein anomaly case’s NYHA functional recovered to class Ⅲ, eight cases’s recovered to NYHA classⅠ-Ⅱ. Conclusion The tricuspid valve disease may be a secondary lesion from many causes. Indication of tricuspid valve replacement must be strictly commanded. The late results of tricuspid valve mechanical prostheses replacement is satisfactory.

    Release date:2016-08-30 06:13 Export PDF Favorites Scan
  • Influence of Bromocriptin on Cardiac Valve in Patients with Pituitary Prolactinoma

    ObjectiveTo investigate the risk of cardiac valve regurgitation in patients with pituitary prolactinoma treated with bromocriptine for a long time. MethodsBetween January 2012 and February 2013, 26 pituitary prolactinoma patients treated with bromocriptine for at least 6 months were included in the observation group, and 101 healthy people were regarded as the control group. Transthoracic echocardiography were performed on these patients for cardiac regurgitation, and the echocardiographic data were compared between the two groups. ResultsTrace tricuspid regurgitation was presented in 38.46% of patients in the observation group, and 19.80% of the controls (P=0.046). Interventricular septum thickness was (8.62±0.31) mm in patients in the observation group, and it was (8.57±0.12) mm in the controls (P=0.042). ConclusionNo clinical significant cardiac valve regurgitation has been observed in pituitary prolactinoma patients treated by bromocriptin for a long time. Long-term echocardiographic follow-up of these patients is necessary.

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  • 心瓣膜置换术后早期心肌顿抑致低心排血量综合征的诊治经验

    目的 探讨心瓣膜置换术后早期心肌顿抑的识别、诊断,以及由此导致严重低心排血量综合征(LCOS)的治疗方法,以提高诊断、治疗水平。 方法 回顾分析我科2004年9月至2006年9月期间4例心瓣膜置换术后早期出现心肌顿抑导致LCOS患者的临床资料,4例均为女性,年龄35~54岁,平均年龄46-75岁。术前左心室大小、收缩功能均基本正常,左心室舒张期末内径(LVEDD)3.5~6.3 cm,射血分数(EF)49%~61%;2例行二尖瓣、主动脉瓣置换术,1例行二尖瓣置换术,1例行主动脉瓣置换术。 结果 4例患者均在术后早期(14~40 h、平均26 h)出现无明确原因的LCOS,给予大剂量肾上腺素[0.10~0.15 μg/(min·kg)]治疗无效而改行主动脉内球囊反搏(IABP)治疗,4例患者IABP支持时间为7~12 d(平均8.5 d),3例痊愈,1例因肺部感染于术后28 d死于多器官功能衰竭。2例出现急性肾功能不全,1例7 d后肾功能恢复正常,1例经腹膜透析治疗2周后痊愈。 结论 心肌顿抑可出现在术前心功能良好,手术经过顺利的心瓣膜置换术患者,由心肌顿抑导致的术后早期LCOS,及时应用IABP可以减轻心脏负荷,增加冠状动脉灌注,改善重要脏器循环,有助于左心室渡过心肌顿抑期,恢复收缩功能,是成功救治的重要手段。

    Release date:2016-08-30 06:06 Export PDF Favorites Scan
  • Midterm Haemodynamic Assessment of the Home-made C-L Pugestrut Tilting Disc Mechanical Valve in Aortic Valve Replacement

    Objective To observe the midterm haemodynamic manifestation of the home made C-L pugestrut tilting disc mechanical valve in aortic valve replacement, and to evaluate its function. Methods Twenty patients underwent aortic valve replacement over 5 years were collected and divided into two groups, the C-L pugestrut group (n=10):aortic valve was replaced by home-made C-L pugestrut tilting disc mechanical valve(21mm); Medtronic-Hall group (n=10):aortic valve was replaced by Medtronic-Hall mechanical valve (21mm). The peak transprosthetic gradients (△P), mean transprosthetic gradients (△Pm)and effective orifice area(EOA) at rest were compared between two groups. Results At rest, △P of the C-L pugestrut group and Medtronic-Hall group were 11.63±3.23mmHg vs. 9. 78±3. 35mmHg; △Pm of the C-L pugestrut group and Medtronic-Hall group were 6. 25±2. 32 mmHg vs. 5.85±2.32mmHg: EOA of the C-L pugestrut group and Medtronic-Hall group were 1.07±0.17 cm2 vs. 1.25±0.27 cm2. There was no statistically significance in △P, △Pm and EOA between two groups(P〉0.05). Conclusions The midterm haemodynamic results of the home-made C-L pugestrut tilting disc mechanical valve show that it has comparable haemodynamic results to those of Medtronic-Hall mechanical valve ,and it has well-done function. The home-made C-L pugestrut valve is one of the reliable mechanical heart valves.

    Release date:2016-08-30 06:23 Export PDF Favorites Scan
  • 心瓣膜置换术1407例临床分析

    目的 为了不断提高心瓣膜置换术的成功率,总结其围手术期的临床经验. 方法 回顾性分析我院1976~2000年,1 407例心瓣膜置换术的手术技术、术后处理以及死亡原因等. 结果 本组二尖瓣置换术(MVR)806例,主动脉瓣置换术(AVR)232 例,三尖瓣置换术(TVR)4例,双瓣膜置换术(DVR)333 例;再次二尖瓣置换术(Re - MVR)22例,再次主动脉瓣置换术(Re-AVR)6例,再次双瓣膜置换术(Re-DVR)4例.全组共死亡72例,总死亡率5.12%;1996年后死亡14例,死亡率1.87%. 结论 提高手术技术、改进心肌保护方法、加强围术期管理等,可大大降低死亡率.

    Release date:2016-08-30 06:31 Export PDF Favorites Scan
  • Clinical Observation of Left Ventricular Remodeling after Valve Replacement for Valvular Heart Disease with Giant Left Ventricle

    Objective To evaluate the left ventricular remodeling after valve replacement for valvular heart disease with giant left ventricle. Methods The clinical material of 92 patients with valvular heart disease and giant left ventricle after valve replacement was retrospectively reviewed. The results of ultrosonic cardial gram(UCG) and the changes of cardiac function before and after operation were compared. Results There was no operative death. The value of left ventricular end-diastolic dimension (LVEDD), left ventricular end-systolic dimension (LVESD), left atrial dimension (LAD), left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS), stroke volume (SV) and cardiothoracic ratio in 2 weeks and 2 months after operation were more decreased than those before operation(P〈0. 05). The value of LVEDD and LAD in 2 months after operation were much more decreased than those in 2 weeks after operation (P〈0. 05). The cardiac function in early stage after operation was more decreased than that before operation,but the cases of cardiac functional class Ⅱ (38 cases, 41.3% ) in 2 months after operation was significantly more than those before operation (5 cases, 5.4 % ). Conclusions The early effect of left ventricular remodeling is significant for valvular heart disease with giant left ventricle after valve replacement. The diameter of left ventricle and left atrial are significantly decreased after operation. The protection for cardiac function should be carefully taken in order to prevent the occurrence of complication after operation.

    Release date:2016-08-30 06:22 Export PDF Favorites Scan
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