Objective To analyze the incidence of valve prosthesis-patient mismatch (PPM) and ventricular remodeling of elderly patients after aortic valve replacement (AVR). Methods We retrospectively analyzed the clinical data of 134 patient aged over 65 years who underwent AVR for the aortic stenosis or regurgitation at our hospital between January 2016 and December 2016. There were 73 males and 61 females aged 69.7±3.6 years ranging from 65-79 years. The clinical and ultrasound cardiography data were evaluated. PPM was defined as an effective orifice area index (EOAI) of ≤0.85 cm2/m2. The incidence of PPM and the left ventricular remodeling after surgical AVR in the patients with aortic stenosis and aortic regurgitation was analyzed, and the outcomes of aortic valve mechanical prosthesis and aortic valve bioprosthesis were compared. Results The incidence of PPM was 32.5% in aortic stenosis and 13.0% in aortic regurgitation (P<0.05). One patient died in the early post-operation, and the incidence of severe PPM was 6.0%. Conclusion The incidence of PPM after AVR in the patients with aortic regurgitation is less than that in the patients with aortic stenosis.
Abstract： Replacement of the aortic valve and aortic root has been the standard surgical strategy for patients with aortic root aneurysm for many years. Along with the increasing knowledge about the aortic root anatomy and physiology, and complications after aortic valve replacement, the technique of valve-sparing aortic root replacement has developed greatly. We focus on the etiology and classification aortic valve insufficiency, the valve-sparing techniques and clinical outcomes of valve-sparing aortic root replacement in this review.
ObjectiveTo summarize surgical treatment experience on unruptured aneurysm of the sinus of Valsalva (SVA). MethodsClinical data of 33 patients with unruptured SVA underwent surgical repair at Fu wai Hospital between February 2007 and January 2012 were retrospectively analyzed. There were 27 males and 6 females with their mean age of 28.5±13.5 years (ranged from 4.5 to 58.0 years). The unruptured SVA originated in the right coronary sinus in 29 cases (87.8%), in non-coronary in 2 cases (6.1%) and in left coronary sinus in 2 cases (6.1%). There were 29 cases with ventricular septal defect and 20 cases with aortic valve insufficiency (AI). ResultsOnly 52.8% of unruptured SVA were correctly diagnosed by echocardiography preoperatively. All unruptured SVA received active surgical management, with no early death after operation. Thirty patients (90.9%) were followed up for 22 to 81 months (mean 42.9±18.8 months) and in NYHA classⅠorⅡ. None SVA recurrence occurred. Postoperative AI could be improved better by using the repair route only through the chamber of right ventricle for patients with unruptured SVA originated in right coronary sinus. ConclusionFor unruptured SVA patients who associated with other kinds of cardiovascular lesions, active surgical repair for unruptured SVA can achieve satisfactory results.
Objective To analyze the relation between preoperative pulmonary artery pressure(PAP) and postoperative complications in heart transplant patients, and summarize the experience of perioperative management of pulmonary hypertension (PH), to facilitate the early period heart function recovery of postoperative heart transplant patients. Methods A total of 125 orthotopic heart transplant patients were divided into two groups according to preoperative pulmonary arterial systolic pressure(PASP) and pulmonary vascular resistance(PVR), pulmonary [CM(1583mm]hypertension group (n=56): preoperativePASPgt;50 mm Hg or PVRgt;5 Wood·U; control group (n=69): preoperative PASP≤50 mmHg and PVR≤5 Wood·U. Hemodynamics index including preoperative cardiac index (CI)，preoperative and postoperative PVR and PAP were collected by SwanGanz catheter and compared. The extent of postoperative tricuspid regurgitation was evaluated by echocardiography. Postoperative pulmonary hypertension was treated by diuresis，nitrogen oxide inhaling，nitroglycerin and prostacyclin infusion, continuous renal replacement therapy(CRRT)and extracorporeal membrane oxygenation(ECMO). Results All patients survived except one patient in pulmonary hypertension group died of multiorgan failure and severe infection postoperatively in hospital. Acute right ventricular failure occurred postoperatively in 23 patients, 10 patients used ECMO support, 10 patients with acute renal insufficiency were treated with CRRT. 124 patients were followed up for 2.59 months，7 patients died of multiple organ failure, infection and acute rejection in follow-up period, the survivals in both groups have normal PAP, no significant tricuspid regurgitation. No significant difference in cold ischemia time of donor heart, cardiopulmonary bypass(CPB) and circulation support time between both groups; but the patients of pulmonary hypertension group had longer tracheal intubation time in comparison with the patients of control group (65±119 h vs. 32±38 h, t=2.17，P=0.028). Preoperative PASP，mean pulmonary artery pressure(MPAP) and PVR in pulmonary hypertension group were significantly higher than those in control group, CI was lower in pulmonary hypertension group ［PASP 64.30±11.50 mm Hg vs. 35.60±10.20 mm Hg; MPAP 43.20±8.50 mm Hg vs. 24.20±7.20 mm Hg; PVR 4.72±2.26 Wood·U vs. 2.27±1.24 Wood·U; CI 1.93±0.62 L/（min·m2） vs. 2.33±0.56 L/（min·m2）; Plt;0.05］. Postoperative early PASP, MPAP and PVR in pulmonary hypertension group were significantly higher than those in control group (PASP 35.40±5.60 mm Hg vs. 31.10±5.70 mm Hg, MPAP 23.10±3.60 mm Hg vs. 21.00±4.00 mm Hg, PVR 2.46±0.78 Wood·U vs. 1.79±0.62 Wood·U; Plt;0.05). Conclusion Postoperative right heart insuficiency is related to preoperative pulmonary hypertension in heart transplant patients. Donor heart can quickly rehabilitate postoperatively by effectively controlling perioperative pulmonary hypertension with good follow-up results.
