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Detection method of early heart valve diseases based on heart sound features

Heart valve disease (HVD) is one of the common cardiovascular diseases. Heart sound is an important physiological signal for diagnosing HVDs. This paper proposed a model based on combination of basic component features and envelope autocorrelation features to detect early HVDs. Initially, heart sound signals lasting 5 minutes were denoised by empirical mode decomposition (EMD) algorithm and segmented. Then the basic component features and envelope autocorrelation features of heart sound segments were extracted to construct heart sound feature set. Then the max-relevance and min-redundancy (MRMR) algorithm was utilized to select the optimal mixed feature subset. Finally, decision tree, support vector machine (SVM) and k-nearest neighbor (KNN) classifiers were trained to detect the early HVDs from the normal heart sounds and obtained the best accuracy of 99.9% in clinical database. Normal valve, abnormal semilunar valve and abnormal atrioventricular valve heart sounds were classified and the best accuracy was 99.8%. Moreover, normal valve, single-valve abnormal and multi-valve abnormal heart sounds were classified and the best accuracy was 98.2%. In public database, this method also obtained the good overall accuracy. The result demonstrated this proposed method had important value for the clinical diagnosis of early HVDs.

The surgical treatment strategy and perioperative management of patients with heart valve disease complicated with severe chronic heart failure

ObjectiveTo summarize the individualized selection of surgical treatment strategies and the key points of perioperative management for patients with heart valve disease complicated with severe chronic heart failure.MethodsThe clinical characteristics of 5 male patients with valvular heart disease complicated with severe chronic heart failure (CHF) were analyzed retrospectively from June 2017 to October 2018 in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, with an average age of 60.21 years.ResultsFive patients were given angiotensin receptor and neprilysin inhibitor (ARNI)-based anti-heart failure treatment after admission. The operation mode of these patients was decided to be valve replacement under cardiopulmonary bypass after individualized evaluation of patients’ improving symptoms. Three patients were treated with intra-aortic balloon pump (IABP) and continuous renal replacement therapy (CRRT) early after operation to assist patients in improving cardiac function. Five patients recovered oral anti-heart failure after awakening. All patients were discharged smoothly 2 weeks after operation.ConclusionIndividualized evaluation is needed for the choice of operation timing and mode, standardized preoperative treatment for heart failure, shortening the aortic blocking time during cardiopulmonary bypass, and early application of left ventricular adjuvant drugs or instruments are all important measures to help patients recover smoothly.

风湿性心脏病与非风湿性心脏病患者三尖瓣置换的病例对照研究

目的分析三尖瓣置换患者的流行病学特征、治疗及随访情况，探讨提高三尖瓣置换疗效的策略。方法回顾性分析 2009 年 8 月至 2016 年 10 月 20 例在我院行三尖瓣置换患者的临床资料。男 4 例、女 16 例，年龄 31～73（54.4±2.2）岁。根据病因学分为风湿性心脏病组（14 例）及非风湿性心脏病组（6 例），比较两组患者术前情况、治疗方法、治疗结果及随访情况的差异。结果本组围手术期死亡 3 例，住院病死率 15.0%。死亡原因均为多器官功能衰竭。术后对 17 例出院患者进行了随访，随访率 100.0%，随访时间 1～84 个月，随访期间共有 2 例死亡。风湿性疾病组与非风湿性疾病组术前存在心房颤动/心房扑动心律（P=0.001）、术前有心脏手术史（P=0.017）、手术中是否进行主动脉阻断（P=0.032）差异有统计学意义。结论尽管风险较大，三尖瓣置换仍是针对器质性三尖瓣病变的有效手段，但需严格掌握手术指征及手术时机。风湿性三尖瓣疾病具有更多的危险因素，尤其是既往有左心瓣膜手术史继发三尖瓣关闭不全的患者。

Research progress on the treatment for aging lung transplantation recipients with cardiovascular disease

As the aging proceeds worldwide, aging lung transplantation recipients have been increased dramatically. Aging population with end-stage lung diseases also have comorbidities, such as cardiovascular disease, which may impact the prognosis of lung transplantation. Recent researches on lung transplantation have explored the characteristics of aging recipients, strategy selection on transplantation and cardiovascular disease management, as well as risk factors for post-transplantation complications and death. However, researches on lung transplantation recipients with cardiac valve disease are just in the initial stage. With the advancement of transcatheter technique, more patients will be benefited. We summarized the advancement in this field and took an outlook for future clinical researches.