Abstract： Objectives To determine the atrial expression of the collagen Ⅰ, collagen Ⅲ and the transforming growth factorbeta 1 (TGF-β1) in patients with rheumatic heart disease (RHD) and permanent atrial fibrillation(PAF) and to investigate the relationship between the extent of atrial fibrosis and the effectiveness of radiofrequency maze procedure in patients with RHD and PAF. Methods A total of 40 patients with RHD and PAF (≥6 months) who underwent a radiofrequency maze procedure with concomitant valvular surgery were collected for the experimental group. We acquired 100 mg of the left auricle tissue in each patient and followed up these patients after 3, 6 months of [CM(158mm]surgery. Then we assigned these patients to nonAF group and persistent AF group according to the results of the 6month followup. Another 10 patients with RHD and sinus rhythm(SR) who underwent valvular surgery alone were assigned to SR group and their left auricle tissue was also obtained. In order to determine the extent of atrial fibrosis, we observed the amount of collagen volume fraction Ⅰ，Ⅲ(CVF-Ⅰ,CVF-Ⅲ) by semiquantitative analysis with picrosirius red staining method. Using the β actin protein as the endogenous reference gene, we detected the expressions of TGF-β1 mRNA by semiquantitative reverse transcriptionpolymerase chain reaction(RT-PCR) technique. Results Each group has the same clinical baseline. At 6month follow-up, 28 among the 40 patients were categorized into the nonAF group and 12 into the AF group. (1) Patients in the nonAF group and the AF group had higher mRNA expressions of TGF-β1, CVF-Ⅰ and CVF-Ⅰ/CVF-Ⅲ compared with the SR group (F=6.487, P=0.003; F=3.711, P=0.032; F=3.697, P=0.032). The AF group had higher mRNA expressions of TGF-β1, CVF-Ⅰ and CVF-Ⅰ/CVF-Ⅲ than the nonAF group (t=4.372, P=0.043; t=4.603, P=0.038; t=4.776, P=0.035). But the CVFⅢ had no significant differences among the three groups (P＞0.05). (2) The patients whose left atrial function recovered after Maze procedure had lower mRNA expression than those patients whose left atrial function did not recover in the nonAF group (t=5.570, P=0.027). (3) The TGF-β1 mRNA expression has a positive correlation with both the contents of CVF-Ⅰ and left atrial diameter (r=0.786, Plt;0.05; r=0.858, Plt;0.05). Multiple logistic regression analysis revealed that the mRNA expression levels of TGF-β1, CVF-Ⅰ and left atrial diameter were independently associated with the postoperative persistence of atrial fibrillation. Conclusion The extent of atrial fibrosis in patients with RHD and PAF may be related to the sinus rhythm restoration and maintenance after AF surgical radiofrequency ablation and the resumption of atrial function.
Objective To evaluate the longterm results of coronary artery bypass grafting (CABG) in treating cardiac diseases with heart insufficiency by analyzing the longterm survival rate and heart failure exemption rate of the patients. Methods A total of 239 patients who had coronary heart disease with left heart dysfunction (LVEFlt;40%) were enrolled in our study. Among the patients, there were 215 males and 24 females aged from 32 to 78 years old with an average age of 59.1. Before operation, 193 patients had a past history of myocardial infarction and 31 had angina. According to the New York heart function assessment (NYHA), 26 patients were categorized as class Ⅰ, 106 as class Ⅱ, 73 as class Ⅲ and 34 as class Ⅳ. Coronary angiography showed 10 cases (4.2%) of single vessel disease, 35 cases (14.6%) of double vessel disease and 194 cases (81.2%) of triple vessel disease. The result of preoperative ultrasound cardiogram showed that LVEF was 35.7%±4.6%. All patients received CABG, including 153 (64.0%) onpump surgeries and 86 (35.9%) offpump surgeries. Selective operation was done on 237 patients and there were 2 emergency cases. Valve repair or replacement, ventricular aneurysmectomy or aneurysm plication were not carried out during the operation. Results There were 1 to 6 (3.4±1.1) bypass grafting vessels in each case. Five (2.09%) patients died during the hospital stay, among which 2 died of low cardiac output and circulation failure, 1 died of malignant arrhythmia, 1 died of renal failure, and 1 died of coma with multiorgan failure. The followup period was 512±1.79 years. During the followup, 18 patients (7.7%) were lost and 29 patients died. Among them, there were 24 cardiac deaths and the cardiac death rate at the first year and the fifth year was 2.8% and 9.4% respectively. There were 40 cases of heart failure during the followup period. The exemption rate of heart failure was 93.7% and 81.8% at the first year and the fifth year respectively. The survival rate was 97.2% at the first year and 89.3% at the fifth year. Conclusion The longterm result of CABG in treating patients with ischemic heart insufficiency is satisfying.