右腋下小切口心脏直视手术3 012例的临床应用

目的 总结右腋下小切口在心脏直视手术中应用的临床经验。 方法 2001年11月至2008年7月我们采用右腋下小切口施行心脏直视手术3 012例，男1 834例，女1 178例；年龄8个月～78岁，平均年龄124岁。行室间隔缺损修补术1 999例（干下型109例），房间隔缺损修补术677例（同期行三尖瓣或二尖瓣成形术107例、行部分型肺静脉畸形引流29例），法洛三联症矫治术43例，法洛四联症矫治术35例，右室双腔心矫治术33例，房室管畸形矫治、肺动脉瓣狭窄交界切开、右心室流出道狭窄疏通、三尖瓣下移畸形行11/2心室矫治或三尖瓣置换术等共123例，二尖瓣成形术28例，二尖瓣置换术74例。 结果 全组均顺利完成手术，早期死亡5例（0.17%），死亡原因分别为灌注肺、鱼精蛋白严重过敏、术中损伤左冠状动脉、低心排血量及脑血栓昏迷。二次开胸止血8例（0.26%），切口感染6例（0.20%），肺不张、灌注肺、低心排血量、感染性心内膜炎、急性肾功能衰竭（ARF）等并发症24例（0.79%）；ARF患者均经连续床旁血液滤过治疗痊愈，其余患者经对症支持治疗痊愈。通过门诊复查、电话等形式随访1~82个月，共随访2 765例，失访247例；3例室间隔缺损出现小型残余漏，2例二尖瓣成形术后出现轻中度二尖瓣关闭不全，1例Ebstein畸形行三尖瓣成形术后出现轻中度三尖瓣关闭不全，其他患者无异常。 结论 右腋下小切口应用于心脏直视手术，有创伤小、失血少、切口美观等优点，但应严格掌握手术适应证。

2017 欧洲心脏病学会/欧洲心胸外科协会心脏瓣膜病管理指南中经导管主动脉瓣置换术相关更新解读

自2012欧洲心脏协会/欧洲心胸外科协会关于心脏瓣膜病的管理指南发布以来，新的临床证据又大量积累。这些新证据使欧洲心脏协会/欧洲心胸外科协会需要更新瓣膜病的管理指南以达到心内科与心外科医师间的共识。该文将从经导管主动脉瓣置换术出发，解读2017年新指南所作出的更新。

Surgical Treatment Experience of Emergency Surgery in Treating Rheumatic Valves Patients with Preoperative Ventricular Electrical Storm

目的探讨成人风湿性心脏瓣膜病术前并发心室电风暴（恶性室性心动过速、心室颤动）行急诊手术的疗效及体会。 方法回顾性分析2004年10月至2014年10月我院成人心脏瓣膜入院后突发恶性室性心动过速、心室颤动的患者6例，其中男2例，女4例，年龄35.0～64.0岁，平均49.8岁。6例患者均为风湿性心脏瓣膜病，二尖瓣中重度狭窄并主动脉瓣及三尖瓣中重度关闭不全2例，二尖瓣中重度关闭不全并三尖瓣中重度关闭不全4例，恶性心律失常发作后立即予艾司洛尔等药物控制，病情基本稳定后急诊手术。其中，行双瓣膜置换+三尖瓣成形术2例，行二尖瓣置换+三尖瓣成形术4例。 结果无围术期患者死亡，术后无心功能显著恶化、无多脏器功能衰竭、无恶性室性心律失常。术后1～2周24 h动态心电图提示室性早搏大于1 000次的2例，室性早搏500～1 000次1例，小于500次的患者3例，短阵室性心动过速2次的患者2例，短阵室性心动过速3次的患者1例。所有6例患者均安全出院，随访6个月至10年，无患者死亡。 结论急诊外科手术联合β受体阻滞剂在治疗成人心脏瓣膜疾病术前突发的反复恶性室性心动过速、心室颤动安全有效。

A Randomized Controlled Trial of Concomitant Tricuspid Annuloplasty for Patients Underwent Mitral Valve Replacement: UCG Evaluation 2 Years After Surgery

Objective To evaluate the right ventricular function of the patients 2 years after surgery by ultrasonic cardiography (UCG) who underwent mitral valve replacement (MVR) concomitant tricuspid annuloplasty (TAP). Method We finally identified 36 patients required MVR with tricuspid valve annular dilation concomitant merely mild tricuspid regurgitaion (TR) based on preoperative UCG in our hospital between April and November 2012 year. All patients were randomly divided into two groups by digital table including a tricuspid annuloplasty group (a TAP group, n=18, 7 males and 11 females at age of 45.67±12.49 years) and a no-tricuspid annuloplasty group (a NTAP group, n=18, 6 males and 12 females at age of 45.44±10.48 years). General clinical data and extracorporeal circulation data were recorded. UCG evaluation was practiced preoperation, alone with 1 week, 6 months, and 2 years after surgery. Results Two years postoperative maximal long-axis of RA (RAmla), mid-RA minor distance (RAmmd), right ventricle dimension-1(RVD1) , right ventricular fractional area change (RVFAC), 3D RV end-systolic volume (3DRVESV), tricuspid valve annular end-diastolic dimension (TVAEDD), tricuspid valve annular end-systolic dimension (TVAESD) of patients were all smaller in the TAP group than those in the NTAP group. Yet right ventricular ejection fraction (RVEF), percent shorting of tricuspid valve annulus (PSTVA) were greater in the TAP group than those in the NTAP group, although there was no statistical difference between the two groups in two years postoperative 3D RV end-diastolic volume (3DRVEDV). The patients in the TAP group had a superior trend than that of the NTAP group. Moreover, the patients' TR constituent ratio in the TAP group was much better than that of the NTAP group in 2 year after operation. Conclusions Concomitant tricuspid annuloplasty for patients with tricuspid valve annulus dilation and mild TR underwent MVR is favorable for the recovery of their 2 years postoperative function of tricuspid valve and right ventricle. It is benefit to reduce patient's long term postoperative TR residues and exacerbation.

心瓣膜置换术的影响因素分析

目的 探讨心瓣膜置换术的危险因素，以提高手术治愈率。 方法 回顾性分析2005年1月至2007年12月我院施行507例心瓣膜置换术患者的临床资料，其中男236例，女271例；病种为风湿性心脏病394例，先天性心脏病87例，退行性病变19例，细菌性心内膜炎6例，梅毒1例。对心瓣膜置换术的潜在危险因素进行单因素分析，采用logistic回归进行多因素分析。 结果 术后顺利恢复482例（95.0%）；术后发生并发症25例，其中治愈16例，死亡9例，病死率1.77%；治愈498例（98.22%）。随访480例，随访率96.38%（480/498），其中心功能Ⅰ级182例，Ⅱ级298例。经对列表进行单因素分析及多因素logistic回归分析结果，心功能Ⅳ级，年龄≥70岁，合并慢性阻塞性肺病，合并肾功能不全，左心室舒张期末内径(LVEDD)≥70 mm,心瓣膜置换术＋冠状动脉旁路移植术（CABG）,二次手术，主动脉阻断时间＞2 h,体外循环时间＞3 h是影响心瓣膜置换术的独立危险因素。 结论 临床工作中重视影响心瓣膜置术的独立危险因素的处理，对提高其疗效有重要意义。

三尖瓣前叶血性囊肿一例